Allergy and asthma proceedings最新文献

Objective: Previously, we reported that older women taking increased numbers of cough medications with increased number and frequency of medical encounters and normal or near-normal lung function more likely had unexplained chronic cough (UCC) versus asthma and/or chronic obstructive pulmonary disease. This study sought to identify clinical risk factors that could differentiate UCC from explained chronic cough (ECC). Methods: A validated electronic questionnaire was distributed to patients with chronic cough (CC) at seven cough centers throughout the United States. The mean ± standard error, frequencies of continuous variables (one-way analysis), and cross-tabulation frequencies for categorical variables (two-way analysis) were calculated. Univariate comparisons between UCC and ECC were performed by using the t-test and nonparametric one-way analysis. Significant determinants of UCC and cough severity were assessed by using multiple logistic regression. Results: A total of 150 patients were enrolled, of whom 29 of 150 were classified as having UCC, and 121 of 150 were classified as having ECC. No significant differences for family history, age, gender, and race, or seasonality differentiated UCC from ECC. Multiple logistic regression revealed the absence of postnasal drip significantly differentiated UCC from ECC (odds ratio 4.8 [95% Confidence Level, 1.6-15.3]). The severity of CC was worse for patients with UCC, patients with chronic bronchitis and/or emphysema, hypertension, ex-smoking history, high body mass index, female gender, education level, and reactivity to more environmental irritants (perfume, p = 0.006; household cleaners, p = 0.01; air fresheners, p = 0.03; cold air, p = 0.007; cigarette smoke, p = 0.05). Conclusion: Patients with UCC more frequently presented with specific demographic features, comorbid characteristics, and more severe cough induced by environmental irritants compared with ECC. These clinical characteristics may be useful for identifying risk factors that can accelerate the diagnosis of UCC.

Background: Allergy immunotherapy is a proven treatment for allergic rhinitis and asthma with the potential to modify the natural history of these disorders. Considerable advances have been seen in the past 15 years since publication of the third update of the Allergen Immunotherapy Practice Parameter. Objective: The aim was to understand new developments that pertain to subcutaneous immunotherapy and sublingual immunotherapy (SLIT). Methods: New evidence related to advances related to efficacy and safety of allergy immunotherapy are presented as well as unmet needs and future directions. Results: Most new evidence has come from large double-blind placebo controlled trials of SLIT tablets, which better define efficacy and safety in patients with allergic rhinitis, allergic asthma, and atopic dermatitis. More evidence has emerged that identifies risk factors for anaphylaxis to subcutaneous injections and approaches to mitigate risk. Conclusion: Two modalities of allergy immunotherapy are available to allergy specialists. Both SLIT and subcutaneous immunotherapy have near equivalent efficacy, but SLIT has a superior safety profile, allowing self-administration.

Background: Hypersensitivity reactions, including anaphylaxis, have been increasingly reported with quinolones. Objective: To characterize the association of different quinolones with anaphylaxis reports in the FDA Adverse Event Reporting System (FAERS) data base. Methods: We searched the FAERS data base for anaphylactic reaction reports (between 2015 and 2024) associated with the three commonly used fluoroquinolones in the United States, viz., levofloxacin, ciprofloxacin, and moxifloxacin. The reporting odds ratio (ROR) was used to assess disproportional reports of anaphylaxis among the individual fluoroquinolones and between the fluoroquinolones and all medications within the data base. Results: We identified 941 anaphylaxis reports (ciprofloxacin, 390; levofloxacin, 299; and moxifloxacin, 252) of 89,351 adverse reactions reported for all fluoroquinolones between 2015 and 2024. There were disproportionally higher reports of anaphylaxis among fluoroquinolones compared with all medications within the data base (ROR 4.56 [95% confidence interval {CI}, 4.28-4.87]) but lower relative to that of amoxicillin (ROR 0.19 [95% CI, 0.17-0.20]). Within the fluoroquinolones, moxifloxacin was associated with the highest disproportionality signal for anaphylaxis relative to all other medications (ROR 8.65 [95% CI, 7.63-9.80]) and relative to all fluoroquinolones (ROR 1.90 [95% CI, 1.65-2.18]), whereas levofloxacin was associated with a disproportionally lower signal when compared with all other fluoroquinolones (ROR 0.77 [95% CI, 0.67-0.88]). The disproportionally higher anaphylaxis report associated with moxifloxacin was especially pronounced among women (ROR 2.11 [95% CI, 1.78-2.49]) and elderly individuals (ROR 2.74 [95% CI, 2.15-3.48]). Conclusion: Moxifloxacin is associated with relatively higher anaphylaxis reports when compared with all other quinolones, especially among female and elderly individuals.

We present the case of a 9-year-old girl with a medical history of growth hormone deficiency, Hashimoto's thyroiditis, failure to thrive, and eosinophilic colitis, and with a new progressive rash. The rash began as erythematous, pruritic papules, which gradually spread and evolved into larger, well-circumscribed plaques. Despite treatment with topical corticosteroids and broad antifungal therapy, the rash persisted without improvement. The patient reported no systemic symptoms. On examination, she was well appearing and afebrile, with normal vital signs. Dermatologic findings included erythematous, pruritic plaques on the abdomen, perioral area, and lower extremities. No lymphadenopathy or other abnormalities were noted. After a more thorough evaluation, an unexpected diagnosis was made. This case highlights the clinical challenge of diagnosing dermatologic conditions in pediatric patients with complex medical histories. Although the presentation was suggestive of atopic dermatitis, the morphology and distribution of the lesions, along with resistance to standard therapy, raised concerns for alternative diagnoses. This case underscores the importance of maintaining a broad differential diagnosis when managing chronic or atypical skin eruptions, particularly in patients with multisystem involvement or a history of autoimmune conditions.

Background: Food allergy (FA) is a prevalent condition in the United States that can cause anaphylaxis. FA cases are becoming increasingly concerning in the United States, with rising trends in the pediatric population. However, increases have not been proportional across racial and/or ethnic groups, with studies that show rapid increases in minority populations. Objective: Due to this trend, we investigated if FA prevalence increased in patients at Texas Children's Hospital (TCH) based on race and gender. Methods: We retrospectively compared patients at TCH between the years 2013 and 2015 (time frame 1) and 2016 and 2018 (time frame 2). Patient FA history was diagnosed via medical diagnosis codes. Patients were stratified by gender and five race categories: Asian, black/African American (AA), Hispanic/Latino, non-Hispanic white, and "other." The prevalence of an FA was calculated by dividing the number of patients with an FA by the total number of patients seen at TCH within a given race, gender, and time frame. The χ² test was used, and two-sided p-values of <0.05 were considered statistically significant. Results: The prevalence of an FA at TCH significantly increased within each race and gender except for patients who self-reported as "other" race. Asian patients had the highest increase in FAs among all the races between the two time frames. Black/AA American patients also had a clinically significant increase, with FA prevalence increased by 1.5 times from time frame 1 to 2. The prevalence increased more for male patients (0.43%) than for female patients (0.28%). The increase for male patients was similar to the increase for blacks (0.46%). Conclusion: FA prevalence increased for all race and gender subcohorts except for those who identified as "other" race, with clinically significant increases noted in males, Asian, and black/AA populations. This increase in FA prevalence suggests that there may be children of specific racial or ethnic groups who are at an increased risk of developing an FA.

Background: The ACAAI//AAAAI Joint Task Force on Practice Parameters periodically develops updated guidance based on all available evidence. Methods: This review summarizes advances in diagnosis and management of insect sting allergy from published practice parameters, and developments under review for the 2026 update. Results: Changes in the species and distribution of stinging insects in the US may be due to migration and invasion. Overall prevalence has not changed, but fatalities from insect sting allergy increased 50% in 30 years. Diagnostic evaluation includes both skin and serum immunoglobulinE testing although positive predictive value is dependent on the history. Evaluation may include venom component testing. Mastocytosis and hereditary alpha tryptasemia must be considered in many cases; testing for baseline serum tryptase is now routine. Testing for c-KIT gene mutation in peripheral blood and tryptase genotype are important supplemental tests. The risk of beta blockers and angiotensin converting enzyme inhibitors is relatively low in most cases, and they are not contraindicated during venom immunotherapy (VIT). VIT is indicated in high-risk patients (30-70% risk of anaphylaxis), but is not required in those with cutaneous reactions (3-10% risk of anaphylaxis). VIT can be safely initiated with rush regimens. Recurrent systemic reactions are rare, and may require omalizumab treatment (off-label). VIT can be discontinued after 5 years in most patients, but extended or indefinite VIT (often at 12-week intervals) is recommended in patients with known high-risk factors or where stopping would cause markedly impaired quality of life. Conclusion: Continued research has refined our clinical approach to patients with concerns about stinging insect hypersensitivity.

Background: This study evaluates the lymphocyte-eosinophil to neutrophil-monocyte ratio (LENMR) as a novel inflammatory indicator of the exacerbation risk in adults with asthma. Methods: This cross-sectional study included 1344 adults with asthma from the 2007-2012 cycles of the National Health and Nutrition Examination Survey. The association between LENMR and asthma exacerbations was evaluated by using multivariable logistic regression with progressive adjustment for confounders. Subgroup analyses were conducted to assess the consistency of associations. Restricted cubic spline and threshold effect models were used to explore potential nonlinear relationships. Results: A higher LENMR was significantly associated with an increased risk of asthma exacerbations. In the fully adjusted model, the participants in the highest quartile had a 77% higher odds of exacerbation compared with the lowest quartile (odds ratio 1.77 [95% confidence interval, 1.19-2.65]; p = 0.007). Associations were consistent across subgroups. Restricted cubic spline analysis revealed a significant nonlinear relationship, with a threshold effect identified at LENMR = 0.31. Conclusion: An elevated LENMR is positively associated with asthma exacerbations under specific thresholds.

Background: It is critical for rescue medications to have rapid absorption and onset of action. Although intranasal formulations of rescue medications have advantages over other forms of administration, the impact of nasal congestion on drug absorption has been questioned. Objective: We aimed to determine if nasal congestion impacts the absorption and efficacy of intranasal rescue medications. Methods: A rescue medication is used as needed for the immediate treatment of an episodic medical event that requires urgent intervention. Systematic searches for 15 pre-identified intranasal rescue medications were conducted in PubMED/MEDLINE up to July 2, 2024. Eligible studies were controlled human studies that compared the absorption or efficacy of an identical dose of intranasal rescue medication administered with and without the presence of nasal congestion that was induced by allergen challenge or that was associated with a medical condition (e.g., allergic rhinitis). Results: The searches identified 160 articles; six studies, all open-label, were eligible for final inclusion. Two intranasal epinephrine studies showed increased maximum plasma concentrations after allergen-induced congestion; one of these epinephrine studies also showed a faster time to maximum plasma concentration. Three additional studies that evaluated epinephrine, glucagon, and fentanyl found no effect of congestion on absorption. In the sixth study, congestion had no effect on zolmitriptan efficacy. Conclusion: Available evidence indicates no negative impact of nasal congestion on the absorption of intranasal rescue medications. Congestion may actually increase absorption of some intranasal epinephrine formulations. The impact of congestion on intranasal medication absorption is likely dependent on each drug's properties, mode of action, and formulation.

Background: Drug provocation tests (DPT) are the criterion standard method for diagnosing nonsteroidal anti-inflammatory drugs (NSAID) and paracetamol hypersensitivity reactions in children. However, there is no consensus in the literature with regard to the duration of DPTs. Objective: The objective was to compare the negative predictive values (NPV) of single- and 2-day DPTs for NSAID and paracetamol hypersensitivity diagnosis in pediatric patients. Methods: We retrospectively evaluated children (ages 1-18 years) with a history of NSAID and paracetamol hypersensitivity. The patients were categorized into two groups based on drug provocation duration: short (single-day test) and extended (test continued on the second day at home). Patients with negative DPT results for the suspected agent were contacted to determine whether they reused the drug and, if so, whether there was a reaction. The NPVs of the DPTs performed for both groups were calculated. Results: The DPT results of 104 patients (53.8% boys) were negative for 116 suspected agents: 67 (57.7%) tested with short DPT and 49 (42.2%) with extended DPT. No significant differences in age, sex, reaction type, or comorbidities were observed between the two groups. In the follow-up, 114 DPTs were performed for 102 patients, of whom 93 used the suspected drug(s) after the tests but none developed a reaction. The NPV was the same for both groups: 100%. Conclusion: To the best of our knowledge, this is the first study to compare the NPVs of single- and 2-day DPTs for children who present with suspected NSAID and paracetamol hypersensitivity. Our results indicate that both approaches have the same NPV and suggest that single-day DPT is sufficient to exclude suspicion of NSAID and paracetamol hypersensitivity in children.

Background: In 1970, W.B. Schwartz predicted that computers would revolutionize medicine by enhancing the physician's intellect, a vision that has largely materialized in the past 5 decades. Recent advancements in artificial intelligence (AI), especially in health care, have transformed AI from a conceptual tool into a fundamental part of clinical practice. AI has been successfully applied in diagnostic imaging, health system management, and patient care workflows. Within immunology, AI's potential for diagnosing and managing complex conditions such as inborn errors of immunity (IEI) is increasingly recognized. This article explores the evolving role of AI in the diagnosis and treatment of IEIs, highlighting its potential to advance precision medicine in allergy/immunology. To illustrate this potential, six representative IEIs were selected, each accompanied by a clinical vignette that summarizes the patient history and laboratory findings. These include severe combined immunodeficiency, common variable immunodeficiency, chronic granulomatous disease, X-linked agammaglobulinemia, Wiskott-Aldrich syndrome, and the activated PI3K delta syndrome. Methods: An extensive literature review was conducted in medical literature data bases by applying terms such as primary immune deficiency, inborn errors of immunity (IEIs), and allergy. The search focused on identifying studies that explored the intersection of AI technologies with immunology, particularly with regard to the diagnosis and management of IEIs. Results: The literature review identified a growing body of work on the application of AI in allergy and immunology, with 1907 articles on AI and allergy, 16 of which focused specifically on IEI. AI has shown promise in diagnostic accuracy, particularly in rare and complex immunologic conditions, and in improving the efficiency of clinical decision-making. Conclusion: AI holds significant potential for the allergist/immunologist by revolutionizing the diagnosis and treatment of IEIs. By enhancing diagnostic precision, improving patient care workflows, and enabling personalized treatment strategies, AI can advance the practice of immunology. However, challenges such as data quality, model generalizability, and ethical considerations must be addressed to fully harness AI's capabilities in the clinical setting. This article highlights the transformative potential of AI in immunology and proposes its integration into clinical practice for better patient outcomes.