Annals of Allergy Asthma & Immunology最新文献_第9页

ADHERENCE AND PERSISTENCE AMONG HEREDITARY ANGIOEDEMA PATIENTS TREATED WITH BEROTRALSTAT, LANADELUMAB, AND SUBCUTANEOUS PLASMA-DERIVED C1-INHIBITOR 遗传性血管性水肿患者接受 berotralstat、lanadelumab 和皮下血浆源性 c1 抑制剂治疗的依从性和持续性

IF 5.8 2区医学 Q1 ALLERGY

Annals of Allergy Asthma & Immunology

Pub Date : 2024-10-25 DOI: 10.1016/j.anai.2024.08.103

B. Zuraw , L. Lopez-Gonzalez , I. Winer , A. Dean , J. Manjelievskaia , S. Nestler-Parr , P. Gillard , S. Christiansen

Introduction

Berotralstat is a novel, targeted oral long-term prophylactic (LTP) treatment for hereditary angioedema (HAE). Real-world evidence comparing WAO/EAACI recommended first-line HAE LTP therapies is limited. We investigated adherence and persistence following initiation of berotralstat, lanadelumab, and subcutaneous plasma-derived C1-inhibitor (SC-pdC1-INH).

Methods

Veradigm Health Network EHR linked to claims data was utilized to select mutually exclusive cohorts of patients ≥12 years initiating one of the three LTPs between 06/22/2017-09/12/2023. Inclusion criteria also included ≥12 months continuous enrollment before and following date of initiation of LTP. Analysis: demographics, clinical characteristics, LTP adherence and persistence. Adherence was defined as the mean proportion of days covered (PDC). Persistence was defined as having no gap in treatment ≥ 45 days after the index LTP. Sensitivity analyses were conducted requiring at least 2 claims for the index LTP.

Results

Included subjects: 90 berotralstat, 189 lanadelumab, and 78 SC-pdC1-INH. Berotralstat patients were older (mean age 44) than lanadelumab (39) and SC-pdC1-INH (36) cohorts (p-value <0.025). >90% had an HAE diagnosis in the baseline period and 46-51% were LTP treatment experienced. Mean PDC was similar between treatments at 0.73, 0.78, and 0.74 for berotralstat, lanadelumab, and SC-pdC1-INH, respectively (p-value=NS). Proportion of patients persistent on index LTP at 12-months follow-up was also similar across LTPs: 61% for berotralstat compared to 58% for lanadelumab (58%) and 53% for SC-pdC1-INH (p-value=NS).

Conclusions

HAE patient adherence and persistence rates for all three LTP treatments are uniformly high. Berotralstat adherence and persistence were comparable to those observed following lanadelumab or SC-pdC1-INH initiation.

简介：Berotralstat 是治疗遗传性血管性水肿 (HAE) 的一种新型、有针对性的口服长期预防 (LTP) 疗法。比较WAO/EAACI推荐的一线HAE LTP疗法的真实世界证据非常有限。我们调查了贝罗曲司他(berotralstat)、拉那度单抗(lanadelumab)和皮下血浆源性C1抑制剂(SC-pdC1-INH)开始治疗后的依从性和持续性。方法利用与理赔数据相连的Veradigm Health Network EHR，选择在6/22/2017-09/12/2023期间开始接受三种LTP之一治疗的≥12岁患者组成相互排斥的队列。纳入标准还包括在开始 LTP 日期之前和之后连续注册≥12 个月。分析：人口统计学、临床特征、LTP依从性和持续性。依从性定义为平均覆盖天数比例（PDC）。持续性的定义是在开始 LTP 后的 45 天内没有中断治疗。进行敏感性分析时，要求指数 LTP 至少有 2 次索赔：结果包括 90 名 Berotralstat 患者、189 名 lanadelumab 患者和 78 名 SC-pdC1-INH 患者。贝罗曲星患者的年龄（平均 44 岁）高于 lanadelumab（39 岁）和 SC-pdC1-INH（36 岁）（P 值为 0.025）。>90% 的患者在基线期诊断为 HAE，46-51% 的患者有 LTP 治疗经验。berotralstat、lanadelumab和SC-pdC1-INH三种治疗方法的平均PDC相似，分别为0.73、0.78和0.74（p值=NS）。在随访12个月时，坚持指数LTP的患者比例在各种LTP中也很相似：berotralstat为61%，而lanadelumab为58%（58%），SC-pdC1-INH为53%（p值=NS）。Berotralstat 的依从性和持续率与开始使用 lanadelumab 或 SC-pdC1-INH 后观察到的情况相当。

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引用次数: 0

QUALITY OF LIFE AND BURDEN OF DISEASE IN PATIENTS WITH HEREDITARY ANGIOEDEMA AND THEIR CAREGIVERS 遗传性血管性水肿患者及其护理人员的生活质量和疾病负担

IF 5.8 2区医学 Q1 ALLERGY

Annals of Allergy Asthma & Immunology

Pub Date : 2024-10-25 DOI: 10.1016/j.anai.2024.08.108

D. Levy , F. Nagase , A. Cheung , M. Manning

Introduction

Hereditary angioedema (HAE) is characterized by recurrent and unpredictable episodes of angioedema. This targeted literature review assessed the burden of disease experienced in HAE patients and their caregivers.

Methods

In January 2024, a search strategy was implemented in Medline and Embase with additional conference abstract screening, using key terms for HAE and burden. Studies describing burden of disease among adults with HAE Type 1 and 2 were included, prioritizing North American and European studies.

Results

A total of 1,975 abstracts were screened for relevance, of which 48 studies met eligibility criteria and were included for analysis. HAE patients had lower quality of life (QoL) than the general population, associated with increased attack frequency, attack severity, depression and anxiety. Anxiety and depression were largely driven by societal perceptions and disease burden, with constant fear of laryngeal attacks. Consistent long-term prophylaxis (LTP) has been shown to alleviate anxiety and depression and improve QoL, compared to no treatment or only on-demand treatment. Uncontrolled attacks and adverse effects were common reasons for treatment discontinuation. Caregiver burden was profoundly influenced by the severity and unpredictability of HAE symptoms, diagnosis delays and negative healthcare provider interactions.

Conclusions

HAE patients and caregivers bear a heavy disease burden, driven by the severity, frequency, location, and unpredictability of attacks. Because of their symptoms, patients experience poor QoL and high psychological distress, the latter of which could also trigger HAE attacks. To improve QoL patients seek LTP that provide less frequent dosing, fewer attacks and less side effects.

导言遗传性血管性水肿（HAE）的特点是反复发作且无法预测。本篇有针对性的文献综述评估了 HAE 患者及其护理人员的疾病负担。方法 2024 年 1 月，我们在 Medline 和 Embase 中使用 HAE 和负担这两个关键词实施了检索策略，并对会议摘要进行了额外筛选。结果共筛选出 1,975 篇相关摘要，其中 48 篇符合资格标准并纳入分析。HAE患者的生活质量（QoL）低于普通人群，与发作频率、发作严重程度、抑郁和焦虑增加有关。焦虑和抑郁在很大程度上是由社会观念和疾病负担以及对喉部疾病发作的持续恐惧造成的。与不治疗或仅按需治疗相比，坚持长期预防（LTP）已被证明可减轻焦虑和抑郁，改善 QoL。无法控制的发作和不良反应是中断治疗的常见原因。HAE症状的严重性和不可预测性、诊断延迟和医疗服务提供者的负面互动对照顾者的负担产生了深远影响。由于其症状，患者的生活质量差，心理压力大，后者也可能诱发 HAE 发作。为了改善患者的生活质量，他们寻求用药次数少、发作次数少、副作用小的 LTP。

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引用次数: 0

DEVELOPMENT OF A NOVEL KININ BIOMARKER ASSAY FOR CHARACTERISATION OF BRADYKININ-MEDIATED DISORDERS 开发一种新型激肽生物标志物测定法，以确定缓激肽介导的疾病的特征

IF 5.8 2区医学 Q1 ALLERGY

Annals of Allergy Asthma & Immunology

Pub Date : 2024-10-25 DOI: 10.1016/j.anai.2024.08.119

E. Pardali , O. Domenig , D. Sexton , G. Zahn , A. Lessage

Introduction

Bradykinin (BK) is involved in various physiological and pathological processes, including angioedema (AE). AE is a predominant manifestation in multiple medical conditions and is generally mediated by BK and/or by histamine. Differentiating BK-mediated from histamine-mediated AE and assessing the role of bradykinin in the pathogenesis of other conditions by measuring kinins remains a challenge. Establishment of a method to accurately measure kinins could aid in identifying, studying, and managing BK-mediated disorders.

Methods

To inhibit ex vivo activation of kallikrein-kinin system (KKS) proteases and degradation of kinins, a protease inhibitor cocktail was developed. An ultra-high performance liquid chromatography-mass spectrometry (UPLC)-MS/MS protocol was optimized to measure BK1-9, BK1-8, BK1-7, BK1-5, and kallidin. Qualification of the UPLC-MS/MS was performed using plasma from healthy volunteers (HV) collected using PI or ethylenediaminetetraacetic acid (EDTA).

Results

The UPLC-MS/MS assay underwent qualification to assess the efficacy of the protease inhibitor cocktail. The range of quantification was 5 to 10,240 pg/mL for BK1-9, BK1-8, BK1-7 and BK1-5 and 20 to 10,240 pg/mL for kallidin. Analysis of the results revealed that kallidin levels were below limit of quantification in HV plasma. BK peptide levels were significantly lower in HV plasma collected using protease inhibitor cocktail vs EDTA. Protease inhibitor cocktail cocktail efficiently inhibited KKS activation and stabilized kinin peptides following 2 freeze and thaw cycles.

Conclusions

The developed BK assay can be used to reliably measure kinin peptides and could become a key tool for identifying, studying, and managing BK-mediated pathologies, including AE.

导言缓激肽（BK）参与各种生理和病理过程，包括血管性水肿（AE）。血管性水肿是多种疾病的主要表现，通常由缓激肽和/或组胺介导。通过测量激肽来区分缓激肽介导的血管性水肿和组胺介导的血管性水肿，以及评估缓激肽在其他疾病发病机制中的作用，仍然是一项挑战。为了抑制体内外激肽-激肽系统（KKS）蛋白酶的激活和激肽的降解，我们开发了一种蛋白酶抑制剂鸡尾酒。优化了超高效液相色谱-质谱（UPLC）-MS/MS 方案，以测量 BK1-9、BK1-8、BK1-7、BK1-5 和 kallidin。使用 PI 或乙二胺四乙酸（EDTA）收集的健康志愿者（HV）血浆对 UPLC-MS/MS 进行了鉴定。BK1-9、BK1-8、BK1-7 和 BK1-5 的定量范围为 5 至 10,240 pg/mL，Kallidin 的定量范围为 20 至 10,240 pg/mL。分析结果显示，HV 血浆中的凯利丁水平低于定量限。在使用蛋白酶抑制剂鸡尾酒和 EDTA 收集的 HV 血浆中，BK 肽水平明显低于 EDTA。结论：所开发的 BK 检测方法可用于可靠地检测激肽，并可成为识别、研究和管理 BK 介导的病症（包括 AE）的重要工具。

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引用次数: 0

IMPROVING THE QUALITY OF CARE FOR PATIENTS WITH CSU: STUDY DESIGN AND PATIENT BASELINE CHARACTERISTICS 提高对 CU 患者的护理质量：研究设计和患者基线特征

IF 5.8 2区医学 Q1 ALLERGY

Annals of Allergy Asthma & Immunology

Pub Date : 2024-10-25 DOI: 10.1016/j.anai.2024.08.110

G. Mosnaim , J. Bernstein , M. Holden , D. Lang , S. Mehlis , S. Saini , E. Schafer , M. Maurer

Introduction

Management and care of patients with chronic spontaneous urticaria (CSU) is not always optimal, with diagnostic delays, dissatisfaction with care, and lack of adherence to international guidelines all impacting CSU management. Here, we propose a real-world study design to develop a greater understanding of factors affecting the management of CSU, with the goal of improving the quality of care for patients.

Methods

In Part 1 of the study, retrospective analysis will be conducted on longitudinal patient data (2012 to 2022) from the Endeavor Health System electronic medical record (EMR) to identify patient risk factors for CSU severity, duration, and relapse, as well as predictors of treatment response for CSU. In Part 2, physicians will be interviewed to assess their knowledge and perceptions of CSU guidelines and management and use of patient-reported outcomes. In Part 3, quality improvement initiatives will be developed, including education for physicians and new clinical workflows and decision tools for CSU management.

Results

For Part 1 of the study, baseline characteristics of patients with CSU from the Endeavor Health System EMR are presented in the Table. Over two-thirds of patients were female with a mean age of 35 years. The most common comorbidities were allergic rhinitis and asthma. About 40% of patients visited a physician with an allergy/immunology primary specialty.

Conclusions

A greater understanding of patient characteristics, physician perspectives, and avenues to improve quality of care will assist physicians in providing better care for patients with CSU and will ultimately improve clinical outcomes and quality of life for patients.

导言慢性自发性荨麻疹（CSU）患者的管理和护理并不总是尽如人意，诊断延误、对护理不满意以及不遵守国际指南都会影响 CSU 的管理。方法在研究的第一部分，我们将对奋进医疗系统电子病历（EMR）中的患者纵向数据（2012 年至 2022 年）进行回顾性分析，以确定 CSU 严重程度、持续时间和复发的患者风险因素，以及 CSU 治疗反应的预测因素。在第 2 部分中，将对医生进行访谈，以评估他们对 CSU 指南和管理的了解和看法，以及患者报告结果的使用情况。在第 3 部分中，将制定质量改进措施，包括对医生的教育、新的临床工作流程和 CSU 管理决策工具。结果在研究的第 1 部分中，表中列出了 Endeavor Health System EMR 中 CSU 患者的基线特征。超过三分之二的患者为女性，平均年龄为 35 岁。最常见的合并症是过敏性鼻炎和哮喘。结论更深入地了解患者特征、医生观点和提高护理质量的途径将有助于医生为 CSU 患者提供更好的护理，并最终改善临床疗效和患者的生活质量。

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引用次数: 0

PATIENT-REPORTED ANXIETY IMPACTS UTILIZATION OF INJECTABLE ON-DEMAND TREATMENT OF HEREDITARY ANGIOEDEMA ATTACKS 患者报告的焦虑影响了按需注射治疗遗传性血管性水肿发作的使用情况

IF 5.8 2区医学 Q1 ALLERGY

Annals of Allergy Asthma & Immunology

Pub Date : 2024-10-25 DOI: 10.1016/j.anai.2024.08.117

C. Radojicic , A. Burnette , S. VanKooten , N. Malloy , M. Heckmann , H. Longhurst

Introduction

Hereditary angioedema (HAE) is characterized by unpredictable, painful, and debilitating attacks of tissue swelling that can be life-threatening and results in disease-related anxiety.

Methods

People with Type I or II HAE were recruited by the US Hereditary Angioedema Association to complete a 20-minute, self-reported, online survey investigating patient anxiety (on a numeric rating scale between 0-“not anxious” and 10-“extremely anxious”) and factors influencing on-demand treatment of HAE attacks, September 6 to October 19, 2022.

Results

Survey respondents included 107 patients with Type I/II HAE (80% female; mean age = 41 years). On average, patients reported waiting 2.4 hours to treat their HAE attack after recognizing the initial onset of the attack. Patients reported a mean (SD) anxiety level of 4.2 (3.4) when anticipating the use of their injectable on-demand treatment. Approximately two thirds (65%) of respondents who were moderately (mean 5.1 [0.5]) to extremely anxious (mean 8.4 [1.4]) about on-demand treatment did not treat all their attacks. Those who reported feeling extremely anxious (rating ≥7) when anticipating the use of on-demand treatment also reported delaying treatment 4.3 hours (mean). Nearly all respondents (95%) reported experiencing a decreased level of anxiety once they realized they were recovering from the attack.

Conclusion

Those who were anxious delayed or did not treat attacks. On-demand treatments with less invasive routes of administration may reduce anxiety with on-demand treatment.

导言遗传性血管性水肿（HAE）的特点是组织肿胀发作时难以预测、疼痛难忍、使人衰弱，可能危及生命，并导致与疾病相关的焦虑。方法2022年9月6日至10月19日，美国遗传性血管性水肿协会招募了I型或II型HAE患者，让他们完成一项20分钟的自我报告在线调查，调查内容包括患者的焦虑（按0-"不焦虑 "和10-"极度焦虑 "之间的数字等级评分）以及影响按需治疗HAE发作的因素。结果调查对象包括107名I型/II型HAE患者（80%为女性；平均年龄=41岁）。患者表示，在意识到HAE发作后，平均需要等待2.4小时才能接受治疗。患者在预期使用按需注射治疗时的平均（标度）焦虑水平为 4.2（3.4）。约三分之二（65%）的受访者对按需治疗感到中度（平均 5.1 [0.5]）至极度焦虑（平均 8.4 [1.4]），但他们并没有治疗所有的发作。在预期使用按需治疗时感到极度焦虑（评分≥7）的受访者还报告说，他们的治疗延迟了 4.3 小时（平均值）。几乎所有受访者（95%）都表示，一旦意识到自己正在从发作中恢复，焦虑程度就会降低。采用侵入性较小的给药途径进行按需治疗可能会减轻按需治疗时的焦虑。

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引用次数: 0

Title Page 标题页

IF 5.8 2区医学 Q1 ALLERGY

Annals of Allergy Asthma & Immunology

Pub Date : 2024-10-25 DOI: 10.1016/S1081-1206(24)01588-6

引用次数: 0

A CALL TO ACTION FOR PENICILLIN ALLERGY DELABELING IN PATIENTS WITH SYPHILIS 梅毒患者青霉素过敏脱标行动呼吁书

IF 5.8 2区医学 Q1 ALLERGY

Annals of Allergy Asthma & Immunology

Pub Date : 2024-10-25 DOI: 10.1016/j.anai.2024.08.058

A. Yan , G. Koo , C. Allocco , E. Phillips , C. Stone

Introduction

The number of people with untreated syphilis in the United States is at its highest since the 1950s. Penicillin, the first-line treatment for syphilis, may be avoided in those labeled as penicillin allergic, thus fueling the public health crisis, risk of congenital syphilis, individual morbidity, and excessive healthcare utilization.

Methods

We retrospectively reviewed penicillin allergy labeled patients with confirmed syphilis referred to our drug allergy clinic for assessment and delabeling from January 2014 to January 2024. We collected data on demographics, syphilis stage, results of penicillin allergy testing, use of second-line treatment, healthcare utilization and use of penicillin after delabeling, and clearance of syphilis.

Results

Of 12 patients identified, 83.3% were male and the median age was 39. Prior to our evaluation, 9 patients were treated with doxycycline, some multiple times (5 successful and 7 failed treatments total). One ceftriaxone-treated patient failed treatment. Three patients were desensitized to penicillin in the ICU. One female patient treated with penicillin desensitization had a pregnancy complicated by congenital syphilis. 12/12 patients were ultimately delabeled of their penicillin allergy. 9/12 had documented subsequent penicillin treatment, while 3/12 had incomplete/lost follow up in our EHR. Of the 9 who received penicillin, 5 had clearance, 3 had failed clearance (2 reinfection, 1 unknown reasons), and 1 had unknown clearance outcome.

Conclusion

Syphilis is an individual and public health emergency. We have shown that most patients labeled as penicillin allergic that are low risk should be aggressively delabeled to avoid treatment failure, increased healthcare utilization, and negative public health consequences.

导言：美国未经治疗的梅毒患者人数达到了自20世纪50年代以来的最高峰。青霉素是梅毒的一线治疗药物，但被贴上青霉素过敏标签的患者可能会避免使用青霉素，从而加剧了公共卫生危机、先天性梅毒风险、个人发病率和过度医疗使用。我们收集了有关人口统计学、梅毒分期、青霉素过敏检测结果、二线治疗使用情况、医疗保健使用情况、脱标后青霉素使用情况以及梅毒清除情况的数据。结果在确定的 12 名患者中，83.3% 为男性，年龄中位数为 39 岁。在我们进行评估之前，9 名患者接受了多西环素治疗，其中一些患者接受了多次治疗（共有 5 次成功治疗和 7 次失败治疗）。一名头孢曲松患者治疗失败。三名患者在重症监护室对青霉素脱敏。一名接受青霉素脱敏治疗的女性患者因先天性梅毒并发妊娠。12/12 名患者最终解除了青霉素过敏标签。9/12 名患者有青霉素后续治疗记录，而 3/12 名患者在电子病历中的随访记录不完整/丢失。在接受青霉素治疗的9人中，5人清除了梅毒，3人清除失败（2人再次感染，1人原因不明），1人清除结果不明。我们的研究表明，大多数被贴上青霉素过敏标签的低危患者都应积极解除标签，以避免治疗失败、医疗保健使用率增加以及负面的公共卫生后果。

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引用次数: 0

TRANSCRIPTOMIC RESPONSES TO DIETARY ELIMINATION IN EOSINOPHILIC ESOPHAGITIS (EOE) ACROSS ADULT AND PEDIATRIC POPULATIONS 成人和儿童嗜酸性粒细胞性食管炎（EOE）饮食消除的转录组反应

IF 5.8 2区医学 Q1 ALLERGY

Annals of Allergy Asthma & Immunology

Pub Date : 2024-10-25 DOI: 10.1016/j.anai.2024.08.044

K. Chhiba, R. Janarthanam, M. Wang, M. Tetreault, B. Wershil, N. Gonsalves, J. Wechsler

Introduction

Eosinophilic esophagitis (EoE) is a dietary antigen-mediated disease affecting children and adults. Numerous studies demonstrate the role of diet-elimination therapy in managing EoE; however, the mechanisms underlying diet therapy are poorly understood.

Methods

We performed bulk RNA-seq on esophageal biopsies of pediatric (N=33) and adult patients (N=44) diagnosed with EoE before and after dietary elimination, and after food reintroduction.

Results

We establish EoE, Adult and Pediatric scores that distinguish controls from active EoE patients and adult EoE from pediatric EoE patients. These scores were validated using public datasets. The Pediatric and EoE scores partially overlapped with the EoE Diagnostic Panel (EDP), while the Adult score (28 genes) did not. Pathway analysis on the Adult score revealed upregulation of NK-mediated immunity and down-regulation of intermediate filament organization. We observe transcriptional differences in diet-responsive EoE patients and develop a 52-gene age-independent Diet Response score. The Diet Response score decreased in diet-responsive patients following food avoidance, increased with food reintroduction and discriminated diet responders from non-responders prior to therapy. While 13 genes in the Diet Response score were shared with the EDP score, 39 genes were unique. Diet non-responsive adult EoE patients showed no significant changes in this score.

Conclusion

Our study represents the first comparative analysis of RNA-seq data from children and adults who responded to diet elimination therapy for EoE. We discovered unique transcriptional signatures specific to adult EoE and a Diet Response score unaffected by age. These findings hold promise for predicting individual responses to diet therapy in EoE patients.

导言嗜酸性粒细胞食管炎（EoE）是一种由饮食抗原介导的疾病，影响儿童和成人。方法我们对食管活检中被诊断为嗜酸性食管炎的儿童患者（33 人）和成人患者（44 人）的食管活检组织进行了批量 RNA 序列分析，结果我们建立了嗜酸性食管炎、成人和儿童评分，以区分对照组和活动性嗜酸性食管炎患者，以及成人嗜酸性食管炎和儿童嗜酸性食管炎患者。这些评分通过公共数据集进行了验证。儿科和咽喉炎评分与咽喉炎诊断面板（EDP）部分重叠，而成人评分（28 个基因）则不重叠。成人评分的通路分析显示，NK介导的免疫功能上调，中间丝组织下调。我们观察到饮食反应性咽喉炎患者的转录差异，并制定了与年龄无关的 52 个基因饮食反应评分。饮食反应评分在饮食反应患者中随着食物的避免而降低，随着食物的重新引入而升高，并能在治疗前区分饮食反应者和非反应者。饮食反应评分中有 13 个基因与 EDP 评分相同，但有 39 个基因是独特的。结论我们的研究首次对接受饮食消除疗法治疗的儿童和成人的 RNA-seq 数据进行了比较分析。我们发现了成人咽喉炎特有的转录特征以及不受年龄影响的饮食反应评分。这些发现有望预测咽喉炎患者对饮食疗法的个体反应。

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引用次数: 0

RISK OF DEVELOPING EOSINOPHILIC ESOPHAGITIS WITH PREEXISTING ASTHMA, ALLERGIC RHINITIS, ATOPIC DERMATITIS, OR FOOD ALLERGY 患有哮喘、过敏性鼻炎、特应性皮炎或食物过敏症的人患嗜酸性粒细胞食管炎的风险

IF 5.8 2区医学 Q1 ALLERGY

Annals of Allergy Asthma & Immunology

Pub Date : 2024-10-25 DOI: 10.1016/j.anai.2024.08.045

C. Haber, T. Al-Shaikhly, P. Jhaveri

Introduction

Eosinophilic esophagitis (EoE) is a chronic antigen-mediated disorder of the esophagus leading to esophageal dysfunction that is frequently seen in atopic patients. We investigated the probability of various atopic conditions developing EoE.

Methods

This retrospective cohort study utilized TriNetX US Collaborative Network to identify pediatric patients ages 1-18 years with a diagnosis of asthma, allergic rhinitis, atopic dermatitis, or food allergies from 2016 to 2018. Separate analyses were run for each diagnosis. The control population consisted of patients without the atopy diagnosis who had any documented ICD-10 diagnosis. The cohorts were matched for age at index, sex, race, ethnicity, and the other atopic conditions. The three-year hazard ratio (HR) of developing EoE relative to the controls was calculated.

Results

For the asthma group, there were 1,885 patients that developed EoE versus 726 in the control group (HR 2.35; 95% CI 2.16 – 2.56; p-value <0.001). For the allergic rhinitis group, there were 1,444 patients that developed EoE versus 829 in the control group (HR 1.45; 95% CI 1.34 - 1.58; p-value <0.001). For atopic dermatitis, there were 533 patients that developed EoE versus 307 patients in the control group (HR 1.53; 95% CI 1.33 - 1.76; p-value <0.001). For patients with food allergies, there were 1,098 patients that subsequently developed EoE versus 166 in the control group (HR 6.31; 95% CI 5.36 - 7.43; p-value <0.001).

Conclusion

All atopic risk factors studied were associated with an increased risk of developing EoE. Food allergy had the highest risk of developing EoE.

导言嗜酸性粒细胞食管炎（EoE）是一种由抗原介导的慢性食管疾病，会导致食管功能障碍，常见于特应性患者。我们调查了各种特应性疾病发生 EoE 的概率。方法这项回顾性队列研究利用 TriNetX 美国协作网络，识别了 2016 年至 2018 年期间诊断为哮喘、过敏性鼻炎、特应性皮炎或食物过敏的 1-18 岁儿科患者。针对每种诊断进行了单独分析。对照人群包括没有特应性皮炎诊断但有任何 ICD-10 诊断记录的患者。两组人群的发病年龄、性别、种族、民族和其他特应性疾病均匹配。结果在哮喘组中，1885 名患者出现了咽喉炎，而对照组中只有 726 人（HR 2.35；95% CI 2.16 - 2.56；P 值为 0.001）。过敏性鼻炎组中，有 1,444 名患者发生了鼻炎，而对照组中只有 829 人（HR 1.45；95% CI 1.34 - 1.58；P 值为 <0.001）。特应性皮炎患者中，有 533 人发生了肠易激综合征，而对照组中则有 307 人（HR 1.53；95% CI 1.33 - 1.76；P 值为 <0.001）。对于食物过敏患者，有 1,098 名患者随后患上了咽喉炎，而对照组只有 166 人（HR 6.31；95% CI 5.36 - 7.43；P 值为 0.001）。食物过敏导致咽喉炎的发病风险最高。

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引用次数: 0

IMPLEMENTATION SCIENCE FRAMEWORK-GUIDED ASSESSMENT OF CLINICIAN STRATEGIES TO IMPROVE EQUITABLE ACCESS TO PENICILLIN ALLERGY DE-LABELING 以实施科学框架为指导，评估临床医生改善青霉素过敏标签公平获取的策略

IF 5.8 2区医学 Q1 ALLERGY

Annals of Allergy Asthma & Immunology

Pub Date : 2024-10-25 DOI: 10.1016/j.anai.2024.08.072

D. Crabtree, O. Asupoto, D. Daudelin, S. Bartels, K. Blumenthal, A. Wurcel, D. Manning, L. Smith

Introduction

Most people with penicillin allergy labels are not truly allergic. Incorrect penicillin allergy labels lead to unnecessary use of broad-spectrum costly antibiotics, drug-resistance, and morbidity. Primary care clinicians document allergies, but the process of removing allergies (de-labeling) is not routine. Implementation science frameworks provide a systematic approach to identifying and contextualizing barriers and facilitators to penicillin allergy de-labeling.

Methods

Using an equity-focused adaptation of the Consolidated Framework for Implementation Research (CFIR), semi-structured interviews were conducted with thirty clinicians from six primary care clinics in the greater Boston area. Robust qualitative methodology guided mixed inductive and deductive coding of interviews that were mapped to themes and CFIR domains.

Results

Four themes emerged: competing priorities, time constraints, fear of negative consequences, and clinical staff role ambiguity. Applying an equity lens, clinicians identified patient factors, including increased number of co-morbid illnesses and speaking languages other than English, creating additional time constraints preventing penicillin allergy de-labeling. These themes mapped most directly to the Inner Setting domain (work infrastructure, human equity-centeredness, and recipient-centeredness) and the Outer Setting domain (external, societal, and market pressures). Strategizes suggested by clinicians included clarifying/expanding the medical assistant role for initiating penicillin allergy de-labeling and leveraging informational technology tools to identify patients for de-labeling.

Conclusion

Implementation science methods can be used to identify barriers and related strategies to improve equitable access to penicillin allergy de-labeling. The next step will leverage partnerships with primary care clinicians and practice administrators to facilitate implementation strategies to increase penicillin allergy de-labeling in primary care.

导言：大多数对青霉素过敏的人并非真正过敏。不正确的青霉素过敏标签会导致不必要地使用昂贵的广谱抗生素、耐药性和发病率。初级保健临床医生会记录过敏情况，但消除过敏（去标签）的过程并非常规。实施科学框架提供了一种系统的方法，可用于识别青霉素过敏去标签化的障碍和促进因素，并将其背景化。方法采用实施研究综合框架（CFIR）的公平性改编版，对来自大波士顿地区六家初级保健诊所的 30 名临床医生进行了半结构化访谈。结果出现了四个主题：相互竞争的优先事项、时间限制、对负面后果的恐惧以及临床人员角色的模糊性。应用公平视角，临床医生发现了患者因素，包括合并疾病数量增加和使用英语以外的语言，这些因素造成了额外的时间限制，阻碍了青霉素过敏标签的去除。这些主题与内部环境领域（工作基础设施、以人的公平为中心和以受援者为中心）和外部环境领域（外部、社会和市场压力）有着最直接的映射关系。临床医生提出的策略包括明确/扩大医疗助理在启动青霉素过敏去标记化中的作用，以及利用信息技术工具识别需要去标记化的患者。下一步将利用与初级保健临床医生和实践管理者的合作关系来促进实施策略，以增加初级保健中的青霉素过敏去标记化。

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