Allergy and asthma proceedings最新文献

Background: Childhood asthma is a common chronic disease in children, which has a double negative impact on children's physical and mental health, and also brings a heavy economic burden to children's families. Maternal indicators during the perinatal period are the key inducement for the occurrence and severity of asthma in children. However, people's lack of awareness of the risk factors that may affect the occurrence of childhood asthma during the perinatal period and effective intervention measures have become the reasons and loopholes for the rising prevalence of childhood asthma. Objective: This systematic review and meta-analysis investigated the influence of perinatal risk factors on pediatric asthma (PA) to provide evidence for optimizing perinatal management and prevention strategies. Methods: The study was conducted in accordance with the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A retrospective search of medical literature data bases was conducted up to April 24, 2024, for observational studies on the impact of perinatal risk factors on PA. A meta-analysis was conducted by using a random or fixed effects model based on the Cochran Q test and I² statistics. Results: A total of 26 observational studies with 2,143,844 participants were included. The meta-analysis identified maternal perinatal smoking (odds ratio [OR] 1.11 [95% confidence interval {CI}, 1.01-1.24]; p = 0.04), gestational age of <37 weeks (OR 1.50 [95% CI, 1.36-1.65]; p < 0.0001), maternal asthma history (OR 1.80 [95% CI, 1.29-2.52]; p = 0.001), and maternal perinatal antibiotic use (OR 1.82 [95% CI, 1.01-3.29]; p = 0.047) as significant risk factors. Multivariate analysis further highlighted maternal smoking (OR 1.83 [95% CI, 1.23-2.72]; p = 0.003) and maternal asthma history (OR 4.49 [95% CI, 2.49-8.12]; p < 0.0001) as key risks. Conclusion: Smoking by mothers, gestational age at birth of <37 weeks, asthma history of mothers, and perinatal use of antibiotics by mothers were all risk factors for PA. Targeted interventions are needed to mitigate these risks.

Background: Initial studies recommended that omalizumab be administered by health-care professionals. However, subsequent research revealed that the prevalence of anaphylaxis after subcutaneous omalizumab injections was only 0.09%. Objective: In this study, we aimed to evaluate the effects of omalizumab self-administration at home compared with hospital administration on asthma control. Method: Medical records of 45 patients diagnosed with severe atopic asthma, treated with omalizumab in our clinic, and subsequently transitioned to self-injection at home after appropriate training were retrospectively reviewed. These patients were monitored regularly for at least 1 year before and after the transition. The asthma control level was assessed by using the Asthma Control Test (ACT). Results: The ACT score average 1 year after home use was significantly higher than 1 year before home use (0.047); however, the scores before and after 6 months and 3 months home use were similar. A significant reduction in the number of exacerbations was observed after home medication use (p = 0.050), whereas no significant differences were detected in systemic steroid use or emergency admissions. The presence of eosinophilia and comorbidities did not significantly affect periodic ACT values after home use. Conclusion: Our study demonstrated the safety and efficacy of omalizumab for home administration in patients with severe atopic asthma, and it should be emphasized that proper patient selection and training are crucial to ensure the safety of home therapy. It is effective in both symptom control and prevention of exacerbations, and the effectiveness of home use was not diminished by the presence of comorbidities or eosinophilia compared with hospital use.

Background: Real-life studies have shown the effects of biologic therapies on severe asthma. However, evidence for discontinuing treatment after targeted improvement remains limited. Objective: This study investigated the factors associated with clinical remission in patients with severe asthma treated with biologics and explores physician decision-making with regard to the continuation or discontinuation of treatment after remission. Method: A retrospective analysis was conducted on 65 patients with severe asthma who received biologics for at least 12 months between 2012 and 2024. Demographic and clinical data were reviewed, alongside physician-reported reasons for continued biologic use after remission and outcomes after treatment discontinuation. Results: Clinical remission was achieved in 44.6% of the patients. Patients with nonsteroidal anti-inflammatory drug-exacerbated respiratory disease, allergic bronchopulmonary aspergillosis, or eosinophilic granulomatosis with polyangiitis, and those with waning effect did not discontinue biologics after remission due to physician judgment and concerns about exacerbating both asthma and coexisting conditions. The decision to continue biologic therapy after remission was influenced by nasal polyposis, intermittent use of high-dose inhaled corticosteroids, previous failed cessations, and certain other factors. Of the 13 patients who discontinued biologic treatment, 3 did so due to biologic nonresponse, all 3 with asthma-chronic obstructive pulmonary disease overlap (ACO). Ten had achieved clinical remission before discontinuation. Treatment was restarted in one of these 10 patients due to exacerbations and loss of symptom control. Nonsevere exacerbations occurred in two of the remaining nine patients. Conclusion: Biologics are highly effective in achieving remission in severe asthma. Achieving the desired goals does not require continuity of biologics in all patients. Attention to waning symptoms may contribute to the success of drug discontinuation. Individualized treatment plans, including consideration of comorbidities, adjustments in dose intervals, and nonbiologic treatment options, are essential for optimal outcomes with regard to cessation of biologics.

Background: Rapid drug desensitizations (RDD) provide a means for patients with a history of acute hypersensitivity reactions (HSR) to platinum-based chemotherapeutics to continue their first-line oncologic treatment. Approximately one third of RDDs have been associated with breakthrough reactions (BTR) but identifying which patients are at risk is challenging. Objective: The objective was to identify factors predictive of patients at risk of developing BTR during their initial RDD. Methods: Forty-three patients who developed HSRs to a platinum drug and subsequently underwent RDDs were included for analysis. A retrospective manual chart review was performed to obtain demographics and information with regard to oncologic history, incident HSR, and RDD. The severity of HSRs and BTRs was determined by using the Brown criteria. Results: BTRs developed in 37% of patients during their initial RDD. Compared with those who tolerated RDDs, the patients who developed BTRs were significantly more likely to have positive allergy skin test results with a platinum drug (100%) than those who tolerated their RDD (47%, p = 0.01). The median (interquartile range) time between incident HSR and initial RDD was significantly shorter among patients who developed BTRs (31 days [21-49 days]) than those who did not develop BTRs (46 days [28-826 days]) (p = 0.04). Only 46% of patients with severe incident HSRs developed a BTR. However, severe BTRs occurred only in patients who had severe incident HSRs (p = 0.02). Conclusion: Severe clinical signs and symptoms of incident HSRs do not always predict if BTRs will occur during initial RDDs. However, patients with severe BTRs are more likely to have had a severe incident HSR.

Background: Idiopathic mast cell activation syndrome (iMCAS) is a rare challenging diagnosis, and its treatment is not well standardized. Objective: This study aimed to evaluate the clinical features of iMCAS and the potential need of omalizumab in clinical practice. Methods: The clinical features and treatment regimens in 21 patients with iMCAS were evaluated. The number of anaphylaxis episodes, symptom severity scores via the visual analog scale (VAS), the disease control via the Likert scale were recorded at baseline, 6th-month and 1st-year visits. Results: The affected organ systems were the skin (100%), respiratory (90%), cardiovascular (76.2%), and neurologic (40%). Nineteen patients (90.5%) experienced a grade V anaphylaxis and received adrenaline at baseline. The median (interquartile range [IQR]) serum tryptase level during an episode and at baseline were 11.7 ng/mL (10.4-14.6 ng/mL) and 5.29 ng/mL (3.32-8.62 ng/mL), respectively. Nineteen patients (90.5%) required omalizumab due to unresponsiveness to other treatments at a median (IQR) duration of 3 years (1-4 years). By the end of 1 year, nine patients (47.4%) continued on 150 mg, seven patients (36.8%) continued on 300 mg, two patients (10.5%) continued on 450 mg, and one patient (5.2%) continued on 600 mg of omalizumab. Overall, the VAS scores significantly decreased at the 6th month and 1st year of omalizumab treatment compared to both the time of diagnosis (6th month vs. diagnosis: p = 0.001; 1st year vs. diagnosis: p = 0.012) and the initiation of omalizumab treatment (6th month vs. initiation: p = 0.001; 1st year vs. initiation: p = 0.001). The number of anaphylaxis episodes was significantly higher at the time of diagnosis compared with the 6th month (p = 0.001) and 1st year (p = 0.001) of omalizumab treatment and the number of anaphylaxis episodes at the initiation of omalizumab treatment was significantly higher compared with the 6th month of omalizumab treatment (p = 0.001) and the 1st year of omalizumab treatment (p = 0.001). Symptom control levels on the Likert scale at the 6th month and 1st year of omalizumab treatment were found to be significantly higher compared to both the time of diagnosis (6th month vs. diagnosis: p = 0.001; 1st year vs. diagnosis: p = 0.001) and the initiation of omalizumab treatment (6th month vs. initiation: p = 0.001; 1st year vs. initiation: p = 0.001). Conclusion: The iMCAS causes severe anaphylaxis episodes that can be successfully prevented by omalizumab as an add-on treatment to other treatment options.

Background: Asthma prevalence is rising globally, with China reporting 2.1%-5.6% rates, particularly in aging populations. Body mass index (BMI), a key measure of weight status (kg/m²), is linked to chronic diseases, yet its bidirectional role in asthma remains unclear. This study evaluated baseline BMI and the asthma risk in Chinese adults ages ≥ 45 years by focusing on underweight and obesity as dual risk factors. Methods: A prospective cohort of 7135 adults ages ≥ 45 years without baseline asthma was derived from the China Health and Retirement Longitudinal Study (CHARLS). Participants were categorized into BMI groups: underweight (<18.5 kg/m²), normal weight (18.5-24.9 kg/m²), overweight (25.0-29.9 kg/m²), and obese (≥30.0 kg/m²). Kaplan-Meier curves estimated the cumulative asthma incidence. Multivariable Cox regression and restricted cubic spline analyses evaluated associations. Results: Over 10 years, 420 participants (5.9%) developed asthma. Incidence rates increased significantly with BMI extremes: underweight (10.9%) and obese (7.3%) groups exhibited higher risks versus the normal weight (5.6%) group. Adjusted models revealed a U-shaped association: individuals who were underweight had a 74% elevated risk (hazard ratio [HR] 1.74 [95% confidence interval {CI}, 1.24-2.42]; p < 0.001), and the participants who were obese had a 39% increase (HR 1.39 [95% CI, 1.01-1.91]; p = 0.039). The overweight status showed no association (HR 0.92; p = 0.519). Restricted cubic spline confirmed nonlinearity (p < 0.05), with risks that escalated at low and high BMIs. Conclusion: We demonstrated a U-shaped association between BMI and incident asthma risk, with both underweight and obesity increasing the risk of asthma development. For elderly Chinese people, being underweight is a more dangerous risk factor for asthma.

Background: Omalizumab has been a valuable option for patients with severe asthma, with increasing data with regard to the effectiveness of omalizumab in patients with allergic bronchopulmonary aspergillosis (ABPA). Objective: The objective was to evaluate the long-term clinical and functional effectiveness of omalizumab in patients with ABPA. Methods: Patients who received omalizumab for ABPA in our clinic between December 2008 and September 2023 were retrospectively evaluated. Data were assessed before the initiation of omalizumab, at the first year of treatment, and at the last visits of the patients. Patients with Asthma Control Test (ACT) scores of ≥20, no hospitalization/emergency admissions due to asthma, a reduced daily oral corticosteroid (OCS) dose, and an increase in forced expiratory volume in 1 second (FEV₁) level were considered as complete responders. Results: A total of 22 patients (no. men/women: 11/11) with ABPA and with a mean age of 53 ± 14.94 years (minimum 27 years, maximum 77 years) were included in the study. Significant increases were observed in FEV₁ measured at the first year and last visit compared with pretreatment (p = 0.007). In patients who received a mean ± standard deviation (SD) of 12.73 ± 8.87 mg of methylprednisolone before treatment, the OCS dose decreased to a mean ± SD of 2.45 ± 3.08 mg of methylprednisolone in the first year and a mean ± SD of 0.36 ± 1 mg of methylprednisolone at the last visit (p < 0.001). Of 22 patients, 21 were treated with OCS, whereas 1 patient refused to use OCS due to corticophobia. The mean ± SD ACT score was 17.50 ± 4.77 (minimum 7, maximum 24) at baseline, increased to 22.23 ± 2.44 (minimum 18, maximum 25) at the first year (p < 0.001), and 23.73 ± 1.88 (minimum 19, maximum 25) at the last visit. A significant decrease in asthma attacks and hospitalizations at the first year and last visit after omalizumab treatment was observed (p < 0.001). Nineteen patients (86.3%) responded completely, and three (13.7%) responded partially to omalizumab treatment. Conclusion: Omalizumab treatment in patients with ABPA resulted in a significant reduction in asthma attacks, hospitalizations, and OCS doses, and in significant increases in FEV₁ and ACT scores.

Background: Patients with penicillin allergy have been shown to have suboptimal antibiotics prescribed for infections as well as an increased risk of adverse effects. However, it is currently unknown at what rate patients with penicillin allergy are prescribed antibiotics after hospitalization. Objective: The purpose of this study was to determine the rate at which patients with penicillin allergy are prescribed antibiotics after hospitalization and if this rate differs from that of patients without penicillin allergy. Methods: This was a retrospective case-control study that evaluated subsequent courses of antibiotics after hospitalization in patients with and those without penicillin allergies. Subsequent courses of antibiotics were compared between patients who with penicillin allergy and patients who were not allergic to penicillin for the 15 months after hospitalization by using the incidence rate ratio of new antibiotics prescribed. Results: Patients in the penicillin allergy group received significantly more outpatient antibiotics in the 15 months after hospitalization compared with patients with no penicillin allergy. The incidence rate ratio between the two groups was 1.27 (95% confidence interval, 1.10-1.48); p = 0.0014. There was no difference between the subsequent courses of inpatient antibiotic courses during the same time period. Conclusion: Patients with a penicillin allergy in the current evaluation received significantly more outpatient courses of antibiotics than did the patients without a penicillin allergy. These data provide more evidence for the importance of penicillin allergy de-labeling to provide patients with the most appropriate antibiotics for their respective infections.