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

英文中文

Prevalence and Characteristics of Accidental Ingestions Among Pediatric Food Allergy Patients 儿科食物过敏患者意外摄入食物的发生率和特点。

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.2024.08.006

Cynhia Hsu BS , Shweta Hosakoppal MD , Meagan Yong MS, MPH , Ruchi Gupta MD , Melanie Makhija MD , Anne Marie Singh MD

Background

Despite a known diagnosis of food allergy, accidental ingestions continue to occur.

Objective

To characterize accidental ingestions, including prevalence, risk factors, food allergen triggers, and severity of reactions.

Methods

A prospective monthly survey developed by the Food Allergy Consortium at Northwestern University was administered to parents of food-allergic children between April 2015 and April 2017. The monthly survey included questions on any allergic reactions experienced in the previous month. In addition, chart reviews of 100 pediatric participants from Lurie Children’s Hospital of Chicago allergy clinics (typical clinical encounters) were compared with the prospective survey results.

Results

A total of 196 survey participants and 100 retrospective review subjects were analyzed—31.1% of participants from the surveyed cohort and 19.0% of participants from the retrospective review reported at least 1 accidental ingestion over 1 year. The rate of accidental ingestions reported in the prospective survey was high: 10% to 25% of participants each month reported an accidental ingestion, and multiple ingestions were common. Common triggers were milk, wheat, and tree nuts. In the retrospective cohort, the highest rate of accidental ingestion (25.0%) occurred for milk, followed by sesame (20.0%) and egg (18.8%). Rates of anaphylaxis after exposure were high in both the prospective and retrospective cohorts (33.1% and 16.7%, respectively).

Conclusions

Accidental ingestion rates were high among food-allergic patients. Multiple exposures, especially to milk, were common. Incidence of anaphylaxis was also high, suggesting that ongoing patient education on allergen avoidance and accidental exposure is imperative.

背景：尽管已确诊食物过敏，但意外摄入仍时有发生：我们试图描述意外摄入的特点，包括发生率、风险因素、食物过敏原诱发因素以及反应的严重程度：2015年4月至2017年4月期间，西北大学食物过敏联合会（FARC）对食物过敏儿童的父母进行了前瞻性月度调查。月度调查包括上个月经历的任何过敏反应的问题。此外，对芝加哥卢瑞儿童医院过敏门诊（典型临床会诊）的100名儿科参与者的病历回顾与前瞻性调查结果进行了比较：对 196 名 FARC 调查参与者和 100 名回顾性审查对象进行了分析。31.1%的调查对象和19.0%的回顾性研究对象报告在一年内至少发生过一次误食。前瞻性调查中报告的误食率很高：每月有 10-25% 的参与者报告误食，而且多次误食很常见。常见的诱发因素是牛奶、小麦和树坚果。在回顾性队列中，误食牛奶的比例最高（25.0%），其次是芝麻（20.0%）和鸡蛋（18.8%）。在前瞻性队列和回顾性队列中，接触后发生过敏性休克的比例都很高（分别为 33.1% 和 16.7%）：结论：食物过敏患者的意外摄入率很高。结论：食物过敏患者中意外摄入食物的比例很高，多次摄入食物（尤其是牛奶）的情况很常见。过敏性休克的发生率也很高，这表明围绕过敏原的避免和意外接触对患者进行持续教育势在必行。

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引用次数: 0

Understanding Inflammatory Heterogeneity in NSAID-Exacerbated Respiratory Disease 了解非甾体抗炎药加重呼吸道疾病的炎症异质性。

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.2024.07.035

Justin H. Turner MD, PhD , Atsushi Kato PhD

引用次数: 0

NSAID-Exacerbated Respiratory Disease—A Century of Discovery and Innovation 非甾体抗炎药致呼吸道疾病--一个世纪的发现与创新。

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.2024.09.011

Whitney W. Stevens MD, PhD , Joaquim Mullol MD, PhD

引用次数: 0

The Link Between Allergic Rhinitis and Keratoconus: A Call for Greater Awareness, Early Intervention, and Future Ocular Surface Diagnostic Tools 过敏性鼻炎与角膜炎之间的联系：呼吁提高意识、早期干预和未来的眼表诊断工具。

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.2024.08.015

Leonard Bielory MD

引用次数: 0

Systemic Therapies for Atopic Dermatitis 特应性皮炎的系统疗法

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.2024.10.005

引用次数: 0

May 2024 Practice Notes 2024 年 5 月练习笔记

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)01006-7

引用次数: 0

The Burden of Nonsteroidal Anti-Inflammatory Drug-Exacerbated Respiratory Disease: Interplay Between Quality of Life and Economic Implications 非甾体抗炎药-胃食管反流病的负担：生活质量与经济影响之间的相互作用。

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.2024.06.044

Nicholas R. Rowan MD , Claire Hopkins DM , Rodney J. Schlosser MD , Zachary M. Soler MD

Nonsteroidal anti-inflammatory drug-exacerbated respiratory disease (NSAID-ERD) presents a significant challenge in clinical management owing to recalcitrant disease with accompanying profound impacts on patient quality of life. Although asthma represents a significant component of this disease, quality of life disruptions are driven primarily by recalcitrant sinonasal problems, olfactory dysfunction, and the associated psychosocial and dietary implications. This review delves into specific quality of life metrics used to assess NSAID-ERD and the associated health care burden and financial implications of this disease, offering insights into the comparative challenges in chronic rhinosinusitis with nasal polyps when available. The article reviews the associated costs and cost-effectiveness of NSAID-ERD–directed therapies, including endoscopic sinus surgery, aspirin desensitization, and biologic therapy. Although some of these emerging treatment approaches show promise, they also present numerous unanswered questions, reflecting the dynamic nature of this field. As the landscape of NSAID-ERD management continues to evolve, this review provides insights into the challenges faced by clinicians and underscores the need for further research to optimize patient care and quality of life outcomes.

非甾体抗炎药加重的呼吸系统疾病（NSAID-ERD）给临床治疗带来了巨大挑战，因为顽固性疾病会对患者的生活质量产生深远影响。虽然哮喘是这种疾病的一个重要组成部分，但生活质量受到影响的主要原因是顽固性鼻窦不适、嗅觉功能障碍以及相关的社会心理和饮食影响。这篇综述深入探讨了用于评估非甾体抗炎药-胃食管反流病的具体生活质量指标，以及这种疾病的相关医疗负担和财务影响，并对慢性鼻炎伴鼻息肉（CRSwNP）（如有）的比较挑战提出了见解。文章回顾了非甾体抗炎药物治疗 ERD 的相关成本和成本效益，包括内窥镜鼻窦手术、阿司匹林脱敏和生物疗法。虽然其中一些新兴的治疗方法显示出良好的前景，但它们也提出了许多悬而未决的问题，反映出这一领域的动态性质。随着非甾体抗炎药物治疗胃食管反流病的不断发展，本综述深入探讨了临床医生所面临的挑战，并强调了进一步开展研究以优化患者护理和生活质量的必要性。

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引用次数: 0

The Challenges of Oral Tolerance Induction in a Diverse Population Advised to Introduce Allergens Early: Insights From the EarlyNuts Study 在建议尽早引入过敏原的多样化人群中进行口服耐受性诱导的挑战：早期坚果研究的启示。

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.2024.08.028

Hannah F. Marshall MBChB , Helen A. Brough MBBS, PhD

引用次数: 0

Impact of Ongoing Treatment With Inhaled Corticosteroids During Specific Inhalation Challenges for Diagnosing Occupational Asthma 在诊断职业性哮喘的特定吸入挑战中持续使用吸入式皮质类固醇治疗的影响。

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.2024.07.021

Gabriel Lavoie MD , Catherine Lemière MD, MSc

Background

Specific inhalation challenge (SIC) tests are still the reference test for diagnosing sensitizer-induced occupational asthma (SIOA). The European Respiratory Society recommends the cessation of inhaled corticosteroids (ICS) 72 hours before SIC.

Objective

To assess the effect of an ongoing ICS treatment during SIC on the maximum fall in forced expiratory volume in 1 second (FEV₁), the change in methacholine provocative concentration of methacholine inducing a 20% fall in FEV₁ (PC₂₀), and sputum eosinophil counts after exposure to the suspected agent.

Methods

We performed a retrospective analysis using a database of cases referred to our center for suspected SIOA from 1999 to 2022. The results of the SIC were compared between subjects treated with ICS during SIC and steroid-naïve subjects.

Results

Six hundred and seventy-one individuals underwent SIC in the laboratory. Three hundred and eighteen were treated with ICS, whereas 353 were steroid naïve. The proportion of subjects with a positive SIC was greater among ICS-treated subjects (39. 6%) compared with steroid-naïve subjects (27.5%, P < .001). A treatment with ICS did not influence the outcome of the SIC. There was no difference in the change in PC₂₀ or the percentage of sputum eosinophils after SIC between steroid-treated and steroid-naïve subjects.

Conclusions

An ongoing ICS treatment during an SIC did not affect the occurrence of an asthmatic reaction, the change in airway responsiveness, or eosinophilic inflammation after exposure to the suspected agent in subjects who have been treated with ICS for a long period of time.

背景：特异性吸入挑战试验（SIC）仍然是诊断致敏剂诱发的职业性哮喘（SIOA）的参考试验。欧洲呼吸学会建议在 SIC 前 72 小时停止吸入皮质类固醇（ICS）：目的：评估 SIC 期间持续使用 ICS 对 FEV1 最大降幅、甲基胆碱 PC20 变化以及痰中嗜酸性粒细胞计数的影响：我们利用 1999 年至 2022 年期间因疑似 SIOA 转诊至本中心的病例数据库进行了回顾性分析。比较了在SIC期间接受ICS治疗的受试者和未接受类固醇治疗的受试者的SIC结果：结果：六百七十一人在实验室接受了SIC治疗。其中 318 人接受了 ICS 治疗，353 人未接受类固醇治疗。在接受过 ICS 治疗的受试者中，SIC 阳性的比例（39.6%）高于类固醇未接受过治疗的受试者（27.5%，P20 或类固醇治疗受试者和类固醇未接受治疗受试者 SIC 后痰中嗜酸性粒细胞的百分比）：结论：对于长期接受 ICS 治疗的受试者来说，在 SIC 期间持续接受 ICS 治疗不会影响哮喘反应的发生、气道反应性的变化或接触可疑病原体后的嗜酸性粒细胞炎症。

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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

Journal of Allergy and Clinical Immunology-In Practice

Pub Date : 2024-11-01 DOI: 10.1016/j.jaip.2024.08.023

Michaela Lucas MD, DrMed , Britta S. von Ungern-Sternberg MD, DrMed, PhD , Annabelle Arnold DipHE , Michelle Trevenen PhD , Susan Herrmann PhD , Laure Braconnier PhD , Syed Ali MD , Catherine Jepp MD , David Sommerfield MD , Kevin Murray PhD , Kristina Rueter MD, DrMed, PhD

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。

{"title":"Comparing Skin and Serum Testing to Direct Challenge Outcomes in Children With β-Lactam Allergies","authors":"Michaela Lucas MD, DrMed , Britta S. von Ungern-Sternberg MD, DrMed, PhD , Annabelle Arnold DipHE , Michelle Trevenen PhD , Susan Herrmann PhD , Laure Braconnier PhD , Syed Ali MD , Catherine Jepp MD , David Sommerfield MD , Kevin Murray PhD , Kristina Rueter MD, DrMed, PhD","doi":"10.1016/j.jaip.2024.08.023","DOIUrl":"10.1016/j.jaip.2024.08.023","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Objective</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"12 11","pages":"Pages 3034-3043.e20"},"PeriodicalIF":8.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142037657","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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