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

{"title":"Angioedema due to acquired C1-inhibitor deficiency without hematological condition: a multicenter French cohort study of 34 patients.","authors":"Romain Stammler, Federica Defendi, Magali Aubineau, Beatrice Bibes, Isabelle Boccon-Gibod, Laurence Bouillet, Yoann Crabol, Marie Caroline Dalmas, Claire de Moreuil, Aurelien Delluc, Claire Dingremont, Aurelie Du-Thanh, Jerome Hadjadj, Pierre-Yves Jeandel, Galith Kalmi, Marion Lacoste, Ludovic Martin, Chloé Mc Avoy, Claire Blanchard-Delaunay, Marie Caroline Taquet, Olivier Fain, Delphine Gobert","doi":"10.1016/j.jaip.2024.12.027","DOIUrl":"https://doi.org/10.1016/j.jaip.2024.12.027","url":null,"abstract":"<p><strong>Background: </strong>Angioedema (AE) due to acquired C1-inhibitor deficiency (AAE-C1-INH) is a rare disease associating recurrent edema of mucosa and skin. Several underlying diseases have been reported, mainly lymphoproliferative diseases and monoclonal gammopathy. However, 15 to 20% of patients never exhibit such a hematological condition.</p><p><strong>Objective: </strong>To analyze specific features of patients with AAE-C1-INH without hematological condition METHODS: A multicenter retrospective cohort study of patients with AAE-C1-INH without hematological condition included from January 1999 to May 2024 in the French national CREAK registry; the clinical and biological characteristics of patients were detailed, then compared to patients with AAE-C1-INH associated with lymphoid hemopathies or monoclonal gammopathy.</p><p><strong>Results: </strong>Thirty-four patients were included. All patients displayed a functional C1-INH below 50% of the reference value; 26 (76%) also had a decreased C1-INH antigen level; 26 (76%) displayed anti-C1-INH antibodies. After a median follow-up of 65 months, 4 (12%) patients were in spontaneous complete remission of angioedema; 15 (44%) were in complete response under long-term prophylactic treatment. Comparatively to 75 patients with lymphoma associated-AAE-C1-INH, patients with AAE-C1-INH without hematological condition displayed a higher incidence of anti-C1-INH antibodies and received more frequently symptomatic or prophylactic treatment with a lower remission rate at last follow-up. Clinical and biological features of AAE-C1-INH without hematological condition patients were similar to those of 30 monoclonal gammopathy associated-AAE-C1-INH patients.</p><p><strong>Conclusion: </strong>AAE-C1-INH without hematological condition display a different clinical and biological presentation from lymphoma associated-AAE-C1-INH. No autoimmune disease was identified. Unlike rituximab, long-term prophylaxis seems to prevent angioedema attacks among these patients.</p>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":" ","pages":""},"PeriodicalIF":8.2,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142933511","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":"A Guide to Pediatric Antibiotic Allergy Testing: A Report From the US Drug Allergy Registry.","authors":"John J O Accarino, Timothy G Chow, Allison Ramsey, Christine R F Rukasin, Alexei Gonzalez-Estrada, Anne Y Liu, David A Khan, Kimberly G Blumenthal","doi":"10.1016/j.jaip.2024.12.036","DOIUrl":"10.1016/j.jaip.2024.12.036","url":null,"abstract":"<p><p>Pediatric antibiotic labels are common, and unnecessary antibiotic avoidance is associated with negative personal and public health outcomes; as a result, there is an increasing emphasis on the importance of pediatric antibiotic allergy evaluations. Different testing strategies have been advised, including skin testing and challenge testing with varied doses and duration. Established consensus testing protocols are lacking. The US Drug Allergy Registry Pediatrics (USDAR-Peds) is a multisite prospective study designed for epidemiology and outcome evaluations of pediatric drug hypersensitivity reactions. Interpretation of multisite data requires a uniform clinical approach, and the USDAR-Peds standardized protocols were developed in response to this need. This rostrum aims to provide a rationale and framework for standardization for pediatric antibiotic allergy protocols and assessment of positive reactions through a pediatric-specific adaptation of the USDAR immediate reaction grading scale to create consistency for multisite research collaboration efforts such as USDAR-Peds.</p>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":" ","pages":""},"PeriodicalIF":8.2,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142928504","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":"Insect Allergy: Barriers in Training and Practice: A Work Group Report of the AAAAI Anaphylaxis Committee.","authors":"Karla Adams, Matthew Greenhawt, Theresa Bingemann, James Tracy, Joel Brooks, Hans Otto, Daniel Steigelman, Yvonne Hsieh, Aikaterini Anagnostou, John Carlson, Jeffrey Demain, Aasha Harish, Nina Hein, Anil Nanda, Monica Hajirawala, Susan Waserman, David B K Golden","doi":"10.1016/j.jaip.2024.12.037","DOIUrl":"https://doi.org/10.1016/j.jaip.2024.12.037","url":null,"abstract":"<p><strong>Background: </strong>The evaluation and management of insect sting allergy is a complex core competency taught in Allergy and Immunology fellowship programs. It is unclear if current training on insect allergy is sufficient to meet the needs of the field, and what training barriers exist.</p><p><strong>Objective: </strong>To investigate the extent of training on stinging insect allergy, and factors currently impacting stinging insect allergy clinical practice through a pilot needs-assessment survey.</p><p><strong>Methods: </strong>A web-based questionnaire was designed and sent to a 20% random sample of American Academy of Allergy, Asthma & Immunology member categories. Data were analyzed for descriptive frequencies.</p><p><strong>Results: </strong>A total of 78 responses were received (11% response rate). Respondents' mean age was 53.7 years, 52% were female and 92.3% were physicians. The mean time since training completion was 18.4 years. During fellowship training, 95.7% were educated on stinging insect allergy, 87.1% reported conducting testing and 82.6% ordered venom immunotherapy (VIT). During training, 50% of respondents managed 1-5 patients with venom allergy, (38% managed >5, and 12% none). After fellowship, 97.3% reported evaluating patients with stinging insect allergy, 90.3% report evaluating 1-5 patients per month and 93.2% and 87.5% offer testing and VIT (respectively). A patient's decision to not start VIT was the most common barrier reported by 81.8%.</p><p><strong>Conclusion: </strong>In this pilot needs-assessment survey, the majority reported training and education on insect allergy during fellowship, though patient exposure was low for most. After fellowship, insect allergy evaluations increase up to 24-fold compared to fellowship training and patient-driven decisions are the most common deterrent for VIT.</p>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":" ","pages":""},"PeriodicalIF":8.2,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142928505","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":"Guidance for the Evaluation by Payors of Claims Submitted Using Current Procedural Terminology Codes 95165, 95115, and 95117.","authors":"J Allen Meadows, Gary N Gross, Anita N Wasan, Dole P Baker, Amber Patterson, Robert Puchalski, Anil Nanda, Jami Lucas, J Wesley Sublett, Paul V Williams","doi":"10.1016/j.jaip.2024.10.025","DOIUrl":"10.1016/j.jaip.2024.10.025","url":null,"abstract":"","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":" ","pages":"66-68"},"PeriodicalIF":8.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142583726","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":"Risk Factors for Severe Sting Reactions and Side Effects During Venom Immunotherapy.","authors":"Gunter J Sturm, Eva Schadelbauer, Giorgia Marta, Patrizia Bonadonna, Mitja Kosnik","doi":"10.1016/j.jaip.2024.08.025","DOIUrl":"10.1016/j.jaip.2024.08.025","url":null,"abstract":"<p><p>Understanding the risk factors leading to severe systemic sting reactions (SSRs) is crucial for initiating venom immunotherapy (VIT) and for educating affected individuals and their families. Some of these risk factors are well established, some are no longer considered risk factors, and some remain controversial. Well-established risk factors for severe SSRs include clonal mast cell disease, high baseline serum tryptase, and advanced age. The absence of skin symptoms and the rapid onset of symptoms are indicators of severe SSRs. Recent publications indicate that antihypertensive treatment and stings in the head and neck area are not risk factors for severe SSRs. VIT is the only available treatment that can potentially prevent further anaphylactic reactions. Although rare and generally manageable, individuals undergoing VIT may experience systemic adverse events (sAEs). More sAEs are expected in patients undergoing bee VIT compared with vespid VIT. The role of elevated baseline serum tryptase as a risk factor for sAEs remains debated, but if it is a factor, the risk is increased by only about 1.5-fold. Rapid updosing protocols, depending on the specific regimen, can also be associated with more sAEs. Severe initial SSRs, antihypertensive medication, high skin test reactivity, and high specific IgE levels are not risk factors for sAEs.</p>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":" ","pages":"17-23"},"PeriodicalIF":8.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142037659","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":"Tolerance of penicillin V in patients with confirmed delayed hypersensitivity reactions to aminopenicillins.","authors":"Ibtihal Alotaibi, Rabea Y Khoudja, Ghislaine A C Isabwe, Michael Fein, Florian Stehlin, Fiona James, Moshe Ben-Shoshan, Jason A Trubiano, Ana Maria Copaescu","doi":"10.1016/j.jaip.2024.10.018","DOIUrl":"10.1016/j.jaip.2024.10.018","url":null,"abstract":"","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":" ","pages":"238-240.e1"},"PeriodicalIF":8.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142512578","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":"Insect Sting Allergy: Getting Better All the Time.","authors":"David B K Golden, Axel Trautmann","doi":"10.1016/j.jaip.2024.09.022","DOIUrl":"https://doi.org/10.1016/j.jaip.2024.09.022","url":null,"abstract":"","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"13 1","pages":"61-65"},"PeriodicalIF":8.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142958576","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":"Dupilumab Induces Long-Term On-Treatment Clinical Remission in Patients With Type 2 Asthma.","authors":"Ian D Pavord, Klaus F Rabe, Elliot Israel, Stanley J Szefler, Guy Brusselle, Nami Pandit-Abid, Arman Altincatal, Zhen Chen, Nikhil Amin, Asif H Khan, David J Lederer, Yi Zhang, Paul J Rowe, Yamo Deniz, Amr Radwan, Juby A Jacob-Nara, William W Busse","doi":"10.1016/j.jaip.2024.10.009","DOIUrl":"10.1016/j.jaip.2024.10.009","url":null,"abstract":"<p><strong>Background: </strong>Remission is proposed as a multicomponent outcome for patients with severe asthma.</p><p><strong>Objective: </strong>This post hoc analysis of QUEST (NCT02414854) and TRAVERSE (NCT02134028) evaluated whether dupilumab treatment leads to clinical asthma remission (≥12 months with no severe exacerbations, zero oral corticosteroid use, stabilized or improved lung function, patient-reported asthma control <1.5) and assessed its durability in patients with uncontrolled, moderate to severe type 2 asthma (blood eosinophils ≥150 cells/μL or fractional exhaled nitric oxide ≥20 ppb at parent-study baseline) who are not receiving maintenance oral corticosteroids.</p><p><strong>Methods: </strong>In QUEST, patients (aged ≥12 years) were randomized to dupilumab 200/300 mg or placebo every 2 weeks for 52 weeks. In TRAVERSE, all patients received dupilumab 300 mg every 2 weeks for up to 96 weeks. We assessed the proportion of patients meeting criteria for on-treatment clinical remission up to 48 weeks of TRAVERSE.</p><p><strong>Results: </strong>At QUEST baseline, 1,040 patients receiving dupilumab and 544 taking placebo had type 2 asthma; of those, 842 (dupilumab/dupilumab) and 437 (placebo/dupilumab) enrolled in TRAVERSE. At QUEST week 52 (year 1), 37.2% of patients receiving dupilumab met clinical remission criteria, compared with 22.2% taking placebo (all P < .001). At week 48 of TRAVERSE (year 2 overall), 42.8% (dupilumab/dupilumab) and 33.4% (placebo/dupilumab) of patients met clinical remission criteria. Overall, 29.5% of patients in the dupilumab/dupilumab group met the criteria at both years 1 and 2.</p><p><strong>Conclusions: </strong>Dupilumab treatment enabled approximately one third of patients with type 2 asthma to meet the multicomponent end point for on-treatment clinical asthma remission for up to 2 years.</p>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":" ","pages":"132-142"},"PeriodicalIF":8.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142480302","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":"Eosinophilia and Adverse Effects of Dupilumab for Respiratory Indications: A Real-World Setting.","authors":"Sylvia H Li, Katharine Foster Nehme, Anna Moshkovich, Lydia Suh, Anna Pawlowski, Yasmeen Ali, Gayatri B Patel, Fei Li Kuang, Anju T Peters","doi":"10.1016/j.jaip.2024.09.013","DOIUrl":"10.1016/j.jaip.2024.09.013","url":null,"abstract":"<p><strong>Background: </strong>Dupilumab has been used with significant benefit in the treatment of asthma and chronic rhinosinusitis with nasal polyps (CRSwNP). Phase 3 clinical trials have demonstrated transient eosinophilia and rare eosinophil-related and other adverse effects.</p><p><strong>Objective: </strong>To characterize dupilumab-associated eosinophilia (absolute eosinophil count ≥1.5 × 10³/μL within 36 weeks of dupilumab initiation) and adverse effects associated in real-world patients with asthma and CRSwNP in the United States.</p><p><strong>Methods: </strong>Retrospective chart review of 251 patients receiving dupilumab for asthma and/or CRSwNP seen at a single institution.</p><p><strong>Results: </strong>Among the 142 patients who had absolute eosinophil counts checked before and after treatment, 16 (11.3%) had posttreatment eosinophilia, including 11 (7.7%) who had new eosinophilia on dupilumab initiation. Thirteen patients with posttreatment eosinophilia remained on dupilumab, 10 of whom had resolution of eosinophilia. Eosinophil-related adverse effects were rare, and cases of eosinophilic granulomatous polyangiitis were limited to one patient with eosinophilia and one patient with normal eosinophil levels who was receiving systemic corticosteroids. Other adverse effects included arthralgias (13 of 251; 5.2%), rash (8 of 251; 3.2%), and conjunctivitis (7 of 251; 2.8%). All patients with pretreatment eosinophilia and most patients with posttreatment eosinophilia received significant treatment benefit for the respiratory disease with dupilumab.</p><p><strong>Conclusions: </strong>Whereas dupilumab-associated eosinophilia is seen in a subset of patients, persistent eosinophilia or eosinophil-related adverse effects are rare. Furthermore, treatment benefit with dupilumab despite eosinophilia supports its continued use in both asthma and CRSwNP.</p>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":" ","pages":"121-131"},"PeriodicalIF":8.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11717595/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332046","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":"Home multifood oral immunotherapy microdosing with Dartmouth Spoon Sheets.","authors":"Sarah Hughes, Karen S Hsu Blatman, Brinda Prasanna Kumar, Marcus S Shaker","doi":"10.1016/j.jaip.2024.10.017","DOIUrl":"10.1016/j.jaip.2024.10.017","url":null,"abstract":"","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":" ","pages":"244-246.e5"},"PeriodicalIF":8.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142512577","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}