Pub Date : 2025-03-01DOI: 10.1016/j.jaip.2025.01.027
{"title":"Cough Reflex Hypersensitivity as a Key Treatable Trait","authors":"","doi":"10.1016/j.jaip.2025.01.027","DOIUrl":"10.1016/j.jaip.2025.01.027","url":null,"abstract":"","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"13 3","pages":"Page 479"},"PeriodicalIF":8.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143549081","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 : 2025-03-01DOI: 10.1016/S2213-2198(25)00104-7
{"title":"Original Article Highlights From This Issue","authors":"","doi":"10.1016/S2213-2198(25)00104-7","DOIUrl":"10.1016/S2213-2198(25)00104-7","url":null,"abstract":"","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"13 3","pages":"Pages A11-A14"},"PeriodicalIF":8.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143549175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Chronic rhinosinusitis and the development of non-cystic fibrosis bronchiectasis","authors":"Nien-Yi Wu RN , Hui-Chin Chang MLS , Shuo-Yan Gau MD, FRSPH","doi":"10.1016/j.jaip.2025.01.008","DOIUrl":"10.1016/j.jaip.2025.01.008","url":null,"abstract":"","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"13 3","pages":"Page 720"},"PeriodicalIF":8.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143549238","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 : 2025-03-01DOI: 10.1016/j.jaip.2024.11.016
Grace Hardwick BS , Twan Sia BA , Leeon Bacchus BA , Xiaolin Jia MD , Andrew R. Chin PhD , Nasim Khavari MD , Marwa Abu El Haija MD , Sean McGhee MD , R. Sharon Chinthrajah MD , John Leung MD , Sayantani B. Sindher MD
{"title":"Management of eosinophilic esophagitis in pediatric patients undergoing oral immunotherapy for food allergies: A 2-center case series","authors":"Grace Hardwick BS , Twan Sia BA , Leeon Bacchus BA , Xiaolin Jia MD , Andrew R. Chin PhD , Nasim Khavari MD , Marwa Abu El Haija MD , Sean McGhee MD , R. Sharon Chinthrajah MD , John Leung MD , Sayantani B. Sindher MD","doi":"10.1016/j.jaip.2024.11.016","DOIUrl":"10.1016/j.jaip.2024.11.016","url":null,"abstract":"","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"13 3","pages":"Pages 702-704"},"PeriodicalIF":8.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774307","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}
Ibuprofen is a main cause of drug hypersensitivity reactions in children. The gold standard for diagnosis is the drug provocation test (DPT).
Objective
We aimed to create a clinical risk-stratification tool to guide this high-risk procedure.
Methods
We prospectively recruited children with suspected ibuprofen hypersensitivity between January 2017 and March 2024. Using stepwise bidirectional multivariable logistic regression, we calculated a predictive score for a positive ibuprofen DPT.
Results
Eighty-two patients with a median age of 5.9 years (interquartile range: 3.4-11.1 years) had an ibuprofen DPT. Eighteen (22.0%) patients had a positive challenge, with an anaphylactic reaction for 11 (61.1%). The I3A score (acronym for ibuprofen, 3As: angioedema, anaphylaxis, age, cutoff of 3) encompasses the following items: angioedema (2 points), anaphylaxis (1 point), and age at reaction ≥10 years old (1 point). The area under the curve of the I3A score was 0.84, and the optimal cutoff of <3 conferred a sensitivity of 84.4% (95% confidence interval [CI]: 66.7%-100.0%) and a specificity of 83.3% (95% CI: 75.0%-92.2%). The negative predictive value was estimated at 94.7% (95% CI: 90.0%-100.0%), and the positive predictive value at 60.0% (95% CI: 46.2%-76.2%). The relative risk of reacting to a challenge in the group I3A 3-4 compared with 0-2 was 11.4 (95% CI: 3.62%-35.7%, P < .001). Anaphylaxis after DPT was observed in 9 of 25 (36.0% [95% CI: 16.0%-56.0%]) in the high-risk group as compared with 2 of 57 (3.5% [95% CI: 0.0%-8.8%]) in the low-risk group (relative risk 10.3 [95% CI: 2.4%-43.5%]).
Conclusions
We generated a risk-stratification tool to identify children at low risk of reacting to ibuprofen challenges. Further validation is required in external cohorts.
{"title":"Guiding Drug Provocation Testing for Ibuprofen Hypersensitivity in a Pediatric Population: Development of the I3A Risk-Stratification Tool","authors":"Florian Stehlin MD , Connor Prosty MD , Angela Mulé BSc , Ibtihal Al-Otaibi MD , Luca Delli Colli MD , Judy Gaffar MD , Joshua Yu MD , Derek Lanoue MD, MEcon , Ana-Maria Copaescu MD , Moshe Ben-Shoshan MD, MSc","doi":"10.1016/j.jaip.2024.11.022","DOIUrl":"10.1016/j.jaip.2024.11.022","url":null,"abstract":"<div><h3>Background</h3><div>Ibuprofen is a main cause of drug hypersensitivity reactions in children. The gold standard for diagnosis is the drug provocation test (DPT).</div></div><div><h3>Objective</h3><div>We aimed to create a clinical risk-stratification tool to guide this high-risk procedure.</div></div><div><h3>Methods</h3><div>We prospectively recruited children with suspected ibuprofen hypersensitivity between January 2017 and March 2024. Using stepwise bidirectional multivariable logistic regression, we calculated a predictive score for a positive ibuprofen DPT.</div></div><div><h3>Results</h3><div>Eighty-two patients with a median age of 5.9 years (interquartile range: 3.4-11.1 years) had an ibuprofen DPT. Eighteen (22.0%) patients had a positive challenge, with an anaphylactic reaction for 11 (61.1%). The I3A score (acronym for ibuprofen, 3As: angioedema, anaphylaxis, age, cutoff of 3) encompasses the following items: angioedema (2 points), anaphylaxis (1 point), and age at reaction ≥10 years old (1 point). The area under the curve of the I3A score was 0.84, and the optimal cutoff of <3 conferred a sensitivity of 84.4% (95% confidence interval [CI]: 66.7%-100.0%) and a specificity of 83.3% (95% CI: 75.0%-92.2%). The negative predictive value was estimated at 94.7% (95% CI: 90.0%-100.0%), and the positive predictive value at 60.0% (95% CI: 46.2%-76.2%). The relative risk of reacting to a challenge in the group I3A 3-4 compared with 0-2 was 11.4 (95% CI: 3.62%-35.7%, <em>P</em> < .001). Anaphylaxis after DPT was observed in 9 of 25 (36.0% [95% CI: 16.0%-56.0%]) in the high-risk group as compared with 2 of 57 (3.5% [95% CI: 0.0%-8.8%]) in the low-risk group (relative risk 10.3 [95% CI: 2.4%-43.5%]).</div></div><div><h3>Conclusions</h3><div>We generated a risk-stratification tool to identify children at low risk of reacting to ibuprofen challenges. Further validation is required in external cohorts.</div></div>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"13 3","pages":"Pages 583-593.e3"},"PeriodicalIF":8.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.jaip.2024.12.021
Ha Young Jang PhD , Boyoon Choi PhD , In-Wha Kim PhD , Hye Ryun Kang MD, PhD , Jung Mi Oh PharmD
Background
The development of hypersensitivity reactions (HSRs) to carboplatin can interrupt anticancer treatment and may shorten patient survival. Several studies have evaluated the risk factors for carboplatin HSRs, but the results have been inconclusive.
Objective
This systematic review and meta-analysis aimed to establish a consensus on the risk factors of HSRs to carboplatin in patients with cancer.
Methods
Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, relevant studies were searched across MEDLINE, Embase, and Korean Medical Database. Inclusion criteria focused on original articles of case-control or cohort studies that evaluated risk factors for carboplatin HSRs in patients with cancer. Exclusion criteria targeted articles with incomplete or overlapping data. The latest search and quality assessment of the included studies, using the Newcastle-Ottawa scale, was performed on February 1, 2023.
Results
Among 1,182 articles identified, 19 studies were included in the final systematic review and meta-analysis. The identified risk factors for carboplatin hypersensitivity included a history of allergy to medicines, food, or environmental factors (odds ratio [OR] = 1.76; 95% CI, 1.46-2.12), BRCA mutation (OR = 4.03; 95% CI, 2.00-8.13), carboplatin free interval of 12 months or more (OR = 4.93; 95% CI, 2.89-8.40), increased cumulative dose (standardized mean difference, 0.58; 95% CI, 0.41-0.75), relapse (OR = 2.26; 95% CI, 1.58-3.25), and younger age (standardized mean difference, –0.15; 95% CI, –0.26 to –0.03).
Conclusions
To our knowledge, this meta-analysis provides the first comprehensive quantitative evaluation of risk factors for carboplatin HSRs in patients with cancer. These findings can guide the development of personalized risk assessment tools and preventive strategies, potentially improving patient safety and treatment outcomes in carboplatin-based chemotherapy.
{"title":"Risk Factors of Hypersensitivity Reactions to Carboplatin: A Systematic Review and Meta-Analysis","authors":"Ha Young Jang PhD , Boyoon Choi PhD , In-Wha Kim PhD , Hye Ryun Kang MD, PhD , Jung Mi Oh PharmD","doi":"10.1016/j.jaip.2024.12.021","DOIUrl":"10.1016/j.jaip.2024.12.021","url":null,"abstract":"<div><h3>Background</h3><div>The development of hypersensitivity reactions (HSRs) to carboplatin can interrupt anticancer treatment and may shorten patient survival. Several studies have evaluated the risk factors for carboplatin HSRs, but the results have been inconclusive.</div></div><div><h3>Objective</h3><div>This systematic review and meta-analysis aimed to establish a consensus on the risk factors of HSRs to carboplatin in patients with cancer.</div></div><div><h3>Methods</h3><div>Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, relevant studies were searched across MEDLINE, Embase, and Korean Medical Database. Inclusion criteria focused on original articles of case-control or cohort studies that evaluated risk factors for carboplatin HSRs in patients with cancer. Exclusion criteria targeted articles with incomplete or overlapping data. The latest search and quality assessment of the included studies, using the Newcastle-Ottawa scale, was performed on February 1, 2023.</div></div><div><h3>Results</h3><div>Among 1,182 articles identified, 19 studies were included in the final systematic review and meta-analysis. The identified risk factors for carboplatin hypersensitivity included a history of allergy to medicines, food, or environmental factors (odds ratio [OR] = 1.76; 95% CI, 1.46-2.12), <em>BRCA</em> mutation (OR = 4.03; 95% CI, 2.00-8.13), carboplatin free interval of 12 months or more (OR = 4.93; 95% CI, 2.89-8.40), increased cumulative dose (standardized mean difference, 0.58; 95% CI, 0.41-0.75), relapse (OR = 2.26; 95% CI, 1.58-3.25), and younger age (standardized mean difference, –0.15; 95% CI, –0.26 to –0.03).</div></div><div><h3>Conclusions</h3><div>To our knowledge, this meta-analysis provides the first comprehensive quantitative evaluation of risk factors for carboplatin HSRs in patients with cancer. These findings can guide the development of personalized risk assessment tools and preventive strategies, potentially improving patient safety and treatment outcomes in carboplatin-based chemotherapy.</div></div>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"13 3","pages":"Pages 610-618.e10"},"PeriodicalIF":8.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142900242","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 : 2025-03-01DOI: 10.1016/j.jaip.2025.02.028
Jessica Oh, Evelyn Capellan Vasquez, Santiago Alvarez-Arango, Manish Ramesh, Mariana C Castells
The transformative discovery of insulin in the early 20th century followed by its rapid clinical implementation was initially complicated by high rates of hypersensitivity reactions. Improvements in purification methods and the transition from animal-derived sources to human insulin products has significantly lowered, though not eliminated, hypersensitivity reactions to insulin products. Although considered rare adverse reactions to insulin, hypersensitivity reactions and immune-mediated manifestations continue to occur in patients requiring insulin treatment. This has broad implications given that approximately 11.6% of the United States population has a diagnosis of diabetes and 8.4 million Americans rely on insulin for survival.(1) Given the scope and impact of insulin as a life-saving treatment for patients with diabetes, it is important for allergists to appropriately evaluate, diagnose, and manage patients with hypersensitivity reactions to insulin. Recognizing early manifestations of insulin hypersensitivity is the first step in providing prompt and targeted management in these complex cases. The following article aims to summarize the allergist's recommend approach to insulin hypersensitivity reactions, including type I IgE-mediated, type III immune-complex mediated, type IV T-cell mediated hypersensitivity reactions, as well as additional immune-mediated manifestations of insulin therapy such as lipoatrophy and insulin auto-antibodies. Furthermore, the authors emphasize approaching insulin hypersensitivity cases with a broad differential diagnosis, which includes hypoglycemia, anaphylaxis mimics, hypersensitivity to excipients and medical devices, and cutaneous manifestations of diabetes.
{"title":"Insulin Allergy: The Allergist's Updated Approach to Evaluation and Management.","authors":"Jessica Oh, Evelyn Capellan Vasquez, Santiago Alvarez-Arango, Manish Ramesh, Mariana C Castells","doi":"10.1016/j.jaip.2025.02.028","DOIUrl":"https://doi.org/10.1016/j.jaip.2025.02.028","url":null,"abstract":"<p><p>The transformative discovery of insulin in the early 20<sup>th</sup> century followed by its rapid clinical implementation was initially complicated by high rates of hypersensitivity reactions. Improvements in purification methods and the transition from animal-derived sources to human insulin products has significantly lowered, though not eliminated, hypersensitivity reactions to insulin products. Although considered rare adverse reactions to insulin, hypersensitivity reactions and immune-mediated manifestations continue to occur in patients requiring insulin treatment. This has broad implications given that approximately 11.6% of the United States population has a diagnosis of diabetes and 8.4 million Americans rely on insulin for survival.(1) Given the scope and impact of insulin as a life-saving treatment for patients with diabetes, it is important for allergists to appropriately evaluate, diagnose, and manage patients with hypersensitivity reactions to insulin. Recognizing early manifestations of insulin hypersensitivity is the first step in providing prompt and targeted management in these complex cases. The following article aims to summarize the allergist's recommend approach to insulin hypersensitivity reactions, including type I IgE-mediated, type III immune-complex mediated, type IV T-cell mediated hypersensitivity reactions, as well as additional immune-mediated manifestations of insulin therapy such as lipoatrophy and insulin auto-antibodies. Furthermore, the authors emphasize approaching insulin hypersensitivity cases with a broad differential diagnosis, which includes hypoglycemia, anaphylaxis mimics, hypersensitivity to excipients and medical devices, and cutaneous manifestations of diabetes.</p>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":" ","pages":""},"PeriodicalIF":8.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544398","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 : 2025-03-01DOI: 10.1016/S2213-2198(25)00108-4
{"title":"March 2025 Practice Notes","authors":"","doi":"10.1016/S2213-2198(25)00108-4","DOIUrl":"10.1016/S2213-2198(25)00108-4","url":null,"abstract":"","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"13 3","pages":"Pages A19-A20"},"PeriodicalIF":8.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143549178","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}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号