Annals of Allergy Asthma & Immunology最新文献

Background: Hymenoptera venom allergy (HVA) is a potentially life-threatening reaction to stings from Apis mellifera (honeybee) or Vespula (yellowjacket).

Objective: We aimed to evaluate re-sting reactions during or after venom immunotherapy (VIT) and the impact of VIT on the quality of life (QoL) of children with HVA.

Methods: Seventy-eight patients who experienced grade 3, 4, or 5 systemic reactions and underwent conventional subcutaneous VIT were included. The modified World Allergy Organization grading system was used to grade the systemic reactions. Patients were asked if they were re-stung by the culprit Hymenoptera to which they were allergic, and the re-sting reactions were evaluated using a questionnaire. The Turkish version of the Vespid Allergy Quality of Life Questionnaire (VQLQ) was used to assess QoL.

Results: Seventeen children (21.8%) were allergic to honeybee, and 61 (78.2%) to yellowjacket. The most common symptoms before VIT were dyspnea (93.6%), angioedema (93.6%), and generalized urticaria (67.9%). Forty-three patients (55.1%) were re-stung by the culprit Hymenoptera: 19 during VIT and 24 after VIT. Seven of 19 patients (36.8%) and 1 of 24 patients (4.1%) who were re-stung reported systemic re-sting reactions during and after VIT, respectively. The median VQLQ score was 2.82 (interquartile range [IQR]: 2.07-3.51) before VIT and 5.62 (IQR: 4.61-6.25) after VIT.

Conclusion: Children with HVA who had received or were receiving VIT showed a substantial reduction in the severity of re-sting reactions. VIT led to a significant improvement in the QoL of children with HVA.

Background: Peanut allergy accounts for 25% of food allergic children, but current testing has a poor positive predictive value (PPV) and low accuracy, with peanut allergy over-diagnoses estimated to be greater than 60% in clinical settings. New methods for peanut allergy diagnosis via Bead-Based Epitope Assay (BBEA) testing with Ara h 2.008 and Ara h 2.019 epitopes have retrospectively shown improved accuracy in peanut allergy diagnosis.

Objective: Prospectively evaluate BBEA testing for peanut allergy in a real-world racially diverse clinical population with determination of BBEA testing accuracy, PPV, negative predictive value (NPV), sensitivity and specificity.

Methods: Patients from a tertiary food allergy clinic underwent standard testing for peanut allergy, including skin prick testing, specific IgE testing, and evaluation of peanut IgE component (Ara h 1, 2, 3, 6, 8, and 9) testing. BBEA evaluation to the Ara h 2.008 and Ara h 2.019 epitopes was performed on all patients and oral food challenges were offered to patients with indeterminate standard testing.

Results: In this real-world population study, BBEA testing has a 96% accuracy, 96% PPV, 94% NPV, 98% sensitivity, and 89.5% specificity. For children under the age of 2 years old and Black children, the accuracy, PPV, NPV, sensitivity, and specificity were 100%.. The NPV was 100% in patients with no peanut ingestion or reaction history.

Conclusion: The use of BBEA testing has a higher diagnostic accuracy compared to standard food allergy testing and may decrease need for unnecessary oral food challenges in clinical settings.

Background: Chronic rhinosinusitis with nasal polyposis is an inflammatory disease associated with type 2 inflammation, which is present in lower airway disease (asthma). Current tools used to track symptoms and quality-of-life burden of disease, such as the 22-item Sinonasal Outcome Test (SNOT-22), lack specificity in the symptoms which are evaluated.

Objective: To combat this shortcoming, we validated a new survey, Standard Tests for Asthma, Allergic Rhinitis, and Chronic Rhinosinusitis (STARR-15), in a population of United States patients with chronic rhinosinusitis with nasal polyposis.

Methods: In this project, STARR-15 was tested in a population of chronic rhinosinusitis patients with nasal polyposis at a single tertiary care center in the United States. The survey was also compared to a corresponding population of patients with chronic rhinosinusitis without nasal polyps from the same institution.

Results: The survey was assessed within the population of chronic rhinosinusitis patients with nasal polyposis and found to demonstrate good test-retest reliability with an intraclass correlation coefficient of 0.93. The survey was internally valid, with Cronbach alpha of 0.85. Furthermore, the survey was assessed for external validity by comparing it to the SNOT-22. STARR-15 correlated positively with the SNOT-22, with a Pearson coefficient of 0.77.

Conclusion: This work has implications in helping follow patient symptoms over time for patients who not only have chronic rhinosinusitis with nasal polyps, but also have other inflammatory conditions of the lower airways. It additionally has potential to be used as a screening tool for patients with chronic rhinosinusitis, asthma, and allergic rhinitis.

Background: Most people in the United States with asthma use therapies for intermittent/mild-persistent disease; however, exacerbations and death occur in patients with infrequent symptoms or labeled as mild asthma.

Objective: To evaluate relationships between short-acting β₂-agonist (SABA) use, exacerbations, and maintenance adherence in intermittent/mild-persistent asthma.

Methods: Retrospective cohort study using US Merative MarketScan administrative claims (January 2010 to December 2017) for patients aged 12 years or older treated as intermittent/mild-persistent asthma. Patients were indexed on a random SABA claim, with 12 months continuous enrollment pre- and post-index. Post-index SABA groups were defined as low (index fill only), medium (2-3 fills), and high (≥4 fills). Severe exacerbations were compared within the treatment, SABA fill, and adherence (medication possession ratio) groups through unadjusted comparison of proportions, χ², and odds ratios (OR [95% CI]); P less than or equal to .05.

Results: A total of 533,679 patients were included: 68.1% female; mean age (SD) 34.6 (18.3) years; 70.0% intermittent (SABA only) and 30.0% mild-persistent (8.6% low-dose inhaled corticosteroid [ICS]; 21.4% leukotriene modifier [LM]). The proportion of patients with high SABA fills differed among the treatments: SABA only (14.8%), low-dose ICS (37.0%), and LM (25.5%) (P < .001). The proportion experiencing 1 or more exacerbations was higher in SABA only (61.2%) vs low-dose ICS (40.4%) or LM (50.4%): OR (95% CI) 2.32 (2.28-2.37) and 1.55 (1.53-1.57), respectively (both P < .001). The medication possession ratio was less than 50% in 59.3% of patients with mild-persistent asthma; however, adherence was only related to exacerbations in the high SABA group.

Conclusion: Patients treated as intermittent/mild-persistent asthma rely on SABA and experience exacerbations. Shifting from SABA only to an anti-inflammatory rescue therapy could decrease morbidity.

Discussions on asthma management tend to focus on the therapeutic aspects when updates on asthma strategies are released. However, many other components of asthma management are now receiving increased attention, as we seek to make right on health disparities and strive toward health equity. In addition, with the therapeutic aspects of asthma, we now realize that our anti-inflammatory approaches largely address the high T2 component of airway inflammation. However, we know very little about what we can do to control the other inflammatory features that contribute to asthma. Factors, such as environmental exposures, social determinants of health, and risk-taking behaviors may be at the root of asthma persistence, progression, and comorbidities. We will continue to learn methods to identify these issues and draw them into a shared decision-making approach for dialogue with patients and their caregivers. This review provides information and tools to address the nonpharmacologic aspects of asthma management.

Background: IgE-mediated food allergy is a major global health concern. While early introduction of allergenic foods and breastfeeding are potential preventive strategies, the role of breast milk in reducing food allergy incidence remains inconclusive.

Objective: We aimed to investigate the impact of exclusive breastfeeding for the first four months compared to partial breastfeeding or cow's milk formula (CMF) on the development of IgE-mediated food allergies (FAs) in an Israeli cohort.

Methods: A cross-sectional online survey of 3,030 mothers with infants aged 6-24 months collected data on early feeding practices, allergen introduction, atopic conditions, and family history. It documented suspected allergic reactions, symptoms, and diagnostic procedures.

Results: Of 3,030 surveyed mothers, 2,920 provided complete feeding data for the first 4 months. Among these, 39.0% exclusively breastfed, 12.1% used CMF, and 48.9% partially breastfed. There were 392 infants with FAs, totaling 480 cases involving cow's milk, sesame, egg, or peanut. Of these cases, 122 (25.4%) were in the breastfeeding group, and 358 (74.6%) were in the other groups. Exclusively breastfed infants had lower odds of egg (OR=0.53), sesame (OR=0.58), and peanut (OR=0.53) allergies compared to others. The interaction between feeding patterns and atopic dermatitis (AD) related to these FAs was insignificant. Exposure to CMF in the nursery and exclusively breastfed was associated with higher odds of developing cow's milk allergy. Delayed exposure to sesame in infants with AD was linked to increased odds of developing sesame allergy.

Conclusion: Exclusive breastfeeding may reduce the odds of developing IgE-mediated FA, regardless of AD status.

Background: Data on anaphylaxis due to allergen immunotherapy (AIT) are limited. This study assessed AIT-induced anaphylaxis using data from the European Anaphylaxis Registry.

Objective: To analyze the characteristics, symptoms, severity, and emergency management of AIT-induced anaphylactic reactions across age groups and the administered allergenic source.

Methods: Data were obtained from 54 allergy centers across 10 European countries from 2007 to 2023. Anaphylactic reactions involving at least 2 organ systems were analyzed for symptoms, severity, associated diseases, administration routes, and emergency treatment. Statistical methods included χ² and Fisher's exact tests.

Results: AIT accounted for 1.1% of the cases in the anaphylaxis registry (173/15,748), of which 1.8% were pediatric and 0.7% were adults. Respiratory symptoms were more frequent in children/adolescents (92%) than in adults (66%) among AIT-related anaphylaxis, whereas cardiovascular and gastrointestinal symptoms were more common in adults (40% vs 78% and 20% vs 42%, respectively). Only a few sublingual immunotherapy-related cases were documented, including 2 grade III reactions, with no fatalities (sublingual immunotherapy [n = 8] vs subcutaneous immunotherapy (SCIT) [n = 153]). One fatality due to SCIT was reported (grass pollen). Delayed reactions (>30 minutes) were reported in 22 cases, predominantly after SCIT. All delayed grade III reactions that occurred more than 120 minutes were reported in children. Adrenaline was underused in emergency management and administered in 30% of grade II and 50% of grade III reactions.

Conclusion: Our study highlights the importance of age-specific monitoring and appropriate emergency treatment to enhance patient safety during AIT.