Annals of Allergy Asthma & Immunology最新文献

Background: Severe asthma is a heterogeneous disease with variable clinical manifestations and treatment responses. Long-term assessment of lung function trajectories may help define phenotypic and endotypic subgroups.

Objective: To identify distinct phenotypic clusters in patients with severe asthma using longitudinal changes in percentage of forced expiratory volume in 1 second (FEV₁%) and assess the associated clinical and inflammatory profiles.

Methods: This single-center, retrospective cohort study analyzed 10-year follow-up data from adult patients with severe asthma. Latent class mixed model analysis was performed using serial FEV₁% changes. Baseline characteristics and medication use were compared with analysis of variance and χ² tests. Linear mixed models assessed longitudinal trends in fractional exhaled nitric oxide (FeNO) levels and blood eosinophil/neutrophil counts.

Results: Altogether, 310 patients (mean age, 44.7 ± 14.4 years; 35.2% were males) were included. The following 3 distinct clusters were identified: group 1 (n = 45) demonstrating a progressive decline in FEV₁% despite receiving maintenance therapy (refractory to current treatments); group 2 (n = 211) maintaining stable FEV₁% (≥80%); and group 3 (n = 54) demonstrating improvement. Group 1 had higher baseline FeNO and eosinophils than group 2, with eosinophil levels comparable to group 3. Over time, group 1 exhibited persistently elevated FeNO and eosinophil levels than groups 2 and 3, whereas neutrophil and IgE trajectories had no differences. Group 1 also required higher cumulative systemic corticosteroid doses.

Conclusion: Three distinct FEV₁% trajectories were identified in severe asthma. The treatment-refractory group demonstrated progressive lung function decline despite higher corticosteroid use and persistent T2 inflammation, underscoring the need for biologic therapies than corticosteroid escalation.

Background: Atopic dermatitis (AD) is the most common pediatric atopic disease and a risk factor for food allergy (FA) development. Children with AD are prone to developing allergic comorbidities. Its relationship with FA phenotype and timing of onset remains unclear.

Objective: To evaluate associations between AD presence and onset timing with FA-related outcomes and atopic comorbidities.

Methods: FORWARD is a longitudinal, multicenter study enrolling children younger than 12 years with physician-diagnosed FA between 2017 and 2024. Written informed consent was obtained. Data were collected from baseline survey and electronic medical records. Logistic regression models adjusted for demographic and socioeconomic factors assessed associations between AD with FA number, type of allergens, and atopic comorbidities.

Results: Among 1309 children with physician-diagnosed FA, 77% reported history of AD, with 30.3% between 1 and 3 months, 50.2% at 4 to 12 months, and 19.5% after 12 months. Multiple FAs, asthma, and allergic rhinitis were each associated with higher odds of AD. Late-onset AD was associated to lower odds of multiple FAs compared with early onset AD (odds ratio 0.57, 95% CI 0.38-0.85), including lower odds of milk and egg allergies. Conversely, late-onset AD was associated with higher odds of asthma and allergic rhinitis.

Conclusion: Among children with FAs, 77% report a history of AD, with more than 80% of children with FA developed AD within the first year of life. Children with multiple FAs and those with allergies to milk and egg are more likely to develop AD on earlier age onset, whereas asthma and allergic rhinitis were associated with late-onset AD.

Background: Penicillin allergy labels affect 1 in 10 people but are uncommonly reflective of a true, IgE-mediated allergy. Penicillin allergy-labeled patients have increased exposure to broad-spectrum antibiotics that increase the risk for treatment failures, antimicrobial resistance, and adverse events. Delabeling of penicillin allergy is an evidence-based strategy to support access to optimal antibiotics and reduce antimicrobial resistance.

Objective: To assess the association of race with penicillin allergy delabeling prevalence.

Methods: We used a retrospective cohort of primary care patients at Mass General Brigham and Tufts Medicine health systems receiving care from January 2019 to April 2022 with any active or inactive (ie, deleted or inactivated) penicillin allergy record in their electronic health record. We assessed penicillin allergy delabeled as the primary outcome, defined as no active penicillin allergy record in the electronic health record using a validated algorithm. The primary exposure was self-reported race in the electronic health record. We also assessed age, sex (at birth), language preference, documented allergies, health care visits, and Charlson comorbidity index as potential associated factors and mediators.

Results: Black patients were less likely to have penicillin allergy delabeling overall (adjusted odds ratio 0.73 [95% CI 0.64-0.84]), but the prevalence and mediation differed across the 2 health care systems. Asian patients had lower penicillin allergy delabeling prevalence (adjusted odds ratio 0.76 [95% CI 0.65-0.88]), which was mediated in both systems by non-English language preference and specific health care utilization.

Conclusion: Racial differences were identified in penicillin allergy delabeling in Black and Asian patients, but with inconsistencies between health care systems. Further studies identifying the clinician-, institution-, and structural-level barriers to penicillin allergy delabeling are necessary to advance equitable penicillin allergy delabeling and antibiotic stewardship.

Background: Nonsteroidal anti-inflammatory drugs (NSAIDs) are major exacerbating factors in approximately one-third of patients with chronic spontaneous urticaria (CSU), contributing to disease chronicity and severity. However, comprehensive comparisons of clinical characteristics and treatment responses remain limited.

Objective: To analyze baseline characteristics, immunologic parameters, and treatment outcomes in patients with NSAID-exacerbated chronic disease (NECD) compared with those with NSAID-tolerant chronic urticaria (NTCU), using long-term outcome models in a large, real-world clinical cohort.

Methods: From a cohort of 9632 adult patients with CSU, 966 patients with NECD were identified by diagnostic codes and were analyzed against the remaining patients with NTCU. Clinical and laboratory findings, medication requirements, and long-term clinical outcomes were compared between the 2 groups.

Results: The disease duration was significantly longer in patients with NECD (42.7 ± 46.3 vs 21.9 ± 30.9 months, P < .001), and the prevalence of angioedema was higher (58.1% vs 23.4%, P < .001). They required longer treatment durations with antihistamines and leukotriene receptor antagonists (P < .001 for all). The daily dose of systemic corticosteroids was also higher (11.7 ± 6.1 vs 10.4 ± 6.9 mg, P < .001). Patients with NECD also had longer omalizumab treatment durations, with no difference in cyclosporine use.

Conclusion: Our findings confirm that NECD represents a more chronic and treatment-resistant phenotype within patients with CSU. These results provide valuable insights into the distinct clinical and immunologic profiles of NECD, underscoring its higher disease burden and refractory nature.