Anna Valerieva, Teresa Caballero, Markus Magerl, Joao P. Frade, Paul K. Audhya, Timothy Craig
Background
Hereditary angioedema (HAE) is a rare genetic disorder characterized by unpredictable, debilitating episodes of submucosal and/or subcutaneous tissue swelling, which may be life-threatening depending on anatomic location. The two primary management strategies for HAE are ready access to effective on-demand treatment in all patients and the prevention of attacks (short-term prophylaxis [STP] and long-term prophylaxis [LTP]) in appropriate patients. All approved on-demand and most LTP medications require subcutaneous or intravenous administration. Injection-related challenges include trypanophobia (fear of needles), difficulty with self-administration, injection-site reactions (e.g., pain, erythema, bleeding, bruising), and anxiety—all contributing to poor compliance and administration delays. Oral HAE treatments may improve outcomes by reducing treatment barriers.
Aim
To review oral therapies, approved or in development, for on-demand treatment and/or prevention of HAE attacks.
Materials and Methods
To provide a comprehensive review, data was obtained from publicly available resources through a targeted PubMed literature review and supplemented by information provided on company websites (search cutoff of May 31, 2024).
Results
Berotralstat, an oral plasma kallikrein (PKa) inhibitor, is approved for LTP. Sebetralstat, another PKa inhibitor, is the investigational first oral on-demand HAE treatment to complete a phase 3 trial. Deucrictibant, an oral bradykinin B2 receptor antagonist, has completed phase 2 trials for on-demand therapy and LTP. Several other oral PKa inhibitors (ATN249, VE-4666, and VE-4062) are in early development for LTP.
Conclusion
Substantial advances have been made in the development of oral treatments for HAE. These treatments have the potential to improve and optimize clinical outcomes, satisfaction, and quality of life among patients with HAE.
{"title":"Advent of oral medications for the treatment of hereditary angioedema","authors":"Anna Valerieva, Teresa Caballero, Markus Magerl, Joao P. Frade, Paul K. Audhya, Timothy Craig","doi":"10.1002/clt2.12391","DOIUrl":"10.1002/clt2.12391","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Hereditary angioedema (HAE) is a rare genetic disorder characterized by unpredictable, debilitating episodes of submucosal and/or subcutaneous tissue swelling, which may be life-threatening depending on anatomic location. The two primary management strategies for HAE are ready access to effective on-demand treatment in all patients and the prevention of attacks (short-term prophylaxis [STP] and long-term prophylaxis [LTP]) in appropriate patients. All approved on-demand and most LTP medications require subcutaneous or intravenous administration. Injection-related challenges include trypanophobia (fear of needles), difficulty with self-administration, injection-site reactions (e.g., pain, erythema, bleeding, bruising), and anxiety—all contributing to poor compliance and administration delays. Oral HAE treatments may improve outcomes by reducing treatment barriers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To review oral therapies, approved or in development, for on-demand treatment and/or prevention of HAE attacks.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>To provide a comprehensive review, data was obtained from publicly available resources through a targeted PubMed literature review and supplemented by information provided on company websites (search cutoff of May 31, 2024).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Berotralstat, an oral plasma kallikrein (PKa) inhibitor, is approved for LTP. Sebetralstat, another PKa inhibitor, is the investigational first oral on-demand HAE treatment to complete a phase 3 trial. Deucrictibant, an oral bradykinin B2 receptor antagonist, has completed phase 2 trials for on-demand therapy and LTP. Several other oral PKa inhibitors (ATN249, VE-4666, and VE-4062) are in early development for LTP.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Substantial advances have been made in the development of oral treatments for HAE. These treatments have the potential to improve and optimize clinical outcomes, satisfaction, and quality of life among patients with HAE.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10334,"journal":{"name":"Clinical and Translational Allergy","volume":"14 9","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11431061/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142342775","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}
Jianwei Wang, Yu Zhang, Ying Chen, Xinjun Xu, Yujuan Yang, Jiali Yin, Jing Guo, Pengyi Yu, Zhen Liu, Huifang Liu, Ting Zuo, Hongfei Zhao, Yan Hao, Bei Zhang, Xicheng Song
Background
Studies involving chronic rhinosinusitis with nasal polyps (CRSwNP) have mostly focused on bilateral cases, making unilateral CRSwNP inadequately recognized. This study examined the differences in clinical characteristics, outcomes, and risk factors for poor outcomes between unilateral and bilateral CRSwNP to facilitate a better assessment in the two groups.
Methods
Demographic information, tissue and blood cells, endoscopic scores, Lund-Mackay scores, recurrence rates, and disease control conditions were compared between 310 unilateral and 596 bilateral CRSwNP patients. Furthermore, the stepwise regression multivariate Cox proportional hazard models were performed to generate risk factors for poor outcomes in the two groups.
Results
Bilateral cases exhibited higher rates of smoking, AR, and asthma comorbidities, along with higher numbers of tissue eosinophils and blood inflammatory cells when compared to unilateral patients. Endoscopic nasal polyp score, total computed tomography (CT) score (with scores for each sinus cavity), and adjusted CT scores were significantly higher in the bilateral group, except for a markedly higher adjusted maxillary score in the unilateral group. Furthermore, significantly higher proportions of bilateral patients experienced nasal polyp recurrence, uncontrolled status, and most disease control-related symptoms at follow-up. The primary risk factors for poor outcomes were asthma, tissue eosinophils, and total CT score in the bilateral group and blood basophils in the unilateral group.
Conclusions
Bilateral CRSwNP patients experience worse disease severity and outcomes than their unilateral counterparts. Primarily, asthma, tissue eosinophils, and total CT score were risk factors for poor outcomes in bilateral CRSwNP patients, with blood basophils in unilateral cases.
{"title":"Risk factors investigation for different outcomes between unilateral and bilateral chronic rhinosinusitis with nasal polyps patients","authors":"Jianwei Wang, Yu Zhang, Ying Chen, Xinjun Xu, Yujuan Yang, Jiali Yin, Jing Guo, Pengyi Yu, Zhen Liu, Huifang Liu, Ting Zuo, Hongfei Zhao, Yan Hao, Bei Zhang, Xicheng Song","doi":"10.1002/clt2.12395","DOIUrl":"https://doi.org/10.1002/clt2.12395","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Studies involving chronic rhinosinusitis with nasal polyps (CRSwNP) have mostly focused on bilateral cases, making unilateral CRSwNP inadequately recognized. This study examined the differences in clinical characteristics, outcomes, and risk factors for poor outcomes between unilateral and bilateral CRSwNP to facilitate a better assessment in the two groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Demographic information, tissue and blood cells, endoscopic scores, Lund-Mackay scores, recurrence rates, and disease control conditions were compared between 310 unilateral and 596 bilateral CRSwNP patients. Furthermore, the stepwise regression multivariate Cox proportional hazard models were performed to generate risk factors for poor outcomes in the two groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Bilateral cases exhibited higher rates of smoking, AR, and asthma comorbidities, along with higher numbers of tissue eosinophils and blood inflammatory cells when compared to unilateral patients. Endoscopic nasal polyp score, total computed tomography (CT) score (with scores for each sinus cavity), and adjusted CT scores were significantly higher in the bilateral group, except for a markedly higher adjusted maxillary score in the unilateral group. Furthermore, significantly higher proportions of bilateral patients experienced nasal polyp recurrence, uncontrolled status, and most disease control-related symptoms at follow-up. The primary risk factors for poor outcomes were asthma, tissue eosinophils, and total CT score in the bilateral group and blood basophils in the unilateral group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Bilateral CRSwNP patients experience worse disease severity and outcomes than their unilateral counterparts. Primarily, asthma, tissue eosinophils, and total CT score were risk factors for poor outcomes in bilateral CRSwNP patients, with blood basophils in unilateral cases.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10334,"journal":{"name":"Clinical and Translational Allergy","volume":"14 9","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clt2.12395","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142320743","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}
Jean Bousquet, Bernardo Sousa-Pinto, Josep M. Anto, Anna Bedbrook, Wienczyslawa Czarlewski, Ignacio J. Ansotegui, Karl-C. Bergmann, Fulvio Braido, Luisa Brussino, Lorenzo Cecchi, Claudia Chaves Loureiro, Alvaro A. Cruz, Philippe Devillier, Alessandro Fiocchi, Bilun Gemicioglu, Tari Haahtela, Juan Carlos Ivancevich, Ludger Klimek, Marek Kulus, Piotr Kuna, Maciej Kupczyk, Violeta Kvedariene, Desiree E. Larenas-Linnemann, Gilles Louis, Renaud Louis, Michael Makris, Mario Morais-Almeida, Marek Niedoszytko, Ken Ohta, Markus Ollert, Nikolaos Papadopoulos, Vincenzo Patella, Benoit Pétré, Oliver Pfaar, Francesca Puggioni, Santiago Quirce, Frederico S. Regateiro, Nicolas Roche, Philip W. Rouadi, Boleslaw Samolinski, Joaquin Sastre, Florence Schleich, Nicola Scichilone, Luis Taborda-Barata, Sanna Toppila-Salmi, Arunas Valiulis, Ilgim Vardaloglu Koyuncu, Maria Teresa Ventura, Arzu Yorgancioglu, Joao A. Fonseca, Torsten Zuberbier
Patient-reported outcome measures (PROMs) are used to assess a patient's health status at a particular point in time. They are essential in the development of person-centred care. This paper reviews studies performed on PROMs for assessing AR and asthma control, in particular VAS scales that are included in the app MASK-air® (Mobile Airways Sentinel networK) for asthma and rhinitis. VASs were initially developed on paper and pencil and tested for their criterion validity, cut-offs and responsiveness. Then, a multicentric, multinational, double-blind, placebo-controlled, randomised control trial (DB-PC-RCT) using an electronic VAS form was carried out. Finally, with the development of MASK-air® in 2015, previously validated VAS questions were adapted to the digital format and further methodologic evaluations were performed. VAS for asthma, rhinitis, conjunctivitis, work and EQ-5D are included in the app. Additionally, two control-medication scores for allergic symptoms of asthma (e-DASTHMA) were validated for their criterion validity, cut-offs and responsiveness.
病人报告结果测量（PROMs）用于评估病人在特定时间点的健康状况。它们对于发展以人为本的护理至关重要。本文回顾了针对评估 AR 和哮喘控制的 PROMs 所做的研究，特别是针对哮喘和鼻炎的应用程序 MASK-air®（移动呼吸哨兵网络）中包含的 VAS 量表。VAS 量表最初是在纸笔上编制的，并对其标准有效性、临界值和响应性进行了测试。然后，使用电子 VAS 表开展了一项多中心、多国、双盲、安慰剂对照、随机对照试验（DB-PC-RCT）。最后，随着 2015 年 MASK-air® 的开发，之前经过验证的 VAS 问题被调整为数字格式，并进行了进一步的方法学评估。应用程序中包含了针对哮喘、鼻炎、结膜炎、工作和 EQ-5D 的 VAS。此外，针对哮喘过敏症状的两个对照用药评分（e-DASTHMA）的标准有效性、临界值和响应性也得到了验证。
{"title":"Concurrent validity, cut-offs and ability to change of patient-reported outcome measures for rhinitis and asthma in MASK-air®","authors":"Jean Bousquet, Bernardo Sousa-Pinto, Josep M. Anto, Anna Bedbrook, Wienczyslawa Czarlewski, Ignacio J. Ansotegui, Karl-C. Bergmann, Fulvio Braido, Luisa Brussino, Lorenzo Cecchi, Claudia Chaves Loureiro, Alvaro A. Cruz, Philippe Devillier, Alessandro Fiocchi, Bilun Gemicioglu, Tari Haahtela, Juan Carlos Ivancevich, Ludger Klimek, Marek Kulus, Piotr Kuna, Maciej Kupczyk, Violeta Kvedariene, Desiree E. Larenas-Linnemann, Gilles Louis, Renaud Louis, Michael Makris, Mario Morais-Almeida, Marek Niedoszytko, Ken Ohta, Markus Ollert, Nikolaos Papadopoulos, Vincenzo Patella, Benoit Pétré, Oliver Pfaar, Francesca Puggioni, Santiago Quirce, Frederico S. Regateiro, Nicolas Roche, Philip W. Rouadi, Boleslaw Samolinski, Joaquin Sastre, Florence Schleich, Nicola Scichilone, Luis Taborda-Barata, Sanna Toppila-Salmi, Arunas Valiulis, Ilgim Vardaloglu Koyuncu, Maria Teresa Ventura, Arzu Yorgancioglu, Joao A. Fonseca, Torsten Zuberbier","doi":"10.1002/clt2.12390","DOIUrl":"10.1002/clt2.12390","url":null,"abstract":"<p>Patient-reported outcome measures (PROMs) are used to assess a patient's health status at a particular point in time. They are essential in the development of person-centred care. This paper reviews studies performed on PROMs for assessing AR and asthma control, in particular VAS scales that are included in the app MASK-air<sup>®</sup> (Mobile Airways Sentinel networK) for asthma and rhinitis. VASs were initially developed on paper and pencil and tested for their criterion validity, cut-offs and responsiveness. Then, a multicentric, multinational, double-blind, placebo-controlled, randomised control trial (DB-PC-RCT) using an electronic VAS form was carried out. Finally, with the development of MASK-air<sup>®</sup> in 2015, previously validated VAS questions were adapted to the digital format and further methodologic evaluations were performed. VAS for asthma, rhinitis, conjunctivitis, work and EQ-5D are included in the app. Additionally, two control-medication scores for allergic symptoms of asthma (e-DASTHMA) were validated for their criterion validity, cut-offs and responsiveness.</p>","PeriodicalId":10334,"journal":{"name":"Clinical and Translational Allergy","volume":"14 9","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clt2.12390","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142307192","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}
Hay fever (HF) presents with various symptoms, including allergic conjunctivitis and rhinitis, and requires cross-organ treatment. This study assessed the impact of the coronavirus disease 2019 (COVID-19) pandemic on HF treatment trends.
Methods
This retrospective cohort study utilized data from the JMDC database collected between January 2018 and May 2021. Patients with HF were identified based on the relevant International Classification of Diseases 10th Revision diagnosis codes and the prescription of HF-related medications. The treatment approaches were compared during the cedar and cypress pollen allergy season (January to May in Japan) before and during the COVID-19 pandemic (2018 and 2019, and 2020 and 2021, respectively).
Results
This study included 2,598,178 patients with HF. The numbers of prescribed HF-related claims in 2018, 2019, 2020, and 2021 were 3,332,854, 3,534,198, 2,774,380, and 2,786,681 times, respectively. Oral second-generation antihistamine prescriptions decreased by >10% from 2019 to 2020, with a <10% change in the subsequent year. Anti-allergic eye drop prescriptions also decreased by >10% from 2019 to 2020 but increased by >10% from 2020 to 2021. Compared with 2018, 2019, and 2020, the number of claims in the rhinitis symptoms dominant group was significantly decreased in 2021 (p < 0.001, all). In contrast, the number of claims in the eye symptoms dominant group and the rhinitis and eye symptoms dominant group increased in 2021 compared with that in 2018, 2019, and 2020 (p < 0.001, all).
Conclusion
Changes in HF treatment and related outcomes could be attributed to lifestyle modifications resulting from the COVID-19 pandemic. Measures, such as limiting outdoor activities and adopting mask-wearing practices may have influenced HF symptoms, preventive behaviors, and the overall approach to treating HF.
{"title":"The impact of COVID-19 on hay fever treatment in Japan: A retrospective cohort study based on the Japanese claims database","authors":"Yasutsugu Akasaki, Takenori Inomata, Masao Iwagami, Jaemyoung Sung, Ken Nagino, Takeya Adachi, Hideaki Morita, Mayumi Tamari, Keigo Kainuma, Keiko Kan-o, Hiroaki Ogata, Masafumi Sakashita, Masaki Futamura, Yosuke Kurashima, Saeko Nakajima, Katsunori Masaki, Yasushi Ogawa, Sakura Sato, Akihiro Miyagawa, Akie Midorikawa-Inomata, Keiichi Fujimoto, Yuichi Okumura, Kenta Fujio, Tianxiang Huang, Kunihiko Hirosawa, Yuki Morooka, Akira Murakami, Shintaro Nakao","doi":"10.1002/clt2.12394","DOIUrl":"https://doi.org/10.1002/clt2.12394","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Hay fever (HF) presents with various symptoms, including allergic conjunctivitis and rhinitis, and requires cross-organ treatment. This study assessed the impact of the coronavirus disease 2019 (COVID-19) pandemic on HF treatment trends.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective cohort study utilized data from the JMDC database collected between January 2018 and May 2021. Patients with HF were identified based on the relevant International Classification of Diseases 10th Revision diagnosis codes and the prescription of HF-related medications. The treatment approaches were compared during the cedar and cypress pollen allergy season (January to May in Japan) before and during the COVID-19 pandemic (2018 and 2019, and 2020 and 2021, respectively).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>This study included 2,598,178 patients with HF. The numbers of prescribed HF-related claims in 2018, 2019, 2020, and 2021 were 3,332,854, 3,534,198, 2,774,380, and 2,786,681 times, respectively. Oral second-generation antihistamine prescriptions decreased by >10% from 2019 to 2020, with a <10% change in the subsequent year. Anti-allergic eye drop prescriptions also decreased by >10% from 2019 to 2020 but increased by >10% from 2020 to 2021. Compared with 2018, 2019, and 2020, the number of claims in the rhinitis symptoms dominant group was significantly decreased in 2021 (<i>p</i> < 0.001, all). In contrast, the number of claims in the eye symptoms dominant group and the rhinitis and eye symptoms dominant group increased in 2021 compared with that in 2018, 2019, and 2020 (<i>p</i> < 0.001, all).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Changes in HF treatment and related outcomes could be attributed to lifestyle modifications resulting from the COVID-19 pandemic. Measures, such as limiting outdoor activities and adopting mask-wearing practices may have influenced HF symptoms, preventive behaviors, and the overall approach to treating HF.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10334,"journal":{"name":"Clinical and Translational Allergy","volume":"14 9","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clt2.12394","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142245070","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}
Axel De Greef, Alexia Degraeuwe, Nina Nielens, Anne-Sophie Darrigade, Céline Bugli, Laurence de Montjoye, Marie Baeck
<p>To the Editor,</p><p>The Harmonizing Outcome Measures for Eczema (HOME) group has established that the evaluation of patients with atopic dermatitis (AD) should measure clinical signs, patient-reported symptoms, long-term control of the disease, and patients' quality of life.<span><sup>1</sup></span> To date, the existing scores<span><sup>2</sup></span> often assess only one of the aspects and are time-consuming. Furthermore, these scores assess the severity only at a certain time-point or over a maximum of seven consecutive days, and do not take into account the disease <i>activity</i>, defined as the fluctuations of AD.<span><sup>3</sup></span> We stated the need for a score that effectively assesses this dynamic aspect of the disease.<span><sup>4</sup></span> Preliminary results of a newly developed score, the “Atopic Dermatitis Score 7” (ADS7), inspired by the Urticaria Activity Score 7 (UAS7), showed a good correlation with the scores currently used in AD (Figure 1).<span><sup>5</sup></span></p><p>The aims of the present study were (i) to demonstrate ADS7 correlation with SCORing Atopic Dermatitis (SCORAD) on a larger cohort, and (ii) to evaluate if ADS7 was able to highlight the <i>activity</i> of the disease. It was therefore renamed “Atopic Dermatitis Activity Score 7” (ADAS7). We prospectively enrolled 137 patients with AD between September 2021 and August 2023 from Belgian academic and non-academic hospitals (outpatient clinics). One hundred patients completed the score daily for a period of maximum 6 months and were included for analyses (37 were lost to follow-up). Study design, statistical analyses and descriptive analysis of the patients' cohort at baseline are detailed in Supporting Information S1.</p><p>Intraclass correlation coefficient was 0.594, with a 95% confidence interval of [0.451–0.708] (<i>p</i> < 0.001) when comparing ADAS7 values with SCORAD. Using a cut-off value of ≥18 (as defined and validated in the preliminary study<span><sup>5</sup></span>) to detect moderate-to-severe patients, positive and negative predictive values were 88.7% and 76.3%, respectively. Sensitivity and specificity were 85.9% and 80.5%, respectively. For a subset of 40 patients for whom long-term data were available, median ± interquartile range (IQR) ADAS7 scores were calculated and presented on boxplots to illustrate disease activity over a period of 15.5 ± 15.7, [9.2–25.0] weeks (median ± IQR, [quartile [Q]1 − Q3]) (Figure 2). Patients had “active” disease when their IQR value was >8.875 (median of the distribution of all patients' IQR values, used as threshold value—detailed demonstration of variability is provided in Supporting Information S1). Of these, 11/20 (55.0%) changed severity category (i.e., their IQR overlapped two categories) in contrast to 4/20 (20.0%) patients with non-active disease.</p><p>Effective management of AD patients and treatment adaptations must be based on reliable outcomes that reflect disease activity. With
阿克塞尔-德格里夫：构思；数据整理；形式分析；资金获取；调查；方法论；写作-原稿；写作-审阅和编辑。Alexia Degraeuwe：构思；数据整理；调查；方法论。妮娜-尼伦斯概念化；数据整理；调查；方法论。Anne-Sophie Darrigade：数据整理；调查Céline Bugli：概念化；方法论。Laurence de Montjoye：概念化；形式分析；调查；方法论；监督；写作-审阅和编辑。玛丽-贝克作者声明无利益冲突。
{"title":"Atopic Dermatitis Activity Score 7 (ADAS7): A tool for disease activity assessment","authors":"Axel De Greef, Alexia Degraeuwe, Nina Nielens, Anne-Sophie Darrigade, Céline Bugli, Laurence de Montjoye, Marie Baeck","doi":"10.1002/clt2.12393","DOIUrl":"https://doi.org/10.1002/clt2.12393","url":null,"abstract":"<p>To the Editor,</p><p>The Harmonizing Outcome Measures for Eczema (HOME) group has established that the evaluation of patients with atopic dermatitis (AD) should measure clinical signs, patient-reported symptoms, long-term control of the disease, and patients' quality of life.<span><sup>1</sup></span> To date, the existing scores<span><sup>2</sup></span> often assess only one of the aspects and are time-consuming. Furthermore, these scores assess the severity only at a certain time-point or over a maximum of seven consecutive days, and do not take into account the disease <i>activity</i>, defined as the fluctuations of AD.<span><sup>3</sup></span> We stated the need for a score that effectively assesses this dynamic aspect of the disease.<span><sup>4</sup></span> Preliminary results of a newly developed score, the “Atopic Dermatitis Score 7” (ADS7), inspired by the Urticaria Activity Score 7 (UAS7), showed a good correlation with the scores currently used in AD (Figure 1).<span><sup>5</sup></span></p><p>The aims of the present study were (i) to demonstrate ADS7 correlation with SCORing Atopic Dermatitis (SCORAD) on a larger cohort, and (ii) to evaluate if ADS7 was able to highlight the <i>activity</i> of the disease. It was therefore renamed “Atopic Dermatitis Activity Score 7” (ADAS7). We prospectively enrolled 137 patients with AD between September 2021 and August 2023 from Belgian academic and non-academic hospitals (outpatient clinics). One hundred patients completed the score daily for a period of maximum 6 months and were included for analyses (37 were lost to follow-up). Study design, statistical analyses and descriptive analysis of the patients' cohort at baseline are detailed in Supporting Information S1.</p><p>Intraclass correlation coefficient was 0.594, with a 95% confidence interval of [0.451–0.708] (<i>p</i> < 0.001) when comparing ADAS7 values with SCORAD. Using a cut-off value of ≥18 (as defined and validated in the preliminary study<span><sup>5</sup></span>) to detect moderate-to-severe patients, positive and negative predictive values were 88.7% and 76.3%, respectively. Sensitivity and specificity were 85.9% and 80.5%, respectively. For a subset of 40 patients for whom long-term data were available, median ± interquartile range (IQR) ADAS7 scores were calculated and presented on boxplots to illustrate disease activity over a period of 15.5 ± 15.7, [9.2–25.0] weeks (median ± IQR, [quartile [Q]1 − Q3]) (Figure 2). Patients had “active” disease when their IQR value was >8.875 (median of the distribution of all patients' IQR values, used as threshold value—detailed demonstration of variability is provided in Supporting Information S1). Of these, 11/20 (55.0%) changed severity category (i.e., their IQR overlapped two categories) in contrast to 4/20 (20.0%) patients with non-active disease.</p><p>Effective management of AD patients and treatment adaptations must be based on reliable outcomes that reflect disease activity. With","PeriodicalId":10334,"journal":{"name":"Clinical and Translational Allergy","volume":"14 9","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clt2.12393","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142230917","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}
Cetirizine and Loratadine are the two best-selling second-generation antihistamines for allergic diseases. This study aims to provide a comparative analysis of the differences in adverse drug events (ADEs) between these two medications, which can assist clinicians in making appropriate treatment decisions.
Methods
ADE reports related to Cetirizine and Loratadine obtained from the FDA adverse event reporting system (FAERS) database were analyzed using disproportionality analysis and Bayesian analysis to evaluate and compare the ADE signals of both drugs.
Results
A total of 28,051 and 28,073 ADE reports were retrieved from the FAERS database related to Cetirizine and Loratadine, respectively, with both drugs showing a predominance of middle-aged females. Specifically, Loratadine was associated with respiratory symptoms, mainly nasal symptoms such as rhinorrhea (n = 326, ROR 6.75), sneezing (n = 251, ROR 15.24), and nasal congestion (n = 185, ROR 4.25), while Cetirizine did not show this association. Notably, both drugs exhibited strong signals for somnolence in the nervous and psychiatric systems, especially Cetirizine (Cetirizine, n = 2556, ROR 10.52 vs. Loratadine, n = 1200, ROR 7.76). Additionally, Cetirizine itself showed strong signals for attention disturbance (n = 233, ROR 3.3), while Loratadine was associated with nervousness (n = 145, ROR 3.3). Further exploration revealed more severe adverse reactions closely associated with Cetirizine, including hallucinations, aggression, and abnormal behavior. Importantly, Cetirizine was significantly associated with the occurrence of pericarditis (n = 138, ROR 8.13), potentially leading to serious adverse consequences.
Conclusion
Compared to Loratadine, Cetirizine poses a greater potential risk in the nervous and psychiatric systems. Additionally, this study reveals previously underestimated potential cardiac toxicity of Cetirizine; albeit at a relatively low incidence rate, the high signal intensity warrants further attention and exploration. These findings highlight the need for enhanced patient monitoring and therapy optimization when prescribing these medications, ensuring better management of allergic diseases while minimizing risks.
{"title":"High-risks drug adverse events associated with Cetirizine and Loratadine for the treatment of allergic diseases: A retrospective pharmacovigilance study based on the FDA adverse event reporting system database","authors":"Weili Kong, Yijun Dong, Sixi Yi, Wei Mo, Hui Yang","doi":"10.1002/clt2.12392","DOIUrl":"https://doi.org/10.1002/clt2.12392","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Cetirizine and Loratadine are the two best-selling second-generation antihistamines for allergic diseases. This study aims to provide a comparative analysis of the differences in adverse drug events (ADEs) between these two medications, which can assist clinicians in making appropriate treatment decisions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>ADE reports related to Cetirizine and Loratadine obtained from the FDA adverse event reporting system (FAERS) database were analyzed using disproportionality analysis and Bayesian analysis to evaluate and compare the ADE signals of both drugs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 28,051 and 28,073 ADE reports were retrieved from the FAERS database related to Cetirizine and Loratadine, respectively, with both drugs showing a predominance of middle-aged females. Specifically, Loratadine was associated with respiratory symptoms, mainly nasal symptoms such as rhinorrhea (<i>n</i> = 326, ROR 6.75), sneezing (<i>n</i> = 251, ROR 15.24), and nasal congestion (<i>n</i> = 185, ROR 4.25), while Cetirizine did not show this association. Notably, both drugs exhibited strong signals for somnolence in the nervous and psychiatric systems, especially Cetirizine (Cetirizine, <i>n</i> = 2556, ROR 10.52 vs. Loratadine, <i>n</i> = 1200, ROR 7.76). Additionally, Cetirizine itself showed strong signals for attention disturbance (<i>n</i> = 233, ROR 3.3), while Loratadine was associated with nervousness (<i>n</i> = 145, ROR 3.3). Further exploration revealed more severe adverse reactions closely associated with Cetirizine, including hallucinations, aggression, and abnormal behavior. Importantly, Cetirizine was significantly associated with the occurrence of pericarditis (<i>n</i> = 138, ROR 8.13), potentially leading to serious adverse consequences.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Compared to Loratadine, Cetirizine poses a greater potential risk in the nervous and psychiatric systems. Additionally, this study reveals previously underestimated potential cardiac toxicity of Cetirizine; albeit at a relatively low incidence rate, the high signal intensity warrants further attention and exploration. These findings highlight the need for enhanced patient monitoring and therapy optimization when prescribing these medications, ensuring better management of allergic diseases while minimizing risks.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10334,"journal":{"name":"Clinical and Translational Allergy","volume":"14 9","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clt2.12392","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142170063","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}
L. A. Miltner, J. M. Vonk, J. L. van der Velde, A. B. Sprikkelman
Background
Eczema in early childhood is associated with the development of subsequent allergic diseases, including food allergy (FA), asthma and hay fever. However, eczema has a heterogenous presentation regarding onset age and persistence, which may lead to different allergic outcomes during childhood/adolescence. Recently, sub-phenotypes of eczema have been suggested as predictors of allergic multimorbidity. Thus, we aimed to identify associations of eczema phenotypes with FA, asthma and hay fever during childhood/adolescence. Additionally, we described the trajectories of eczema, asthma and hay fever stratified by FA presence.
Methods
TRACKER (Trajectories of Allergy in Children in Real Life Databases) is a population-based cohort study of 6852 children/adolescents from the Lifelines cohort. We investigated the associations of seven eczema phenotypes, based on onset age and persistence, with FA, asthma and hay fever using logistic regression, adjusted for appropriate covariates. Disease trajectories were determined by calculating prevalence at different ages.
Results
Participants who suffered from eczema throughout childhood showed higher risks of developing FA, hay fever and asthma. “Very early onset—persistent” eczema showed the strongest associations with FA, asthma and hay fever. The prevalence of eczema, asthma and hay fever at all ages was significantly higher in participants with FA, compared to those without.
Conclusion
One of the largest cohort studies on this topic to date shows that (very) early onset and persistent eczema increases the risk of allergic multimorbidity. Identification of infants at risk for developing (very) early onset eczema is of utmost importance to prevent allergic multimorbidity.
背景：幼儿湿疹与随后的过敏性疾病（包括食物过敏（FA）、哮喘和花粉症）的发生有关。然而，湿疹在发病年龄和持续时间方面表现各异，这可能会导致儿童期/青春期出现不同的过敏结果。最近，湿疹的亚表型被认为是过敏性多病的预测因素。因此，我们旨在确定湿疹表型与儿童/青少年时期FA、哮喘和花粉症之间的关联。此外，我们还描述了湿疹、哮喘和花粉症的发病轨迹，并根据是否存在 FA 进行了分层：TRACKER（真实生活数据库中的儿童过敏症轨迹）是一项基于人群的队列研究，研究对象是生命线队列中的 6852 名儿童/青少年。我们根据发病年龄和持续时间，采用逻辑回归法调查了七种湿疹表型与FA、哮喘和花粉症的关系，并对适当的协变量进行了调整。通过计算不同年龄段的患病率，确定了疾病的发展轨迹：结果：在整个童年时期都患有湿疹的参与者罹患湿疹、花粉症和哮喘的风险较高。"极早发持续性 "湿疹与花粉症、哮喘和花粉热的关系最为密切。与没有湿疹、哮喘和花粉症的人相比，有湿疹、哮喘和花粉症的人在各个年龄段的患病率都明显较高：迄今为止有关该主题的最大规模队列研究之一表明，（非常）早发和持续的湿疹会增加过敏性多病症的风险。识别有患（极）早发湿疹风险的婴儿对预防过敏性多病症至关重要。
{"title":"Eczema in early childhood increases the risk of allergic multimorbidity","authors":"L. A. Miltner, J. M. Vonk, J. L. van der Velde, A. B. Sprikkelman","doi":"10.1002/clt2.12384","DOIUrl":"10.1002/clt2.12384","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Eczema in early childhood is associated with the development of subsequent allergic diseases, including food allergy (FA), asthma and hay fever. However, eczema has a heterogenous presentation regarding onset age and persistence, which may lead to different allergic outcomes during childhood/adolescence. Recently, sub-phenotypes of eczema have been suggested as predictors of allergic multimorbidity. Thus, we aimed to identify associations of eczema phenotypes with FA, asthma and hay fever during childhood/adolescence. Additionally, we described the trajectories of eczema, asthma and hay fever stratified by FA presence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>TRACKER (Trajectories of Allergy in Children in Real Life Databases) is a population-based cohort study of 6852 children/adolescents from the Lifelines cohort. We investigated the associations of seven eczema phenotypes, based on onset age and persistence, with FA, asthma and hay fever using logistic regression, adjusted for appropriate covariates. Disease trajectories were determined by calculating prevalence at different ages.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Participants who suffered from eczema throughout childhood showed higher risks of developing FA, hay fever and asthma. “Very early onset—persistent” eczema showed the strongest associations with FA, asthma and hay fever. The prevalence of eczema, asthma and hay fever at all ages was significantly higher in participants with FA, compared to those without.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>One of the largest cohort studies on this topic to date shows that (very) early onset and persistent eczema increases the risk of allergic multimorbidity. Identification of infants at risk for developing (very) early onset eczema is of utmost importance to prevent allergic multimorbidity.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10334,"journal":{"name":"Clinical and Translational Allergy","volume":"14 9","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clt2.12384","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142104932","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}
Anne R. Schlösser, Lotte Bult, John C. Thelen, Alberta A. H. J. Thiadens, Renske Schappin, Tamar E. C. Nijsten, Johannes C. C. M. in 't Veen, Gerrit J. Braunstahl, DirkJan Hijnen
Background
Dupilumab has been shown to be an effective treatment in moderate-to-severe atopic dermatitis (AD) and severe asthma (SA). However, comparative real-world analyses of adverse events (AE), particularly dupilumab-associated ocular surface disease (DAOSD), are lacking.
Objective
This is the first real-world study to provide insight into the prevalence of AEs associated with dupilumab in AD compared with SA. Secondary objectives were to assess the prevalence, onset and therapeutic strategies of DAOSD and evaluate dupilumab discontinuation rates.
Methods
Data from two daily practice registries including AD and SA patients receiving dupilumab treatment were analyzed. Adverse events, including DAOSD, were evaluated.
Results
In total, 322 AD and 148 SA patients were included. Headaches (23.6%), injection site reactions (10.1%), and influenza-like symptoms (13.5%) were more prevalent in SA patients. Interestingly, ocular AEs were significantly more prevalent in AD patients (62.1%, p < 0.001), including conjunctivitis (17.1%, p = 0.004). 88% AD and 47% SA patients with ocular AEs received one or more ophthalmic treatment(s). Additionally, 20% of AD and 17.6% of SA patients discontinued dupilumab treatment due to ocular AEs, while only 65% of these AD and none of these SA patients were referred to an ophthalmologist.
Conclusion
The higher incidence of DAOSD in AD patients compared with SA patients in this real-world study highlights the importance of physician awareness, especially when prescribing dupilumab to AD patients. Conversely, the findings of this study help alleviate potential concerns about ocular AEs in patients with SA who do not have comorbid AD. Furthermore, the effective management of most ocular AEs with ophthalmic treatments suggests favorable tolerability of dupilumab in daily practice, and multidisciplinary collaboration is essential to proactively manage ocular AEs before discontinuing dupilumab.
背景 杜匹单抗已被证明是治疗中重度特应性皮炎（AD）和重症哮喘（SA）的有效药物。然而，目前还缺乏对不良事件（AE），尤其是杜匹单抗相关眼表疾病（DAOSD）的真实世界对比分析。 目的 这是第一项真实世界研究，旨在深入了解与杜比单抗相关的不良反应在 AD 和 SA 中的发生率。次要目标是评估DAOSD的患病率、发病率和治疗策略，并评估杜必鲁单抗的停药率。 方法 分析了来自两个日常实践登记处的数据，包括接受杜比单抗治疗的 AD 和 SA 患者。对包括DAOSD在内的不良事件进行了评估。 结果 共纳入 322 例 AD 和 148 例 SA 患者。在SA患者中，头痛（23.6%）、注射部位反应（10.1%）和流感样症状（13.5%）更为普遍。有趣的是，眼部 AEs 在 AD 患者中的发生率明显更高（62.1%，p < 0.001），包括结膜炎（17.1%，p = 0.004）。88%的 AD 和 47% 的 SA 眼部 AE 患者接受了一种或多种眼科治疗。此外，20%的AD和17.6%的SA患者因眼部AE停止了dupilumab治疗，而这些AD患者中只有65%被转诊到眼科医生处，SA患者中没有人被转诊到眼科医生处。 结论 在这项真实世界研究中，AD 患者的 DAOSD 发生率高于 SA 患者，这凸显了医生意识的重要性，尤其是在为 AD 患者开具杜比单抗处方时。相反，本研究的结果有助于减轻不合并 AD 的 SA 患者对眼部 AEs 的潜在担忧。此外，眼科治疗能有效控制大多数眼部 AEs，这表明杜比单抗在日常治疗中具有良好的耐受性，多学科合作对于在停用杜比单抗前积极控制眼部 AEs 至关重要。
{"title":"Higher prevalence of dupilumab-induced ocular adverse events in atopic dermatitis compared to asthma: A daily practice analysis","authors":"Anne R. Schlösser, Lotte Bult, John C. Thelen, Alberta A. H. J. Thiadens, Renske Schappin, Tamar E. C. Nijsten, Johannes C. C. M. in 't Veen, Gerrit J. Braunstahl, DirkJan Hijnen","doi":"10.1002/clt2.12386","DOIUrl":"https://doi.org/10.1002/clt2.12386","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Dupilumab has been shown to be an effective treatment in moderate-to-severe atopic dermatitis (AD) and severe asthma (SA). However, comparative real-world analyses of adverse events (AE), particularly dupilumab-associated ocular surface disease (DAOSD), are lacking.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This is the first real-world study to provide insight into the prevalence of AEs associated with dupilumab in AD compared with SA. Secondary objectives were to assess the prevalence, onset and therapeutic strategies of DAOSD and evaluate dupilumab discontinuation rates.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data from two daily practice registries including AD and SA patients receiving dupilumab treatment were analyzed. Adverse events, including DAOSD, were evaluated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In total, 322 AD and 148 SA patients were included. Headaches (23.6%), injection site reactions (10.1%), and influenza-like symptoms (13.5%) were more prevalent in SA patients. Interestingly, ocular AEs were significantly more prevalent in AD patients (62.1%, <i>p</i> < 0.001), including conjunctivitis (17.1%, <i>p</i> = 0.004). 88% AD and 47% SA patients with ocular AEs received one or more ophthalmic treatment(s). Additionally, 20% of AD and 17.6% of SA patients discontinued dupilumab treatment due to ocular AEs, while only 65% of these AD and none of these SA patients were referred to an ophthalmologist.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The higher incidence of DAOSD in AD patients compared with SA patients in this real-world study highlights the importance of physician awareness, especially when prescribing dupilumab to AD patients. Conversely, the findings of this study help alleviate potential concerns about ocular AEs in patients with SA who do not have comorbid AD. Furthermore, the effective management of most ocular AEs with ophthalmic treatments suggests favorable tolerability of dupilumab in daily practice, and multidisciplinary collaboration is essential to proactively manage ocular AEs before discontinuing dupilumab.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10334,"journal":{"name":"Clinical and Translational Allergy","volume":"14 8","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clt2.12386","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141994174","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}
Muwada Bashir Awad Bashir, Rani Basna, Göran Wennergren, Madeleine Rådinger, Helena Backman, Emma Goksör, Jan Lötvall, Linda Ekerljung, Hannu Kankaanranta, Bright I. Nwaru
Conclusion
Education, but not occupation, was differentially associated with adult asthma phenotypes in the general population. Further research into socioeconomic status variation in various asthma phenotypes is warranted.
{"title":"Level of education, but not occupation, is differentially associated with asthma phenotypes in adults","authors":"Muwada Bashir Awad Bashir, Rani Basna, Göran Wennergren, Madeleine Rådinger, Helena Backman, Emma Goksör, Jan Lötvall, Linda Ekerljung, Hannu Kankaanranta, Bright I. Nwaru","doi":"10.1002/clt2.12389","DOIUrl":"10.1002/clt2.12389","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Education, but not occupation, was differentially associated with adult asthma phenotypes in the general population. Further research into socioeconomic status variation in various asthma phenotypes is warranted.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10334,"journal":{"name":"Clinical and Translational Allergy","volume":"14 8","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clt2.12389","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141975237","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}
Tamazoust Guiddir, Audrey Siberil, Françoise Lepape, Marion Hacker, Ariane Nemni
<p>To the Editor</p><p>Cashew nut allergy (CNA) is increasing worldwide and is responsible for severe anaphylaxis, particularly in young children.<span><sup>1</sup></span> Symptoms range from mild reactions to severe anaphylaxis. The three main allergens are storage proteins: Ana o 1, Ana o 2 (cupin superfamily) and Ana o 3 (prolamin superfamily).<span><sup>2</sup></span> Lifetime avoidance of cashew nut is currently recommended for those with CNA. However, little is known about the natural history of CNA.</p><p>We report a cohort of five children with severe anaphylaxis to cashew nut who recovered and were able to eat cashew nut after a successful oral food challenge (Table 1). They all presented severe anaphylaxis according to the ordinal food allergy severity score (oFAAS-5)<span><sup>3</sup></span> (grade 3 to grade 5) at diagnosis at a mean age of 3 years [1.5–4]. Two patients had no atopy, one had a personal and familial atopic history and two others had only personal atopy. They all had no allergies or sensitizations to peanuts or tree nuts. Three patients consumed native cashew (between one and three cashew units) during the first reaction and two patients consumed cashew in cooked meals (unknown quantity). Allergology explorations were performed a mean 1.1 years [0.15–5] after the first reaction. All patients were sensitized to pistachio, but only two had a confirmed food allergy to pistachio. Skin prick tests (SPTs) were performed with commercial extract (ALK-Abello) and were deemed positive when wheal size was ≥ 3 mm. Cashew SPTs were positive for four children (mean 6 mm, range [3–20]). Cashew-specific IgEs (ImmunoCap® by Phadia 1000 System, Thermo Fisher Scientific) were positive for all patients, with a mean of 1 KU/L [0.36–2.49]. The recombinant Ana o 3 was not tested for at diagnosis for three patients and was positive for two of them (0.63 and 1.97 KU/L). After the reaction, they all observed strict avoidance of cashew and pistachio in their diet, without any recurrence. During a mean follow-up of 2.4 years (range [1–4]), the SPT and the cashew-specific IgEs became negative (Figure 1) and all patients tested negative for recombinant Ana o 3. An oral food challenge in four patients was successful at a cashew nut cumulated dose of 7800 mg. One patient refused the challenge, but after a successful pistachio challenge, he ate one cashew unit at home without any reaction.</p><p>We reported the cases of five children who presented severe anaphylaxis to cashew nut and who spontaneously recovered after a mean follow-up of 2.4 years [1–4]. As for peanut, ingestion of cashew is associated with a high rate of severe anaphylactic reactions,<span><sup>4</sup></span> but in our cohort it seemed not to be correlated with persistence of the allergy. Oral immunotherapy (OIT) may help develop tolerance to cashew, as reported by Elizur et al.<span><sup>5</sup></span> in a cohort of 50 children aged >4 years, who presented severe clinical reactio
致编辑腰果过敏（CNA）在全球范围内呈上升趋势，是导致严重过敏性休克的原因之一，尤其是在幼儿中。三种主要过敏原是贮存蛋白：Ana o 1、Ana o 2（cupin 超家族）和 Ana o 3（prolamin 超家族）。2 目前建议 CNA 患者终生避免食用腰果。然而，人们对 CNA 的自然病史知之甚少。我们报告了一组对腰果有严重过敏性休克的五名儿童，他们在成功接受口服食物挑战后恢复并能够食用腰果（表 1）。根据食物过敏严重程度顺序评分（oFAAS-5）3（3 级至 5 级），他们在确诊时均出现严重过敏性休克，平均年龄为 3 岁 [1.5-4]。两名患者没有过敏史，一名患者有个人和家族过敏史，另外两名患者只有个人过敏史。他们都对花生或树坚果没有过敏反应。三名患者在第一次反应期间食用了本地腰果（1 至 3 个腰果单位），两名患者在熟食中食用了腰果（数量不详）。在首次反应后平均 1.1 年 [0.15-5] 进行了过敏学检查。所有患者都对开心果过敏，但只有两名患者确诊对开心果食物过敏。皮肤点刺试验（SPTs）是用商品提取物（ALK-Abello）进行的，当出现≥3 毫米的皮疹时即为阳性。四名儿童的腰果 SPT 呈阳性（平均 6 毫米，范围 [3-20]）。所有患者的腰果特异性 IgE（ImmunoCap® by Phadia 1000 System，赛默飞世尔科技公司）均呈阳性，平均值为 1 KU/L [0.36-2.49]。3 名患者在诊断时未检测重组 Ana o 3，其中 2 人呈阳性（0.63 和 1.97 KU/L）。反应发生后，他们都严格遵守了在饮食中避免食用腰果和开心果的规定，但没有复发。在平均 2.4 年（范围 [1-4]）的随访期间，SPT 和腰果特异性 IgE 均为阴性（图 1），所有患者的重组 Ana o 3 检测结果均为阴性。四名患者成功接受了腰果累积剂量为 7800 毫克的口服食物挑战。一名患者拒绝接受挑战，但在挑战开心果成功后，他在家中吃了一个腰果单位，没有出现任何反应。我们曾报告过五名儿童对腰果出现严重过敏性休克的病例，他们在平均 2.4 年的随访后自发康复[1-4]。至于花生，摄入腰果与严重过敏性反应的发生率很高4，但在我们的队列中，这似乎与过敏的持续性无关。口服免疫疗法 (OIT) 可能有助于培养对腰果的耐受性，Elizur 等人5 对 50 名 4 岁儿童进行了研究，这些儿童出现了严重的皮肤和生物过敏临床反应。在治疗方案结束时，88% 的儿童能够食用 4000 毫克腰果，94% 的儿童食用量超过 1200 毫克。然而，据报告，在 OIT 期间出现了严重的反应，在急诊科就诊时使用了肾上腺素。这种耐受性是通过每天食用腰果获得的。就我们的患者而言，在避免食用腰果后，他们自然而然地对腰果产生了耐受性。在我们的队列中，有 3 名患者在诊断时没有重组 Ana o 3 致敏数据，但所有患者在随访后的重组 Ana o 3 检测结果均为阴性。我们推测所有患者在确诊时都对重组 Ana o 3 呈阳性反应，因为所有患者在首次反应时都出现了严重的临床过敏性休克。6 在 Elizur 等人的队列中，所有患者在诊断时重组 Ana o 3 均呈高水平，对照组患者（Ana o 3- sIgE，中位数为 8.3-5.9 kU/L，p = 0.5）的重组 Ana o 3 并未显著下降，而只有脱敏患者（中位数为 3.7-1.6 kU/L，p <0.001）的重组 Ana o 3 呈下降趋势。在他们的研究中，脱敏患者的中位随访时间为 12 个月（范围为 3-57 个月），对照组患者的中位随访时间为 17 个月（范围为 5-44.1 个月），而在我们的队列中，平均随访时间为 28 个月 [12-48]，这可能需要更长时间的随访来监测 IgE 和 SPT。正如 Foong 等人所述，树坚果特异性 IgE <2 KU/L 可预测随访期间过敏症的缓解。7 然而，在腰果过敏症患者中，临床和实验室结果并不一致，因为严重过敏性休克患者的特异性 IgE 并不总是很高。如果实验室指标呈阴性，则可建议进行口服食物挑战，以确认恢复情况。
{"title":"Can cashew nut allergy resolve spontaneously?","authors":"Tamazoust Guiddir, Audrey Siberil, Françoise Lepape, Marion Hacker, Ariane Nemni","doi":"10.1002/clt2.12385","DOIUrl":"10.1002/clt2.12385","url":null,"abstract":"<p>To the Editor</p><p>Cashew nut allergy (CNA) is increasing worldwide and is responsible for severe anaphylaxis, particularly in young children.<span><sup>1</sup></span> Symptoms range from mild reactions to severe anaphylaxis. The three main allergens are storage proteins: Ana o 1, Ana o 2 (cupin superfamily) and Ana o 3 (prolamin superfamily).<span><sup>2</sup></span> Lifetime avoidance of cashew nut is currently recommended for those with CNA. However, little is known about the natural history of CNA.</p><p>We report a cohort of five children with severe anaphylaxis to cashew nut who recovered and were able to eat cashew nut after a successful oral food challenge (Table 1). They all presented severe anaphylaxis according to the ordinal food allergy severity score (oFAAS-5)<span><sup>3</sup></span> (grade 3 to grade 5) at diagnosis at a mean age of 3 years [1.5–4]. Two patients had no atopy, one had a personal and familial atopic history and two others had only personal atopy. They all had no allergies or sensitizations to peanuts or tree nuts. Three patients consumed native cashew (between one and three cashew units) during the first reaction and two patients consumed cashew in cooked meals (unknown quantity). Allergology explorations were performed a mean 1.1 years [0.15–5] after the first reaction. All patients were sensitized to pistachio, but only two had a confirmed food allergy to pistachio. Skin prick tests (SPTs) were performed with commercial extract (ALK-Abello) and were deemed positive when wheal size was ≥ 3 mm. Cashew SPTs were positive for four children (mean 6 mm, range [3–20]). Cashew-specific IgEs (ImmunoCap® by Phadia 1000 System, Thermo Fisher Scientific) were positive for all patients, with a mean of 1 KU/L [0.36–2.49]. The recombinant Ana o 3 was not tested for at diagnosis for three patients and was positive for two of them (0.63 and 1.97 KU/L). After the reaction, they all observed strict avoidance of cashew and pistachio in their diet, without any recurrence. During a mean follow-up of 2.4 years (range [1–4]), the SPT and the cashew-specific IgEs became negative (Figure 1) and all patients tested negative for recombinant Ana o 3. An oral food challenge in four patients was successful at a cashew nut cumulated dose of 7800 mg. One patient refused the challenge, but after a successful pistachio challenge, he ate one cashew unit at home without any reaction.</p><p>We reported the cases of five children who presented severe anaphylaxis to cashew nut and who spontaneously recovered after a mean follow-up of 2.4 years [1–4]. As for peanut, ingestion of cashew is associated with a high rate of severe anaphylactic reactions,<span><sup>4</sup></span> but in our cohort it seemed not to be correlated with persistence of the allergy. Oral immunotherapy (OIT) may help develop tolerance to cashew, as reported by Elizur et al.<span><sup>5</sup></span> in a cohort of 50 children aged >4 years, who presented severe clinical reactio","PeriodicalId":10334,"journal":{"name":"Clinical and Translational Allergy","volume":"14 8","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clt2.12385","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141975174","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}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号