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

{"title":"Guiding Drug Provocation Testing for Ibuprofen Hypersensitivity in a Pediatric Population: Development of the I3A Risk-Stratification Tool","authors":"Florian Stehlin MD ,&nbsp;Connor Prosty MD ,&nbsp;Angela Mulé BSc ,&nbsp;Ibtihal Al-Otaibi MD ,&nbsp;Luca Delli Colli MD ,&nbsp;Judy Gaffar MD ,&nbsp;Joshua Yu MD ,&nbsp;Derek Lanoue MD, MEcon ,&nbsp;Ana-Maria Copaescu MD ,&nbsp;Moshe Ben-Shoshan MD, MSc","doi":"10.1016/j.jaip.2024.11.022","DOIUrl":"10.1016/j.jaip.2024.11.022","url":null,"abstract":"<div><h3>Background</h3><div>Ibuprofen is a main cause of drug hypersensitivity reactions in children. The gold standard for diagnosis is the drug provocation test (DPT).</div></div><div><h3>Objective</h3><div>We aimed to create a clinical risk-stratification tool to guide this high-risk procedure.</div></div><div><h3>Methods</h3><div>We prospectively recruited children with suspected ibuprofen hypersensitivity between January 2017 and March 2024. Using stepwise bidirectional multivariable logistic regression, we calculated a predictive score for a positive ibuprofen DPT.</div></div><div><h3>Results</h3><div>Eighty-two patients with a median age of 5.9 years (interquartile range: 3.4-11.1 years) had an ibuprofen DPT. Eighteen (22.0%) patients had a positive challenge, with an anaphylactic reaction for 11 (61.1%). The I3A score (acronym for ibuprofen, 3As: angioedema, anaphylaxis, age, cutoff of 3) encompasses the following items: angioedema (2 points), anaphylaxis (1 point), and age at reaction ≥10 years old (1 point). The area under the curve of the I3A score was 0.84, and the optimal cutoff of &lt;3 conferred a sensitivity of 84.4% (95% confidence interval [CI]: 66.7%-100.0%) and a specificity of 83.3% (95% CI: 75.0%-92.2%). The negative predictive value was estimated at 94.7% (95% CI: 90.0%-100.0%), and the positive predictive value at 60.0% (95% CI: 46.2%-76.2%). The relative risk of reacting to a challenge in the group I3A 3-4 compared with 0-2 was 11.4 (95% CI: 3.62%-35.7%, <em>P</em> &lt; .001). Anaphylaxis after DPT was observed in 9 of 25 (36.0% [95% CI: 16.0%-56.0%]) in the high-risk group as compared with 2 of 57 (3.5% [95% CI: 0.0%-8.8%]) in the low-risk group (relative risk 10.3 [95% CI: 2.4%-43.5%]).</div></div><div><h3>Conclusions</h3><div>We generated a risk-stratification tool to identify children at low risk of reacting to ibuprofen challenges. Further validation is required in external cohorts.</div></div>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"13 3","pages":"Pages 583-593.e3"},"PeriodicalIF":8.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787555","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":"Performance of serum IL-18 levels for the follow-up of patients with familial Mediterranean fever","authors":"Inès Elhani MD, PhD ,&nbsp;Laure Calas MD ,&nbsp;Farah Bejar MSc ,&nbsp;Laurence Pieroni MD ,&nbsp;Isabelle Kone-Paut MD, PhD ,&nbsp;Linda Rossi-Semerano MD ,&nbsp;Isabelle Melki MD, PhD ,&nbsp;Brigitte Bader-Meunier MD, PhD ,&nbsp;Bénédicte Neven MD, PhD ,&nbsp;Pierre Quartier MD, PhD ,&nbsp;Guilaine Boursier MD, PhD ,&nbsp;Irina Giurgea MD, PhD ,&nbsp;Laurence Cuisset MD ,&nbsp;Gilles Grateau MD ,&nbsp;Véronique Hentgen MD ,&nbsp;Philippe Mertz MD ,&nbsp;Marion Delplanque MD ,&nbsp;Léa Savey MD ,&nbsp;Sophie Georgin-Lavialle MD, PhD","doi":"10.1016/j.jaip.2024.11.025","DOIUrl":"10.1016/j.jaip.2024.11.025","url":null,"abstract":"","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"13 3","pages":"Pages 695-697.e1"},"PeriodicalIF":8.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142820111","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":"Outpatient epinephrine administration reduces ICU admission rates in anaphylactic reactions: A propensity score–matched cohort","authors":"Roy Khalaf ,&nbsp;Connor Prosty MD ,&nbsp;Ann E. Clarke MD, MS ,&nbsp;Christine McCusker MD ,&nbsp;Adam Bretholz MD ,&nbsp;Moshe Ben-Shoshan MD, MS","doi":"10.1016/j.jaip.2024.12.020","DOIUrl":"10.1016/j.jaip.2024.12.020","url":null,"abstract":"","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"13 3","pages":"Pages 689-691"},"PeriodicalIF":8.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142882609","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":"Risk Factors of Hypersensitivity Reactions to Carboplatin: A Systematic Review and Meta-Analysis","authors":"Ha Young Jang PhD ,&nbsp;Boyoon Choi PhD ,&nbsp;In-Wha Kim PhD ,&nbsp;Hye Ryun Kang MD, PhD ,&nbsp;Jung Mi Oh PharmD","doi":"10.1016/j.jaip.2024.12.021","DOIUrl":"10.1016/j.jaip.2024.12.021","url":null,"abstract":"<div><h3>Background</h3><div>The development of hypersensitivity reactions (HSRs) to carboplatin can interrupt anticancer treatment and may shorten patient survival. Several studies have evaluated the risk factors for carboplatin HSRs, but the results have been inconclusive.</div></div><div><h3>Objective</h3><div>This systematic review and meta-analysis aimed to establish a consensus on the risk factors of HSRs to carboplatin in patients with cancer.</div></div><div><h3>Methods</h3><div>Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, relevant studies were searched across MEDLINE, Embase, and Korean Medical Database. Inclusion criteria focused on original articles of case-control or cohort studies that evaluated risk factors for carboplatin HSRs in patients with cancer. Exclusion criteria targeted articles with incomplete or overlapping data. The latest search and quality assessment of the included studies, using the Newcastle-Ottawa scale, was performed on February 1, 2023.</div></div><div><h3>Results</h3><div>Among 1,182 articles identified, 19 studies were included in the final systematic review and meta-analysis. The identified risk factors for carboplatin hypersensitivity included a history of allergy to medicines, food, or environmental factors (odds ratio [OR] = 1.76; 95% CI, 1.46-2.12), <em>BRCA</em> mutation (OR = 4.03; 95% CI, 2.00-8.13), carboplatin free interval of 12 months or more (OR = 4.93; 95% CI, 2.89-8.40), increased cumulative dose (standardized mean difference, 0.58; 95% CI, 0.41-0.75), relapse (OR = 2.26; 95% CI, 1.58-3.25), and younger age (standardized mean difference, –0.15; 95% CI, –0.26 to –0.03).</div></div><div><h3>Conclusions</h3><div>To our knowledge, this meta-analysis provides the first comprehensive quantitative evaluation of risk factors for carboplatin HSRs in patients with cancer. These findings can guide the development of personalized risk assessment tools and preventive strategies, potentially improving patient safety and treatment outcomes in carboplatin-based chemotherapy.</div></div>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"13 3","pages":"Pages 610-618.e10"},"PeriodicalIF":8.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142900242","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":"March 2025 Practice Notes","authors":"","doi":"10.1016/S2213-2198(25)00108-4","DOIUrl":"10.1016/S2213-2198(25)00108-4","url":null,"abstract":"","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"13 3","pages":"Pages A19-A20"},"PeriodicalIF":8.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143549178","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 Pharmacovigilance Analysis of Post-Marketing Safety of Tezepelumab","authors":"Huqun Li MD ,&nbsp;Chongshu Wang MD ,&nbsp;Cuilian Guo MD","doi":"10.1016/j.jaip.2024.10.045","DOIUrl":"10.1016/j.jaip.2024.10.045","url":null,"abstract":"<div><h3>Background</h3><div>Tezepelumab has shown promising efficacy for adult patients with severe asthma since its approval. However, the post-marketing safety evaluation of tezepelumab is currently lacking.</div></div><div><h3>Objective</h3><div>To investigate the post-marketing safety of tezepelumab based on the US Food and Drug Administration Adverse Event Reporting System database.</div></div><div><h3>Methods</h3><div>Adverse events (AEs) reported from January 2022 to December 2023 were extracted from the US Food and Drug Administration Adverse Event Reporting System database. Disproportionality analysis by reporting odds ratio and empirical Bayesian geometric mean was performed to detect potential AEs related to tezepelumab. We also assessed clinical characteristics and time to onset of AEs.</div></div><div><h3>Results</h3><div>A total of 1,699 tezepelumab-related AE reports were identified during the study period. We detected 30 tezepelumab-related AE signals by simultaneously applying the two algorithms. At the system organ class level, the most common system organ class related to tezepelumab was respiratory, thoracic, and mediastinal disorders. At the preferred term level, common AEs including arthralgia and back pain were detected, which were also documented in the label of tezepelumab and clinical trials. New unexpected AEs such as chest pain and myalgia were also identified. Median time to onset of tezepelumab-related AEs was 7.5 days and most AEs occurred within the first 1 month after tezepelumab initiation.</div></div><div><h3>Conclusions</h3><div>This study presents a comprehensive evaluation of the post-marketing safety of tezepelumab in the real-world setting. Our findings will provide valuable evidence for future clinical studies and management of safety issues of tezepelumab.</div></div>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"13 3","pages":"Pages 551-558.e6"},"PeriodicalIF":8.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631719","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":"Common Variable Immunodeficiency Clinical Manifestations Are Shaped by Presence and Type of Heterozygous NFKB1 Variants","authors":"Jie Yin MD ,&nbsp;Kevin M. Hayes BS ,&nbsp;Mei-Sing Ong PhD ,&nbsp;Joseph P. Mizgerd ScD ,&nbsp;Charlotte Cunningham-Rundles MD, PhD ,&nbsp;Isabel Dominguez PhD ,&nbsp;Sara Barmettler MD ,&nbsp;Jocelyn R. Farmer MD, PhD ,&nbsp;Paul J. Maglione MD, PhD","doi":"10.1016/j.jaip.2024.12.002","DOIUrl":"10.1016/j.jaip.2024.12.002","url":null,"abstract":"<div><h3>Background</h3><div><em>NFKB1</em> encodes p105, which is processed to p50 to mediate canonical nuclear factor-κB (NF-κB) signaling. Although NF-κB is a central driver of inflammation and heterozygous <em>NFKB1</em> variants are considered the most common monogenic etiologies of common variable immunodeficiency (CVID), few studies have explored how <em>NFKB1</em> variants shape clinical course or inflammation in CVID.</div></div><div><h3>Objective</h3><div>We leveraged a regional cohort of patients with CVID with and without heterozygous <em>NFKB1</em> variants to assess how clinical and inflammatory features of CVID are shaped by the presence of these variants.</div></div><div><h3>Methods</h3><div>We compared clinical complications, immunologic features, and plasma cytokine levels of 15 patients with CVID with heterozygous <em>NFKB1</em> variants and 77 genetically undefined patients with CVID from the same referral base. We also assessed differences between patients with CVID with frameshift or nonsense <em>NFKB1</em> variants compared with those with missense <em>NFKB1</em> variants.</div></div><div><h3>Results</h3><div>We found patients with CVID with heterozygous <em>NFKB1</em> variants to have increased autoimmune disease, bronchiectasis, gastrointestinal infections, inflammatory bowel disease, and plasma cytokines. These findings were more pronounced and included elevation of monocytes in patients with CVID with frameshift or nonsense <em>NFKB1</em> variants relative to those with missense <em>NFKB1</em> variants.</div></div><div><h3>Conclusions</h3><div>In a regional cohort, heterozygous <em>NFKB1</em> variants were associated with worsened CVID clinical course and increased evidence of inflammation in the blood. Patients with CVID with frameshift or nonsense <em>NFKB1</em> variants had more significant increases in noninfectious complications and peripheral monocytes than those with missense <em>NFKB1</em> variants. Presence of pathogenic <em>NFKB1</em> variants in patients with CVID may worsen the disease course and warrant closer monitoring.</div></div>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"13 3","pages":"Pages 639-646"},"PeriodicalIF":8.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822659","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":"Iron deficiency in children with food protein–induced enterocolitis syndrome","authors":"Rebekah Epstein BS,&nbsp;Marion Groetch MS, RDN ,&nbsp;Mary Grace Baker MD, MS","doi":"10.1016/j.jaip.2024.12.016","DOIUrl":"10.1016/j.jaip.2024.12.016","url":null,"abstract":"","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"13 3","pages":"Pages 708-710.e1"},"PeriodicalIF":8.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142873435","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 Randomized Comparison of Bencycloquidium Bromide, Mometasone Furoate, and a Combination for Persistent Allergic Rhinitis","authors":"Xian Li MSc ,&nbsp;Xueyan Wang MD ,&nbsp;Qintai Yang MD, PhD ,&nbsp;Jianjun Chen MD ,&nbsp;Hao Tian MD ,&nbsp;Meiping Lu MD, PhD ,&nbsp;Tingting Ma MD, PhD ,&nbsp;Yana Zhang MD ,&nbsp;Yue Zhou MD ,&nbsp;Jiao Xia MD, PhD ,&nbsp;Lei Cheng MD, PhD ,&nbsp;Yuan Zhang MD ,&nbsp;Luo Zhang MD, PhD","doi":"10.1016/j.jaip.2024.12.035","DOIUrl":"10.1016/j.jaip.2024.12.035","url":null,"abstract":"<div><h3>Background</h3><div>Moderate to severe persistent allergic rhinitis (AR) poses a substantial socioeconomic burden.</div></div><div><h3>Objectives</h3><div>We aimed to establish the superiority of bencycloquidium bromide (BCQB) nasal spray and BCQB combined with mometasone furoate nasal spray (MFNS) over MFNS alone in adults with moderate to severe persistent AR.</div></div><div><h3>Methods</h3><div>In this multicenter, randomized, controlled clinical trial (NCT05038202), adults with moderate to severe persistent AR were randomly assigned to receive BCQB, MFNS, or a combination treatment for 4-week periods. Mean changes from baseline in the daily reflective runny nose, nasal congestion, sneezing, nasal itching scores, total nasal symptom score (TNSS) and Rhinoconjunctivitis Quality of Life Questionnaire scores were recorded. We also assessed the exploratory end points and adverse events.</div></div><div><h3>Results</h3><div>Bencycloquidium bromide led to a significant improvement in the mean change from baseline in daily reflective runny nose during the 4-week treatment, compared with MFNS (least-squares mean difference, –0.27; 95% CI, –0.44 to –0.09; <em>P</em> = .004). The BCQB combined with MFNS significantly improved runny nose, nasal congestion, sneezing, TNSS, and Rhinoconjunctivitis Quality of Life Questionnaire scores compared with MFNS alone, except for nasal itching. Bencycloquidium bromide significantly decreased the percent change in eosinophilic cationic protein, eotaxin, vasoactive intestinal peptide, and IL-6 levels. Treatment-emergent adverse events were similar among the three groups.</div></div><div><h3>Conclusions</h3><div>Bencycloquidium bromide was superior to MFNS in reducing daily runny nose symptoms. The combination of BCQB and MFNS was superior to MFNS alone in alleviating TNSS in patients with moderate to severe persistent AR with a predominant symptom of runny nose.</div></div>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"13 3","pages":"Pages 670-679.e3"},"PeriodicalIF":8.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142924034","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":"Insulin Allergy: The Allergist's Updated Approach to Evaluation and Management.","authors":"Jessica Oh, Evelyn Capellan Vasquez, Santiago Alvarez-Arango, Manish Ramesh, Mariana C Castells","doi":"10.1016/j.jaip.2025.02.028","DOIUrl":"https://doi.org/10.1016/j.jaip.2025.02.028","url":null,"abstract":"<p><p>The transformative discovery of insulin in the early 20^th century followed by its rapid clinical implementation was initially complicated by high rates of hypersensitivity reactions. Improvements in purification methods and the transition from animal-derived sources to human insulin products has significantly lowered, though not eliminated, hypersensitivity reactions to insulin products. Although considered rare adverse reactions to insulin, hypersensitivity reactions and immune-mediated manifestations continue to occur in patients requiring insulin treatment. This has broad implications given that approximately 11.6% of the United States population has a diagnosis of diabetes and 8.4 million Americans rely on insulin for survival.(1) Given the scope and impact of insulin as a life-saving treatment for patients with diabetes, it is important for allergists to appropriately evaluate, diagnose, and manage patients with hypersensitivity reactions to insulin. Recognizing early manifestations of insulin hypersensitivity is the first step in providing prompt and targeted management in these complex cases. The following article aims to summarize the allergist's recommend approach to insulin hypersensitivity reactions, including type I IgE-mediated, type III immune-complex mediated, type IV T-cell mediated hypersensitivity reactions, as well as additional immune-mediated manifestations of insulin therapy such as lipoatrophy and insulin auto-antibodies. Furthermore, the authors emphasize approaching insulin hypersensitivity cases with a broad differential diagnosis, which includes hypoglycemia, anaphylaxis mimics, hypersensitivity to excipients and medical devices, and cutaneous manifestations of diabetes.</p>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":" ","pages":""},"PeriodicalIF":8.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544398","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}