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

Background: We assessed health-related quality of life (HRQoL) in patients with allergy to the venom of the jack jumper ant (JJA), Myrmecia pilosula, a Hymenoptera order species native and endemic to the Southeastern quarter of Australia. To our knowledge, this has not previously been studied despite an estimated population prevalence of generalized allergic symptoms as high as 3% in some areas.

Objective: To validate the Venom Quality of Life Questionnaire (VQLQ) HRQoL instrument, which was previously validated in patients with wasp and bee venom allergy, for use in this specific ant venom-allergic population.

Methods: The 14-item VQLQ survey instrument was administered to patients with clinical allergy to JJA venom presenting at the state treatment center for venom immunotherapy. Surveys were performed at different time points of the progression through visits for venom immunotherapy treatment. We performed cross-sectional and longitudinal validation against the Expectation of Outcome (EO) questionnaire by determining correlations and agreement.

Results: A total of 271 individuals contributed survey data, median age 52 years (range, 3-85 years; bimodal distribution with 25% aged <18 years). Internal consistency was excellent (Cronbach α = 0.95). Cross-sectional validity was demonstrated with a positive correlation of VQLQ to EO of 0.44 (P < .001). Performance was nearly identical when stratified into adults and children (aged <18 years). Longitudinal validity was suggested as both VQLQ and EO improved over time in both adults and children, but this had paired correlation at only two time points in adults. Bland-Altman analysis demonstrated acceptable agreement between VQLQ and EO and no evidence of systematic bias.

Conclusions: The VQLQ appears to offer performance of HRQoL measurement in patients with JJA venom allergy, similar to that previously demonstrated in other Hymenoptera species. In addition, this study demonstrates cross-sectional validity specifically in a pediatric population aged 3 to 18 years.

Background: Venom-allergic patients are frequently double-sensitized to honeybee venom (BV) and Vespula venom (VV). Genuine double allergy is uncommon.

Objectives: To assess whether a quantitative comparison of BV- and VV-specific IgE levels permits an identification of the culprit venom in double-sensitized patients, and to evaluate whether independent sensitization to BV- and VV-specific components corresponds to an indication for double immunotherapy.

Methods: This single-center observational study evaluated 1,069 consecutive patients; 490 nonallergic controls were available for statistical comparison. The diagnosis (BV allergy, VV allergy, or double allergy) was based on a comprehensive allergological workup including patient history, IgE serology, intradermal skin test, and, when required, basophil activation testing. Quantitative allergen-specific IgE to BV, VV, rApi m 1, and rVes v 5 was retrospectively compared with the final diagnosis. The ratio of BV/VV-specific IgE levels was considered in double-sensitized venom-allergic patients.

Results: Sensitization to whole-venom preparations and components was frequent in patients and asymptomatic controls, with higher specific IgE levels in the patient group. At least 5:1 dominance of the specific IgE to either BV or VV was documented in 239 of 459 double-sensitized venom-allergic patients (52.1%). Of these patients 232 (97.1%) received a diagnosis of monoallergy to only the venom to which they were dominantly sensitized.

Conclusions: Dominant specific IgE at a ratio of 5:1 indicates the culprit venom in double-sensitized allergic patients. Additional component-resolved diagnostic testing can be restricted to cases with double sensitization to whole venom at a ratio of less than 5:1. Double sensitization to rApi m 1 and rVes v 5 per se does not justify double venom immunotherapy.

Background: β-Lactams are the most common antibiotic class reported to cause allergic drug reactions. Previous literature suggests an increased prevalence of penicillin drug allergy in female patients in both inpatient and outpatient settings. However, the effects of sex and gender have not been well characterized regarding the entire class of β-lactam antibiotics.

Objective: This systematic review and meta-analysis aimed to identify sex- and gender-based differences in the prevalence of immediate β-lactam allergy.

Methods: We performed an electronic search of Ovid MEDLINE/PubMed, Embase, Web of Science, Scopus, and the Cochrane Library between 2013 and 2023. Patients with a documented β-lactam allergy who underwent allergy testing with skin testing, oral drug challenge, or serum-specific IgE were included. We quantitatively assessed sex- and gender-based differences in β-lactam allergy with meta-analysis.

Results: We included 69 primary studies assessing 53,989 participants from outpatient and inpatient cohorts. A total of 7,558 patients had a confirmed β-lactam allergy. There was no difference in the prevalence of positive β-lactam allergy test between males and females. Subgroup analysis of studies that performed oral challenges showed a higher risk of β-lactam allergy in females compared with males (relative risk = 1.40; 95% CI, 1.18-1.66; P < .001; I² = 77.8%). Finally, there was a higher proportion of females (64.8%) than males enrolled in β-lactam allergy studies.

Conclusions: Our findings suggest both sex-based and gender-based differences in the prevalence of immediate β-lactam allergy. Biological factors such as sex hormones and gender-based behaviors including increased health care use may contribute to higher rates of β-lactam allergy diagnosis in females.

Background: Moderate to severe persistent allergic rhinitis (AR) poses a substantial socioeconomic burden.

Objectives: We aimed to establish the superiority of bencycloquidium bromide (BCQB) nasal spray and BCQB combined with mometasone furoate nasal spray (MFNS) over MFNS alone in adults with moderate-to-severe persistent AR.

Methods: In this multicentre, randomised controlled clinical trial (NCT05038202), adults with moderate-to-severe persistent AR were randomly assigned to receive the BCQB, MFNS, or a combination treatment, for 4-week periods. The mean changes from baseline in the daily reflective runny nose, nasal congestion, sneezing, nasal itching scores, total nasal symptom score (TNSS) and Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) scores were recorded. The exploratory endpoints and adverse events were also assessed.

Results: BCQB led to a significant improvement in the mean change from baseline in daily reflective runny nose during the 4-week treatment, in comparison to MFNS (least-squares [LS] mean difference, -0.27; 95% confidence interval [CI], -0.44 to -0.09; P=.004). BCQB combined with MFNS significantly improved runny nose, nasal congestion, sneezing, TNSS, and RQLQ scores compared to MFNS alone, except for nasal itching. BCQB significantly decreased the percentage change in eosinophilic cationic protein, eotaxin, vasoactive intestinal peptide, and interleukin-6 levels. Treatment-emergent adverse events were similar among the three groups.

Conclusion: BCQB was superior to the MFNS in reducing daily runny nose symptoms. The combination of BCQB and MFNS was superior to MFNS alone in alleviating TNSS in patients with moderate-to-severe persistent AR with a predominant symptom of runny nose.

Clinical implications: Female sex is associated with allergic rhinitis among adults, but not with nonallergic rhinitis. These findings could support a role of sex hormones in the pathogenesis of allergic rhinitis and nasal inflammation, but more research is needed to establish causation.

Background: Oral Food Challenges (OFC) are essential for the diagnosis and follow-up of acute Food Protein-Induced Enterocolitis Syndrome (FPIES) because no diagnostic or prognostic biomarkers are available. However, the optimal OFC procedure remains unclear.

Objectives: This systematic review aimed to assess OFC procedures' design and clinical outcomes in patients with FPIES.

Methods: Ten databases were searched for studies published in English between 1978 and February 2024 involving children or adults undergoing OFC for FPIES. Critical appraisal followed Effective Public Health Practice Project parameters.

Results: Fifty-two studies met the inclusion criteria, all observational studies. Of these, 35 were judged to have strong methodological quality. There was great heterogeneity in OFC procedures, particularly in cumulative dose, number, size, and timing between doses. OFC outcome reporting was often inadequate, especially regarding reaction symptoms and severity grading. In single-dose OFC protocols, most children reacted after at least two hours. Four small studies showed that a single dose of 25% of an age-appropriate portion was sufficient to trigger reactions in 80-100% of cases, and this was associated with less severe reactions. Due to methodological heterogeneity and insufficient outcome reporting, further assessment of the OFC protocol characteristics associated with safer outcomes was not possible.

Conclusion: There is significant heterogeneity in FPIES OFC practices. Current recommendations on OFC procedures and outcome assessments have limitations and should be revisited, as this may impact patient safety and diagnostic accuracy. Future studies should focus on standardizing clinical outcomes and generating evidence to support safer, more accurate OFC protocols in FPIES.

Background: Indolent Systemic Mastocytosis (ISM) is a rare disease associated with numerous and diverse symptoms that significantly impact patients' overall health, psychological, emotional, and professional well-being, ultimately affecting their quality of life.

Objective: We aim to estimate the Disability-adjusted Life Year (DALY) of ISM to assess the burden for patients and society.

Methods: We used prospective and retrospective data on symptoms and quality of life from an ISM population recruited at the French expert center CEREMAST, to estimate Disability Weight allowing DALY calculation. An agent-based model was developed to more accurately assess the DALY of ISM over lifetime.

Results: Prospective data were available for 168 ISM patients. A wide variety of symptoms were assessed, with 12.7 (±5.9) symptoms per patient and huge impact on the quality of life. However, the emotional dimension and the impact on social life were also affected. Finally, we estimated the DALY per patient to be between 4.56 and 8.79, representing 89 to 168 per 100,000 inhabitants. The DALY of ISM is comparable to that of lymphoma, leukemia, and psoriasis.

Conclusion: This is the first study to focus on the DALY of ISM. Despite the differences in disease characteristics (such as prevalence, mortality, and age at diagnosis), DALY allows for the ranking of conditions and provides a better understanding of the disease burden. These data may help research prioritization by offering valuable information to healthcare policymakers.