Is the Anamnesis Enough to De-Label Patients with Reported Beta-Lactam Allergy?

Rozłucka L, Rymarczyk B, Gawlik R, Glück J. J Clin Med. 2024 Nov 29;13(23):7267. doi: 10.3390/jcm13237267.

Abstract

Background: The decision whether to de-label patient with suspected BL hypersensitivity is based on risk stratification. The aim of this study was to prepare a characteristic of diagnostic risk groups and to create a model enabling the identification of the low-risk diagnostic group. Methods: We analyzed the medical records of patients hospitalized due to suspected hypersensitivity to BL antibiotics. Based on their medical-history data, patients were divided into three diagnostic risk groups, using the criteria proposed by Shenoy et al. Univariate and multivariate analysis models were used to create a diagnostic tool.

Sensitivity and specificity for the multivariate logistic regression
model of the low-diagnostic-risk group shown as a ROC
(Receiver Operating Characteristic) curve.

Results: Among 263 patients referred for BL hypersensitivity diagnosis, 88 (33.5%) were allocated to group I, 129 (49%) to group II, and 46 (17.5%) to group III. There were significant differences between diagnostic risk groups regarding history of hypersensitivity to penicillins (p < 0.001), cephalosporins (p < 0.001), >1 BL (p < 0.05), several episodes of BL hypersensitivity (p < 0.001), medical intervention (p < 0.001), documented hypersensitivity (p < 0.001), time from drug intake to symptoms (p < 0.001), and time from hypersensitivity to diagnosis (p < 0.001). In total, 81 patients (30.8%) were de-labeled: 52 (59.8%) in group I, 27 (20.9%) in group II, and 2 (4.3%) in group III. The univariate analysis model of the low-diagnostic-risk group applied to the de-labeled part showed 90% specificity and 21.93% sensitivity. NPV and PPV were estimated at 72.04% and 49.53%, respectively. The multivariate model had high specificity but low sensitivity; its NPV was 76%, with 68% PPV. Conclusions: The tool enabling the identification of low-diagnostic-risk patients based on anamnesis is not sensitive enough to de-label patients on its basis.

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Medication adherence in allergic diseases and asthma: a literature review

Malaya E, Piątkowska A, Panek M, Kuna P, Kupczyk M, Kardas G.  Front Pharmacol. 2024 Dec 2;15:1488665. doi: 10.3389/fphar.2024.1488665. 

Abstract

5 Dimensions affecting adherence.

Patients' collaboration with healthcare providers, along with their individual dedication to follow medical recommendations, is a crucial component of effective therapy in chronic diseases. If a patient fails to fill their prescription, administers the medication improperly in terms of method and/or dosage, misses follow-up visits, or discontinues the treatment for any reason, these lapses can adversely affect disease management, impairing the effectiveness of symptom relief and prevention of progression and complications. A comparable situation pertains to allergic diseases, which require long-term and consistent treatment to achieve symptom alleviation and control. Research has shown that adherence rates for long-term therapy in chronic diseases have improved marginally over the years and continue to hover at approximately the figure published in a World Health Organization (WHO) report "Adherence to long-term therapies: evidence for action." from 2003, which had stated that only 50% of patients in developed countries follow medical recommendations and that this rate would be even lower in developing countries.

Efficacy and safety of SQ house dust mite sublingual immunotherapy-tablet (12 SQ-HDM) in children with allergic rhinitis/rhinoconjunctivitis with or without asthma (MT-12): a randomised, double-blind, placebo-controlled, phase III trial

Schuster A, Caimmi D, Nolte H et al. Lancet Reg Health Eur. 2024 Nov 26;48:101136. doi: 10.1016/j.lanepe.2024.101136. 

Abstract

Background: Allergic rhinitis/rhinoconjunctivitis (AR/C) induced by house dust mites (HDM) often begins in childhood and negatively impacts a child's quality of life. The daily burden can be further compounded by comorbid asthma. Allergen immunotherapy is the only available treatment targeting the underlying cause of allergic disease. Efficacy and safety of the SQ HDM sublingual immunotherapy (SLIT)-tablet has been demonstrated in adults and adolescents with HDM AR/C with or without asthma, but data are lacking for younger children.

Methods: Phase III, randomised, double-blind, placebo-controlled trial in younger children (5-11 years) with HDM AR/C with or without asthma. Eligible subjects were randomised 1:1 to SQ HDM SLIT-tablet or placebo for ∼1 year and had free access to AR/C symptom-relieving medications. The primary outcome was the total combined rhinitis score (TCRS) during the final 8 weeks of the treatment period (∼1 year). Secondary outcomes included the rhinitis daily symptom score (DSS) and medication score (DMS), the rhinoconjunctivitis total combined score (TCS), and the Paediatric Rhinoconjunctivitis Quality of Life Questionnaire (PRQLQ) score.

Practical Guide for Allergy and Immunology in Canada 2024: Allergen immunotherapy

Boursiquot, JN., Gagnon, R., Quirt, J. et al. Allergy Asthma Clin Immunol 20 (Suppl 3), 66 (2024). https://doi.org/10.1186/s13223-024-00935-2

Abstract

Allergen immunotherapy (AIT) is a potentially disease-modifying therapy that is effective for the treatment of allergic rhinitis/conjunctivitis, allergic asthma and stinging insect hypersensitivity. The decision to proceed with AIT should be made on a case-by-case basis, based on a comprehensive evaluation of the patient, allergy testing and a thorough discussion with the patient about treatment goals, risks vs. benefits, and long-term commitment to the treatment plan. For those with allergic rhinitis and/or asthma, it is also important to consider individual patient factors, such as the degree to which symptoms can be reduced by avoidance measures and pharmacological therapy, the amount and type of medication required to control symptoms, the adverse effects of pharmacological treatment, and patient preferences.

Indications, available allergens, contraindications and special considerations for AIT

Since AIT is associated with a risk of anaphylaxis, it should only be prescribed by physicians who are adequately trained in the treatment of allergic conditions.

Double-blind, placebo-controlled trial of the efficacy and safety of azelastine hydrochloride in children with perennial allergic rhinitis

Jean Bousquet, Ludger Klimek, Hans-Christian Kuhl, Duc Tung Nguyen, Rajesh Kumar Ramalingam, G. Walter Canonica, William Berger;  Int Arch Allergy Immunol 2024; https://doi.org/10.1159/000542054

Abstract

Background: Allergic rhinitis (AR) affects up to 40% of the pediatric population. The US practice parameter recommends the use of INAH or INCS as first-line therapy for the treatment of AR. Although not directly targeted to children, the recent US Practice Parameters proposed intranasal antihistamines as first-line therapy whereas the ARIA guidelines did not. Methods: This was a randomized, double-blind, parallel-group study with a duration of 28 days. It compared Azelastine hydrochloride 0.10% and 0.15% to placebo of one spray per nostril twice daily in pediatric subjects with moderate-to-severe symptomatic perennial allergic rhinitis (PAR).

Results: A total of 486 subjects were included in the study. The change from baseline rTNSS was statistically significant for 0.15% AZE (P = .005) and 0.10% AZE (P = .015) vs. placebo.

Efficacy and Safety of Montelukast+Levocetirizine Combination Therapy Compared to Montelukast Monotherapy for Allergic Rhinitis in Children

Kim CK, Hwang Y, Song DJ, Yu J, Sohn MH, Park YM, Lim DH, Ahn K, Rha YH. Allergy Asthma Immunol Res. 2024 Nov;16(6):652-667. https://doi.org/10.4168/aair.2024.16.6.652

Abstract

Purpose

The combination therapy of leukotriene receptor antagonists and antihistamines may alleviate allergic rhinitis (AR) symptoms better than monotherapy. This study aimed to investigate the safety and efficacy of Monterizine®, a fixed-dose combination of montelukast and levocetirizine, compared to montelukast monotherapy in pediatric patients with AR.

Methods

One hundred seventy-six children aged 6 to 14 years with perennial AR symptoms were recruited. One hundred forty-seven subjects were randomized into 1 of 2 groups: the mont+levo group (fixed-dose combination of montelukast [5 mg] + levocetirizine [5 mg]) or the mont group (montelukast single agent [5 mg]).

When patient-reported respiratory symptoms shed light on pathophysiology in adult asthma: a cross-sectional study

Louis G, Pétré B, Sousa-Pinto B, Bousquet J, Van Ganse É, Schleich F, Louis R.  Sci Rep. 2024 Dec 2;14(1):29997. doi: 10.1038/s41598-024-81745-9.

Abstract

Schematic representation of the relationship between demographics,
functional, inflammatory features and asthma symptoms.
+Corresponds to a positive association,
while −corresponds to a negative association.

While studies have demonstrated the impact of asthma symptoms on quality of life, very few studies have investigated the relationship between detailed asthma symptoms, as reported by the patient, and lung function and inflammation. A cross-sectional study was conducted on treated (ICS/LABA) adult (> 18 years) asthma patients recruited from the Liege University Hospital Asthma Clinic (Belgium) between 2018 and 2023 (n = 505). The intensity of asthma symptoms (dyspnea, wheezing, chest tightness, cough, and airway secretion) was measured using five-point Likert scales (5 expressing the greatest intensity).

Successful Introduction of Peanut in Sensitized Infants With Reported Reactions at Home

Verhoeven DHJ, Benjamin-van Aalst O, Klok T, de Weger WW, Breukels M, Hendriks T, Gerth van Wijk R, de Groot H.  J Allergy Clin Immunol Pract. 2024 Dec;12(12):3363-3369. doi: 10.1016/j.jaip.2024.08.047. 

Abstract

Background and objective

Previous studies have shown efficacy of early introduction of peanut to prevent peanut allergy. It is currently unknown which diagnostic pathway is optimal after parental-reported reactions to peanut at home after early introduction.

Methods

The PeanutNL cohort study included high-risk infants who were referred for early introduction of peanut. A subgroup of 186 infants with reactions to peanut at home underwent peanut skin prick tests and a supervised open oral food challenge (OFC) at a median age of 8 months. After a negative OFC, peanut was introduced at home.

Results

Evaluating peanut allergy and reintroduction of peanut in infants
with reactions to peanut at first introduction.

Sensitization to peanut was detected in 69% of 186 infants, of whom 80% had >4 mm wheals in skin prick tests. An OFC with a cumulative dose of 4.4 g of peanut protein was performed in 163 infants with Sampson severity score grade I-III reactions at home; 120 challenges were negative. Peanut was subsequently introduced at home in infants with a negative challenge outcome.