Journal of Allergy and Clinical Immunology-In Practice最新文献

Background: Otitis media with effusion (OME) is associated with comorbidities such as allergic rhinitis, gastroesophageal reflux disease, asthma, and more. Many of these comorbidities can be caused by type 2 inflammation (T2I). This study aims to determine the risk of undergoing OME surgery in patients with and without T2I disease.

Objective: To determine whether T2I disease is associated with an increased incidence of OME surgery.

Methods: This retrospective, matched-cohort study involved the retrospective recruitment of patients with T2I disease (n = 31,603) and non-T2I disease (n = 31,603) from 2010 to 2019, using the Taiwan National Health Insurance Research Database. Statistical analyses were performed using t tests, Cox proportional regression models, Kaplan-Meier estimators, and log-rank tests.

Results: Among patients with OME, those with T2I disease had a greater risk of undergoing OME surgery, with an adjusted hazard ratio of 9.84 (95% confidence interval [CI], 8.90-10.88), than those without T2I disease. The adjusted relative risk for the number of OME surgeries in patients with T2I disease was 11.14 (95% CI, 10.30-12.05). Kaplan-Meier analysis showed consistently higher cumulative incidence curves in patients with T2I disease throughout the follow-up period (log-rank test: P < .001).

Conclusions: OME patients with T2I disease had a significantly higher incidence of undergoing surgery due to failed conservative treatment, indicating that T2I may play an important role in middle ear disorders. Further research on this topic should be considered significant and worthy of investigation.

Background: Antimicrobial stewardship (AMS) is crucial for optimising antimicrobial use and restraining emergence of antimicrobial resistance. The overall increase in reported antibiotic allergies in children can pose a significant barrier to AMS, but its impact on clinical AMS care in children has not been addressed.

Objective: Compare the clinical outcomes for children with a reported antibiotic allergy label (AAL) with those with no AAL reviewed by AMS.

Method: A retrospective cohort study conducted in a paediatric tertiary hospital, capturing 1590 inpatient admissions reviewed under the AMS between 2017-2019. Logistic, log-binomial and Cox regression analyses were undertaken. Data collected included documented AAL, antibiotic prescriptions, principal diagnosis, admitting specialty, hospital length of stay, intensive care admissions and hospital readmissions.

Results: All 1590 paediatric patients were prescribed at least one antibiotic. AALs were recorded in 6.6% of patients; majority were beta-lactam (82%), mostly penicillins (71%). AALs increased with age (p<0.001); no gender effect was seen. Patients with AALs received more quinolones (p<0.001), lincosamides (p=0.001), aminoglycosides (p<0.001), and metronidazole (p=0.015), than patients with no AALs. In contrast, children with no AAL received more penicillin (p<0.001). Children with any AAL had marginally longer hospital length of stay, median (IQR) 7.0 (4.0, 15.0) days, than those without (median (IQR) 5.0 (3.75, 11.0) days, p=0.027).

Conclusion: This study is the first to show how AALs impact clinical outcomes in children under an AMS program. With recent advances in delabelling, early intervention in cases of AAL should target children under AMS services who are in immediate need of optimal antibiotic management.

Background: Clinical studies of biologics in severe asthma exclude smokers or ex-smokers (ExS) with over 10 pack-years (py). Thus, the effectiveness of this therapy in ex-smokers with severe asthma is not well understood.

Objectives: To assess the impact of smoking on clinical efficiency of biologics in patients with severe asthma from the German Asthma Net (GAN), a comprehensive international registry.

Methods: This analysis included 1129 patients (55.8 % females, mean age 53.82 ± 14.67) from which 56% were never-smokers (NS), while 44% were ExS (<10 py: 22.9%, 10-20 py: 10.3%, >20 py: 10.6%). They received benralizumab (38.3%), dupilumab (28.9%), mepolizumab (18.3%), omalizumab (14%), or reslizumab (0.5%).

Results: Biologic therapy significantly improved asthma control, measured by change in ACT, ACQ-5, and miniAQLQ, lung function, reduced exacerbations and daily oral prednisolone dose in all patients at week 52. Of note, no significant differences in asthma control between NS and ExS at week 52 (P=0.48, 0.09, and 0.15, respectively), were observed. Also, lung function improvement (FEV1, FVC, TLC, PEF, MEF50, P>0.05), reduction in AE (P=0.8) and OCS doses (P=0.15) were comparable in NS and ES. Markers of type 2 inflammation, such as fraction of exhaled nitric oxide (FeNO) and blood eosinophils, decreased in ex-smokers similarly to never-smokers (P=0.29 and P=0.48 respectively).

Conclusion: In summary, ex-smokers with severe asthma experienced similar improvements in asthma control, exacerbations, lung function and biomarkers as NS after one year of biologics, suggesting that severe asthmatics even with a substantial smoking history can benefit from biologic therapy.

Background: The prevalence and clinical implications of chronic cough (CC) in patients with severe asthma receiving asthma treatment remain relatively unknown.

Objective: This study aimed to evaluate the relationships between CC and asthma control and quality-of-life (QoL) in patients with severe asthma through longitudinal analysis.

Methods: Baseline and 6-month follow-up data from the Korean Severe Asthma Registry were analyzed. CC was defined as a cough visual analog scale (VAS) score of ≥40 at both baseline and 6-months. Demographic parameters and clinical outcomes were compared between patients with severe asthma and CC and those without CC. Generalized estimating equation (GEE) analysis was performed to identify associations of CC with asthma control and QoL scores.

Results: Of the total 286 participants with severe asthma, 116 (40.6%) were defined as having CC. Patients with CC had higher baseline cough and wheeze severity VAS scores (all P<0.001), poorer asthma control (P<0.001), and worse QoL (Severe Asthma Questionnaire [SAQ] and Euro-QoL 5-dimension [EQ-5D] index, all P<0.001), compared to those without CC. During follow-up, patients with CC were more frequently exposed to oral corticosteroids (58.6% vs. 38.6%, P=0.010) and experienced more frequent asthma exacerbations (48.3% vs. 28.6%, P=0.009) than those without CC. GEE analysis revealed that CC was independently associated with poor asthma control, lower SAQ scores, and lower EQ-5D index after adjusting for confounders.

Conclusion: The presence of CC was associated with worse asthma control and QoL in patients with severe asthma. Further studies are warranted to better evaluate and manage CC in these patients.

Background: Data on oral immunotherapy (OIT) for hazelnut allergy is limited and its potential to cross-desensitize for other nuts is unknown.

Objective: To study the efficacy and safety of hazelnut OIT in desensitizing hazelnut and additional tree nuts.

Methods: A prospective observational study of 30 hazelnut allergic patients aged ≥4 years who underwent hazelnut OIT. Full desensitization (4000 mg protein) rates were compared to 14 observational controls, and immunological changes during OIT were measured. Cross-desensitization was determined in cases of walnut and cashew co-allergy (n=12). Inhibition of IgE binding to walnut by hazelnut was evaluated in a separate set of walnut-hazelnut dual allergic patients, by ELISA.

Results: The rate of full hazelnut desensitization following OIT was 96.7% (29/30) compared to 14.3% (2/14) in controls (OR=25.7, 95% CI 3.7-178.7, p<0.001). Five patients (16.7%) were treated with injectable epinephrine for home reactions. Hazelnut SPT and sIgE to hazelnut and its main components, Cor a 9, 14 and 16, decreased while sIgG4 increased during OIT. A maintenance dose of 1200 mg hazelnut protein was sufficient to maintain full desensitization. No cross-desensitization was noted in dual hazelnut-cashew allergic patients (n=6). In dual hazelnut-walnut allergic patients, an increase in the walnut eliciting dose was observed in 2/6 (33.2%) patients (to 1200 and 4200 mg, respectively). Similarly, by cross-inhibition ELISA, hazelnut competed for IgE-binding to walnut in 5/25 (20%) hazelnut-walnut co-allergic patients.

Conclusions: Hazelnut OIT is highly effective, with a similar safety profile as OIT to other nuts. Cross-desensitization to walnut and cashew is unlikely.

Clinical implications: If a cypress-sensitized patient experiences severe reactions to fruits-particularly with periorbital angioedema and cofactors present-consider testing for Pru p 7-specific IgE, even if initial tests, such as specific IgE to peach and SPT with peach extract, are negative.

Clinical implication: Black patients with allergic rhinitis are under-prescribed sublingual immunotherapy tablets. Barriers to sublingual immunotherapy need to be explored and mitigated to ensure equitable access.

Clinical implication: Two cases demonstrate the effects of presumed intra-blood bolus injections from an autoinjector with rapid epinephrine concentrations of > 2000 pg/mL, resulting in increases in systolic blood pressure to >200 mmHg.

Background: Angioedema (AE) due to acquired C1-inhibitor deficiency (AAE-C1-INH) is a rare disease associating recurrent edema of mucosa and skin. Several underlying diseases have been reported, mainly lymphoproliferative diseases and monoclonal gammopathy. However, 15 to 20% of patients never exhibit such a hematological condition.

Objective: To analyze specific features of patients with AAE-C1-INH without hematological condition METHODS: A multicenter retrospective cohort study of patients with AAE-C1-INH without hematological condition included from January 1999 to May 2024 in the French national CREAK registry; the clinical and biological characteristics of patients were detailed, then compared to patients with AAE-C1-INH associated with lymphoid hemopathies or monoclonal gammopathy.

Results: Thirty-four patients were included. All patients displayed a functional C1-INH below 50% of the reference value; 26 (76%) also had a decreased C1-INH antigen level; 26 (76%) displayed anti-C1-INH antibodies. After a median follow-up of 65 months, 4 (12%) patients were in spontaneous complete remission of angioedema; 15 (44%) were in complete response under long-term prophylactic treatment. Comparatively to 75 patients with lymphoma associated-AAE-C1-INH, patients with AAE-C1-INH without hematological condition displayed a higher incidence of anti-C1-INH antibodies and received more frequently symptomatic or prophylactic treatment with a lower remission rate at last follow-up. Clinical and biological features of AAE-C1-INH without hematological condition patients were similar to those of 30 monoclonal gammopathy associated-AAE-C1-INH patients.

Conclusion: AAE-C1-INH without hematological condition display a different clinical and biological presentation from lymphoma associated-AAE-C1-INH. No autoimmune disease was identified. Unlike rituximab, long-term prophylaxis seems to prevent angioedema attacks among these patients.

Pediatric antibiotic labels are common, and unnecessary antibiotic avoidance is associated with negative personal and public health outcomes; as a result, there is an increasing emphasis on the importance of pediatric antibiotic allergy evaluations. Different testing strategies have been advised, including skin testing and challenge testing with varied doses and duration. Established consensus testing protocols are lacking. The United States Drug Allergy Registry Pediatrics (USDAR-Peds) is a multi-site prospective study designed for epidemiology and outcome evaluations of pediatric drug hypersensitivity reactions (HSRs). Interpretation of multi-site data requires a uniform clinical approach, and the USDAR-Peds standardized protocols were developed in response to this need. This rostrum aims to provide a rationale and framework for standardization for pediatric antibiotic allergy protocols and assessment of positive reactions through a pediatric-specific adaptation of the USDAR immediate reaction grading scale to create consistency for multi-site research collaboration efforts such as USDAR-Peds.