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

Modern drug allergy practice is witnessing the steady expansion of electronic health records and digital health applications. This creates both obstacles and opportunities for optimising allergy care. In this review we describe ways that novel technology is being utilized with regards to immunologically-mediated drug hypersensitivity research and clinical practice. We propose future directions to strengthen drug allergy diagnostic accuracy, clinical decision-making, and patient safety.

Background: Behavioural interventions (BI) to increase physical activity in daily life (PADL) seem to improve asthma control. However, studies have included fewer individuals and assessed only the short-term effect. In addition, the responders' profiles remain unknown.

Objective: To identify the characteristics of patients who respond to a BI to increase PADL and assess the clinical response to BI in the short and medium term.

Methods: In this prospective pragmatic study, one hundred inactive individuals with uncontrolled or partially controlled moderate-to-severe asthma (Asthma Control Questionnaire (ACQ) >0.75) underwent an 8-week BI (up to 90 min/session, once a week). Preintervention, postintervention (short-term), and postintervention 4-month follow-up (medium-term) assessments included PADL (triaxial accelerometry), ACQ, health-related quality of life (HRQoL) (Asthma Quality of Life Questionnaire, AQLQ), and anxiety and depression symptoms (Hospital Anxiety and Depression Scale, HADS). The stage of change for physical activity was classified using the transtheoretical model. Individuals who increased their activity by ≥2,500 steps/day were considered responders.

Results: Most individuals were female (89%), had a median age of 53 y, a BMI of 31.0 kg/cm², an ACQ score of 2.17, steps/day of 4,340, and moderate-to-vigorous physical activity (MVPA) of 69.5 min/week. After intervention, individuals increased steps/day, MVPA, and AQLQ scores and decreased ACQ and HADS scores (p<0.05). Most individuals also demonstrated a positive behaviour change toward becoming more physically active. Improvements in PADL, ACQ and AQLQ were maintained at follow-up. At baseline, responders had lower BMI, fewer steps/day, and spent less time in MVPA than nonresponders (p<0.05).

Conclusion: Individuals who responded to BI had lower BMI and lower levels of PADL at baseline. BI improves PADL, clinical control, and HRQoL in the short and medium-term. The intervention also promoted sustained behaviour change toward a more active lifestyle.

Background: Asthma negatively impacts the lives of patients and their families in physical, emotional, and social dimensions. Sexual dysfunction is one of the factors that contribute to reduced quality of life in individuals with chronic diseases. The symptoms induced by asthma negatively affect the sexual life of individuals.

Objective: The aim of this study was to evaluate the impact of asthma on women's sexual life, sexual quality of life, and marital adjustment.

Methods: This study was conducted using a case-control comparative cross-sectional design. The case group consisted of 80 female patients with asthma who met the inclusion criteria and volunteered to participate in the study, and the control group consisted of 80 women with similar characteristics who came to the outpatient clinic as companions. The data for the study were collected using the Personel Information Form, Arizona Sexual Experience Scale-Female, Sexual Quality of Life Questionnaire-Female, Revised Dyadic Adjustment Scale, and Asthma Control Test.

Results: The findings obtained in the present study demonstrated that asthma adversely affects women's sexual function and sexual quality of life but does not have a significant impact on marital adjustment.

Conclusion: As an essential aspect of life, sexuality may be compromised by asthma, thereby reducing the overall quality of life.

Clinical implications: Physiological parameters predicted objective allergic reactions accurately in about 60% of the food challenges, possibly enabling future earlier detection and intervention. This may help prevent severe symptoms, though larger studies are required to confirm these findings.

Background: Although the visual analog scale (VAS) is recommended in guidelines for assessing perennial allergic rhinitis (PAR), its validity in non-allergic rhinitis (NAR) remains unclear.

Objective: To evaluate the concurrent validity of the VAS in assessing symptom severity and its association with quality-of-life (QoL) outcomes in PAR and NAR.

Methods: This cross-sectional study prospectively included adults with moderate-to-severe PAR and NAR, all of whom had experienced symptoms for >6 months and underwent skin prick and/or specific IgE testing. Individual nasal symptoms, total nasal symptom score (TNSS), VAS, and Rhinoconjunctivitis Quality of Life-36 (RCQ-36) scores were compared between groups. VAS validity was assessed via Spearman's correlation with TNSS. Participants were dichotomized at the median VAS to examine associations with RCQ-36 and symptom profiles.

Results: Among 445 patients (298 PAR, 147 NAR), TNSS was lower in NAR, but VAS global scores and RCQ-36 domains were similar, except for a trend toward higher eye symptom burden in PAR. VAS correlated moderately with TNSS in PAR (Spearman correlation = 0.49, 95% CI: 0.40-0.57) but weakly in NAR (0.35, 95% CI: 0.20-0.49). Patients with VAS ≥70 mm (median cutoff) had significantly worse RCQ-36 in both groups, along with higher VAS for eye itching, postnasal drip, nasal voice, facial pressure, hyposmia, and cough. Greater nasal obstruction and rhinorrhea severity strongly correlated with poorer QoL.

Conclusion: VAS demonstrates comparable validity in PAR and NAR, effectively categorizing disease severity and QoL impairment. Nasal congestion and rhinorrhea severity are key drivers of reduced QoL in both conditions.

Background: Although treatment burden significantly affects the management of pediatric asthma, no specific instrument exists to measure it in this population.

Objective: To develop and validate a questionnaire measuring treatment burden in pediatric asthma from both children's and parents' perspectives.

Methods: We conducted semi-structured interviews with 20 children with asthma (aged 8-12 years) and their parents to identify relevant components of treatment burden. Items were refined through a Delphi process with pediatric pulmonologists. The questionnaire was then validated in 202 parent-child dyads across eight teaching hospitals. We assessed psychometric properties, including factorial validity, internal consistency, construct validity, and test-retest reliability.

Results: The final questionnaire was composed of seven items for children (Cronbach α = 0.78) and 13 items for parents (Cronbach α = 0.86). Both versions demonstrated strong construct validity, with significant correlations with quality of life measures (r = -0.52 for children and r = -0.53 for parents) and global impression of treatment burden (r = +0.66 for children and r = +0.77 for parents). Test-retest reliability was acceptable for both children (intraclass correlation coefficient = 0.72) and parents (intraclass correlation coefficient = 0.80). Higher treatment burden scores were associated with being female (for both children and caregivers), having multiple scheduled visits, and poor asthma control. Parent and child scores showed moderate correlation (r = 0.33; P < .01), highlighting the importance of capturing both perspectives.

Conclusion: This validated questionnaire provides a reliable tool for measuring treatment burden in pediatric asthma, enabling clinicians to better understand and address the impact of asthma management on children and their families.

Clinical implications: Penicillin Allergy Decision & Mobile Empowerment (PADME) is a free, patient-facing, mobile-enabled platform designed to perform risk stratification and promote penicillin allergy delabeling. Clinical validation of this tool, its downstream impacts, and its role in enhancing access should be examined.

Antibiotic allergy labels, especially to penicillins, are common but often inaccurate, with more than 90% disproven upon formal evaluation. These unverified labels lead to suboptimal antibiotic use, increased healthcare costs, and worse clinical outcomes. Traditional allergist-led assessment models are not scalable due to global shortages of allergy specialists. Recent evidence supports a shift toward proactive, ambulatory, multidisciplinary delabelling strategies that integrate risk-stratified direct oral drug provocation testing into routine care. Validated point-of-care tools now enable non-allergists, including pharmacists, nurses, and physicians, to safely identify low-risk patients suitable for delabelling without skin testing. Successful programs in hospitals, outpatient clinics, and community settings demonstrate that ambulatory delabelling is safe, cost-effective, and scalable. High-yield populations such as pregnant women, immunocompromised individuals, and older adults benefit significantly from timely evaluation. Effective implementation requires structured training, standardized protocols, integration into electronic health records, and a Hub-and-Spoke model linking non-specialist "spokes" to allergist-led "hubs" for oversight. Clear documentation, patient education, and post-challenge follow-up are essential to prevent re-labelling. Future efforts must focus on equitable access, workforce development, and research to validate tools in underrepresented populations and quantify long-term antimicrobial stewardship benefits. Ambulatory delabelling is no longer the sole domain of allergists but a shared responsibility across healthcare systems to improve prescribing, patient safety, and global antimicrobial resistance outcomes.