Annals of Allergy Asthma & Immunology最新文献

{"title":"Peripheral eosinophil count as a biomarker for asthma exacerbation severity in acute care settings.","authors":"Emily A Scott, Aparna Balasubramanian, John Henry Brems, Tianshi David Wu, Michelle N Eakin, Scott L Zeger, Meredith C McCormack","doi":"10.1016/j.anai.2025.04.005","DOIUrl":"10.1016/j.anai.2025.04.005","url":null,"abstract":"<p><strong>Background: </strong>Eosinophilic asthma is associated with frequent exacerbations, but the relevance of peripheral eosinophil count at the time of exacerbation is unknown.</p><p><strong>Objective: </strong>To evaluate peripheral eosinophil count during an exacerbation requiring health care utilization and its associations with exacerbation course in adults with asthma.</p><p><strong>Methods: </strong>Adult asthma exacerbations between 2016 and 2023 which resulted in an emergency department visit or hospitalization were identified by International Classification of Diseases, 10th Revision, Clinical Modification diagnosis codes in the Johns Hopkins Asthma Precision Medicine Center of Excellence data repository. Outcomes included probability of admission, maximal level of care, length of stay, and discharge rate. We estimated associations between outcomes and eosinophil count using generalized estimating equations and generalized linear models.</p><p><strong>Results: </strong>Among 11,178 asthma exacerbations, 63% had peripheral eosinophil count measured during the encounter before steroid administration, and eosinophilia (≥150 cells/µL) was present in 61% of these. Risk of admission was nonlinearly associated with eosinophil count; exacerbations with eosinophil count of 150 to 300 cells/µL at presentation were least likely to result in admission, whereas those with 30 (odds ratio: 1.39, 95% CI: 1.26-1.54, P < .001) or 1000 cells/µL (odds ratio: 1.55, 95% CI: 1.35-1.79, P < .001) had higher odds of admission. Among inpatient exacerbations (N = 3825), encounters with eosinophil count more than or equal to 300 cells/µL had shorter median length of stay (3.1 vs 2.4 days, P < .001) and higher discharge rate (hazard ratio: 1.34, 95% CI: 1.22-1.48, P < .001) than those without eosinophilia (<150 cells/µL).</p><p><strong>Conclusion: </strong>Peripheral eosinophil count is a biomarker for asthma exacerbation severity and duration, offering opportunities for improved assessment and management of asthma exacerbations in acute care settings.</p>","PeriodicalId":50773,"journal":{"name":"Annals of Allergy Asthma & Immunology","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143994532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evolving paradigms of treatment of allergic and nonallergic rhinitis.","authors":"Nina Rackerby, Curie Ahn, Bruce D Ball, Shefali Samant, Joshua S Bernstein, Jonathan A Bernstein","doi":"10.1016/j.anai.2025.04.003","DOIUrl":"https://doi.org/10.1016/j.anai.2025.04.003","url":null,"abstract":"<p><p>Allergic rhinitis (AR) is a prevalent disease affecting approximately 15% of the US population, which is approximately 50 million individuals. More broadly, it is estimated that 400 to 500 million people worldwide experience AR. Not surprisingly, AR has a significant impact on quality of life due to increased fatigue, cognitive impairment, sleep disturbances, presenteeism or absenteeism, and impairment of performance, which all contribute to an increased cost burden to the medical system. Recent studies have identified social determinants of health including income level, age of migration from rural to urban areas or to high-income countries, and access to health care as important factors associated with the prevalence of allergic diseases. However, up to 25% of individuals have non-AR triggered by mechanical, osmotic, and chemical irritants, and 50% have mixed rhinitis characterized by allergic and nonallergic triggers. Uncontrolled chronic rhinitis subtypes have all been associated with asthma, eczema, chronic or recurrent sinusitis, cough, and both tension and migraine headaches. This review will address AR and non-AR with a focus on evolving treatments in adults.</p>","PeriodicalId":50773,"journal":{"name":"Annals of Allergy Asthma & Immunology","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144023730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of a validated, updated North American pediatric food allergy anaphylaxis management plan.","authors":"Aikaterini Anagnostou, Elissa M Abrams, William C Anderson, Melanie Carver, Sanaz Eftekhari, David B K Golden, Hannah Jaffee, Jay A Lieberman, Douglas P Mack, S Shahzad Mustafa, Marcus S Shaker, Jonathan M Spergel, David R Stukus, Julie Wang, Matthew Greenhawt","doi":"10.1016/j.anai.2025.03.027","DOIUrl":"https://doi.org/10.1016/j.anai.2025.03.027","url":null,"abstract":"<p><strong>Background: </strong>Current North American anaphylaxis action plans (AAPs) lack updated anaphylaxis guidelines that conditionally recommend \"immediate activation of emergency medical services\" after epinephrine use for patients experiencing a \"prompt, complete, and durable response\" to treatment. This offers a contextualized \"watchful waiting\" approach. AAPs may not include newly approved nasal epinephrine or differentiate anaphylaxis presentations by age.</p><p><strong>Objective: </strong>To develop an updated AAP.</p><p><strong>Methods: </strong>A prototype AAP was iteratively developed incorporating a \"watchful waiting\" approach, the nasal epinephrine option, and age-specific anaphylaxis symptom presentations among a team of anaphylaxis experts and patient and advocacy stakeholders to assess medical accuracy, readability, clarity, and bias. This underwent validated assessment of decisional acceptability, decisional conflict, and decisional self-efficacy in a sample of stakeholders with children at risk for anaphylaxis, or at risk themselves.</p><p><strong>Results: </strong>We developed a 2-page written plan (Flesch-Kincaid reading level 5.9) explaining management choices for severe and nonsevere reactions, indications for watchful waiting vs emergency medical services activation after epinephrine use, updated medication options, and age-based symptom differentiation. A total of 229 stakeholders assessed the AAP, noting good acceptability, high decisional self-efficacy (mean score 86.2/100, SD 15.9), and moderate decisional conflict (mean score 43.7/100, SD 18.8). Decisional conflict was unrelated to past anaphylaxis or epinephrine use. Information content was clear and sufficiently explained options with balanced and without a \"best choice\" bias. Overall, 86% of the respondents would recommend using this AAP.</p><p><strong>Conclusion: </strong>This is the first validated AAP incorporating preference-sensitive post-epinephrine management options consistent with updated North American guidelines, newly approved nasal epinephrine, and age-specific anaphylaxis presentation.</p>","PeriodicalId":50773,"journal":{"name":"Annals of Allergy Asthma & Immunology","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056549","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and safety of epicutaneous immunotherapy in children with peanut allergy with atopic comorbidities.","authors":"Amy M Scurlock, David M Fleischer, George Du Toit, Nicolette J T Arends, Jacqueline A Pongracic, Juan Trujillo, Paul Turner, Christian Vogelberg, Katharine J Bee, Todd D Green, Jonas Meney, Timothée Bois, Dianne E Campbell, Hugh A Sampson, A Wesley Burks","doi":"10.1016/j.anai.2025.04.002","DOIUrl":"10.1016/j.anai.2025.04.002","url":null,"abstract":"<p><strong>Background: </strong>There is a high prevalence rate of atopic comorbidities, including atopic dermatitis (AD), asthma, and concomitant food allergy (CFA), in children with peanut allergy.</p><p><strong>Objective: </strong>To evaluate whether concomitant atopic comorbidities affect the safety and efficacy of VIASKIN peanut patch (patch containing 250 µg peanut protein [VP250]).</p><p><strong>Methods: </strong>EPITOPE was a phase 3, double-blind, placebo-controlled trial designed to assess treatment response to VP250, as measured by eliciting dose at 12 months, in children with peanut allergy aged 1 to 3 years. This subgroup analysis assessed response rates for prespecified subgroups, including children with asthma, AD/eczema, and CFA. The safety profile of VP250 was evaluated by atopic condition in all randomized participants who received at least 1 dose.</p><p><strong>Results: </strong>Responder rates were significantly greater with VP250 vs placebo, irrespective of the presence of atopic conditions. There was no significant interaction effect between participants with an atopic comorbidity and those without. The safety profile was generally similar across subgroups without any additional safety signals. There was no clinically meaningful change in severity of AD in those receiving VP250, regardless of baseline AD status. Rates of anaphylaxis were higher in those with AD or CFA receiving VP250 vs those without; however, these imbalances were also observed in the placebo group.</p><p><strong>Conclusion: </strong>The results suggest that 12 months of treatment with VP250 was effective in desensitizing children with peanut allergy aged 1 to 3 years, with no difference in efficacy and a favorable safety profile, regardless of the presence of atopic comorbidities.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NCT03211247.</p>","PeriodicalId":50773,"journal":{"name":"Annals of Allergy Asthma & Immunology","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056553","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vanishing allergen: Addressing the crisis of American elm pollen extracts in allergy treatment.","authors":"Maureen M Petersen, Joseph P Forester, Richard Lankow, Rosemary Moak, J Allen Meadows","doi":"10.1016/j.anai.2025.04.001","DOIUrl":"10.1016/j.anai.2025.04.001","url":null,"abstract":"","PeriodicalId":50773,"journal":{"name":"Annals of Allergy Asthma & Immunology","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143804733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health care-seeking behaviors for acute asthma: A US cross-sectional survey.","authors":"Donna D Gardner, Raj Gokani, Juliana Hey-Hadavi, Dennis Williams, Mario Castro, Elliot Israel, Andres Quintero","doi":"10.1016/j.anai.2025.03.025","DOIUrl":"10.1016/j.anai.2025.03.025","url":null,"abstract":"<p><strong>Background: </strong>Understanding patient motivations for acute care-seeking behavior for asthma attacks could guide interventions to improve outcomes and mitigate health care resource use.</p><p><strong>Objective: </strong>To characterize health care-seeking behaviors and motivations of patients in the United States who obtain care for an asthma attack in urgent care (UC), emergency department (ED), or hospital settings.</p><p><strong>Methods: </strong>A cross-sectional survey was conducted online between July and August 2023 among adults in a market research panel treated for asthma in the past 12 months and who had experienced an asthma attack that required care in an UC, ED, or hospital or an oral corticosteroid prescription.</p><p><strong>Results: </strong>Of the 504 survey participants (female = 72%; White = 79%; Hispanic = 12%), 68% self-reported asthma of moderate severity and 72% had uncontrolled asthma. Oral corticosteroids were prescribed an average of 4.2 times in the past year. During their last asthma attack, 37% of participants took medicines at home, 20% went to UC, 15% went to the ED, and 5% were hospitalized. Participants who were younger, Asian, Hispanic, or with severe asthma were the most likely to go to the ED. Using a rescue inhaler was the most common action taken when first experiencing symptoms (72%). When participants considered seeking acute care, the severity of asthma symptoms was the most common factor considered (76%), followed by fast access to help (29%) and medication access (28%).</p><p><strong>Conclusion: </strong>Most patients seeking acute asthma care reported moderately severe, uncontrolled disease. Seeking acute care seems to be motivated by symptom severity and the need for fast access to care after trying rescue medications. It would be of interest in a future study to also evaluate the acute care-seeking needs of patients who are at lower risk of seeking acute care.</p>","PeriodicalId":50773,"journal":{"name":"Annals of Allergy Asthma & Immunology","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143789371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of mast cell activation disorders and hereditary alpha tryptasemia among patients with postural orthostatic tachycardia syndrome and Ehlers-Danlos syndrome: A systematic review.","authors":"Matthew Farley, Ricardo J Estrada-Mendizabal, Emily A Gansert, Dayne Voelker, Lisa A Marks, Alexei Gonzalez-Estrada","doi":"10.1016/j.anai.2025.03.022","DOIUrl":"10.1016/j.anai.2025.03.022","url":null,"abstract":"<p><strong>Background: </strong>Postural orthostatic tachycardia syndrome (POTS) and Ehlers-Danlos syndrome (EDS) are often reported to occur concurrently with mast cell activation disorders (MCADs) and hereditary alpha tryptasemia (HAT). However, it remains unclear whether evidence supporting this relationship exists.</p><p><strong>Objective: </strong>To determine the prevalence of MCADs and HAT in patients diagnosed with having EDS and or POTS.</p><p><strong>Methods: </strong>We conducted a systematic search of MEDLINE (OVID), EMBASE (OVID), Scopus, and Web of Science with the assistance of an experienced medical librarian. We focused on patients with any MCAD or HAT in conjunction with a diagnosis of POTS and/or EDS.</p><p><strong>Results: </strong>A total of 200 records were screened, 107 were excluded based on the title or abstract, 92 full texts were reviewed, and 1 record was not retrieved. No studies were identified that met our primary criterion of including patients diagnosed with any MCAD or HAT alongside POTS and/or EDS based on our prespecified diagnostic criteria.</p><p><strong>Conclusion: </strong>Our review did not find evidence to confirm a relationship between MCADs, HAT, POTS, and EDS. However, it must be mentioned that 1 study revealed an association between mast cell activation syndrome, POTS, and EDS and came close to meeting the full diagnostic criteria for mast cell activation syndrome, unlike other studies. This indicates that further research using strict and validated diagnostic criteria is needed to clarify whether a true association between conditions exists.</p>","PeriodicalId":50773,"journal":{"name":"Annals of Allergy Asthma & Immunology","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143789373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Authors' response","authors":"Rory Chan PhD, FRCPE ,&nbsp;Carlo Lombardi MD ,&nbsp;Pasquale Comberiati MD ,&nbsp;Alvise Berti MD ,&nbsp;Francesco Menzella MD ,&nbsp;Ronald J. Dandurand MD ,&nbsp;Zuzana Diamant MD, PhD ,&nbsp;Marcello Cottini MD","doi":"10.1016/j.anai.2025.01.008","DOIUrl":"10.1016/j.anai.2025.01.008","url":null,"abstract":"","PeriodicalId":50773,"journal":{"name":"Annals of Allergy Asthma & Immunology","volume":"134 4","pages":"Pages 491-492"},"PeriodicalIF":5.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143760372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From the pages of AllergyWatch","authors":"Stanley M. Fineman MD ,&nbsp;Shyam R. Joshi MD ,&nbsp;Gerald B. Lee MD ,&nbsp;Timothy Chow MD","doi":"10.1016/j.anai.2025.01.016","DOIUrl":"10.1016/j.anai.2025.01.016","url":null,"abstract":"","PeriodicalId":50773,"journal":{"name":"Annals of Allergy Asthma & Immunology","volume":"134 4","pages":"Pages 495-496"},"PeriodicalIF":5.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143043307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Highly accurate, noninvasive early identification of infants with a filaggrin loss-of-function mutation by in vivo Raman spectroscopy, followed from birth to 12 months","authors":"Gerwin J. Puppels PhD ,&nbsp;Jonathan O'B. Hourihane MD ,&nbsp;Claudio Nico PhD ,&nbsp;Carol Ni Chaoimh PhD ,&nbsp;Colin Wong BSc ,&nbsp;John E. Common PhD ,&nbsp;Peter J. Caspers PhD ,&nbsp;Alan D. Irvine MD, DSc","doi":"10.1016/j.anai.2025.01.010","DOIUrl":"10.1016/j.anai.2025.01.010","url":null,"abstract":"<div><h3>Background</h3><div>Loss-of-function <em>FLG</em> mutation (<em>FLGmut</em>) carriers are at an increased risk of developing atopic dermatitis (AD), characterized by earlier onset and more severe disease. AD is driven by a complex interplay between skin barrier function, T_H2 and T_H2-dominant immune dysregulation, and dysbiosis. Results from the Short-Term Topical Application for Prevention of Atopic Dermatitis study suggest 2 early initiating AD pathogenetic pathways: an <em>FLGmut</em>-related skin barrier deficiency pathway and an immune function-related inflammatory pathway. The Short-Term Topical Application for Prevention of Atopic Dermatitis study suggested that early preventative intervention with specialized emollients for barrier function augmentation may benefit newborns with <em>FLGmut</em>. This requires early identification of <em>FLGmut</em> carriers, for which noninvasive Raman spectroscopic determination of natural moisturizing factor (NMF) levels in the stratum corneum of the thenar eminence provides a surrogate marker.</div></div><div><h3>Objective</h3><div>To identify strategies for early identification of infants with <em>FLGmut</em>.</div></div><div><h3>Methods</h3><div><em>FLG</em> sequencing was performed on 253 infants, and NMF concentrations were measured in the stratum corneum of the palmar eminence (pSC-NMF) using noninvasive Raman spectroscopy at 6 time points after birth. Furthermore, the pSC-NMF concentrations were obtained from both parents of 150 infants.</div></div><div><h3>Results</h3><div>Babies are born with little to no NMF. In the first days after birth, NMF levels rapidly increase and 65% of newborns with <em>FLG</em> wild type already reach pSC-NMF concentrations, which excludes them as <em>FLGmut</em> carriers with high specificity. At 2 weeks of age, <em>FLGmut</em> carriers could be distinguished from newborns with <em>FLG</em> wild type with high sensitivity (97%) and specificity (97%). In addition, parent pSC-NMF concentrations offer the possibility to exclude their newborn as <em>FLGmut</em> carriers with high specificity.</div></div><div><h3>Conclusion</h3><div>Noninvasive Raman spectroscopy enables the accurate early identification of infants with <em>FLGmut</em>.</div></div>","PeriodicalId":50773,"journal":{"name":"Annals of Allergy Asthma & Immunology","volume":"134 4","pages":"Pages 457-464"},"PeriodicalIF":5.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}