Eosinophilia Induced by Blocking the IL-4/IL-13 Pathway: Potential Mechanisms and Clinical Outcomes

Olaguibel JM1, Sastre J2, Rodríguez JM3, del Pozo V4

1Servicio de Alergología, Hospital Universitario de Navarra, CIBER de Enfermedades Respiratorias (CIBERES), Pamplona, Spain
2Allergy Department, Fundación Jiménez Díaz, CIBER de Enfermedades Respiratorias (CIBERES), School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
3Department of Immunology, IIS-Fundación Jiménez Díaz and CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
4Department of Immunology, IIS-Fundación Jiménez Díaz; CIBER de Enfermedades Respiratorias (CIBERES) and School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain

J Investig Allergol Clin Immunol 2022; Vol 32(3) : 165-180
doi: 10.18176/jiaci.0823

• Abstract

Five biological drugs are currently marketed for treatment of uncontrolled severe asthma. They all block type 2 inflammatory pathways by targeting IgE (omalizumab), the IL-5 pathway (mepolizumab, reslizumab, benralizumab), or the IL-4/IL-13 pathway (dupilumab). Hypereosinophilia has been observed in 4%-25% of patients treated with dupilumab and is transient in most cases, although there have been reports of persistent cases of symptomatic hypereosinophilia consistent with eosinophilic granulomatosis with polyangiitis (EGPA), eosinophilic pneumonia, eosinophilic vasculitis, and sudden worsening of asthma symptoms. Cases of EGPA have been reported with all biologics, including anti–IL-5 agents, and with leukotriene receptor antagonists in publications or in the EudraVigilance database. In many cases, EGPA appears during tapering of systemic corticosteroids or after switching from an anti–IL-5 biologic to dupilumab, suggesting that systemic corticosteroids or the anti–IL-5 agent were masking vasculitis.

Diagnostic therapeutic care pathway for pediatric food allergies and intolerances in Italy: a joint position paper by the Italian Society for Pediatric Gastroenterology Hepatology and Nutrition (SIGENP) and the Italian Society for Pediatric Allergy and Immunology (SIAIP)

• Review
• Open Access
• 
  

• Roberto Berni Canani, 
• Carlo Caffarelli, 
• Mauro Calvani, 
• Alberto Martelli, 
• Laura Carucci, 
• Tommaso Cozzolino, 
• Patrizia Alvisi, 
• Carlo Agostoni, 
• Paolo Lionetti & 
• Gian Luigi Marseglia 

Italian Journal of Pediatrics volume 48, Article number: 87 (2022) 

• details

Abstract

Epidemiologic data suggest an increased prevalence of pediatric food allergies and intolerances (FAIs) during the last decades. This changing scenario has led to an increase in the overall healthcare costs, due to a growing demand for diagnostic and treatment services. There is the need to establish Evidence-based practices for diagnostic and therapeutic intervention that could  be adopted in the context of public health policies for FAIs are needed.

Food protein-induced enterocolitis syndrome in a tertiary pediatric center: safety of guideline-conforming food challenges

• Letter to the editor
• Open Access
• 
  

• Samantha Wong, 
• Lucy Duan, 
• Alana Galper, 
• Adelle Atkinson, 
• Julia Upton & 
• Thomas Eiwegger 

Allergy, Asthma & Clinical Immunology volume 18, Article number: 54 (2022)

• details

Abstract

Food protein-induced enterocolitis syndrome is a non-IgE-mediated reaction to food that is poorly understood, and underdiagnosed. Trigger foods can belong to any food group, but are most commonly milk, soy, rice, oat, egg, and fish. In this retrospective study (2015–2020), we describe the clinical presentations and triggers of 37 children referred to tertiary hospital with a confirmed or suspected diagnosis of food protein-inducted enterocolitis.

Long-Term Natural History of Severe Asthma Exacerbations and Their Impact on the Disease Course

Lee TY, Petkau J, Sadatsafavi M. Ann Am Thorac Soc. 2022 Jun;19(6):907-915. doi: 10.1513/AnnalsATS.202012-1562OC. 

Abstract

Rationale: The long-term natural history of asthma in terms of successive severe exacerbations and the influence of each exacerbation on the course of the disease is not well studied.

Objectives: To investigate the long-term natural history of asthma among patients who are hospitalized for asthma for the first time in terms of the risk of future severe exacerbations and heterogeneity in this risk across patients.

Methods: Using the administrative health databases of British Columbia, Canada (January 1, 1997 to March 31, 2016), we created an incident cohort of patients with at least one asthma exacerbation that required inpatient care.

Efficacy and Safety of Masitinib in Corticosteroid-Dependent Severe Asthma: A Randomized Placebo-Controlled Trial

Davidescu L, Ursol G, Korzh O, Deshmukh V, Kuryk L, Nortje MM, Godlevska O, Devouassoux G, Khodosh E, Israel E, Moussy A, Mansfield CD, Hermine O, Chanez P. J Asthma Allergy. 2022 Jun 7;15:737-747. doi: 10.2147/JAA.S337284.

Background: Masitinib is an oral tyrosine kinase inhibitor that selectively targets mast cell activity and platelet-derived growth factor receptor (PDGFR) signaling, both of which are implicated in various mechanisms of asthma pathogenesis.

Objective: Assessment of masitinib as an add-on to standard maintenance therapy as compared with placebo in the treatment of oral corticosteroid-dependent severe asthma.

Patient selection for milk and egg ladders using a food ladder safety checklist

Letter to the editor - Open Access

Gilbert T. Chua, Edmond S. Chan, Joanne Yeung, Scott B. Cameron, Lianne Soller, Brock A. Williams, Alanna Chomyn, Timothy K. Vander Leek, Elissa M. Abrams, Raymond Mak & Tiffany Wong 

Allergy, Asthma & Clinical Immunology volume 18, Article number: 51 (2022)

Abstract

A food ladder is a form of home-based dietary advancement therapy that gradually increases exposure to an allergenic food through the gradual introduction of egg or milk containing food with increasing quantity and allergenicity from extensively heated forms, such as baked goods, to less processed products.

Simplifying the drug provocation test in non-immediate hypersensitivity reactions to amoxicillin in children: The experience of a tertiary care allergy unit

Open AccessLiccioli, G, Giovannini, M, Caubet, J-C, et al.  Pediatr Allergy Immunol. 2022; 33:e13809. doi:10.1111/pai.13809

Abstract

Background

Mild non-immediate reactions (NIR) to beta-lactams (βLs) are the most common manifestation of adverse drug reactions in children, and the drug provocation test (DPT) remains the gold standard for diagnosis. However, there are still controversies about the protocol that should be used, especially regarding the administration of doses and the DPT length.

Objective

This study aimed to evaluate a pediatric population with a history of mild NIR to amoxicillin (AMX) or to amoxicillin-clavulanic acid (AMX/CL) who underwent a diagnostic workup including a DPT with the culprit drug, to understand if a graded DPT or, instead, a single full dose could be the most appropriate way of administration in clinical practice.

Serum antioxidant vitamins and respiratory morbidity and mortality: a pooled analysis

• Research
• Open Access
• 
  

• Paivi M. Salo, 
• Angelico Mendy, 
• Jesse Wilkerson, 
• Samantha A. Molsberry, 
• Lydia Feinstein, 
• Stephanie J. London, 
• Michael B. Fessler, 
• Peter S. Thorne & 
• Darryl C. Zeldin 

Respiratory Research volume 23, Article number: 150 (2022) 

• details

Abstract

Background

Oxidative stress plays a key role in the pathogenesis of respiratory diseases; however, studies on antioxidant vitamins and respiratory outcomes have been conflicting. We evaluated whether lower serum levels of vitamins A, C, D, and E are associated with respiratory morbidity and mortality in the U.S. adult population.

Methods

We conducted a pooled analysis of data from the 1988–1994 and 1999–2006 National Health and Nutrition Examination Survey (participants aged ≥ 20 years). We estimated covariate-adjusted odds ratios (aOR) per interquartile decrease in each serum vitamin level to quantify associations with respiratory morbidity, and covariate-adjusted hazard ratios (aHR) to quantify associations with respiratory mortality assessed prospectively through 2015.