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

Autoinflammatory diseases (AIDs) are characterized by dysregulation of innate immunity, leading to systemic inflammation. Familial Mediterranean fever (FMF) is the most common AID, associated with variants in exon 10 of MEFV. This gene codes for pyrin, a key protein in the inflammasome of the same name, involved in the innate immune response. Since the discovery of FMF, many other pathogenic variants of MEFV have been identified. These variants, apart from exon 10, are responsible for a variety of AIDs known as pyrin-associated AIDs or pyrinopathies. Variants in exon 10, 8, 5, and 3 are associated with dominant forms of FMF. Other inflammatory clinical pictures not resembling typical FMF are possible: pyrin-associated autoinflammation with neutrophilic dermatosis is characterized by febrile attacks and severe neutrophilic dermatosis associated with variants in exon 2; pyrin-associated autoinflammation with hypereosinophilia was described among patients displaying severe inflammation and hypereosinophilia-associated variants in exon 2, different from pyrin-associated autoinflammation with neutrophilic dermatosis; and pyrin-associated autoinflammation associated with neuroinflammation manifests with systemic inflammation, serositis, and neuroinflammation associated with variants in exon 9. Somatic forms of FMF have also been described. We present here a review of the literature on the various AIDs associated with pathogenic MEFV variants and propose a practical approach to the genetic diagnosis of MEFV-associated AIDs.

Penicillin allergy labels (PAL) are common but rarely correspond with a patient's likelihood to tolerate penicillin. This results in unnecessary penicillin avoidance in many patients, driving numerous negative health outcomes. Evaluation strategies for PAL are driven by risk stratification and include a spectrum of modalities such as delabeling without any testing, direct oral challenge, and skin testing followed by challenge testing. Historically, PAL delabeling has primarily been the domain of the allergist, but this has resulted in significant limitations in access to testing for many patients globally and in the United States. Novel strategies to increase access to penicillin allergy evaluations are urgently needed, and non-allergist delabeling has been proposed as one strategy to help address this. Using a pro/con format, we review the evidence for non-allergist PAL delabeling in children and adults, focusing on direct challenge testing and highlighting considerations to guide non-allergist implementation of penicillin allergy evaluations.

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 approximately 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 patients with asthma from 2010 to 2023, excluding those with pre-existing diabetes mellitus or concurrent chronic lung diseases. Asthma exacerbations were defined by the need for an oral corticosteroid prescription. Multivariable logistic regression and zero-inflated Poisson regression were used to adjust for age, race, body mass index (BMI), prepregnancy asthma exacerbation history, and insurance status.

Results: Among 10,985 individuals, 1492 had GDM. Patients with GDM were older with higher BMIs. GDM was associated with increased asthma exacerbation risk during pregnancy (adjusted odds ratio [OR] = 1.36, 95% confidence interval [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 = 2.02, 95% CI: 1.45-2.81). Other factors associated with asthma exacerbation included prepregnancy 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.