Annals of Allergy Asthma & Immunology最新文献

Cough is one of the most common reasons patients seek medical care in the outpatient setting. Chronic cough (CC) in adults is defined as a cough lasting more than 8 weeks, with a global prevalence of approximately 10%. CC significantly impairs quality of life, affecting physical, social, and psychological well-being. In most cases, CC is attributed to 1 or more of the following 3 key conditions: upper airway cough syndrome, gastroesophageal or laryngopharyngeal reflux, and asthma or non-asthmatic eosinophilic bronchitis-assuming a normal chest x-ray result and no use of angiotensin-converting enzyme inhibitors. If the cough persists despite thorough guideline-based evaluation and treatment, it is classified as refractory CC (RCC). RCC is thought to arise from neuronal dysregulation involving both peripheral and central mechanisms, termed cough hypersensitivity syndrome. This is typically characterized by a tickle or itch sensation in the throat, leading to an urge to cough in response to seemingly harmless stimuli. Current treatment options for RCC include "off-label" use of centrally acting neuromodulators and speech therapy. In addition, a new peripherally acting oral P2×3 receptor antagonist, gefapixant, has been approved in the European Union, United Kingdom, Switzerland, and Japan, though not in the United States or Canada. Emerging treatments hold promise for improving management in the future.

Inborn errors of immunity (IEIs) are a rapidly expanding group of monogenetic disorders affecting the immune system. Advancements in genetic testing and functional validation studies have accelerated the pace of IEI gene discovery and mechanism of disease, particularly in the past 5 years. To keep up with this rapid expansion, the International Union of Immunological Societies Expert Committee has periodically, since 1999, released updated IEI classifications with corresponding genotypic and phenotypic catalogues with its most recent update in 2022. Now, there are more than 485 monogenetic disorders of the immune system described among 10 main groups of classification. This article reviews recent clinical developments in IEI, including a closer look at some of the more recently described IEI disorders. In particular, we highlight a few disorders with the following clinical phenotypes of IEI: severe atopy, immunodeficiency with immune dysregulation, immune dysregulation with lymphoproliferation, autoinflammation, and innate phenotype. To aid the clinician, we also provide a diagnostic approach to use when there is suspicion of IEI and a discussion of management and treatment.

Background: Chronic spontaneous urticaria (CSU) is an unpredictable inflammatory skin condition with substantial clinical burden that affects 0.23% to 0.78% of the US population.

Objective: To describe the incidence and prevalence of patients with a record of CSU diagnosis, treatment patterns, disease control, and clinical and economic burden in a US cohort of patients with CSU.

Methods: Adults with a record of CSU diagnosis within the US HealthVerity claims database were eligible. Age- and gender-adjusted prevalence/incidence rates were calculated for January 2017 to December 2022. Clinical characteristics were described during the 1 year before CSU diagnosis (baseline) and the time after (follow-up). Proxy events representing uncontrolled CSU (any record of prescriptions for corticosteroids, biologics, or immunosuppressants [excluding all antihistamines and over-the-counter medication] or any CSU-related inpatient admissions or emergency department or urgent care visits) were used to identify patients with uncontrolled CSU. Health care resource utilization (HCRU) and health care costs were described.

Results: Overall, 200,298 patients were followed-up for a median of 2.3 years after diagnosis. Estimated cumulative prevalence of diagnosed CSU was 0.57% (women: 0.80%; men: 0.32%). The average annual incidence rate was 0.08%. Corticosteroids were the most prescribed treatment during follow-up among the 166,195 patients prescribed at least 1 treatment (94.3%). Proxy events were observed in 59.1% of the patients. HCRU and health care costs increased from baseline in patients with uncontrolled CSU during follow-up.

Conclusion: Of patients with CSU who were prescribed treatment, more than 50% experienced uncontrolled CSU, which was associated with increased HCRU and health care costs.

Background: Hereditary angioedema (HAE) is clinically characterized by recurrent attacks of subcutaneous and submucosal swelling.

Objective: To investigate real-world timing, potential barriers, and impact of delaying on-demand treatment (OD) of HAE attacks.

Methods: Patients with HAE (type I or II) aged 12 years or older with more than or equal to 1 treated (Treated Cohort) or untreated (Untreated Cohort) attack in the past 3 months were recruited by the US HAE Association. Respondents completed a 20-minute, self-reported, online survey about their last HAE attack.

Results: In the Treated Cohort (n = 94), of the 67% who reported treating their attack early, only 26% administered OD in less than 1 hour. Furthermore, 79% (n = 74) reported treatment-related anxiety, which correlated with treatment delay. Time to treatment paralleled changes in attack severity (33% mild attacks treated in <1 hour vs 67% in ≥1 hour, progressed to moderate/severe) and mean duration (<1 hour: 0.7 day; >8 hours: 2.7 days). In the Untreated Cohort (n = 20), 50% of the respondents describing their last untreated attack as mild experienced progression to moderate or severe and 25% reported spread to another site including the larynx and face. Untreated attacks lasted a mean of 2.3 days.

Conclusion: The disparity between survey respondents' perception of treating early and actual time to OD administration is striking. Treatment-related anxiety was a common reason for delaying OD. Increased treatment intervals translated into progression of HAE attack severity, duration, and spread to other sites. Suboptimal management of attacks intensifies the HAE disease burden, underscoring the need for improved treatment options, guidance, and removal of OD administration barriers.

Humoral immune disorders such as common variable immunodeficiency (CVID) and specific antibody deficiency (SAD) are prevalent in clinical practice and require accurate functional testing of humoral immunity for diagnosis and to guide treatment approach. Traditionally, the 23-valent pneumococcal polysaccharide vaccine (PPSV23) has been used to assess polysaccharide antibody responses by measuring pre- and post-vaccination pneumococcal titers. However, the recent introduction of pneumococcal conjugate vaccines (PCVs), such as PCV13, PCV15, and PCV20, into the childhood and adult vaccine schedules has significantly reduced the number of unique serotypes available for testing and in turn has complicated the evaluation process. We retrospectively analyzed serotype-specific antibody responses in patients aged 2-65 years who received PPSV23 at the University of Virginia Health System to compare diagnostic outcomes using all 23 serotypes versus the limited number of unique serotypes not included in prior PCVs-11 serotypes for PCV13 recipients and 4 for PCV20 recipients. Our findings demonstrate that although prior PCVs mean there is a reduced number of serotypes available for interpretation, PPSV23 testing maintains diagnostic accuracy between 81% and 84%. Despite limitations, the use of PPSV23 remains a valuable tool for identifying patients with clinically significant humoral immune deficiencies. In the future, alternative diagnostic approaches like Salmonella typhi polysaccharide vaccine response and opsonophagocytosis assays may become more commonly utilized as part of the evaluation of humoral immune disorders.

Background: Atopic dermatitis (AD) is a prevalent allergic disease that significantly impacts pediatric health.

Objective: To comprehensively describe the global, regional, and national AD prevalence trends among children aged 0 to 14 years between 2000 and 2021.

Methods: Data from the Global Burden of Disease Study 2021 were used to analyze AD prevalence and case numbers. The annual average percentage change was calculated to assess prevalence trends.

Results: In 2021, global pediatric AD cases reached 72.4 million (95% uncertainty interval: 68.5-76.5), a 6.2% increase from 2000. Despite the rise in cases, the prevalence rate decreased on average by 0.15% (95% CI: 0.14%-0.16%). Regional prevalence varied widely, with the highest rates in Central Asia, high-income Asia Pacific, and Western Europe and the lowest in Sub-Saharan Africa. Nationally, the AD prevalence rates ranged from 1.50% in Rwanda to 10.67% in Mongolia. Between 2000 and 2021, 108 countries or territories showed a significant increase in AD prevalence, with the most notable rises in Russia, Ghana, and Latvia. In contrast, 48 countries, including the United States, Syria, and Japan, experienced a marked decrease in AD prevalence. Age and sex (male and female) patterns showed the highest prevalence in children aged 5 to 9 years, with girls having higher rates than boys across all age groups.

Conclusion: This study reveals complex global patterns in pediatric AD prevalence, underscoring the necessity of regionally tailored public health strategies and further research into the diverse causes of AD to enhance prevention and management efforts.

Hypogammaglobulinemia is defined as a reduced immunoglobulin level, which can be either primary due to inborn errors of immunity or acquired in the setting of poor antibody production or increased antibody loss. Secondary hypogammaglobulinemia (SHG) should be considered in patients with a history of immunosuppressive therapy, transplant, protein loss syndromes, certain autoimmune conditions, and malignancies, as it can be associated with increased infectious risk. Appropriate history and lab-based screening in these populations can identify SHG allowing treatment and close monitoring as appropriate. Ideally, treatment focuses on control of underlying condition or removal of iatrogenic causes of SHG. However, in many cases, treatment of the underlying condition does not reverse SHG, or immunosuppressive therapy cannot be discontinued without significant risk to the patient. For these patients, strategies for risk mitigation against infectious complications include vaccination, antibiotic prophylaxis and immunoglobulin replacement therapy. This report aims to summarize the existing and emerging data in evaluation and management of SHG and highlight areas which require further investigation.