Allergy And Asthma Proceedings[JOURNAL]
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200 papers
Is it time for the A/I (allergist/immunologist) to embrace AI (artificial intelligence) in diagnosis and treatment of the inborn errors of immunity?
Bellanti JA
Allergy Asthma Proc · 2025 Sep · PMID 40958180 · Publisher ↗
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 intelli...
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. 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. 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. 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.
Artificial intelligence and allergy: Shaping the future of diagnosis and therapy.
Bellanti JA, Settipane RA
Allergy Asthma Proc · 2025 Sep · PMID 40958179 · Full text
Abstract loading — click title to view on PubMed.
The burden of systemic corticosteroids in patients with chronic rhinosinusitis with nasal polyps.
Peters AT, Pinto JM, Buchheit KM … +8 more , Reitsma S, Thamboo A, Fujieda S, Corbett M, Zaccone E, Radwan A, Rowe PJ, Deniz Y
Allergy Asthma Proc · 2025 Sep · PMID 40958178 · Full text
Systemic corticosteroids (SCS) are widely used to treat patients with chronic rhinosinusitis with nasal polyps (CRSwNP) that is insufficiently controlled with first-line treatments. However, such treatment must be balanc...
Systemic corticosteroids (SCS) are widely used to treat patients with chronic rhinosinusitis with nasal polyps (CRSwNP) that is insufficiently controlled with first-line treatments. However, such treatment must be balanced against the risk of adverse effects with protracted or repeated use. Increasing awareness of these adverse effects and the introduction of biologics are changing established management approaches. The objective was to review the role of SCS in the management of CRSwNP in the evolving treatment landscape. A literature search was conducted for salient articles on SCS in CRSwNP, including guidelines. SCS reduce inflammation through broad actions on various immune mediators. Short courses of SCS improve symptoms (especially olfactory function) and reduce polyp size, benefits that do not persist long-term after treatment ends. SCS are widely used before endoscopic sinus surgery to improve the visibility of the surgical field and after surgery to improve outcomes, although evidence for benefit of postsurgical SCS is lacking. Adverse effects associated with SCS can manifest in a wide range of organs and systems. Use of SCS in patients with CRSwNP is associated with an increased risk of avascular necrosis, pneumonia, obesity, anxiety and/or depression, fracture, sleep apnea, hypothalamic-pituitary-adrenal axis suppression, diabetes, and hypertension. The SCS dosage regimen for CRSwNP is not well defined, and there is wide variation in clinical practice. Clinical guidelines refer to "short courses" of SCS but provide minimal guidance and lack consensus. Biologic treatments for CRSwNP have well-documented steroid-sparing effects, but the extent to which biologics might be able to reduce the use of or replace SCS may depend on economics as well as relative benefit-to-risk ratios. Short courses of SCS are widely used in patients with CRSwNP, but their use must be balanced against the risk of adverse effects. Use of biologics may reduce the use of SCS in CRSwNP, minimizing these adverse effects.
Got milk? Enzyme-linked immunosorbent assay analysis of casein proteins in methylprednisolone.
Hatcher VR, Caballero MY, Schuldt MM … +1 more , Adams KE
Allergy Asthma Proc · 2025 Sep · PMID 40958177 · Publisher ↗
Sporadic reports have been published with regard to allergic reactions in patients with bovine milk allergy after receiving parenteral lactose-containing methylprednisolone. Persistent milk allergy is a risk factor for o...
Sporadic reports have been published with regard to allergic reactions in patients with bovine milk allergy after receiving parenteral lactose-containing methylprednisolone. Persistent milk allergy is a risk factor for other atopic diseases, in which corticosteroids, methylprednisolone, are commonly an adjunctive treatment. Laboratory investigations to validate the presence of residual milk protein as the cause for reactions are scarce. Thus, individualized recommendations for the use of methylprednisolone in patients with milk allergy remain undefined. We hypothesized that excipient contaminants, e.g., residual caseins, may be responsible for these reactions. We sought to evaluate for the presence of casein proteins in lactose-containing methylprednisolone and provide recommendations with regard to its use in patients with milk allergy. To assess for incomplete purification of lactose from its bovine milk source, standardized enzyme-linked immunosorbent assay (ELISA) was performed from five vials across four lots of commercially available lactose-containing methylprednisolone to detect casein subtypes Bos d 9 and Bos d 11, the two most abundant milk proteins. High-fidelity ELISA revealed no detectable Bos d 9 in any vials of lactose-containing methylprednisolone. Trace amounts of Bos d 11 were detected in all vials compared with Bos d 9 (p = 0.008). Molecular modeling revealed minimal similarity between Bos d 9 and Bos d 11. Undetectable Bos d 9 and trace Bos d 11 in lactose-containing methylprednisolone raises optimism but warrants further investigation of immunoglobulin E binding epitopes and the clinical relevance of casein subtypes. It is reassuring that milk protein eliciting doses are usually 10-fold higher than the nanogram quantities of Bos d 11 detected in our study, although this is limited by exposure route. Vaccines and medications with possible trace milk proteins remain largely well tolerated in patients with milk allergy. Lactose-containing methylprednisolone can likely be used with low risk of adverse reaction in most patients with milk allergy.
Delayed pressure urticaria successfully treated with omalizumab: A tertiary-level health-care center experience.
Cakmak ME, Oztop N
Allergy Asthma Proc · 2025 Jul · PMID 40624787 · Publisher ↗
Delayed pressure urticaria (DpU) is a subtype of inducible urticaria characterized by painful erythematous swellings that appear after pressure is applied to the skin. The aim of this study was to evaluate the efficacy...
Delayed pressure urticaria (DpU) is a subtype of inducible urticaria characterized by painful erythematous swellings that appear after pressure is applied to the skin. The aim of this study was to evaluate the efficacy of omalizumab treatment in patients with DpU and the effect of omalizumab treatment on disease control. This retrospective observational study included a total of 78 patients with chronic spontaneous urticaria (CSU) or DpU who received omalizumab treatment. At 6 months after the initiation of omalizumab treatment, the effects of the treatment on the the urticaria control test (UCT) and the Dermatology Quality of Life questionnaire (DLQI) score and the effects on pressure urticaria were evaluated. The effect of omalizumab on pressure urticaria was determined by performing a pressure provocation test. At the end of the 6th month of omalizumab treatment, the increase in UCT scores was statistically significant in all the patients, in the patients with CSU, and in the patients with CSU plus DpU (p < 0.001, p = 0.025, and p < 0.001, respectively). At the end of the 6th month of omalizumab treatment, the improvement in DLQI scores was statistically significant in all the patients, in patients with CSU, and in patients with CSU plus DpU (p < 0.001, p = 0.002, and p < 0.001, respectively). After the pressure provocation test, no urticarial wheals were observed in the area where pressure had been applied in any patient within 6 hours. The findings of the current study provide evidence that omalizumab treatment may be effective in patients with DpU.
Impact of perinatal risk factors on pediatric asthma: A systematic review and meta-analysis.
Liu N, Ding Y, Hu C … +4 more , Luo F, Wang Y, Yuan B, Jialei T
Allergy Asthma Proc · 2025 Jul · PMID 40624786 · Publisher ↗
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 d...
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. 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. 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. 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. 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.
Clinical predictors of breakthrough reactions during initial rapid drug desensitizations to platinum chemotherapeutics.
Knowles TR, Nehme KJ, Kim SL … +3 more , Saltoun CA, Peters AT, Stevens WW
Allergy Asthma Proc · 2025 Jul · PMID 40624785 · Publisher ↗
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...
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. The objective was to identify factors predictive of patients at risk of developing BTR during their initial RDD. 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. 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). 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.
Abstract Presented at the WSAAI 2025 62nd Annual Scientific Session, February 9-13, 2025, Waimea, HI.
Allergy Asthma Proc · 2025 Jul · PMID 40624784 · Publisher ↗
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Omalizumab home injection versus hospital administration in severe asthma: Impact on asthma control.
Arslan B, Pacaci Cetin G, Seker S … +7 more , Bozkurt Yilmaz HE, Aktas Yapici E, Koyluce S, Acar E, Ertugrul T, Turk M, Yilmaz I
Allergy Asthma Proc · 2025 Jul · PMID 40624783 · Publisher ↗
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%....
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%. In this study, we aimed to evaluate the effects of omalizumab self-administration at home compared with hospital administration on asthma control. 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). 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. 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.
Biologic treatment discontinuation in severe asthma: A real-life study on factors influencing clinical remission and physician decision-making.
Onalan T, Colkesen F, Akkus FA … +3 more , Gerek ME, Aykan FS, Arslan S
Allergy Asthma Proc · 2025 Jul · PMID 40624782 · Publisher ↗
Real-life studies have shown the effects of biologic therapies on severe asthma. However, evidence for discontinuing treatment after targeted improvement remains limited. This study investigated the factors associated w...
Real-life studies have shown the effects of biologic therapies on severe asthma. However, evidence for discontinuing treatment after targeted improvement remains limited. 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. 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. 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. 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.
Expanding horizons of omalizumab: New frontiers in asthma and beyond.
Bellanti JA, Settipane RA
Allergy Asthma Proc · 2025 Jul · PMID 40624781 · Full text
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Penicillin allergy labels are associated with a greater number of courses of antibiotics after hospitalization.
Waters CD, Cruzan A, Silge R
Allergy Asthma Proc · 2025 Jul · PMID 40624780 · Publisher ↗
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 penic...
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. 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. 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. 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. 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.
Idiopathic mast cell activation syndrome in real-life practice: clinical features and management.
Hormet Igde M, Korkmaz P, Toprak ID … +4 more , Eyice Karabacak D, Demir S, Unal D, Gelincik A
Allergy Asthma Proc · 2025 Jul · PMID 40624779 · Publisher ↗
Idiopathic mast cell activation syndrome (iMCAS) is a rare challenging diagnosis, and its treatment is not well standardized. This study aimed to evaluate the clinical features of iMCAS and the potential need of omalizu...
Idiopathic mast cell activation syndrome (iMCAS) is a rare challenging diagnosis, and its treatment is not well standardized. This study aimed to evaluate the clinical features of iMCAS and the potential need of omalizumab in clinical practice. 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. 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). The iMCAS causes severe anaphylaxis episodes that can be successfully prevented by omalizumab as an add-on treatment to other treatment options.
Long-term omalizumab treatment outcomes in patients with allergic bronchopulmonary aspergillosis.
Aytekin F, Efe O, Beyhan N … +8 more , Gidik E, Gul O, Tunca B, Celebi Sozener Z, Sin BA, Mungan VD, Bavbek S, Aydin O
Allergy Asthma Proc · 2025 Jul · PMID 40624778 · Publisher ↗
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). The objective w...
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). The objective was to evaluate the long-term clinical and functional effectiveness of omalizumab in patients with ABPA. 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 (FEV) level were considered as complete responders. 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 FEV 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. Omalizumab treatment in patients with ABPA resulted in a significant reduction in asthma attacks, hospitalizations, and OCS doses, and in significant increases in FEV and ACT scores.
Body weight trajectory of non-obese asthmatics: Relationship with inhaled corticosteroids maintenance therapy.
Burch MO, Rocha DG, Belleze L … +5 more , Da Silva MJO, Assuncao RP, Antunes D, Mamoni RL, Ponte EV
Allergy Asthma Proc · 2025 Jul · PMID 40624777 · Publisher ↗
It is unclear whether the continuous use of a high dose of inhaled corticosteroids (ICS) could contribute to an unfavorable trajectory in body weight. The objective was to evaluate whether a high dose of ICS used contin...
It is unclear whether the continuous use of a high dose of inhaled corticosteroids (ICS) could contribute to an unfavorable trajectory in body weight. The objective was to evaluate whether a high dose of ICS used continuously for maintenance therapy increases the risk of an unfavorable body weight trajectory in individuals with asthma and who are not obese. We screened consecutive individuals with chronic respiratory symptoms suggestive of asthma who underwent a medical consultation in any of the 42 public health facilities in the municipality of Jundiaí, Brazil. We included individuals with proven asthma who were ≥ 20 years of age and who had a body mass index (BMI) < 30 kg/m² on the day of screening for the study. Individuals participated in two study visits 12 months apart, named V and V₂. Between study visits, individuals had one intermediate consultation with their referring physician. Ninety-nine individuals used a high dose of ICS during the study and 294 used a low-medium dose. The individual with asthma and no obesity and who used a high dose of ICS had a similar risk of having obesity at V₂ compared with those who used a low-medium dose (adjusted odds ratio 1.18 [95% confidence interval, 0.46-3.04]). The probability of gaining weight was similar between the two groups. The use of a high dose of ICS for 1 year does not increase the risk of obesity among individuals with asthma and who are not obese, nor is it associated with an unfavorable body weight trajectory compared with individuals with asthma who were using a low-medium dose of ICS. This information may help reduce fears about using ICS.
Abstracts Presented at the Eastern Allergy Conference May 29-June 1, 2025, Palm Beach, Florida.
Allergy Asthma Proc · 2025 Jul · PMID 40624776 · Publisher ↗
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Impact of baseline body mass index on asthma incidence in middle-aged and elderly populations: A prospective analysis from China.
Chen Z, Lin C, Zhang J
Allergy Asthma Proc · 2025 Jul · PMID 40555506 · Publisher ↗
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 bidirec...
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. 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. 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. 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.
Anaphylaxis in children: Latest insights.
Luccioli S, Seabol L
Allergy Asthma Proc · 2025 May · PMID 40380371 · Publisher ↗
The diagnosis and management of anaphylaxis in pediatric populations can be a particularly formidable challenge due to its variable definitions and atypical symptom presentation, which can often masquerade as other condi...
The diagnosis and management of anaphylaxis in pediatric populations can be a particularly formidable challenge due to its variable definitions and atypical symptom presentation, which can often masquerade as other conditions. This complexity often leads to delays in early recognition and timely intervention. Most pediatric anaphylaxis guidelines emphasize the importance of identifying and avoiding triggers, ensuring accurate dosing and prompt administration of epinephrine to prevent severe complications. There is also growing scientific interest in strategies to intervene early in food allergy development to prevent allergies and protect infants and children from severe allergic reactions. This report aimed to review key aspects of the pathophysiology, epidemiology, management, and prevention of anaphylaxis in the pediatric population. Also, approved treatment modalities and future research to treat and prevent anaphylactic reactions are discussed. A review of the medical literature was conducted by using terms that included anaphylaxis, severe allergic reaction, pediatric, prevalence, desensitization, and immunotherapy. Food allergies remain the leading trigger of pediatric anaphylaxis, followed by Hymenoptera venom, whereas drug allergies are less common in children compared with adults. A review of the literature underscores the importance of recognizing early signs and symptoms of anaphylaxis, particularly in preverbal infants, of identifying and eliminating key triggers and of prompt epinephrine administration in the immediate management of pediatric anaphylaxis. Advances in oral immunotherapy and other treatments (e.g., biologics) provide new management options. Notably, anti-immunoglobulin E therapy with omalizumab has shown substantial protection against reactions to accidental food exposure in children as young as 1 year old and with food allergy. This report explores critical aspects of anaphylaxis that affect allergic diseases in infants and children. Gaining a deeper understanding of age-specific triggers and the diverse symptoms of anaphylaxis will significantly enhance diagnosis, treatment, and prevention strategies, ultimately improving the timeliness of interventions. Recent approvals of novel therapies for food allergies, along with promising developments for future treatment and prevention of anaphylaxis in pediatric populations, hold exciting potential for better management of these conditions.
Can depression and anxiety be predicted in hereditary angioedema? A comprehensive assessment.
Akten HS, Dilek E, Orman M … +1 more , Mete Gokmen EN
Allergy Asthma Proc · 2025 May · PMID 40380370 · Publisher ↗
Hereditary angioedema (HAE) is a rare genetic disorder marked by unpredictable episodes of recurrent swelling. This unpredictability, combined with the risk of death and its impact on daily life, leads to significant psy...
Hereditary angioedema (HAE) is a rare genetic disorder marked by unpredictable episodes of recurrent swelling. This unpredictability, combined with the risk of death and its impact on daily life, leads to significant psychological distress, which profoundly affects patients' quality of life. This study assessed the levels of depression, general anxiety, and death anxiety in patients with HAE, along with the factors that influence them. This single-center cohort study included patients ages ≥18 years and with HAE type 1 or 2, who were followed up at the Allergy and Clinical Immunology Department, Medical Faculty, Ege University, between December 2023 and September 2024. Participants completed questionnaires with regard to their demographics, general health, and disease characteristics. In addition, their psychological conditions were assessed by using the Hospital Anxiety and Depression Scale (HADS) and Templer Death Anxiety Scale, a tool that has not been previously applied to this group. One hundred patients participated in the study, with a mean ± standard deviation age of 40.5 ± 14.5 years; 66% (n = 66) were women. Among the participants, 30% (n = 30) had a family history of death related to HAE, and 74% (n = 74) reported experiencing oropharyngeal/laryngeal edema. Anxiety was observed in 54% of the patients (n = 54), whereas 36% (n = 36) experienced depression. Women had higher levels of anxiety than men (p = 0.048), and younger patients (ages <65 years) exhibited greater anxiety levels (p = 0.022). Mild-to-moderate depression was more prevalent among patients who had experienced a recent laryngeal attack (p = 0.031). Seventy-seven percent of the patients (n = 77) reported experiencing death anxiety, which was notably higher in those who had recent laryngeal attacks (p = 0.004) and moderate-to-severe attacks (p = 0.003). Patients with HAE, especially those who experienced frequent severe attacks or recent laryngeal episodes, face a higher risk of psychological distress.
New England Society of Allergy Spring Meeting Abstracts presented March 28, 2025, Worcester, MA.
Allergy Asthma Proc · 2025 May · PMID 40380369 · Publisher ↗
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