Annals of Allergy Asthma & Immunology最新文献

{"title":"Hereditary angioedema","authors":"Timothy Craig DO ,&nbsp;Alan P. Baptist MD, MPH ,&nbsp;John Anderson MD ,&nbsp;Rafael H. Zaragoza-Urdaz MD ,&nbsp;Autumn F. Burnette MD ,&nbsp;Theodore E. Kelbel MD ,&nbsp;Marc A. Riedl MD, MS ,&nbsp;Alejandro Vanegas MS ,&nbsp;Kimberly Boyle MBA ,&nbsp;Jennifer L. Bartsch MSTAT ,&nbsp;Christina Darden BS ,&nbsp;T. Michelle Brown PhD ,&nbsp;Bob G. Schultz PharmD, MS ,&nbsp;Christopher Blair MS ,&nbsp;Krystal Sing MD ,&nbsp;Daniel Fox PharmD, MBA ,&nbsp;Salomé Juethner MSN, RN","doi":"10.1016/j.anai.2025.01.007","DOIUrl":"10.1016/j.anai.2025.01.007","url":null,"abstract":"<div><h3>Background</h3><div>Hereditary angioedema (HAE) is a rare disorder in which unpredictable angioedema attacks significantly affect patient quality of life. Information on patient experiences and perspectives of HAE management within underrepresented racial and ethnic groups is limited.</div></div><div><h3>Objective</h3><div>To gain insight into the experiences and perspectives of medical care and treatment of HAE among underrepresented racial and ethnic groups in the United States.</div></div><div><h3>Methods</h3><div>Adult patients diagnosed with having HAE who self-identified as members of an underrepresented racial and/or ethnic group were recruited to participate in a noninterventional, observational, web-based patient survey. The questionnaire included questions on medical history, current and past treatments, resource utilization, and perceived disease severity. The patient-perceived impact of HAE on the quality of life was also measured.</div></div><div><h3>Results</h3><div>Overall, 139 patients participated in the survey; 33.1% were identified solely as “African American or Black” and 30.2% solely as “Hispanic, Latin American, Latin, or Latine, or Latinx.” Before the diagnosis, 12.3% of the patients were satisfied with their HAE-related health care experiences. Many participants experienced difficulties obtaining an HAE diagnosis. Barriers to treatment include insufficient provider knowledge of HAE and misdiagnoses. More than 90% of the patients were satisfied with their care; however, patients reported 6 HAE attacks (median) in the past year and only 10.4% of the patients were attack free. Furthermore, 38.1% found it difficult or very difficult to cover the monthly out-of-pocket costs for HAE-related treatments and 24.6% felt that their provider sometimes/rarely/never considered their individual background when making medical decisions.</div></div><div><h3>Conclusion</h3><div>Barriers to HAE diagnosis and effective treatment persist among US patients from underrepresented racial and ethnic groups.</div></div>","PeriodicalId":50773,"journal":{"name":"Annals of Allergy Asthma & Immunology","volume":"134 4","pages":"Pages 465-473.e3"},"PeriodicalIF":5.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025693","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}

{"title":"The risk of donor-acquired allergy in solid-organ transplant recipients","authors":"Erika Yue Lee MD, MSc ,&nbsp;Kaylee Sohng MD ,&nbsp;Lianne G. Singer MD ,&nbsp;Susan M. Tarlo MBBS ,&nbsp;Elizabeth J. Phillips MD","doi":"10.1016/j.anai.2025.01.004","DOIUrl":"10.1016/j.anai.2025.01.004","url":null,"abstract":"<div><h3>Background</h3><div>Donor-acquired allergy (DAA) occurs when donors transfer their allergies to recipients through solid-organ transplant (SOT). However, the risk of DAA in recipients of organs from allergic donors has not been systematically characterized.</div></div><div><h3>Objective</h3><div>To synthesize the available evidence on the risk of DAA in SOT recipients.</div></div><div><h3>Methods</h3><div>We searched Embase and MEDLINE databases for original and peer-reviewed articles related to transplant allergy since database inception to February 11, 2024. Two reviewers independently screened records, extracted data, and assessed risk of bias.</div></div><div><h3>Results</h3><div>The review included 24 studies with 747 SOT recipients and their 135 allergic donors in the category of food, drug, or venom. Only 40 recipients (5.4%) underwent allergy testing to donor allergens, and 23 of them had the testing done before an exposure to donor allergens. Among the 30 recipients (4.0%) who were diagnosed with having DAA based on a clinical reaction or positive allergy testing result, 19 (2.5%) had anaphylaxis to donor allergens. Only the type of SOT (lung or liver) was associated with an increased risk of DAA (odds ratio 88.0, 95% CI 22.5-481.3), with no association found for other organs.</div></div><div><h3>Conclusion</h3><div>Despite the uncommon occurrence, recipients of organs from allergic donors could be at risk of severe allergic reactions to donor allergens. Although infrequently performed, allergy testing to donor allergens can effectively assess the risk of developing DAA. These findings highlight the risk of DAA and underscore the importance of proactive allergy assessment to prevent unnecessary anaphylaxis in this vulnerable population.</div></div>","PeriodicalId":50773,"journal":{"name":"Annals of Allergy Asthma & Immunology","volume":"134 4","pages":"Pages 474-483.e7"},"PeriodicalIF":5.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143043309","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}

{"title":"Asthma and evolving trends in allergy and immunology","authors":"Mitchell H. Grayson MD","doi":"10.1016/j.anai.2025.01.015","DOIUrl":"10.1016/j.anai.2025.01.015","url":null,"abstract":"","PeriodicalId":50773,"journal":{"name":"Annals of Allergy Asthma & Immunology","volume":"134 4","pages":"Page 369"},"PeriodicalIF":5.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143760456","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":"Precision medicine 2045","authors":"Erin L. Reigh MD, MS","doi":"10.1016/j.anai.2024.11.010","DOIUrl":"10.1016/j.anai.2024.11.010","url":null,"abstract":"","PeriodicalId":50773,"journal":{"name":"Annals of Allergy Asthma & Immunology","volume":"134 4","pages":"Pages 418-419"},"PeriodicalIF":5.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143761030","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":"The utility of casein spt and IgE values in predicting anaphylaxis and reactivity to baked-milk.","authors":"Mujde Tuba Cogurlu, Nezihe Nefise Uluc, Ismail Ozanli, Yeşim Ece Ozkan, Nagihan Iskender, Sibel Balci, Isıl Eser Simsek, Metin Aydogan","doi":"10.1016/j.anai.2025.03.020","DOIUrl":"https://doi.org/10.1016/j.anai.2025.03.020","url":null,"abstract":"<p><strong>Background: </strong>Most children with milk allergy can tolerate baked-milk; however, a small percent still react to it. Identifying indicators that might forecast potential reactions to baked goods is essential.</p><p><strong>Objective: </strong>The aim of this study is to determine the predictive factors and some decision points for estimation of baked-milk reactivity and severe reactions.</p><p><strong>Methods: </strong>A cross-sectional study was performed. Participants who were reactive to unheated-milk underwent an oral food challenge with baked milk. The reactive group was classified into anaphylactic and non-anaphylactic reaction categories. The immunoglobulin E and skin prick test levels of milk and its components were compared among these groups.</p><p><strong>Results: </strong>The study was conducted with 110 patients. The median age of participants was 16 months (IQR:12-31). Baked-milk reactivity was observed in 41% (n:46/110) of patients. The optimal cut-off point for baked-milk reactivity was 4.68kIU/L for casein-sIgE (84% specificity, 75% sensitivity, AUC:0.827) and 7mm for casein-SPT (87.2% specificity, 51.1% sensitivity, AUC:0.721)(p<0.001, p<0.001). The positive decision point for anaphylaxis for casein-sIgE was 34kIU/L (95% specificity, 47.6% sensitivity, AUC 0.707). In the group younger than 24 months old, the cut-off values for casein-sIgE were found to be 5.4kIU/L (95% specificity, 66.6% sensitivity, AUC:0.844) and casein-SPT 7mm (91% specificity, 37% sensitivity, AUC:0.708)(p<0.001, p:0.002).</p><p><strong>Conclusion: </strong>Our investigation revealed that the most accurate indicator for BM reactivity was casein-spIgE and SPT. While we established a threshold for severe reaction with BM in our study population, we consider that our findings require validation prior to therapeutic implementation.</p>","PeriodicalId":50773,"journal":{"name":"Annals of Allergy Asthma & Immunology","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143774837","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":"Discrepancies in Anaphylaxis Protocols Across Emergency Medical Services in the United States - Opportunities for Improvement.","authors":"Carly A Gunderson, Sandra M Lopez, Karishma Lukose, Nicole Akar-Ghibril","doi":"10.1016/j.anai.2025.03.021","DOIUrl":"https://doi.org/10.1016/j.anai.2025.03.021","url":null,"abstract":"<p><strong>Background: </strong>Across the United States, there are significant inconsistencies in the protocols used by Emergency Medical Services (EMS) in the prehospital treatment of anaphylaxis. These discrepancies include variations in the definition of anaphylaxis as well as treatment recommendations.</p><p><strong>Objective: </strong>This study performed an analysis of statewide anaphylaxis protocols to identify gaps in the recognition of anaphylaxis and to provide areas for improvement in prehospital management.</p><p><strong>Methods: </strong>States with mandatory or model state-wide protocols were included (total of 30). Each allergic reaction and/or anaphylaxis protocol was reviewed - emphasis was placed on the definitions used to identify reactions and treatment algorithms.</p><p><strong>Results: </strong>Of the 30 states, only 50% (15) included gastrointestinal symptoms in the definition of anaphylaxis, and only 40% (12) included neurologic manifestations. 47% (14) used a two-organ system definition. For anaphylactic reactions, 100% (30) of protocols recommended diphenhydramine and epinephrine. 90% (27) recommended albuterol if respiratory symptoms were present, and 60% (18) recommended steroids. Epinephrine was the first line recommendation for anaphylaxis in 97% (29) of protocols. 25 states (83%) allowed epinephrine autoinjectors and 17 (57%) provided autoinjectors.</p><p><strong>Conclusion: </strong>Many EMS anaphylaxis protocols are incomplete and/or outdated. Many protocols do not consider gastrointestinal or neurologic manifestations. Additionally, many contain outdated recommendations, including the use of steroids and first-generation antihistamines. Despite the convenience of epinephrine autoinjectors, many protocols do not permit or provide them. Given the frequency of EMS activation for allergic reactions, our communities would benefit from standardized protocols using current evidence-based guidelines for the management of anaphylaxis.</p>","PeriodicalId":50773,"journal":{"name":"Annals of Allergy Asthma & Immunology","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755323","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":"INSIGHTS INTO THE NATURAL HISTORY AND DISEASE COURSE OF EOSINOPHILIC ESOPHAGITIS.","authors":"Corey J Ketchem, Alexandra Strauss Starling","doi":"10.1016/j.anai.2025.03.019","DOIUrl":"https://doi.org/10.1016/j.anai.2025.03.019","url":null,"abstract":"<p><p>Eosinophilic esophagitis (EoE) is a chronic, immune-mediated disease marked by eosinophilic inflammation and esophageal dysfunction, with a significant impact on morbidity, quality of life, and healthcare utilization. Once considered rare, EoE has become increasingly prevalent, with global estimates exceeding 140 cases per 100,000 individuals. This rise highlights the need to better understand the natural history and disease course to inform diagnosis and management strategies. Evidence suggests EoE is a progressive condition, such that untreated inflammation contributes to esophageal remodeling and fibrotic complications over years to decades. Patients can develop esophageal food impactions, leading to emergency department utilization and the need for emergent endoscopy. Additionally, patients with fibrostenotic disease can require serial dilations. Long-term management, including dietary therapy, proton pump inhibitors (PPIs), topical corticosteroids (tCS), and newer therapies like dupilumab, show promise in altering the disease course. However, variability exists in the strength of evidence regarding each therapy's ability to halt or reverse fibrosis. Knowledge gaps persist, particularly in defining fibrosis, identifying phenotypes prone to progression, and tailoring therapies to individual patients. Addressing these gaps will require continued research into understanding fibrosis progression and how therapies alter this trajectory. These efforts are poised to significantly improve clinical care and enhance outcomes for patients with EoE.</p>","PeriodicalId":50773,"journal":{"name":"Annals of Allergy Asthma & Immunology","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755621","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":"The LEARN Early Project: Learning Educators' Anaphylaxis Response Needs.","authors":"Kelsey Kaman, Ashley Lahoud, Chris Flessner, Kelly Butler, Sarah Jane Lowery, Alice Hoyt","doi":"10.1016/j.anai.2025.03.018","DOIUrl":"https://doi.org/10.1016/j.anai.2025.03.018","url":null,"abstract":"<p><strong>Background: </strong>Food allergies are a growing public health problem, and young children in preschools and early childhood education centers face a significant risk of in-school allergic reactions. Food allergies also disproportionately affect children in underserved communities.</p><p><strong>Objective: </strong>The LEARN Early Project: Learning Educators' Anaphylaxis Response Needs was designed to assess food allergy knowledge and preparedness at federally funded Head Start centers.</p><p><strong>Methods: </strong>Upon partnership with Head Start centers in CT and LA, program directors and health care managers completed an Allergy Preparedness Questionnaire as well as the Food Allergy Knowledge Test. Additional questions examined rates of food allergies and feelings of preparedness to manage food allergy emergencies.</p><p><strong>Results: </strong>In a review of food allergy management policies at the centers, we identified multiple areas for potential policy improvement. We also found that the average food allergy knowledge test score was only 67.2% correct despite high levels of self-reported preparedness. There was not a positive correlation between self-reported preparedness and food allergy knowledge test score. These results suggest under-preparedness and overconfidence, which may create a barrier in motivating centers to pursue additional food allergy training. Indeed, we found that nearly half of teachers declined the need for additional education when asked what additional training would be helpful, and only 20% of center staff cited training as something that would help them feel more prepared in managing food allergy emergencies.</p><p><strong>Conclusion: </strong>Initial surveys demonstrate multiple barriers and knowledge gaps that exist surrounding food allergy and Head Start centers. This reveals an opportunity that could be key in improving health care outcomes among children in underserved communities.</p>","PeriodicalId":50773,"journal":{"name":"Annals of Allergy Asthma & Immunology","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755628","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":"Food Allergy and Asthma in a Nationally Representative Sample of Adolescents in the United States.","authors":"Saurabh Kalra, Deepak Kalra, Nandakumar Nagaraja, WayWay M Hlaing","doi":"10.1016/j.anai.2025.03.015","DOIUrl":"https://doi.org/10.1016/j.anai.2025.03.015","url":null,"abstract":"","PeriodicalId":50773,"journal":{"name":"Annals of Allergy Asthma & Immunology","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755332","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":"Safety and Pharmacokinetics of Long-Acting Plasma Kallikrein Inhibitor Navenibart (STAR-0215) in Healthy Adults.","authors":"William Lumry, Michele Gunsior, Theodora Cohen, Kristine Bernard, Pamela Gustafson, Jou-Ku Chung, Christopher Morabito","doi":"10.1016/j.anai.2025.03.016","DOIUrl":"https://doi.org/10.1016/j.anai.2025.03.016","url":null,"abstract":"<p><strong>Background: </strong>Hereditary angioedema (HAE) is a rare, autosomal dominant disorder characterized by bradykinin-mediated episodic, localized swelling that can be fatal. Currently approved long-term prophylactic therapies for HAE attacks incur substantial treatment burden through frequent dosing. Navenibart (STAR-0215) is a monoclonal antibody inhibitor of plasma kallikrein modified to extend circulating half-life and is under investigation for HAE prophylaxis.</p><p><strong>Objective: </strong>The aim of this study was to evaluate the safety, tolerability, pharmacokinetics (PK), and pharmacodynamics of a single dose of navenibart in healthy adults and to assess feasibility of every 3- and 6-month dosing.</p><p><strong>Methods: </strong>In this phase 1a study, participants were randomized 3:1 to receive placebo or navenibart in escalating (100 mg to 1200 mg) dosing cohorts. Safety outcomes, including treatment-emergent adverse events (TEAEs) and serious AEs, were monitored through end of study (Day 224). Additional endpoints included PK parameters and inhibition of plasma kallikrein activity.</p><p><strong>Results: </strong>In total, 31 participants received navenibart and 10 received placebo. The median age of participants was 36 years; 53.7% were male; 51.2% were Black or African American. Rates of TEAEs were similar between navenibart and placebo, and no serious AEs were reported. Navenibart-related TEAEs included injection-site reactions, inclusive of erythema, pruritic, and swelling, that resolved without intervention. For all doses ≥300 mg, navenibart mean half-life ranged from 82 to 105 days and inhibition of factor XIIa-induced plasma kallikrein activity versus placebo was statistically significant (P<0.05) Statistically significant inhibition of factor XIIa-induced plasma kallikrein activity versus placebo (P<0.05) was observed with all doses of navenibart.</p><p><strong>Conclusion: </strong>In this first-in-human study, up to 1200 mg of navenibart was well tolerated and demonstrated an extended half-life with durable plasma kallikrein inhibition.</p>","PeriodicalId":50773,"journal":{"name":"Annals of Allergy Asthma & Immunology","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755625","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}