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

{"title":"(FEV₃-FEV₁)/FVC: A Terminal-Airflow Variable for Airway Hyperresponsiveness and Inflammation Prediction in Patients With Symptoms Despite Preserved Spirometry.","authors":"Wuping Bao, Yanmei Lin, Lei Zhao, Yingying Zhang, Jingwang Lin, Junfeng Yin, Yiting Wu, Jifei Wu, Yan Zhou, Min Zhang","doi":"10.1016/j.jaip.2024.10.010","DOIUrl":"10.1016/j.jaip.2024.10.010","url":null,"abstract":"<p><strong>Background: </strong>Small-airway function assessment is crucial for asthma diagnosis and management. Abnormalities in terminal airflow deserve attention.</p><p><strong>Objective: </strong>This study investigated whether (FEV₃-FEV₁)/FVC correlates with airway hyperresponsiveness (AHR) and inflammation in patients with preserved spirometry.</p><p><strong>Methods: </strong>This cross-sectional study enrolled patients with FEV₁ of 80% predicted or greater, FEV₁/FVC of 0.7 or greater, and recurring asthma-like symptoms. Data included demographics, FeNO, impulse oscillometry, and spirometry. Univariate and combined models predicting AHR were analyzed in 553 patients and validated in 561. We also assessed correlations between sputum inflammation and spirometrics.</p><p><strong>Results: </strong>Airway-hyperresponsive patients exhibited higher (FEV₃-FEV₁)/FVC ratios compared with those who were negative for AHR. This ratio showed the strongest association with the methacholine dose causing a 20% FEV₁ decrease and the response dose ratio (r = -0.26 and 0.39, respectively; P < .001 for both). The area under the receiver operating characteristic curve for AHR diagnosis using (FEV₃-FEV₁)/FVC was 0.751, increasing to 0.821 when it was combined with FeNO, as confirmed in the validation cohort. Moreover, (FEV₃-FEV₁)/FVC was superior to maximal expiratory flow at 50% of FVC for identifying eosinophilic airway inflammation characterized by elevated FeNO levels. It correlated better with sputum eosinophil count than with the other spirometrics.</p><p><strong>Conclusions: </strong>Elevated (FEV₃-FEV₁)/FVC levels were evident in AHR-positive patients with preserved FEV₁/FVC ratios. They serve as a sensitive marker of AHR and airway inflammation correlating with the response dose ratio, a provocative dose causing a 20% fall in FEV₁, and sputum eosinophils, suggesting their utility in monitoring patients at risk for uncontrolled asthma.</p>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":" ","pages":"107-118.e8"},"PeriodicalIF":8.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142480290","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":"Validation of the Cholinergic Urticaria Activity Score (CholUAS).","authors":"Pia Schnarkowski, Pascale Salameh, Eva Grekowitz, Dorothea Terhorst-Molawi, Marcus Maurer, Karsten Weller, Sabine Altrichter","doi":"10.1016/j.jaip.2024.10.011","DOIUrl":"10.1016/j.jaip.2024.10.011","url":null,"abstract":"<p><strong>Background: </strong>In cholinergic urticaria (CholU), itchy wheal and flare-type skin reactions are triggered by sweat-inducing activities. The CholU activity score (CholUAS) is used to assess disease activity but has not yet been validated. The aim of the study was to validate the CholUAS, develop an English version, and provide instructions for scoring.</p><p><strong>Methods: </strong>Cognitive debriefing of CholUAS was performed. Patients with CholU (n = 75) used the CholUAS on 7 consecutive days, underwent provocation testing, completed additional anchor instrument questionnaires including global evaluation tools, and established quality of life instruments. A scoring protocol for the calculation of the weekly CholUAS, the CholUAS7, was developed. The CholUAS7 was tested for validity, reliability, and influencing factors. An English version of the CholUAS was developed.</p><p><strong>Results: </strong>The final CholUAS contains 3 questions that are used for scoring as well as 1 global question. The weekly CholUAS, CholUAS7, showed excellent test-retest reliability and good correlations with anchor instruments. Statistical analysis showed no significant influence of age or duration of disease on CholUAS7 results.</p><p><strong>Conclusion: </strong>The validated CholUAS is ready for use in clinical trials and routine clinical practice.</p>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":" ","pages":"213-219.e3"},"PeriodicalIF":8.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142480305","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":"Catamenial anaphylaxis in adolescents and young adults: A case series.","authors":"Dehlia Moussaoui, Tracy Foran, Stephanie Richards, Sonia R Grover","doi":"10.1016/j.jaip.2024.09.032","DOIUrl":"10.1016/j.jaip.2024.09.032","url":null,"abstract":"","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":" ","pages":"220-224"},"PeriodicalIF":8.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142401846","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":"Safety and Feasibility of Peanut, Tree Nut, and Sesame Oral Immunotherapy in Infants and Toddlers in a Real-World Setting.","authors":"Jenny Huang, Leah H Puglisi, Kevin A Cook, John M Kelso, Hannah Wangberg","doi":"10.1016/j.jaip.2024.09.025","DOIUrl":"10.1016/j.jaip.2024.09.025","url":null,"abstract":"<p><strong>Background: </strong>Oral immunotherapy (OIT) for food allergy has been largely studied in older children within the context of clinical trials, and its availability has historically been limited for younger patients with food allergy. Data have shown that the most impact may actually be seen with the use of OIT in younger infants and toddlers.</p><p><strong>Objective: </strong>To evaluate the safety and feasibility of OIT in subjects 24 months and younger in a real-world setting using commercially available food products.</p><p><strong>Methods: </strong>This was a retrospective study of subjects 24 months and younger initiated on OIT for peanut, tree nut, or sesame allergy within the Scripps Clinic allergy department. Medical records were reviewed for data regarding initial oral food challenges, OIT, and adverse outcomes.</p><p><strong>Results: </strong>Fifty-two subjects 24 months and younger were initiated on OIT. Most subjects (84.6%) were on single-food OIT, and some (15.4%) were on multifood OIT. No increased adverse outcomes were observed on multifood OIT. Of the 59 initial oral food challenges, objective reactions occurred during 42 challenges, most being low-grade reactions. During initial oral food challenges, 86.1% of peanut-allergic children tolerated 1/8 of 1 Bamba stick with no reaction. Most subjects (73.1%) updosed at home, and most (51.9%) had no reactions while updosing. Some had low-grade cutaneous reactions, none requiring epinephrine or emergency evaluation.</p><p><strong>Conclusions: </strong>OIT in infants is safe and feasible to perform in a real-world setting using commercially available food products with at-home updosing, thus increasing the availability of OIT for patients.</p>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":" ","pages":"185-191.e3"},"PeriodicalIF":8.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142367370","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":"Age- and Elicitor-Dependent Characterization of Hymenoptera Venom-Induced Anaphylaxis in Children and Adolescents.","authors":"Margitta Worm, Ewa Cichocka-Jarosz, Franziska Ruëff, Thomas Spindler, Alice Köhli, Johannes Trück, Lars Lange, Karin Hartmann, Thomas Hawranek, Katja Nemat, Claudia Pföhler, Maria Beatrice Bilò, Dominique Sabouraud-Leclerc, Nicola Wagner, Nikolaos Papadopoulos, Susanne Hämmerling, Luis Felipe Ensina, Sabine Dölle-Bierke, Veronika Höfer","doi":"10.1016/j.jaip.2024.08.036","DOIUrl":"10.1016/j.jaip.2024.08.036","url":null,"abstract":"<p><strong>Background: </strong>Hymenoptera venom is one of the most frequent causes of anaphylaxis. Studies from adults indicate the clinical profiles and risk factors of Hymenoptera venom-induced anaphylaxis (VIA). Much less is known about pediatric VIA.</p><p><strong>Objective: </strong>To understand elicitor- and age-related factors determining pediatric VIA by analyzing data from the anaphylaxis registry.</p><p><strong>Methods: </strong>We selected pediatric VIA, pediatric food-induced anaphylaxis (FIA), and adult VIA cohorts from the anaphylaxis registry and performed a comparative data analysis regarding elicitors, symptoms, and management.</p><p><strong>Results: </strong>We identified 725 pediatric patients with VIA, 3,149 with pediatric FIA, and 5,534 with adult VIA. In pediatric VIA, boys were more frequently affected, atopy was not increased, and the onset of the reaction after exposure was fast (≤30 min; 91%) compared with pediatric FIA. Symptoms in pediatric VIA were age dependent, and although respiratory symptoms occurred most frequently besides skin symptoms in both pediatric patients with VIA and FIA, cardiovascular symptoms were more frequently reported in pediatric patients with VIA than pediatric patients with FIA. The analysis of pediatric versus adult VIA revealed clear differences in the frequency of involved organ systems (skin: 93% vs 78%; respiratory: 77% vs 64%; and cardiovascular: 61% vs 85%). For both pediatric and adult VIA, the rates of adrenaline application by a professional were low (29% vs 31%) but hospitalization rates were higher in children than in adults (61% vs 42%). Venom immunotherapy was frequently initiated regardless of age (78% each).</p><p><strong>Conclusions: </strong>Pediatric VIA is more frequent in boys, symptoms are age dependent, and hospitalization is often required. Adrenaline should be applied according to current guidelines. Venom immunotherapy is an important treatment option in pediatric VIA and should be considered in severely affected children.</p>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":" ","pages":"69-78.e2"},"PeriodicalIF":8.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142114599","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":"Class I HLA Alleles Are Associated With an Increased Risk of Osimertinib-Induced Hypersensitivity.","authors":"Chun-Bing Chen, Chuang-Wei Wang, Chun-Wei Lu, Wei-Ti Chen, Bing-Rong Zhou, Chia-Yu Chu, Shang-Fu Hsu, Cheng-Ta Yang, John Wen-Cheng Chang, Chan-Keng Yang, Chih-Liang Wang, Yueh-Fu Fang, Ping-Chih Hsu, Chung-Ching Hua, Chiao-En Wu, How-Wen Ko, Kun-Chieh Chen, Yi-Chien Yang, Han-Chi Tseng, An-Yu Cheng, Li-Chuan Tseng, Feng-Ya Shih, Shuen-Iu Hung, Cheng-Yang Huang, Wen-Hung Chung","doi":"10.1016/j.jaip.2024.10.027","DOIUrl":"10.1016/j.jaip.2024.10.027","url":null,"abstract":"<p><strong>Background: </strong>Osimertinib, a third-generation epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI), shows superior lung cancer treatment efficacy. However, osimertinib-induced severe hypersensitivity, including Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN), is frequently observed in Asian populations and hinders cancer treatment.</p><p><strong>Objective: </strong>We investigated the genetic HLA predisposition and immune pathomechanism of osimertinib-induced hypersensitivity.</p><p><strong>Methods: </strong>We enrolled 17 patients with osimertinib-induced delayed hypersensitivity (seven with severe SJS/TEN and 10 with mild maculopapular exanthema), 98 osimertinib-tolerant subjects, and 2,123 general population controls. We performed HLA genotyping, drug-induced lymphocyte activation test, and surface plasmon resonance assay.</p><p><strong>Results: </strong>HLA-B∗51:02 was present in 83.3% of osimertinib-induced SJS/TEN patients but in only 3.3% of the general population controls (P = 2.8 × 10^-7; corrected P = 6.9 × 10^-6; odds ratio [OR] = 146), and 0% of osimertinib-tolerant controls (P = 6.5 × 10^-8; corrected P = 1.6 × 10^-6; OR = 707). The association of HLA-B∗51:01 and HLA-A∗24:02 with osimertinib-induced maculopapular exanthema patients, rather than with osimertinib-tolerant subjects (P = .002, OR = 15.7 for HLA-B∗51:01; and P = .003, OR = 9.5 for HLA-A∗24:02), was identified as a phenotype-specific association. Granulysin, the SJS/TEN-specific cytotoxic protein, was significantly higher in plasma of SJS/TEN patients (39.8 ± 4.5 ng/mL; P < .001) and in in vitro lymphocyte activation test (sensitivity = 83.3%; P < .01) compared with tolerant controls. Patients with osimertinib-induced hypersensitivity appeared to tolerate alternative EGFR-TKIs. Surface plasmon resonance results also confirmed that HLA-B∗51:02 protein has a higher binding affinity for osimertinib and lower or no affinity for other EGFR-TKIs.</p><p><strong>Conclusions: </strong>HLA-B∗51:02 frequently occurs in Asian populations and is strongly associated with osimertinib-induced SJS/TEN. Our findings suggest HLA-B∗51:02 screening as a preemptive test to reduce osimertinib-induced severe hypersensitivity.</p>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":" ","pages":"143-154.e10"},"PeriodicalIF":8.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142591059","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":"Disparities in hereditary angioedema in an urban medical district.","authors":"John S Trickett, David A Khan, Jeffrey M Chambliss","doi":"10.1016/j.jaip.2024.09.019","DOIUrl":"10.1016/j.jaip.2024.09.019","url":null,"abstract":"","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":" ","pages":"247-249.e1"},"PeriodicalIF":8.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142373484","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":"Should Patients With a Large Local Reaction Be Offered Venom Immunotherapy? A Pro-Con Debate.","authors":"M Beatrice Bilò, David B K Golden, M Chiara Braschi, Matteo Martini","doi":"10.1016/j.jaip.2024.06.043","DOIUrl":"10.1016/j.jaip.2024.06.043","url":null,"abstract":"<p><p>Insect stings can cause large local reactions (LLRs) that are IgE-mediated and associated with considerable morbidity. A risk for systemic reactions including anaphylaxis to subsequent stings has been reported and is often noted by patients and health care providers. Guidelines do not recommend venom immunotherapy (VIT) for LLRs based on the relatively low risk of anaphylaxis, but this is debated in this review. On the pro side: the risk of anaphylaxis may be higher than reported in the limited literature, especially in patients who had only 1 LLR; new species with more potent stings are spreading into new areas; the quality of life can be markedly impaired by LLRs; and VIT is generally safe and highly effective. On the con side: LLRs are benign, stings occur infrequently, VIT has significant cost, systemic reactions occur more often to VIT than to stings in patients with LLRs, and Food and Drug Administration approval and published guidelines do not recommend VIT for LLRs. In practice, shared decision-making is appropriate to incorporate knowledge of the natural history and known high-risk factors in the context of the patient's personal values and preferences.</p>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":" ","pages":"49-54"},"PeriodicalIF":8.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141555870","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":"Disparities in pediatric seafood allergy by social determinants of health.","authors":"Ellen R Conroy, Roxanne Dupuis, Gabrielle D'Ambosi, Linda J Herbert, Michael C Young, Wanda Phipatanakul, Lisa M Bartnikas","doi":"10.1016/j.jaip.2024.10.014","DOIUrl":"10.1016/j.jaip.2024.10.014","url":null,"abstract":"","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":" ","pages":"241-243.e2"},"PeriodicalIF":8.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11717610/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142480301","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":"Addressing health inequities in pediatric asthma through implementation of school-supervised asthma therapy.","authors":"Grace W Ryan, Daniel Mendoza Martinez, Janvi Nanavati, Kali Pereira, John Almeida, Melissa Goulding, Michelle Spano, Wanda Phipatanakul, Sybil Crawford, Milagros C Rosal, Lynn B Gerald, Nancy Byatt, Stephenie C Lemon, Lori Pbert, Michelle Trivedi","doi":"10.1016/j.jaip.2024.10.008","DOIUrl":"10.1016/j.jaip.2024.10.008","url":null,"abstract":"","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":" ","pages":"228-232.e2"},"PeriodicalIF":8.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11717619/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142480291","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}