Pub Date : 2026-01-01DOI: 10.1016/j.jaip.2025.10.001
Nyla Thyara Melo Lobão MD, PhD , Maine Luellah Demaret Bardou MD , Shirley Yajaira Cerinza Vila MD , Lucas Salomão de Sousa Ferreira MSc , Luisa Karla Arruda MD, PhD , José Eduardo Seneda Lemos MD , Mariana Paes Leme Ferriani MD, PhD , Marina Mendonça Dias MSc , Eliana Cristina Toledo MD, PhD , Faradiba Sarquis Serpa MD, PhD , Therezinha Ribeiro Moyses MD , Herberto J. Chong-Neto MD, PhD , Nelson Augusto Rosário Filho MD, PhD , Caroline Guth de Freitas Batista de Moraes MSc , Fernanda Casares Marcelino MD , Eli Mansour MD, PhD , Caroline Rosa Emergente Coutinho MD , Ronney Corrêa Mendes MD , Rozana de Fátima Gonçalves MD , Solange Oliveira Rodrigues Valle MD, PhD , Anete Sevciovic Grumach MD, PhD
Background
Hereditary angioedema (HAE) with normal C1 inhibitor (HAE-nC1INH) is a rare and heterogeneous group of bradykinin-mediated disorders, characterized by diagnostic challenges and limited evidence-based recommendations.
Objective
To describe the clinical features and therapeutic strategies of Brazilian patients with HAE-nC1INH, supporting individualized, subtype-oriented management. Methods: This multicenter, cross-sectional analytical study was conducted through the Brazilian Group for the Study of Hereditary Angioedema (GEBRAEH). Data were collected in December 2024 using a standardized online questionnaire and analyzed descriptively and inferentially.
Results
A total of 116 symptomatic patients were included: 92 with HAE with mutation in coagulation factor XII, 21 with HAE of unknown genetic cause, and 3 with HAE with mutation in angiopoietin-1. Females accounted for 96%. Abdominal symptoms were predominant, and diagnostic delay decreased in more recent generations. Initial interventions most often involved isolated combined estrogen-progestin oral contraceptive (COC) withdrawal (33 of 116; 28%) or combined with progestins (35 of 116; 30%). In HAE with mutation in coagulation factor XII, COC withdrawal was effective in 97% (29 of 30), further enhanced with progestins (30 of 30; 100%). COC withdrawal reduced median attack days (4.5 to 1; P < .001) and prolonged attack-free intervals (P < .001). Four patients relapsed after more than 10 years of remission, associated with hormonal changes. Tranexamic acid demonstrated variable efficacy (2 of 10 achieved complete cessation, 5 of 10 partial reduction, and 3 of 10 no response). Lanadelumab showed clinical efficacy in HAE of unknown genetic cause (2 of 2) and HAE with mutation in angiopoietin-1 (1 of 1). Androgens showed only limited benefit (7 of 7; all partial reduction).
Conclusions
COC withdrawal is the most effective first-line intervention in HAE with mutation in coagulation factor XII, with greater efficacy when combined with progestins. Tranexamic acid and lanadelumab may serve as complementary options in selected cases. Late relapse highlights the need for long-term follow-up, with intensified monitoring during periods of hormonal fluctuation.
{"title":"Real-World Evidence on the Management of Hereditary Angioedema With Normal C1 Inhibitor","authors":"Nyla Thyara Melo Lobão MD, PhD , Maine Luellah Demaret Bardou MD , Shirley Yajaira Cerinza Vila MD , Lucas Salomão de Sousa Ferreira MSc , Luisa Karla Arruda MD, PhD , José Eduardo Seneda Lemos MD , Mariana Paes Leme Ferriani MD, PhD , Marina Mendonça Dias MSc , Eliana Cristina Toledo MD, PhD , Faradiba Sarquis Serpa MD, PhD , Therezinha Ribeiro Moyses MD , Herberto J. Chong-Neto MD, PhD , Nelson Augusto Rosário Filho MD, PhD , Caroline Guth de Freitas Batista de Moraes MSc , Fernanda Casares Marcelino MD , Eli Mansour MD, PhD , Caroline Rosa Emergente Coutinho MD , Ronney Corrêa Mendes MD , Rozana de Fátima Gonçalves MD , Solange Oliveira Rodrigues Valle MD, PhD , Anete Sevciovic Grumach MD, PhD","doi":"10.1016/j.jaip.2025.10.001","DOIUrl":"10.1016/j.jaip.2025.10.001","url":null,"abstract":"<div><h3>Background</h3><div>Hereditary angioedema (HAE) with normal C1 inhibitor (HAE-nC1INH) is a rare and heterogeneous group of bradykinin-mediated disorders, characterized by diagnostic challenges and limited evidence-based recommendations.</div></div><div><h3>Objective</h3><div>To describe the clinical features and therapeutic strategies of Brazilian patients with HAE-nC1INH, supporting individualized, subtype-oriented management. Methods: This multicenter, cross-sectional analytical study was conducted through the Brazilian Group for the Study of Hereditary Angioedema (GEBRAEH). Data were collected in December 2024 using a standardized online questionnaire and analyzed descriptively and inferentially.</div></div><div><h3>Results</h3><div>A total of 116 symptomatic patients were included: 92 with HAE with mutation in coagulation factor XII, 21 with HAE of unknown genetic cause, and 3 with HAE with mutation in angiopoietin-1. Females accounted for 96%. Abdominal symptoms were predominant, and diagnostic delay decreased in more recent generations. Initial interventions most often involved isolated combined estrogen-progestin oral contraceptive (COC) withdrawal (33 of 116; 28%) or combined with progestins (35 of 116; 30%). In HAE with mutation in coagulation factor XII, COC withdrawal was effective in 97% (29 of 30), further enhanced with progestins (30 of 30; 100%). COC withdrawal reduced median attack days (4.5 to 1; <em>P</em> < .001) and prolonged attack-free intervals (<em>P</em> < .001). Four patients relapsed after more than 10 years of remission, associated with hormonal changes. Tranexamic acid demonstrated variable efficacy (2 of 10 achieved complete cessation, 5 of 10 partial reduction, and 3 of 10 no response). Lanadelumab showed clinical efficacy in HAE of unknown genetic cause (2 of 2) and HAE with mutation in angiopoietin-1 (1 of 1). Androgens showed only limited benefit (7 of 7; all partial reduction).</div></div><div><h3>Conclusions</h3><div>COC withdrawal is the most effective first-line intervention in HAE with mutation in coagulation factor XII, with greater efficacy when combined with progestins. Tranexamic acid and lanadelumab may serve as complementary options in selected cases. Late relapse highlights the need for long-term follow-up, with intensified monitoring during periods of hormonal fluctuation.</div></div>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"14 1","pages":"Pages 233-242.e2"},"PeriodicalIF":6.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145281692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.jaip.2025.09.025
Boqing Chen MSc , Andrew S.C. Yuen MPharm , Kenneth K.C. Man PhD , Joseph F. Hayes PhD , David P.J. Osborn PhD , Ian C.K. Wong PhD , Adrienne Y.L. Chan PhD , Lok Yin Cheng MBChB , Yogini H. Jani PhD , Wallis C.Y. Lau PhD
Background
Whether leukotriene receptor antagonist (LTRA) or inhaled corticosteroid (ICS) use can increase the risk of self-harm remains unclear.
Objective
To evaluate the association between self-harm and use of LTRAs and ICSs among patients with asthma.
Methods
This self-controlled case series study used data from the UK Clinical Practice Research Datalink linked to hospital and mortality records. We included patients with asthma aged 10 years or more who had at least 1 prescription of LTRA, 1 prescription of ICS, and an incident self-harm during the period 2005 to 2020. Incidence rate ratios (IRRs) of self-harm during periods of (presented in order of precedence if they overlapped) pre-LTRA, pre-ICS, LTRA-alone, ICS-alone, and combination use of LTRA and ICS, versus nonuse, were calculated using conditional Poisson regression model. Additional analyses using self-controlled case series extension, case-case-time-control, and cohort study designs were used to examine robustness of results.
Results
Among 313,943 individuals prescribed LTRAs and ICSs, 2900 had incident self-harm. IRRs were 0.77 (95% CI, 0.58-1.01) during pre-LTRA, 0.68 (95% CI, 0.57-0.82) during LTRA-alone, and 0.70 (95% CI, 0.56-0.86) during combination use. Further analysis suggested that the self-harm incidence was lower during the first 90 days of LTRA use (IRR, 0.74; 95% CI, 0.58-0.95), before returning to nonuse level (IRR, 0.93; 95% CI, 0.74-1.17). Comparable incidence to nonuse was observed during pre-ICS (IRR, 0.99; 95% CI, 0.71-1.39) and ICS-alone (IRR, 0.88; 95% CI, 0.75-1.04). The results were robust across sensitivity analyses and study designs, which did not suggest increased risk of self-harm with LTRA/ICS use.
Conclusions
Using the self-controlled case series design, which was based on comparisons within a population with both the outcome and exposure of interest, our study does not support an association between self-harm and LTRA or ICS use in patients with asthma.
{"title":"Risk of Self-Harm and the Use of Leukotriene Receptor Antagonists and Inhaled Corticosteroids: A Population-Based Study","authors":"Boqing Chen MSc , Andrew S.C. Yuen MPharm , Kenneth K.C. Man PhD , Joseph F. Hayes PhD , David P.J. Osborn PhD , Ian C.K. Wong PhD , Adrienne Y.L. Chan PhD , Lok Yin Cheng MBChB , Yogini H. Jani PhD , Wallis C.Y. Lau PhD","doi":"10.1016/j.jaip.2025.09.025","DOIUrl":"10.1016/j.jaip.2025.09.025","url":null,"abstract":"<div><h3>Background</h3><div>Whether leukotriene receptor antagonist (LTRA) or inhaled corticosteroid (ICS) use can increase the risk of self-harm remains unclear.</div></div><div><h3>Objective</h3><div>To evaluate the association between self-harm and use of LTRAs and ICSs among patients with asthma.</div></div><div><h3>Methods</h3><div>This self-controlled case series study used data from the UK Clinical Practice Research Datalink linked to hospital and mortality records. We included patients with asthma aged 10 years or more who had at least 1 prescription of LTRA, 1 prescription of ICS, and an incident self-harm during the period 2005 to 2020. Incidence rate ratios (IRRs) of self-harm during periods of (presented in order of precedence if they overlapped) pre-LTRA, pre-ICS, LTRA-alone, ICS-alone, and combination use of LTRA and ICS, versus nonuse, were calculated using conditional Poisson regression model. Additional analyses using self-controlled case series extension, case-case-time-control, and cohort study designs were used to examine robustness of results.</div></div><div><h3>Results</h3><div>Among 313,943 individuals prescribed LTRAs and ICSs, 2900 had incident self-harm. IRRs were 0.77 (95% CI, 0.58-1.01) during pre-LTRA, 0.68 (95% CI, 0.57-0.82) during LTRA-alone, and 0.70 (95% CI, 0.56-0.86) during combination use. Further analysis suggested that the self-harm incidence was lower during the first 90 days of LTRA use (IRR, 0.74; 95% CI, 0.58-0.95), before returning to nonuse level (IRR, 0.93; 95% CI, 0.74-1.17). Comparable incidence to nonuse was observed during pre-ICS (IRR, 0.99; 95% CI, 0.71-1.39) and ICS-alone (IRR, 0.88; 95% CI, 0.75-1.04). The results were robust across sensitivity analyses and study designs, which did not suggest increased risk of self-harm with LTRA/ICS use.</div></div><div><h3>Conclusions</h3><div>Using the self-controlled case series design, which was based on comparisons within a population with both the outcome and exposure of interest, our study does not support an association between self-harm and LTRA or ICS use in patients with asthma.</div></div>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"14 1","pages":"Pages 166-175"},"PeriodicalIF":6.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.jaip.2025.12.019
{"title":"Pharmacological Management of Severe Asthma in Pregnancy","authors":"","doi":"10.1016/j.jaip.2025.12.019","DOIUrl":"10.1016/j.jaip.2025.12.019","url":null,"abstract":"","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"14 1","pages":"Page 315"},"PeriodicalIF":6.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145903929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.jaip.2025.08.016
Matan Elkan MD , Liat Nachshon MD , Ortal Cohen BSc , Michael B. Levy MD , Yael Koren MD , Naama Epstein-Rigby MD , Arnon Elizur MD , Michael R. Goldberg MD, PhD
Background
Children with IgE-mediated food allergies, particularly milk, are at risk for hampered growth. Limited data are available regarding the benefit of oral immunotherapy (OIT) on growth outcomes.
Objective
To evaluate the impact of OIT on growth metrics in this population.
Methods
We retrospectively analyzed data from patients (aged 4-15 [females] and 4-16.5 [males] years) who successfully completed OIT. Pre- and post-OIT height-for-age and weight-for-age z-scores (HAZ and WAZ, respectively) were calculated using World Health Organization standards.
Results
Patients (n = 458, mean age 8.0 ± 2.7 years) successfully treated for tree nut (33.4%), peanut (29.7%), milk (17.2%), sesame (14.6%), and egg (4.8%) allergy were analyzed. Baseline mean HAZ –0.19 ± 1.05 improved to –0.10 ± 1.05 (P < .001) after OIT (median duration, 19.4 months). This was positively correlated with the mean change in WAZ (r = 0.44, P < .001). Milk-allergic patients had lower baseline HAZ than non–milk-allergic patients (–0.45 ± 0.91 vs –0.14 ± 1.07, P = .016). Patients beginning OIT before age 6 had the greatest HAZ improvement (0.16 ± 0.42), whereas those starting after age 12 experienced a decrease (–0.11 ± 0.49). In 113 patients with a median 34-month follow-up, HAZ improved by 0.30 ± 0.73 (P < .001). This effect was not observed at long-term follow-up in a group of patients who did not achieve successful OIT (n = 21). Using a linear regression model, significant predictors of follow-up HAZ were younger age at baseline (B = –0.09, 95% confidence interval [CI] [–0.15, –0.03], P = .002) and lower baseline HAZ (B = 0.83, 95% CI [0.69, 0.97], P < .001).
Conclusions
OIT may enhance long-term growth in allergic children, especially in younger patients and those with a lower baseline HAZ. Effects on their final stature remain to be determined.
{"title":"Effects of Oral Immunotherapy on the Growth Trajectories of Food-Allergic Children","authors":"Matan Elkan MD , Liat Nachshon MD , Ortal Cohen BSc , Michael B. Levy MD , Yael Koren MD , Naama Epstein-Rigby MD , Arnon Elizur MD , Michael R. Goldberg MD, PhD","doi":"10.1016/j.jaip.2025.08.016","DOIUrl":"10.1016/j.jaip.2025.08.016","url":null,"abstract":"<div><h3>Background</h3><div>Children with IgE-mediated food allergies, particularly milk, are at risk for hampered growth. Limited data are available regarding the benefit of oral immunotherapy (OIT) on growth outcomes.</div></div><div><h3>Objective</h3><div>To evaluate the impact of OIT on growth metrics in this population.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed data from patients (aged 4-15 [females] and 4-16.5 [males] years) who successfully completed OIT. Pre- and post-OIT height-for-age and weight-for-age <em>z</em>-scores (HAZ and WAZ, respectively) were calculated using World Health Organization standards.</div></div><div><h3>Results</h3><div>Patients (n = 458, mean age 8.0 ± 2.7 years) successfully treated for tree nut (33.4%), peanut (29.7%), milk (17.2%), sesame (14.6%), and egg (4.8%) allergy were analyzed. Baseline mean HAZ –0.19 ± 1.05 improved to –0.10 ± 1.05 (<em>P</em> < .001) after OIT (median duration, 19.4 months). This was positively correlated with the mean change in WAZ (<em>r</em> = 0.44, <em>P</em> < .001). Milk-allergic patients had lower baseline HAZ than non–milk-allergic patients (–0.45 ± 0.91 vs –0.14 ± 1.07, <em>P</em> = .016). Patients beginning OIT before age 6 had the greatest HAZ improvement (0.16 ± 0.42), whereas those starting after age 12 experienced a decrease (–0.11 ± 0.49). In 113 patients with a median 34-month follow-up, HAZ improved by 0.30 ± 0.73 (<em>P</em> < .001). This effect was not observed at long-term follow-up in a group of patients who did not achieve successful OIT (n = 21). Using a linear regression model, significant predictors of follow-up HAZ were younger age at baseline (B = –0.09, 95% confidence interval [CI] [–0.15, –0.03], <em>P</em> = .002) and lower baseline HAZ (B = 0.83, 95% CI [0.69, 0.97], <em>P</em> < .001).</div></div><div><h3>Conclusions</h3><div>OIT may enhance long-term growth in allergic children, especially in younger patients and those with a lower baseline HAZ. Effects on their final stature remain to be determined.</div></div>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"14 1","pages":"Pages 215-222.e5"},"PeriodicalIF":6.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144977928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.jaip.2025.11.016
Melody C. Carter MD , Magdalena Lange MD, PhD , Ivan Alvarez-Twose MD, PhD , Joanna Renke MD , Cristina Morales-Cabeza MD , Horacio Caligaris MD , Karin Hartmann MD
Mastocytosis is characterized by mast cell infiltration in various tissues and organs. More than half of the patients are children. Pediatric mastocytosis has several features that differentiate the disease from adult mastocytosis. Importantly, the disease, which usually starts in the first months of life or at birth, often shows a transient course with spontaneous resolution in adolescence. In most children, mastocytosis is limited to skin. Cutaneous involvement can present as maculopapular cutaneous mastocytosis, mostly with the polymorphic variant, cutaneous mastocytoma, or diffuse cutaneous mastocytosis. When children present with monomorphic maculopapular skin lesions, the variant typically seen in adults, this may indicate rare persistent disease until adulthood, often associated with systemic mastocytosis. Many pediatric patients suffer from symptoms of mast cell activation, ranging from pruritus to flushing and blistering. Children with cutaneous mastocytosis typically exhibit mutations in various regions of the KIT gene, whereas those with systemic disease predominantly carry KIT D816V. Diagnosis is mainly based on noninvasive measures, including skin inspection, elicitation of the Darier's sign, and analyses of the serum tryptase and KIT variant in blood. Treatment options encompass avoidance of triggers of mast cell activation, H1 and H2 antihistamines, cromolyn, and omalizumab. In children with systemic mastocytosis, tyrosine kinase inhibitors tailored to the specific KIT variant may be considered.
{"title":"Management of Mastocytosis and Mast Cell Activation in Children","authors":"Melody C. Carter MD , Magdalena Lange MD, PhD , Ivan Alvarez-Twose MD, PhD , Joanna Renke MD , Cristina Morales-Cabeza MD , Horacio Caligaris MD , Karin Hartmann MD","doi":"10.1016/j.jaip.2025.11.016","DOIUrl":"10.1016/j.jaip.2025.11.016","url":null,"abstract":"<div><div>Mastocytosis is characterized by mast cell infiltration in various tissues and organs. More than half of the patients are children. Pediatric mastocytosis has several features that differentiate the disease from adult mastocytosis. Importantly, the disease, which usually starts in the first months of life or at birth, often shows a transient course with spontaneous resolution in adolescence. In most children, mastocytosis is limited to skin. Cutaneous involvement can present as maculopapular cutaneous mastocytosis, mostly with the polymorphic variant, cutaneous mastocytoma, or diffuse cutaneous mastocytosis. When children present with monomorphic maculopapular skin lesions, the variant typically seen in adults, this may indicate rare persistent disease until adulthood, often associated with systemic mastocytosis. Many pediatric patients suffer from symptoms of mast cell activation, ranging from pruritus to flushing and blistering. Children with cutaneous mastocytosis typically exhibit mutations in various regions of the KIT gene, whereas those with systemic disease predominantly carry <em>KIT</em> D816V. Diagnosis is mainly based on noninvasive measures, including skin inspection, elicitation of the Darier's sign, and analyses of the serum tryptase and KIT variant in blood. Treatment options encompass avoidance of triggers of mast cell activation, H1 and H2 antihistamines, cromolyn, and omalizumab. In children with systemic mastocytosis, tyrosine kinase inhibitors tailored to the specific KIT variant may be considered.</div></div>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"14 1","pages":"Pages 30-42"},"PeriodicalIF":6.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145598149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.jaip.2025.11.003
Tang Li MD, Tao Yu MD
{"title":"Reappraising self-harm risk linked to leukotriene receptor antagonists and inhaled corticosteroids","authors":"Tang Li MD, Tao Yu MD","doi":"10.1016/j.jaip.2025.11.003","DOIUrl":"10.1016/j.jaip.2025.11.003","url":null,"abstract":"","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"14 1","pages":"Page 320"},"PeriodicalIF":6.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145904248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.jaip.2025.08.013
Salman Siddiqui MBBS, PhD , Christopher Brightling FMedSci , Dave Singh MD , Janwillem Kocks MD, PhD , Leonardo M. Fabbri MD , Alberto Papi MD , Klaus F. Rabe MD, PhD , Marielle van der Deijl MSc , Maarten van den Berge MD, PhD , Monica Kraft MD
Small airway dysfunction (SAD) is both common and clinically relevant in patients with asthma. However, there is no recognized "gold standard" approach for the identification of SAD in clinical practice. The ATLANTIS (AssessmenT of smalL Airways involvemeNT In aSthma) study was a prospective (1-year follow-up), multicenter, international observational study that aimed to identify the best, or best combination of biomarkers, physiological tests, and imaging markers for the determination of the presence of SAD, and to evaluate the contribution of SAD across all asthma severities to meaningful clinical asthma outcomes. A large number of analyses from the ATLANTIS study have been conducted or are planned. This narrative review summarizes the key findings to date and the future directions. Perhaps the most important finding so far is that a "toolbox" of spirometry, oscillometry, and a small airways dysfunction questionnaire can detect SAD with high accuracy (area under the receiver operating characteristic curve 0.96 and positive likelihood ratio 12.8). Further, collaboration with other consortia has demonstrated the use of oscillometry to identify asthma phenotypes. We advocate the adoption of the ATLANTIS toolbox into interventional studies in asthma—and if validated, this could form a useful part of research and daily clinical practice.
{"title":"Detecting Small Airways Dysfunction in Asthma: Rationale, Findings, and Future of ATLANTIS","authors":"Salman Siddiqui MBBS, PhD , Christopher Brightling FMedSci , Dave Singh MD , Janwillem Kocks MD, PhD , Leonardo M. Fabbri MD , Alberto Papi MD , Klaus F. Rabe MD, PhD , Marielle van der Deijl MSc , Maarten van den Berge MD, PhD , Monica Kraft MD","doi":"10.1016/j.jaip.2025.08.013","DOIUrl":"10.1016/j.jaip.2025.08.013","url":null,"abstract":"<div><div>Small airway dysfunction (SAD) is both common and clinically relevant in patients with asthma. However, there is no recognized \"gold standard\" approach for the identification of SAD in clinical practice. The ATLANTIS (AssessmenT of smalL Airways involvemeNT In aSthma) study was a prospective (1-year follow-up), multicenter, international observational study that aimed to identify the best, or best combination of biomarkers, physiological tests, and imaging markers for the determination of the presence of SAD, and to evaluate the contribution of SAD across all asthma severities to meaningful clinical asthma outcomes. A large number of analyses from the ATLANTIS study have been conducted or are planned. This narrative review summarizes the key findings to date and the future directions. Perhaps the most important finding so far is that a \"toolbox\" of spirometry, oscillometry, and a small airways dysfunction questionnaire can detect SAD with high accuracy (area under the receiver operating characteristic curve 0.96 and positive likelihood ratio 12.8). Further, collaboration with other consortia has demonstrated the use of oscillometry to identify asthma phenotypes. We advocate the adoption of the ATLANTIS toolbox into interventional studies in asthma—and if validated, this could form a useful part of research and daily clinical practice.</div></div>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"14 1","pages":"Pages 56-66"},"PeriodicalIF":6.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144977754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.jaip.2025.10.049
Shamsa Naveed MBBS, MRCP (London), PhD
Obesity is one of the most prevalent comorbidities in adults with asthma and is consistently associated with greater symptom burden, reduced response to inhaled corticosteroids, and increased health care use. Despite this, structured obesity management remains an uncommon feature of routine asthma care. The study by Olayiwola et al,1 “Management of patients with comorbid asthma and obesity: a large language model evaluation of clinical documentation,” offers a timely and thought-provoking lens on this persistent gap between evidence and practice.
{"title":"Unlocking Asthma Control: Integrating Obesity Management Through Artificial Intelligence–Driven Insight","authors":"Shamsa Naveed MBBS, MRCP (London), PhD","doi":"10.1016/j.jaip.2025.10.049","DOIUrl":"10.1016/j.jaip.2025.10.049","url":null,"abstract":"<div><div>Obesity is one of the most prevalent comorbidities in adults with asthma and is consistently associated with greater symptom burden, reduced response to inhaled corticosteroids, and increased health care use. Despite this, structured obesity management remains an uncommon feature of routine asthma care. The study by Olayiwola et al,<span><span><sup>1</sup></span></span> “Management of patients with comorbid asthma and obesity: a large language model evaluation of clinical documentation,” offers a timely and thought-provoking lens on this persistent gap between evidence and practice.</div></div>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"14 1","pages":"Pages 151-152"},"PeriodicalIF":6.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145903976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.jaip.2025.11.019
James G. Krings MD, MSc , Hannu Kankaanranta MD, PhD
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