Annals of Allergy Asthma & Immunology最新文献

英文中文

Pediatric Asthma Impairment and Risk Questionnaire 儿童哮喘损害和风险问卷：一种复合控制工具的原理和发展。

IF 5.8 2区医学 Q1 ALLERGY

Annals of Allergy Asthma & Immunology

Pub Date : 2025-02-01 DOI: 10.1016/j.anai.2024.11.021

Miguel J. Lanz MD , Bradley E. Chipps MD , Robert S. Zeiger MD, PhD , Leonard B. Bacharier MD , Theresa W. Guilbert MD , Kevin R. Murphy MD , Tonya Winders MBA , Acklema Mohammad MD , Monique LeNoir MA , Ileen Gilbert MD , James M. Eudicone MS, MBA , Karin S. Coyne PhD, MPH , Gale Harding MA , Maureen George PhD, RN

Background

Asthma in children is a leading cause of missed school days, emergency department visits, and hospitalizations. Approximately 40% of children with asthma experience uncontrolled disease and annual exacerbations. There is a need for a validated composite tool for children, such as the Asthma Impairment and Risk Questionnaire (AIRQ), which was developed to assess current control and predict exacerbations in adolescents and adults with asthma.

Objective

To obtain feedback from children with asthma and their parents/caregivers to inform development of a version of the AIRQ for pediatric use (Peds-AIRQ).

Methods

Children with asthma aged 5 to 11 years and their parents/caregivers participated in cognitive interviews to elicit language describing asthma symptoms and exacerbations and to assess understanding and relevance of draft Peds-AIRQ questions. Physicians and parents/caregivers provided clinical information and performed assessments relative to the children's asthma morbidity.

Results

There were 60 dyads that participated: children's mean (SD) age = 7.9 (1.9) years; 68% male, 45% non-White, 32% Hispanic, and 40% with public health insurance. Overall, 53% had well-controlled, 30% partly controlled, and 17% uncontrolled asthma, based on the Global Initiative for Asthma symptom control questions. Oral or injected corticosteroids were used for asthma by 53% of the children in the previous year. Participants found draft Peds-AIRQ items understandable and relevant. Seven impairment and 3 risk questions were retained for validation, along with 5 additional items containing wording or control threshold variations.

Conclusion

This study supports the need for developing a composite (impairment and risk) control tool to assess children aged 5 to 11 years with asthma and identified suitable questions for the validation of a Peds-AIRQ.

背景：儿童哮喘是缺课、急诊和住院的主要原因。大约40%的哮喘患儿病情不受控制且每年加重。儿童需要一种经过验证的复合工具，如哮喘损害和风险问卷（AIRQ®），该问卷旨在评估青少年和成人哮喘患者的当前控制情况并预测病情恶化。目的：从哮喘儿童及其父母/照顾者那里获得反馈，为儿科使用AIRQ （Peds-AIRQ）的开发提供信息。方法：5-11岁的哮喘儿童及其父母/照顾者参与认知访谈，以获得描述哮喘症状和恶化的语言，并评估对Peds-AIRQ问题草案的理解和相关性。医生和家长/照顾者提供了与儿童哮喘发病率相关的临床信息并进行了评估。结果：60对参与者：儿童平均（SD）年龄=7.9（1.9）岁；68%为男性，45%为非白人，32%为西班牙裔，40%有公共医疗保险。总体而言，根据全球哮喘症状控制问题倡议，53%的哮喘得到良好控制，30%得到部分控制，17%未得到控制。在前一年，53%的儿童使用口服或注射皮质类固醇治疗哮喘。与会者认为Peds-AIRQ草案的内容是可以理解和相关的。7个减值问题和3个风险问题，以及5个包含措辞或控制阈值变化的附加项目，被保留下来进行验证。结论：本研究支持开发一种复合（损伤和风险）控制工具来评估5-11岁哮喘儿童的必要性，并确定了验证Peds-AIRQ的合适问题。

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引用次数: 0

Corrigendum to ‘Inflammatory pathways in patients with post-acute sequelae of COVID-19’ [Annals of Allergy, Asthma & Immunology 133/5 (2024) 507 – 515] “COVID-19急性后后遗症患者的炎症途径”的勘误表[Annals of Allergy， Asthma & Immunology] 133/5(2024) 507 - 515]。

IF 5.8 2区医学 Q1 ALLERGY

Annals of Allergy Asthma & Immunology

Pub Date : 2025-02-01 DOI: 10.1016/j.anai.2024.11.026

Matthew R. Elliott MD, Anna E. O'Connor MD, Gailen D. Marshall MD, PhD

引用次数: 0

Osteonecrosis: A disabling disease not to be ignored in asthma and atopic conditions 骨质疏松症：哮喘和特应性疾病中不可忽视的致残性疾病。

IF 5.8 2区医学 Q1 ALLERGY

Annals of Allergy Asthma & Immunology

Pub Date : 2025-02-01 DOI: 10.1016/j.anai.2024.10.025

Chase P. Rupprecht MD , Guha Krishnaswamy MD

Osteonecrosis, also referred to as avascular necrosis, is a disease characterized by necrosis or death of a bone secondary to impairment in blood supply. The condition affects the epiphyseal ends of the bones such as the femur and the humerus, but it can also involve the metacarpal and metatarsal bones, the patella, the knee, the vertebrae, and the jaw. A plethora of inflammatory, autoimmune, hematological, thrombotic, and vascular diseases can lead to osteonecrosis. Corticosteroids are intimately linked to the development of osteonecrosis. The frequent use of systemic corticosteroids in patients with asthma, eczema, nasal polyposis, sinusitis, urticaria and angioedema, or anaphylaxis makes this disease of great relevance to the practicing allergist and pulmonologist. Untreated, bone necrosis leads to frustrated bone remodeling and angiogenesis, leading to subchondral fractures and collapse of the articular heads of the bones, and culminating in debilitating osteoarthritis, often requiring arthroplasty. Recent studies have shed light on the molecular mechanisms underlying osteonecrosis and on the role of glucocorticoids. The gold standard test in patients suspected of having the disease is magnetic resonance imaging scanning, with plain radiographs having a lower sensitivity and specificity. Early diagnosis and intervention are essential. The allergist should avoid the frequent use of glucocorticoids and consider early introduction of steroid-sparing alternatives for asthma or sinusitis. Smoking and alcohol ingestion need to be addressed, and the management of glucocorticoid-induced osteoporosis may be helpful. It is essential for allergists to familiarize themselves with the disease and its diagnosis and to consider early referral to an orthopedic surgeon for surgical intervention.

骨坏死又称血管性坏死，是一种因供血障碍而导致骨骼坏死或死亡的疾病。这种疾病会影响骨骼的骺端，如股骨和肱骨，但也会累及掌骨和跖骨、髌骨、膝关节、椎骨和颌骨。多种炎症、自身免疫、血液、血栓和血管疾病均可导致骨坏死。皮质类固醇与骨坏死的发生密切相关。哮喘、湿疹、鼻息肉、鼻窦炎、荨麻疹、血管性水肿或过敏性休克患者经常使用全身性皮质类固醇，这使得本病与过敏症和肺科医生密切相关。如不及时治疗，骨坏死会导致骨重塑和血管生成受挫，导致软骨下骨折和骨关节头塌陷，最终导致令人衰弱的骨关节炎，通常需要进行关节成形术。最近的研究揭示了骨坏死的分子机制和糖皮质激素的作用。对疑似骨坏死患者的金标准检查是核磁共振成像扫描，而普通X光片的敏感性和特异性较低。早期诊断和干预至关重要。过敏专科医生应避免频繁使用糖皮质激素，并考虑尽早使用节省类固醇的替代药物治疗哮喘或鼻窦炎。吸烟和饮酒问题需要解决，糖皮质激素引起的骨质疏松症的治疗可能会有所帮助。过敏症医生必须熟悉这种疾病及其诊断，并考虑尽早转诊给骨科医生进行手术干预。

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引用次数: 0

How I diagnose IgE-mediated food allergy 临床大师：我是如何诊断 IgE 导致的食物过敏的？

IF 5.8 2区医学 Q1 ALLERGY

Annals of Allergy Asthma & Immunology

Pub Date : 2025-02-01 DOI: 10.1016/j.anai.2024.10.027

Matthew Greenhawt MD, MBA, MSc

引用次数: 0

Oscillometry-defined small airways dysfunction as a treatable trait in asthma 摆动测定法将小气道功能障碍定义为可治疗的哮喘特征。

IF 5.8 2区医学 Q1 ALLERGY

Annals of Allergy Asthma & Immunology

Pub Date : 2025-02-01 DOI: 10.1016/j.anai.2024.11.006

Marcello Cottini MD , Carlo Lombardi MD , Pasquale Comberiati MD , Alvise Berti MD , Francesco Menzella MD , Ronald J. Dandurand MD , Zuzana Diamant MD, PhD , Rory Chan MBChB, PhD

The small airways, also referred to as the lung's silent zone, are closely associated with poor symptom control and more frequent asthma exacerbations. The oscillometry technique superimposes sound or airwaves onto normal tidal breathing and provides information on resistance and reactance, that is, obstacles to airflow occurring inside and outside of the bronchi. More recently, a management paradigm based on so-called “treatable traits” has been proposed to personalize and improve asthma care for individuals by proactively identifying and targeting modifiable pulmonary, extrapulmonary, and behavioral traits affecting asthma control. In this review article, we evaluate the literature on small airways dysfunction as a potential treatable trait in persistent asthma. In particular, we discuss whole- and intrabreath oscillometry and the impact of extrafine inhaled corticosteroids and systemic biologics on the peripheral airways.

小气道也被称为肺的沉默区，与症状控制不佳和哮喘加重更频繁密切相关。振荡测量技术将声波或气波叠加到正常的潮式呼吸上，提供有关阻力和反应的信息，即支气管内外发生的气流障碍。最近，有人提出了一种基于所谓 "可治疗特征 "的管理模式，通过主动识别和针对影响哮喘控制的可改变的肺部、肺外和行为特征，为个人提供个性化的哮喘治疗并改善其效果。在这篇综述文章中，我们研究了有关小气道功能障碍作为持续性哮喘潜在可治疗特征的文献。其中，我们重点讨论了全呼气和呼气内振荡测定法以及超细吸入皮质类固醇和全身生物制剂对外周气道的影响。

引用次数: 0

Role of diamine oxidase in the management of angioedema 二胺氧化酶在治疗血管性水肿中的作用。

IF 5.8 2区医学 Q1 ALLERGY

Annals of Allergy Asthma & Immunology

Pub Date : 2025-02-01 DOI: 10.1016/j.anai.2024.11.011

María Carmen Díaz Donado MD, PhD , Zuelem Evelyn Danz Luque MD , Juan Majada Guijo PhD , Juan Jesús Fernández Madera MD , María Dolores Quiñones Estévez MD, PhD

引用次数: 0

Airway oscillometry in asthma 哮喘的气道振荡测量--现状与未来展望。

IF 5.8 2区医学 Q1 ALLERGY

Annals of Allergy Asthma & Immunology

Pub Date : 2025-02-01 DOI: 10.1016/j.anai.2024.09.007

Rory Chan MBChB, PhD, Brian Lipworth MD

引用次数: 0

The paradigm shift in drug development for atopic dermatitis: Addressing the variables of the equation leading to disease modification 特应性皮炎药物研发模式的转变：解决导致疾病改变的方程式中的变量。

IF 5.8 2区医学 Q1 ALLERGY

Annals of Allergy Asthma & Immunology

Pub Date : 2025-02-01 DOI: 10.1016/j.anai.2024.09.022

Thomas Bieber MD, PhD, MDRA

The recent development of new therapies for atopic dermatitis (AD) has greatly benefited from the advances in understanding the mechanisms underlying this disease. This progress now allows one to envisage pushing the therapeutic boundaries beyond the simple symptomatic treatment of the exacerbations of AD and considering new therapeutic strategies aimed to allow an off-therapy long-term and deep remission, that is, disease modification. Owing to the complexity of the phenotype and underlying mechanisms of AD, it is expected that this will not fit to the current one-size-fits-all model in drug development. Thus, aiming at disease modification will lead to a paradigm shift in drug development strategy in AD requiring the consideration of a precision medicine approach with a phenotype-endotype (biomarker)-based stratification as well as a consensus definition of specific study endpoints for the clinical development program. This review addresses the scientific rationale for this strategy, some general aspects of the design of confirmatory clinical trials, and the variables along the Population, Intervention, Comparator, and Outcome framework to be addressed for reaching the ultimate goal of disease modification in AD.

近年来，特应性皮炎（AD）新疗法的开发极大地得益于人们对这种疾病内在机制认识的进步。现在，这一进展使得我们可以设想将治疗范围从简单的特应性皮炎加重的对症治疗扩展到考虑采用新的治疗策略，以实现非治疗性的长期和深度缓解，即疾病的改变。由于注意力缺失症的表型和潜在机制非常复杂，预计这将不适合当前的 "一刀切 "药物开发模式。因此，以疾病改变为目标将导致AD药物开发战略的范式转变，需要考虑基于表型-端型（生物标志物）分层的精准医学方法，以及临床开发计划中特定研究终点的共识定义。本综述将阐述这一策略的科学依据、确证性临床试验设计的一些一般方面，以及为实现改变 AD 疾病的最终目标而需要解决的人群、干预措施、比较者和结果 (PICO) 框架下的变量。

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引用次数: 0

The Supraglottic Index 声门上指数：哮喘患者对喉咽反流疗法反应的指标。

IF 5.8 2区医学 Q1 ALLERGY

Annals of Allergy Asthma & Immunology

Pub Date : 2025-02-01 DOI: 10.1016/j.anai.2024.10.012

Laurie A. Manka MD , Vamsi P. Guntur MD, MSc , Allen D. Stevens BA , Christena Kolakowski MS , Camille M. Moore PhD , Richard J. Martin MD

Background

Laryngopharyngeal reflux (LPR) is associated with gastroesophageal reflux and is known to cause poor asthma control. Moreover, LPR and asthma frequently coexist in the same individual. Controlling LPR could be associated with improved asthma control. The Supraglottic Index (SGI) is a clinically applied visual scale, which correlates with the presence of LPR. The role of SGI in monitoring LPR therapy in individuals with asthma is not known.

Objective

To determine whether the SGI can be used over time to assess the presence of LPR in patients with asthma, and whether the SGI improves with LPR treatment.

Methods

This is a pilot study in 15 participants with asthma. Those without evidence of LPR by SGI measurement were assigned to the observation arm. Those with LPR were assigned to the treatment arm and were treated with either standard-of-care LPR treatment (antacids and behavioral management) or a novel therapy (upper esophageal assist device).

Results

The SGI remained stable in individuals with asthma who underwent observation over 8 weeks. The SGI improved in participants with asthma treated for LPR (P = .024).

Conclusion

The SGI is a readily available clinical tool to assess the presence of LPR and monitor its therapy in asthma.

背景：喉咽反流（LPR）与胃食管反流（GERD）有关，已知会导致哮喘控制不佳。LPR 和哮喘经常在同一个人身上同时存在。控制 LPR 可能与改善哮喘控制有关。声门上指数（SGI）是一种临床应用的视觉量表，与 LPR 的存在相关。SGI 在监测哮喘患者 LPR 治疗方面的作用尚不清楚：目标：SGI 是否可长期用于评估哮喘患者是否存在 LPR，SGI 是否会随着 LPR 治疗而改善？这是一项针对 15 名哮喘患者的试点研究。通过 SGI 测量未发现 LPR 的参与者被分配到观察组。有 LPR 的患者被分配到治疗组，接受标准的 LPR 治疗（抗酸剂和行为管理）或新型疗法（食管上辅助装置）：接受 8 周观察的哮喘患者的 SGI 保持稳定。结论：SGI 是一项可用于临床试验的指标：结论：SGI 是一种易于使用的临床工具，可用于评估是否存在 LPR 以及监测哮喘患者的治疗情况。

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引用次数: 0

“Oscillometry Associates”

IF 5.8 2区医学 Q1 ALLERGY

Annals of Allergy Asthma & Immunology

Pub Date : 2025-02-01 DOI: 10.1016/j.anai.2024.09.004

Erin L. Reigh MD, MS

引用次数: 0

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