Annals of Allergy Asthma & Immunology最新文献

Background: Long-term prophylaxis (LTP) can help manage hereditary angioedema (HAE). With increasing LTP treatment options, understanding patients' preferences is important for shared decision-making.

Objective: To understand the way individuals with HAE assess the importance of LTP treatment attributes, their LTP treatment preferences, and the impact of disease and treatment attributes on their willingness to switch LTP.

Methods: We conducted an online survey in 2023 among US adults (aged ≥18 years) self-reporting an HAE diagnosis and receiving treatment (LTP, on-demand, or both) or experiencing at least 1 attack in the past 3 months. Best-worst scaling and a discrete choice experiment assessed LTP preferences. A behavior change model assessed willingness to switch LTP.

Results: A total of 150 individuals completed the survey. Respondents rated effectiveness in preventing attacks and reducing the severity of attacks as the most important LTP attributes. Route of administration and convenience were more than twice as important as dosing frequency. Individuals preferred oral daily therapy to biweekly (54% vs 46%) or monthly injections (54% vs 46%). Most individuals (71%) were at least somewhat willing to switch LTP treatments in the next 6 months, particularly those whose HAE was not well controlled, were anxious about taking LTP, were burdened by treating their HAE, or preferred oral administration.

Conclusion: Effectiveness was the primary driver of LTP preference; other factors were also important, including convenience. When effectiveness was equivalent, oral administration was preferred to injectable administration. Individuals with HAE were moderately willing to switch their LTP. By better understanding patients' treatment preferences, health care professionals can individualize LTP recommendations.

Severe asthma management has changed dramatically over the last decade following the introduction of T2 directed biologic therapies. This has enabled more ambitious treatment goals including on-treatment clinical remission in severe asthma. Definitions of clinical remission have invariably included absence of both systemic corticosteroids for disease control and asthma exacerbations but have varied regarding the level of required symptom control and optimal lung function; a single definition would allow a better understanding of the longer-term impact of achieving clinical remission in both clinical practice and in research studies. Studies have shown a minority of severe asthma patients achieve clinical remission and key barriers have been identified, including those associated with disease related airways damage, such as fixed airflow obstruction associated high symptom burden, and comorbidities including those from corticosteroid toxicity, such as obesity, anxiety and depression. Earlier intervention with biologic therapy has been posed as a potential method to overcome these barriers, tackling the T2 inflammation before disease and corticosteroid related damage is established. However, biologic therapy should not be considered a panacea, and appropriate patient selection remains key to ensuring their optimal use. T2 biomarker guided therapy allows clinicians to correlate clinical manifestations to the underlying biological aetiology. Biomarker-guided biologic therapy alongside treatment of non T2 driven disease may improve clinical remission attainment rates. Conversely, the presence of ongoing T2 inflammation alongside on treatment clinical remission raises questions regarding the long-term effect of subclinical inflammation.

Background: An underlying allergic diathesis is a risk factor for acquiring COVID-19; however, some have found it attenuates outcomes of hospitalization/death.

Objective: To examine the effect of background allergic conditions on COVID-19 outcomes in patients with and without COVID-19 treated with casirivimab plus imdevimab (CAS+IMD).

Methods: This analysis included 4057 outpatients with COVID-19 and ≥1 risk factor. Supplementary analyses involved 2652 patients without COVID-19, investigating prevention in home or community settings. Participants were equally randomized to CAS+IMD 1.2 g, 2.4 g, or placebo. Patients with allergic conditions were identified by medical history of atopic dermatitis, asthma, allergic rhinitis, or anaphylaxis, categorized as: any allergy; allergy excluding asthma; and asthma excluding other allergies. Assessments included duration from CAS+IMD to hospitalization/death.

Results: The adjusted risk of hospitalization/death in patients receiving placebo was 2.37 times higher for patients with asthma vs those without allergy (hazard ratio [HR] [95% CI], 2.366 [1.006-5.563]; nominal P = .048). The HR for hospitalization/death for CAS+IMD vs placebo was 0.276 for patients without allergies (95% CI, 0.175-0.437; nominal P < .001). In prevention studies, those with allergies excluding asthma exhibited >2-fold increase in the rate of contracting COVID-19 vs those without allergies (HR [95% CI], 2.16, [1.202-3.912); nominal P = .009).

Conclusion: In outpatients with COVID-19, a history of allergic disease was associated with heightened susceptibility to infection but better clinical outcomes (hospitalization/death). CAS+IMD improved clinical outcomes in those with established infection and prevented infection in both allergic and non-allergic participants.

Asthma is the commonest chronic respiratory disease during pregnancy and is a major contributor to preventable maternal morbidity and adverse foetal outcomes when poorly controlled. Although most asthma therapies are considered safe during pregnancy, asthma control frequently deteriorates, reflecting diagnostic uncertainty, suboptimal monitoring, poor treatment adherence, and clinician hesitancy to escalate therapy. This review focuses on strategies to optimise asthma control throughout pregnancy. We highlight the importance of objective assessment, demonstrating that pregnancy does not significantly alter spirometry or fractional exhaled nitric oxide (FeNO) levels, thereby supporting their routine use to guide diagnosis and monitoring. Effective asthma management is underpinned by four core pillars: regular review, treatment optimisation, lifestyle and comorbidity management, and patient education. Structured, proactive follow-up, particularly during the second and third trimesters when exacerbation risk is highest, is essential for early identification of deteriorating control. Contemporary pharmacological approaches play a central role in improving outcomes. Anti-inflammatory reliever strategies such as anti-inflammatory reliever (AIR) therapy and maintenance and reliever therapy (MART), may reduce exacerbations by linking symptom relief with anti-inflammatory treatment and improving adherence. For women with severe asthma, emerging registry and real-world data, supported by international consensus recommendations, suggest that biologic therapies can be continued or initiated during pregnancy when clinically indicated to maintain disease control and reduce reliance on systemic corticosteroids. Improving asthma control in pregnancy requires consistent, evidence-based messaging, multidisciplinary care, and shared decision making. Future research should prioritise biomarker-guided strategies and implementation of contemporary treatment models, to further refine care and reduce preventable asthma-related complications in pregnancy.

Background: Biologic therapies are recommended for severe, uncontrolled chronic rhinosinusitis with nasal polyps (CRSwNP), but evidence in moderate disease remains limited.

Objective: To evaluate the effectiveness of omalizumab in patients with moderate CRSwNP and mild-to-moderate IgE-mediated asthma without prior sinus surgery.

Methods: In this randomized, controlled, open-label study, adult patients were recruited through integrated otolaryngology and allergy clinics. Fifty-nine patients were randomized (3:2) to omalizumab plus standard therapy (n = 36) or standard therapy alone (n = 23) and followed for 12 months. The primary endpoint was change in Nasal Polyp Score (NPS). Secondary endpoints included nasal obstruction, asthma control, exacerbations, systemic corticosteroid use, and biomarkers of type 2 inflammation.

Results: Omalizumab significantly reduced NPS, improved nasal obstruction and asthma control, reduced asthma exacerbations and systemic corticosteroid exposure, and improved biomarkers of type 2 inflammation compared with controls.

Conclusion: Omalizumab is effective in patients with moderate CRSwNP and mild-to-moderate asthma and may have a role earlier in the treatment algorithm for selected patients, pending confirmation in larger, multicenter studies.

Background: Inaccurate penicillin allergy (PA) labels are associated with clinical and public health burdens. While delabelling programs are effective, long-term data on the sustainability of delabelling and patient-centered outcomes remain limited.

Objective: This study evaluated 12-month relabelling rates, antibiotic use, and changes in health-related quality of life (HRQoL) following PA evaluation.

Methods: HK-SPADE study was a prospective, longitudinal cohort embedded within the Hong Kong Drug Allergy Delabelling Initiative. Adults referred for suspected PA underwent standardized evaluation including skin testing and drug provocation testing (DPT). Patients were stratified into delabelled (negative DPT) and confirmed-allergic groups. Incorrect relabelling, antibiotic reuse, and HRQoL using the Drug Hypersensitivity Quality of Life Questionnaire (DrHy-Q) were assessed at 6 and 12 months.

Results: Of 141 patients, 117 (83%) were delabelled and 24 (17%) were confirmed allergic. Among 88 delabelled patients with complete follow-up, one-third had reused penicillins but 15 (17%) were incorrectly relabelled within 12 months, despite a territory-wide unified electronic medical record system. Both delabelled and confirmed-allergic groups demonstrated sustained improvements in DrHy-Q scores at 6 and 12 months (p<0.001). Notably, within the confirmed-allergic group, patients who safely reused non-penicillin antibiotics showed further HRQoL improvements compared to those who did not (p=0.043).

Conclusion: Incorrect penicillin allergy relabelling persists despite integrated electronic records, highlighting factors beyond mere documentation errors. Structured PA evaluation confers durable HRQoL improvements for all patients, regardless of delabeling outcome. The findings underscore the need for reinforced educational interventions to protect delabeling success and uphold the broader therapeutic and psychological benefits of delabeling.

Background: Food Protein-Induced Enterocolitis Syndrome (FPIES) is a non-IgE-mediated food allergy presenting in infancy with delayed gastrointestinal symptoms. While cow's milk and soy are common triggers globally, fish has emerged as a significant culprit in Mediterranean regions.

Objective: To describe the clinical profile, natural history, and tolerance development of fish-induced FPIES in a pediatric Greek population.

Methods: A retrospective review was conducted on 96 children, diagnosed with acute fish-induced FPIES at a tertiary pediatric allergy unit in Greece between October 2014 and June 2024. Demographic, clinical, and follow-up data were analyzed, including oral food challenge (OFC) outcomes and multivariable predictors of tolerance.

Results: Median age at first reaction was 11 months, and diagnosis was confirmed by 2 years. Codfish was the most common offending fish and was used in all OFCs. During follow-up, 73% of patients developed tolerance at a median age of 5.5 years. The amount of fish protein tolerated during the OFC exceeded 3 grams (median 10 grams). A higher number of FPIES episodes prior to diagnosis was associated with non-achievement of tolerance (p<0.001). A subset of children (14%) reported mild delayed abdominal discomfort after reintroduction despite a negative OFC, leading to partial avoidance. No IgE sensitization was observed. Atopic comorbidities, particularly allergic rhinitis, were common.

Conclusion: Fish-induced FPIES represents a clinically significant diagnosis among Greek children. Most patients develop tolerance in early childhood, though a subset experiences lingering gastrointestinal discomfort post-reintroduction. These findings highlight the need for awareness, early diagnosis, and careful reintroduction strategies in the management of fish-FPIES.

Background: Over the past decade, significant progress has occurred with utilizing oral immunotherapy (OIT) in the treatment of IgE-mediated food allergies. Eosinophilic esophagitis (EoE) is a known potential adverse effect of OIT.

Objective: The primary objective was to assess the rate of a new diagnosis of EoE. Secondary objectives included evaluating the development of EoE among patients undergoing single versus multi-food OIT, assessing the symptoms among those who developed EoE, as well as, identifying which foods were associated with the development of EoE.

Methods: A retrospective review of patients undergoing OIT from 2018 through May 2024 at the Children's Hospital of Philadelphia was performed.

Results: This study identified 1200 children who have undergone or were undergoing OIT. A total of 51 patients underwent evaluation for suspected EoE and 8 were ultimately diagnosed with EoE. No difference in EoE development was observed between those on single versus multi-food OIT. Peanut and egg were the most common foods for which patients experienced gastrointestinal symptoms. No patients on milk, wheat or soy OIT were found to have EoE.

Conclusion: In a cohort of 1200 children on OIT at a tertiary pediatric hospital with robust OIT and EoE programs, the rate of newly diagnosed EoE during OIT was found to be 0.7%, which is lower than prior studies. This study demonstrated regular screening before and during OIT is associated with a reduced rate of EoE. Clinicians should be mindful that patients undergoing OIT with more numerous, severe and persistent gastrointestinal symptoms may be at higher risk for EoE.

Background: Allergic rhinitis (AR) involves nasal inflammation from aeroallergens that is treatable with nasal corticosteroids (NCS). However, NCS efficacy following diesel exhaust (DE) exposure and effects on nasal epigenetic age acceleration (EAA) are unknown.

Objective: To investigate the effects of nasal budesonide on AR-related nasal inflammation and nasal EAA following DE exposure.

Methods: In this double-blinded randomized crossover trial, twenty healthy non-smokers with AR used once-daily 256 mcg budesonide and placebo nasal spray for ≥4 weeks each, with an intervening ≥4-week washout. Initial and re-exposure to allergen and DE was completed over consecutive days in separate periods, preceded by ≥2 weeks of pre-treatment/washout. Nasal lavage fluid, nasal brushings, peak nasal inspiratory flow (PNIF), and total nasal symptom scores (TNSS) were collected at treatment baselines, and before and 24h after each exposure. PNIF and TNSS were additionally collected 0.5h post-exposure. Nasal cytokines and EAA were quantified using multiplex assays and Illumina EPIC arrays, respectively.

Results: Reductions in nasal IL-5 from budesonide pre-treatment persisted 24h after initial and re-exposure to allergen and DE, despite their pro-inflammatory effects. Reductions in IL-17A persisted 24h after initial DE exposure. Budesonide increased PNIF 24h after initial and re-exposure to allergen, and at 0.5h after initial exposure and 24h after re-exposure to DE. Allergen-induced TNSS was suppressed by budesonide at 0.5h and 24h after re-exposure. Budesonide and allergen/DE exposures modulated nasal EAA across different clocks.

Conclusion: In allergic rhinitics, prophylactic nasal budesonide spray attenuated nasal inflammation and modulated nasal EAA and PNIF before and after repeated acute exposures to allergen and DE.