Journal of Allergy and Clinical Immunology-In Practice最新文献

{"title":"Severe Fatigue in Uncontrolled Asthma: Contributing Factors and Impact of Rehabilitation.","authors":"Karin B Fieten, Lianne Ten Have, Linde N Nijhof, Lucia Rijssenbeek-Nouwens, Anneke Ten Brinke","doi":"10.1016/j.jaip.2024.08.050","DOIUrl":"https://doi.org/10.1016/j.jaip.2024.08.050","url":null,"abstract":"<p><strong>Background: </strong>Fatigue is a major concern for patients with severe asthma.</p><p><strong>Objective: </strong>This observational study aims to assess fatigue severity and associated factors, to explore the effect of pulmonary rehabilitation on fatigue, and to investigate which factors predict persistent severe fatigue.</p><p><strong>Methods: </strong>Patients with severe, uncontrolled asthma referred for alpine altitude climate treatment (AACT) between 2007 and 2018 were systematically assessed pre- and post-rehabilitation regarding clinical, inflammatory, functional, and psychological characteristics. Fatigue severity was assessed by Checklist Individual Strength (CIS-Fatigue). Multivariable regression analyses were used to identify factors associated with fatigue severity and persistence.</p><p><strong>Results: </strong>420 patients were assessed of whom 91% reported severe fatigue (CIS-Fatigue ≥36). Stepwise multiple regression explained 35% of variance in initial fatigue severity. Significant contributing factors were higher ACQ (36%), sleeping problems (21%), female sex (19%), reflux (12%) and lower FENO (12%). AACT led to significant improvements in CIS-Fatigue (median(IQR) 50(11) to 27(21)) (p<0.001), ACQ (3.0(1.3) to 1.2(1.3)) (p<0.001), and other asthma outcomes. However, 27% of patients reported persistent severe fatigue, correlating with less improvement in asthma outcomes. Daily oral corticosteroid (OCS) use OR(95%CI) 2.4(1.4-4.1), sleeping problems OR(95%CI) 2.7(1.6-4.5), initial very severe fatigue OR(95%CI) 3.1(1.6-6.3), and older age OR(95%CI) 1.02 (1.0-1.04) were independent predictors of persistent severe fatigue.</p><p><strong>Conclusion: </strong>Severe fatigue is highly prevalent in patients with severe, uncontrolled asthma. Alpine altitude climate treatment results in recovered fatigue and improved asthma control in most patients. Predicting factors of persistent fatigue suggest exploring the effect of targeted treatment strategies beyond the asthma domain.</p>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":null,"pages":null},"PeriodicalIF":8.2,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142141709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Successful introduction of peanut in sensitized infants with reported reactions at home.","authors":"Dirk H J Verhoeven, Olga Benjamin-van Aalst, Ted Klok, Wouter W de Weger, Mijke Breukels, Tom Hendriks, Roy Gerth van Wijk, Hans de Groot","doi":"10.1016/j.jaip.2024.08.047","DOIUrl":"https://doi.org/10.1016/j.jaip.2024.08.047","url":null,"abstract":"<p><strong>Background and objective: </strong>Previous studies have shown efficacy of early introduction of peanut to prevent peanut allergy. It is currently unknown which diagnostic pathway is optimal after parental-reported reactions to peanut at home after early introduction.</p><p><strong>Methods: </strong>The PeanutNL cohort study included high-risk infants that were referred for early introduction of peanut. A subgroup of 186 infants with reactions to peanut at home underwent peanut skin prick tests and a supervised open oral food challenge (OFC) at a median age of 8 months. After a negative OFC, peanut was introduced at home.</p><p><strong>Results: </strong>Sensitization to peanut was detected in 69% of 186 infants, of which 80% had > 4mm wheals in skin prick tests. An OFC with a cumulative dose of 4.4 gr peanut protein was performed in 163 infants with Sampson severity score grade I-III reactions at home; 120 challenges were negative. Peanut was subsequently introduced at home in infants with a negative challenge outcome. After 6 months, 96% were still eating peanut and 81% ate single portions of 3.0 gr peanut protein. One patient was considered to be peanut allergic after reintroduction of peanut at home.</p><p><strong>Conclusion: </strong>These data show that 65% of infants with reported reactions to peanut at home have negative OFCs. In those children, peanut could be introduced safely and 96% were able to consume peanut regularly without reactions. Challenging infants under 12 months of age prevents the misdiagnosis of peanut allergy, and enables safe continued exposure to peanut and the induction of long-term tolerance.</p>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":null,"pages":null},"PeriodicalIF":8.2,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142134428","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Depressive Symptom Severity in Mid- to Late-Life in Individuals with and without Asthma.","authors":"Jayme M Palka, Marquis Peacock, Megan Tusken, Madad Ibrahim, Aysha Najjab, Lillian Carter, David A Khan, E Sherwood Brown","doi":"10.1016/j.jaip.2024.08.046","DOIUrl":"https://doi.org/10.1016/j.jaip.2024.08.046","url":null,"abstract":"<p><strong>Clinical implications: </strong>In a large sample with assessments at multiple timepoints, older people with asthma had higher depressive symptom severity than those without asthma. Depression screening might be warranted in this population to address a modifiable risk factor for poor asthma outcomes.</p>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":null,"pages":null},"PeriodicalIF":8.2,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142134427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevention of exercise-induced anaphylaxis by ibrutinib","authors":"","doi":"10.1016/j.jaip.2024.05.036","DOIUrl":"10.1016/j.jaip.2024.05.036","url":null,"abstract":"","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":null,"pages":null},"PeriodicalIF":8.2,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141186911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of Pregnancy-Onset Asthma on Perinatal Outcomes: A Retrospective Cohort Study","authors":"","doi":"10.1016/j.jaip.2024.06.011","DOIUrl":"10.1016/j.jaip.2024.06.011","url":null,"abstract":"<div><h3>Background</h3><p>It is unknown whether women with pregnancy-onset asthma are predisposed to worse pregnancy outcomes compared with women with pre-pregnancy asthma.</p></div><div><h3>Objective</h3><p>To explore whether pregnancy-onset asthma leads to worse perinatal outcomes compared with pre-pregnancy asthma.</p></div><div><h3>Methods</h3><p>Women who were discharged with a diagnosis of asthma and gave birth to a live singleton were included in this retrospective cohort analysis. Women were separated into groups based on whether the asthma was diagnosed during or before pregnancy. We compared clinical characteristics, perinatal outcomes, and asthma exacerbations (AEs) between groups.</p></div><div><h3>Results</h3><p>A total of 335 women were included in this study, 39 of whom (11.6%) had pregnancy-onset asthma and 296 had pre-pregnancy asthma. All pregnant women in the pregnancy-onset group experienced AEs during pregnancy. The proportion of chronic hypertension, chronic hypertension with superimposed preeclampsia, and spontaneous preterm births in the pregnancy-onset group was significantly higher than that in the pre-pregnancy asthma group. After adjusting for age, body mass index, onset of asthma during pregnancy, and severity of AEs through multivariate analysis, pregnancy-onset asthma was an independent risk factor for spontaneous preterm birth (adjusted odds ratio = 7.71; 95% CI, 1.30-46.12) and severe AE was an independent risk factor for gestational hypertension and preeclampsia (adjusted odds ratio = 3.58; 95% CI, 1.30-9.87).</p></div><div><h3>Conclusions</h3><p>During pregnancy, pregnancy-onset asthma in women is associated with an exacerbation of the condition. Obstetricians should be vigilant for signs of asthma onset during pregnancy. Other health care providers should watch for symptoms of gestational hypertension and preeclampsia in pregnant women with preexisting or new-onset asthma.</p></div>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":null,"pages":null},"PeriodicalIF":8.2,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2213219824006317/pdfft?md5=65e9291b6c1191e2363b8ea7e1fe5395&pid=1-s2.0-S2213219824006317-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141332472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safe Penicillin Allergy Delabeling in Primary Care: A Systematic Review and Meta-Analysis","authors":"","doi":"10.1016/j.jaip.2024.06.017","DOIUrl":"10.1016/j.jaip.2024.06.017","url":null,"abstract":"<div><h3>Background</h3><p>Ten percent of the population is labeled as allergic to penicillin(s), when in fact 90% of these labels are inappropriate. Recent studies have shown that inpatient delabeling by a direct drug challenge (dDC) is safe in low-risk patients. However, there is a need for outpatient and nonallergist delabeling.</p></div><div><h3>Objective</h3><p>To assess the safety of delabeling low-risk adults by means of dDC in primary care.</p></div><div><h3>Methods</h3><p>We searched the MEDLINE, Embase, and Cochrane Library databases from inception to March 15, 2022 (updated June 5, 2023) for studies performing dDC in adults in primary care or other outpatient settings. Two researchers independently screened studies for eligibility. The data extraction and critical appraisal were performed by 1 reviewer, and we pooled the results in a meta-analysis.</p></div><div><h3>Results</h3><p><span><span>Of 2138 results, 12 studies (1070 participants) were eligible for inclusion. Three studies evaluated delabeling in primary care and 9 studies in an outpatient hospital setting. There were no critical </span>adverse events during dDC. No reaction occurred in 97.13% of the 1070 patients, who previously labeled as penicillin-allergic, and were safely delabeled. Ten patients (&lt;1%) developed an immediate reaction: 3 had self-limiting reactions and 7 needed </span>antihistaminics<span>, steroids, epinephrine, and/or salbutamol.</span></p></div><div><h3>Conclusions</h3><p><span>No serious allergic reactions are observed during direct </span>amoxicillin<span> challenge in adults in an outpatient setting. However, with the exception of 1 recent report, these studies are of low to moderate quality. Nonspecialist delabeling is promising, but further research is required on correct risk stratification<span> and safety assessment in large cohort studies evaluating dDC in primary care.</span></span></p></div>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":null,"pages":null},"PeriodicalIF":8.2,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141433329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anaphylaxis in Practice: A Guide to the 2023 Practice Parameter Update","authors":"","doi":"10.1016/j.jaip.2024.06.036","DOIUrl":"10.1016/j.jaip.2024.06.036","url":null,"abstract":"<div><p>This review summarizes new research developments and clinical practice recommendations for the diagnosis and management of anaphylaxis presented in the Joint Task Force on Practice Parameters 2023 Anaphylaxis practice parameter Update. It is intended to serve as a high-level summary of the 2023 practice parameter, which makes clinically impactful recommendations based on evidence that has emerged since the 2015 practice parameter. We invite clinicians to explore the full 2023 practice parameter to understand the research methods and underlying evidence that have informed the recommendations summarized here. There are new and evolving diagnostic criteria for anaphylaxis, rules for defining elevated tryptase levels, and recognition of signs and symptoms particular to infants and toddlers. The administration of epinephrine should not be used as a surrogate to diagnose anaphylaxis. Risk factors for anaphylaxis should be assessed on a case-by-case basis. Patient counseling and shared decision-making are essential to support patients' treatment decisions and capacity to manage the risk of anaphylaxis at home and in other community settings. Activation of emergency medical services after home epinephrine administration may not be required in all cases, and patients should be engaged in shared decision-making to determine when home management may be appropriate.</p></div>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":null,"pages":null},"PeriodicalIF":8.2,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141472468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comorbid Scenarios in Contact Dermatitis: Atopic Dermatitis, Irritant Dermatitis, and Extremes of Age","authors":"","doi":"10.1016/j.jaip.2024.04.052","DOIUrl":"10.1016/j.jaip.2024.04.052","url":null,"abstract":"<div><p>Contact dermatitis (allergic and irritant) occurs when the skin encounters haptens that elicit a T cell–mediated hypersensitivity reaction (allergic) or a nonimmunologic, toxic reaction (irritant). Patch testing is the reference standard for diagnosing allergic contact dermatitis (ACD), although positive results are not always relevant. Therefore, the definitive diagnosis of ACD requires an astute clinician able to connect the results of patch testing appropriately with the clinical history and the cutaneous examination findings. Comorbid conditions such as atopic dermatitis can confound the accurate diagnosis of ACD because of the similarities in clinical presentation. Furthermore, both extremes of age can further challenge the diagnostic specificity of ACD owing to the maturing immune system and the space limitations present when the very young are patch tested. The goal of this Continuing Medical Education article is to discuss the challenges of diagnosing ACD in patients with unique comorbidities such as atopic dermatitis, given the morphologic similarities, and when to patch test these patients. Diagnosis of ACD will also be discussed in very young patients with a focus on patch test allergen selection despite the limited geographic space. The most common allergens reported in very young and old patients will also be discussed.</p></div>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":null,"pages":null},"PeriodicalIF":8.2,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142146835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extending Personalized Evidence-Based Medicine in Severe Asthma","authors":"","doi":"10.1016/j.jaip.2024.06.038","DOIUrl":"10.1016/j.jaip.2024.06.038","url":null,"abstract":"","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":null,"pages":null},"PeriodicalIF":8.2,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142146837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Information for Readers","authors":"","doi":"10.1016/S2213-2198(24)00786-4","DOIUrl":"10.1016/S2213-2198(24)00786-4","url":null,"abstract":"","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":null,"pages":null},"PeriodicalIF":8.2,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2213219824007864/pdfft?md5=644e30069f5faeb633bffabb340f3cbd&pid=1-s2.0-S2213219824007864-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142149505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}