Allergy And Asthma Proceedings[JOURNAL]
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200 papers
Clinical remission in patients with severe eosinophilic asthma treated with mepolizumab: A analysis of RELIght study.
Papaioannou AI, Kallieri M, Zervas E … +31 more , Fouka E, Porpodis K, Hadji Mitrova M, Tzortzaki E, Makris M, Ntakoula M, Lyberopoulos P, Dimakou K, Koukidou S, Ampelioti S, Papaporfyriou A, Katsoulis K, Kipourou M, Rovina N, Antoniou K, Vittorakis S, Bakakos P, Steiropoulos P, Markopoulou K, Avarlis P, Papanikolaou ΙC, Markatos M, Gaki E, Samitas K, Glynos K, Papiris SA, Papakosta D, Tzanakis N, Gaga M, Kostikas K, Loukides S
Allergy Asthma Proc · 2025 Jan · PMID 39741370 · Publisher ↗
Remission of asthma can occur as part of the natural history of the disease; however, the use of biologics can result in disease remission in some patients. In this post hoc analysis of the RELIght study, we aimed to ev...
Remission of asthma can occur as part of the natural history of the disease; however, the use of biologics can result in disease remission in some patients. In this post hoc analysis of the RELIght study, we aimed to evaluate clinical remission in real life among patients treated with mepolizumab, to detect possible differences between "remitters" and "nonremitters," and to evaluate possible predictors of remission. Clinical remission was defined as the absence of asthma exacerbations, discontinuation of oral corticosteroids (OCS), achievement of asthma control (Asthma Control Test [ACT] ≥ 20), and stable or improved lung function. A total of 146 patients were evaluated; remission was achieved in 40 (27.4%) and 29 (22%) after 12 and 24 months, respectively. At 12 months, the patients in remission had a better baseline ACT score (17.0 [14.0-19.0] versus 15.0 [12.0-17.0]; p = 0.027), were more rarely using OCS (35% versus 62.2%; p = 0.004), and required a lower baseline dose of OCS (5.0 mg/day [5.0-10.0 mg/day] versus 10.0 mg/day [5.0-15.0 mg/day]; p = 0.042) at baseline, whereas, at 24 months, they less frequently carried a baseline diagnosis of gastroesophageal reflux disease (GERD) (10.3% versus 32%; p = 0.031) and used lower doses of OCS at baseline (5.0 [1.0-5.0] versus 10.0 [5.0-15.0]; p = ≤0.001) versus nonremitters; 52.5% of patients had sustained remission, whereas 42.5% experienced relapse. These patients more frequently had GERD versus patients with sustained remission (52.9% versus 4.8%; p = 0.002). Finally, regression analysis has shown that GERD was the only predictor of relapse. Remitters had better asthma control and needed lower doses or no maintenance OCS at baseline, whereas GERD seems to be an important factor that affects remission and relapse.Clinical trial NCT04084613, <ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="http://www.clinical trials.gov">www.clinical trials.gov</ext-link>.
Allergen immunotherapy: How to stay current with USP 797 and practice guidelines.
Petersen MM
Allergy Asthma Proc · 2025 Jan · PMID 39741369 · Publisher ↗
The United States Pharmacopeia (USP) Chapter 797 provides critical standards for compounding sterile preparations to ensure patient safety and medication efficacy. The latest revision, effective November 1, 2023, introdu...
The United States Pharmacopeia (USP) Chapter 797 provides critical standards for compounding sterile preparations to ensure patient safety and medication efficacy. The latest revision, effective November 1, 2023, introduces updates particularly relevant to the compounding of allergenic extracts, which emphasizes stringent compliance measures. This article aims to review the key updates to USP Chapter 797, outline the compliance requirements for personnel and facilities, and offer strategies for staying current with these practice guidelines, leveraging resources from professional organizations such as American College of Allergy, Asthma, and Immunology and American Academy of Allergy, Asthma, and Immunology. An extensive review of the updated USP Chapter 797 guidelines was conducted, along with supplementary research from professional resources and literature to provide a comprehensive overview of the new standards and best practices for compliance. The updated USP Chapter 797 mandates comprehensive training and competency testing for compounding personnel, facility maintenance and documentation standards, and robust quality assurance protocols to minimize contamination and ensure the efficacy of compounded allergenic extracts. Key requirements include enhanced personnel hygiene and garbing requirements, facility maintenance protocols, and detailed documentation practices. Staying current with USP Chapter 797 and practice guidelines is crucial for allergists and immunotherapy practitioners to ensure high standards of patient care and safety. By understanding the key updates, complying with personnel and facility requirements, leveraging professional resources, and adopting standardized practices, health-care providers can effectively navigate the evolving regulatory landscape. Continuous education and adherence to quality assurance protocols will further support compliance and enhance patient outcomes in allergen immunotherapy.
Efficacy of parenteral bronchodilators on ventilatory outcomes in pediatric critical asthma: a national cohort study.
Gabbay JM, Fishman MD, Bajaj BVM … +3 more , Guenther CS, Graham RJ, Perez JM
Allergy Asthma Proc · 2025 Jan · PMID 39741368 · Publisher ↗
To evaluate the association of parenteral epinephrine and terbutaline use on ventilatory support in children admitted to the intensive care unit (ICU) with critical asthma in the United States. Data were obtained from t...
To evaluate the association of parenteral epinephrine and terbutaline use on ventilatory support in children admitted to the intensive care unit (ICU) with critical asthma in the United States. Data were obtained from the Pediatric Health Information System data base for children ages 2 to 18 years admitted to the ICU with a diagnosis of asthma exacerbation from January 1, 2016, to December 31, 2023. The primary outcomes included noninvasive ventilation (NIV) and/or invasive mechanical ventilation (IMV) use after receipt of terbutaline and/or epinephrine. Secondary outcomes included serious adverse events from parenteral bronchodilators, including arrhythmias and elevated troponins. Our study population included 53,328 patient encounters. Terbutaline and epinephrine were associated with decreased odds of subsequent NIV (terbutaline: odds ratio [OR] 0.52 [95% confidence interval {CI}, 0.44-0.63], p < 0.001; and epinephrine: OR 0.49 [95% CI, 0.43-0.55], p < 0.001) and subsequent IMV (terbutaline: OR 0.51 [95% CI, 0.42-0.61], p < 0.001; and epinephrine: OR 0.34 [95% CI, 0.29-0.41], p < 0.001). There were no differences in adverse events in the terbutaline group when compared with the epinephrine group for both arrhythmia and elevated troponins (arrhythmia: terbutaline = 1.9%, epinephrine = 1.7%; p = 0.6; and elevated troponins: terbutaline = 0.1%, epinephrine = 0.1%, p > 0.9). Parenteral bronchodilator use was associated with decreased odds of receiving subsequent ventilatory support in critical asthma. There were low rates of arrhythmia and elevated troponin overall. Our findings should inform future clinical trials to evaluate the use of parenteral bronchodilators in critical asthma in the United States.
Atopic dermatitis: Best of guidelines and yardstick.
Boguniewicz M
Allergy Asthma Proc · 2025 Jan · PMID 39741367 · Publisher ↗
Atopic dermatitis (AD), a common chronic inflammatory skin disorder is characterized by a complex pathology with skin-barrier abnormalities, immune dysregulation, and microbial dysbiosis. Patients' quality of life is oft...
Atopic dermatitis (AD), a common chronic inflammatory skin disorder is characterized by a complex pathology with skin-barrier abnormalities, immune dysregulation, and microbial dysbiosis. Patients' quality of life is often negatively impacted by persistent pruritus, sleep disturbance, and recurrent skin infections. In addition, patients may have comorbid atopic as well as nonatopic diseases. The objective was to help clinicians better manage AD by using new therapies and new indications, including a topical (Janus kinase [JAK]) inhibitor as well as monoclonal antibodies and oral JAK inhibitors, have been approved for AD. This review presents highlights from the American College of Allergy, Asthma and Immunology AD Yardstick Update, which incorporates Expert Commentary, and from the Joint Task Force (JTF) AD 2023 Guidelines that use Grading of Recommendations, Assessment, Development, and Evaluation methodology. Practical pearls from the AD Yardstick Update Expert Commentary are presented, along with results from systematic reviews and meta-analyses that addressed specific recommendations on the role of (1) dilute bleach baths, (2) dietary avoidance and/or elimination diets, (3) allergen immunotherapy, (4) topical treatments, and (5) systemic treatments, informing the JTF 2023 AD Guidelines. These guidelines are noteworthy for addressing patient values and preferences. The AD Yardstick Update Expert Commentary and JTF 2023 AD Guidelines provide timely, practical, and trustworthy information to help clinicians manage patients with AD.
Studies of methylated CpG ODN from subsp. in a murine model: Implications for treatment of human allergic disease.
Li D, Sorkhabi S, Cruz I … +2 more , Foley PL, Bellanti JA
Allergy Asthma Proc · 2025 Jan · PMID 39741366 · Publisher ↗
Allergen immunotherapy (AIT) is currently the most effective immunologic form of treatment for patients with atopic allergic diseases commonly used by allergist/immunologists to reduce allergic symptoms by gradually dese...
Allergen immunotherapy (AIT) is currently the most effective immunologic form of treatment for patients with atopic allergic diseases commonly used by allergist/immunologists to reduce allergic symptoms by gradually desensitizing the immune system to specific allergens. Currently, the primary mechanism of AIT emphasizes the crucial role of immune regulation, which involves a shift from a T-helper type 2 (Th2) cell response, which promotes allergy, to a T-regulatory (Treg) cell population, which inhibits the allergic inflammatory response through the production of immunosuppressive cytokines interleukin 10 and transforming growth factor β, which play pivotal roles in suppressing the allergic reaction. In a series of previous in vitro and in vivo experiments, we have demonstrated the capacity of synthetic methylated cytosine-phosphate-guanine (CpG) oligodeoxynucleotide (ODN) moieties as well as methylated genomic DNA ODN motifs from Bifidobacterium longum subspecies infantis to activate Treg cell differentiation in contrast to the unmethylated ODN moiety, which promotes proinflammatory responses driven by Th17-mediated responses. The purpose of the present study was to continue exploring the reciprocally related effects of methylated and unmethylated forms of DNA motifs from B. longum subspecies infantis on inflammation, specifically focusing on evaluating their capacity to alleviate allergic symptoms in a murine allergic disease model. We show that methylated CpG moieties (ODNA) inhibit inflammation by stimulating Treg cells whereas unmethylated CpG moieties (ODNB) promote inflammation through Th1/Th17 pathways. Analysis of our data confirms and extends our previous research on the mechanisms by which methylated and unmethylated forms of DNA motifs influence inflammation. Specifically, the findings demonstrate that methylated CpG moiety (OVA + ODNA) inhibits inflammation by stimulating Treg cells, whereas unmethylated CpG moiety (OVA + ODNB) promotes inflammation through Th1/Th17 pathways. Consequently, these effects were shown to alleviate or to exacerbate allergic symptoms in a murine model of allergic disease. These results set the stage for future clinical trials and studies in humans to explore the therapeutic potential of targeting CpG motifs in the treatment of allergic diseases.
Health disparities investigated in a primary care penicillin allergy removal pathway.
Mari D, Henson K, Day W … +2 more , Mcglynn A, Banks T
Allergy Asthma Proc · 2025 Jan · PMID 39741365 · Full text
Unconfirmed penicillin allergies over time lead to poor health outcomes and increased health-care cost. Health disparities (HD) can create barriers in optimizing penicillin allergy care. The objective was to characteriz...
Unconfirmed penicillin allergies over time lead to poor health outcomes and increased health-care cost. Health disparities (HD) can create barriers in optimizing penicillin allergy care. The objective was to characterize HDs in our primary care-led amoxicillin challenge (PLAC) delabeling pathway within a universal coverage health care system. In three outpatient clinic sites, 41,104 patients were screened, and 1,749 patients were discovered to have penicillin allergies. Of the 1,749 patients with penicillin allergy, 336 (ages 4 months to 76 years) were determined to be candidates for PLAC. A retrospective chart review was completed after 1 year of PLAC implementation to compare demographic characteristics and HD core categories (neighborhood living type, economic stability, background education status, and access to care) between those who completed and those who did not complete their PLAC appointment. All candidates underwent the same PLAC protocol and had universal health coverage that reduced health cost. Of 336 PLAC candidates (45.8%), 154 presented for their PLAC appointment and had their penicillin allergy removed without adverse outcomes. One hundred and eighty-two candidates (54.2%) did not complete a PLAC appointment and retained their penicillin allergy label. Candidates who did not complete their PLAC appointment were older (p = 0.001) and white (p = 0.006), and did not identify as officers (p = 0.04). There was no significant difference in neighborhood type or gender between the groups. In candidates ages ≥ 19 years, those without proactively scheduled appointments more commonly (p < 0.001) did not complete their PLAC appointment; whereas proactive scheduling increased delabeling from 5.8% to 91.3% in candidates ages ≥ 19 years. Of the 199 candidates with proactively scheduled PLAC appointments, those with less perceived economic stability and background education status (enlisted members) were more likely not to attend their PLAC appointment (p < 0.001). Results of our study suggest that our PLAC protocol provides a foundation of decreased HDs to successfully delabel patients at low risk of penicillin allergy when scheduling appointments for all and controlling for health-care cost.
Management of hereditary angioedema attacks by patients on long-term prophylaxis versus on-demand therapy only.
Lumry WR, Grumach AS, Betschel SD … +7 more , Radojicic C, van Kooten S, Heckmann M, Danese S, Malloy N, Goga L, Guilarte M
Allergy Asthma Proc · 2025 Jan · PMID 39586588 · Publisher ↗
Despite the use of long-term prophylaxis (LTP) for hereditary angioedema (HAE), the risk of having an attack remains and patients with HAE and on LTP may still experience attacks that can be life threatening. However, th...
Despite the use of long-term prophylaxis (LTP) for hereditary angioedema (HAE), the risk of having an attack remains and patients with HAE and on LTP may still experience attacks that can be life threatening. However, the behavioral patterns and perspectives surrounding HAE attack management by patients on LTP are not fully understood. This survey aimed to better understand and compare the behavioral patterns and perspectives, including attitudes and perceptions associated with on-demand treatment among patients on LTP versus those using on-demand therapy only. People living with HAE were recruited by the US Hereditary Angioedema Association to complete a 20-minute online survey between September 6 and October 19, 2022. Participants were stratified by treatment (50% using LTP [+on-demand therapy], 50% on-demand therapy only). Respondents included 107 patients with HAE (mean age, 41 years [range, 16-83 years]). Patients using LTP reported treating a mean ± standard deviation 84.8% ± 23.8% of their HAE attacks compared with a mean ± standard deviation 75.6% ± 27.5% for patients with on-demand only treatment. Similar percentages of patients on LTP versus patients on-demand only reported always carrying on-demand treatment when away from home (35% versus 38%) and modifying their daily lives to minimize the occurrence of HAE attacks, which included avoiding potential triggers (42.9% versus 45.5%). Although patients on LTP treat a higher percentage of their attacks compared with patients with on-demand only treatment, both groups reported similar behaviors in terms of carrying on-demand treatment when away from home and modifying their daily lives to minimize the occurrence of HAE attacks. These findings highlight the importance of understanding patient perspectives and behaviors in the management of HAE.
Military accession, retention, and deployment: Defining the role of the allergy consultant.
Hatcher VR, Adams KE
Allergy Asthma Proc · 2024 Nov · PMID 39517086 · Full text
Knowledge of the military regulations is key to guiding medical evaluations for applicants and service members. Military and civilian allergy consultants are often called on for their expertise to provide guidance with r...
Knowledge of the military regulations is key to guiding medical evaluations for applicants and service members. Military and civilian allergy consultants are often called on for their expertise to provide guidance with regard to the allergic conditions that may be potentially disqualifying from service per the published regulations for accession and retention. This review focuses on the role of the allergy consultant in military accession, retention, and deployments. To better understand and attempt to define the role of the allergy consultant in the process of medical evaluation for military applicants and for active duty service members, in the context of the ongoing national recruitment and force sustainment crisis, it is imperative to comprehend the intricacies of military accession and retention guidelines. Military medical standards guidelines are easy to access and should be used when evaluating applicants or active duty service members with allergic conditions. Medical documentation that aligns with military guidelines can help our patients streamline accession, retention, and waiver requests. The objective of this review is to provide a framework for how to address allergic concerns in the context of military service and apply accession and retention standards as indicated for patients who present with common allergic diagnoses.
Eating increases disease activity in pediatric patients with symptomatic dermographism.
Eke Gungor H, Turk M, Yucel MB … +4 more , Koca SB, Yuce Atamulu K, Maurer M, Ertas R
Allergy Asthma Proc · 2024 Nov · PMID 39517085 · Publisher ↗
Symptomatic dermographism (SD) is the most common form of chronic inducible urticaria. SD disease activity increases with food intake in adult patients. Whether this is also so in children with SD is currently unknown....
Symptomatic dermographism (SD) is the most common form of chronic inducible urticaria. SD disease activity increases with food intake in adult patients. Whether this is also so in children with SD is currently unknown. To assess children with SD for their disease activity by standardized provocation testing before and after eating. We subjected 44 children with SD (29 girls; median [interquartile range] age 12.5 years [8.3-15 years]), before and after eating, to standardized skin provocation testing with a dermographometer. Dermographometer scores were calculated based on responses evaluated at 1-minute intervals for 10 minutes and recorded as negative (-) or positive (+ to ++++). Clinical characteristics and urticaria control test scores were documented. Dermographometer scores before eating were 2.3 of 4 on average and inversely correlated with urticaria control test scores. Dermographometer scores were higher after eating than before eating. Of 44 children with SD, 35 had increased dermographometer scores after eating and 9 patients had a postprandial increase of ≥1 point. Eating-induced increases in dermographometer scores were linked to earlier whealing in 17 of 35 patients, and differences in preprandial versus postprandial dermographometer responses were more pronounced at earlier than later time points after testing. Disease activity, as assessed by provocation testing, is increased in most pediatric patients with SD after eating. Future studies should explore the prevalence of food-exacerbated SD in larger pediatric SD populations. Most pediatric patients with symptomatic dermographism have higher disease activity, assessed by provocation testing, after eating as compared to before eating. Standardized provocation testing and trigger threshold assessments in children with symptomatic dermographism should be performed before and after eating. Knowledge of food-exacerbated disease may help patients with the management of their symptomatic dermographism.
Abstracts presented at the Eastern Allergy Conference May 30-June 2, 2024, Palm Beach, Florida.
Allergy Asthma Proc · 2024 Nov · PMID 39517084 · Publisher ↗
Abstract loading — click title to view on PubMed.
A case of a rash after tetanus-diphtheria-pertussis and meningococcal vaccination.
Salazar L, Acevedo J, Adame F … +2 more , Kelly B, Covington C
Allergy Asthma Proc · 2024 Nov · PMID 39517083 · Publisher ↗
We present a case of a 12-year-old healthy girl who presented with acute onset of dry, hyperpigmented, and raised pruritic rash. The lesions initially presented on her thighs then progressed to the trunk and arms hours a...
We present a case of a 12-year-old healthy girl who presented with acute onset of dry, hyperpigmented, and raised pruritic rash. The lesions initially presented on her thighs then progressed to the trunk and arms hours after receiving the tetanus-diphtheria-pertussis (Tdap) and meningococcal vaccine. After a poor response to medium potency topical steroids, a biopsy specimen was taken, which led to our diagnosis. Current literature reports this condition occurring after Tdap; measles, mumps, and rubella; and COVID-19 vaccinations; but, to our knowledge, not after meningitis vaccines. The role that vaccines play in the pathophysiology remains unclear. This condition may get mistaken for an allergic reaction and lead to vaccine avoidance.
The use of biologics in food allergy management.
Shaker MS
Allergy Asthma Proc · 2024 Nov · PMID 39517082 · Publisher ↗
Patients and families living with food allergy may experience significant burdens, including social isolation, impaired quality of life, and anxiety. Allergists/immunologists play a critical role in educating families li...
Patients and families living with food allergy may experience significant burdens, including social isolation, impaired quality of life, and anxiety. Allergists/immunologists play a critical role in educating families living with food allergies about risk, particularly with regard to the rarity of fatal food allergy. Appropriate risk framing can greatly decrease the fear-based burden of disease. In 2024, an increasing complex fabric of food allergy treatments has emerged that includes oral immunotherapy (OIT), sublingual immunotherapy (SLIT), and omalizumab, with the promise of additional treatments, including epicutaneous immunotherapy and oral mucosal immunotherapy in the near future. Younger children may be most likely to benefit from OIT and SLIT, with some evidence that suggests the possibility of an immunomodulatory effect. Omalizumab, approved in 2024 for use in conjunction with strict avoidance, increases the threshold of reactivity before a moderate-to-severe reaction for many, but not all, patients. There is no evidence to date that omalizumab has an immunomodulatory effect, and young children treated with omalizumab monotherapy may bear a lost opportunity cost from possible immunomodulation would they have been treated with OIT or SLIT instead; however, within a shared decision-making paradigm, beyond label use of omalizumab may include treatment with OIT or SLIT. Fortunately, the co-evolution of shared decision-making with modern food allergy treatments will facilitate the critical preference-sensitive care that must be characteristic of all decisions surrounding active food allergy management.
Assessment of pediatric patients with suspected nonsteroidal anti-inflammatory drug hypersensitivity.
Dogan S, Ertugrul A, Ozer M … +3 more , Severcan EU, Sirin S, Ozmen S
Allergy Asthma Proc · 2024 Nov · PMID 39517081 · Publisher ↗
Beta-lactam antibiotics are the most common cause of hypersensitivity reactions to medications, followed by nonsteroidal anti-inflammatory drugs (NSAID). The aim of this study was to classify children with hypersensitiv...
Beta-lactam antibiotics are the most common cause of hypersensitivity reactions to medications, followed by nonsteroidal anti-inflammatory drugs (NSAID). The aim of this study was to classify children with hypersensitivity reactions to nonsteroidal anti-inflammatory drugs (NSAID-H) according to the latest updates. ENDA recommendations were used to evaluate all patients with suspected NSAID-H. Children were classified as either selective responders (SR) or cross-intolerant based on the results of the drug provocation test (DPT). Sixty-seven patients with suspected NSAID-H were evaluated in this study. NSAID-H was confirmed in 20 patients (29.9%). Among the 20 patients diagnosed with NSAID-H, 15 were classified according to the 2018 EAACI/ENDA Position Paper. Twelve patients (80%) were classified as cross-intolerant and 3 (20%) as SRs. NSAID-H was confirmed in 4 of 37 patients (10.8%) ages <10 years and 16 of 30 patients (53.3%) ages >10 years (p < 0.001). Twelve patients ages >10 years were classified. Cross-intolerance was detected in nine patients (66.6%). In patients >10 years of age, NSAID-induced urticaria/angioedema (NIUA) (16.7%) was the most common type in the group with classifiable cross-intolerant. In addition, NSAID-exacerbated respiratory disease was detected in one patient. Ibuprofen is the most common NSAID-H drug used in children. NIUA is the most common reaction. In pediatric allergy, hypersensitivity to NSAIDs is a challenging diagnostic issue. Hypersensitivity to NSAIDs poses a challenging diagnostic issue in pediatric allergies. The oral challenge test is the main diagnostic tool; however, in clinical practice, performing multiple challenge tests is difficult.
COVID-19 and severe cutaneous allergic reactions to sulfonamides.
Deng E, Craig TJ, Nguyen DV … +1 more , Al-Shaikhly T
Allergy Asthma Proc · 2024 Nov · PMID 39517080 · Full text
Sulfonamides are associated with severe cutaneous adverse reactions (SCARs). Coronavirus disease 2019 (COVID-19) triggers an immune response, which may increase the likelihood of developing a hypersensitivity reaction....
Sulfonamides are associated with severe cutaneous adverse reactions (SCARs). Coronavirus disease 2019 (COVID-19) triggers an immune response, which may increase the likelihood of developing a hypersensitivity reaction. We sought to explore the impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on the probability of developing SCARs and/or erythema multiforme (EM) reactions to sulfonamides. In the propensity score-matched cohort study by using the de-identified TriNetX Research data base, patients who had an exposure to antibiotic or non-antibiotic sulfonamides between March 1, 2020, and January 1, 2023, were divided into two groups based on the presence or absence of a previous COVID-19 infection within 6 months of starting the sulfonamide agent. The outcomes studied were the 30-day risk of developing SCARs or EM (Stevens-Johnson syndrome, toxic epidermal necrolysis, drug reaction with eosinophilia and systemic symptoms, or EM) within 3 months of sulfonamide exposure. Cohorts were matched based on baseline demographics; malignant lymphoid neoplasms; human immunodeficiency virus; systemic lupus erythematosus; bone marrow transplantation; diabetes; psoriasis; seizures; gout; solid organ or stem cell transplantation; COVID-19 vaccination; and exposure to risk medications, including allopurinol, levetiracetam, carbamazepine, lamotrigine, oxcarbazepine, phenytoin, phenobarbital, abacavir, nevirapine, piroxicam, tenoxicam, or mexiletine. When comparing 345,119 patients on sulfonamides and with previous COVID-19 to an equal number of sulfonamides users without a previous COVID-19, patients with COVID-19 had a lower risk of developing any form of SCARs (relative risk 0.39 [95% confidence interval, 0.26, 0.58]; p < 0.001). Previous SARS-CoV-2 infection seems to be associated with a lower probability of developing SCARs or EM among patients using sulfonamides.
Considering different Montreal Cognitive Assessment cutoff scores for older adults with asthma.
Moritz G, Becker JH, Ankam JV … +8 more , Arcoleo K, Wysocki M, Holtzer R, Wisnivesky J, Busse PJ, Federman AD, Jariwala SP, Feldman JM
Allergy Asthma Proc · 2024 Nov · PMID 39517079 · Full text
There is a greater prevalence of cognitive impairment among ethnic and/or racial minorities, and cognitive impairment is a barrier to asthma self-management (SM) behaviors and outcomes in older adults. The aim of this s...
There is a greater prevalence of cognitive impairment among ethnic and/or racial minorities, and cognitive impairment is a barrier to asthma self-management (SM) behaviors and outcomes in older adults. The aim of this study was to examine the relationship between cognitive impairment, assessed by using the Montreal Cognitive Assessment (MoCA), and asthma SM behaviors and outcomes in a sample of predominantly Black and Latino participants. In addition, we evaluated whether using two different MoCA cutoff scores influenced the association between cognitive impairment and asthma outcomes. Baseline cross-sectional data were extracted from a longitudinal study of older adults with asthma (N = 165) ages ≥60 years. Cognition was assessed by using the MoCA. Asthma Control Questionnaire, asthma-related quality of life (AQOL), and inhaled corticosteroid (ICS) adherence were assessed by using self-report. ICS dosing was collected through chart review and inhaler technique was observed and rated. Using established MoCA cutoff scores of 23 and 26 yielded 45% and 74% cognitive impairment rates, respectively. Cognitive impairment, defined by using the cutoff score of 23, was significantly associated with worse asthma control (p = 0.04) and worse ICS adherence (p = 0.01). With a cutoff score of 26, only AQOL was significantly associated with cognitive impairment (p = 0.03). Race and/or ethnicity moderated the relationship between cognitive impairment and asthma control with a MoCA cutoff score of 23, and between cognitive impairment and AQOL with a MoCA cutoff score of 26. Cognitive impairment in older adults with asthma is associated with important clinical outcomes, but this relationship is influenced by the cutoff score used to define cognitive impairment.
The utility of shared decision making in the management of hereditary angioedema.
Odin R, Anderson J, Jacobs J … +8 more , Jones D, Li HH, Lumry W, Manning M, Soteres D, Tachdjian R, Yang W, Bernstein JA
Allergy Asthma Proc · 2024 Nov · PMID 39517078 · Publisher ↗
Hereditary angioedema (HAE) is a complex disorder with a wide array of treatment options. Shared decision-making (SDM) should be used to ensure that patients are choosing their best treatment option. The goal was to deve...
Hereditary angioedema (HAE) is a complex disorder with a wide array of treatment options. Shared decision-making (SDM) should be used to ensure that patients are choosing their best treatment option. The goal was to develop and psychometrically test a brief instrument for assessing the patient's perspective of the SDM process during his or her clinical encounters with an HAE specialist/allergist. We hypothesized that SDM could be used effectively to help patients in their choice of therapy for HAE. Ten HAE treating physicians from the United States with a total of 50 patients with HAE used SDM to help patients choose the best prophylactic therapies (oral kallikrein inhibitor, androgens, subcutaneous C1 inhibitor replacement therapy, intravenous C1 inhibitor replacement therapy, monoclonal antibody kallikrein inhibitor) for their HAE and then completed surveys to analyze the effectiveness of the implementation of SDM as a quality indicator in health services assessment. The congruence of answers between the physicians and the patients was then analyzed; 90% of the patient-physician pairs agreed that the advantages and disadvantages of the treatment options were precisely explained; 92% of the patient-physician pairs agreed that the physician helped them understand all the information and that the physician asked them which treatment option they preferred; 88% of the pairs agreed that the different treatment options were thoroughly weighed and 92% of the pairs felt that they selected a treatment option together. In summary, SDM is being implemented by treating physicians to determine the best management options for their patients with HAE.
Ultrafiltered dog allergen skin test compared with acetone precipitated and conventional dog: A retrospective study.
Pollock J, Watson N, Pittman L … +1 more , Schwartz D
Allergy Asthma Proc · 2024 Nov · PMID 39517077 · Full text
Various formulations of dog allergen extracts, including conventional dog (also known as dog epithelium) and acetone precipitated (AP) dog, have been used for skin-prick testing (SPT), with AP dog showing improved antige...
Various formulations of dog allergen extracts, including conventional dog (also known as dog epithelium) and acetone precipitated (AP) dog, have been used for skin-prick testing (SPT), with AP dog showing improved antigen content but experiencing stability issues due to precipitant formation. Ultrafiltered (UF) dog extract has been developed to address these concerns by offering comparable allergen content to AP dog. This study retrospectively compared UF dog with conventional dog and AP dog in SPT. To compare the efficacy of UF dog extract with conventional dog and AP dog extracts in detecting dog sensitization through SPT. Retrospective analysis of SPT results from a single U.S. allergy clinic was conducted. Tests performed between October 2022 and March 2024 were included. Primary and secondary outcomes were analyzed by using descriptive statistics and statistical tests. UF dog, AP dog, and conventional dog showed positivity rates of 24.2%, 23.5%, and 16.3%, respectively. UF dog demonstrated significantly higher average wheal and erythema sizes compared with conventional dog and AP dog, but UF dog was not statistically different from AP dog in terms of test positivity. UF dog extract showed comparable number of positive tests to AP dog and a greater number of positive tests to conventional dog. Results of the study suggest UF dog as a viable alternative to AP dog, which offered improved stability and similar test responses. Further research with larger sample sizes is recommended to confirm these findings.
Operationalizing shared decision making in clinical practice.
Shaker MS, Verdi M
Allergy Asthma Proc · 2024 Nov · PMID 39517076 · Publisher ↗
Shared decision-making (SDM) requires a clear-eyed view of evidence certainty, context, and equipoise in clinical care. This paradigm of care builds on the foundational ethical principle of patient autonomy, further leve...
Shared decision-making (SDM) requires a clear-eyed view of evidence certainty, context, and equipoise in clinical care. This paradigm of care builds on the foundational ethical principle of patient autonomy, further leveraging beneficence, nonmaleficence, and justice to provide bespoke care in the appropriate clinical setting. When evidence is carefully evaluated together with acceptability and feasibility, equity, cost-effectiveness, resources, and patient preferences, an individualized assessment of the trade-off between possible benefits and harms can optimize patient management. In the setting of a conditional recommendation, it is appropriate to engage in SDM with patient partners, to the extent each patient is willing and able to engage in the SDM process. Three conversations inform SDM and include team talk, option talk, and decision talk with discussion of the plan of care. During these conversations, clear communication strategies that are specific, measurable, achievable, realistic, time sensitive, and provide assessment of absolute (not just relative) risk are important to provide necessary education to patient partners. Follow-up is key to ensure that decisions lead to effective treatment. Through this process, it is necessary to minimize cognitive overload and promote a minimally disruptive medicine approach. The acronym "HOW" promotes a holistic appraisal of evidence in context, open-minded teamwork with patients and families, and willingness to be a listening presence while serving as a partner and guide and appreciating the multidimensional and unique nature of each individual. SDM is and will continue to remain a cornerstone of appropriate medical care in settings of clinical equipoise.
The safety of initial single therapeutic dose challenge with a 5-day prolonged drug provocation test in children with a history of low-risk non-immediate reactions to beta-lactam antibiotics.
Comert M, Yilmaz Topal O, Guler T … +3 more , Tekcan D, Artac H, Kulhas Celik I
Allergy Asthma Proc · 2024 Nov · PMID 39517075 · Publisher ↗
Although the gold standard for diagnosing beta-lactam antibiotic (BLA) allergy is the drug provocation test (DPT), there is no standardized protocol for children. We aimed to evaluate the clinical features and DPT resul...
Although the gold standard for diagnosing beta-lactam antibiotic (BLA) allergy is the drug provocation test (DPT), there is no standardized protocol for children. We aimed to evaluate the clinical features and DPT results of children with a history of low-risk non-immediate reactions (NIR) to BLA who underwent initial direct single therapeutic dose challenge with a 5-day prolonged DPT. We retrospectively evaluated children ages 0-18 years with a history of low-risk NIRs to BLAs. On the first day of provocation, a single-dose DPT protocol without any skin test was administered at the clinic. The therapeutic dose was adjusted to not exceed the maximum single-unit dose (MSUD) for age and weight. The DPT protocol was administered with 100% of MSUD. To identify children with delayed reactions, the parents or caregivers were told to continue giving the medication at home for 5 days. One hundred and nine children were included in this study. The median (interquartile range) age of the children was 62.5 months (26.5-94 months). Of the suspected drugs, the main culprit drug was amoxicillin-clavulanic acid for 89 children (81.7%). The most common clinical manifestation was maculopapular exanthema, which occurred in 85 children (78%), and 8 (7.3%) had a positive DPT result. Three children (2.8%) developed a reaction after the first DPT dose. The remaining children continued to use the suspected BLA at home. Five children (4.7%) developed a reaction while using the drug at home. All the children with positive DPT results developed mild cutaneous signs and presented with a reaction to amoxicillin-clavulanic acid. None had a systemic or severe cutaneous reaction. Initial direct single therapeutic dose challenge with a 5-day prolonged DPT is a useful and safe way to assess low-risk NIRs to BLAs in children.
Do commercial dog extracts cross-react with allergen 1.
Hellu T, Gomez R, Weiss S … +2 more , Smith D, Steigelman D
Allergy Asthma Proc · 2024 Nov · PMID 39517074 · Full text
Half of U.S. households own a dog despite 10% of individuals being sensitized to dog. Assessment and treatment options for dog allergy include the use of commercial dog extracts which have inconsistent performance, makin...
Half of U.S. households own a dog despite 10% of individuals being sensitized to dog. Assessment and treatment options for dog allergy include the use of commercial dog extracts which have inconsistent performance, making diagnosing and managing dog allergy challenging. Contamination of dog extracts with other allergens has previously been reported. We sought to determine whether commercial dog extracts contain other aeroallergens. An extract purity and quantification study on acetone precipitated dog hair and dander extract (AP dog) was performed, 6 aeroallergens; Alternaria (Alt a 1), Ragweed (Amb a 1), German Cockroach (Bla g 2), Dust Mite (Der p t), Cat (Fel d 1), and Rye Grass (Lol p 1). Following, conventional dog hair and dander extract (CV dog) and the new ultrafiltered dog hair and dander extract (UF dog) were also assessed based on the initial results of AP dog. SDS-PAGE was performed on all three dog extracts to compare allergen content. Lastly, serology results and aeroallergen immunotherapy prescriptions were compared. The ELISA trays with Alt a 1, Amb a 1, Bla g 2, Der p 1, and Lol p 1 antibodies did not capture AP dog, while the ELISA tray with Fel d 1 antibody captured AP dog, CV dog, and UF dog. SDS-PAGE results of the 3 dog extracts did not reveal a band at the molecular weight for Fel d 1. Contamination of commercial dog extracts was not found. However, our findings are supportive of commercial dog extracts containing a Fel d 1-like dog allergen that is cross-reactive to Fel d 1. Cross-reactivity between commercial dog extracts and Fel d 1 could be responsible for double positivity to cat and dog in serology. Additional studies are needed to better illustrate this Fel d 1-like dog allergen.
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