Pub Date : 2024-08-27DOI: 10.1016/j.jaip.2024.08.038
Jorge F Maspero, Martti A Antila, Antoine Deschildre, Leonard B Bacharier, Arman Altincatal, Elizabeth Laws, Eric Mortensen, Amr Radwan, Juby A Jacob-Nara, Yamo Deniz, Paul J Rowe, David J Lederer, Megan Hardin
Background: In phase 3 VOYAGE (NCT02948959), dupilumab showed clinical efficacy with an acceptable safety profile in children (6-11 years) with uncontrolled, moderate-to-severe type 2 asthma (blood eosinophils ≥150 cells/μL or fractional exhaled nitric oxide ≥20 ppb).
Objective: We analyzed dupilumab's efficacy in children with type 2 asthma by high- or medium-dose inhaled corticosteroids (ICS) at baseline.
Methods: Children were randomized to receive add-on dupilumab 100/200 mg (by body-weight ≤30 kg/>30 kg) every 2 weeks or placebo for 52 weeks and stratified by high- or medium-dose ICS at baseline. Endpoints were annualized severe exacerbation rate, changes from baseline in percent-predicted forced expiratory volume in 1 second (ppFEV1) and 7-item Asthma Control Questionnaire - Interviewer Administered (ACQ-7-IA) score, proportions of ACQ-7-IA responders (improvement ≥0.5), and biomarker changes.
Results: In children receiving high- (n = 152) or medium- (n = 195) dose ICS at baseline, dupilumab versus placebo reduced severe exacerbation rates by 63% (P < .001) and 59% (P = .003), respectively. At week 52, dupilumab improved ppFEV1 by least squares mean difference versus placebo of 5.7 percentage points (P = .02) and 9.35 points (P < .001), and reduced ACQ-7-IA scores by 0.53 points (P < .001) and 0.40 points (P < .001), respectively. No significant treatment interactions between ICS subgroups were detected at week 52. Significant improvements were observed in ACQ-7-IA responder rates and most type 2 biomarker levels.
Conclusion: Dupilumab reduced severe exacerbation rates and improved lung function and asthma control in children with uncontrolled, moderate-to-severe type 2 asthma, regardless of ICS dose at baseline.
{"title":"Dupilumab Efficacy in Children With Type 2 Asthma Receiving High/Medium-Dose ICS (VOYAGE).","authors":"Jorge F Maspero, Martti A Antila, Antoine Deschildre, Leonard B Bacharier, Arman Altincatal, Elizabeth Laws, Eric Mortensen, Amr Radwan, Juby A Jacob-Nara, Yamo Deniz, Paul J Rowe, David J Lederer, Megan Hardin","doi":"10.1016/j.jaip.2024.08.038","DOIUrl":"https://doi.org/10.1016/j.jaip.2024.08.038","url":null,"abstract":"<p><strong>Background: </strong>In phase 3 VOYAGE (NCT02948959), dupilumab showed clinical efficacy with an acceptable safety profile in children (6-11 years) with uncontrolled, moderate-to-severe type 2 asthma (blood eosinophils ≥150 cells/μL or fractional exhaled nitric oxide ≥20 ppb).</p><p><strong>Objective: </strong>We analyzed dupilumab's efficacy in children with type 2 asthma by high- or medium-dose inhaled corticosteroids (ICS) at baseline.</p><p><strong>Methods: </strong>Children were randomized to receive add-on dupilumab 100/200 mg (by body-weight ≤30 kg/>30 kg) every 2 weeks or placebo for 52 weeks and stratified by high- or medium-dose ICS at baseline. Endpoints were annualized severe exacerbation rate, changes from baseline in percent-predicted forced expiratory volume in 1 second (ppFEV<sub>1</sub>) and 7-item Asthma Control Questionnaire - Interviewer Administered (ACQ-7-IA) score, proportions of ACQ-7-IA responders (improvement ≥0.5), and biomarker changes.</p><p><strong>Results: </strong>In children receiving high- (n = 152) or medium- (n = 195) dose ICS at baseline, dupilumab versus placebo reduced severe exacerbation rates by 63% (P < .001) and 59% (P = .003), respectively. At week 52, dupilumab improved ppFEV<sub>1</sub> by least squares mean difference versus placebo of 5.7 percentage points (P = .02) and 9.35 points (P < .001), and reduced ACQ-7-IA scores by 0.53 points (P < .001) and 0.40 points (P < .001), respectively. No significant treatment interactions between ICS subgroups were detected at week 52. Significant improvements were observed in ACQ-7-IA responder rates and most type 2 biomarker levels.</p><p><strong>Conclusion: </strong>Dupilumab reduced severe exacerbation rates and improved lung function and asthma control in children with uncontrolled, moderate-to-severe type 2 asthma, regardless of ICS dose at baseline.</p>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":null,"pages":null},"PeriodicalIF":8.2,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142114601","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}
Pub Date : 2024-08-27DOI: 10.1016/j.jaip.2024.08.036
Margitta Worm, Ewa Cichocka-Jarosz, Franziska Ruëff, Thomas Spindler, Alice Köhli, Johannes Trück, Lars Lange, Karin Hartmann, Thomas Hawranek, Katja Nemat, Claudia Pföhler, Maria Beatrice Bilò, Dominique Sabouraud-Leclerc, Nicola Wagner, Nikolaos Papadopoulos, Susanne Hämmerling, Luis Felipe Ensina, Sabine Dölle-Bierke, Veronika Höfer
Background: Hymenoptera venom is one of the most frequent causes of anaphylaxis. Studies from adults indicate the clinical profiles and risk factors of Hymenoptera venom induced anaphylaxis (VIA). Much less is known about pediatric VIA.
Objective: To better understand elicitor and age related factors determining pediatric VIA by analyzing data from the anaphylaxis registry.
Methods: We selected pediatric VIA, pediatric food induced anaphylaxis (FIA) and adult VIA cohorts from the anaphylaxis registry and performed a comparative data analysis regarding elicitors, symptoms and management.
Results: 725 pediatric VIA, 3,149 pediatric FIA and 5,534 adult VIA were identified. In pediatric VIA, boys were more frequently affected, atopy was not increased and the onset of the reaction after exposure was fast (≤ 30 min; 91%) when compared to pediatric FIA. Symptoms in pediatric VIA were age dependent, and although respiratory symptoms occurred besides skin symptoms most frequent in both, pediatric VIA and FIA, cardiovascular symptoms were more frequently reported in pediatric VIA than pediatric FIA. The analysis of pediatric versus adult VIA reveled clear differences of the frequency of involved organ systems (skin: 93/78%, respiratory: 77/64%, and cardiovascular: 61/85%). Among both, the pediatric and adult VIA, the rates of adrenaline application by a professional were low (29/31%) but the hospitalization rates were higher in children than in adults (61%/42%). Venom immunotherapy (VIT) was initiated frequently regardless of age (78% each).
Conclusion: Pediatric VIA is more frequent in boys, symptoms are age dependent and often hospitalization is required. Adrenaline should be applied according the current guidelines. VIT is an important treatment option in pediatric VIA and should be considered in severely affected children.
背景:膜翅目昆虫毒液是导致过敏性休克的最常见原因之一。成人研究表明了膜翅目昆虫毒液诱发过敏性休克(VIA)的临床特征和风险因素。但对小儿 VIA 的了解却很少:目的:通过分析过敏性休克登记数据,更好地了解决定小儿 VIA 的诱发因素和年龄相关因素:我们从过敏性休克登记处选取了小儿 VIA、小儿食物诱发过敏性休克(FIA)和成人 VIA 队列,并对诱发因素、症状和管理进行了数据对比分析:结果:共发现 725 例小儿 VIA、3149 例小儿 FIA 和 5534 例成人 VIA。在小儿 VIA 中,与小儿 FIA 相比,男孩发病率更高,而过敏性体质的儿童发病率并不增加,并且在接触后反应很快(≤ 30 分钟;91%)。小儿 VIA 的症状与年龄有关,虽然呼吸道症状是小儿 VIA 和 FIA 中除皮肤症状外最常见的症状,但小儿 VIA 比小儿 FIA 更常出现心血管症状。对小儿和成人 VIA 的分析显示,受累器官系统的频率存在明显差异(皮肤:93/78%;呼吸系统:77/64%;心血管系统:61/85%)。在儿童和成人 VIA 中,由专业人员使用肾上腺素的比例较低(29/31%),但儿童的住院率高于成人(61/42%)。毒液免疫疗法(VIT)的使用频率与年龄无关(各占 78%):结论:小儿 VIA 多见于男孩,症状与年龄有关,通常需要住院治疗。应根据现行指南使用肾上腺素。VIT 是治疗小儿 VIA 的重要选择,严重患儿应考虑使用 VIT。
{"title":"Age and elicitor dependent characterization of Hymenoptera venom induced anaphylaxis in children and adolescents.","authors":"Margitta Worm, Ewa Cichocka-Jarosz, Franziska Ruëff, Thomas Spindler, Alice Köhli, Johannes Trück, Lars Lange, Karin Hartmann, Thomas Hawranek, Katja Nemat, Claudia Pföhler, Maria Beatrice Bilò, Dominique Sabouraud-Leclerc, Nicola Wagner, Nikolaos Papadopoulos, Susanne Hämmerling, Luis Felipe Ensina, Sabine Dölle-Bierke, Veronika Höfer","doi":"10.1016/j.jaip.2024.08.036","DOIUrl":"https://doi.org/10.1016/j.jaip.2024.08.036","url":null,"abstract":"<p><strong>Background: </strong>Hymenoptera venom is one of the most frequent causes of anaphylaxis. Studies from adults indicate the clinical profiles and risk factors of Hymenoptera venom induced anaphylaxis (VIA). Much less is known about pediatric VIA.</p><p><strong>Objective: </strong>To better understand elicitor and age related factors determining pediatric VIA by analyzing data from the anaphylaxis registry.</p><p><strong>Methods: </strong>We selected pediatric VIA, pediatric food induced anaphylaxis (FIA) and adult VIA cohorts from the anaphylaxis registry and performed a comparative data analysis regarding elicitors, symptoms and management.</p><p><strong>Results: </strong>725 pediatric VIA, 3,149 pediatric FIA and 5,534 adult VIA were identified. In pediatric VIA, boys were more frequently affected, atopy was not increased and the onset of the reaction after exposure was fast (≤ 30 min; 91%) when compared to pediatric FIA. Symptoms in pediatric VIA were age dependent, and although respiratory symptoms occurred besides skin symptoms most frequent in both, pediatric VIA and FIA, cardiovascular symptoms were more frequently reported in pediatric VIA than pediatric FIA. The analysis of pediatric versus adult VIA reveled clear differences of the frequency of involved organ systems (skin: 93/78%, respiratory: 77/64%, and cardiovascular: 61/85%). Among both, the pediatric and adult VIA, the rates of adrenaline application by a professional were low (29/31%) but the hospitalization rates were higher in children than in adults (61%/42%). Venom immunotherapy (VIT) was initiated frequently regardless of age (78% each).</p><p><strong>Conclusion: </strong>Pediatric VIA is more frequent in boys, symptoms are age dependent and often hospitalization is required. Adrenaline should be applied according the current guidelines. VIT is an important treatment option in pediatric VIA and should be considered in severely affected children.</p>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":null,"pages":null},"PeriodicalIF":8.2,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142114599","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}
Pub Date : 2024-08-27DOI: 10.1016/j.jaip.2024.08.037
Jenika Ferretti-Gallon, Jeffrey Fine, Navdeep Riar, Suzanne Teuber, Anh P Nguyen
{"title":"EMR Alert Is Effective in Reducing Food Allergy Panel Testing.","authors":"Jenika Ferretti-Gallon, Jeffrey Fine, Navdeep Riar, Suzanne Teuber, Anh P Nguyen","doi":"10.1016/j.jaip.2024.08.037","DOIUrl":"https://doi.org/10.1016/j.jaip.2024.08.037","url":null,"abstract":"","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":null,"pages":null},"PeriodicalIF":8.2,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142114603","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}
Pub Date : 2024-08-26DOI: 10.1016/j.jaip.2024.08.039
Hyun Jee Kim, Ji-Su Shim, Ga-Yoon Park, Dong Yoon Kang, Je-Young Shin, Sung-Min Kim, Sae Hoon Kim, Jaechun Lee, Young Hee Nam, Gil-Soon Choi, Min-Gyu Kang, Da Woon Sim, Min-Hye Kim, Myoung Shin Kim, Young-Min Ye, Chang-Gyu Jung, Min-Suk Yang, Sujeong Kim, Yi Yeong Jeong, Seung Eun Lee, Hye-Kyung Park, Kyoung-Hee Sohn, James Yun, Hye-Ryun Kang
{"title":"Association of HLA-B*13:01 with DRESS and HLA-A*31:01 with Eosinophilia in SJS/TEN induced by carbamazepine.","authors":"Hyun Jee Kim, Ji-Su Shim, Ga-Yoon Park, Dong Yoon Kang, Je-Young Shin, Sung-Min Kim, Sae Hoon Kim, Jaechun Lee, Young Hee Nam, Gil-Soon Choi, Min-Gyu Kang, Da Woon Sim, Min-Hye Kim, Myoung Shin Kim, Young-Min Ye, Chang-Gyu Jung, Min-Suk Yang, Sujeong Kim, Yi Yeong Jeong, Seung Eun Lee, Hye-Kyung Park, Kyoung-Hee Sohn, James Yun, Hye-Ryun Kang","doi":"10.1016/j.jaip.2024.08.039","DOIUrl":"https://doi.org/10.1016/j.jaip.2024.08.039","url":null,"abstract":"","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":null,"pages":null},"PeriodicalIF":8.2,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142094154","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}
Pub Date : 2024-08-26DOI: 10.1016/j.jaip.2024.08.033
Claudia Crimi, Santi Nolasco, Alberto Noto, Angelantonio Maglio, Vitaliano Nicola Quaranta, Danilo Di Bona, Giulia Scioscia, Francesco Papia, Maria Filomena Caiaffa, Cecilia Calabrese, Maria D'Amato, Corrado Pelaia, Raffaele Campisi, Carolina Vitale, Luigi Ciampo, Silvano Dragonieri, Elena Minenna, Federica Massaro, Lorena Gallotti, Luigi Macchia, Massimo Triggiani, Nicola Scichilone, Giuseppe Valenti, Girolamo Pelaia, Maria Pia Foschino Barbaro, Giovanna Elisiana Carpagnano, Alessandro Vatrella, Nunzio Crimi
Background: Biological therapies, such as mepolizumab, have transformed the treatment of severe eosinophilic asthma. While mepolizumab's short-term effectiveness is established, there is limited evidence on its ability to achieve long-term clinical remission.
Objective: To evaluate the long-term effectiveness and safety of mepolizumab, explore its potential to induce clinical and sustained remission, and identify baseline factors associated with the likelihood of achieving remission over 24 months.
Methods: The REMI-M is a retrospective, real-world, multicenter study that analyzed 303 severe eosinophilic asthma patients who received mepolizumab. Clinical, demographic, and safety data were collected at baseline, 3, 6, 12, and 24 months. The most commonly used definitions of clinical remission, which included no exacerbations, no oral corticosteroids (OCS) use, and good asthma control with or without assessment of lung function parameters, were assessed. Sustained remission was defined as reaching clinical remission at 12 months and maintaining it until the end of the 24-month period.
Results: Clinical remission rates ranged from 28.6% to 43.2% after 12 months and from 26.8% to 52.9% after 24 months, based on the different remission definitions. The proportion of patients achieving sustained remission varied between 14.6% to 29%. Factors associated with the likelihood of achieving clinical remission included the presence of aspirin-exacerbated respiratory disease, better lung function at baseline, male sex, absence of anxiety/depression, gastro-esophageal reflux disease, bronchiectasis, and reduced OCS consumption. Adverse events were infrequent.
Conclusions: This study demonstrates the real-world effectiveness of mepolizumab in achieving clinical remission and sustained remission in severe eosinophilic asthma over 24 months. The identification of distinct factors associated with the likelihood of achieving clinical remission emphasizes the importance of comprehensive management of comorbidities and timely identification of patients who may benefit from biologics.
{"title":"Long-Term Clinical and Sustained REMIssion in Severe Eosinophilic Asthma treated with Mepolizumab: The REMI-M study.","authors":"Claudia Crimi, Santi Nolasco, Alberto Noto, Angelantonio Maglio, Vitaliano Nicola Quaranta, Danilo Di Bona, Giulia Scioscia, Francesco Papia, Maria Filomena Caiaffa, Cecilia Calabrese, Maria D'Amato, Corrado Pelaia, Raffaele Campisi, Carolina Vitale, Luigi Ciampo, Silvano Dragonieri, Elena Minenna, Federica Massaro, Lorena Gallotti, Luigi Macchia, Massimo Triggiani, Nicola Scichilone, Giuseppe Valenti, Girolamo Pelaia, Maria Pia Foschino Barbaro, Giovanna Elisiana Carpagnano, Alessandro Vatrella, Nunzio Crimi","doi":"10.1016/j.jaip.2024.08.033","DOIUrl":"https://doi.org/10.1016/j.jaip.2024.08.033","url":null,"abstract":"<p><strong>Background: </strong>Biological therapies, such as mepolizumab, have transformed the treatment of severe eosinophilic asthma. While mepolizumab's short-term effectiveness is established, there is limited evidence on its ability to achieve long-term clinical remission.</p><p><strong>Objective: </strong>To evaluate the long-term effectiveness and safety of mepolizumab, explore its potential to induce clinical and sustained remission, and identify baseline factors associated with the likelihood of achieving remission over 24 months.</p><p><strong>Methods: </strong>The REMI-M is a retrospective, real-world, multicenter study that analyzed 303 severe eosinophilic asthma patients who received mepolizumab. Clinical, demographic, and safety data were collected at baseline, 3, 6, 12, and 24 months. The most commonly used definitions of clinical remission, which included no exacerbations, no oral corticosteroids (OCS) use, and good asthma control with or without assessment of lung function parameters, were assessed. Sustained remission was defined as reaching clinical remission at 12 months and maintaining it until the end of the 24-month period.</p><p><strong>Results: </strong>Clinical remission rates ranged from 28.6% to 43.2% after 12 months and from 26.8% to 52.9% after 24 months, based on the different remission definitions. The proportion of patients achieving sustained remission varied between 14.6% to 29%. Factors associated with the likelihood of achieving clinical remission included the presence of aspirin-exacerbated respiratory disease, better lung function at baseline, male sex, absence of anxiety/depression, gastro-esophageal reflux disease, bronchiectasis, and reduced OCS consumption. Adverse events were infrequent.</p><p><strong>Conclusions: </strong>This study demonstrates the real-world effectiveness of mepolizumab in achieving clinical remission and sustained remission in severe eosinophilic asthma over 24 months. The identification of distinct factors associated with the likelihood of achieving clinical remission emphasizes the importance of comprehensive management of comorbidities and timely identification of patients who may benefit from biologics.</p>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":null,"pages":null},"PeriodicalIF":8.2,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142094155","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}
Pub Date : 2024-08-26DOI: 10.1016/j.jaip.2024.08.040
Charles Feng, Satish Mudiganti, Xiaowei Sherry Yan, Diamonne Mitchell, Meng Chen, Anne Y Liu, Latha Palaniappan, Anna Chen Arroyo
{"title":"Allergic disease prevalence among Asian American children in Northern California.","authors":"Charles Feng, Satish Mudiganti, Xiaowei Sherry Yan, Diamonne Mitchell, Meng Chen, Anne Y Liu, Latha Palaniappan, Anna Chen Arroyo","doi":"10.1016/j.jaip.2024.08.040","DOIUrl":"https://doi.org/10.1016/j.jaip.2024.08.040","url":null,"abstract":"","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":null,"pages":null},"PeriodicalIF":8.2,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142094153","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}
Pub Date : 2024-08-24DOI: 10.1016/j.jaip.2024.08.034
Nathan A Boggs, Ilaria Tanasi, Karin Hartmann, Roberta Zanotti, David Gonzalez-de-Olano
Patients with Hymenoptera venom allergy (HVA), especially those with severe anaphylaxis, frequently have concomitant clonal mast cell disease (MCD) in the form of systemic mastocytosis or monoclonal mast cell activation syndrome. Detection of clonal MCD is important since it will have significant consequences for management of HVA. Therefore, we recommend patients with HVA be systematically screened for clonal MCD. The pre-test probability of clonal MCD can be assessed in a stepwise fashion starting with examination of the skin for typical monomorphic maculopapular cutaneous mastocytosis (MPCM) lesions; measurement of the baseline serum tryptase (BST) and tryptase genotyping for patients with BST>11 ng/mL; followed by the REMA score which is calculated by utilizing anaphylaxis clinical features, BST, and patient sex. A bone marrow biopsy should be performed in patients with monomorphic MPCM, a REMA score ≥2, or an elevated BST based upon tryptase genotype. Patients with HVA and a clonal MCD should be treated with immunotherapy directed against the Hymenoptera venom for which they are sensitized. For this high-risk subgroup of HVA patients, it is recommended to continue immunotherapy for more than 5 years or indefinitely and to carry at least three epinephrine autoinjectors. Future studies should determine whether KIT D816V-selective tyrosine kinase inhibitors are effective at preventing or reducing severity of Hymenoptera-venom triggered anaphylaxis in patients with clonal MCD.
{"title":"Mast cell disorders and Hymenoptera venom-triggered anaphylaxis: evaluation and management.","authors":"Nathan A Boggs, Ilaria Tanasi, Karin Hartmann, Roberta Zanotti, David Gonzalez-de-Olano","doi":"10.1016/j.jaip.2024.08.034","DOIUrl":"https://doi.org/10.1016/j.jaip.2024.08.034","url":null,"abstract":"<p><p>Patients with Hymenoptera venom allergy (HVA), especially those with severe anaphylaxis, frequently have concomitant clonal mast cell disease (MCD) in the form of systemic mastocytosis or monoclonal mast cell activation syndrome. Detection of clonal MCD is important since it will have significant consequences for management of HVA. Therefore, we recommend patients with HVA be systematically screened for clonal MCD. The pre-test probability of clonal MCD can be assessed in a stepwise fashion starting with examination of the skin for typical monomorphic maculopapular cutaneous mastocytosis (MPCM) lesions; measurement of the baseline serum tryptase (BST) and tryptase genotyping for patients with BST>11 ng/mL; followed by the REMA score which is calculated by utilizing anaphylaxis clinical features, BST, and patient sex. A bone marrow biopsy should be performed in patients with monomorphic MPCM, a REMA score ≥2, or an elevated BST based upon tryptase genotype. Patients with HVA and a clonal MCD should be treated with immunotherapy directed against the Hymenoptera venom for which they are sensitized. For this high-risk subgroup of HVA patients, it is recommended to continue immunotherapy for more than 5 years or indefinitely and to carry at least three epinephrine autoinjectors. Future studies should determine whether KIT D816V-selective tyrosine kinase inhibitors are effective at preventing or reducing severity of Hymenoptera-venom triggered anaphylaxis in patients with clonal MCD.</p>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":null,"pages":null},"PeriodicalIF":8.2,"publicationDate":"2024-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142074527","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}
Pub Date : 2024-08-24DOI: 10.1016/j.jaip.2024.08.032
Annalyse Kohley, Safin Attwal, Stacie M Jones, Chary Akmyradov, Peggy Chandler, Christina Tootle, Safia Nawaz, Travis Ayers, David Kawatu, Robbie D Pesek
Background: Nearly 80% of patients with eosinophilic esophagitis have co-existing atopic disease, yet a subset do not. It is unclear if this lack of atopy impacts presentation or response to therapy.
Objectives: To characterize the presentation and response to therapy in atopic versus non-atopic pediatric patients with EoE METHODS: A case-control study of EoE patients, ages 6 months to 18 years (between 2018-2021) was performed. Patients were eligible if they had allergy testing, assessment of atopic history, and at least one endoscopy following initiation of treatment. Patients were considered non-atopic if they had negative allergy testing and no history of significant atopy. Response to therapy was classified as complete (peak eos < 15/hpf), partial (≥ 15 eos/hpf but at least a 50% reduction in peak eos), or non-response.
Results: 168 participants were enrolled. The majority were white (n=141, 84%), male (n=124, 74%), and non-Hispanic (n=158, 95%). Mean age at diagnosis was 9.4 years (SD: ± 4.8). 123 participants (73.2%) were atopic and 45 (26.8%) were non-atopic. There was no significant difference between atopic and non-atopic for most demographics or presenting symptoms. Non-atopic participants presented younger than atopic participants (8.14 vs. 9.8 years, p=0.046). Swallowed topical corticosteroids (STC) and food elimination diets (FED) were utilized at a similar rate. There were no differences in treatment response between atopic/non-atopic participants in regards to STC, FED, or STC+FED.
Conclusion: Atopic status does not significantly impact presentation or response to treatment in pediatric EoE, but a lack of atopy may be a risk for earlier onset of disease.
{"title":"Impact of atopic status on clinical presentation and treatment response in pediatric patients with eosinophilic esophagitis.","authors":"Annalyse Kohley, Safin Attwal, Stacie M Jones, Chary Akmyradov, Peggy Chandler, Christina Tootle, Safia Nawaz, Travis Ayers, David Kawatu, Robbie D Pesek","doi":"10.1016/j.jaip.2024.08.032","DOIUrl":"https://doi.org/10.1016/j.jaip.2024.08.032","url":null,"abstract":"<p><strong>Background: </strong>Nearly 80% of patients with eosinophilic esophagitis have co-existing atopic disease, yet a subset do not. It is unclear if this lack of atopy impacts presentation or response to therapy.</p><p><strong>Objectives: </strong>To characterize the presentation and response to therapy in atopic versus non-atopic pediatric patients with EoE METHODS: A case-control study of EoE patients, ages 6 months to 18 years (between 2018-2021) was performed. Patients were eligible if they had allergy testing, assessment of atopic history, and at least one endoscopy following initiation of treatment. Patients were considered non-atopic if they had negative allergy testing and no history of significant atopy. Response to therapy was classified as complete (peak eos < 15/hpf), partial (≥ 15 eos/hpf but at least a 50% reduction in peak eos), or non-response.</p><p><strong>Results: </strong>168 participants were enrolled. The majority were white (n=141, 84%), male (n=124, 74%), and non-Hispanic (n=158, 95%). Mean age at diagnosis was 9.4 years (SD: ± 4.8). 123 participants (73.2%) were atopic and 45 (26.8%) were non-atopic. There was no significant difference between atopic and non-atopic for most demographics or presenting symptoms. Non-atopic participants presented younger than atopic participants (8.14 vs. 9.8 years, p=0.046). Swallowed topical corticosteroids (STC) and food elimination diets (FED) were utilized at a similar rate. There were no differences in treatment response between atopic/non-atopic participants in regards to STC, FED, or STC+FED.</p><p><strong>Conclusion: </strong>Atopic status does not significantly impact presentation or response to treatment in pediatric EoE, but a lack of atopy may be a risk for earlier onset of disease.</p>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":null,"pages":null},"PeriodicalIF":8.2,"publicationDate":"2024-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142074526","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}
Pub Date : 2024-08-24DOI: 10.1016/j.jaip.2024.08.031
Malina C Patel, Dan Costin, Beth McLellan, Sara DiFalco, Jessica Oh
{"title":"Transient Serpentine Supravenous Erythema during Rapid Drug Desensitization.","authors":"Malina C Patel, Dan Costin, Beth McLellan, Sara DiFalco, Jessica Oh","doi":"10.1016/j.jaip.2024.08.031","DOIUrl":"https://doi.org/10.1016/j.jaip.2024.08.031","url":null,"abstract":"","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":null,"pages":null},"PeriodicalIF":8.2,"publicationDate":"2024-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142074528","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}
Pub Date : 2024-08-23DOI: 10.1016/j.jaip.2024.08.029
Angela Augustino, Kristin S Alvarez, Layla Kassem, Lonnie Roy, Cesar Termulo, Jillian Smartt, Madeline Sparks, Candice Mercadel, Timothy G Chow
Background: Documented penicillin allergies are associated with increased morbidity, increased hospital stay, and an increase in resistant infections. Penicillin allergy evaluations using direct oral challenge with or without skin testing has been recommended as a delabeling strategy for patients with penicillin reaction histories. Barriers for achieving equitable access, however, exist. Understanding patient perceptions regarding their penicillin allergy across diverse populations is crucial to mitigate potential obstacles to penicillin allergy testing (PAT) and the use of penicillin-like antibiotics after delabeling.
Objective: The objective of this study is to gather perceptions of patients delabeled of their penicillin allergy after testing through a PAT program.
Methods: Patients who underwent PAT and had a subsequent allergy removal due to a negative result were interviewed using closed and open-ended questions.
Results: A total of 100 patient interviews were completed. Awareness of the risks associated with unnecessary penicillin avoidance and PAT was low. Initial concerns regarding PAT were common, however, were frequently alleviated with targeted education. Most patients undergoing testing reported a positive experience and would recommend PAT to others. A minority of patients continued to have discordant perceptions regarding their penicillin allergy label with mistrust in the negative result being a critical theme identified.
Conclusion: Future interventions increasing the awareness of penicillin allergy labels and the risks and benefits of PAT in the general population are needed and must consider health literacy levels, languages, and cultural contexts. Measures to offer PAT within a clinical setting that has built high levels of patient trust will likely achieve the greatest long-term success.
背景:有记录的青霉素过敏与发病率增加、住院时间延长和耐药性感染增加有关。有人建议使用直接口服挑战法进行青霉素过敏评估,并进行或不进行皮肤测试,以此作为对有青霉素反应史的患者进行脱敏治疗的策略。然而,实现公平就诊的障碍依然存在。了解不同人群中患者对青霉素过敏的看法对于减少青霉素过敏试验(PAT)的潜在障碍以及脱标后青霉素类抗生素的使用至关重要:本研究的目的是收集通过青霉素过敏检测项目进行检测后被取消青霉素过敏标签的患者的看法:方法:采用封闭式和开放式问题对接受过 PAT 检测并在随后因结果呈阴性而去除过敏标签的患者进行访谈:结果:共完成了对 100 名患者的访谈。对不必要的青霉素回避和 PAT 相关风险的认知度较低。最初对 PAT 的顾虑很常见,但通过有针对性的教育,这种顾虑经常得到缓解。大多数接受检测的患者都表示体验良好,并愿意向他人推荐 PAT。少数患者仍然对自己的青霉素过敏标签有不一致的看法,其中对阴性结果的不信任是一个关键的主题:结论:未来需要采取干预措施,提高普通人群对青霉素过敏标签以及 PAT 风险和益处的认识,并且必须考虑健康知识水平、语言和文化背景。在患者高度信任的临床环境中提供 PAT 的措施可能会取得最大的长期成功。
{"title":"Patient Perceptions of Penicillin Allergy Testing in a Public Health System.","authors":"Angela Augustino, Kristin S Alvarez, Layla Kassem, Lonnie Roy, Cesar Termulo, Jillian Smartt, Madeline Sparks, Candice Mercadel, Timothy G Chow","doi":"10.1016/j.jaip.2024.08.029","DOIUrl":"https://doi.org/10.1016/j.jaip.2024.08.029","url":null,"abstract":"<p><strong>Background: </strong>Documented penicillin allergies are associated with increased morbidity, increased hospital stay, and an increase in resistant infections. Penicillin allergy evaluations using direct oral challenge with or without skin testing has been recommended as a delabeling strategy for patients with penicillin reaction histories. Barriers for achieving equitable access, however, exist. Understanding patient perceptions regarding their penicillin allergy across diverse populations is crucial to mitigate potential obstacles to penicillin allergy testing (PAT) and the use of penicillin-like antibiotics after delabeling.</p><p><strong>Objective: </strong>The objective of this study is to gather perceptions of patients delabeled of their penicillin allergy after testing through a PAT program.</p><p><strong>Methods: </strong>Patients who underwent PAT and had a subsequent allergy removal due to a negative result were interviewed using closed and open-ended questions.</p><p><strong>Results: </strong>A total of 100 patient interviews were completed. Awareness of the risks associated with unnecessary penicillin avoidance and PAT was low. Initial concerns regarding PAT were common, however, were frequently alleviated with targeted education. Most patients undergoing testing reported a positive experience and would recommend PAT to others. A minority of patients continued to have discordant perceptions regarding their penicillin allergy label with mistrust in the negative result being a critical theme identified.</p><p><strong>Conclusion: </strong>Future interventions increasing the awareness of penicillin allergy labels and the risks and benefits of PAT in the general population are needed and must consider health literacy levels, languages, and cultural contexts. Measures to offer PAT within a clinical setting that has built high levels of patient trust will likely achieve the greatest long-term success.</p>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":null,"pages":null},"PeriodicalIF":8.2,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142057286","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}