Annals of Allergy Asthma & Immunology最新文献

{"title":"Outcomes and variation in management of penicillin allergy in pregnant patients presenting for prenatal care","authors":"Victoria T. Nguyen DO , Mitchell Shelton MD , Monica T. Kraft MD","doi":"10.1016/j.anai.2025.02.014","DOIUrl":"10.1016/j.anai.2025.02.014","url":null,"abstract":"","PeriodicalId":50773,"journal":{"name":"Annals of Allergy Asthma & Immunology","volume":"134 5","pages":"Pages 610-611"},"PeriodicalIF":5.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143532137","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":"Thinking like a Bayesian: Diagnostic food allergy testing at the extremes of clinical certainty","authors":"Marcus S. Shaker MD, MS , Aikaterini Anagnostou MD, PhD , Matthew Greenhawt MD, MBA, MSc , Benjamin T. Prince MD, MSCI , Kristin Sokol MD, MS, MPH","doi":"10.1016/j.anai.2024.11.027","DOIUrl":"10.1016/j.anai.2024.11.027","url":null,"abstract":"","PeriodicalId":50773,"journal":{"name":"Annals of Allergy Asthma & Immunology","volume":"134 5","pages":"Pages 504-505"},"PeriodicalIF":5.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792733","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":"Mannitol provocation enhances laryngoscopic diagnosis of suspected inducible laryngeal obstruction","authors":"Stephanie Stojanovic MBBS ,&nbsp;Asger Sverrild PhD, MD ,&nbsp;Tunn Ren Tay MRCP ,&nbsp;Eve Denton PhD, MPH ,&nbsp;Kavitha Garuna Murthee MBBS, MRCP ,&nbsp;Tiffany Lin MBBS ,&nbsp;Logan Gardner MBBS ,&nbsp;Melanie Wong MBBS ,&nbsp;Brigitte Borg BAppSc ,&nbsp;Janine Mahoney B Speech Pathology ,&nbsp;Joy Lee PhD ,&nbsp;Mark Hew PhD, MSc","doi":"10.1016/j.anai.2025.02.001","DOIUrl":"10.1016/j.anai.2025.02.001","url":null,"abstract":"<div><h3>Background</h3><div>Inducible laryngeal obstruction (ILO) is confirmed by observing paradoxical vocal fold movement (PVFM) on laryngoscopy, but test sensitivity is reduced by its intermittent nature. Specificity of isolated expiratory PVFM is also unclear, possibly denoting a physiological response to lower airway obstruction.</div></div><div><h3>Objective</h3><div>To clarify laryngoscopic diagnosis in suspected ILO through mannitol provocation.</div></div><div><h3>Methods</h3><div>In patients with suspected ILO, we assessed rates of laryngoscopic PVFM, both at baseline and after mannitol provocation, defined as any inspiratory adduction, more than or equal to 50% expiratory adduction, or both. We also studied accentuation of laryngoscopic findings after mannitol provocation, defined as new or increased PVFM. We explored relationships between isolated expiratory PVFM, lower airway obstruction on spirometry, and bronchial hyperresponsiveness to mannitol. We also studied healthy volunteers.</div></div><div><h3>Results</h3><div>Among 80 patients with suspected ILO, PVFM rates were 42 (52.5%) at baseline and 58 (72.5%) after mannitol. Mannitol accentuated laryngoscopic findings in 45 of 80 (56%), with new PVFM in 17 of 80 (21%) and increased PVFM in 28 of 80 (35%) and 28 of 42 (67%) of patients with PVFM at baseline. Among patients with baseline isolated expiratory PVFM, 21 of 30 had accentuation by mannitol and there was no relationship with airway obstruction or bronchial hyperresponsiveness. Among healthy volunteers, PVFM rates were identical at baseline and after mannitol (4/15, 27%, all 4 with isolated expiratory PVFM); none (0/15) had accentuation by mannitol.</div></div><div><h3>Conclusion</h3><div>Accentuation of laryngoscopic findings after mannitol provocation is more useful than PVFM at baseline laryngoscopy in distinguishing patients with suspected ILO from healthy volunteers. Isolated expiratory PVFM without accentuation by mannitol can be a normal finding and unrelated to bronchial obstruction or hyperresponsiveness.</div></div>","PeriodicalId":50773,"journal":{"name":"Annals of Allergy Asthma & Immunology","volume":"134 5","pages":"Pages 563-569"},"PeriodicalIF":5.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392236","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":"Managing childhood asthma with an eye toward environmental, social, and behavioral features","authors":"Emily H. Skeen MD,&nbsp;Katharine L. Hamlington PhD,&nbsp;Heather H. De Keyser MD,&nbsp;Andrew H. Liu MD,&nbsp;Stanley J. Szefler MD","doi":"10.1016/j.anai.2025.02.013","DOIUrl":"10.1016/j.anai.2025.02.013","url":null,"abstract":"<div><div>Discussions on asthma management tend to focus on the therapeutic aspects when updates on asthma strategies are released. However, many other components of asthma management are now receiving increased attention, as we seek to make right on health disparities and strive toward health equity. In addition, with the therapeutic aspects of asthma, we now realize that our anti-inflammatory approaches largely address the high T2 component of airway inflammation. However, we know very little about what we can do to control the other inflammatory features that contribute to asthma. Factors, such as environmental exposures, social determinants of health, and risk-taking behaviors may be at the root of asthma persistence, progression, and comorbidities. We will continue to learn methods to identify these issues and draw them into a shared decision-making approach for dialogue with patients and their caregivers. This review provides information and tools to address the nonpharmacologic aspects of asthma management.</div></div>","PeriodicalId":50773,"journal":{"name":"Annals of Allergy Asthma & Immunology","volume":"134 5","pages":"Pages 516-524"},"PeriodicalIF":5.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143517132","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":"Want to help your patients with food allergy anxiety? Do proximity challenges!","authors":"Katherine K. Dahlsgaard PhD, ABPP ,&nbsp;Megan O. Lewis MSN, RN, CPNP-PC","doi":"10.1016/j.anai.2025.02.020","DOIUrl":"10.1016/j.anai.2025.02.020","url":null,"abstract":"<div><div>Excessive anxiety regarding the potential for accidental and fatal cross-contamination is very common among patients and families with food allergy and contributes significantly to burden, reduced quality of life, and poorer management. In their landmark paper published nearly a decade ago, Dr Chitra Dinakar and colleagues recommended that food allergists incorporate proximity food challenges such as smelling or touching an allergen into regular clinical practice to improve patient knowledge regarding safety and relative risk and reduce anxiety. Such proximity challenges are akin to the exposure tasks routinely used to treat anxiety in cognitive-behavioral therapy, the first-line psychosocial intervention for anxiety disorders. Exposure is a highly evidence-based therapy technique in which patients—guided and encouraged by their providers—directly and strategically confront a feared object, situation, or activity. Anxiety eventually diminishes and erroneous beliefs are corrected when exposures happen repeatedly in the absence of the feared negative outcome. Following a summary of the history and evidence base for exposure in both the psychiatric and food allergy literature, we review several considerations related to conducting in-office proximity challenges. Topics include in-office assessment of food allergy anxiety and medically unnecessary avoidance; choosing appropriate, individualized proximity challenges based on patient presentation; and practical considerations in carrying out in-office proximity challenges to maximize benefits to anxious patients.</div></div>","PeriodicalId":50773,"journal":{"name":"Annals of Allergy Asthma & Immunology","volume":"134 5","pages":"Pages 525-532"},"PeriodicalIF":5.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634593","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":"Depression and anxiety in patients with atopic dermatitis","authors":"Jennifer S. LeBovidge PhD ,&nbsp;Lynda C. Schneider MD","doi":"10.1016/j.anai.2025.02.017","DOIUrl":"10.1016/j.anai.2025.02.017","url":null,"abstract":"<div><div>The psychosocial burden of atopic dermatitis (AD) is extensive, stemming from intense itch, sleep disturbance, unpredictable flares, lifestyle restrictions and missed activities, social stigma, and treatment burden. Overall, adults with AD are at a 2- to 3-fold greater risk for depression and anxiety compared with individuals without AD and children at a 1.5-fold greater risk, with greatest risk for those with more severe disease. A number of mechanisms seem to affect the relationship between AD and mental health, including poorly controlled disease, sleep disturbance, stress-induced itch, inflammation, and coping patterns. In some cases, the mental health burden of AD may also negatively affect AD management and course, creating a reinforcing cycle of psychosocial burden. Although depression and anxiety are known comorbidities of AD, the mental health burden of AD often goes unaddressed, which may further a sense of isolation for patients and families. Given the strong association between symptom severity and increased mental health burden, optimizing AD treatment and reducing itch are critical. Health care professionals can support patients with AD and their caregivers by encouraging open conversations about mental health, addressing common areas of condition-related stress, screening for depression and anxiety, and facilitating referrals to mental health professionals for further assessment and evidence-based care. Existing research supports use of cognitive-behavioral interventions to help manage the physical and mental health burden of AD. Further research is needed to evaluate psychological interventions for pediatric patients with AD and for patients with clinical diagnoses of depression and anxiety to better guide shared decision-making around support for these patients.</div></div>","PeriodicalId":50773,"journal":{"name":"Annals of Allergy Asthma & Immunology","volume":"134 5","pages":"Pages 506-515"},"PeriodicalIF":5.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674510","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":"10 ways to improve …","authors":"Mitchell H. Grayson MD","doi":"10.1016/j.anai.2025.01.023","DOIUrl":"10.1016/j.anai.2025.01.023","url":null,"abstract":"","PeriodicalId":50773,"journal":{"name":"Annals of Allergy Asthma & Immunology","volume":"134 5","pages":"Page 499"},"PeriodicalIF":5.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143913161","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":"10 ways to improve your management of food allergy","authors":"Aikaterini Anagnostou MD, MSc, PhD ,&nbsp;Jay Lieberman MD ,&nbsp;Theresa Bingemann MD ,&nbsp;Tim Buckey MD ,&nbsp;Antonella Cianferoni MD, PhD ,&nbsp;Arjola Cosper DO ,&nbsp;Edwin Kim MD ,&nbsp;Marissa Love MD ,&nbsp;Anu Mallapaty DO ,&nbsp;Lindsey Moore MD ,&nbsp;Richard Wasserman MD, PhD ,&nbsp;Anna Nowak-Wegrzyn MD ,&nbsp;Shaan Somani MD ,&nbsp;Joyce Yu MD ,&nbsp;Matthew Greenhawt MD, MBA, MSc","doi":"10.1016/j.anai.2025.01.014","DOIUrl":"10.1016/j.anai.2025.01.014","url":null,"abstract":"","PeriodicalId":50773,"journal":{"name":"Annals of Allergy Asthma & Immunology","volume":"134 5","pages":"Pages 616-618"},"PeriodicalIF":5.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143913085","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":"On-demand treatment of hereditary angioedema attacks","authors":"Sandra Christiansen MD ,&nbsp;Maeve O'Connor MD ,&nbsp;Timothy Craig DO ,&nbsp;Cristine Radojicic MD ,&nbsp;H. James Wedner MD ,&nbsp;Sherry Danese MBA ,&nbsp;Julie Ulloa BA ,&nbsp;Vibha Desai PhD ,&nbsp;Christopher Utter PhD ,&nbsp;Tomas Andriotti MD ,&nbsp;Paul Audhya MD ,&nbsp;Paula Busse MD","doi":"10.1016/j.anai.2024.12.012","DOIUrl":"10.1016/j.anai.2024.12.012","url":null,"abstract":"<div><h3>Background</h3><div>Hereditary angioedema (HAE) is clinically characterized by recurrent attacks of subcutaneous and submucosal swelling.</div></div><div><h3>Objective</h3><div>To investigate real-world timing, potential barriers, and impact of delaying on-demand treatment (OD) of HAE attacks.</div></div><div><h3>Methods</h3><div>Patients with HAE (type I or II) aged 12 years or older with more than or equal to 1 treated (Treated Cohort) or untreated (Untreated Cohort) attack in the past 3 months were recruited by the US HAE Association. Respondents completed a 20-minute, self-reported, online survey about their last HAE attack.</div></div><div><h3>Results</h3><div>In the Treated Cohort (n = 94), of the 67% who reported treating their attack early, only 26% administered OD in less than 1 hour. Furthermore, 79% (n = 74) reported treatment-related anxiety, which correlated with treatment delay. Time to treatment paralleled changes in attack severity (33% mild attacks treated in &lt;1 hour vs 67% in ≥1 hour, progressed to moderate/severe) and mean duration (&lt;1 hour: 0.7 day; &gt;8 hours: 2.7 days). In the Untreated Cohort (n = 20), 50% of the respondents describing their last untreated attack as mild experienced progression to moderate or severe and 25% reported spread to another site including the larynx and face. Untreated attacks lasted a mean of 2.3 days.</div></div><div><h3>Conclusion</h3><div>The disparity between survey respondents’ perception of treating early and actual time to OD administration is striking. Treatment-related anxiety was a common reason for delaying OD. Increased treatment intervals translated into progression of HAE attack severity, duration, and spread to other sites. Suboptimal management of attacks intensifies the HAE disease burden, underscoring the need for improved treatment options, guidance, and removal of OD administration barriers.</div></div>","PeriodicalId":50773,"journal":{"name":"Annals of Allergy Asthma & Immunology","volume":"134 5","pages":"Pages 570-579.e4"},"PeriodicalIF":5.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142856548","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":"A health economic analysis of noninjectable epinephrine compared with intramuscular epinephrine","authors":"Marcus S. Shaker MD, MS ,&nbsp;John Oppenheimer MD ,&nbsp;Nicholas L. Rider DO ,&nbsp;David B.K. Golden MDCM ,&nbsp;Aikaterini Anagnostou MD, PhD ,&nbsp;Matthew Greenhawt MD, MBA, MSc","doi":"10.1016/j.anai.2024.11.025","DOIUrl":"10.1016/j.anai.2024.11.025","url":null,"abstract":"<div><h3>Background</h3><div>Noninjectable epinephrine to treat allergic reactions addresses an unmet need. Intranasal epinephrine is approved and a sublingual form is under development. Inhaled epinephrine is poorly studied for anaphylaxis. These forms have unknown cost-effectiveness.</div></div><div><h3>Objective</h3><div>To evaluate cost-effectiveness of commercially available noninjectable epinephrine compared with intramuscular epinephrine for treatment of anaphylaxis.</div></div><div><h3>Methods</h3><div>Markov cohort analyses evaluated the cost-effectiveness of noninjectable epinephrine forms. The base-case assumed exaggerated anaphylaxis fatality rates (50-fold increase) for using inhaled epinephrine given low certainty evidence in anaphylaxis and deliberately reduced fatality risk for nasal or sublingual forms (10-fold reduction) theorizing higher adherence and early use during an allergic reaction.</div></div><div><h3>Results</h3><div>In the base-case scenario, assuming a 10-fold decreased risk in peanut allergy fatality associated with intranasal or sublingual epinephrine treatment for a severe allergic reaction (net monetary benefit [NMB], $2,189,134) vs intramuscular epinephrine use (NMB, $2,189,114), intranasal or sublingual epinephrine was the most cost-effective option (incremental cost-effectiveness ratio [ICER], $83,748/quality-adjusted life-year [QALY]), but only at a marginal annual cost of $4. Intramuscular epinephrine was cost-effective (ICER, $17,900/QALY) vs inhaled epinephrine (NMB, $2,183,531), although inhaled epinephrine reached cost-effectiveness (willingness to pay [$100,000/QALY]) if associated fatality risk fell below 2.5-fold. Substituting a single noninjectable form of epinephrine for a second injectable device (in patients prescribed 2 autoinjectors already) would be cost-effective; however, adding a supplemental noninjectable device was not cost-effective, even assuming a 10-fold risk reduction with multiple device carriage (ICER, $858,462).</div></div><div><h3>Conclusion</h3><div>Noninjectable routes of epinephrine can be cost-effective options provided fatality risk is not significantly elevated. Carriage of redundant epinephrine autoinjectors with noninjectable forms is not cost-effective if associated with excess cost of redundant device packs.</div></div>","PeriodicalId":50773,"journal":{"name":"Annals of Allergy Asthma & Immunology","volume":"134 5","pages":"Pages 587-593.e1"},"PeriodicalIF":5.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787681","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}