Pub Date : 2024-11-01DOI: 10.1016/j.jaip.2024.05.050
Jui-En Lo MD , Yen-Hsi Huang MD , Neil Bhattacharyya MD, FACS , Eric Alan Moulton OD, PhD , Kevin Sheng-Kai Ma DDS, FRSPH, FRSM
Background
The relationship between keratoconus and various allergic diseases has been a subject of controversy.
Objective
In the present study, a systematic review and meta-analysis was conducted to investigate the association between allergic rhinitis (AR) and keratoconus.
Methods
Relevant and eligible studies from PubMed, Web of Science, and the Cochrane Library were systematically reviewed to evaluate the association between AR and keratoconus. Observational studies that reported the number of patients with and without keratoconus, as well as the number of patients with keratoconus diagnosed with or without AR, were included. Two reviewers independently screened eligible studies and extracted data. A bivariate meta-analysis was conducted to calculate the pooled odds ratio of keratoconus in patients with versus without AR. A sensitivity analysis was performed using the adjusted odds ratio reported in the included studies to validate the findings.
Results
Seven studies involving 775,574 participants were included in the meta-analysis. Among them, 29,082 patients had keratoconus. The pooled odds ratio of keratoconus in patients with AR was 1.71 (95% confidence interval [CI]: 1.36-2.15; P < .001; I2 = 96%), and the pooled adjusted odds ratio was 1.72 (95% CI: 1.23-2.40; P = .001; I2 = 97%).
Conclusions
Patients with AR have significantly higher odds of keratoconus than those without AR. Future studies are warranted to investigate the causal relationship and evaluate the cost-effectiveness of early screening, using methods such as corneal topography, and referral for keratoconus in patients with AR.
背景：角膜炎与各种过敏性疾病之间的关系一直存在争议：角膜塑形镜与各种过敏性疾病之间的关系一直存在争议：本研究对过敏性鼻炎（AR）与角膜炎之间的关系进行了系统回顾和荟萃分析：方法：系统回顾了 PubMed、Web of Science 和 Cochrane Library 中符合条件的相关研究，以评估 AR 与角膜炎之间的关联。纳入的观察性研究包含角膜病患者和非角膜病患者的人数，以及被诊断出患有或未患有 AR 的角膜病患者的人数。两名审稿人独立筛选符合条件的研究，并从纳入的研究中提取数据。我们进行了一项双变量荟萃分析，以比较有 AR 和无 AR 患者发生角膜炎的几率。主要结果是有 AR 患者发生角膜炎的几率。为了验证研究结果，使用纳入研究中报告的调整后几率进行了敏感性测试：本次荟萃分析共纳入了七项研究，涉及 775,574 名参与者。其中，29082 名患者患有角膜炎。AR患者发生角膜炎的汇总几率比为1.71（95%置信区间[CI]：1.36-2.15；P < 0.001；I2 = 96%），汇总调整几率比为1.72（95% CI：1.23-2.40；P = 0.001；I2 = 97%）：结论：有AR的患者发生角膜炎的几率明显高于无AR的患者。今后有必要开展研究，以调查因果关系，并评估使用角膜地形图等方法进行早期筛查和转诊角膜塑形镜患者的成本效益。
{"title":"Allergic Rhinitis and Keratoconus: A Systematic Review and Meta-Analysis","authors":"Jui-En Lo MD , Yen-Hsi Huang MD , Neil Bhattacharyya MD, FACS , Eric Alan Moulton OD, PhD , Kevin Sheng-Kai Ma DDS, FRSPH, FRSM","doi":"10.1016/j.jaip.2024.05.050","DOIUrl":"10.1016/j.jaip.2024.05.050","url":null,"abstract":"<div><h3>Background</h3><div>The relationship between keratoconus and various allergic diseases has been a subject of controversy.</div></div><div><h3>Objective</h3><div>In the present study, a systematic review and meta-analysis was conducted to investigate the association between allergic rhinitis (AR) and keratoconus.</div></div><div><h3>Methods</h3><div>Relevant and eligible studies from PubMed, Web of Science, and the Cochrane Library were systematically reviewed to evaluate the association between AR and keratoconus. Observational studies that reported the number of patients with and without keratoconus, as well as the number of patients with keratoconus diagnosed with or without AR, were included. Two reviewers independently screened eligible studies and extracted data. A bivariate meta-analysis was conducted to calculate the pooled odds ratio of keratoconus in patients with versus without AR. A sensitivity analysis was performed using the adjusted odds ratio reported in the included studies to validate the findings.</div></div><div><h3>Results</h3><div>Seven studies involving 775,574 participants were included in the meta-analysis. Among them, 29,082 patients had keratoconus. The pooled odds ratio of keratoconus in patients with AR was 1.71 (95% confidence interval [CI]: 1.36-2.15; P < .001; I<sup>2</sup> = 96%), and the pooled adjusted odds ratio was 1.72 (95% CI: 1.23-2.40; P = .001; I<sup>2</sup> = 97%).</div></div><div><h3>Conclusions</h3><div>Patients with AR have significantly higher odds of keratoconus than those without AR. Future studies are warranted to investigate the causal relationship and evaluate the cost-effectiveness of early screening, using methods such as corneal topography, and referral for keratoconus in patients with AR.</div></div>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"12 11","pages":"Pages 3096-3104"},"PeriodicalIF":8.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141293936","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}
A safe and pragmatic guide for labelling and delabelling patients with suspected penicillin allergy is mandatory.
Objective
To compare the performance of 4 penicillin-allergy prediction strategies in a large independent cohort.
Methods
We conducted a retrospective study for subjects presenting between January 2014 and December 2021 at the University Hospital of Montpellier, with a history of hypersensitivity to penicillins. The outcome targeted by the study was a positive penicillin-allergy test.
Results
Of the 1,884 participants included, 382 (20.3%) had positive penicillin-allergy tests. The ENDA (European Network on Drug Allergy) and Blumenthal strategies yielded relatively high sensitivities and low specificities and, by design, did not misclassify any positive subjects with severe index reactions. The PEN-FAST <3 score had a negative predictive value of 90% (95% confidence interval [95% CI] 88%–91%), with a sensitivity of 66% (95% CI 62%–71%) and a specificity of 73% (95% CI 71%–75%), and incorrectly delabelled 18 subjects with anaphylaxis and 15 with other severe nonimmediate reactions. For the adapted Chiriac score, the specificity corresponding to 66% sensitivity was 73% (95% CI 70%–75%). Conversely, at a 73% specificity threshold, the sensitivity was 65% (95% CI, 61%–70%). Attempts to improve these prediction algorithms did not substantially enhance performance.
Conclusions
The ENDA and Blumenthal strategies are safe for high-risk subjects, but their delabelling effectiveness is limited, leading to unnecessary avoidance. Conversely, the PEN-FAST and Chiriac scores are performant in delabelling, but more frequently misclassify high-risk subjects with positive penicillin-allergy tests. Selection of the most appropriate tool requires careful consideration of the target population and the desired goal.
{"title":"Comparative Performance of 4 Penicillin-Allergy Prediction Strategies in a Large Cohort","authors":"Ileana-Maria Ghiordanescu MD , Iuliana Ciocănea-Teodorescu PhD , Nicolas Molinari PhD , Anais Jelen DPharm , Omar Al-Ali MD , Rik Schrijvers PhD , Pascal Demoly PhD , Anca Mirela Chiriac PhD","doi":"10.1016/j.jaip.2024.07.012","DOIUrl":"10.1016/j.jaip.2024.07.012","url":null,"abstract":"<div><h3>Background</h3><div>A safe and pragmatic guide for labelling and delabelling patients with suspected penicillin allergy is mandatory.</div></div><div><h3>Objective</h3><div>To compare the performance of 4 penicillin-allergy prediction strategies in a large independent cohort.</div></div><div><h3>Methods</h3><div>We conducted a retrospective study for subjects presenting between January 2014 and December 2021 at the University Hospital of Montpellier, with a history of hypersensitivity to penicillins. The outcome targeted by the study was a positive penicillin-allergy test.</div></div><div><h3>Results</h3><div>Of the 1,884 participants included, 382 (20.3%) had positive penicillin-allergy tests. The ENDA (European Network on Drug Allergy) and Blumenthal strategies yielded relatively high sensitivities and low specificities and, by design, did not misclassify any positive subjects with severe index reactions. The PEN-FAST <3 score had a negative predictive value of 90% (95% confidence interval [95% CI] 88%–91%), with a sensitivity of 66% (95% CI 62%–71%) and a specificity of 73% (95% CI 71%–75%), and incorrectly delabelled 18 subjects with anaphylaxis and 15 with other severe nonimmediate reactions. For the adapted Chiriac score, the specificity corresponding to 66% sensitivity was 73% (95% CI 70%–75%). Conversely, at a 73% specificity threshold, the sensitivity was 65% (95% CI, 61%–70%). Attempts to improve these prediction algorithms did not substantially enhance performance.</div></div><div><h3>Conclusions</h3><div>The ENDA and Blumenthal strategies are safe for high-risk subjects, but their delabelling effectiveness is limited, leading to unnecessary avoidance. Conversely, the PEN-FAST and Chiriac scores are performant in delabelling, but more frequently misclassify high-risk subjects with positive penicillin-allergy tests. Selection of the most appropriate tool requires careful consideration of the target population and the desired goal.</div></div>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"12 11","pages":"Pages 2985-2993"},"PeriodicalIF":8.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141749631","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 : 2024-11-01DOI: 10.1016/j.jaip.2024.07.022
Alexei Gonzalez-Estrada MD , Ismael Carrillo-Martin MD , W. Tatiana Garzon-Siatoya MD , Hajara Joundi MD , Dan Morgenstern-Kaplan MD, MS , J. Ross Renew MD , H. Ross Powers MD , Jared D. Nelson DO , Wendelyn Bosch MD , Kevin L. Epps PharmD, RPh , Aurora Gonzalez-Estrada MD , Susan Kinate PA-C , Matthew A. Rank MD , Christine R.F. Rukasin MD , Gerald W. Volcheck MD , Miguel Park MD
Background
Maximal skin testing (ST) nonirritant concentrations (NICs) are consistent for penicillin and aminopenicillin among guidelines. However, there is variability among guidelines for maximal ST NICs of cephalosporins.
Objective
To determine maximal immediate and delayed ST NICs of 15 β-lactams in β-lactam-tolerant and β-lactam-naïve participants.
Methods
We performed a single-center, nonrandomized prospective study between September 2019 and January 2022 in adult participants. Participants received skin prick testing (SPT) and intradermal test (IDT) injections at 6 increasing concentrations of 1 or more β-lactams. A concentration was considered irritant when more than 5% of participants had a positive test. A positive test was defined as a wheal ≥3 mm compared with negative control accompanied by a ≥5 mm flare for SPT/IDT and induration ≥5 mm with associated erythema at 48 hours for delayed readings (dIDT). Sensitivity analyses using 3 alternative IDT positive criteria were conducted.
Results
A total of 747 participants with a median age of 64 (interquartile range: 54-72) years (52% male, 85% White, and 92% non-Hispanic) underwent 20,858 skin tests. All undiluted SPT concentrations were nonirritant. We found the following maximal IDT/dIDT NICs (mg/mL): ampicillin (41.6/125), ampicillin-sulbactam (93.8/187.5), aztreonam (6.3/25), cefazolin (55/165), cefepime (35/140), cefoxitin (45/90), ceftaroline (7.5/15), ceftriaxone (58.3/175), cefuroxime (55/110), ertapenem (16.6/50), imipenem-cilastin (6.3/25), meropenem (8.3/25), nafcillin (31.3/62.5), oxacillin (20.9/83.5), and piperacillin-tazobactam (112.5/225). dIDTs were almost all completely nonirritant close to or at undiluted concentrations. There were no differences when we applied 3 IDT positivity criteria to our raw data.
Conclusions
Our results suggest that SPTs with undiluted stock β-lactam antibiotic concentrations are nonirritant. Compared with previously published nonirritant concentrations, we propose a 2- to 50-fold increase to the maximal IDT and dIDT NICs of 15 β-lactam antibiotics. When performing dIDTs, a higher concentration should be used rather than the same IDT concentration.
{"title":"The Immediate and Delayed Maximal Nonirritating Skin Testing Concentrations of β-Lactam Antibiotics","authors":"Alexei Gonzalez-Estrada MD , Ismael Carrillo-Martin MD , W. Tatiana Garzon-Siatoya MD , Hajara Joundi MD , Dan Morgenstern-Kaplan MD, MS , J. Ross Renew MD , H. Ross Powers MD , Jared D. Nelson DO , Wendelyn Bosch MD , Kevin L. Epps PharmD, RPh , Aurora Gonzalez-Estrada MD , Susan Kinate PA-C , Matthew A. Rank MD , Christine R.F. Rukasin MD , Gerald W. Volcheck MD , Miguel Park MD","doi":"10.1016/j.jaip.2024.07.022","DOIUrl":"10.1016/j.jaip.2024.07.022","url":null,"abstract":"<div><h3>Background</h3><div>Maximal skin testing (ST) nonirritant concentrations (NICs) are consistent for penicillin and aminopenicillin among guidelines. However, there is variability among guidelines for maximal ST NICs of cephalosporins.</div></div><div><h3>Objective</h3><div>To determine maximal immediate and delayed ST NICs of 15 β-lactams in β-lactam-tolerant and β-lactam-naïve participants.</div></div><div><h3>Methods</h3><div>We performed a single-center, nonrandomized prospective study between September 2019 and January 2022 in adult participants. Participants received skin prick testing (SPT) and intradermal test (IDT) injections at 6 increasing concentrations of 1 or more β-lactams. A concentration was considered irritant when more than 5% of participants had a positive test. A positive test was defined as a wheal ≥3 mm compared with negative control accompanied by a ≥5 mm flare for SPT/IDT and induration ≥5 mm with associated erythema at 48 hours for delayed readings (dIDT). Sensitivity analyses using 3 alternative IDT positive criteria were conducted.</div></div><div><h3>Results</h3><div>A total of 747 participants with a median age of 64 (interquartile range: 54-72) years (52% male, 85% White, and 92% non-Hispanic) underwent 20,858 skin tests. All undiluted SPT concentrations were nonirritant. We found the following maximal IDT/dIDT NICs (mg/mL): ampicillin (41.6/125), ampicillin-sulbactam (93.8/187.5), aztreonam (6.3/25), cefazolin (55/165), cefepime (35/140), cefoxitin (45/90), ceftaroline (7.5/15), ceftriaxone (58.3/175), cefuroxime (55/110), ertapenem (16.6/50), imipenem-cilastin (6.3/25), meropenem (8.3/25), nafcillin (31.3/62.5), oxacillin (20.9/83.5), and piperacillin-tazobactam (112.5/225). dIDTs were almost all completely nonirritant close to or at undiluted concentrations. There were no differences when we applied 3 IDT positivity criteria to our raw data.</div></div><div><h3>Conclusions</h3><div>Our results suggest that SPTs with undiluted stock β-lactam antibiotic concentrations are nonirritant. Compared with previously published nonirritant concentrations, we propose a 2- to 50-fold increase to the maximal IDT and dIDT NICs of 15 β-lactam antibiotics. When performing dIDTs, a higher concentration should be used rather than the same IDT concentration.</div></div>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"12 11","pages":"Pages 3016-3024.e14"},"PeriodicalIF":8.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141876656","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 : 2024-11-01DOI: 10.1016/j.jaip.2024.07.028
Siyan Lyu MS , Eric T. Oliver MD , Melanie C. Dispenza MD, PhD , Kristin L. Chichester MS , Jennifer Hoffman NP , Donald W. MacGlashan MD, PhD , N. Franklin Adkinson MD , Elizabeth J. Phillips MD , Santiago Alvarez-Arango MD
Background
Vancomycin infusion reaction (VIR), reportedly mediated through Mas-Related G Protein–Coupled Receptor-X2, is the primary vancomycin-induced immediate drug reaction. Clinically, distinguishing the underlying drug-induced immediate drug reaction mechanisms is crucial for future treatment strategies, including drug restriction, re-administration, and pretreatment considerations. However, the lack of validated diagnostic tests makes this challenging, often leading to unnecessary drug restriction.
Objective
To determine whether intradermal tests (IDTs) and, separately, the basophil activation test (BAT) differentiate VIR from vancomycin-tolerant subjects.
Methods
This was a cross-sectional study of vancomycin-exposed adults with and without a history of VIR. Data on demographics, allergy-related comorbidities, history of vancomycin exposures, and VIR characteristics were collected. IDT with vancomycin was performed. IDT dose-response EC50, IDT-related local symptoms, and BAT results were compared between groups.
Results
A total of 11 VIR and 10 vancomycin-tolerant subjects were enrolled. The most reported VIR symptoms were pruritus (82%), flushing (82%), hives (46%), angioedema (27%), and dyspnea (19%). The IDT dose-response mean EC50 was 328 μg/mL (95% CI, 296-367) in the VIR versus 1166 μg/mL (95% CI, 1029-1379) in the tolerant group (P < .0001). All VIR subjects reported IDT-related local pruritus compared with 60% of tolerant subjects (P = .0185). The %CD63+ basophils were consistently less than 2%, without significant differences between groups (P < .54).
Conclusions
Variations in skin test methodologies could help identify other immediate drug reaction mechanisms beyond IgE. This skin test protocol holds the potential for identifying VIR, particularly in cases where patients have received multiple drugs while BAT is insufficient. Future studies will validate and delineate its predictive value, assessing the risk of VIR.
背景：据报道，万古霉素输注反应（VIR）是通过马氏相关 G 蛋白偶联受体-X2（MRGPRX2）介导的，是万古霉素诱导的主要即时药物反应（IDR）。在临床上，区分药物诱导即刻药物反应的基本机制对于未来的治疗策略至关重要，包括药物限制、重新给药和预处理注意事项。然而，由于缺乏经过验证的诊断测试，这具有挑战性，往往会导致不必要的药物限制：目的：确定皮内试验（IDT）和嗜碱性粒细胞活化试验（BAT）是否能区分万古霉素耐受者和万古霉素感染者：方法：对暴露于万古霉素的成人进行横断面研究，包括有 VIR 病史和无 VIR 病史者。收集了人口统计学资料、过敏相关合并症、万古霉素接触史和 VIR 特征。使用万古霉素进行了 IDT。比较各组之间的 IDT 剂量反应 EC50、IDT 相关局部症状和 BAT：结果：共招募了 11 名 VIR 受试者和 10 名耐受万古霉素的受试者。报告最多的 VIR 症状是瘙痒（82%）、潮红（82%）、荨麻疹（46%）、荨麻疹（46%）、血管性水肿（27%）和呼吸困难（19%）。VIR组的IDT剂量反应平均EC50为328微克/毫升（95% CI为296，367），而耐受组为1,166微克/毫升（95% CI为1029，1379）（p结论：皮试方法的变化有助于确定 IgE 以外的其他 IDR 机制。该皮试方案具有识别 VIR 的潜力，尤其是在患者接受多种药物治疗而 BAT 不足的情况下。未来的研究将验证和界定其预测价值，评估 VIR 的风险。
{"title":"A Skin Testing Strategy for Non–IgE-Mediated Reactions Associated With Vancomycin","authors":"Siyan Lyu MS , Eric T. Oliver MD , Melanie C. Dispenza MD, PhD , Kristin L. Chichester MS , Jennifer Hoffman NP , Donald W. MacGlashan MD, PhD , N. Franklin Adkinson MD , Elizabeth J. Phillips MD , Santiago Alvarez-Arango MD","doi":"10.1016/j.jaip.2024.07.028","DOIUrl":"10.1016/j.jaip.2024.07.028","url":null,"abstract":"<div><h3>Background</h3><div>Vancomycin infusion reaction (VIR), reportedly mediated through Mas-Related G Protein–Coupled Receptor-X2, is the primary vancomycin-induced immediate drug reaction. Clinically, distinguishing the underlying drug-induced immediate drug reaction mechanisms is crucial for future treatment strategies, including drug restriction, re-administration, and pretreatment considerations. However, the lack of validated diagnostic tests makes this challenging, often leading to unnecessary drug restriction.</div></div><div><h3>Objective</h3><div>To determine whether intradermal tests (IDTs) and, separately, the basophil activation test (BAT) differentiate VIR from vancomycin-tolerant subjects.</div></div><div><h3>Methods</h3><div>This was a cross-sectional study of vancomycin-exposed adults with and without a history of VIR. Data on demographics, allergy-related comorbidities, history of vancomycin exposures, and VIR characteristics were collected. IDT with vancomycin was performed. IDT dose-response EC<sub>50</sub>, IDT-related local symptoms, and BAT results were compared between groups.</div></div><div><h3>Results</h3><div>A total of 11 VIR and 10 vancomycin-tolerant subjects were enrolled. The most reported VIR symptoms were pruritus (82%), flushing (82%), hives (46%), angioedema (27%), and dyspnea (19%). The IDT dose-response mean EC<sub>50</sub> was 328 μg/mL (95% CI, 296-367) in the VIR versus 1166 μg/mL (95% CI, 1029-1379) in the tolerant group (<em>P</em> < .0001). All VIR subjects reported IDT-related local pruritus compared with 60% of tolerant subjects (<em>P</em> = .0185). The %CD63<sup>+</sup> basophils were consistently less than 2%, without significant differences between groups (<em>P</em> < .54).</div></div><div><h3>Conclusions</h3><div>Variations in skin test methodologies could help identify other immediate drug reaction mechanisms beyond IgE. This skin test protocol holds the potential for identifying VIR, particularly in cases where patients have received multiple drugs while BAT is insufficient. Future studies will validate and delineate its predictive value, assessing the risk of VIR.</div></div>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"12 11","pages":"Pages 3025-3033.e6"},"PeriodicalIF":8.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141908261","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 : 2024-11-01DOI: 10.1016/j.jaip.2024.08.008
Michael E. Wechsler MD , Daiana Stolz MD , Njira L. Lugogo MD , Scott Caveney MD , Gun Almqvist MSc , Artur Bednarczyk MD , Ales Kotalik PhD , Shradha Chandarana MRPharmS , Christopher S. Ambrose MD
{"title":"Oral and inhaled corticosteroid dose reductions with tezepelumab versus placebo in patients with severe, uncontrolled asthma from DESTINATION","authors":"Michael E. Wechsler MD , Daiana Stolz MD , Njira L. Lugogo MD , Scott Caveney MD , Gun Almqvist MSc , Artur Bednarczyk MD , Ales Kotalik PhD , Shradha Chandarana MRPharmS , Christopher S. Ambrose MD","doi":"10.1016/j.jaip.2024.08.008","DOIUrl":"10.1016/j.jaip.2024.08.008","url":null,"abstract":"","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"12 11","pages":"Pages 3128-3131.e2"},"PeriodicalIF":8.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141914565","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}
Dupilumab was approved for treating moderate to severe atopic dermatitis (AD). However, a notable subset of patients remains unresponsive and factors associated with dupilumab response remain limited.
Objective
To review and establish factors related to dupilumab response systematically in AD.
Methods
We searched electronic databases, including PubMed and MEDLINE, Embase, Ovid, and the Cochrane Center of Controlled Trials from inception to March 2023. The primary outcome was factors linked to dupilumab response in AD. The odds ratios and 95% CIs related to a 75% reduction at 12 to 16 weeks in the Eczema Area and Severity Index (EASI) score were synthesized using a random-effects meta-analysis.
Results
Of 21 studies involving 5,575 patients with AD, three were post hoc analyses of phase 3 dupilumab studies, 12 were retrospective, and six were prospective studies. Factors associated with favorable responses to dupilumab, defined by the percentage of patients achieving EASI75 at 12 to 16 weeks, included female sex (OR [95% CI] = 2.16 [1.38-3.38]), young age (2.81 [1.64-4.81]), absence of allergic rhinitis (2.64 [1.07-6.50]), low body mass index (1.97 [1.18-3.30]), and low blood eosinophil count (6.47 [3.36-12.48]), with very low certainty of evidence. Age at onset, baseline EASI score, total IgE level, and serum lactate dehydrogenase level were unrelated to dupilumab response.
Conclusions
Female sex, young age, absence of allergic rhinitis, low body mass index, and low blood eosinophil count were associated with a favorable response to dupilumab in patients with AD. These factors should be taken into account when considering dupilumab therapy in clinical practice.
{"title":"Factors Associated With Dupilumab Response in Atopic Dermatitis: A Systematic Review and Meta-Analysis","authors":"Piyaporn Chokevittaya MD , Noraworn Jirattikanwong MD , Torpong Thongngarm MD , Phichayut Phinyo MD. PhD , Chamard Wongsa MD","doi":"10.1016/j.jaip.2024.08.054","DOIUrl":"10.1016/j.jaip.2024.08.054","url":null,"abstract":"<div><h3>Background</h3><div>Dupilumab was approved for treating moderate to severe atopic dermatitis (AD). However, a notable subset of patients remains unresponsive and factors associated with dupilumab response remain limited.</div></div><div><h3>Objective</h3><div>To review and establish factors related to dupilumab response systematically in AD.</div></div><div><h3>Methods</h3><div>We searched electronic databases, including PubMed and MEDLINE, Embase, Ovid, and the Cochrane Center of Controlled Trials from inception to March 2023. The primary outcome was factors linked to dupilumab response in AD. The odds ratios and 95% CIs related to a 75% reduction at 12 to 16 weeks in the Eczema Area and Severity Index (EASI) score were synthesized using a random-effects meta-analysis.</div></div><div><h3>Results</h3><div>Of 21 studies involving 5,575 patients with AD, three were <em>post hoc</em> analyses of phase 3 dupilumab studies, 12 were retrospective, and six were prospective studies. Factors associated with favorable responses to dupilumab, defined by the percentage of patients achieving EASI75 at 12 to 16 weeks, included female sex (OR [95% CI] = 2.16 [1.38-3.38]), young age (2.81 [1.64-4.81]), absence of allergic rhinitis (2.64 [1.07-6.50]), low body mass index (1.97 [1.18-3.30]), and low blood eosinophil count (6.47 [3.36-12.48]), with very low certainty of evidence. Age at onset, baseline EASI score, total IgE level, and serum lactate dehydrogenase level were unrelated to dupilumab response.</div></div><div><h3>Conclusions</h3><div>Female sex, young age, absence of allergic rhinitis, low body mass index, and low blood eosinophil count were associated with a favorable response to dupilumab in patients with AD. These factors should be taken into account when considering dupilumab therapy in clinical practice.</div></div>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"12 11","pages":"Pages 3044-3056"},"PeriodicalIF":8.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142300429","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 : 2024-11-01DOI: 10.1016/j.jaip.2024.10.030
Pooja Mehta, Zhaoxing Pan, Glenn T Furuta, Kara Kliewer
{"title":"Empiric elimination diets for eosinophilic esophagitis: barriers, facilitators, and impact on quality of life.","authors":"Pooja Mehta, Zhaoxing Pan, Glenn T Furuta, Kara Kliewer","doi":"10.1016/j.jaip.2024.10.030","DOIUrl":"https://doi.org/10.1016/j.jaip.2024.10.030","url":null,"abstract":"","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":" ","pages":""},"PeriodicalIF":8.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570357","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 : 2024-11-01DOI: 10.1016/j.jaip.2024.07.026
Rafael José Vieira MD , Luís Filipe Azevedo MD PhD , Ana Margarida Pereira MD , Diogo Nogueira-Leite PhD , Francisco Nuno Rocha Gonçalves PhD , Desirée E. Larenas-Linnemann MD , Alvaro A. Cruz MD, PhD , Bilun Gemicioglu MD, PhD , Boleslaw Samolinski MD, PhD , Leticia de las Vecillas MD, PhD , Mattia Giovannini MD , Maria João Cunha MD , Jorge Rodrigues MD, PhD , Violeta Kvedariene MD, PhD , Ludger Klimek MD, PhD , Oliver Pfaar MD, PhD , Torsten Zuberbier MD, PhD , João A. Fonseca MD, PhD , Jean Bousquet MD, PhD , Bernardo Sousa-Pinto MD, PhD
Background
Allergic rhinitis (AR) has a substantial socioeconomic impact associated with impaired work productivity.
Objective
To study the impact of AR on work productivity and estimate the corresponding indirect costs for 40 countries.
Methods
We conducted a cross-sectional study using direct patient data from the MASK-air app on users with self-reported AR. We used the Work Productivity and Activity Impairment Questionnaire: Allergy Specific to measure the impact of AR on work productivity (presenteeism and absenteeism). Weekly indirect costs were estimated per country for each level of rhinitis control. Patients with and without asthma were considered.
Results
We assessed data from 677 weeks (364 patients), 280 of which were reported by patients with asthma. Regarding presenteeism, the median impact of AR in weeks of poor disease control was 60.7% (percentiles 25–75 [P25–P75] 24.9%–74.2%), whereas partial and good disease control were, respectively, associated with an impact of 25.0% (P25–P75 12.1%–42.4%) and 4.4% (P25–P75 0.8%–12.9%). In poorly controlled weeks, presenteeism was associated with indirect costs ranging from 65.7 US$ purchase power parities (PPPs) (P25–P75 29.2–143.2) in Brazil to 693.6 US$ PPP (P25–P75 405.2–1,094.9) in Iceland. Median absenteeism per week was of 0% for all levels of rhinitis control. Patients with AR + asthma showed higher overall work impairment than patients with AR alone, particularly in poorly controlled weeks (median work impairment in AR alone 39.1% [P25–P75 12.5%–71.9%]; median work impairment in AR + asthma 68.4% [P25–P75 54.6%–80.2%]).
Conclusions
Poor AR control was associated with decreased work productivity and increased indirect costs, particularly in patients with AR + asthma. The estimates from this study underpin the economic burden of AR.
背景：过敏性鼻炎（AR）与工作效率受损有关，对社会经济有重大影响：研究过敏性鼻炎对工作效率的影响，并估算40个国家的相应间接成本：我们使用来自 MASK-air® 应用程序的直接患者数据，对自我报告患有 AR 的用户进行了横断面研究。我们使用了工作效率和活动障碍问卷：过敏特异性问卷来衡量 AR 对工作效率（出席率和缺勤率）的影响。我们对每个国家的每周间接成本进行了估算，每个国家的鼻炎控制水平不同，有哮喘和无哮喘的患者均考虑在内：我们评估了 677 周（364 名患者）的数据，其中 280 周由哮喘患者报告。关于旷工，AR 对疾病控制不佳的周数的影响中位数为 60.7% (P25-P75=24.9-74.2%)，而对部分和良好疾病控制的影响分别为 25.0% (P25-P75=12.1-42.4%) 和 4.4% (P25-75=0.8-12.9%)。在病情控制不佳的周数中，缺勤与间接成本相关，巴西为 65.7 美元购买力平价（PPPs）（P25-P75=29.2-143.2），冰岛为 693.6 美元购买力平价（P25-P75=405.2-1094.9）。在所有鼻炎控制水平中，每周缺勤率的中位数均为 0%。AR+哮喘患者的总体工作损害高于单纯AR患者，尤其是在控制不佳的几周（单纯AR患者的工作损害中位数=39.1% [P25-P75=12.5-71.9%]；AR+哮喘患者的工作损害中位数=68.4% [P25-P75=54.6-80.2%]）：结论：AR控制不佳与工作效率下降和间接成本增加有关，尤其是AR+哮喘患者。这项研究的估算结果证明了 AR 所带来的经济负担。
{"title":"Impact of Allergic Rhinitis Control on Work Productivity and Costs: A Real-World Data MASK-air Study","authors":"Rafael José Vieira MD , Luís Filipe Azevedo MD PhD , Ana Margarida Pereira MD , Diogo Nogueira-Leite PhD , Francisco Nuno Rocha Gonçalves PhD , Desirée E. Larenas-Linnemann MD , Alvaro A. Cruz MD, PhD , Bilun Gemicioglu MD, PhD , Boleslaw Samolinski MD, PhD , Leticia de las Vecillas MD, PhD , Mattia Giovannini MD , Maria João Cunha MD , Jorge Rodrigues MD, PhD , Violeta Kvedariene MD, PhD , Ludger Klimek MD, PhD , Oliver Pfaar MD, PhD , Torsten Zuberbier MD, PhD , João A. Fonseca MD, PhD , Jean Bousquet MD, PhD , Bernardo Sousa-Pinto MD, PhD","doi":"10.1016/j.jaip.2024.07.026","DOIUrl":"10.1016/j.jaip.2024.07.026","url":null,"abstract":"<div><h3>Background</h3><div>Allergic rhinitis (AR) has a substantial socioeconomic impact associated with impaired work productivity.</div></div><div><h3>Objective</h3><div>To study the impact of AR on work productivity and estimate the corresponding indirect costs for 40 countries.</div></div><div><h3>Methods</h3><div>We conducted a cross-sectional study using direct patient data from the MASK-air app on users with self-reported AR. We used the Work Productivity and Activity Impairment Questionnaire: Allergy Specific to measure the impact of AR on work productivity (presenteeism and absenteeism). Weekly indirect costs were estimated per country for each level of rhinitis control. Patients with and without asthma were considered.</div></div><div><h3>Results</h3><div>We assessed data from 677 weeks (364 patients), 280 of which were reported by patients with asthma. Regarding presenteeism, the median impact of AR in weeks of poor disease control was 60.7% (percentiles 25–75 [P25–P75] 24.9%–74.2%), whereas partial and good disease control were, respectively, associated with an impact of 25.0% (P25–P75 12.1%–42.4%) and 4.4% (P25–P75 0.8%–12.9%). In poorly controlled weeks, presenteeism was associated with indirect costs ranging from 65.7 US$ purchase power parities (PPPs) (P25–P75 29.2–143.2) in Brazil to 693.6 US$ PPP (P25–P75 405.2–1,094.9) in Iceland. Median absenteeism per week was of 0% for all levels of rhinitis control. Patients with AR + asthma showed higher overall work impairment than patients with AR alone, particularly in poorly controlled weeks (median work impairment in AR alone 39.1% [P25–P75 12.5%–71.9%]; median work impairment in AR + asthma 68.4% [P25–P75 54.6%–80.2%]).</div></div><div><h3>Conclusions</h3><div>Poor AR control was associated with decreased work productivity and increased indirect costs, particularly in patients with AR + asthma. The estimates from this study underpin the economic burden of AR.</div></div>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"12 11","pages":"Pages 3107-3115.e13"},"PeriodicalIF":8.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141903561","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 : 2024-11-01DOI: 10.1016/j.jaip.2024.09.021
Kathleen M. Buchheit MD , Elke Vandewalle MMed , Hester B.E. Elzinga MD , Sietze Reitsma MD, PhD , Wytske Fokkens MD, PhD , Phillippe Geveart MD, PhD
Nonsteroidal anti-inflammatory drug (NSAID)–exacerbated respiratory disease (NSAID-ERD), the clinical triad of chronic rhinosinusitis with nasal polyps (CRSwNP), asthma, and respiratory reactions to cyclooxygenase 1 inhibitors, is often challenging to manage, with many patients failing first-line therapies for CRSwNP and asthma. There are now 6 biologic medications approved for asthma and/or severe CRSwNP: omalizumab, mepolizumab, reslizumab, benralizumab, dupilumab, and tezepelumab. With the availability of respiratory biologic treatment for both asthma and CRSwNP, clinicians now have a multitude of additional management options for patients with NSAID-ERD. Herein, we review the currently available clinical trial and real-world evidence for biologic efficacy and safety in patients with NSAID-ERD, discuss the mechanisms of biologic therapy specific to NSAID-ERD, and review evidence regarding the use of biologic therapy versus endoscopic sinus surgery for CRSwNP in patients with NSAID-ERD. We propose a management approach for choosing biologic therapy or endoscopic sinus surgery paired with aspirin therapy after desensitization for patients with NSAID-ERD.
{"title":"Efficacy of Biologics in NSAID-ERD: United Airways From the Nose to the Bronchi","authors":"Kathleen M. Buchheit MD , Elke Vandewalle MMed , Hester B.E. Elzinga MD , Sietze Reitsma MD, PhD , Wytske Fokkens MD, PhD , Phillippe Geveart MD, PhD","doi":"10.1016/j.jaip.2024.09.021","DOIUrl":"10.1016/j.jaip.2024.09.021","url":null,"abstract":"<div><div>Nonsteroidal anti-inflammatory drug (NSAID)–exacerbated respiratory disease (NSAID-ERD), the clinical triad of chronic rhinosinusitis with nasal polyps (CRSwNP), asthma, and respiratory reactions to cyclooxygenase 1 inhibitors, is often challenging to manage, with many patients failing first-line therapies for CRSwNP and asthma. There are now 6 biologic medications approved for asthma and/or severe CRSwNP: omalizumab, mepolizumab, reslizumab, benralizumab, dupilumab, and tezepelumab. With the availability of respiratory biologic treatment for both asthma and CRSwNP, clinicians now have a multitude of additional management options for patients with NSAID-ERD. Herein, we review the currently available clinical trial and real-world evidence for biologic efficacy and safety in patients with NSAID-ERD, discuss the mechanisms of biologic therapy specific to NSAID-ERD, and review evidence regarding the use of biologic therapy versus endoscopic sinus surgery for CRSwNP in patients with NSAID-ERD. We propose a management approach for choosing biologic therapy or endoscopic sinus surgery paired with aspirin therapy after desensitization for patients with NSAID-ERD.</div></div>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"12 11","pages":"Pages 2917-2932"},"PeriodicalIF":8.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332045","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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