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

Clinical implications: We propose 6.3 (small effect), 12.5 (medium effect), and 18.8 (large effect) as the DrHy-Q6's minimal clinically important difference. Drug hypersensitivity reactions delabelling significantly and progressively improves most patients' health-related quality of life.

Clinical implications: Cough reflex hypersensitivity is increasingly recognized as a key treatable trait, and the Cough Hypersensitivity Questionnaire may serve as a reliable and responsive tool for measuring hypersensitivity symptoms in patients with chronic cough.

Clinical implications: Chronic norovirus infection can lead to significant diarrhoea, malabsorption, and weight loss in immunodeficiency. The clinical and histological picture in these patients is remarkably similar, suggesting that the virus is a main driver for the enteropathy.

Background: Due to limited treatment options for peanut allergy, patients remain at risk for allergic reactions due to accidental exposure. Epicutaneous immunotherapy (EPIT) is a novel treatment being investigated for peanut allergy.

Objective: This study assessed long-term safety of EPIT with VIASKIN® peanut patch 250 μg (VP250) via an open-label extension of the REAL Life Use and Safety of EPIT (REALISE) trial.

Methods: REALISE was a phase 3 trial in peanut-allergic children aged 4 through 11 years that included a 6-month, randomized, double-blind, placebo-controlled treatment phase, followed by an open-label, single-arm, active treatment period for up to 36 months.

Results: Of the 392 participants (male, 54.8%; median age, 7.2 years) who received at least 1 dose of treatment, 77.8% completed the 36-month active treatment. Mean adherence to treatment was high at 96.4%. Most participants (98.7%) experienced at least 1 treatment-emergent adverse event (TEAE); the majority were mild or moderate and decreased in frequency and severity over time. Most (94.6%) participants experienced at least 1 treatment-related TEAE. Local skin reactions were the most common treatment-related TEAE with the incidence decreasing from year 1 (87.8%) to year 3 (19.2%). Serious treatment-related TEAEs were reported in 2 participants. No specific safety signals were identified in the 14 participants enrolled with a history of severe anaphylaxis (Anaphylaxis Staging System grade 3).

Conclusion: Consistent with previous phase 3 studies, long-term EPIT with VP250 was well tolerated with high adherence in peanut-allergic children aged 4 through 11 years (clinicaltrials.gov; NCT: NCT02916446).

Background: Exercise-induced bronchospasm (EIB) commonly coexists with asthma. However, the data on the efficacy of maintenance therapies for asthma with EIB are scarce.

Objective: This network meta-analysis assessed the comparative efficacy and safety of maintenance regimens for asthmatics with EIB.

Methods: We searched PubMed, Scopus, Embase, the Cochrane Center of Controlled Trials, and Google Scholar for randomized controlled trials (RCTs) that addressed the efficacy and safety of maintenance treatments in adolescent and adult asthmatics with EIB from inception to April 2024. The primary outcome was the change in forced expiratory volume in 1 second (FEV1) post-exercise following maintenance therapy. The secondary outcome focused on treatment-related adverse events (AEs).

Results: Eleven RCTs involving 1,054 patients were included. Low-dose inhaled corticosteroids (ICS)-montelukast significantly improved EIB with a mean difference (95% CI) of 14.96% (9.61, 20.31), followed by low-to-medium (LM) dose ICS-salmeterol 13.7% (8.68, 18.72), high-dose ICS 13.30% (1.34, 25.26), montelukast 11.35% (5.76, 16.95), ICS-vilanterol 9.24% (4.41,14.07), zafirlukast 8.80% (2.28, 15.32), LM-dose ICS 7.55% (3.48, 16.63), and as-needed ICS-formoterol 6.91% (2.07, 11.75). Low-dose ICS-montelukast and LM-dose ICS-salmeterol were comparably effective. There were no significant efficacy differences among ICS monotherapy, as-needed ICS-formoterol, and anti-leukotrienes. Anti-leukotrienes were inferior to ICS monotherapy in reducing asthma exacerbation. Long-acting β2-agonist (LABA)-induced tachyphylaxis may occur despite using alongside ICS.

Conclusion: Low-dose ICS and as-needed ICS-formoterol were equally effective in managing asthmatics with EIB. Adding anti-leukotrienes or LABA to ICS should be considered for more severe cases, with close monitoring to assess treatment response and detect potential tachyphylaxis or AEs.

Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS), a severe cutaneous adverse reaction (SCAR), represents a diagnostic and therapeutic challenge due to its varied, evolving clinical presentation, complex pathophysiology, and potential for severe systemic involvement. This article explores DRESS syndrome through three illustrative cases from diverse populations and with different background co-morbidities. Cases highlight different challenges in DRESS care, including: i) the need for early diagnosis and severity scoring, ii) identification of offending drugs and risk stratification to consider a possible drug challenge, and iii) best practice management including long-term monitoring for emergent autoimmunity. Recent developments in our understanding of clinical spectrum of disease, genomic and non-genomic biomarkers, severity groupings, and pharmacological and longer-term management strategies are described. Critical gaps remain in several of these domains, particularly in vulnerable groups such as the immune-compromised. In this absence of robust evidence, we aim for this article to assist attending clinicians with current expert opinion in DRESS management. Finally, we highlight areas for further research needed to improve the clinical care and outcomes of DRESS.

Management of IgE-mediated food allergy is shifting from reactive management strategies (allergen avoidance and ready access to autoinjectable epinephrine in case of exposure) to proactive therapies. These therapies are in various stages of clinical development and implementation; the two main approaches include allergen-specific/active therapies (induce the immune system to produce a protective response to the allergen; e.g., FDA-approved AR101/Palforzia for peanut allergy), and allergen-agnostic, passive therapies (provide the body with the tools needed to suppress immediate hypersensitivity reactions in a non-specific manner; e.g., FDA-approved omalizumab/xolair). These therapies provide a similar degree of protection, specifically desensitization (increased reaction threshold while receiving food allergy therapy, "bite safety"), but differ in mechanisms, dosing protocols and side effects. The goals of therapeutics in development are shifting to sustained unresponsiveness/remission (absence of clinical reactivity after allergen and food allergy therapy avoidance, typically for weeks to months) and tolerance (no clinical reaction/free ingestion of the allergen). As the food allergy management repertoire expands, important considerations in selecting a therapy will be patient-specific and include mode of delivery, dosing regimens, side effect profiles and goals/outcomes. The role of shared decision making and implementation strategies to support equitable access across patient populations and clinical contexts will be critical to move an increasing number of patients beyond desensitization to tolerance, if they wish.

Background: The COP28 Declaration on Climate and Health promotes steps to curb emissions and reduce waste in the health sector.

Objective: To describe and quantify greenhouse gas (GHG) emissions associated with severe asthma (SA) care in the UK, by carbon source and transition status from SA to severe uncontrolled asthma (SUA) and/or regular specialist care (RSC).

Methods: This was a cohort study using routinely collected data from the Clinical Practice Research Datalink Aurum, Hospital Episode Statistics and CO₂ equivalent emissions data. Patients were ≥12 years old at index date (i.e. date of first recorded ICS + controller prescription) with a validated asthma diagnosis. Total-, medication-, exacerbation- and healthcare resource utilisation (HCRU)-related GHG emissions were estimated, overall and by transition along stages of the SA-SUA-RSC continuum. Five pathways and stage orders were identified: 1. SA, 2. SA-SUA, 3. SA-RSC, 4. SA-RSC-SUA, 5. SA-SUA-RSC.

Results: Total CO₂ eq for the SA population (n=93,054) was 2167 tonnes/10K patients/year. GHG emissions were 5.2-23.0% greater for patients transitioned to SUA (versus previous stage), mostly due to exacerbation-related emissions (4.2-7.7 times greater; predominantly hospitalizations) and medication-related emissions (3.5-10.9% greater; predominantly SABAs). Conversely, total GHG emissions decreased by 12.1-23.9% for those referred to RSC, due to decreased exacerbation-related emissions (1.7-5.2 times lower; all sources) and medication-related emissions (14.8-20.6% lower; both SABA and overall ICS).

Conclusion: Our findings suggest that RSC not only improves patient outcomes but also reduces GHG emissions in line with aims to reduce the health sector's contribution to the total national carbon footprint.