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

Flooding events, particularly those caused by hurricanes and other large storm events, are increasingly fueled by climate change. Stormwater intrusion into homes creates ideal conditions for mold growth. Homes inundated by floodwaters become vulnerable to production of mold spores, particulate matter, and volatile organic compounds, all of which trigger a variety of poor health outcomes. Disadvantaged communities often bear the brunt of these hazards and face additional challenges due to limited resources for effective remediation. Moisture control is the cornerstone of effective mold remediation. Removal of porous material and rapid initiation of dehumidification reduce potentially harmful exposures. During cleanup, protective measures, especially the use of N95 respirators, reduce the inhalation of particulate matter from mold and from the remediation process itself. Individuals with immunodeficiency or respiratory conditions should be excluded from damp environments and remediation activities. Public health approaches are needed after flooding events, including prioritization of remediation in resource-limited communities and communication on effective, ineffective, and potentially harmful strategies in addressing mold exposure.

Urban living requires a careful balance between human health and environmental sustainability when selecting urban vegetation. Public gardens and green roofs offer significant environmental benefits, including air filtration, exposure to health-associated microbiota, and mitigation of the urban heat island effect. However, prioritizing allergy-friendly species is crucial to prevent the exacerbation of pollen allergies. This review highlights 3 primary criteria for selecting vegetation that supports these ecosystem services while minimizing allergy risks. First, reducing the use of many wind-pollinated plants, such as birch trees and grasses, is crucial due to their high pollen production and cross-reactivity with other species, which can exacerbate allergies. In contrast, insect-pollinated plants are generally safer for allergy sufferers. Secondly, cultivating multispecies plant communities with minimal maintenance supports habitats for microbiota and invertebrates, further providing ecosystem services. Lastly, balancing plant gender ratios in urban spaces can help control pollen levels. Together these criteria provide a framework for urban planners to create green spaces that are both environmentally beneficial and allergy friendly. Although this review focuses on European data, the principles discussed have global relevance, reinforcing the need to integrate environmental sustainability with public health considerations in urban planning. Future studies should also investigate the health impacts of plant volatile emissions, explore heat-resistant plant varieties, and assess the ecological risks of invasive species to support sustainable, allergy-friendly urban environments.

As the effects of anthropogenic climate change have become more apparent, the influences of climate and extreme weather events on health have continued to gain attention. The fact Earth has warmed over the past century is indisputable and the rate of warming is more alarming. As a result of anthropogenic climate change, an alteration in the air mixture has occurred over time. These changes have increased human exposures to respiratory irritants such as ground-level ozone, volatile organic compounds, nitrogen dioxide, sulfur dioxide, carbon monoxide, and polycyclic aromatic hydrocarbons. A significant amount of research has investigated the effects of climate change on aeroallergens, which has shown that elevated temperatures and increased carbon dioxide levels have produced prolonged and more robust pollen seasons for most taxa studied. In addition, it appears possible that exposure of some plants to air pollution may result in more allergenic pollen. Increased human exposures to these respiratory irritants and aeroallergens appears to disproportionality effect vulnerable populations throughout the world. It is essential to understand that climate change is more than an environmental inconvenience and realize the effects to human health are directly related and conceivably immeasurable. It is vital to conduct additional research related to climate change and health that is collaborative, multisectoral, and transdisciplinary. There should be a focus on risk reduction, mitigation, and preparedness for climate change and extreme weather events for all populations around the globe.

Background: Asthma, affecting approximately 13% of pregnancies worldwide, and gestational diabetes mellitus (GDM), present in about 14%, are both associated with adverse maternal and perinatal outcomes. This study aims to address a lack of current knowledge about how GDM affects asthma during pregnancy.

Objective: To determine whether GDM is associated with an increased risk of asthma exacerbations during pregnancy and the first year postpartum.

Methods: This retrospective cohort study analyzed electronic health records of pregnant asthma patients from 2010-2023, excluding those with pre-existing diabetes mellitus or concurrent chronic lung diseases. Asthma exacerbations were defined by the need for an oral corticosteroid (OCS) prescription. Multivariable logistic regression and zero-inflated Poisson regression were used to adjust for age, race, body mass index (BMI), pre-pregnancy asthma exacerbation history, and insurance status.

Results: Among 10985 individuals, 1492 had GDM. Patients with GDM were older with higher BMIs. GDM was associated with increased asthma exacerbation risk during pregnancy (adjusted OR 1.36, 95% CI 1.10-1.67), but not postpartum. Stratified analyses of 4331 individuals with gestational blood glucose measurement showed that each doubling of blood glucose levels doubled the risk of asthma exacerbations during pregnancy (adjusted OR of 2.02, 95% CI 1.45-2.81). Other factors associated with asthma exacerbation included pre-pregnancy asthma exacerbations, older age, and Medicaid coverage.

Conclusion: The association between GDM and increased risk of asthma exacerbations underscores the need for early, universal screening and effective interventions to improve blood glucose control in pregnant individuals with pre-existing asthma.

The current FDA paradigm may not fully capture important patient-centered outcomes or measure a primary outcome that is truly meaningful to patients. Patient reported outcome measures (PROMs) are standardized tools measuring the patient's experience in food allergy clinical trials, which can help support shared decision-making (SDM) and further our understanding of treatment impact. Food allergy PROMs include quality of life (QoL), health state utility (HSU), severity, and self-efficacy measures. Currently, FDA registration trials for product approval only consider a fixed increase in allergen threshold from pre-to-post intervention as a primary outcome (vs. a more flexible "X-fold" increase not accounting for an upper and lower specific threshold), though many use QoL as a secondary outcome for patient-centered assessment of treatment impact. Currently used QoL PROMs were not designed to measure change on therapy nor measure HSU (e.g., quantitative risk a patient may be willing to take to improve their current health), which can be used to determine therapy value. While the current paradigm for primary and secondary outcomes in food allergy clinical trials was appropriate at the early stages of food allergy therapy development when conceived in the late 2000's and early 2010's, in the 2020's these outcome choices risk being stagnant and outdated. As such, the current paradigm for food allergy outcomes should evolve to incorporate more patient-centered primary outcome measures which patient data indicate are meaningful, so outcomes more realistically reflect a therapy's impact. This evolution will better support SDM discussions as patients consider their therapy options and can inform new product development.

Background: Hereditary angioedema (HAE) is a rare genetic disease characterized by recurrent episodes of cutaneous or subcutaneous edema. There is clinical need for treatments that reduce the rate of HAE attacks in patients.

Objectives: Primary objectives were to evaluate the effectiveness of lanadelumab on attack free rate (AFR; proportion of patients who had zero HAE attacks), and on every two weeks (Q2W) and every four weeks (Q4W) adjustments on AFR.

Methods: A retrospective medical chart review study was conducted in 19 HAE centers and included data from HAE type I or II patients treated with lanadelumab (index treatment) in Germany, France, Greece and Austria who were ≥ 12 years of age. Data abstraction occurred 15 September 2021 to 29 June 2022. Analyses were primarily descriptive.

Results: Data from 198 patients were collected (61.6% female, 91.9% type I HAE). Lanadelumab treatment patterns varied between countries. Cumulative AFR improved from 0% (pre-index) to 54.4% (12 months post-index) and 39.4% (post-index; median 28.8 months duration). Monthly AFRs varied from 16.2% to 28.3% pre-index (17.7% AFR in the month before index date), and from 82.7% (month 1) to >95% at multiple timepoints between 26- and 43-months post-index. Patients with interval increases (n=144, 72.7%) showed improved cumulative AFR (0% pre-index to 50.0% post-index).

Conclusions: This real-world study demonstrates that lanadelumab LTP is effective in improving AFR in HAE type I/II patients on Q2W and dose interval increases. Effectiveness with lanadelumab is rapid and was observed starting from the first month of starting therapy.

Background: Food allergy (FA) affects approximately one in 12 US children, with prevalence increasing. Aside from considerable health care utilization, accumulating research suggests heightened psychosocial burden among this population.

Objective: To characterize FA-related psychosocial burden among a large, nationally representative pediatric sample, and its correlates, including sociodemographic characteristics, comorbid conditions, allergy severity, allergic symptoms, number and type of allergens, and healthcare utilization.

Methods: A survey was administered between October 2015 and September 2016 to a nationally representative sample of US households. Survey constructs included the Food Allergy Independent Measure (FAIM), which was developed to quantify adverse impacts of living with FA on psychosocial burden (range = 1-7; higher scores indicate greater burden). FAIM responses were analyzed from caregivers reporting current FA in their child (N = 4734). Linear regression models examined associations with sociodemographic and FA characteristics.

Results: The overall estimated mean caregiver-proxy FAIM scores for the US pediatric population were 2.79 (SE = 0.03) for reported FA, 2.96 (SE = 0.04) for convincing FA, and 3.21 (SE = 0.05) for physician-confirmed, convincing FA. Significant differences in caregiver-reported burden (p < .05) were found for sociodemographic (i.e., household income, birth country, child age), and clinical (i.e., FA severity, physician diagnosis, specific allergens) factors.

Conclusion: While heterogenous to a degree, the psychosocial burden of children with FA was substantial irrespective of sociodemographic and clinical characteristics. FAIM norms can be used clinically, as well as be leveraged by other economic, epidemiological, and health efforts to understand the public health impact of FA.

Food allergy is a common disease which has substantial impacts on the quality of life of patients and their families, and all reactions have the potential for causing life-threatening anaphylaxis. Food allergic individuals currently have 2 FDA approved therapeutic options available to them aside from life-long allergen avoidance: oral immunotherapy (OIT), and omalizumab. OIT for food allergy has been extensively studied in clinical trials and currently provides the greatest level of protection, however it also has a high burden of treatment. Studies suggest that more successful OIT outcomes may be attained with earlier intervention; however, early OIT presents its own challenges. Omalizumab, recently FDA-approved, is a biologic targeting immunoglobulin E, a major driver of allergic reactions. In contrast to OIT, omalizumab monotherapy offers a low treatment burden therapeutic option that provides a safety net against reactions to accidental ingestion to multiple allergens. Additionally, omalizumab has also been investigated as an adjunct to OIT, improving the speed and safety of single or multi-allergen OIT. Here we discuss the clinical use of these therapeutic options and provide a guide for shared decision-making between patients and physicians about what therapeutic option might be more appropriate.