Allergy Clin Immunol Research Articles

Practices and perspectives on medical cannabis and cannabinoids: A survey of the National Psoriasis Foundation Medical Advisory Board

Practices and perspectives on medical cannabis and cannabinoids: A survey of the National Psoriasis Foundation Medical Advisory Board

Lung lavage inflammatory patterns and pathogen profiles in preschool children with problematic wheeze

Practicing clinicians regularly encounter the preschool child with intermittent episodes of wheeze. Preschool wheezing episodes account for a large burden of unscheduled ambulatory care visits and hospitalizations across the globe. Recurrent episodes of acute wheeze are often referred to as “problematic.” However, guidelines to treat these children are not based on solid evidence. There are few clinical trials applicable to real-world practice to direct treatment of problematic wheeze. 1 Bacharier LB Guilbert TW Mauger DT Boehmer S Beigelman A Fitzpatrick AM et al. Early administration of azithromycin and prevention of severe lower respiratory tract illnesses in preschool children with a history of such illnesses: a randomized clinical trial. JAMA. 2015; 314: 2034-2044 Crossref PubMed Scopus (193) Google Scholar , 2 Fitzpatrick AM Jackson DJ Mauger DT Boehmer SJ Phipatanakul W Sheehan WJ et al. Individualized therapy for persistent asthma in young children. J Allergy Clin Immunol. 2016; 138 (1608-1618.e12) Abstract Full Text Full Text PDF PubMed Scopus (164) Google Scholar , 3 Wallace A Sinclair O Shepherd M Neutze J Trenholme A Tan E et al. Impact of oral corticosteroids on respiratory outcomes in acute preschool wheeze: a randomised clinical trial. Arch Dis Child. 2021; 106: 339-344 Crossref PubMed Scopus (4) Google Scholar A helpful study by Bacharier et al 1 Bacharier LB Guilbert TW Mauger DT Boehmer S Beigelman A Fitzpatrick AM et al. Early administration of azithromycin and prevention of severe lower respiratory tract illnesses in preschool children with a history of such illnesses: a randomized clinical trial. JAMA. 2015; 314: 2034-2044 Crossref PubMed Scopus (193) Google Scholar found that a burst of azithromycin given early during an episode of virus-triggered wheeze in preschool children with a history of recurrent wheeze was effective in preventing the progression of symptoms. Azithromycin treatment was effective in not only the first but subsequent wheeze episodes over 1 year. Although guidelines on the management of preschool wheeze have been published, inconsistencies prevail as to the endorsement of azithromycin to treat acute exacerbations.

Determinants of asthma control and exacerbations in moderate to severe asthma

Determinants of asthma control and exacerbations in moderate to severe asthma

Passive immunization against COVID-19 by anti-SARS-CoV-2 spike IgG in commercially available immunoglobulin preparations in severe antibody deficiency

Passive immunization against COVID-19 by anti-SARS-CoV-2 spike IgG in commercially available immunoglobulin preparations in severe antibody deficiency

Peanut anaphylaxis in 2022: Decoupling epinephrine usage from emergency department evaluation

Peanut anaphylaxis in 2022: Decoupling epinephrine usage from emergency department evaluation

We should abandon the Brighton Collaboration criteria for vaccine-associated anaphylaxis

We should abandon the Brighton Collaboration criteria for vaccine-associated anaphylaxis

Allergy evaluation of messenger RNA vaccine reactions is crucial, with a specific role for polyethylene glycol testing

Allergy evaluation of messenger RNA vaccine reactions is crucial, with a specific role for polyethylene glycol testing

Anti–Integrin αvβ6 Antibody as a Diagnostic Marker for Pediatric Patients With Ulcerative Colitis

Anti–Integrin αvβ6 Antibody as a Diagnostic Marker for Pediatric Patients With Ulcerative Colitis

Phenotyping older adults with asthma by means of cluster analysis

Whereas a number of publications have identified asthma phenotypes in adults, 1 Haldar P Pavord ID Shaw DE Berry MA Thomas M Brightling CE et al. Cluster analysis and clinical asthma phenotypes. Am J Respir Crit Care Med. 2008; 178: 218-224 Crossref PubMed Scopus (1492) Google Scholar few have focused only on older adults. 2 Hanania NA King MJ Braman SS Saltoun C Wise RA Enright P et al. Asthma in the elderly: current understanding and future research needs–a report of a National Institute on Aging (NIA) workshop. J Allergy Clin Immunol. 2011; 128: S4-24 Abstract Full Text Full Text PDF PubMed Scopus (173) Google Scholar ,3 Baptist AP Hao W Karamched KR Kaur B Carpenter L Song PX. Distinct asthma phenotypes among older adults with asthma. J Allergy Clin Immunol Prac. 2018; 6: 244-249 Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar As a component of a randomized controlled trial of older adults (≥50 years old) with persistent asthma, Baptist et al, 3 Baptist AP Hao W Karamched KR Kaur B Carpenter L Song PX. Distinct asthma phenotypes among older adults with asthma. J Allergy Clin Immunol Prac. 2018; 6: 244-249 Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar identified 4 phenotypic clusters. The purpose of this study was to compare findings from the Baptist et al 3 Baptist AP Hao W Karamched KR Kaur B Carpenter L Song PX. Distinct asthma phenotypes among older adults with asthma. J Allergy Clin Immunol Prac. 2018; 6: 244-249 Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar study with cluster analysis findings from a cohort of older adults with asthma participating in a longitudinal observational study.

Tolerance of the mRNA COVID-19 vaccines in patients with reported taxane reactions

Tolerance of the mRNA COVID-19 vaccines in patients with reported taxane reactions

Anti-BP230 Only Bullous Pemphigoid Constitutes a Distinct Disease Subgroup with Characteristic Serological and Clinical Features

Anti-BP230 Only Bullous Pemphigoid Constitutes a Distinct Disease Subgroup with Characteristic Serological and Clinical Features

SARS-CoV-2 symptomatic reinfection among patients with primary antibody deficiency

SARS-CoV-2 symptomatic reinfection among patients with primary antibody deficiency

Sensitization to trometamol in patients with delayed local reactions after administration of the Moderna mRNA-1273 vaccine against SARS-CoV-2

Sensitization to trometamol in patients with delayed local reactions after administration of the Moderna mRNA-1273 vaccine against SARS-CoV-2

Tyrosine kinase inhibitors for the treatment of indolent systemic mastocytosis: Are we there yet?

Indolent systemic mastocytosis (ISM) is the most prevalent form of systemic mastocytosis. Many patients with ISM suffer from mast cell (MC) mediator-related symptoms. In a small number of patients, hematologic progression is seen in the follow-up. In some patients with ISM, symptoms arising from MC-derived mediators including gastrointestinal symptoms, anaphylaxis, and neuropsychiatric symptoms are kept under control with conventional mediator-targeting drugs or MC-stabilizing agents. However, in a substantial number of patients, the symptoms are refractory to such conventional therapy. For these patients, novel drugs and targeted approaches are considered. One reasonable approach may be to apply tyrosine kinase inhibitors directed against KIT and other key kinase targets expressed in neoplastic MCs in ISM. Because MCs in more than 90% of all patients with typical ISM display the KIT D816V mutant receptor, clinically effective KIT-targeting drugs have to be active against this mutant form of KIT. The 2 such most effective and well-studied agents currently available are midostaurin and avapritinib. Other KIT-targeting drugs, such as imatinib or masitinib, are less effective or even noneffective against KIT D816V and are thus recommended for use only in patients with other KIT mutant forms (noncodon 816 mutations) or with wild-type KIT. In the present article, we review the current state in the treatment of ISM with tyrosine kinase inhibitors, with special emphasis on treatment responses and potential adverse effects. In fact, all of these agents also have unique and common adverse effects, and their use to treat patients with ISM should be balanced against their toxicity and short- and long-term safety.

Gender dimorphism in IgA subclasses in T2-high asthma

Immunoglobulin A (Chan in J Allergy Clin Immunol 134:1394–14014e4, 2014), the second most abundant immunoglobulin in serum, plays an important role in mucosal homeostasis. In human serum, there are two subclasses of IgA, IgA1 (≅ 90%) and IgA2 (≅ 10%), transcribed from two distinct heavy chain constant regions. This study evaluated the serum concentrations of total IgA, IgA1, and IgA2, and total IgG, IgG1, IgG2, IgG3, and IgG4 in T2-high asthmatics compared to healthy controls and the presence of gender-related variations of immunoglobulins. Total IgA levels were increased in asthmatics compared to controls. Even more marked was the increase in total IgA in male asthmatics compared to healthy male donors. IgA1 were increased only in male, but not in female asthmatics, compared to controls. Concentrations of IgG2, but not IgG1, IgG3, and IgG4, were reduced in asthmatics compared to controls. IgG4 levels were reduced in female compared to male asthmatics. In female asthmatics, IgA and IgA1 levels were increased in postmenopause compared to premenopause. IgA concentrations were augmented in mild, but not severe asthmatics. A positive correlation was found between IgA levels and the age of patients and an inverse correlation between serum concentrations of IgA2 and IgE in asthmatics. A positive correlation between total IgA or IgA2 and IgG2 was found in asthmatics. These results highlight a gender dimorphism in IgA subclasses in male and female T2-high asthmatics. More adequate consideration of immunological gender disparity in asthma may open new opportunities in personalized medicine by optimizing diagnosis and targeted therapy.

Fixed drug eruption after Pfizer-BioNTech COVID-19 vaccine: A case report

Fixed drug eruption after Pfizer-BioNTech COVID-19 vaccine: A case report

Weight excess association with severity in children and adolescents with COVID-19: A systematic review.

Background & aimsConcomitantly to the coronavirus disease 2019 (COVID-19), in the child population there was already another pandemic wave in progress: childhood obesity. Numerous studies in adults have been carried out and describe obesity as an independent risk and prognostic factor for the severity of COVID-19. This study aims to systematically review the literature on the relation between weight excess and the severity of COVID-19 in children and adolescents.MethodsThis systematic review was developed following the PRISMA standards (Preferred Reporting Items for Systematic Review and Meta-Analysis). The literature search was performed in September 2020, in the following databases: MEDLINE (via PubMed), Embase, Scopus, The Cochrane Library (Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials (CENTRAL)), Web of Science, BVS/LILACS and SciELO. Registration on the PROSPERO platform (International Prospective Registry of Systematic Reviews) can be found under the registration number: CRD42021230686.ResultsOf the 667 selected articles, 11 were included according to all agreed criteria, most of them being unicentric and American. In assessing the risk of bias and quality, following the criteria of the Newcastle–Ottawa Scale, eight studies achieved scores higher than 7. Only 5 studies sought to assess obesity and its relation with worse outcomes (such as need for pediatric intensive care unit (PICU), mechanical ventilation (MV), tracheostomy, hospital readmission and mortality), and out of these, only one article demonstrated this comorbidity as a prognostic factor for worse evolution of the COVID picture.ConclusionsFew studies in the literature seek to assess excess weight and its relation with worse outcomes of COVID-19 in children and adolescents. Taking into account that there is already scientific evidence on this subject in adult patients, it is necessary to carry out more research in the pediatric age group.

Outbreak of Silicosis in Workers Producing Artificial Stone Skirting Boards: A Novel Application of Silica-Based Composites

Outbreak of Silicosis in Workers Producing Artificial Stone Skirting Boards: A Novel Application of Silica-Based Composites

Partnering to Improve Pediatric Asthma Quality.

Partnering to Improve Pediatric Asthma Quality.

The efficacy and safety of Janus kinase inhibitors in patients with atopic dermatitis: A systematic review and meta-analysis

To the Editor: Current treatments may not satisfactorily relieve symptoms of atopic dermatitis (AD), especially severe AD.1Leung D.Y. Guttman-Yassky E. Assessing the current treatment of atopic dermatitis: unmet needs.J Allergy Clin Immunol. 2017; 139: S47-S48Abstract Full Text Full Text PDF PubMed Scopus (19) Google Scholar Janus kinase inhibitors (JAKis) are increasingly being used in the treatment of AD, with both topical (ruxolitinib cream) and oral (upadacitinib and abrocitinib) versions recently receiving US Food and Drug Administration approval for this indication.2Kim B.S. Sun K. Papp K. Venturanza M. Nasir A. Kuligowski M.E. Effects of ruxolitinib cream on pruritus and quality of life in atopic dermatitis: results from a phase 2, randomized, dose-ranging, vehicle- and active-controlled study.J Am Acad Dermatol. 2020; 82: 1305-1313Abstract Full Text Full Text PDF PubMed Scopus (49) Google Scholar We systematically review the efficacy and safety of JAKis among existing randomized, double-blinded, and placebo-controlled clinical trials of JAKis for the treatment of AD. This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and registered in PROSPERO (CRD42020188514). We searched electronic databases (Embase, PubMed, and Cochrane Central Register of Controlled Trials) from their inception to September 16, 2021. We also searched unpublished clinical trials at ClinicTrials.gov. The search strategies and methods are provided in Supplementary Materials (available via Mendeley at https://data.mendeley.com/datasets/89x8s56p5z/2). We initially identified 1209 records from all 4 databases, as summarized in Supplementary Fig 1 (available via Mendeley at https://data.mendeley.com/datasets/89x8s56p5z/2). Of these, a total of 25 studies were finally included in the meta-analysis, including 8 studies on topical JAKis and 17 on oral JAKis. There were 9931 participants, consisting of 2383 involved in studies on topical JAKis and 7548 in studies on oral JAKis. Four kinds of topical JAKis (tofacitinib ointment, delgocitinib ointment, delgocitinib cream, and ruxolitinib cream) were applied, and 5 kinds of oral JAKis (baricitinib, abrocitinib, ASN002, SHR0302, and upadacitinib) were given at varying dosages. The detailed characteristics of the included studies are summarized in Supplementary Table I (available via Mendeley at https://data.mendeley.com/datasets/89x8s56p5z/2). We also assessed the risk of bias, as summarized in Supplementary Fig 2 (available via Mendeley at https://data.mendeley.com/datasets/89x8s56p5z/2) and Supplementary Table II (available via Mendeley at https://data.mendeley.com/datasets/89x8s56p5z/2). Overall, compared with placebos, the use of JAKis showed a significant improvement in the lesion score and pruritus: Eczema Area and Severity Index score (standard mean difference [95% CI], −0.79 [−0.97 to −0.61]; P < .00001); investigators’ global assessment score (odds ratio [OR] [95% CI], 5.08 [3.78-6.82]; P < .00001); and pruritus numerical rating scale (standard mean difference [95% CI], −0.49 [−0.67 to −0.32]; P < .00001) (Supplementary Table III [available via Mendeley at https://data.mendeley.com/datasets/89x8s56p5z/2] and Supplementary Figs 3 to 5 [available via Mendeley at https://data.mendeley.com/datasets/89x8s56p5z/2]). Although no significant adverse effects (AEs) were found for the topical JAKis, the oral JAKis showed an increased risk of at least 1 AE (OR [95% CI], 1.23 [1.11-1.36]; P < .0001) and the following most frequently reported AEs: gastrointestinal disorders (OR [95% CI], 2.49 [1.84-3.37]; P < .00001), nasopharyngitis (OR [95% CI], 1.23 [1.04-1.46]; P = .02), and headache (OR [95% CI], 1.57 [1.23-2.00]; P = .0003) (Supplementary Table IV, available via Mendeley at https://data.mendeley.com/datasets/89x8s56p5z/2). No malignancy or death was reported. Previous systematic reviews have reported that herpes zoster and serious infections are common in JAKi treatment.3Olivera P.A. Lasa J.S. Bonovas S. Danese S. Peyrin-Biroulet L. Safety of Janus kinase inhibitors in patients with inflammatory bowel diseases or other immune-mediated diseases: a systematic review and meta-analysis.Gastroenterology. 2020; 158: 1554-1573Abstract Full Text Full Text PDF PubMed Scopus (113) Google Scholar, 4Bechman K. Subesinghe S. Norton S. et al.A systematic review and meta-analysis of infection risk with small molecule JAK inhibitors in rheumatoid arthritis.Rheumatology (Oxford). 2019; 58: 1755-1766Crossref PubMed Scopus (140) Google Scholar, 5Khoo J.K. Barnes H. Key S. Glaspole I.N. Östör A.J. Pulmonary adverse events of small molecule JAK inhibitors in autoimmune disease: systematic review and meta-analysis.Rheumatology (Oxford). 2020; 59: 2217-2225Crossref PubMed Scopus (17) Google Scholar However, these were infrequent in our systematic review. Creatine phosphokinase level elevations were mentioned in baricitinib and upadacitinib treatments: even though patients with creatine phosphokinase level elevation were asymptomatic, the incidence and relationship with JAKi therapy remain to be further investigated. Undoubtedly, long-term follow-up trials are needed for better assessing the safety profile. In conclusion, this systematic review and meta-analysis showed that JAKis are a promising treatment option for AD. Because of the higher risk of gastrointestinal disorders, nasopharyngitis, and headache during oral JAKi treatments, more attention should be paid to the AEs of patients treated with oral JAKis. Further studies with long follow-up in different conditions will be needed to fully elucidate the safety profile of the different JAKis. None disclosed.