Pub Date : 2026-01-01DOI: 10.1016/j.jaip.2025.10.004
Oluwatobi Olayiwola MD , Richard Yang MBI , David Stein PhD , Liqin Wang PhD , Dinah Foer MD
Background
Obesity is a well-known asthma risk factor, and weight loss benefits asthma outcomes. Asthma guidelines recommend weight reduction as part of care; however, provider practices are not known.
Objective
To evaluate whether weight management is integrated into routine asthma care for patients with comorbid obesity.
Methods
We analyzed outpatient encounter notes from patients with both asthma and obesity seen by primary care, allergy/immunology, or pulmonary providers at a large health system between January 1, 2020, and September 30, 2023. Notes were extracted from electronic health records for visits with a primary asthma diagnosis. Using Generative Pretrained Transformer-4 Omni (GPT-4o), a large language model (LLM), we assessed documentation of (1) asthma management, (2) obesity management, (3) integration of obesity management into asthma care, and (4) specific weight management strategies. Inclusion rates were compared across specialties, and encounter-level predictors were identified. Chart review evaluated the performance of GPT-4o.
Results
Of 17,658 encounters (N = 8992 patients), only 12.6% included obesity management as part of asthma care, more frequently in subspecialty (11.0%) than in primary care (1.6%) settings. In adjusted models, male sex, middle age, higher body mass index, higher education, and pulmonology care increased odds of an encounter with obesity management linked to asthma care; oral steroid use decreased the odds. Obesity management strategies differed by specialty, though exercise and general weight counseling was common. GPT-4o demonstrated robust performance.
Conclusions
LLM evaluation of >17,000 encounters demonstrate that, in contrast to guidelines, weight management is infrequently addressed in asthma care. These results highlight actionable opportunities to improve asthma outcomes.
{"title":"Management of Patients With Comorbid Asthma and Obesity: A Large Language Model Evaluation of Clinical Documentation","authors":"Oluwatobi Olayiwola MD , Richard Yang MBI , David Stein PhD , Liqin Wang PhD , Dinah Foer MD","doi":"10.1016/j.jaip.2025.10.004","DOIUrl":"10.1016/j.jaip.2025.10.004","url":null,"abstract":"<div><h3>Background</h3><div>Obesity is a well-known asthma risk factor, and weight loss benefits asthma outcomes. Asthma guidelines recommend weight reduction as part of care; however, provider practices are not known.</div></div><div><h3>Objective</h3><div>To evaluate whether weight management is integrated into routine asthma care for patients with comorbid obesity.</div></div><div><h3>Methods</h3><div>We analyzed outpatient encounter notes from patients with both asthma and obesity seen by primary care, allergy/immunology, or pulmonary providers at a large health system between January 1, 2020, and September 30, 2023. Notes were extracted from electronic health records for visits with a primary asthma diagnosis. Using Generative Pretrained Transformer-4 Omni (GPT-4o), a large language model (LLM), we assessed documentation of (1) asthma management, (2) obesity management, (3) integration of obesity management into asthma care, and (4) specific weight management strategies. Inclusion rates were compared across specialties, and encounter-level predictors were identified. Chart review evaluated the performance of GPT-4o.</div></div><div><h3>Results</h3><div>Of 17,658 encounters (N = 8992 patients), only 12.6% included obesity management as part of asthma care, more frequently in subspecialty (11.0%) than in primary care (1.6%) settings. In adjusted models, male sex, middle age, higher body mass index, higher education, and pulmonology care increased odds of an encounter with obesity management linked to asthma care; oral steroid use decreased the odds. Obesity management strategies differed by specialty, though exercise and general weight counseling was common. GPT-4o demonstrated robust performance.</div></div><div><h3>Conclusions</h3><div>LLM evaluation of >17,000 encounters demonstrate that, in contrast to guidelines, weight management is infrequently addressed in asthma care. These results highlight actionable opportunities to improve asthma outcomes.</div></div>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"14 1","pages":"Pages 138-150.e6"},"PeriodicalIF":6.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145314176","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.2025.10.008
Christine R.F. Rukasin MD , Timothy G. Chow MD , Payge Van Stechelman DO , Allison E. Norton MD , Cosby A. Stone Jr. MD, MPH , Caroline Hoelker APRN , Kimberly Risma MD, PhD , Grace Koo MD
{"title":"Direct challenges are safe and effective in children with low-risk allergies to oral cephalosporins","authors":"Christine R.F. Rukasin MD , Timothy G. Chow MD , Payge Van Stechelman DO , Allison E. Norton MD , Cosby A. Stone Jr. MD, MPH , Caroline Hoelker APRN , Kimberly Risma MD, PhD , Grace Koo MD","doi":"10.1016/j.jaip.2025.10.008","DOIUrl":"10.1016/j.jaip.2025.10.008","url":null,"abstract":"","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"14 1","pages":"Pages 286-288.e1"},"PeriodicalIF":6.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145330887","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.2025.10.026
Tolly G. Epstein MD, MS , Karen Berendts BS , David I. Bernstein MD
Background
Protocols for adjusting allergy injection doses after gaps in therapy, and optimal intervals for maintenance injections, are based on expert opinion only.
Objective
To assess (1) incidences of systemic allergic reactions (SRs) to subcutaneous allergen immunotherapy (SCIT), (2) clinical practices that reduce the risk of SRs, (3) SCIT-related infections, and (4) risks associated with interruptions in SCIT.
Methods
From 2008 to 2023, members of the American Academy of Allergy, Asthma & Immunology and the American College of Allergy, Asthma, & Immunology completed annual surveys of SCIT-related SRs; SCIT-related infections were assessed since 2014. Questions were added in 2020 regarding dose adjustment after gaps in immunotherapy, and maintenance intervals prescribed.
Results
Data were gathered on 84.1 million injection visits and 4.9 million patients (2008-2023). Four new SCIT-related fatalities were confirmed (2018-2023). One contaminated vial, resulting in 2 local skin infections, was identified (2014-2023). Practices reducing to 1 vial lower in patients who were more than 7 weeks late for maintenance vial injections had fewer grade 4 SRs (P = .02). Practices decreasing to the next lower vial in patients who were more than 28 days late during buildup had fewer grade 3 and 4 SRs (P = .03). For the period from 2021 to 2022, there was an increased rate of total (P < .0001), grade 2 (P < .0001), and grade 3 SRs (P = .0005) for practices that used a maintenance injection interval longer than 4 weeks.
Conclusions
Fatal reactions to SCIT still rarely occur. The risk of infections from SCIT is extremely low. Controlled studies are needed to define optimal dose adjustment strategies after gaps in therapy as well as the safest, most efficacious maintenance intervals for aeroallergen SCIT.
{"title":"Impact of Dose Adjustment After Gaps in Subcutaneous Immunotherapy: Update From the North American Immunotherapy Surveillance Study (2008-2023)","authors":"Tolly G. Epstein MD, MS , Karen Berendts BS , David I. Bernstein MD","doi":"10.1016/j.jaip.2025.10.026","DOIUrl":"10.1016/j.jaip.2025.10.026","url":null,"abstract":"<div><h3>Background</h3><div>Protocols for adjusting allergy injection doses after gaps in therapy, and optimal intervals for maintenance injections, are based on expert opinion only.</div></div><div><h3>Objective</h3><div>To assess (1) incidences of systemic allergic reactions (SRs) to subcutaneous allergen immunotherapy (SCIT), (2) clinical practices that reduce the risk of SRs, (3) SCIT-related infections, and (4) risks associated with interruptions in SCIT.</div></div><div><h3>Methods</h3><div>From 2008 to 2023, members of the American Academy of Allergy, Asthma & Immunology and the American College of Allergy, Asthma, & Immunology completed annual surveys of SCIT-related SRs; SCIT-related infections were assessed since 2014. Questions were added in 2020 regarding dose adjustment after gaps in immunotherapy, and maintenance intervals prescribed.</div></div><div><h3>Results</h3><div>Data were gathered on 84.1 million injection visits and 4.9 million patients (2008-2023). Four new SCIT-related fatalities were confirmed (2018-2023). One contaminated vial, resulting in 2 local skin infections, was identified (2014-2023). Practices reducing to 1 vial lower in patients who were more than 7 weeks late for maintenance vial injections had fewer grade 4 SRs (<em>P</em> = .02). Practices decreasing to the next lower vial in patients who were more than 28 days late during buildup had fewer grade 3 and 4 SRs (<em>P</em> = .03). For the period from 2021 to 2022, there was an increased rate of total (<em>P</em> < .0001), grade 2 (<em>P</em> < .0001), and grade 3 SRs (<em>P</em> = .0005) for practices that used a maintenance injection interval longer than 4 weeks.</div></div><div><h3>Conclusions</h3><div>Fatal reactions to SCIT still rarely occur. The risk of infections from SCIT is extremely low. Controlled studies are needed to define optimal dose adjustment strategies after gaps in therapy as well as the safest, most efficacious maintenance intervals for aeroallergen SCIT.</div></div>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"14 1","pages":"Pages 253-259.e2"},"PeriodicalIF":6.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145423321","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.2025.10.037
Meera Patel BS , Chen Wang MD , Amanda Urban DNP , Iris Martin BS , Jean Ulrick RN , Susan Roy RN , Kirsten Zambell PhD , Anjali Rai MD , David E. Kleiner MD, PhD , Jatin Raj Matta DHSc , Nader S. Metwalli PhD , Ronald Ouwerkerk PhD , Ami Makadia BS , Theo Heller MD , Ahmed M. Gharib MD , Alexandra F. Freeman MD
{"title":"Obesity and hepatic steatosis in STAT3 hyper-IgE syndrome","authors":"Meera Patel BS , Chen Wang MD , Amanda Urban DNP , Iris Martin BS , Jean Ulrick RN , Susan Roy RN , Kirsten Zambell PhD , Anjali Rai MD , David E. Kleiner MD, PhD , Jatin Raj Matta DHSc , Nader S. Metwalli PhD , Ronald Ouwerkerk PhD , Ami Makadia BS , Theo Heller MD , Ahmed M. Gharib MD , Alexandra F. Freeman MD","doi":"10.1016/j.jaip.2025.10.037","DOIUrl":"10.1016/j.jaip.2025.10.037","url":null,"abstract":"","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"14 1","pages":"Pages 303-305.e1"},"PeriodicalIF":6.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145453884","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.2025.10.043
Natasha Correa MD , Jennifer Namazy MD
{"title":"Pharmacological Management of Severe Asthma in Pregnancy","authors":"Natasha Correa MD , Jennifer Namazy MD","doi":"10.1016/j.jaip.2025.10.043","DOIUrl":"10.1016/j.jaip.2025.10.043","url":null,"abstract":"","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"14 1","pages":"Pages 313-314.e22"},"PeriodicalIF":6.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145903930","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.2025.10.001
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}
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