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

英文中文

Prospective Piperacillin Lymphocyte Transformation Testing in Patients With Cystic Fibrosis Receiving Regular and Desensitization Courses of Piperacillin-Tazobactam 对接受哌拉西林-他唑巴坦常规疗程和脱敏疗程的囊性纤维化患者进行前瞻性哌拉西林淋巴细胞转化试验。

IF 8.2 1区医学 Q1 ALLERGY

Journal of Allergy and Clinical Immunology-In Practice

Pub Date : 2025-03-01 DOI: 10.1016/j.jaip.2024.12.003

Paul Whitaker MD , Andrew Gibson PhD , John Farrell MSc , Lindsey Gillgrass BSN , Xiaoli Meng PhD , Daniel Peckham DM , Dean John Naisbitt PhD

Background

Piperacillin-tazobactam is used in patients with cystic fibrosis to treat recurrent respiratory infections. Exposure is associated with a high frequency of nonimmediate hypersensitivity.

Objective

To assess the applicability of the lymphocyte transformation test (LTT) for the diagnosis of piperacillin hypersensitivity and the influence of desensitization on piperacillin-specific T-cell responses.

Methods

Study arm 1 was an analysis of LTT responses from 58 naive/baseline tolerant patients with samples collected over a 3-year interventional phase. In study arm 2, 17 hypersensitive patients were recruited and LTTs were conducted before and after desensitization. Clinical hypersensitivity reactions in both arms were monitored over an 8-year observational period.

Results

In study arm 1, 58 patients received 611 piperacillin-tazobactam courses (range, 2-40; mean ± SD, 10.5 ± 8.1) during the interventional phase; 11 patients developed hypersensitivity. The patients who remained tolerant received 236 piperacillin-tazobactam courses in the observational period, 9 of whom developed hypersensitivity. Ten of 11 interventional phase hypersensitive patients had a positive LTT whereas one remained negative. We recorded 136 negative LTTs with 39 tolerant patients, whereas eight patients had a positive LTT and four developed hypersensitivity during the observational period. Ten LTT-positive patients in study arm 2 underwent piperacillin-tazobactam desensitization, with seven tolerating the drug. The strength of the LTT decreased during desensitization, and negative results were recorded for a minimum of 14 days. During follow-up, eight patients tolerated 62 piperacillin-tazobactam courses through desensitization.

Conclusions

The LTT is a sensitive marker of drug sensitization that could be used to inform future patient management. Desensitization is associated with attenuation of the piperacillin-specific T-cell response.

背景：哌拉西林-他唑巴坦用于囊性纤维化患者治疗复发性呼吸道感染。接触与非即时超敏反应的高频率有关。目的：探讨淋巴细胞转化试验（LTT）对哌拉西林过敏诊断的适用性及脱敏对哌拉西林特异性t细胞反应的影响。方法：研究一组是对58名naïve/基线耐受患者的LTT反应进行分析，这些患者的样本收集于三年的介入期。在研究组2中，招募了17名过敏患者，在脱敏前后进行ltt。在8年的观察期内监测了两组患者的临床超敏反应。结果：研究1组58例患者接受611(范围2-40；平均±SD， 10.5±8.1)个哌拉西林-他唑巴坦疗程，其中11例发生超敏反应。对哌拉西林-他唑巴坦耐受的患者在观察期内接受了236个疗程的哌拉西林-他唑巴坦治疗，其中9个出现过敏反应。10 / 11例介入期过敏患者LTT阳性，1例仍为阴性。136例LTT阴性，39例耐药，8例LTT阳性，其中4例在观察期间出现过敏反应。研究2组10例LTT阳性患者接受哌拉西林-他唑巴坦脱敏治疗，其中7例耐受该药。在脱敏过程中，LTT的强度下降，阴性结果至少记录了14天。在随访期间，8例患者通过脱敏耐受了62个哌拉西林-他唑巴坦疗程。结论：LTT是药物致敏的敏感标志物，可用于指导未来的患者管理。脱敏与哌拉西林特异性t细胞反应的衰减有关。

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引用次数: 0

The Psychosocial Burden of Pediatric Food Allergy in the United States: A Population-Based Survey 美国儿童食物过敏的社会心理负担：基于人口的调查。

IF 8.2 1区医学 Q1 ALLERGY

Journal of Allergy and Clinical Immunology-In Practice

Pub Date : 2025-03-01 DOI: 10.1016/j.jaip.2024.12.007

Melissa L. Engel PhD , Christopher M. Warren PhD , Linda J. Herbert PhD , Andrea A. Pappalardo PhD , Ashley Ramos PhD , Ruchi S. Gupta MD, MPH

Background

Food allergy (FA) affects approximately 1 in 12 US children, with prevalence increasing. Aside from considerable health care utilization, accumulating research suggests heightened psychosocial burden among this population.

Objective

To characterize FA-related psychosocial burden among a large, nationally representative pediatric sample, and its correlates, including sociodemographic characteristics, comorbid conditions, allergy severity, allergic symptoms, number and type of allergens, and health care utilization.

Methods

A survey was administered between October 2015 and September 2016 to a nationally representative sample of US households. Survey constructs included the Food Allergy Independent Measure (FAIM), which was developed to quantify adverse impacts of living with FA on psychosocial burden (range, 1-7; higher scores indicate greater burden). FAIM responses were analyzed from caregivers reporting current FA in their child (N = 4734). Linear regression models examined associations with sociodemographic and FA characteristics.

Results

The overall estimated mean caregiver-proxy FAIM scores for the US pediatric population were 2.79 (SE, 0.03) for reported FA, 2.96 (SE, 0.04) for convincing FA, and 3.21 (SE, 0.05) for physician-confirmed, convincing FA. Significant differences in caregiver-reported burden (P < .05) were found for sociodemographic (ie, household income, birth country, child age) and clinical (ie, FA severity, physician diagnosis, specific allergens) factors.

Conclusions

Although heterogeneous to a degree, the psychosocial burden of children with FA was substantial irrespective of sociodemographic and clinical characteristics. FAIM norms can be used clinically, as well as be leveraged by other economic, epidemiological, and health efforts to understand the public health impact of FA.

背景：食物过敏（FA）影响大约十二分之一的美国儿童，患病率不断上升。除了大量使用卫生保健服务外，越来越多的研究表明，这一人群的心理社会负担加重。目的：在一个具有全国代表性的大型儿科样本中，表征fa相关的心理社会负担及其相关因素，包括社会人口统计学特征、合并症、过敏严重程度、过敏症状、过敏原的数量和类型以及医疗保健利用。方法：在2015年10月至2016年9月期间对具有全国代表性的美国家庭样本进行了一项调查。调查结构包括食物过敏独立测量（FAIM），该测量用于量化生活中FA对心理社会负担的不利影响(范围= 1-7；分数越高表明负担越重)。对报告其孩子当前FA的护理人员的FAIM反应进行分析（N = 4734）。线性回归模型检验了与社会人口统计学和FA特征的关系。结果：美国儿科人群报告的FA的总体估计平均平均FAIM评分为2.79 (SE = 0.03)，可信FA为2.96 (SE = 0.04)，医生确认的可信FA为3.21 （SE = 0.05）。社会人口学（即家庭收入、出生国家、儿童年龄）和临床（即FA严重程度、医生诊断、特定过敏原）因素在护理人员报告的负担方面存在显著差异（p < 0.05）。结论：虽然在一定程度上存在异质性，但FA患儿的心理社会负担是巨大的，与社会人口学和临床特征无关。FAIM规范可用于临床，也可被其他经济、流行病学和卫生工作所利用，以了解FA对公共卫生的影响。

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引用次数: 0

Preimplantation genetic testing for hereditary angioedema as a potential dominant cost-effective intervention 植入前基因检测遗传性血管性水肿作为潜在的优势成本效益的干预。

IF 8.2 1区医学 Q1 ALLERGY

Journal of Allergy and Clinical Immunology-In Practice

Pub Date : 2025-03-01 DOI: 10.1016/j.jaip.2024.12.023

Willem Roosens MD , Lore Lannoo MD, PhD , Ellen Denayer MD, PhD , Liesbeth Gilissen PharmD, PhD , Karen Peeraer MD, PhD , Eftychia Dimitriadou PhD , Jeroen Luyten PhD , Kristel Van Calsteren MD, PhD , Rik Schrijvers MD, PhD

引用次数: 0

Nonpharmacological Approaches to Chronic Cough

IF 8.2 1区医学 Q1 ALLERGY

Journal of Allergy and Clinical Immunology-In Practice

Pub Date : 2025-03-01 DOI: 10.1016/j.jaip.2025.01.028

引用次数: 0

In Lasting Tribute: Professor Marcus Maurer (1966-2024)—A visionary in allergy research and a highly respected physician

IF 8.2 1区医学 Q1 ALLERGY

Journal of Allergy and Clinical Immunology-In Practice

Pub Date : 2025-03-01 DOI: 10.1016/j.jaip.2025.01.025

Jonathan A. Bernstein MD , Michael Schatz MD, MS , Torsten Zuberbier MD, PhD

引用次数: 0

Information for Readers

IF 8.2 1区医学 Q1 ALLERGY

Journal of Allergy and Clinical Immunology-In Practice

Pub Date : 2025-03-01 DOI: 10.1016/S2213-2198(25)00107-2

引用次数: 0

Cough-Variant Asthma: A Review of Clinical Characteristics, Diagnosis, and Pathophysiology 咳嗽变异性哮喘：临床特征、诊断和病理生理学综述。

IF 8.2 1区医学 Q1 ALLERGY

Journal of Allergy and Clinical Immunology-In Practice

Pub Date : 2025-03-01 DOI: 10.1016/j.jaip.2024.11.005

Joshua K. Cox MD, Richard Lockey MD, Juan Carlos Cardet MD

Chronic cough is among the most common symptoms prompting medical care. Cough-variant asthma (CVA) is an asthma subset where cough is the primary symptom, without wheezing, chest tightness, or dyspnea. It is an important cause of chronic cough, estimated to account for 25% to 42% of cases, but likely underdiagnosed due to delayed recognition and pitfalls of diagnostic testing. Early recognition and treatment can reduce morbidity and delay its progression to more typical asthma. This review details the clinical characteristics, diagnosis, pathophysiology, and treatment of CVA and contrasts it with classic asthma and other causes of chronic cough.

慢性咳嗽是引发医疗护理的最常见症状之一。咳嗽变异性哮喘（CVA）是一种以咳嗽为主要症状的哮喘亚型，不伴有喘息、胸闷或呼吸困难。它是慢性咳嗽的一个重要原因，估计占病例的 25% 至 42%，但由于识别延迟和诊断检测的误区，很可能诊断不足。早期识别和治疗可以降低发病率，并延缓其发展为更典型的哮喘。本综述详细介绍了 CVA 的临床特征、诊断、病理生理学和治疗方法，并将其与典型哮喘（CA）和其他原因引起的慢性咳嗽进行了对比。

引用次数: 0

Asthma Increases Long-Term Risk of Death by Suicide: A Nationwide Population-Based Cohort Study 哮喘增加自杀死亡的长期风险：一项基于全国人群的队列研究

IF 8.2 1区医学 Q1 ALLERGY

Journal of Allergy and Clinical Immunology-In Practice

Pub Date : 2025-03-01 DOI: 10.1016/j.jaip.2024.11.013

Sang Hyuk Kim MD , Hyun Lee MD, PhD , Jin-Hyung Jung PhD , Bo-Guen Kim MD, PhD , Dong Won Park MD, PhD , Tai Sun Park MD, PhD , Ji-Yong Moon MD, PhD , Tae-Hyung Kim MD, PhD , Jang Won Sohn MD, PhD , Ho Joo Yoon MD, PhD , Kyungdo Han PhD , Sang-Heon Kim MD, PhD

Background

Previous studies have identified an increased risk of suicidal behaviors among individuals with asthma.

Objective

To evaluate the long-term risk and factors related to suicide in the adult population with asthma.

Methods

This study used the Korean National Health Insurance Service data. We investigated the risk of suicide concerning the presence or absence of asthma and potential risk factors for suicide among 3,914,041 adults aged 20 years or more.

Results

During a median follow-up of 12.3 years (interquartile range, 12.1-12.6 years), 1383 (0.48%) individuals with asthma died by suicide. Individuals with asthma had an increased risk of suicide compared with controls (adjusted hazard ratio [aHR], 1.26; 95% CI, 1.19-1.33). Suicide risk was especially high in individuals with asthma phenotypes: hospitalization-prone (aHR, 1.61; 95% CI, 1.40-1.84), nonobese (aHR, 1.37; 95% CI, 1.27-1.64), and asthma-chronic obstructive pulmonary disease overlap (aHR, 1.47; 95% CI, 1.22-1.76). Coexisting underweight status (aHR, 2.54; 95% CI, 2.05-3.16), mental health disorders (schizophrenia [aHR, 3.38; 95% CI, 2.28-5.02], depression [aHR, 3.24; 95% CI, 2.85-3.68], and anxiety disorder [aHR, 2.47; 95% CI, 2.00-3.05]), and cancers (aHR, 2.22; 95% CI, 1.73-2.84) further increased the suicide risk.

Conclusions

Asthma was associated with an increased risk of suicide, particularly in hospitalization-prone, nonobese, and asthma-chronic obstructive pulmonary disease overlap phenotypes. The risk was further increased when asthma coexisted with underweight status, mental health disorders, or cancers.

背景：先前的研究已经确定哮喘患者自杀行为的风险增加。目的：评估成人哮喘患者自杀的长期危险及相关因素。方法：本研究采用韩国国民健康保险服务的数据。我们调查了3,914,041名年龄≥20岁的成年人的自杀风险，包括是否存在哮喘和潜在的自杀危险因素。结果：在中位随访12.3年（四分位数间距12.1-12.6年）期间，1383例（0.48%）哮喘患者自杀身亡。与对照组相比，哮喘患者的自杀风险增加（校正风险比[aHR] = 1.26, 95%可信区间[CI] = 1.19-1.33）。有哮喘表型的个体自杀风险特别高：住院倾向（aHR = 1.61, 95% CI = 1.40-1.84）、非肥胖（aHR = 1.37, 95% CI = 1.27-1.64）和哮喘-慢性阻塞性肺疾病重叠（ACO）（aHR = 1.47, 95% CI = 1.22-1.76）。同时存在的体重不足状况（aHR = 2.54, 95% CI = 2.05-3.16）、精神健康障碍（精神分裂症[aHR = 3.38, 95% CI = 2.28-5.02]、抑郁症[aHR = 3.24, 95% CI = 2.85-3.68]、焦虑症[aHR = 2.47, 95% CI = 2.00-3.05]）和癌症（aHR = 2.22, 95% CI = 1.73-2.84）进一步增加了自杀风险。结论：哮喘与自杀风险增加有关，特别是在住院倾向、非肥胖和ACO表型中。当哮喘与体重不足、精神健康障碍或癌症共存时，风险进一步增加。

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引用次数: 0

The Mastocytosis Control Test: A Patient-Reported Outcome Measure Assessing Disease Control 肥大细胞增多症控制试验：一种评估疾病控制的病人报告的结果测量方法。

IF 8.2 1区医学 Q1 ALLERGY

Journal of Allergy and Clinical Immunology-In Practice

Pub Date : 2025-03-01 DOI: 10.1016/j.jaip.2024.11.021

Frank Siebenhaar MD , Senan Sofi MD , Sophia Neisinger MD , Cem Akin MD, PhD , Polina Pyatilova MD , Eva Grekowitz MD , Antje Haendel , Tomasz Hawro MD , Lea Kiefer MD , Markus Magerl MD , Martin Metz MD , Marcus Maurer MD , Karsten Weller MD

Background

Mastocytosis is characterized by expanding neoplastic mast cells in organs such as the skin, bone marrow, and gastrointestinal tract. The release of mast cell mediators triggers cutaneous, gastrointestinal, and other symptoms. Currently, no validated mastocytosis-specific patient-reported outcome measure (PROM) exists to assess disease control.

Objective

Here, we developed a disease-specific instrument, the Mastocytosis Control Test (MCT), for evaluating and monitoring disease control in patients with nonadvanced disease.

Methods

Six potential MCT items were generated using a combined approach consisting of a literature review, patient interviews, and expert input. Item selection and reduction were performed by impact analysis and interitem correlation, followed by expert reviews and cognitive debriefings. In a validation study, the resulting MCT was tested for validity and reliability by assessing internal consistency, test-retest reliability, convergent validity, known-groups validity, and receiver operating characteristics (ROC) analysis.

Results

Ten patients participated in the item generation phase and 101 in the item reduction and validation phase. The final MCT consisted of 5 items. Our methods showed a valid total score, high internal consistency, and test-retest reliability. Convergent and known-groups validity demonstrated a strong correlation with related anchors. The ROC curve analysis suggested a cutoff value of ≥13 points to identify patients with good disease control.

Conclusions

The MCT is a disease-specific, valid, and reliable PROM for adult patients with nonadvanced disease. It may measure and monitor disease control in routine daily practice and clinical trials.

背景：肥大细胞增多症的特点是肿瘤肥大细胞在皮肤、骨髓和胃肠道等器官中扩大。肥大细胞介质的释放引发皮肤、胃肠和其他症状。目前，没有经过验证的肥大细胞增多症特异性患者报告的结果测量（PROM）存在，以评估疾病控制。目的：在这里，我们开发了一种疾病特异性仪器，肥大细胞增多症控制试验（MCT），用于评估和监测非晚期疾病患者的疾病控制。方法：采用文献综述、患者访谈和专家意见相结合的方法生成六个潜在的MCT项目。通过影响分析和项目间关联进行项目选择和缩减，然后进行专家评审和认知汇报。在一项验证研究中，通过评估内部一致性、测试-重测信度、收敛效度、已知组效度和受试者工作特征（ROC）分析来检验结果MCT的效度和信度。结果：10例患者参加了项目生成阶段，101例患者参加了项目减少和验证阶段。最后的MCT包括五个项目。我们的方法显示出有效的总分、较高的内部一致性和重测信度。收敛效度和已知组效度与相关锚点有很强的相关性。ROC曲线分析建议截断值≥13点为疾病控制良好的患者。结论：MCT是一种疾病特异性的、有效的、可靠的非晚期成年患者PROM。可在日常实践和临床试验中测量和监测疾病控制情况。

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引用次数: 0

Insect Allergy: Barriers in Training and Practice—A Work Group Report of the AAAAI Anaphylaxis Committee 昆虫过敏：培训和实践中的障碍：AAAAI过敏反应委员会工作组报告。

IF 8.2 1区医学 Q1 ALLERGY

Journal of Allergy and Clinical Immunology-In Practice

Pub Date : 2025-03-01 DOI: 10.1016/j.jaip.2024.12.037

Karla Adams MD , Matthew Greenhawt MD, MBA, MS , Theresa Bingemann MD , James Tracy DO , Joel Brooks DO , Hans Otto MD , Daniel Steigelman MD , Yvonne Hsieh MD , Aikaterini Anagnostou MD, MS, PhD , John Carlson MD, PhD , Jeffrey Demain MD , Aasha Harish MD , Nina Hein MD , Anil Nanda MD , Monica Hajirawala MD , Susan Waserman MS, MD , David B.K. Golden MDCM

Background

The evaluation and management of insect sting allergy is a complex core competency taught in Allergy and Immunology fellowship programs. It is unclear whether current training on insect allergy is sufficient to meet the needs of the field and what training barriers exist.

Objective

To investigate the extent of training on stinging insect allergy and factors currently impacting stinging insect allergy clinical practice through a pilot needs-assessment survey.

Methods

A Web-based questionnaire was designed and sent to a 20% random sample of American Academy of Allergy, Asthma & Immunology member categories. Data were analyzed for descriptive frequencies.

Results

A total of 78 responses were received (11% response rate). Respondents’ mean age was 53.7 years, 52% were female, and 92.3% were physicians. The mean time since training completion was 18.4 years. During fellowship training, 95.7% were educated on stinging insect allergy, 87.1% reported conducting testing, and 82.6% ordered venom immunotherapy (VIT). During training, 50% of respondents managed 1 to 5 patients with venom allergy (38% managed > 5, and 12% none). After fellowship, 97.3% reported evaluating patients with stinging insect allergy, 90.3% report evaluating 1 to 5 patients per month, and 93.2% and 87.5% offer testing and VIT, respectively. A patient’s decision to not start VIT was the most common barrier reported by 81.8%.

Conclusions

In this pilot needs-assessment survey, the majority reported training and education on insect allergy during fellowship, although patient exposure was low for most. After fellowship, insect allergy evaluations increased up to 24-fold compared with fellowship training and patient-driven decisions are the most common deterrent for VIT.

背景：昆虫蜇伤过敏的评估和管理是变态反应和免疫学奖学金项目中一个复杂的核心能力。目前尚不清楚昆虫过敏的培训是否足以满足该领域的需要，以及存在哪些培训障碍。目的：通过一项试点需求评估调查，了解叮虫变态反应培训的程度，以及目前影响叮虫变态反应临床实践的因素。方法：设计一份基于网络的调查问卷，随机抽取20%的美国过敏、哮喘和免疫学学会会员。对数据进行描述性频率分析。结果：共收到回复78份，回复率11%。受访者平均年龄53.7岁，女性占52%，医生占92.3%。培训结束后的平均时间为18.4年。在研究员培训期间，95.7%的人接受了昆虫叮咬过敏相关知识的培训，87.1%的人接受了检测，82.6%的人接受了毒液免疫治疗。在培训期间，50%的应答者处理了1-5例毒液过敏患者，（38%处理了50例，12%没有）。研究结束后，97.3%的人报告了对叮咬昆虫过敏的患者进行评估，90.3%的人报告每月评估1-5例患者，93.2%和87.5%的人分别进行了测试和VIT。据报道，患者决定不开始VIT是最常见的障碍，占81.8%。结论：在这项试点需求评估调查中，大多数报告了在研究期间对昆虫过敏的培训和教育，尽管大多数患者的接触率很低。与奖学金培训相比，在奖学金培训后，昆虫过敏评估增加了24倍，患者驱动的决定是最常见的VIT威慑。

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