Journal of Allergy and Clinical Immunology-In Practice最新文献

英文中文

Empiric elimination diets for eosinophilic esophagitis: barriers, facilitators, and impact on quality of life. 嗜酸性粒细胞食管炎的经验性消除饮食：障碍、促进因素以及对生活质量的影响。

IF 8.2 1区医学 Q1 ALLERGY

Journal of Allergy and Clinical Immunology-In Practice

Pub Date : 2024-11-01 DOI: 10.1016/j.jaip.2024.10.030

Pooja Mehta, Zhaoxing Pan, Glenn T Furuta, Kara Kliewer

引用次数: 0

Impact of Allergic Rhinitis Control on Work Productivity and Costs: A Real-World Data MASK-air Study 控制过敏性鼻炎对工作效率和成本的影响：真实世界数据 MASK-air 研究。

IF 8.2 1区医学 Q1 ALLERGY

Journal of Allergy and Clinical Immunology-In Practice

Pub Date : 2024-11-01 DOI: 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。

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引用次数: 0

Efficacy of Biologics in NSAID-ERD: United Airways From the Nose to the Bronchi 生物制剂对非甾体抗炎药物引起的胃食管反流病的疗效：从鼻子到支气管的联合气道"。

IF 8.2 1区医学 Q1 ALLERGY

Journal of Allergy and Clinical Immunology-In Practice

Pub Date : 2024-11-01 DOI: 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.

非甾体抗炎药加重的呼吸道疾病（NSAID-ERD）是严重慢性鼻炎伴鼻息肉（CRSwNP）、哮喘和环氧化酶 1 抑制剂呼吸道反应的临床三联症，其治疗通常具有挑战性，许多患者无法通过一线疗法治疗 CRSwNP 和哮喘。目前有六种生物制剂获准用于治疗哮喘和/或严重的 CRSwNP：奥马珠单抗（omalizumab）、mepolizumab、reslizumab、benralizumab、dupilumab 和 tezepelumab。随着呼吸系统生物制剂治疗哮喘和 CRSwNP 的问世，临床医生现在有了更多治疗非甾体抗炎药物引起的哮喘和 CRSwNP 患者的选择。在此，我们将回顾目前可用的临床试验和真实世界证据，说明生物制剂对非甾体类抗炎药物引起的ERD患者的疗效和安全性，讨论生物制剂治疗非甾体类抗炎药物引起的ERD的机制，并回顾有关使用生物制剂治疗与内窥镜鼻窦手术治疗CRSwNP和非甾体类抗炎药物引起的ERD的证据。我们将为非甾体抗炎药物引起的胃食管反流患者提出一种管理方法，即选择生物疗法或内窥镜鼻窦手术，并在脱敏后使用阿司匹林治疗。

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引用次数: 0

Information for Readers 读者信息

IF 8.2 1区医学 Q1 ALLERGY

Journal of Allergy and Clinical Immunology-In Practice

Pub Date : 2024-11-01 DOI: 10.1016/S2213-2198(24)01005-5

引用次数: 0

Continuing Medical Education Calendar 继续医学教育日历

IF 8.2 1区医学 Q1 ALLERGY

Journal of Allergy and Clinical Immunology-In Practice

Pub Date : 2024-11-01 DOI: 10.1016/S2213-2198(24)01007-9

引用次数: 0

Interleukin (IL)-1/IL-6-Inhibitor–Associated Drug Reaction With Eosinophilia and Systemic Symptoms (DReSS) in Systemic Inflammatory Illnesses 全身性炎症疾病中白细胞介素（IL）-1/IL-6 抑制剂相关药物反应伴嗜酸性粒细胞增多和全身症状（DReSS）。

IF 8.2 1区医学 Q1 ALLERGY

Journal of Allergy and Clinical Immunology-In Practice

Pub Date : 2024-11-01 DOI: 10.1016/j.jaip.2024.07.002

Vivian E. Saper MD , Lu Tian PhD , Ruud H.J. Verstegen MD, PhD , Carol K. Conrad MD , Michal Cidon MD , Rachel K. Hopper MD , Christin S. Kuo MD , Kazutoyo Osoegawa PhD , Kevin Baszis MD , Catherine A. Bingham MD , Ian Ferguson MD , Timothy Hahn MD , Annacarin Horne MD, PhD , Eugenia A. Isupova MD , Jordan T. Jones DO , Özgür Kasapcopur MD , Marisa S. Klein-Gitelman MD , Mikhail M. Kostik MD , Seza Ozen MD , Omkar Phadke MD , A. Zhu

Background

After introducing IL-1/IL-6 inhibitors, some patients with Still and Still-like disease developed unusual, often fatal, pulmonary disease. This complication was associated with scoring as DReSS (drug reaction with eosinophilia and systemic symptoms) implicating these inhibitors, although DReSS can be difficult to recognize in the setting of systemic inflammatory disease.

Objective

To facilitate recognition of IL-1/IL-6 inhibitor-DReSS in systemic inflammatory illnesses (Still/Still-like) by looking at timing and reaction-associated features. We evaluated outcomes of stopping or not stopping IL-1/IL-6 inhibitors after DReSS reaction began.

Methods

In an international study collaborating primarily with pediatric specialists, we characterized features of 89 drug-reaction cases versus 773 drug-exposed controls and compared outcomes of 52 cases stopping IL-1/IL-6 inhibitors with 37 cases not stopping these drugs.

Results

Before the reaction began, drug-reaction cases and controls were clinically comparable, except for younger disease-onset age for reaction cases with preexisting cardiothoracic comorbidities. After the reaction began, increased rates of pulmonary complications and macrophage activation syndrome differentiated drug-reaction cases from drug-tolerant controls (P = 4.7 × 10⁻³⁵ and P = 1.1 × 10⁻²⁴, respectively). The initial DReSS feature was typically reported 2 to 8 weeks after initiating IL-1/IL-6 inhibition. In drug-reaction cases stopping versus not stopping IL-1/IL-6–inhibitor treatment, reaction-related features were indistinguishable, including pulmonary complication rates (75% [39 of 52] vs 76% [28 of 37]). Those stopping subsequently required fewer medications for treatment of systemic inflammation, had decreased rates of macrophage activation syndrome, and improved survival (P = .005, multivariate regression). Resolution of pulmonary complications occurred in 67% (26 of 39) of drug-reaction cases who stopped and in none who continued inhibitors.

Conclusions

In systemic inflammatory illnesses, recognition of IL-1/IL-6-inhibitor–associated reactions followed by avoidance of IL-1/IL-6 inhibitors significantly improved outcomes.

背景：在引入白细胞介素（IL）-1/IL-6 抑制剂后，一些 Still 和 Still-like 患者出现了不寻常的、往往是致命的肺部疾病。这种并发症与 DReSS（伴有嗜酸性粒细胞增多和全身症状的药物反应）评分有关，牵涉到这些抑制剂，但 DReSS 在全身炎症性疾病的情况下很难识别：我们试图通过观察时间和反应相关特征，帮助识别全身性炎症性疾病（Still/Still 类）中的 IL-1/IL-6 抑制剂-DReSS。我们评估了在DReSS反应开始后停用或不停用IL-1/IL-6抑制剂的结果：在一项主要与儿科专家合作的国际研究中，我们对 89 例药物反应病例与 773 例药物接触对照组的特征进行了分析，并对 52 例停用 IL-1/IL-6 抑制剂的病例与 37 例未停用这些药物的病例的结果进行了比较：结果：在反应开始前，药物反应病例和对照组在临床上具有可比性，但有心胸合并症的反应病例发病年龄较小。反应开始后，肺部并发症和巨噬细胞活化综合征（MAS）发生率增加，将药物反应病例与耐药对照组区分开来（p=4.7x10-35；p=1.1x10-24）。最初的 DReSS 特征通常在开始使用 IL-1/IL-6 抑制剂 2 至 8 周后出现。在停止和未停止IL-1/IL-6抑制剂治疗的药物反应病例中，与反应相关的特征没有区别，包括肺部并发症发生率[75%（39/52）对[76%（28/37）]。随后停药的患者所需的全身炎症治疗药物减少，MAS发生率降低，生存率提高（p=0.005，多变量回归）。67%（26/39）的停药病例出现了肺部并发症，而继续使用抑制剂的病例无一例外：结论：在全身性炎症性疾病中，识别IL-1/IL-6抑制剂相关反应并避免使用IL-1/IL-6抑制剂可显著改善预后。

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引用次数: 0

Validation of a digital self-assessment to identify low-risk penicillin and sulfa antibiotic allergies in adults (SELF-FAST) 鉴定成人低风险青霉素和磺胺类抗生素过敏的数字自我评估（SELF-FAST）的验证。

IF 8.2 1区医学 Q1 ALLERGY

Journal of Allergy and Clinical Immunology-In Practice

Pub Date : 2024-11-01 DOI: 10.1016/j.jaip.2024.07.025

Morgan T. Rose MBBS , Saranya Ramesh MBBS , Sara Vogrin MBiostat , Natasha E. Holmes PhD , Belinda Lambros MAdvNursPrac , Monica A. Slavin PhD , Jason A. Trubiano PhD

引用次数: 0

Difficult Cases in Mast Cell Disorders 肥大细胞疾病的疑难病例。

IF 8.2 1区医学 Q1 ALLERGY

Journal of Allergy and Clinical Immunology-In Practice

Pub Date : 2024-11-01 DOI: 10.1016/j.jaip.2024.08.024

Kristy M. Semenza MD , Matthew P. Giannetti MD

引用次数: 0

Omalizumab Implementation in Practice: Lessons Learned From the OUtMATCH Study 奥马珠单抗在实践中的应用：从 OUtMATCH 研究中汲取的经验教训。

IF 8.2 1区医学 Q1 ALLERGY

Journal of Allergy and Clinical Immunology-In Practice

Pub Date : 2024-11-01 DOI: 10.1016/j.jaip.2024.08.056

Brian P. Vickery MD , J. Andrew Bird MD , R. Sharon Chinthrajah MD , Stacie M. Jones MD , Corinne A. Keet MD, PhD , Edwin H. Kim MD , Donald Y.M. Leung MD, PhD , Wayne G. Shreffler MD, PhD , Scott H. Sicherer MD , Sayantani Sindher MD , Jonathan Spergel MD, PhD , Robert A. Wood MD

In February 2024, omalizumab was approved by the U.S. Food and Drug Administration for the treatment of food allergy, based on data from the landmark phase 3 clinical trial, Omalizumab as Monotherapy and as Adjunct Therapy in Children and Adults (OUtMATCH). In this Rostrum, OUtMATCH investigators share their perspectives on the trial results, the implications for translation into daily practice, and on remaining gaps in the field. The study met its primary and key secondary end points, demonstrating a large effect size in multiallergen desensitization compared with placebo; yet there were some participants who did not respond, and the percentage of responders tolerating all 3 food allergens was lower than that for single foods. Clinicians are likely to have many questions about appropriate patient selection, monitoring for treatment responsiveness, and how to manage off-label considerations such as dietary incorporation or cotreatment with oral immunotherapy. Additional research is needed to answer these remaining questions and ensure that the translation of omalizumab in real-world practice leads to high-quality outcomes.

2024 年 2 月，根据具有里程碑意义的 3 期临床试验 "奥马珠单抗作为儿童和成人的单药和辅助疗法（OUtMATCH）"的数据，奥马珠单抗被美国食品和药物管理局批准用于治疗食物过敏。在本期Rostrum中，OUtMATCH研究人员分享了他们对试验结果、转化为日常实践的意义以及该领域尚存差距的看法。这项研究达到了主要终点和关键次要终点，与安慰剂相比，在多过敏原脱敏方面显示出很大的效应规模；但也有一些参与者没有反应，而且能耐受所有三种食物过敏原的反应者比例低于耐受单一食物过敏原的反应者比例......"。临床医生可能会有很多问题，如如何选择合适的患者、如何监测治疗反应、如何处理标签外的注意事项，如饮食结合或与口服免疫疗法联合治疗等。我们需要开展更多的研究来回答这些遗留问题，并确保奥马珠单抗在实际应用中能带来高质量的疗效。

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引用次数: 0

Severe Eosinophilic Asthma or Eosinophilic Granulomatosis With Polyangiitis: Potential Biomarkers for Novel Diagnostic Strategies 严重嗜酸性粒细胞性哮喘或嗜酸性粒细胞性肉芽肿伴多发性咽炎：新型诊断策略的潜在生物标记物。

IF 8.2 1区医学 Q1 ALLERGY

Journal of Allergy and Clinical Immunology-In Practice

Pub Date : 2024-11-01 DOI: 10.1016/j.jaip.2024.08.011

Manuela Latorre MD, PhD , Veronica Seccia MD, PhD , Ilaria Puxeddu MD, PhD , Francesco Pisani MD , Erica Statuti MD , Lodovica Cristofani-Mencacci MD , Alessandro Celi MD, PhD , Silvana Cianchetti MD , Cristina Cardini MD , Eleonora Di Carluccio MD , Francesco Ferro MD, PhD , Pierluigi Paggiaro MD, PhD , Chiara Baldini MD, PhD

Background

Severe eosinophilic asthma (SEA) may be the prodromal phase of eosinophilic granulomatosis with polyangiitis (EGPA). Nevertheless, few studies have tried to recognize EGPA in the early stages of the disease.

Objective

To identify a panel of clinical and biological markers to detect which severe asthmatic patient might be considered in a prodromal phase of EGPA and crafting a strategy for diagnostic decision-making.

Methods

A total of 30 patients with EGPA and 49 with SEA were enrolled. A complete pulmonary, ear, nose, and throat, and rheumatologic assessment were made. Blood (eosinophil count, eosinophilic cationic protein, IL-5, IL-4, total-IgE, IgG₄, and antineutrophil cytoplasmic antibody), sputum (eosinophils count, periostin, IL-8, and granulocyte-monocyte colony-stimulating factor [GM-CSF]), and nasal smear (eosinophilia) biomarkers were assessed. Asthma Control Test, Short Form-36, SinoNasalOutcome Test-22, and Asthma Quality of Life Questionnaire were also used.

Results

Patients with SEA had poorer asthma control (P < .001) and a higher level of sputum eosinophils (P < .002), whereas patients with EGPA reported higher levels of blood eosinophils in the past. Sputum GM-CSF was the only biomarker significantly increased in patients with EGPA compared with those with SEA (P < .0001). Among patients with SEA, those with some suggestive but not diagnostic criteria of EGPA, particularly tissue eosinophilic infiltrates, presented higher levels of sputum GM-CSF (P < .0005), blood, and sputum eosinophils (P < .0006 and P < .011) than the other patients.

Conclusion

Sputum GM-CSF and eosinophils might be useful biomarkers to support early diagnosis and treatment choices in patients with SEA, suspected of having EGPA.

背景：严重嗜酸性粒细胞性哮喘（SEA严重嗜酸性粒细胞性哮喘（SEA）可能是嗜酸性粒细胞性多血管炎（EGPA）的前驱期。然而，很少有研究试图在疾病的早期阶段识别 EGPA：确定一组临床和生物标记物，以检测哪些重症哮喘患者可能被认为处于 EGPA 的前驱期，并制定诊断决策策略。方法：30 名 EGPA 患者和 49 名 SEA 患者接受了全面的肺部、耳鼻喉（ENT）和风湿病学评估。对血液（嗜酸性粒细胞计数、嗜酸性粒细胞阳离子蛋白-ECP、IL5、IL4、总 IgE、IgG4、抗中性粒细胞胞浆抗体 (ANCA)）、痰液（嗜酸性粒细胞计数、骨膜蛋白、IL8 和 GMCSF）和鼻涂片（嗜酸性粒细胞增多）生物标记物进行了评估。此外，还使用了哮喘控制测试、短表格-36、SinoNasalOutcome Test-22 和哮喘生活质量问卷：结果：SEA 患者的哮喘控制能力较差（pConclusion：痰GMCSF和嗜酸性粒细胞可能是有用的生物标志物，有助于对疑似EGPA的SEA患者进行早期诊断和治疗选择。

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