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

{"title":"Deciding which patients with atopic dermatitis to prioritize for biologics and Janus kinase inhibitors.","authors":"Masahiro Kamata, Dingyuan I Sun, Amy S Paller","doi":"10.1016/j.jaip.2025.04.042","DOIUrl":"https://doi.org/10.1016/j.jaip.2025.04.042","url":null,"abstract":"<p><p>Atopic dermatitis (AD) is a common, chronic inflammatory skin disorder associated with reduced quality of life related to itch, sleep disturbance, risk of cutaneous infections, mental health issues, and high caregiver stress. Biologics and Janus kinase (JAK) inhibitors are transformative treatments for moderate-to-severe AD, providing options for patients unresponsive to conventional topical therapies. Dupilumab, tralokinumab, lebrikizumab, and nemolizumab are injectable biologics that offer durable control by targeting the underlying skewing to type 2 inflammation. Dupilumab, the first available biologic, is approved for patients as >6 months old and concurrently manages atopic comorbidities, particularly allergic asthma. In contrast, JAK inhibitors-upadacitinib, abrocitinib, and baricitinib-are oral therapies, offering rapid relief of inflammation and pruritus by inhibiting the JAK-STAT (signal transducer and activator of transcription) pathway, which is downstream of type 2 immune receptors. JAK inhibitors are approved for >12 years old in the USA, but in other geographic regions for those >2 years of age (baricitinib). This review highlights key considerations for selecting among these advanced therapies, including age, comorbidities, efficacy, and safety profiles. By integrating the latest evidence, this article provides a practical guide for clinicians to tailor treatment approaches and improve outcomes for individuals with AD.</p>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":" ","pages":""},"PeriodicalIF":8.2,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081863","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":"The Evolution of IgE-Based Allergy Testing in Atopic Dermatitis: Where Do We Stand?","authors":"Camille Braun, François Graham, David M Fleischer, John Molloy, Philippe Bégin, Philippe Eigenmann","doi":"10.1016/j.jaip.2025.05.013","DOIUrl":"https://doi.org/10.1016/j.jaip.2025.05.013","url":null,"abstract":"<p><p>The pathophysiology of atopic dermatitis (AD) involves cutaneous inflammation, predominantly mediated by innate immunity and T cells, with Immunoglobulin E (IgE) playing a marginal role in most patients. Over previous decades, however, there has been an ongoing debate regarding the relevance of IgE-mediated allergy testing in AD patients. Patients with AD have a defective skin barrier that facilitates a high inflammatory response to environmental antigens, placing them at greater risk for food allergies. Nevertheless, because these patients often produce very high levels of IgE, the positive predictive value of skin prick tests and specific IgE measurements is low; such tests should be performed only when there is a concordant immediate hypersensitivity reaction (i.e. urticaria or angioedema) rather than eczema. In recent years, numerous studies have emphasized the importance of maintaining oral exposure to foods in order to prevent the development or progression of food allergies in atopic patients. While acknowledging that food allergens may contribute to AD in certain cases, it is critical that patients understand the risk of developing IgE-mediated food allergies if they exclude allergenic foods from their diet. Ultimately, controlling AD while retaining these foods in the diet should be the goal for all patients.</p>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":" ","pages":""},"PeriodicalIF":8.2,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081839","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":"Gummy shark is tolerated by children with IgE-mediated fish allergy.","authors":"Kathryn Dawes, Joanne Smart, Thimo Ruethers, Andreas L Lopata, Paulina Alhucema, Dianne E Campbell, John Ainsworth, Bridget Simpson, Samara Baldwin, Gabby Mahoney, JoJo Baumgratner, Sam Mehr","doi":"10.1016/j.jaip.2025.05.011","DOIUrl":"https://doi.org/10.1016/j.jaip.2025.05.011","url":null,"abstract":"","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":" ","pages":""},"PeriodicalIF":8.2,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081835","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":"Longer Term Effects of SARS-CoV-2 infection on Asthma Exacerbation.","authors":"Kevin E Duong, Sonya S Henry, Michael D Cabana, Tim Q Duong","doi":"10.1016/j.jaip.2025.05.010","DOIUrl":"https://doi.org/10.1016/j.jaip.2025.05.010","url":null,"abstract":"<p><strong>Background: </strong>The long-term impact of COVID-19 on asthma exacerbations remains unclear.</p><p><strong>Objective: </strong>We assessed the future risk of asthma exacerbations after SARS-CoV-2 infection in pediatric and adult asthma patients.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of 12,719 asthma patients with SARS-CoV-2 infection (polymerase-chain-reaction test confirmed) and 91,763 without recorded SARS-CoV-2 infection in a large urban health care system (03/1/2020-12/31/2023). After matching on observation time, age, race, and ethnicity, 1898 children and 8532 adults were included in each group (with and without COVID-19). Andersen-Gill models adjusted for covariates (e.g., allergic rhinitis, GERD, eczema, obesity, unmet social needs) were used to calculate adjusted hazard ratios (aHR) for recurrent asthma exacerbations.</p><p><strong>Results: </strong>Both hospitalized and non-hospitalized COVID-19 children with pre-existing asthma had higher exacerbation rates than controls (40.68%, 24.81%, vs. 14.70%, p<0.001) and increased risk of future exacerbations (aHR=3.29 [2.27, 4.76]; aHR=1.82 [1.51, 2.21]), p<0.001). Adults also showed increased asthma exacerbation rates in hospitalized (23.13%) and non-hospitalized (21.49%) individuals when compared with controls (10.68%), p<0.001. Similarly, both hospitalized and non-hospitalized COVID-19 adults had increased risk of future exacerbations (aHR=2.78 [2.29, 3.38]; aHR=2.13 [1.73, 2.62]). Overall, children faced higher risks than adults. Unmet social needs elevated risk of future exacerbation in children (aHR=1.36 [1.00, 1.86]) and adults (aHR=1.26 [1.04, 1.52]).</p><p><strong>Conclusions: </strong>SARS-CoV-2 infection was associated with a higher cumulative incidence of asthma exacerbations. Patients with unmet social needs were at higher risk of exacerbation. Clinicians should prioritize preventive strategies, trigger reduction, and immunizations for patients with a history of asthma and SARS-CoV-2 infection.</p>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":" ","pages":""},"PeriodicalIF":8.2,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059227","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":"Combination of allergen-specific immunotherapy with biologics in severe asthma: contra-intuitive or rational?","authors":"Désirée Larenas-Linnemann, Zuzana Diamant, Milos Jesenak, Elsy Navarrete-Rodríguez, Jasper Kappen, Celeste Porsbjerg","doi":"10.1016/j.jaip.2025.05.003","DOIUrl":"https://doi.org/10.1016/j.jaip.2025.05.003","url":null,"abstract":"<p><p>Although numbers vary, most patients with severe asthma suffer from eosinophilic asthma; many of them have the allergic asthma endotype, particularly those with concomitant allergic rhinitis. Allergen immunotherapy (AIT) is the only disease modifying therapy offering long-term effectiveness for allergic respiratory disorders, including asthma, but contraindicated in uncontrolled patients. Severe asthma patients often suffer from frequent exacerbations, making them poor candidates for AIT. However, after approximately 6-12 months on biologic therapy, many patients become exacerbation-free, obtain good symptom control and even improved lung-function. Thus, in these patients, add-on AIT, subcutaneous or sublingual, is possible. Importantly, AIT could potentially contribute to achieving clinical remission in severe asthma on a biologic therapy, possibly even sustained after cessation of treatment. In a few landmark trials of AIT added to biologics (omalizumab, dupilumab or tezepelumab) mechanisms were also studied, unveiling additional benefit of these combinations not only enhancing safety and tolerability, but possibly also efficacy. We here present a summary of the clinical trials combining immunotherapy with aeroallergens with biologic therapy in patients with respiratory allergy and discuss the cons and pros of AIT in patients with severe allergic asthma on biological therapy, concluding this combination could benefit many of these patients.</p>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":" ","pages":""},"PeriodicalIF":8.2,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144062407","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":"Optimizing Pediatric Asthma Management: Implementation and Evaluation of Anti-Inflammatory Reliever and Single Maintenance and Reliever Therapies.","authors":"Thinh H Nguyen, Megan Elios, Anne M Fitzpatrick, Sharmilee M Nyenhuis, Wanda Phipatanakul","doi":"10.1016/j.jaip.2025.05.004","DOIUrl":"10.1016/j.jaip.2025.05.004","url":null,"abstract":"<p><p>Asthma is one of the most prevalent chronic disorders in children. Anti-inflammatory reliever (AIR) therapy and single maintenance and reliever therapy (SMART) have been adopted into the asthma management of adolescents and adults. However, limited evidence and guidance are currently available for asthma management of younger children with AIR therapy and SMART. Despite the potential benefits of these therapies, the evidence supporting their safety and efficacy in early childhood is evolving. Our review summarizes the current evidence regarding the risks and benefits of AIR therapy and SMART. Moreover, we also identified commonly known challenges of adopting AIR therapy and SMART for younger children as well as proposed potential solutions. Our review aims to offer a foundation for future research and clinical guidance to serve younger patients who could benefit from AIR therapy and SMART. This insight could ultimately lead to safer, more effective, and widely accessible asthma management options for children.</p>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":" ","pages":""},"PeriodicalIF":8.2,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144016161","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":"Development and Validation of a Disease Severity Index for Patients with Cold Urticaria.","authors":"Tatjana Altunergi, Manuel P Pereira, Sabine Altrichter, Annika Gutsche, Dalia M Ahsan, Lena Fox Cand, Eva Grekowitz, Hanna Bonnekoh, Karsten Weller, Marcus Maurer, Pascale Salameh, Dorothea Terhorst-Molawi","doi":"10.1016/j.jaip.2025.04.047","DOIUrl":"https://doi.org/10.1016/j.jaip.2025.04.047","url":null,"abstract":"<p><strong>Background: </strong>Cold urticaria (ColdU) is a common type of chronic inducible urticaria (CIndU) where cold induces wheals and/or angioedema, with a wide range of disease severity, from very mild to life-changing and life-threatening, based on symptoms, day-to-day burden, general response to therapies, the need for cold avoidance, and the use of emergency treatment. There are no validated instruments to objectively assess disease severity in ColdU patients.</p><p><strong>Objective: </strong>To develop and validate a disease specific severity index for ColdU (SICU).</p><p><strong>Methods: </strong>The development of the SICU followed four phases: 1. conceptual framework, 2. item generation 3. item reduction 4. final editing. Seven and eight patients were interviewed in the item generation phase and in the item reduction phase, respectively. Then, a validation study with 75 patients was performed, which included construct, structural, convergent and known groups validity assessments as well as the characterization of reliability (internal consistency and test-retest).</p><p><strong>Results: </strong>The preliminary tool consisted of 24 items. After item reduction, the final SICU included 13 items and 4 domains: \"trigger factors\", \"signs and symptoms\", \"quality of life\" and \"therapy and efficiency\". The validation study revealed appropriate structural and construct validity with excellent measures of sample adequacy, appropriate convergent validity, as well as an adequate known-group validity, high internal consistency, and high test-retest reliability.</p><p><strong>Conclusion: </strong>The SICU is the first validated disease-specific PROM for assessing ColdU disease severity. This PROM will facilitate patient care, by evaluating disease severity and consequently better informing physicians and patients on an appropriate therapeutic approach.</p>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":" ","pages":""},"PeriodicalIF":8.2,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144065202","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":"Nonpharmacological Interventions for Dysfunctional Breathing in Adults: A Systematic Review.","authors":"Janet Bondarenko, Angela T Burge, Jean Bremner, Elizabeth Webb, Atsuhito Nakazawa, Simone Dal Corso, Véronique Pepin, Brenda Button, Mark Hew, Anne E Holland","doi":"10.1016/j.jaip.2025.04.053","DOIUrl":"10.1016/j.jaip.2025.04.053","url":null,"abstract":"<p><strong>Background: </strong>Dysfunctional breathing is common and leads to worse asthma outcomes.</p><p><strong>Objective: </strong>To describe the characteristics of nonpharmacological interventions to treat dysfunctional breathing, and evidence for their efficacy.</p><p><strong>Methods: </strong>We searched electronic databases (MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trials, and Physiotherapy Evidence Database) to identify studies that involved nonpharmacological interventions for people with the diagnosis of dysfunctional breathing. The primary aim was to determine the characteristics of intervention protocols according to the Template for Intervention Description and Replication checklist. Secondary aims included the assessment tools used, outcomes measured, and the clinical impact of the intervention. We assessed the risk of bias using the Cochrane Risk of Bias 1.0 tool or the Standard Quality Assessment Criteria, depending on the study design.</p><p><strong>Results: </strong>A total of 68 trials met review criteria (26 cohort studies, 20 case series, 19 randomized trials, and three nonrandomized trials), with 2,119 participants. Most studies had a high or unclear risk of bias across multiple domains. Five groups of nonpharmacological interventions were identified: breathing retraining with or without biofeedback, psychological therapy, acupoint therapy, manual therapy, and exercise therapy. Intervention components were highly variable and inadequately reported. Breathing retraining was the most reported intervention and showed positive effects across biochemical (29 of 34 studies; 85%), biomechanical (10 of 10 studies; 100%), and psychophysiological (15 of 19; 79%) domains of dysfunctional breathing. There was marked heterogeneity across studies and outcomes.</p><p><strong>Conclusions: </strong>A variety of nonpharmacological interventions have been applied in people with dysfunctional breathing. Breathing retraining was frequently studied, with low-quality evidence for efficacy. Future studies should report intervention components in sufficient detail to allow replication and use consistent objective measurements to assess outcomes.</p>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":" ","pages":""},"PeriodicalIF":8.2,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144055497","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":"Treatable Traits as a Pathway to Remission in Asthma.","authors":"Inês Farinha, Peter G Gibson, Vanessa M McDonald, Liam G Heaney","doi":"10.1016/j.jaip.2025.05.002","DOIUrl":"https://doi.org/10.1016/j.jaip.2025.05.002","url":null,"abstract":"<p><p>In recent years, the significant impact of disease-modifying anti-asthmatic drugs has provided a chance to re-evaluate goals in asthma treatment and consider remission as a more ambitious and achievable target. Clinical remission in asthma, both on- and off-treatment, has been characterized by the absence of asthma-related symptoms, attacks, and systemic corticosteroids, and the improvement or stabilization of lung function, all maintained over a minimum period of twelve months. Targeting 'treatable traits' has emerged as a promising strategy for the personalized treatment of chronic airway diseases, both in primary and specialist care. This multidimensional approach involves the initial identification and tailored treatment of clinically essential characteristics in individual patients, called 'super-traits'. Considering the heterogeneous and multifaceted nature of asthma and associated comorbidities, the novelty of this review is the proposal to use pulmonary, extrapulmonary, and behavioral treatable traits as a tool to reach remission.</p>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":" ","pages":""},"PeriodicalIF":8.2,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144050202","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":"Organizing pneumonia in patients on dupilumab therapy for nasal polyposis: A report of three cases.","authors":"Laetitia Pellicer-Garcia, Chloé Molimard, Olivier Mauvais, Didier Pernet, Philippe Bonniaud, Marie-Blanche Valnet-Rabier, Cindy Barnig","doi":"10.1016/j.jaip.2025.04.052","DOIUrl":"10.1016/j.jaip.2025.04.052","url":null,"abstract":"","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":" ","pages":""},"PeriodicalIF":8.2,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143994137","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}