Allergy and asthma proceedings最新文献

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.

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: Food allergy (FA) affects more than 30 million individuals in the United States and presents challenges that extend far beyond clinical symptoms. From infancy to adulthood, FA impacts quality of life, mental health, social participation, and access to safe environments. These burdens are often compounded by limited emergency preparedness, lack of institutional support, and social stigma. Methods: This narrative review synthesizes disparities and barriers faced by individuals with FA across key life stages, including early childhood, elementary and middle school, high school, college, and the transition to the workplace. It also highlights evidence-based strategies and resources developed by a leading national center for food allergy and asthma research that address FA barriers throughout the lifespan. Results: Findings demonstrate that despite advances in FA innovation and treatment, disparities in education, preparedness, and accommodation persist. These inequities disproportionately affect underserved populations and environments where awareness and policy enforcement are limited. Conclusion: Promoting inclusion and safety across the lifespan requires a coordinated, multi-sector approach that equips caregivers, educators, peers, and employers with the tools and training necessary to support individuals with FA in every setting.

Background: Although the relationship of seasonal allergens with allergic rhinitis is well known, conflicting results exist with regard to their association with asthma. Objective: To investigate the effect of seasonal allergen sensitization on the severity of bronchial hyperreactivity (BHR) and variables that affect BHR in individuals without any chronic respiratory disease who presented to the outpatient clinic with asthma symptoms. Methods: Adult subjects who were admitted to our hospital's allergy outpatient clinic between January 2016 and May 2023, presented with at least one of the symptoms of dyspnea, wheezing or cough, and underwent bronchial provocation test (BPT) for the differential diagnosis of asthma were included in the study. Patients with any chronic respiratory disease, such as chronic obstructive pulmonary disease (COPD) or bronchiectasis, were excluded. Demographic characteristics and clinical features of the patients, including admission symptoms, BPT results, skin-prick test results, IgE results, and allergy history were obtained by reviewing patient records. Results: A total of 325 patients were included in the study, 248 (76.3%) of whom were women, and the median (min-max) age was 40 years (18-82 years). Aeroallergen sensitization was positive in 131 patients (40.3%), of whom 38 (11.7%) had single and 93 (28.6%) had multiple allergen sensitization. Sensitization was to perennial allergens in 53 patients (16.3%), to seasonal allergens in 40 patients (12.3%), and to both in 38 patients (11.7%). BPT was positive in 105 patients (32.3%). Among the patients with BHR, 73 (69.5%) had at least one allergen sensitization. The BHR risk was 7.13 times higher in patients sensitized to perennial allergens, 4.14 times higher in those sensitized to seasonal allergens, and 8.67 times higher in patients with sensitization to both. There was no significant difference in PC20 values according to the type of allergen sensitization (perennial allergens, seasonal allergens, mixed type) (p = 0.878). Conclusion: Both seasonal and perennial allergens can elevate the risk of BHR.

Background: Hereditary angioedema (HAE) substantially impairs patients' quality of life (QoL), both physically and psychologically, with unpredictable attacks that cause disruptions in education, work, and social life. Objective: To identify key themes and existing knowledge gaps around the multifaceted burden of HAE. Methods: A literature review was conducted in January 2024 through a search of medical literature data bases. English-language studies considered relevant to patient burden and QoL were selected for analysis. Results: A total of 48 studies were included in the analysis; 50% were cross-sectional and 54% were conducted in North America. Twenty-three studies reported outcomes on QoL and pain, 10 studies reported outcomes on psychological distress, 16 studies reported outcomes on experiences with long-term prophylaxis, 36 studies reported outcomes on HAE attacks, and one study detailed caregiver burden. Patients with HAE had worse QoL compared with the general population, and worse QoL was associated with a higher frequency or severity of attacks, anxiety, and depression. The use of long-term prophylaxis improved QoL, and treatment satisfaction was driven by improvements in mental health and fostering a sense of control and independence. Conclusion: HAE continues to substantially impact QoL of patients. Although recent work has demonstrated progress in standardizing assessment tools for QoL in HAE, additional research is needed to determine the correlation between individual patient factors and QoL.

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: 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: 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.