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Dupilumab improves pediatric type 2 asthma outcomes independent of patient baseline characteristics. 杜匹单抗能改善小儿2型哮喘的疗效,而不受患者基线特征的影响。
IF 8.2 1区 医学 Q1 ALLERGY Pub Date : 2024-11-01 Epub Date: 2024-08-08 DOI: 10.1016/j.jaip.2024.08.010
Jorge F Maspero, Alessandro G Fiocchi, Antoine Deschildre, Leonard B Bacharier, Arman Altincatal, Elizabeth Laws, David J Lederer, Bolanle Akinlade, Megan Hardin
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引用次数: 0
Comparing Skin and Serum Testing to Direct Challenge Outcomes in Children With β-Lactam Allergies. 比较皮肤和血清测试与直接挑战β-内酰胺过敏儿童的结果。
IF 8.2 1区 医学 Q1 ALLERGY Pub Date : 2024-11-01 Epub Date: 2024-08-20 DOI: 10.1016/j.jaip.2024.08.023
Michaela Lucas, Britta S von Ungern-Sternberg, Annabelle Arnold, Michelle Trevenen, Susan Herrmann, Laure Braconnier, Syed Ali, Catherine Jepp, David Sommerfield, Kevin Murray, Kristina Rueter

Background: There is a scarcity of prospective studies investigating the relative roles of skin prick and intradermal testing, serum specific IgE, and extended oral challenges in diagnosing children with reported β-lactam allergies.

Objective: To determine the sensitivity and specificity of skin testing and serum specific IgE in children with β-lactam allergies, with immediate and nonimmediate historic reactions.

Methods: Four hundred children with parent-reported β-lactam allergies were recruited into an open-label prospective study. Detailed allergy histories were collected. Those with medically observed and documented histories of anaphylaxis, requiring epinephrine, or severe cutaneous adverse reactions were excluded. In total, 380 children underwent all testing modalities and a direct provocation test. Each child was followed up for a minimum of 3 years.

Results: True allergy in children was uncommon; 8.3% reacted to the direct provocation challenge or the 5-day extended oral provocation challenge. Children reporting cephalosporin allergy or a reaction within 1 year were more likely to react to direct provocation testing. The sensitivity, specificity, and positive predictive value of skin testing were 12.5%, 98.8%, and 20.0% for direct challenge outcomes, 4.76%, 99.0%, and 25.0% for extended challenge outcomes, and 6.9%, 99.0%, and 40.0% for both challenges combined, respectively. Follow-up investigations revealed that 5.7% of children had a mild repeat reaction and 2.7% continued to avoid the culprit despite successful delabeling. The relabeling rate for children readmitted to hospital was 15%, with the relabeing being unfounded.

Conclusions: Genuine β-lactam allergies were rare, with over 90% of children effectively delabeled. Skin and serum specific IgE testing did not aid the diagnosis of β-lactam antibiotic allergy in children, regardless of medical history. Extended oral challenges proved valuable in confirming allergies and boosted parental confidence.

背景:很少有前瞻性研究调查皮肤点刺和皮内试验、血清特异性免疫球蛋白 E 和扩展口服挑战在诊断报告的β-内酰胺过敏儿童中的相对作用:目的:确定皮肤测试和血清特异性免疫球蛋白 E 在β-内酰胺过敏儿童中的敏感性和特异性:一项开放标签的前瞻性研究招募了四百名由家长报告的β-内酰胺过敏儿童。研究人员收集了详细的过敏史资料。经医学观察并记录有过敏性休克病史、需要肾上腺素或 SCAR 的儿童被排除在外。共有 380 名儿童接受了所有测试方式和直接激发试验。每个儿童都接受了至少三年的随访:结果:儿童真正的过敏并不常见,8%-3% 的儿童对直接激发试验或 5 天延长口服激发试验有反应。对头孢菌素过敏或一年内出现过过敏反应的儿童更有可能对直接激发试验产生反应。皮试的敏感性、特异性和阳性预测值分别为:直接激发试验结果的 12-5%、98-8% 和 20-0%;延长激发试验结果的 4-76%、99-0% 和 25-0%;两种激发试验结果的 6-9%、99-0% 和 40-0%。后续调查显示,5%-7% 的儿童有轻微的重复反应,2%-7% 的儿童在成功脱标后仍继续回避罪魁祸首。再次入院治疗的儿童中,再次标签率为 15%,且再次标签没有依据:结论:真正的β-内酰胺过敏很少见,90% 以上的儿童能有效解除标签。无论病史如何,皮肤和血清特异性免疫球蛋白 E 测试都不能帮助诊断儿童对β-内酰胺类抗生素过敏。事实证明,扩展口服挑战对确认过敏和增强家长的信心很有价值。
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引用次数: 0
History of Aspirin-Exacerbated Respiratory Disease: Discovery, Clinical Features, and Treatment. 阿司匹林加重呼吸道疾病的历史:发现、临床特征和治疗。
IF 8.2 1区 医学 Q1 ALLERGY Pub Date : 2024-11-01 Epub Date: 2024-08-20 DOI: 10.1016/j.jaip.2024.08.027
Donald Day Stevenson, Ronald Alan Simon
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引用次数: 0
Associations Between Chronic Rhinosinusitis and the Development of Non-Cystic Fibrosis Bronchiectasis. 慢性鼻炎与非囊性纤维化支气管扩张症之间的关系。
IF 8.2 1区 医学 Q1 ALLERGY Pub Date : 2024-11-01 Epub Date: 2024-08-05 DOI: 10.1016/j.jaip.2024.07.027
So Lim Kim, Brian S Schwartz, Thanh-Huyen Vu, David B Conley, Leslie C Grammer, Amina Guo, Atsushi Kato, Robert C Kern, Michelle H Prickett, Robert P Schleimer, Stephanie Smith, Whitney W Stevens, Lydia Suh, Bruce K Tan, Kevin C Welch, Anju T Peters

Background: Studies have shown an association between chronic rhinosinusitis (CRS) and non-cystic fibrosis (CF) bronchiectasis.

Objective: We aimed to determine whether CRS increases the risk of developing non-CF bronchiectasis.

Methods: A retrospective analysis was conducted utilizing electronic medical records from an academic center. Patients with CRS without bronchiectasis, with at least 1 chest computed tomography (CT) scan performed after the diagnosis of CRS, were identified between January 2006 and December 2015. Charts were reviewed until May 2022. The control group was age-, sex-, and race-matched, and included patients without CRS, asthma, or chronic obstructive pulmonary disease (COPD) who had at least 1 chest CT scan. Bronchiectasis was identified by chest CT radiology reports. The odds of developing bronchiectasis were analyzed in patients with CRS without asthma or COPD (cohort 1) and patients with CRS with asthma or COPD (cohort 2).

Results: The odds of developing bronchiectasis were significantly higher in patients with CRS (139 of 1,594; 8.7%) than in patients in the control group (443 of 7,992; 5.5%; odds ratio OR 1.63; 95% confidence interval [95% CI] 1.34-1.99). Furthermore, the odds of developing bronchiectasis were higher in cohort 1 (63 of 863; 7.3%; OR 1.34; 05% CI 1.02-1.76) and cohort 2 (76/ of 731; 10.4%; OR 1.98; 95% CI 1.53-2.55) versus the control group. After adjusting for confounding diseases, the association was attenuated in cohort 1 (OR 1.22; 95% CI 0.92-1.61) but remained significant in cohort 2 (OR 1.78; 95% CI 1.37-2.31).

Conclusions: The CRS is associated with the future development of non-CF bronchiectasis. Patients with CRS, especially those with asthma or COPD, have a higher likelihood of developing bronchiectasis than patients without CRS.

背景:研究表明,慢性鼻炎(CRS)与非囊性纤维化(CF)支气管扩张之间存在关联:我们旨在确定 CRS 是否会增加非囊性纤维化支气管扩张症的发病风险:我们利用一家学术中心的电子病历进行了回顾性分析。2006年1月至2015年12月期间,对确诊CRS后至少进行过一次胸部计算机断层扫描(CT)的无支气管扩张的CRS患者进行了鉴定。在 2022 年 5 月之前,对这些患者的病历进行了复查。对照组的年龄、性别和种族均匹配,包括未患 CRS、哮喘或慢性阻塞性肺病 (COPD) 并至少做过一次胸部 CT 的患者。支气管扩张症通过胸部 CT 放射学报告确定。对无哮喘或慢性阻塞性肺病的 CRS 患者(队列 1)和有哮喘或慢性阻塞性肺病的 CRS 患者(队列 2)发生支气管扩张的几率进行了分析:结果:与对照组患者(443/7992 [5.5%],OR 1.63 [1.34-1.99])相比,CRS 患者(139/1594,8.7%)发生支气管扩张的几率明显更高。此外,与对照组相比,队列 1(63/863 [7.3%],OR 1.34 [1.02-1.76])和队列 2(76/731 [10.4%],OR 1.98 [1.53-2.55])患支气管扩张的几率更高。在对混杂疾病进行调整后,队列 1 的相关性有所减弱(OR 1.22 [0.92-1.61]),但队列 2 的相关性仍然显著(OR 1.78 [1.37-2.31]):结论:CRS 与非慢性支气管炎支气管扩张症的未来发展有关。结论:CRS 与非慢性阻塞性肺病支气管扩张症的未来发展有关。CRS 患者,尤其是哮喘或慢性阻塞性肺病患者,比无 CRS 的患者患支气管扩张症的可能性更高。
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引用次数: 0
Polycystic ovary syndrome and the risk of asthma in reproductive-age women: Insights from 2 real-world large cohorts. 多囊卵巢综合征与育龄妇女的哮喘风险:来自两个真实世界大型队列的启示。
IF 8.2 1区 医学 Q1 ALLERGY Pub Date : 2024-11-01 Epub Date: 2024-08-08 DOI: 10.1016/j.jaip.2024.08.009
Battoul Fakhry, Amy Attaway, Hyun Jo Kim, Zaid Yaqoob, Sadeer G Al-Kindi, Celine Chedraoui, Joelle Sleiman, Joe G Zein
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引用次数: 0
Atopic Dermatitis (Eczema) Guidelines 2023: Highlights. 特应性皮炎(湿疹)指南 2023》:亮点。
IF 8.2 1区 医学 Q1 ALLERGY Pub Date : 2024-11-01 Epub Date: 2024-09-07 DOI: 10.1016/j.jaip.2024.08.052
Anna De Benedetto, Mark Boguniewicz, Peck Y Ong, Derek K Chu, Lynda C Schneider

Atopic dermatitis is a common chronic inflammatory skin disorder, with a complex pathogenesis. It is characterized by eczematous skin lesions, pruritus, and recurrent skin infections and has a negative impact on patients' and caregivers' quality of life. The American Academy of Allergy, Asthma & Immunology/American College of Allergy, Asthma and Immunology Joint Task Force Atopic Dermatitis Guideline Panel recently released updated AD guidelines. This guideline focuses on addressing clinical questions using trustworthy guideline development standards, including mitigating the potential influence of financial and nonfinancial conflicts of interest, and Grading of Recommendations Assessment, Development, and Evaluation methodology. A multidisciplinary panel used systematic reviews and meta-analyses to inform specific recommendations addressing optimal use of topical treatments, dilute bleach bath, dietary avoidance/elimination, allergen immunotherapy, and systemic treatments. The comprehensive recommendations, emphasizing the third principle of evidence-based medicine-that evidence alone is never enough, and that patient values and preferences must be carefully considered when determining optimal treatments for patients and populations-provide a framework to support clinicians in selecting an optimal treatment plan for each patient. This review provides an overview of the guideline and discusses how those recommendations relate to current practice.

特应性皮炎(AD)是最常见的慢性炎症性皮肤病之一,发病机制复杂。特应性皮炎以皮肤湿疹、瘙痒和反复皮肤感染为特征,对患者(和护理人员)的生活质量有负面影响。美国过敏、哮喘和免疫学学会(AAAAI)/美国过敏、哮喘和免疫学学院(ACAAI)特应性皮炎联合工作组(JTF)指南小组最近发布了最新的特应性皮炎指南。该指南的重点是采用值得信赖的指南制定标准(包括减轻经济和非经济利益冲突的潜在影响)和 GRADE 方法解决临床问题。一个多学科小组利用系统综述和荟萃分析,针对以下方面提出了具体建议:(1) 局部治疗;(2) 稀释漂白浴;(3) 避免/消除饮食;(4) 过敏原免疫疗法;(5) 全身治疗。这些全面的建议强调了循证医学的第三条原则--仅有证据是远远不够的;在为患者和人群确定最佳治疗方法时,必须仔细考虑患者的价值观和偏好--为临床医生为每位患者选择最佳治疗方案提供了一个框架。本综述概述了该指南,并讨论了这些建议与当前实践的关系。
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引用次数: 0
Characterization and Incidence of Sunflower Seed Allergy in a Pediatric Allergy Clinic. 儿科过敏门诊中葵花籽过敏的特征和发病率。
IF 8.2 1区 医学 Q1 ALLERGY Pub Date : 2024-11-01 Epub Date: 2024-08-06 DOI: 10.1016/j.jaip.2024.07.029
Elsa R Treffeisen, Claire Mepyans, Ellen R Conroy, Heather J Baer, David N Williams, Kathryn A Williams, Lynda C Schneider

Background: Sunflower seeds are a popular allergen-free peanut alternative.

Objective: To describe sunflower seed allergy incidence and characteristics.

Methods: We conducted a retrospective cohort study of patients with sunflower seed allergy from 1995 to 2021 in a pediatric allergy clinic. We described demographic characteristics, testing results, atopic comorbidities, and reaction histories of patients with sunflower seed allergy and calculated the annual cumulative incidence of the allergy. Logistic regression was used to estimate the increase in odds of sunflower seed allergy diagnosis for each year from 1995 to 2021.

Results: From 1995 to 2021, we identified 235 patients with sunflower seed allergy. Among patients with sunflower seed allergy, the median age at diagnosis was 3.9 years. More than three-quarters of patients had another atopic condition. Half of the reactions consisted of mild urticaria or rash, and a quarter met criteria for anaphylaxis. The cumulative incidence ranged from 0% (1995-1999, 2001-2004, and 2006) to 0.38% (2021). From 1995 to 2021, the odds of sunflower seed allergy diagnosis increased annually by 21% (odds ratio, 1.21; 95% CI, 1.17-1.25).

Conclusions: In our single-center cohort of children with sunflower seed allergy, most children were diagnosed in early childhood, had high rates of comorbid atopic conditions, and had high rates of cutaneous reactions to sunflower seed products. Moreover, in our cohort, incidence of sunflower seed allergy increased.

背景:葵花籽是一种广受欢迎的不含过敏原的花生替代品:葵花籽是一种广受欢迎的不含过敏原的花生替代品:描述葵花籽过敏的发病率和特征:我们对一家儿科过敏诊所 1995 年至 2021 年期间的葵花籽过敏患者进行了一项回顾性队列研究。我们描述了葵花籽过敏患者的人口统计学特征、检测结果、特应性合并症和反应史,并计算了过敏的年累计发病率。我们使用逻辑回归法估算了 1995 年至 2021 年间每年确诊葵花籽过敏几率的增长情况:从 1995 年到 2021 年,我们共发现 235 名葵花籽过敏患者。在葵花籽过敏患者中,确诊年龄的中位数为 3.9 岁。超过四分之三的患者患有其他特应性疾病。半数反应为轻度荨麻疹或皮疹,四分之一符合过敏性休克的标准。累计发病率从 0%(1995-1999 年、2001-2004 年和 2006 年)到 0.38%(2021 年)不等。从 1995 年到 2021 年,诊断出葵花籽过敏的几率每年增加 21%(OR 1.21,95% CI:1.17-1.25):在我们的单中心葵花籽过敏儿童队列中,大多数儿童在幼儿期就被确诊,合并特应性疾病的比例很高,对葵花籽产品的皮肤反应发生率也很高。此外,在我们的队列中,葵花籽过敏的发病率呈上升趋势。
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引用次数: 0
The Belgian IgE study: Staphylococcus aureus toxins in adult severe asthma. 比利时 IgE(BEIgE)研究:成人重症哮喘中的金黄色葡萄球菌毒素。
IF 8.2 1区 医学 Q1 ALLERGY Pub Date : 2024-11-01 Epub Date: 2024-08-14 DOI: 10.1016/j.jaip.2024.08.016
Florence Schleich, Eléonore Maury, Claus Bachert, Mieke Jansen, Sandra Gurdain, Jan Van Schoor
{"title":"The Belgian IgE study: Staphylococcus aureus toxins in adult severe asthma.","authors":"Florence Schleich, Eléonore Maury, Claus Bachert, Mieke Jansen, Sandra Gurdain, Jan Van Schoor","doi":"10.1016/j.jaip.2024.08.016","DOIUrl":"10.1016/j.jaip.2024.08.016","url":null,"abstract":"","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":null,"pages":null},"PeriodicalIF":8.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141996923","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}
引用次数: 0
Transient Serpentine Supravenous Erythema During Rapid Drug Desensitization. 快速药物脱敏过程中的短暂蛇麻素静脉上红斑
IF 8.2 1区 医学 Q1 ALLERGY Pub Date : 2024-11-01 Epub Date: 2024-08-24 DOI: 10.1016/j.jaip.2024.08.031
Malina C Patel, Dan Costin, Beth McLellan, Sara DiFalco, Jessica Oh
{"title":"Transient Serpentine Supravenous Erythema During Rapid Drug Desensitization.","authors":"Malina C Patel, Dan Costin, Beth McLellan, Sara DiFalco, Jessica Oh","doi":"10.1016/j.jaip.2024.08.031","DOIUrl":"10.1016/j.jaip.2024.08.031","url":null,"abstract":"","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":null,"pages":null},"PeriodicalIF":8.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142074528","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}
引用次数: 0
Prevalence and Determinants of Food Allergy in the Era of Early Allergen Introduction: The EarlyNuts Population-Based Study. 早期引入过敏原时代食物过敏症的发病率和决定因素:早期坚果人群研究。
IF 8.2 1区 医学 Q1 ALLERGY Pub Date : 2024-11-01 Epub Date: 2024-07-09 DOI: 10.1016/j.jaip.2024.07.001
Victoria X Soriano, Katrina J Allen, Shyamali C Dharmage, Desalegn Markos Shifti, Kirsten P Perrett, Rushani Wijesuriya, Jennifer J Koplin, Rachel L Peters

Background: Infant feeding guidelines in Australia changed in 2016 to recommend introducing common allergy-causing foods by age 1 year to prevent food allergy. Although most Australian infants now eat peanut and egg by age 6 months, some still develop food allergy despite the early introduction of allergens.

Objectives: To describe the prevalence of food allergy in a cohort recruited after introducing the nationwide allergy prevention recommendations; identify characteristics of infants who developed allergy despite early introduction of allergens; and estimate the causal effect of modifiable exposures on food allergy prevalence and whether this differed between infants who were introduced to allergens before or after age 6 months.

Methods: We recruited a population-based sample of 12-month-old infants in Melbourne, Australia. Infants had skin prick tests to four foods and parents completed questionnaires. Infants with evidence of sensitization were offered oral food challenges. Prevalence estimates were adjusted using inverse probability weighting.

Results: In a cohort of infants (n = 1,420) in which nearly all infants had been introduced to common allergens such as egg, milk, and peanut by age 1 year, the prevalence of food allergy remained high at 11.3% (95% CI, 9.6-13.4). Infants who developed food allergy despite introduction of the allergen by age 6 months were more likely to have Asian-born parents. Early-onset moderate or severe eczema was associated with an increased odds of food allergy irrespective of whether allergens were introduced before or after age 6 months. Among infants who were introduced to peanut at age 6 months or earlier, antibiotic use by age 6 months was associated with an increased odds of peanut allergy (adjusted odds ratio = 6.03; 95% CI, 1.15-31.60).

Conclusions: In a cohort in which early allergen introduction was common, the prevalence of food allergy remained high. Infants who developed food allergy despite introduction of the respective allergen by age 6 months were more likely to have had Asian parents and early-onset eczema. New interventions are needed for infants with a phenotype of food allergy that is not amenable to early allergen introduction.

背景:澳大利亚的婴儿喂养指南于 2016 年做出改变,建议在婴儿 1 岁前引入常见的致敏食物,以预防食物过敏。虽然现在大多数澳大利亚婴儿在6个月大之前就能吃花生和鸡蛋,但尽管很早就引入了过敏原,仍有一些婴儿患上了食物过敏症:我们的目的是描述在引入全国性过敏预防建议后所招募的人群中食物过敏的发生率;确定尽管较早引入过敏原但仍发生过敏的婴儿的特征;估计可改变的暴露对食物过敏发生率的因果效应,以及在 6 个月之前或之后引入过敏原的婴儿之间是否存在差异:方法:我们在澳大利亚墨尔本市对 12 个月大的婴儿进行了人口抽样调查。婴儿对 4 种食物进行了皮肤点刺试验,家长填写了调查问卷。有过敏证据的婴儿将接受口服食物挑战。采用反概率加权法对患病率估计值进行了调整:在一组婴儿(人数=1420)中,几乎所有婴儿在一岁前都接触过鸡蛋、牛奶和花生等常见过敏原,但食物过敏的患病率仍然高达 11.3% (95% CI 9.6-13.4%)。在 6 个月大之前引入过敏原但仍出现食物过敏的婴儿,其父母更有可能是亚裔。无论过敏原是在 6 个月之前还是之后引入,早发中度/重度湿疹都与食物过敏几率增加有关。在6个月以下接触花生的婴儿中,6个月前使用抗生素与花生过敏几率增加有关(aOR 6.03 (95%CI 1.15-31.60)):在一个普遍早期引入过敏原的人群中,食物过敏的发病率仍然很高。尽管在 6 个月前引入了相应的过敏原,但仍出现食物过敏的婴儿更有可能父母为亚洲人,并患有早发湿疹。对于那些食物过敏表型不适合早期引入过敏原的婴儿,需要采取新的干预措施。
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引用次数: 0
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Journal of Allergy and Clinical Immunology-In Practice
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