Allergy And Asthma Proceedings[JOURNAL]
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200 papers
Association of exposure to ambient particulate matter with asthma in children: Systematic review and meta-analysis.
Ke X, Liu S, Wang X … +6 more , You J, Zhang W, Wang L, Ge L, Wang M, Zheng S
Allergy Asthma Proc · 2025 Mar · PMID 40011989 · Publisher ↗
To assess the association between airborne particulate matter (PM) exposure and the development of asthma in children, a systematic review and meta-analysis that included nearly 10 years of related literature was conduct...
To assess the association between airborne particulate matter (PM) exposure and the development of asthma in children, a systematic review and meta-analysis that included nearly 10 years of related literature was conducted. The study investigators conducted a systematic review of relevant research articles published between March 2013 and March 2023, which were accessible through several medical literature data bases of. Random-effects meta-analyses were used to analyze the effects of PM on childhood asthma. Subgroup analyses, including exposure period, type of PM, regional factors, and study type, were also used. Odds ratio (OR) and 95% confidence intervals (CI) were used to represent the estimated effect of the population. Publication bias was assessed by using the Egger test and funnel plot. Data analyses were performed using statistical analysis software and a systematic review management tool. A total of 15,365 articles were identified, of which 19 studies were included in this meta-analysis. The results showed that PM exposure was positively correlated with asthma in children, with the overall random-effects risk estimates of OR 1.10 (95% CI, 1.07-1.13). In stratified analyses, PM exposure was found to be a risk factor for the development of childhood asthma. Both prenatal and postnatal PM exposure were associated with an increased risk of asthma in children, but prenatal exposure was associated with a greater increase in risk than postnatal exposure, with an effect estimate OR of 1.21 (95% CI, 1.02-1.43). In the analysis of different PM types, the OR of PM (PM < 2.5 μm in diameter) exposure was OR 1.10 (95% CI, 1.05-1.15), and no association was found between PM (PM < 10 μm in diameter), coarse PM (PM with an aerodynamic diameter between 2.5 and 10 μm), and black carbon BC (diameter of 0.01-0.05 μm) exposure. In different regional analyses, the effects of PM exposure on childhood asthma risk were OR 1.15 (95% CI, 1.13-1.17) in South America and OR 1.02 (95% CI, 1.01-1.03) in Asia, but no association was found in Europe and North America. In addition, the results of different study types only found that the literature that used the time-series research method had a significant association with OR 1.03 (95% CI, 1.02-1.04), whereas the literature that used the cohort study method had no statistical difference. Exposure to airborne PM increased the risk of asthma in children. Both prenatal and postnatal PM exposure was associated with an increased risk of childhood asthma, but prenatal PM exposure was associated with a greater increase than postnatal PM exposure.
Rapid drug desensitization in seven patients with delayed hypersensitivity reactions to biologics and targeted therapies: Reason, successes, and failures.
Onalan T, Colkesen F, Gerek ME … +3 more , Akkus FA, Evcen R, Arslan S
Allergy Asthma Proc · 2025 Mar · PMID 40011988 · Publisher ↗
Rapid drug desensitization (RDD) is commonly used for immediate drug hypersensitivity reactions (DHR) across various drugs. In delayed DHRs, the conventional approach is slow desensitization; however, limitations may ari...
Rapid drug desensitization (RDD) is commonly used for immediate drug hypersensitivity reactions (DHR) across various drugs. In delayed DHRs, the conventional approach is slow desensitization; however, limitations may arise due to drug-specific or disease-related factors. With the increasing role of targeted molecular drugs in delayed DHRs, data on the efficacy of RDD in these contexts remain scarce. This case series aims to explore the rationale and outcomes of RDD in managing delayed DHRs associated with targeted therapies. We analyzed data from patients referred to a tertiary university hospital's drug allergy outpatient clinic between January 2021 and April 2024. The subjects experienced delayed DHRs during treatment with targeted drugs and, subsequently, underwent RDD. The drugs administered via RDD included bevacizumab, rituximab, daratumumab, lenalidomide, bortezomib, and carfilzomib. The index reactions included maculopapular eruptions (MPE), drug reaction with eosinophilia and systemic symptoms (DRESS), and acute generalized exanthematous pustulosis (AGEP). Delayed breakthrough reactions were observed in four of seven patients. RDD with bortezomib was unsuccessful in all three patients, and delayed reactions were observed in all patients with severe cutaneous adverse reactions (AGEP and DRESS). Suggesting significant success of RDD for delayed DHRs induced by targeted therapies may be overly optimistic. Nevertheless, four of seven patients, including one with AGEP, were able to continue their treatment. Managing patients with advanced diseases and delayed DHR poses notable challenges. The risk to patient survival from withholding life-saving medication must be weighed against the risks of desensitization. The low sensitivity of skin tests and the critical waiting period complicate decision-making. Given the unique contribution of targeted agents in the treatment of severe, life-threatening diseases, further research on desensitization is warranted.
Allergic comorbidities in fibromyalgia.
Magen E, Merzon E, Green I … +4 more , Magen I, Golan-Cohen A, Vinker S, Israel A
Allergy Asthma Proc · 2025 Mar · PMID 40011987 · Publisher ↗
The relationship between fibromyalgia (FM) and allergic diseases remains poorly understood, despite emerging evidence that suggests a possible association. This study aimed to evaluate the prevalence of allergic comorbi...
The relationship between fibromyalgia (FM) and allergic diseases remains poorly understood, despite emerging evidence that suggests a possible association. This study aimed to evaluate the prevalence of allergic comorbidities in patients with FM compared with a matched control group. We conducted a retrospective, population-based case-control study within Leumit Health Services, which caters to ∼750,000 members. Patients meeting the evolving criteria of the American College of Rheumatology from January 2002 to December 2023 were included. Control subjects were selected from the same population base but did not have a diagnosis of FM, were matched 5:1 on sex, age, and year of first membership. All diagnoses were identified by using International Classification of Diseases, Ninth Revision (ICD-9) codes up to March 2024. The analysis included 15,869 patients diagnosed with FM and 79,345 matched controls. There was a predominant female representation (82.1%) in both groups. The prevalence of bronchial asthma was higher in patients with FM compared with the controls, with an odds ratio (OR) of 1.91. The patients with FM also exhibited higher rates of both nonseasonal and seasonal allergic rhinitis, with ORs of 1.60 and 1.30, respectively, and chronic rhinosinusitis without nasal polyps demonstrated an OR of 2.46. Acute allergic conjunctivitis had an OR of 2.05. Skin-related allergies such as contact dermatitis and atopic dermatitis showed ORs of 1.48 and 1.41, respectively. Furthermore, the patients with FM displayed elevated rates of various forms of urticaria and chronic pruritus, alongside higher incidences of food allergies and specific drug allergies. Anaphylactic reactions to food were notably more common in patients with FM, who presented an OR of 2.50. FM is associated with a higher prevalence of allergic diseases compared with the controls. Analysis of these findings suggests the need for allergological assessments in FM management.
Factors associated with treatment response in eosinophilic esophagitis patients: Experience from a pediatric tertiary care center.
Mongkonsritragoon W, Varre A, Beydoun S … +5 more , Revan R, Gary L, Thomas R, Poowuttikul P, Seth D
Allergy Asthma Proc · 2025 Mar · PMID 40011986 · Publisher ↗
Eosinophilic esophagitis (EoE) is a disease characterized by eosinophilic inflammation of the esophagus and associated esophageal dysfunction with increasing worldwide prevalence. Clinical presentation is nonspecific and...
Eosinophilic esophagitis (EoE) is a disease characterized by eosinophilic inflammation of the esophagus and associated esophageal dysfunction with increasing worldwide prevalence. Clinical presentation is nonspecific and varies with age, with limited studies in the pediatric population. Our study aimed to compile clinical phenotypes, esophagogastroduodenoscopy findings, and treatment response of EoE in a tertiary pediatric center, and to examine factors associated with the response of treatment. In this retrospective study, we reviewed the medical records of 824 patients diagnosed with EoE at Children's Hospital of Michigan from 2011 to 2021. Data collected included a demographic profile, symptoms, esophagogastroduodenoscopic and histopathologic findings, treatment modalities, response, and compliance. We then performed a multivariable logistic regression to assess the associating factors that influenced the treatment response rate. A high proportion of males and coexisting allergic conditions were observed in the patients with EoE, with the most common presentation of vomiting in children and of abdominal pain in adolescents. Among 656 of the 824 patients who had follow-up esophagogastroduodenoscopy, treatment response rates varied among modalities, with proton-pump inhibitor treatment exhibiting the highest response rate, at 60.8%, followed by diet modification (50%) and topical steroid treatment (43.5%). Significant predictors of normal endoscopic findings at follow-up included female gender, normal endoscopic appearance, good compliance to treatment, and absence of topical steroids in the treatment regimen. There were no significant differences in outcomes observed for targeted elimination led by a skin-prick test or specific immunoglobulin E test. Medication compliance did not significantly differ among the treatment options. Managing EoE in pediatric patients poses significant challenges, which emphasizes the need for multidisciplinary care to achieve treatment response effectively. The findings underscore the complexity of managing EoE and the need for individualized treatment approaches. Further research is warranted to elucidate the underlying mechanisms and optimize management strategies for pediatric patients with EoE.
Clinical characteristics and biological treatment responses of patients with late-onset asthma phenotype.
Kayikci H, Damadoglu E, Cihanbeylerden M … +3 more , Tuccar C, Karakaya G, Kalyoncu AF
Allergy Asthma Proc · 2025 Mar · PMID 40011985 · Publisher ↗
The data on subphenotypes and treatment responses to biologicals in late-onset asthma (LOA) is limited. This study aims to compare the clinical characteristics and treatment responses in severe asthma patients receiving...
The data on subphenotypes and treatment responses to biologicals in late-onset asthma (LOA) is limited. This study aims to compare the clinical characteristics and treatment responses in severe asthma patients receiving biological treatments, categorized into early-onset asthma (EOA) and LOA groups. Patients treated with omalizumab or mepolizumab for at least six months at a tertiary care adult allergy clinic between December 2015 and December 2023 were included. Patients with persistent respiratory symptoms starting at age ≥40 years were categorized as LOA, while those with onset <40 years were categorized as EOA. Changes in Asthma Control Questionnaire (ACQ-6) scores, forced expiratory volume in one second (FEV1) percentages, and blood eosinophil counts were assessed at baseline and 6 months. The percentage change in FEV1 (liters) at 6 months relative to baseline was measured. Clinical remission rates were evaluated in those completing one year of treatment. Among 87 patients, 38 (43.7%) had LOA and 49 (56.3%) had EOA. Of these, 22 (25.3%) received omalizumab and 65 (74.7%) received mepolizumab, with a mean treatment duration of 24.7 (±19.7) months. LOA patients had higher obesity rates and tobacco consumption compared to EOA patients (p = 0.041 and p = 0.024, respectively). There were no significant differences between LOA and EOA groups in ACQ scores, FEV1 percentage, the percentage change in FEV1 in liters and eosinophil counts (p = 0.531, p = 0.219, p = 0.632, p = 0.700, respectively). Within LOA patients, ACQ scores did not significantly differ between those treated with omalizumab and mepolizumab (p = 0.801). At 6 months, eosinophil counts significantly decreased with mepolizumab but not with omalizumab (p = 0.002). Biological treatment responses were similar between LOA and EOA groups. Omalizumab and mepolizumab showed comparable efficacy, with the exception of eosinophil count changes in LOA patients.
Efficacy and safety of Janus kinase selective inhibitors in the treatment of atopic dermatitis: A systematic review and meta-analysis.
Wang M, Gao X, Zhang L
Allergy Asthma Proc · 2025 Mar · PMID 40011984 · Publisher ↗
Although previous studies have confirmed that Janus kinase (JAK) inhibitors have good efficacy and safety in the treatment of atopic dermatitis, the U.S. Food and Drug Administration has issued a black box warning for al...
Although previous studies have confirmed that Janus kinase (JAK) inhibitors have good efficacy and safety in the treatment of atopic dermatitis, the U.S. Food and Drug Administration has issued a black box warning for all JAKs. Therefore, it is necessary for us to further pay attention to their safety. The medical literature data bases were searched from database creation until August 26, 2023. Randomized controlled trials of moderate-to-severe atopic dermatitis treated with JAK1-selective inhibitors (upadacitinib and abrocitinib) were included. In this meta-analysis, which included 12 studies (one of which reported two outcomes), we collected data at 2, 4, 8, 12, and 16 weeks. Almost all results showed that JAK1-selective inhibitors were more efficacious than controls and had an onset of action at week 2. There was no significant difference in the incidence of serious adverse events and adverse events, leading to discontinuation, whereas, for treatment-associated adverse events, the JAK1-selective inhibitors were higher than the control group (RR 1.16 [95% confidence interval, 1.11-1.21]; p < 0.00001). Overall, the treatment of atopic dermatitis with JAK1-selective inhibitors has a rapid onset of action. However, we need to be aware of the treatment-associated adverse events, more studies need to be conducted to provide better decisions on clinical medications for patients with moderate-to-severe atopic dermatitis.
Association between allergic diseases and hypertension: Co-occurrence pattern analysis.
Cao X, Zhao G, Peng H … +3 more , Mi Y, Zhou M, Guo Y
Allergy Asthma Proc · 2025 Mar · PMID 40011983 · Publisher ↗
The hypertension risk in the co-occurrence of allergic diseases remains largely unknown. We aimed to investigate the association between allergic diseases co-occurrence pattern and hypertension morbidity and mortality,...
The hypertension risk in the co-occurrence of allergic diseases remains largely unknown. We aimed to investigate the association between allergic diseases co-occurrence pattern and hypertension morbidity and mortality, and to evaluate additive interaction effects between allergic diseases. A nationally representative population from the U.S. National Health Interview Survey 2012 was enrolled. Hypertension and five specific allergic diseases, including asthma, allergic rhinitis (AR), food allergy (FA), eczema, and other allergy (OA), were determined. Hypertension mortality was identified until December 31, 2019. We evaluated additive interaction effects between two allergic diseases on hypertension risk: relative excess risk due to interaction (RERI) and attributable proportion of joint effect due to interaction (AP) (shown as percentages) were calculated. For modifiable lifestyle factors with significant heterogeneity in the subgroups, we examined the effect modification. Totally, 34,392 participants were enrolled. Four co-occurrence patterns of two allergic diseases were associated with an increased risk of hypertension, including AR + FA (odds ratio [OR] 2.25 [95% confidence interval {CI}, 1.52-3.35]), eczema + OA (OR 1.94 [95% CI, 1.14-3.30]), AR + eczema (OR 1.76 [95% CI, 1.18-2.64]), asthma + AR (OR 1.67 [95% CI, 1.33-2.08]). Five co-occurrence patterns of three allergic diseases were associated with increased risk of hypertension. Additive interactions were seen in AR + FA (RERI, 0.65; AP, 29%), eczema + OA (RERI, 0.43; AP, 22%), AR + eczema (RERI, 0.21; AP, 12%), and asthma + AR (RERI, 0.05; AP, 3%). The significant association between asthma + FA and hypertension was only seen among participants with a body mass index (BMI) ≥ 30 kg/m² (p = 0.021). With a median follow-up of 7.5 years, one co-occurrence pattern of asthma + FA showed a significant increased risk of hypertension mortality (hazard ratio 4.32, 95% CI: 1.52-12.23), with an additive interaction was observed (RERI, 2.33; AP, 52%). We identified several allergic diseases co-occurrence patterns with a significantly increased risk of hypertension morbidity and mortality. Potential biologic additive effect among allergic diseases and effect modification of BMI was found. Precision primary prevention of hypertension is necessary for patients with co-occurring allergic diseases.
From diagnosis to desensitization in immediate hypersensitivity reactions to both oral and parenteral iron salts.
Aslan AF, Demir S, Toprak ID … +5 more , Korkmaz P, Karabacak DE, Kahveci N, Unal D, Gelincik A
Allergy Asthma Proc · 2025 Mar · PMID 40011982 · Publisher ↗
Hypersensitivity reactions (HRs) to iron agents are increasing in parallel with increased use of iron preparations. We aimed to evaluate the clinical features and our previous desensitization protocol in patients with i...
Hypersensitivity reactions (HRs) to iron agents are increasing in parallel with increased use of iron preparations. We aimed to evaluate the clinical features and our previous desensitization protocol in patients with immediate hypersensitivity reactions (IHR) to iron agents. We screened the medical records of 96 patients with a history of IHRs to oral or intravenous (IV) iron agents. We evaluated clinical features and diagnostic test results. Furthermore, we assessed the safety and success rate of the desensitization protocol. Forty-seven patients had a history of IHRs to oral iron preparations, whereas 49 patients had a history of IHRs to IV iron agents. Skin-prick tests (SPT) with suspected and alternative oral iron salts were performed in 52.1% of the patients, and five were positive. SPTs and intradermal tests with IV iron products were applied to 67.7% and 65.6% of the patients, respectively, and four yielded positivity. Anaphylaxis was more common in patients hypersensitive to IV iron agents (n = 33) (p < 0.001). In 15 patients for whom iron agents were mandatory, 52 successful desensitizations with ferric carboxymaltose were performed. Our study demonstrated that skin tests were not helpful in the diagnosis of IHRs to iron agents and the parenteral route of administration was related to more severe IHRs. Furthermore, in case of necessity, our IV desensitization protocol generated for ferric carboxymaltose is a safe, effective, and practical treatment of choice.
Type 2 inflammation: A unifying pathway in allergic diseases and a call to action for the Allergist-Immunologist.
Bellanti JA, Settipane RA
Allergy Asthma Proc · 2025 Mar · PMID 40011981 · Full text
Abstract loading — click title to view on PubMed.
Influence of aeroallergen sensitization and nasal polyposis on mepolizumab response in eosinophilic severe asthma.
Akkus FA, Colkesen F, Onalan T … +5 more , Evcen R, Gerek ME, Kilinc M, Sadi Aykan F, Arslan S
Allergy Asthma Proc · 2025 Mar · PMID 40011980 · Publisher ↗
Studies on the impact of comorbidities on treatment responses in severe eosinophilic asthma (SEA) are limited. This study was a real-world investigation into how the presence or absence of nasal polyps (NP) and sensitivi...
Studies on the impact of comorbidities on treatment responses in severe eosinophilic asthma (SEA) are limited. This study was a real-world investigation into how the presence or absence of nasal polyps (NP) and sensitivity to aeroallergens influence the outcomes of mepolizumab therapy. In this retrospective study, data obtained from patients with SEA and who received at least 6 months of mepolizumab treatment were analyzed. The patients were initially divided into two groups based on the presence of NPs. Within these two groups, the patients were further categorized into subgroups according to the presence of aeroallergen sensitivity (AE). Asthma-related outcomes in the resulting four groups were evaluated both before mepolizumab treatment and during the follow-up period. Among the 36 patients with NPs, 14 (38.8%) had AE (NP+AE+), whereas 22 (61.2%) did not (NP+AE-). Of the 35 patients without NPs, 17 (48.5%) had AE (NP-AE+), and 18 (51.5%) did not (NP-AE-). The presence of NPs, independent of AE, was significantly associated with an increase in asthma exacerbations and oral corticosteroid (OCS) use before treatment (p < 0.001). In the NP+AE+ group, the baseline Asthma Control Test (ACT) score was lower, and the number of hospitalizations was significantly higher (p < 0.001). After mepolizumab treatment, all four groups showed significant reductions in asthma-related exacerbations, hospitalizations, and OCS use. Furthermore, ACT scores and pulmonary function test parameters significantly improved. There were limited differences in asthma improvements among the groups, with the NP+AE+ group showing a significant increase in ACT scores and a reduction in hospitalizations compared with the other groups (p < 0.001). Mepolizumab significantly reduced asthma exacerbations, hospitalizations, and OCS use in the patients with SEA with four different phenotypes. Analysis of these findings suggests that mepolizumab provides real-world benefits regardless of the presence or absence of NPs and AE.
To test or not to test: Lessons learned from screening infants for peanut allergy.
Engelhardt E, Prince BT, Stukus DR … +2 more , Messeh E, Mikhail I
Allergy Asthma Proc · 2025 Mar · PMID 40011979 · Publisher ↗
In recent years, there has been a trend to forgo screening for peanut allergy (PA), even in infants at high risk. This study aimed to better understand the implications of screening for PA before peanut introduction. We...
In recent years, there has been a trend to forgo screening for peanut allergy (PA), even in infants at high risk. This study aimed to better understand the implications of screening for PA before peanut introduction. We sought to characterize the outcomes of infants who underwent PA skin testing in a tertiary-care allergy clinic. We performed a retrospective chart review between July 1, 2017, and December 31, 2020, on all infants seen in the allergy clinic who had a peanut skin-prick test and recorded their demographic and clinical characteristics as well as outcomes with regard to PA and tolerance. Twenty percent of the infants screened were identified as having PA. Infants with a PA were more likely to be older at the time of testing, more likely to have another allergist-diagnosed immunoglobulin E (IgE) mediated food allergy, and more likely to have a prescription for a stronger (class VI or stronger) topical steroid. When conducted, oral food challenge was safe, with the majority of infants being treated with observation or antihistamines. A large percentage of infants with a PA developed tolerance during the follow-up period. Conversely, 5% of the infants who were initially tolerant developed a new PA. PA is associated with severe atopic dermatitis and other IgE-mediated food allergies. However, it is unclear if there is a benefit from screening infants before peanut introduction. It is important to monitor for resolution in the infant population.
Blended problem based learning in postgraduate education: The Eastern Allergy Conference and the PBL Institute experience.
Conway AE, Kartha N, Shaker MS … +3 more , Davis RS, Settipane RA, Bukstein DA
Allergy Asthma Proc · 2025 Mar · PMID 40000016 · Publisher ↗
Problem-based learning (PBL) is an interactive learning model well accepted in undergraduate medical education. Utilization of PBL in most postgraduate continuing medical education (CME) programs has been limited. The tr...
Problem-based learning (PBL) is an interactive learning model well accepted in undergraduate medical education. Utilization of PBL in most postgraduate continuing medical education (CME) programs has been limited. The traditional didactic lecture (TDL) model alone in CME programs, although much more commonly used, may fail to assess self-efficacy, educational needs, and appropriate use of shared decision-making (SDM). These aspects of practice are essential, and assessment of these skills is necessary to ensure effective change in physician behavior to improve patient outcomes. PBL case discussions during CME breakout groups foster a participant-centered interactive environment that strengthens critical thinking, team collaboration, and clinical reasoning. Through engagement with clinically relevant cases, PBL allows for tailored educational interventions. Integrating or blending PBL with TDL engages the learners in a real-world case discussion first, followed by succinct post-PBL lectures, which are uniquely "in context" to the actual case discussion. The post-PBL lectures are designed to address knowledge gaps that may have been uncovered during the PBL case discussions and reinforce practice guidelines to correct identified misinformation by learners. The PBL approach not only improves knowledge retention but also leads to better adherence to clinical guidelines by producing significant changes in physician behavior, leading to higher-value patient care. Furthermore, PBL promotes effective and appropriate SDM. Still, there are challenges to PBL implementation in postgraduate CME, including logistical constraints and facilitator training requirements. Thus far, integration of PBL is variable across fields of medicine. Further research is needed to optimize PBL application in postgraduate training. This review advocates for a shift from passive learning systems by TDLs alone to interactive educational models, e.g., blended PBL, which synergizes the two adult learning theories.
Evaluation of a disease-state education program in asthma: Application of the Knowledge-to-Action Framework.
Yusufova N, Gilbert IA, Trudo F … +5 more , Barlows T, Salvato S, Motawakel O, Eudicone JM, Murphy KR
Allergy Asthma Proc · 2025 Mar · PMID 39870378 · Publisher ↗
In patients with asthma, bronchoconstriction and airway inflammation both contribute to airway narrowing and airflow limitations, which lead to symptoms and exacerbations. Short-acting β₂-agonist (SABA)-only rescue thera...
In patients with asthma, bronchoconstriction and airway inflammation both contribute to airway narrowing and airflow limitations, which lead to symptoms and exacerbations. Short-acting β₂-agonist (SABA)-only rescue therapy addresses only bronchoconstriction and is associated with increased morbidity and mortality. Current asthma management guidelines recommend concomitant treatment of symptoms and inflammation with a fast-acting bronchodilator and inhaled corticosteroid (ICS) as rescue therapy for patients ≥12 years of age. However, there is an education and outreach gap for the wider adoption of anti-inflammatory rescue therapy in clinical practice. AstraZeneca has developed an education program for health-care practitioners (HCPs) based on a Knowledge-to-Action Framework, with the aim of increasing HCPs' understanding of key disease-state concepts related to evidence-based management of asthma. A multichannel, evidence-based education program was presented at medical conferences across the United States between December 2022 and December 2023. Before and after each event, attendees were asked to complete a survey that rated their agreement with six disease-state concepts on a five-point Likert scale. These concepts related to the role of airway inflammation, fluctuations in inflammation, SABA and ICS therapy, and the risk of exacerbations. Postevent responses to the survey were assessed relative to pre-event responses and longitudinally over 12 months by using calculated odds ratios and 95% confidence intervals. Acceptance and/or understanding of a concept was defined as a rating of "agree" or "strongly agree" from at least 80% of respondents. The proportion of respondents who agreed or strongly agreed with each concept was significantly higher postevent versus pre-event (p < 0.001). The 80% acceptance and/or understanding threshold was surpassed for all concepts after the event. The medical education program improved understanding and/or acceptance of key disease-state concepts related to asthma management among participating HCPs. Effective communication of disease management concepts may lead to improved patient health outcomes through more rapid acceptance of guideline-recommended medical therapies.
Exploring mast cell disorders: Tryptases, hereditary alpha-tryptasemia, and MCAS treatment approaches.
Bellanti JA, Settipane RA
Allergy Asthma Proc · 2025 Jan · PMID 39741377 · Full text
Abstract loading — click title to view on PubMed.
Idiopathic non-mast cell angioedema: Treatment insights from global experts.
Christiansen SC, Zuraw BL
Allergy Asthma Proc · 2025 Jan · PMID 39741376 · Publisher ↗
Idiopathic non-mast cell angioedema (INMA) is a rare disease typified by recurrent attacks of cutaneous and subcutaneous swelling. Every attack carries the potential for severe morbidity and, in the case of laryngeal inv...
Idiopathic non-mast cell angioedema (INMA) is a rare disease typified by recurrent attacks of cutaneous and subcutaneous swelling. Every attack carries the potential for severe morbidity and, in the case of laryngeal involvement, mortality. Whereas therapies approved for hereditary angioedema (HAE) have been used in the care of patients with INMA, little is known with regard to their efficacy for the treatment of this disease. The objective was to gather evidence from global experts, ranking their assessment of on-demand therapy (ODT) and long-term prophylactic (LTP) treatment efficacy for INMA. A survey was developed and distributed to international experts invited to attend a 2023 symposium. INMA was diagnosed by standardized criteria. Linkert scales were used to rate the efficacy for ODT and LTP therapy. Enrollment was closed after 1 month and the data were analyzed. Surveys were distributed to 31 experts from 16 countries with a 77% response rate (n = 24) reporting on 300 patients with INMA. Efficacy rankings of ODT were the following: icatibant (14 experts with 93 treated patients), 46.2% high and 38.7% moderate; and plasma-derived C1 inhibitor (C1INH) (13 experts with 31 treated patients), 32.3% moderate and 45.2% mild. Efficacy rankings of LTP were the following: antifibrinolytics (11 experts with 52 treated patients), 23.1% high and 38.5% moderate; lanadelumab (5 experts with 19 treated patients), 21% high and 79% moderate; and subcutaneous C1INH (3 experts with 19 treated patients), 21.1% moderate and 79.0% mild. LTP efficacy was also recorded for berotralstat and progestin. Icatibant (ODT) and either antifibrinolytics or lanadelumab (LTP) were ranked as the most efficacious treatments for the patients with INMA (among medications with at least five treated patients) by the expert physicians. Progestins, berotralstat, and plasma derived C1INH each demonstrated a favorable prophylactic effect; however, broader experience will be required to formulate overall recommendations.
Real-world surveillance of standardized quality (SQ) house dust mite sublingual immunotherapy tablets for 3 years in Japan.
Gotoh M, Maekawa Y, Saito S … +3 more , Kato N, Horikawa E, Nishino N
Allergy Asthma Proc · 2025 Jan · PMID 39741375 · Publisher ↗
Standardized quality (SQ) house-dust mite (HDM) sublingual immunotherapy tablets (10,000 Japanese allergy units [JAU], equivalent to 6 SQ-HDM in Europe and the United States) are licensed for the treatment of HDM-induced...
Standardized quality (SQ) house-dust mite (HDM) sublingual immunotherapy tablets (10,000 Japanese allergy units [JAU], equivalent to 6 SQ-HDM in Europe and the United States) are licensed for the treatment of HDM-induced allergic rhinitis (AR) without age restriction, based on 52-week administration clinical trials. There are no large-scale data on the administration of 10,000 JAU for > 1 year in actual clinical practice. To examine the safety and effectiveness of 10,000 JAU during use for up to 3 years at real-world clinical sites in Japan. This survey was a multicenter, observational, prospective study. We assessed the safety and effectiveness of the long-term administration of 10,000 JAU as well as effectiveness after its discontinuation in patients with HDM AR with an observation period of 3 years. The safety analysis included 815 patients, and the effectiveness analysis included 768 patients. Adverse reactions that occurred in 144 patients (17.67%) were mainly site-related events that occurred early in the dosing period. Serious adverse reactions were dyspnea and anaphylactic reaction in one patient each, and both patients recovered. With regard to effectiveness, compared with scores before the administration of SQ-HDM, nasal symptom scores decreased, depending on the administration period, from 6 months to 3 years. Overall, 67.34% of the patients had improved quality of life after 6 months, and this improvement continued after 12 months. The proportion of patients with "improved and slightly improved" of overall improvement exceeded 90% after 2 years. Treatment discontinuation because "symptoms disappeared" occurred in 24.42% of the patients at 3 years. Patients who discontinued 10,000 JAU ( = 39) had a sustained improvement in nasal symptom scores compared with baseline, even 1 year after discontinuing treatment. The real-world safety and effectiveness of 10,000 JAU SQ-HDM sublingual immunotherapy tablets were confirmed in Japanese patients with HDM AR. No new safety and effectiveness precautions were required.
Appraisal of the evidence linking hereditary α-tryptasemia with mast cell disorders, hypermobility and dysautonomia.
Lyons JJ
Allergy Asthma Proc · 2025 Jan · PMID 39741374 · Full text
Since its first description more than a decade ago, our understanding of the clinical impact of hereditary alpha-tryptasemia has continued to evolve. First considered to be a genetic disorder with a subset of patients ha...
Since its first description more than a decade ago, our understanding of the clinical impact of hereditary alpha-tryptasemia has continued to evolve. First considered to be a genetic disorder with a subset of patients having a syndromic presentation composed of connective tissue abnormalities, symptoms of autonomic dysfunction, and findings of mast cell activation, we now know that hereditary alpha-tryptasemia is a common genetic trait and modifier of mast cell-mediated reactions. More recent studies have shown some previously held associations with congenital hypermobility and postural orthostatic tachycardia syndrome (POTS) to be lacking, and illuminated previously unappreciated associations with clonal and nonclonal mast cell disorders. With the discovery of heterotetrameric tryptases and demonstration of their unique functional activities, the importance of tryptase gene composition in general has begun to take focus. Hereditary alpha-tryptasemia exists at the end of a spectrum of alpha-tryptase expression and as a natural overexpression model of this protein, brought to the fore the potential of tryptase genotyping as a genetic biomarker for anaphylaxis severity. These data and future studies hold the promise of enhancing our understanding of the role that tryptases play in health and disease.
Systematic review of omalizumab for refractory clonal and non-clonal mast cell activation syndrome.
Matheny MV, Craig T, Al-Shaikhly T
Allergy Asthma Proc · 2025 Jan · PMID 39741373 · Publisher ↗
Patients with mast cell activation syndrome (MCAS) can be refractory to standard antimediator therapy. Alternative treatment options to reduce disease burden and improve quality of life are needed. To compile the eviden...
Patients with mast cell activation syndrome (MCAS) can be refractory to standard antimediator therapy. Alternative treatment options to reduce disease burden and improve quality of life are needed. To compile the evidence that supports the use of omalizumab for patients with refractory MCAS. Through a systematic review of the PubMed database, we compiled and analyzed the characteristics of patients with refractory MCAS, unresponsive to histamine 1 receptor antihistamines plus another antimediator agent (refractory MCAS), and who were treated with omalizumab. We categorized the clinical response to omalizumab as no, partial, or complete response. We identified nine studies that described a total of 28 patients (median age, 48 years; males, 54%) with refractory MCAS. Twenty-one patients (75%) had nonclonal MCAS, and seven patients (25%) had clonal MCAS. The omalizumab dose ranged from 150 mg every 4 weeks to 300 mg every 3 weeks, with the most common dose being 150 mg every 2 weeks. Most patients had a partial response (61%), and five patients achieved a complete response. Omalizumab was successful in ameliorating anaphylaxis and allowed for discontinuation of systemic glucocorticoids in two of three patients. The response pattern was not influenced by sex or mast cell clonality, but a complete response was reported more commonly among receivers of a higher omalizumab dose (≥300 mg/month). No major adverse events were reported. The majority of patients with refractory MCAS reported in the literature had a reduction in mast cell mediator-related symptoms with the addition of omalizumab.
Evaluation of allergic diseases in children diagnosed with cutaneous mastocytosis.
Celik HI, Guvenir FA, Emeksiz ZS … +1 more , Misirlioglu ED
Allergy Asthma Proc · 2025 Jan · PMID 39741372 · Publisher ↗
Cutaneous mastocytosis (CM) is the most common type of mastocytosis in children. The atopy frequency in these patients is typically similar to that in the general population, but a higher incidence of anaphylaxis is repo...
Cutaneous mastocytosis (CM) is the most common type of mastocytosis in children. The atopy frequency in these patients is typically similar to that in the general population, but a higher incidence of anaphylaxis is reported. This study aimed to evaluate the presence of allergic diseases in children diagnosed with CM and its impact on clinical manifestations. Children diagnosed with CM at Ankara Bilkent City Hospital Pediatric Allergy and Immunology Clinic between September 2019 and September 2023 were included in the study. Data, including demographic information, clinical details, and laboratory results, were gathered from medical records, encompassing personal and family allergy history. The study included 58 patients (median [interquartile range{IQR}] age, 64 months [29-100.5 months]; 69% boys) with skin lesions as the primary concern. The median (IQR) age at which the lesions appeared was 9 months (3-39.25 months), and the median (IQR) age at hospital admission was 12 months (5- 50 months). The median (IQR) age at CM diagnosis was 13 months (6-53.5 months). The median (IQR) baseline tryptase value was 5.45 μg/L (3.93-9.00 μg/L), and 16 had an elevated tryptase value (>8 μg/L). Allergic diseases were present in 39.65% of the patients, with atopic dermatitis (18.9%) being the most common, followed by asthma (10.3%), allergic rhinitis (5.2%), food allergy (1.7%), and drug and bee venom allergies (1.7%). One patient had a history of anaphylaxis, diagnosed 4 months after consuming yogurt. A total of 18 patients, including this patient, were prescribed an adrenaline autoinjector. Various allergic diseases occurred in ∼40% of patients with CM and most commonly manifest as atopic dermatitis; 31% patients with risk factors for anaphylaxis were prescribed an adrenaline autoinjector.
Perioperative anaphylaxis manifesting as cardiac arrest during cardiac surgery.
Jaroenpuntaruk V, Volcheck GW
Allergy Asthma Proc · 2025 Jan · PMID 39741371 · Publisher ↗
Perioperative anaphylaxis is a serious entity with high morbidity and mortality. Perioperative anaphylaxis can be caused by any of the multitude of medications and substances used in anesthesia and surgery, and the most...
Perioperative anaphylaxis is a serious entity with high morbidity and mortality. Perioperative anaphylaxis can be caused by any of the multitude of medications and substances used in anesthesia and surgery, and the most common causes include neuromuscular blocking agents, antibiotics, antiseptics, latex, and dyes. The differential diagnosis of perioperative anaphylaxis is wide from both an immunologic and a nonimmunologic standpoint. The majority of the intraoperative anaphylaxis reactions are thought to be immunoglobulin E (IgE) mediated; however, other primary non-IgE-mediated mechanisms can also be present. Clinical manifestations can vary from mild cutaneous exanthema to cardiac arrest. Tryptase can be helpful in identifying perioperative anaphylaxis. In this article, we present the case of a 75-year-old man who had a cardiac arrest without skin symptoms perioperatively during coronary artery bypass surgery. We describe the presentation, strategic evaluation, and subsequent management with recommendations for future surgery based on his evaluation and the identified culprit. Subsequent surgery was later completed. Understanding the clinical presentation, key components of testing, and recommendations for future management of perioperative anaphylaxis are invaluable skills that the allergist can provide for the patient and the anesthesia and surgery teams.
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