Pub Date : 2024-08-20DOI: 10.1016/j.waojou.2024.100946
Drug provocation tests (DPTs) are also used in some patients with a history of a contrast medium (CM)-hypersensitivity reaction. Since the use of contrast agents requires special knowledge that is present in radiology but not necessarily in allergology, this overview should close the knowledge gaps. The literature, and the package inserts of the industry dealing with DPTs in contrast hypersensitivity reactions was analyzed and the results presented. Historical analyses revealed that provocation tests were already done in the past, and called pre-testing. Due to disadvantages, this diagnostic tool was abandoned. A few years later, DPT was introduced as an innovative diagnostic procedure. The DPT has the 3 main disadvantages: a missing standardization, patients at risk (such as compromised renal function) are rarely taken into account, and a negative DPT does not exclude a subsequent CM reaction. DPTs (formerly called pre-testing) are a well-known method for diagnosing CM-related hypersensitivity reactions. Since the disadvantages of this diagnosis outweigh the advantages, we propose replacing DPT with routine contrast-enhanced imaging examination in radiology.
药物激发试验(DPT)也用于某些有造影剂过敏反应病史的患者。由于造影剂的使用需要特殊的知识,而这些知识在放射学中存在,但在过敏学中却不一定存在,因此本综述应能弥补这方面的知识空白。我们分析了有关造影剂超敏反应中 DPT 的文献和行业包装插页,并介绍了分析结果。历史分析表明,激惹试验在过去已经存在,并被称为预试验。由于其缺点,这种诊断工具被放弃了。几年后,DPT 作为一种创新的诊断程序被引入。DPT 有三大缺点:标准化缺失、高危患者(如肾功能受损者)很少被考虑在内、DPT 阴性并不能排除后续的 CM 反应。DPT(以前称为预试验)是一种众所周知的诊断中药相关超敏反应的方法。由于这种诊断方法弊大于利,我们建议用放射科常规对比增强成像检查取代 DPT。
{"title":"Drug provocation tests (DPTs) of contrast media: Useful or not useful? – A narrative review","authors":"","doi":"10.1016/j.waojou.2024.100946","DOIUrl":"10.1016/j.waojou.2024.100946","url":null,"abstract":"<div><p>Drug provocation tests (DPTs) are also used in some patients with a history of a contrast medium (CM)-hypersensitivity reaction. Since the use of contrast agents requires special knowledge that is present in radiology but not necessarily in allergology, this overview should close the knowledge gaps. The literature, and the package inserts of the industry dealing with DPTs in contrast hypersensitivity reactions was analyzed and the results presented. Historical analyses revealed that provocation tests were already done in the past, and called pre-testing. Due to disadvantages, this diagnostic tool was abandoned. A few years later, DPT was introduced as an innovative diagnostic procedure. The DPT has the 3 main disadvantages: a missing standardization, patients at risk (such as compromised renal function) are rarely taken into account, and a negative DPT does not exclude a subsequent CM reaction. DPTs (formerly called pre-testing) are a well-known method for diagnosing CM-related hypersensitivity reactions. Since the disadvantages of this diagnosis outweigh the advantages, we propose replacing DPT with routine contrast-enhanced imaging examination in radiology.</p></div>","PeriodicalId":54295,"journal":{"name":"World Allergy Organization Journal","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1939455124000772/pdfft?md5=dcfaceeedb9d86d93984989aac11943a&pid=1-s2.0-S1939455124000772-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142012985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-20DOI: 10.1016/j.waojou.2024.100921
Luciana Kase Tanno MD PhD, Alain Perie PhD, Jonathan A. Bernstein MD, James L. Sublett MD, Karapet Davtyan MD MPH MBA, Frederic Berard MD PhD, Ruby Pawankar MD PhD, Marylin Valentin Rostan MD, Herberto Chong MD PhD, Anahi Yañez MD, Ignacio J. Ansontegui MD PhD, Motohiro Ebisawa MD PhD, Gary W.K. Wong MD PhD, Mario Morais-Almeida MD, Bryan Martin MD, Yann Briand PhD, Pascal Demoly MD PhD, the American Academy of Allergy Asthma & Immunology (AAAAI), the American College of Allergy Asthma and Immunology (ACAAI), the Asia Pacific Association of Allergy Asthma and Clinical Immunology (APAAACI), the French Allergy Society (SFA), the French WHO Collaborating Centre, the WHO Regional Office for Europe, the Latin American Society of Allergy and Immunology (SLAAI), the Montpellier WHO Collaborating Centre, the World Allergy Organization (WAO)
In 2010, the United States Human and Health Services (US HHS) and the European Union's (EU) Directorate General for Communications Networks, Content and Technology signed a memorandum of understanding to stimulate cooperation surrounding health-related information communications technology. The key project that emerged from this agreement is the (IPS), intended to provide succinct clinically relevant patient summaries, which are generalizable and condition-independent, that can be readily used by all clinicians for the care of patients. Although allergies are included in the main information required by the IPS library and framework, it is misrepresented which leads to underdiagnosis or misdiagnosis of patients suffering from allergic and hypersensitivity conditions (A/H). The French and Montpellier World Health Organization (WHO) Collaborating Centres have provided arguments for supporting representation of A/H in the IPS. These are based on the relevance of the new classification of A/H in the WHO International Classification of Diseases 11th version (ICD-11), and the need for alignment of eHealth tools with harmonized health information. We first present the A/H in the IPS initiative with the mission of producing an international information system that can be used globally in electronic health records to standardize clinical diagnoses and facilitate communication between clinicians caring for patients with A/H diseases. It is believed this initiative will provide a strong voice for the allergy community and an effective process for improving the quality of health data that will optimize medical care for our patients worldwide.
{"title":"Allergic and hypersensitivity condition in the International Patients’ Summary (IPS) standard: The need of updates through the International Classification of Diseases (ICD)-11","authors":"Luciana Kase Tanno MD PhD, Alain Perie PhD, Jonathan A. Bernstein MD, James L. Sublett MD, Karapet Davtyan MD MPH MBA, Frederic Berard MD PhD, Ruby Pawankar MD PhD, Marylin Valentin Rostan MD, Herberto Chong MD PhD, Anahi Yañez MD, Ignacio J. Ansontegui MD PhD, Motohiro Ebisawa MD PhD, Gary W.K. Wong MD PhD, Mario Morais-Almeida MD, Bryan Martin MD, Yann Briand PhD, Pascal Demoly MD PhD, the American Academy of Allergy Asthma & Immunology (AAAAI), the American College of Allergy Asthma and Immunology (ACAAI), the Asia Pacific Association of Allergy Asthma and Clinical Immunology (APAAACI), the French Allergy Society (SFA), the French WHO Collaborating Centre, the WHO Regional Office for Europe, the Latin American Society of Allergy and Immunology (SLAAI), the Montpellier WHO Collaborating Centre, the World Allergy Organization (WAO)","doi":"10.1016/j.waojou.2024.100921","DOIUrl":"https://doi.org/10.1016/j.waojou.2024.100921","url":null,"abstract":"In 2010, the United States Human and Health Services (US HHS) and the European Union's (EU) Directorate General for Communications Networks, Content and Technology signed a memorandum of understanding to stimulate cooperation surrounding health-related information communications technology. The key project that emerged from this agreement is the (IPS), intended to provide succinct clinically relevant patient summaries, which are generalizable and condition-independent, that can be readily used by all clinicians for the care of patients. Although allergies are included in the main information required by the IPS library and framework, it is misrepresented which leads to underdiagnosis or misdiagnosis of patients suffering from allergic and hypersensitivity conditions (A/H). The French and Montpellier World Health Organization (WHO) Collaborating Centres have provided arguments for supporting representation of A/H in the IPS. These are based on the relevance of the new classification of A/H in the WHO International Classification of Diseases 11th version (ICD-11), and the need for alignment of eHealth tools with harmonized health information. We first present the A/H in the IPS initiative with the mission of producing an international information system that can be used globally in electronic health records to standardize clinical diagnoses and facilitate communication between clinicians caring for patients with A/H diseases. It is believed this initiative will provide a strong voice for the allergy community and an effective process for improving the quality of health data that will optimize medical care for our patients worldwide.","PeriodicalId":54295,"journal":{"name":"World Allergy Organization Journal","volume":null,"pages":null},"PeriodicalIF":5.1,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142177434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-20DOI: 10.1016/j.waojou.2024.100957
Background
Anti-type 2 (T2) biologic therapies (biologics) improve exacerbation rates, lung function, and asthma-related quality of life (QoL) in patients with severe T2 asthma. However, studies comparing different biologics are lacking. We evaluated the QoL in patients with severe asthma comprehensively and compare the efficacy of different T2-directed biologics using QoL questionnaires.
Methods
We compared the QoL between severe and mild-to-moderate asthma and between severe asthma with and without biologics treatment. Data of mild-to-moderate were extracted from the Cohort for Reality and Evolution of Adult Asthma in Korea, and data of severe asthma were collected from the Precision Medicine Intervention in Severe Asthma. We included 183 patients with severe asthma treated with T2 biologics or conventional therapy between April 2020 and May 2021 and assessed QoL of them using the Questionnaire for Adult Korean Asthmatics (QLQAKA), Severe Asthma Questionnaire (SAQ), and EuroQoL-5Dimensions (EQ-5D) at baseline and 6 months.
Results
The EQ-5D index (0.803) of severe asthma was lower than that of other chronic diseases representing a worse QoL. The scores for all questions of QLQAKA, except “cough,” were lower (less control) in the severe asthma group than in the mild-to-moderate asthma group at baseline and 6 months (P < 0.05). The total scores and subscores of all domains of the QLQAKA, SAQ, and EQ-5D improved significantly 6 months after biologic therapy but not after conventional therapy. The total QLQAKA, SAQ, and EQ-5D scores improved after 6 months in the anti-IL-5 (P < 0.05) and anti-IL-4/IL-13 (P < 0.05) treatment groups with no significant difference between groups (P > 0.05).
Conclusion
QoL was worse in severe asthma than in mild-to-moderate asthma and other chronic diseases. T2 biologics equally improved QoL in patients with severe asthma.
{"title":"Effect of biologic therapies on quality of life in severe asthma: Findings from the PRISM study","authors":"","doi":"10.1016/j.waojou.2024.100957","DOIUrl":"10.1016/j.waojou.2024.100957","url":null,"abstract":"<div><h3>Background</h3><p>Anti-type 2 (T2) biologic therapies (biologics) improve exacerbation rates, lung function, and asthma-related quality of life (QoL) in patients with severe T2 asthma. However, studies comparing different biologics are lacking. We evaluated the QoL in patients with severe asthma comprehensively and compare the efficacy of different T2-directed biologics using QoL questionnaires.</p></div><div><h3>Methods</h3><p>We compared the QoL between severe and mild-to-moderate asthma and between severe asthma with and without biologics treatment. Data of mild-to-moderate were extracted from the Cohort for Reality and Evolution of Adult Asthma in Korea, and data of severe asthma were collected from the Precision Medicine Intervention in Severe Asthma. We included 183 patients with severe asthma treated with T2 biologics or conventional therapy between April 2020 and May 2021 and assessed QoL of them using the Questionnaire for Adult Korean Asthmatics (QLQAKA), Severe Asthma Questionnaire (SAQ), and EuroQoL-5Dimensions (EQ-5D) at baseline and 6 months.</p></div><div><h3>Results</h3><p>The EQ-5D index (0.803) of severe asthma was lower than that of other chronic diseases representing a worse QoL. The scores for all questions of QLQAKA, except “cough,” were lower (less control) in the severe asthma group than in the mild-to-moderate asthma group at baseline and 6 months (<em>P</em> < 0.05). The total scores and subscores of all domains of the QLQAKA, SAQ, and EQ-5D improved significantly 6 months after biologic therapy but not after conventional therapy. The total QLQAKA, SAQ, and EQ-5D scores improved after 6 months in the anti-IL-5 (<em>P</em> < 0.05) and anti-IL-4/IL-13 (<em>P</em> < 0.05) treatment groups with no significant difference between groups (<em>P</em> > 0.05).</p></div><div><h3>Conclusion</h3><p>QoL was worse in severe asthma than in mild-to-moderate asthma and other chronic diseases. T2 biologics equally improved QoL in patients with severe asthma.</p></div>","PeriodicalId":54295,"journal":{"name":"World Allergy Organization Journal","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1939455124000887/pdfft?md5=ff4eb96c06bff5c16bd0b552f1cd6e80&pid=1-s2.0-S1939455124000887-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142011954","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-14DOI: 10.1016/j.waojou.2024.100954
Background
Allergic rhinitis (AR) is a nasal disorder characterized by the simultaneous manifestation of at least 2 out of 4 possible symptoms: rhinorrhea, nasal itching, nasal pruritus, and sneezing. Presently, among Chinese young adults from Singapore, we characterised AR phenotypes, established Total Nasal Symptom Score (TNSS) baselines, and examined the management of AR.
Methods
Participants completed an investigator-administered International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire and underwent a skin prick test (SPT). Individuals exhibiting sensitization during the SPT while having at least 2 rhinitis symptoms were identified as AR cases, then categorized into Allergic Rhinitis in Asthma (ARIA) classifications.
Results
There were 9323 subjects analyzed. AR prevalence was estimated at 35.4%. Rhinorrhea was perceived as the most severe (mean Nasal Symptom Score (mNSS) ± SD: 1.42 ± 0.74), while nasal pruritus was the least severe (mNSS ± SD: 1.24 ± 0.68). Among moderate-severe AR (68.1%), most were affected by either troublesome symptoms (27.7%) or sleep disturbances (18.4%). By ARIA classes, 26.6% were mild intermittent, 5.4% were mild persistent, 50.3% were moderate-severe intermittent, and 17.6% were moderate-severe persistent. The mean TNSS (mTNSS) of AR cases was 4.43 (SD = 2.49) and between AR classifications, the mTNSS was significantly different. Notably, a large proportion of AR cases remained undiagnosed (85.2%), untreated (72.5%), or both (65.4%); 19.8% self-medicated for AR.
Conclusions
There was a significant difference in TNSS of the AR phenotypes, and among phenotypes with a higher mTNSS, a large proportion remained untreated, undiagnosed, or both. The evidence indicates an existing burden of AR among Chinese young adults in Singapore which is notably undermanaged.
背景过敏性鼻炎(AR)是一种鼻部疾病,其特征是同时出现鼻出血、鼻痒、鼻瘙痒和打喷嚏这四种症状中的至少两种。目前,我们在新加坡的华裔年轻人中研究了AR的表型特征,确定了鼻部症状总评分(TNSS)基线,并研究了AR的治疗方法。方法参与者填写了由研究人员管理的国际儿童哮喘和过敏研究(ISAAC)问卷,并接受了皮肤点刺试验(SPT)。在 SPT 中表现出过敏症状,同时至少有两种鼻炎症状的个体被确定为 AR 病例,然后按哮喘中的过敏性鼻炎 (ARIA) 进行分类。AR 患病率估计为 35.4%。鼻出血被认为是最严重的症状(平均鼻部症状评分 (mNSS) ± SD:1.42 ± 0.74),而鼻瘙痒则是最不严重的症状(平均鼻部症状评分 (mNSS) ± SD:1.24 ± 0.68)。在中度-重度 AR 患者(68.1%)中,大多数人都有烦恼症状(27.7%)或睡眠障碍(18.4%)。按照 ARIA 分级,26.6% 为轻度间歇性,5.4% 为轻度持续性,50.3% 为中度重度间歇性,17.6% 为中度重度持续性。AR 病例的平均 TNSS(mTNSS)为 4.43(标度 = 2.49),不同 AR 分类之间的 mTNSS 有显著差异。值得注意的是,很大一部分 AR 病例仍未确诊(85.2%)、未治疗(72.5%)或两者皆有(65.4%);19.8% 的病例因 AR 而自行用药。这些证据表明,在新加坡的华人青壮年中,AR 的发病率较高,但管理不足。
{"title":"The burden of allergic rhinitis is undermanaged in a large proportion of Chinese young adults from Singapore","authors":"","doi":"10.1016/j.waojou.2024.100954","DOIUrl":"10.1016/j.waojou.2024.100954","url":null,"abstract":"<div><h3>Background</h3><p>Allergic rhinitis (AR) is a nasal disorder characterized by the simultaneous manifestation of at least 2 out of 4 possible symptoms: rhinorrhea, nasal itching, nasal pruritus, and sneezing. Presently, among Chinese young adults from Singapore, we characterised AR phenotypes, established Total Nasal Symptom Score (TNSS) baselines, and examined the management of AR.</p></div><div><h3>Methods</h3><p>Participants completed an investigator-administered International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire and underwent a skin prick test (SPT). Individuals exhibiting sensitization during the SPT while having at least 2 rhinitis symptoms were identified as AR cases, then categorized into Allergic Rhinitis in Asthma (ARIA) classifications.</p></div><div><h3>Results</h3><p>There were 9323 subjects analyzed. AR prevalence was estimated at 35.4%. Rhinorrhea was perceived as the most severe (mean Nasal Symptom Score (mNSS) ± SD: 1.42 ± 0.74), while nasal pruritus was the least severe (mNSS ± SD: 1.24 ± 0.68). Among moderate-severe AR (68.1%), most were affected by either troublesome symptoms (27.7%) or sleep disturbances (18.4%). By ARIA classes, 26.6% were mild intermittent, 5.4% were mild persistent, 50.3% were moderate-severe intermittent, and 17.6% were moderate-severe persistent. The mean TNSS (mTNSS) of AR cases was 4.43 (SD = 2.49) and between AR classifications, the mTNSS was significantly different. Notably, a large proportion of AR cases remained undiagnosed (85.2%), untreated (72.5%), or both (65.4%); 19.8% self-medicated for AR.</p></div><div><h3>Conclusions</h3><p>There was a significant difference in TNSS of the AR phenotypes, and among phenotypes with a higher mTNSS, a large proportion remained untreated, undiagnosed, or both. The evidence indicates an existing burden of AR among Chinese young adults in Singapore which is notably undermanaged.</p></div>","PeriodicalId":54295,"journal":{"name":"World Allergy Organization Journal","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1939455124000851/pdfft?md5=704eba7a94756e704aca6ff08ade6be3&pid=1-s2.0-S1939455124000851-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141985461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01DOI: 10.1016/j.waojou.2024.100936
Background
Severe cutaneous adverse reactions (SCAR) are a group of delayed presumed T-cell mediated hypersensitivities associated with significant morbidity and mortality. Despite their shared global healthcare burden and impact, the clinical phenotypes, genomic predisposition, drug causality, and treatment outcomes may vary. We describe the establishment and results from the first Australasian registry for SCAR (AUS-SCAR), that via a collaborative network advances strategies for the prevention, diagnosis and treatment of SCAR.
Methods
Prospective multi-center registry of SCAR in Australian adult and adolescents, with planned regional expansion. The registry collects externally verified phenotypic data drug causality, therapeutics and long-term patient outcomes. In addition, biorepository specimens and DNA are collected at participating sites.
Results
we report on the first 100 patients enrolled in the AUS-SCAR database. DRESS (50%) is the most predominant phenotype followed by SJS/TEN (39%) and AGEP (10%), with median age of 52 years old (IQR 37.5, 66) with 1:1 male-to-female ratio. The median latency for all implicated drugs is highly variable but similar for DRESS (median 15 days IQR 5,25) and SJS/TEN (median 21 days, IQR 7,27), while lowest for AGEP (median 2.5 days, IQR 1,8). Antibiotics (54.5%) are more commonly listed as primary implicated drug compare with non-antibiotics agent (45.5%). Mortality rate at 90 days was highest in SJS/TEN at 23.1%, followed by DRESS (4%) and AGEP (0%).
Conclusion
In the first prospective national phenotypic and biorepository of SCAR in the southern hemisphere we demonstrate notable differences to other reported registries; including DRESS-predominant phenotype, varied antibiotic causality and low overall mortality rate. This study also highlights the lack of standardised preventative pharmacogenomic measures and in vitro/in vivo diagnostic strategies to ascertain drug causality.
Trial registration
ANZCTR ACTRN12619000241134. Registered 19 February 2019.
{"title":"The Australasian Registry for Severe Cutaneous Adverse Reactions (AUS-SCAR) – Providing a roadmap for closing the diagnostic, patient, and healthcare gaps for a group of rare drug eruptions","authors":"","doi":"10.1016/j.waojou.2024.100936","DOIUrl":"10.1016/j.waojou.2024.100936","url":null,"abstract":"<div><h3>Background</h3><p>Severe cutaneous adverse reactions (SCAR) are a group of delayed presumed T-cell mediated hypersensitivities associated with significant morbidity and mortality. Despite their shared global healthcare burden and impact, the clinical phenotypes, genomic predisposition, drug causality, and treatment outcomes may vary. We describe the establishment and results from the first Australasian registry for SCAR (AUS-SCAR), that via a collaborative network advances strategies for the prevention, diagnosis and treatment of SCAR.</p></div><div><h3>Methods</h3><p>Prospective multi-center registry of SCAR in Australian adult and adolescents, with planned regional expansion. The registry collects externally verified phenotypic data drug causality, therapeutics and long-term patient outcomes. In addition, biorepository specimens and DNA are collected at participating sites.</p></div><div><h3>Results</h3><p>we report on the first 100 patients enrolled in the AUS-SCAR database. DRESS (50%) is the most predominant phenotype followed by SJS/TEN (39%) and AGEP (10%), with median age of 52 years old (IQR 37.5, 66) with 1:1 male-to-female ratio. The median latency for all implicated drugs is highly variable but similar for DRESS (median 15 days IQR 5,25) and SJS/TEN (median 21 days, IQR 7,27), while lowest for AGEP (median 2.5 days, IQR 1,8). Antibiotics (54.5%) are more commonly listed as primary implicated drug compare with non-antibiotics agent (45.5%). Mortality rate at 90 days was highest in SJS/TEN at 23.1%, followed by DRESS (4%) and AGEP (0%).</p></div><div><h3>Conclusion</h3><p>In the first prospective national phenotypic and biorepository of SCAR in the southern hemisphere we demonstrate notable differences to other reported registries; including DRESS-predominant phenotype, varied antibiotic causality and low overall mortality rate. This study also highlights the lack of standardised preventative pharmacogenomic measures and <em>in vitro</em>/<em>in vivo</em> diagnostic strategies to ascertain drug causality.</p></div><div><h3>Trial registration</h3><p>ANZCTR ACTRN12619000241134. Registered 19 February 2019.</p></div>","PeriodicalId":54295,"journal":{"name":"World Allergy Organization Journal","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S193945512400067X/pdfft?md5=0260a54465065321a2ef23b882d23af7&pid=1-s2.0-S193945512400067X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141950411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01DOI: 10.1016/j.waojou.2024.100949
Background
Cardiovascular diseases (CVDs) have been associated with atopic dermatitis (AD), including in Korean patients. Previous studies on AD have primarily focused on patients of European ancestry, while the Asian endotype exhibits distinct characteristics. This study aimed to characterize the blood proteomic signature of Korean patients with moderate-to-severe AD, with an emphasis on proteins related to CVDs.
Methods
A total of 78 participants, including 39 patients with moderate-to-severe AD and 39 age- and sex-matched healthy controls, were enrolled. Blood proteomics analysis was performed using the Olink CVD II panel, which measures the expression levels of 92 proteins associated with CVDs.
Results
Unsupervised hierarchical clustering revealed 44 upregulated and 5 downregulated proteins in AD patients compared to healthy controls. Principal component analysis (PCA) effectively distinguished AD patients from healthy subjects based on the complete set of proteins or the subset of upregulated proteins. A multiple linear regression model comprising CCL17 and FGF21 showed a strong correlation with disease severity (R = 0.619). Correlation analysis identified 25 highly correlated proteins, including STK4, ITGB1BP2, and DECR1, which were newly found to be upregulated in Korean AD patients. Pathway analysis highlighted the involvement of these proteins in vascular system, inflammation, and lipid metabolism pathways.
Conclusion
The blood proteomic profile of moderate-to-severe AD patients in Korea differed from healthy controls using the CVD II panel. This study provides potential biomarkers for the AD-CVD association and insights into the pathways contributing to this relationship in the Korean population.
{"title":"Proteomic analysis of cardiovascular disease-associated proteins in Korean patients with moderate-to-severe atopic dermatitis","authors":"","doi":"10.1016/j.waojou.2024.100949","DOIUrl":"10.1016/j.waojou.2024.100949","url":null,"abstract":"<div><h3>Background</h3><p>Cardiovascular diseases (CVDs) have been associated with atopic dermatitis (AD), including in Korean patients. Previous studies on AD have primarily focused on patients of European ancestry, while the Asian endotype exhibits distinct characteristics. This study aimed to characterize the blood proteomic signature of Korean patients with moderate-to-severe AD, with an emphasis on proteins related to CVDs.</p></div><div><h3>Methods</h3><p>A total of 78 participants, including 39 patients with moderate-to-severe AD and 39 age- and sex-matched healthy controls, were enrolled. Blood proteomics analysis was performed using the Olink CVD II panel, which measures the expression levels of 92 proteins associated with CVDs.</p></div><div><h3>Results</h3><p>Unsupervised hierarchical clustering revealed 44 upregulated and 5 downregulated proteins in AD patients compared to healthy controls. Principal component analysis (PCA) effectively distinguished AD patients from healthy subjects based on the complete set of proteins or the subset of upregulated proteins. A multiple linear regression model comprising CCL17 and FGF21 showed a strong correlation with disease severity (R = 0.619). Correlation analysis identified 25 highly correlated proteins, including STK4, ITGB1BP2, and DECR1, which were newly found to be upregulated in Korean AD patients. Pathway analysis highlighted the involvement of these proteins in vascular system, inflammation, and lipid metabolism pathways.</p></div><div><h3>Conclusion</h3><p>The blood proteomic profile of moderate-to-severe AD patients in Korea differed from healthy controls using the CVD II panel. This study provides potential biomarkers for the AD-CVD association and insights into the pathways contributing to this relationship in the Korean population.</p></div>","PeriodicalId":54295,"journal":{"name":"World Allergy Organization Journal","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1939455124000802/pdfft?md5=b0ca8d5b954693f598553d79af6abf94&pid=1-s2.0-S1939455124000802-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141953153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01DOI: 10.1016/j.waojou.2024.100938
Background
Chronic rhinosinusitis with nasal polyps (CRSwNP) is a chronic inflammatory disease. Exosomes were involved in different inflammatory diseases, but their roles in CRSwNP were poorly explored.
Method
We collected serum samples from 8 CRSwNP patients and 8 healthy controls (HC) and isolated their exosomes. MiRNA sequencing was performed for the exosome samples and differentially expressed miRNAs were identified. The top 3 differentially expressed exosomal miRNAs were confirmed in 2 validation cohorts, and their diagnostic values, predictive values for eosinophilic endotype, and recurrence were evaluated.
Results
Distinctive serum exosomal miRNA profiles were observed between CRSwNP and HC groups. Reverse transcription-polymerase chain reaction results in the first validation cohort revealed that serum exosomal miR-141-3p levels were increased, and miR-18a-5p and miR-3679-5p levels were decreased in the CRSwNP group compared to the HC group. These 3 miRNAs were further validated in the second validation cohort, and the results showed that miR-141-3p levels were elevated and miR-3679-5p levels were reduced in the serum exosomes in the eosinophilic CRSwNP group in comparison with the non-eosinophilic CRSwNP group. Receiver operating characteristic (ROC) curves highlighted that exosomal miR-141-3p and miR-3679-5p exhibited promising values for predicting the eosinophilic endotype. The patients in the second cohort were followed up for 2 years, and categorized into recurrence and non-recurrence groups. The serum exosomal miR-141-3p levels were increased and miR-3679-5p levels were reduced in the recurrence group in comparison with the non-recurrence group. ROC curves and Kaplan-Meier survival analysis revealed significant associations between the levels of exosomal miR-141-3p and miR-3679-5p and the risk of postoperative recurrence.
Conclusions
This study identified unique miRNA expression patterns in serum exosomes of CRSwNP patients. Circulating exosomal miR-141-3p and miR-3679-5p emerged as novel biomarkers for diagnosing CRSwNP, predicting the eosinophilic endotype, and forecasting postoperative recurrence.
{"title":"Serum exosomal miR-141-3p and miR-3679-5p levels associated with endotype and postoperative recurrence in chronic rhinosinusitis with nasal polyps","authors":"","doi":"10.1016/j.waojou.2024.100938","DOIUrl":"10.1016/j.waojou.2024.100938","url":null,"abstract":"<div><h3>Background</h3><p>Chronic rhinosinusitis with nasal polyps (CRSwNP) is a chronic inflammatory disease. Exosomes were involved in different inflammatory diseases, but their roles in CRSwNP were poorly explored.</p></div><div><h3>Method</h3><p>We collected serum samples from 8 CRSwNP patients and 8 healthy controls (HC) and isolated their exosomes. MiRNA sequencing was performed for the exosome samples and differentially expressed miRNAs were identified. The top 3 differentially expressed exosomal miRNAs were confirmed in 2 validation cohorts, and their diagnostic values, predictive values for eosinophilic endotype, and recurrence were evaluated.</p></div><div><h3>Results</h3><p>Distinctive serum exosomal miRNA profiles were observed between CRSwNP and HC groups. Reverse transcription-polymerase chain reaction results in the first validation cohort revealed that serum exosomal miR-141-3p levels were increased, and miR-18a-5p and miR-3679-5p levels were decreased in the CRSwNP group compared to the HC group. These 3 miRNAs were further validated in the second validation cohort, and the results showed that miR-141-3p levels were elevated and miR-3679-5p levels were reduced in the serum exosomes in the eosinophilic CRSwNP group in comparison with the non-eosinophilic CRSwNP group. Receiver operating characteristic (ROC) curves highlighted that exosomal miR-141-3p and miR-3679-5p exhibited promising values for predicting the eosinophilic endotype. The patients in the second cohort were followed up for 2 years, and categorized into recurrence and non-recurrence groups. The serum exosomal miR-141-3p levels were increased and miR-3679-5p levels were reduced in the recurrence group in comparison with the non-recurrence group. ROC curves and Kaplan-Meier survival analysis revealed significant associations between the levels of exosomal miR-141-3p and miR-3679-5p and the risk of postoperative recurrence.</p></div><div><h3>Conclusions</h3><p>This study identified unique miRNA expression patterns in serum exosomes of CRSwNP patients. Circulating exosomal miR-141-3p and miR-3679-5p emerged as novel biomarkers for diagnosing CRSwNP, predicting the eosinophilic endotype, and forecasting postoperative recurrence.</p></div>","PeriodicalId":54295,"journal":{"name":"World Allergy Organization Journal","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1939455124000693/pdfft?md5=fdcb88433f972d72b5931b52ae839c60&pid=1-s2.0-S1939455124000693-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141951697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01DOI: 10.1016/j.waojou.2024.100943
The presence of angioedema, or deep skin swelling, in addition to hives (wheals) in patients with chronic spontaneous urticaria (CSU) can complicate disease management. There is evidence that omalizumab is effective for patients with CSU with angioedema, but the time to a clinically meaningful response has not been assessed. This post hoc analysis examined data from the phase 3, randomized, double-blind ASTERIA I and ASTERIA II studies: patients with CSU with hives were grouped by presence (n = 216) or absence of angioedema (n = 265) at baseline. The time to minimally important difference (MID, change from baseline of ≥11 points) in weekly Urticaria Activity Score (UAS7) was analyzed using Kaplan-Meier analyses. Median time to MID for omalizumab 300 mg was similar in patients with and without angioedema. Median time to MID for omalizumab 150 mg was similar to 300 mg for patients without angioedema, and was longer for patients with angioedema. Therefore, the response to omalizumab for patients with CSU with angioedema was dose dependent. We recommend that the best approach for clinicians, in line with guidelines, would be initial administration of omalizumab 300 mg every 4 weeks for all patients.
Clinical trials registration
Clinicaltrials.gov NCT01287117 (registered 27 January 2011) and NCT01292473 (registered 7 February 2011).
慢性自发性荨麻疹(CSU)患者除了荨麻疹(麦粒肿)外,还伴有血管性水肿或深层皮肤肿胀,这可能会使疾病治疗变得复杂。有证据表明,奥马珠单抗对伴有血管性水肿的慢性自发性荨麻疹(CSU)患者有效,但尚未评估产生有临床意义的反应的时间。这项事后分析检查了 3 期随机双盲 ASTERIA I 和 ASTERIA II 研究的数据:根据基线时存在(n = 216)或不存在(n = 265)血管性水肿的 CSU 伴荨麻疹患者进行分组。每周荨麻疹活动评分(UAS7)达到最小重要差异(MID,与基线相比变化≥11分)的时间采用卡普兰-梅耶分析法进行分析。在有血管性水肿和无血管性水肿的患者中,奥马珠单抗300毫克的中位MID时间相似。对于无血管性水肿的患者,奥马珠单抗150毫克的中位MID时间与300毫克相似,而血管性水肿患者的中位MID时间较长。因此,伴有血管性水肿的 CSU 患者对奥马珠单抗的反应与剂量有关。临床试验注册Clinicaltrials.gov NCT01287117(2011年1月27日注册)和NCT01292473(2011年2月7日注册)。
{"title":"Does angioedema in patients with chronic spontaneous urticaria impact response to omalizumab?","authors":"","doi":"10.1016/j.waojou.2024.100943","DOIUrl":"10.1016/j.waojou.2024.100943","url":null,"abstract":"<div><p>The presence of angioedema, or deep skin swelling, in addition to hives (wheals) in patients with chronic spontaneous urticaria (CSU) can complicate disease management. There is evidence that omalizumab is effective for patients with CSU with angioedema, but the time to a clinically meaningful response has not been assessed. This <em>post hoc</em> analysis examined data from the phase 3, randomized, double-blind ASTERIA I and ASTERIA II studies: patients with CSU with hives were grouped by presence (n = 216) or absence of angioedema (n = 265) at baseline. The time to minimally important difference (MID, change from baseline of ≥11 points) in weekly Urticaria Activity Score (UAS7) was analyzed using Kaplan-Meier analyses. Median time to MID for omalizumab 300 mg was similar in patients with and without angioedema. Median time to MID for omalizumab 150 mg was similar to 300 mg for patients without angioedema, and was longer for patients with angioedema. Therefore, the response to omalizumab for patients with CSU with angioedema was dose dependent. We recommend that the best approach for clinicians, in line with guidelines, would be initial administration of omalizumab 300 mg every 4 weeks for all patients.</p></div><div><h3>Clinical trials registration</h3><p>Clinicaltrials.gov <span><span>NCT01287117</span><svg><path></path></svg></span> (registered 27 January 2011) and <span><span>NCT01292473</span><svg><path></path></svg></span> (registered 7 February 2011).</p></div>","PeriodicalId":54295,"journal":{"name":"World Allergy Organization Journal","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1939455124000747/pdfft?md5=ee64bd00420dc27599643e88b5916440&pid=1-s2.0-S1939455124000747-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141950412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01DOI: 10.1016/j.waojou.2024.100944
Background
Refractory anaphylaxis poses an ongoing, lethal hypersensitivity response that unpredictably involves multiple organs despite appropriate intramuscular (IM) adrenaline injections. Studies on the association of the platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) concerning anaphylactic severity have yet to be carried out. The study aimed to evaluate the association between blood PLR and NLR levels and refractory anaphylaxis.
Methods
We carried out a retrospective cross-sectional study in which medical records of patients with anaphylaxis who sought urgent care at the Emergency Department (ED) of Tertiary Hospital in Hanoi, Vietnam, were evaluated. Based on the United Kingdom Resuscitation Council guidelines in 2021, patients were classified as refractory anaphylaxis if they needed more than two appropriate doses of intramuscular adrenaline for anaphylactic symptoms resolution. Clinical data and laboratory results were obtained in the medical records. Logistic regression analysis determined the association between contributing factors and refractory anaphylaxis.
Results
One-hundred eighteen adults (age 51.80 ± 18.25 years) were analyzed, including 38 refractory anaphylaxis patients (32.2%). Refractory anaphylaxis patients exhibited notably elevated platelet-to-lymphocyte ratio (PLR) (P = 0.006) and increased neutrophil-to-lymphocyte ratio (NLR) (P < 0.001) in comparison to non-refractory anaphylaxis patients. Receiver operating characteristic curve (ROC) analysis demonstrated an optimal PLR cutoff value of 129.5 (area under the ROC curve [AUC] 0.658, sensitivity 73.68%, specificity 61.25%, P = 0.004) and an optimal NLR cutoff value of 4 (AUC 0.736, sensitivity 65.79%, specificity 73.75%, P < 0.001) for refractory anaphylaxis. Multivariate logistic regression analysis revealed a PLR≥129.5 (OR = 4.83, 95% CI: 1.87–12.48) and an NLR≥4 (OR = 4.60, 95% CI: 1.86–11.41) were independently associated with refractory anaphylaxis.
Conclusion
Elevated PLR and NLR serve as independent indicators significantly associated with refractory anaphylaxis.
{"title":"Platelet-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio as predictors of refractory anaphylaxis","authors":"","doi":"10.1016/j.waojou.2024.100944","DOIUrl":"10.1016/j.waojou.2024.100944","url":null,"abstract":"<div><h3>Background</h3><p>Refractory anaphylaxis poses an ongoing, lethal hypersensitivity response that unpredictably involves multiple organs despite appropriate intramuscular (IM) adrenaline injections. Studies on the association of the platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) concerning anaphylactic severity have yet to be carried out. The study aimed to evaluate the association between blood PLR and NLR levels and refractory anaphylaxis.</p></div><div><h3>Methods</h3><p>We carried out a retrospective cross-sectional study in which medical records of patients with anaphylaxis who sought urgent care at the Emergency Department (ED) of Tertiary Hospital in Hanoi, Vietnam, were evaluated. Based on the United Kingdom Resuscitation Council guidelines in 2021, patients were classified as refractory anaphylaxis if they needed more than two appropriate doses of intramuscular adrenaline for anaphylactic symptoms resolution. Clinical data and laboratory results were obtained in the medical records. Logistic regression analysis determined the association between contributing factors and refractory anaphylaxis.</p></div><div><h3>Results</h3><p>One-hundred eighteen adults (age 51.80 ± 18.25 years) were analyzed, including 38 refractory anaphylaxis patients (32.2%). Refractory anaphylaxis patients exhibited notably elevated platelet-to-lymphocyte ratio (PLR) (<em>P</em> = 0.006) and increased neutrophil-to-lymphocyte ratio (NLR) (<em>P</em> < 0.001) in comparison to non-refractory anaphylaxis patients. Receiver operating characteristic curve (ROC) analysis demonstrated an optimal PLR cutoff value of 129.5 (area under the ROC curve [AUC] 0.658, sensitivity 73.68%, specificity 61.25%, <em>P</em> = 0.004) and an optimal NLR cutoff value of 4 (AUC 0.736, sensitivity 65.79%, specificity 73.75%, <em>P</em> < 0.001) for refractory anaphylaxis. Multivariate logistic regression analysis revealed a PLR≥129.5 (OR = 4.83, 95% CI: 1.87–12.48) and an NLR≥4 (OR = 4.60, 95% CI: 1.86–11.41) were independently associated with refractory anaphylaxis.</p></div><div><h3>Conclusion</h3><p>Elevated PLR and NLR serve as independent indicators significantly associated with refractory anaphylaxis.</p></div>","PeriodicalId":54295,"journal":{"name":"World Allergy Organization Journal","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1939455124000759/pdfft?md5=6b0ac9485144fae069fa1e6aa6fee96f&pid=1-s2.0-S1939455124000759-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141953154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01DOI: 10.1016/j.waojou.2024.100933
Background
Type 2 inflammation is the principal determinant of asthma in children, and it leads to the downstream activation of eosinophils (EOS), the production of immunoglobulin-E (IgE), and increased levels of fraction of exhaled nitric oxide (FeNO). Dupilumab received the approval for the treatment of uncontrolled severe Type 2 asthma in children.
Objective
The aim of this analysis was to calculate the Type 2 severe asthma paediatric population who would be eligible for treatment with dupilumab in Italy and characterize them by expected biomarker status.
Methods
The calculation of the dupilumab-eligible population employed a two-phase approach: 1) estimating the total number of children aged 6–11 years with uncontrolled severe asthma; and 2) stratifying the severe uncontrolled asthma population, based on appropriate biomarker levels, thus identifying patients eligible for treatment with dupilumab. The VOYAGE study provided the data for this analysis.
Results
The two-phase approach utilizing VOYAGE data revealed that the average number of paediatric patients with uncontrolled severe asthma was N = 1007. Stratification of these patients, as per VOYAGE data, indicated that the majority (N = 740; 73.5%) would have ≥2 elevated biomarkers, and over one-third patients (N = 434, 43.1%) would exhibit simultaneously elevated levels of EOS, FeNO and IgE. Of the paediatric patients, N = 864 were identified as eligible to dupilumab treatment, constituting 85.8% of the target population. Notably, nearly half eligible patients (N = 454) displayed elevated levels of both EOS and FeNO biomarkers, while the substantial majority (81.1%) exhibited at least an increase of EOS levels (N = 817). Patients with increased FeNO levels without a concurrent increase in EOS were less frequent (N = 47; 5.4% of the eligible population).
Conclusion
The simultaneous testing of multiple biomarkers during baseline patient assessment and disease follow-up is highly recommended. Utilizing cost-effective tests, physicians can estimate the prevalence of severe Type 2 asthma, categorize patients into distinct phenotypes (eosinophilic, allergic, or mixed), and consequently identify and prescribe the most suitable therapeutic interventions. This approach also facilitates the ongoing evaluation and adjustment of the treatment strategies based on individual patient responses.
{"title":"Type 2 asthma paediatric patients eligible for dupilumab: An Italian biomarker-based analysis","authors":"","doi":"10.1016/j.waojou.2024.100933","DOIUrl":"10.1016/j.waojou.2024.100933","url":null,"abstract":"<div><h3>Background</h3><p>Type 2 inflammation is the principal determinant of asthma in children, and it leads to the downstream activation of eosinophils (EOS), the production of immunoglobulin-E (IgE), and increased levels of fraction of exhaled nitric oxide (FeNO). Dupilumab received the approval for the treatment of uncontrolled severe Type 2 asthma in children.</p></div><div><h3>Objective</h3><p>The aim of this analysis was to calculate the Type 2 severe asthma paediatric population who would be eligible for treatment with dupilumab in Italy and characterize them by expected biomarker status.</p></div><div><h3>Methods</h3><p>The calculation of the dupilumab-eligible population employed a two-phase approach: 1) estimating the total number of children aged 6–11 years with uncontrolled severe asthma; and 2) stratifying the severe uncontrolled asthma population, based on appropriate biomarker levels, thus identifying patients eligible for treatment with dupilumab. The VOYAGE study provided the data for this analysis.</p></div><div><h3>Results</h3><p>The two-phase approach utilizing VOYAGE data revealed that the average number of paediatric patients with uncontrolled severe asthma was N = 1007. Stratification of these patients, as per VOYAGE data, indicated that the majority (N = 740; 73.5%) would have ≥2 elevated biomarkers, and over one-third patients (N = 434, 43.1%) would exhibit simultaneously elevated levels of EOS, FeNO and IgE. Of the paediatric patients, N = 864 were identified as eligible to dupilumab treatment, constituting 85.8% of the target population. Notably, nearly half eligible patients (N = 454) displayed elevated levels of both EOS and FeNO biomarkers, while the substantial majority (81.1%) exhibited at least an increase of EOS levels (N = 817). Patients with increased FeNO levels without a concurrent increase in EOS were less frequent (N = 47; 5.4% of the eligible population).</p></div><div><h3>Conclusion</h3><p>The simultaneous testing of multiple biomarkers during baseline patient assessment and disease follow-up is highly recommended. Utilizing cost-effective tests, physicians can estimate the prevalence of severe Type 2 asthma, categorize patients into distinct phenotypes (eosinophilic, allergic, or mixed), and consequently identify and prescribe the most suitable therapeutic interventions. This approach also facilitates the ongoing evaluation and adjustment of the treatment strategies based on individual patient responses.</p></div>","PeriodicalId":54295,"journal":{"name":"World Allergy Organization Journal","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1939455124000644/pdfft?md5=dc291fef14ab1f2546be46a32599a53f&pid=1-s2.0-S1939455124000644-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141951699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}