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

Background: Social determinants of health (SDOH) have a significant impact on asthma outcomes, with factors such as income level and neighborhood environment playing crucial roles.

Objective: This study aimed to assess the impact of Neighborhood Deprivation Index (NDI) and Total Crime Index (TCI) on acute asthma exacerbation (AAE) and asthma-related Emergency Department and urgent care (ED/UC) visits in adults with mild asthma.

Methods: This retrospective cohort study utilized administrative data from Kaiser Permanente Southern California among 198,873 mild adult asthma patients between January 1, 2013, and December 31, 2018. Robust Poisson regression models, adjusted for age and sex, were employed to investigate the associations of NDI and TCI with AAE and asthma-related ED/UC visits. Data analysis included subgroup assessments by race and ethnicity and BMI categories to explore potential disparities in asthma outcomes.

Results: Among the cohort, 12,906 patients (6.5%) experienced AAE in one year, with Black patients having the highest AAE percentage (7.1%). Higher NDI quintiles were associated with increased AAE risk (aRRs: 1.11-1.27), with similar trends across BMI categories and race or ethnicity, except for Black patients. TCI showed weaker associations with AAE. Regarding ED/UC visits, 5.0% had such visits within one year. Higher NDI quintiles were associated with higher ED/UC visit risk (aRRs: 1.23-1.75), while TCI associations were weaker.

Conclusion: Addressing socioeconomic disparities, as indicated by NDI, may be crucial in mitigating asthma exacerbations and reducing healthcare utilization, highlighting the importance of incorporating social determinants into asthma management strategies even in patients with mild asthma.

Clinical implications: Tezepelumab use for asthma successfully induced and sustained eosinophilic esophagitis remission and reversed its pathologic transcriptome. This case provides insight into the mechanistic underpinnings of type 2 inflammation in EoE and the clinical utility of targeting these pathways for treatment.

Background: Severe eosinophilic asthma (SEA) may be the prodromal phase of eosinophilic granulomatosis with polyangiitis (EGPA). Nevertheless, few studies have tried to recognize EGPA in the early stages of the disease.

Objective: To identify a panel of clinical and biological markers to detect which severe asthmatic patient might be considered in a prodromal phase of EGPA and crafting a strategy for diagnostic decision-making.

Methods: A total of 30 patients with EGPA and 49 with SEA were enrolled. A complete pulmonary, ear, nose, and throat, and rheumatologic assessment were made. Blood (eosinophil count, eosinophilic cationic protein, IL-5, IL-4, total-IgE, IgG₄, and antineutrophil cytoplasmic antibody), sputum (eosinophils count, periostin, IL-8, and granulocyte-monocyte colony-stimulating factor [GM-CSF]), and nasal smear (eosinophilia) biomarkers were assessed. Asthma Control Test, Short Form-36, SinoNasalOutcome Test-22, and Asthma Quality of Life Questionnaire were also used.

Results: Patients with SEA had poorer asthma control (P < .001) and a higher level of sputum eosinophils (P < .002), whereas patients with EGPA reported higher levels of blood eosinophils in the past. Sputum GM-CSF was the only biomarker significantly increased in patients with EGPA compared with those with SEA (P < .0001). Among patients with SEA, those with some suggestive but not diagnostic criteria of EGPA, particularly tissue eosinophilic infiltrates, presented higher levels of sputum GM-CSF (P < .0005), blood, and sputum eosinophils (P < .0006 and P < .011) than the other patients.

Conclusion: Sputum GM-CSF and eosinophils might be useful biomarkers to support early diagnosis and treatment choices in patients with SEA, suspected of having EGPA.

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

Objectives: We sought 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 (FARC) 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. Additionally, chart review of 100 pediatric participants from Lurie Children's Hospital of Chicago allergy clinics (typical clinical encounters) were compared to the prospective survey results.

Results: 196 FARC 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 one year. The rate of accidental ingestions reported in the prospective survey was high: 10-25% of participants each month report 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 to milk, followed by sesame (20.0%) and egg (18.8%). Rates of anaphylaxis after exposure were high among 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 around allergen avoidance and accidental exposure is imperative.

Clinical implications: Dupilumab, a biological therapy that blocks the shared receptor component for interleukins-4/13, reduced exacerbations and improved lung function in children with uncontrolled moderate-to-severe type 2 asthma independent of most baseline patient and asthma characteristics.