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

Background: The impact of inducible laryngeal obstruction (ILO) is significant, supporting the importance of determining effective treatments.

Objective: Double-blind randomized controlled trial examining the addition of amitriptyline to speech pathology (SP) for ILO.

Methods: Adults aged 18 to 85 years with ILO diagnosed on laryngoscopy were randomized to amitriptyline (target maintenance dose of 75 mg daily) or placebo, in combination with six SP sessions. We assessed ILO symptom severity and frequency using the Vocal Cord Dysfunction Questionnaire (VCDQ) and Dyspnea Index (DI), respectively. Co-primary outcomes were the difference in posttreatment VCDQ and DI scores between groups, adjusted for baseline scores and analyzed per protocol. Target recruitment was 50 participants to provide 46 for analysis, assuming 8% dropout.

Results: Twenty-one participants were randomized to SP plus amitriptyline, and 20 to SP plus placebo. Three participants dropped out, leaving 19 per group for analysis. There were no differences in posttreatment ILO symptom severity (VCDQ) or frequency (DI) between groups; VCDQ 37.35 (95% CI, 32.54-42.17) for SP plus amitriptyline versus 38.12 (95% CI, 33.31-42.94) for SP plus placebo (P = .82); and DI 15.96 (95% CI, 12.24-19.68) for SP plus amitriptyline versus 16.52 (95% CI, 12.79-20.24) for SP plus placebo (P = .83). There were significant improvements in posttreatment mean scores compared with baseline scores in ILO symptom severity (VCDQ) and frequency (DI) in both groups. The minimal clinically important difference on ILO symptom questionnaires (VCDQ and/or DI) was achieved in 28 of 38 participants (73.7%).

Conclusions: In this trial, speech pathology effectively reduced ILO symptom severity and/or frequency in 73.7% of participants, with no additional benefit from concurrent amitriptyline.

Background: Eosinophilic esophagitis (EoE) is a chronic type-2 inflammatory disease of the esophagus that progresses to a fibrotic phenotype when left untreated. Current treatment options aim at controlling clinical, endoscopic and histological disease activity. However, as of yet, it remains elusive if achieving disease control, particularly the long-term control of histological disease activity, can prevent the development of disease complications.

Objective: To assess the impact of ongoing histological disease activity on the development of disease complications in adult EoE patients.

Methods: We evaluated prospectively-included patients in the Swiss EoE cohort. Data on all patients with ongoing maintenance treatment, and at least two follow-up visits, but without concomitant gastroesophageal reflux or strictures at baseline, were analyzed. We compared patients with ongoing histological disease activity vs patients with disease control, with regards to development of disease complications over time (strictures, bolus impactions and need for treatment escalation). Histological disease activity was defined by a peak eosinophil count of >15 eosinophil during all follow-up visits.

Results: We included a total of 151 patients with a median follow-up of 56.0 months (70.9% males, median age 39.0 years). 93 patients were classified as having disease control during follow-up (61.6%), while 58 patients (38.4%) showed ongoing histological disease activity. Development of complications occurred in a total of 108 patients (71.5%), significantly more often in patients with ongoing histological activity compared to patients with disease control (89.7% vs 60.2%, p<0.001). This difference was mainly due to higher rates of stricture formation and need for treatment escalation. Multivariate Cox regression models revealed ongoing histologic disease activity as a significant predictor for the development of complications in the follow-up (HR 2.45, p<0.001), particularly for need for treatment escalation (2.63, p<0.001) and development of strictures (HR 3.16, p=0.025).

Conclusion: Ongoing histological disease activity predicts development of complicating disease course in EoE patients. Current treatment strategies should aim at controlling both clinical and histological disease activity to prevent disease complications.

Penicillin allergy is frequently reported yet rarely confirmed in pregnant women, similar to the general population. Historically, there has been hesitation to perform penicillin allergy testing in pregnant patients due to perceived risk to the patient and fetus in the event of an allergic reaction. Given the multiple clinical indications for penicillin in pregnancy and delivery, there are also risks of using non-first-line antibiotics; thus clarity is needed regarding the safety of undergoing penicillin allergy testing during pregnancy. A workgroup subcommittee of members from the American Academy of Allergy, Asthma & Immunology committees on Women's Health in Allergy/Immunology and Adverse Reactions to Drugs, Biologics, and Vaccines was convened, and a survey of current allergist practices as well as a scoping review of the literature was conducted. Although survey respondents reported mixed comfort with testing, evidence from numerous recent studies representing hundreds of pregnant patients demonstrates that penicillin allergy testing can be safely performed via an oral challenge with or without preceding skin testing. To implement this testing in clinical practice, allergists and immunologists can learn from the clinical experience of numerous institutions that have reported a successful approach to offering definitive allergy evaluation in this population.

Background: Systemic corticosteroids are a standard part of treatment for asthma exacerbations. Multiple options for administration exist without consensus recommendations, leading to variability in treatment regimens across sites.

Objective: To examine variation in corticosteroid regimens used to treat pediatric asthma exacerbations from 2012-2024 and identify sociodemographic and clinical characteristics associated with type of corticosteroid administered.

Methods: We performed a retrospective cohort study of encounters of children ages 2-17 years with asthma exacerbations using the Pediatric Emergency Care Applied Research Network Registry. Frequencies of corticosteroid types administered by site were summarized using median and interquartile ranges. Multivariable logistic regression compared treatment with enteral dexamethasone versus enteral prednisone by sociodemographic and clinical characteristics, adjusting for year and clinical site.

Results: The analysis included 206,388 encounters over 17 sites. Overall, 69.5% of encounters received enteral dexamethasone, 24.7% enteral prednisone/prednisolone, 4.8% intramuscular/intravenous methylprednisolone and 1.0% intramuscular/intravenous dexamethasone. There was an increase in the proportion of encounters receiving enteral dexamethasone at sites throughout the study period (p<0.001). Encounters with younger age, Hispanic race and ethnicity, Spanish language, and public insurance/self-pay were more likely to received enteral dexamethasone. Encounters with emergency severity index triage level 1 or 2, who were overweight, had moderate exacerbation severity, or with tachypnea were more likely to receive prednisone.

Conclusion: Use of enteral dexamethasone in the management of asthma exacerbations has increased over time, and the type of corticosteroid administered varied by sociodemographic and clinical characteristics. Future studies should explore the comparative effectiveness of different corticosteroid regimens on clinical outcomes.

Background: There has been a striking shift towards earlier allergen introduction following updated 2016 Australian infant feeding guidelines. Identifying factors contributing to community uptake is important for ongoing allergy prevention efforts.

Objective: To determine if and how families received feeding advice, factors associated with receipt and accuracy of advice, and the influence of advice on allergen introduction.

Methods: Parent-completed questionnaires from the EarlyNuts population-based study of 11-15-month-old infants (n=1699), captured demographic characteristics, timing of allergen introduction, and information about feeding advice.

Results: Most families (99%) received feeding advice. Advice accuracy was highest for solids, egg and peanut (93-97%), and lowest for dairy (81%). Families receiving accurate advice had greater odds of timely (4-11 months) introduction of peanut (OR 9.2 [95% confidence interval (CI) 5.5-15.6]), egg (OR 6.2 [95%CI 2.9-13.4]), tree nuts (OR 3.0 [95%CI 1.9-5.0]) and dairy products (OR 2.9 [95%CI 1.8-4.7]). Maternal child health nurses (MCHNs) were the most common source of advice (87%) and associated with increased odds of timely peanut (OR 1.5 [95% CI 1.0-2.2], p=0.04), egg (OR 2.2 [95%CI 1.4-3.6], p=0.001) and dairy (OR 1.7 [95%CI 1.0-2.8], p=0.04) introduction. Infants with parents born outside Australia, were less likely to receive allergen advice (e.g. peanut advice: Australia [92%], other country [80%], East-Asia [76%]). Families residing in the North-East region of Melbourne (Australia) had highest rates of any and accurate advice.

Conclusion: Receipt and accuracy of infant feeding advice was widespread and associated with timely allergen introduction, however rates were lower in culturally-and-linguistically diverse families. Guideline dissemination and adherence likely benefited from local council and MCHN programs.