Hypersensitivity reactions to nonsteroidal anti-inflammatory drugs in adults: Beyond current classification

Çerçi P, Kendirlinan R, Büyüköztürk S et al. Allergol Immunopathol (Madr). 2023 Sep 1;51(5):84-92. doi: 10.15586/aei.v51i5.946. 

Abstract

Background: Hypersensitivity reactions (HSRs) to nonsteroidal anti-inflammatory drugs (NSAIDs) are a significant clinical issue. Several classifications have been proposed to categorize these reactions, including the current European Academy of Allergy and Clinical Immunology/European Network for Drug Allergy (EAACI/ENDA) classification. This study aimed to evaluate the applicability of this classification in a real-world clinical setting.

Methods: We conducted a national multicenter study involving patients from nine hospitals in four major urban centers in Turkey. All patients had a suggestive clinical history of hypersensitivity reactions to NSAIDs. Researchers collected data using a structured form and classified reactions based on the EAACI/ENDA classification.

Mental health problems associated with idiopathic anaphylaxis

• Research
• Open Access
• 
  

• Logan S Gardner, 
• Zihao Tan, 
• David Brown, 
• David Gillis, 
• James G. Scott & 
• Roger Prentice 

Allergy, Asthma & Clinical Immunology volume 19, Article number: 84 (2023) 

• details

Abstract

Background

Idiopathic Anaphylaxis (IA) is the most common anaphylactic syndrome in adults. Mental health problems associated with IA are not well recognised. We aimed to assess if patients diagnosed with IA were more likely to experience mental health problems compared to a normative Australian population.

A case of possible anaphylaxis to ASA and structurally unrelated NSAIDs

• Case report
• Open Access
• 
  

• Sarah Edgerley & 
• Harold Kim 

Allergy, Asthma & Clinical Immunology volume 19, Article number: 81 (2023) 

• details

Abstract

Background

Non-steroidal anti-inflammatory drugs (NSAIDs) are one of the most commonly used classes of medications, and are among the leading causes of drug hypersensitivity. NSAIDs hypersensitivity reactions are classified by symptom involvement and NSAIDs subclass cross-reactivity. Reactions varying from cutaneous involvement to respiratory symptoms can be triggered by multiple NSAIDs subclasses. Anaphylaxis, while rare, can be induced by a single NSAID, with tolerability of other structurally unrelated subclasses.

Efficacy and Tolerability of Gefapixant for Treatment of Refractory or Unexplained Chronic Cough A Systematic Review and Dose-Response Meta-Analysis

Kum E, Patel M, Diab N, Wahab M, Zeraatkar D, Chu DK, O'Byrne PM, Guyatt GH, Satia I. JAMA. 2023 Sep 11. doi: 10.1001/jama.2023.18035.

Key Points

Question  Is the use of gefapixant to treat refractory or unexplained chronic cough associated with greater benefits or harms compared with placebo?

Effects of Gefapixant by Approximate Dose Compared With Placebo
Estimated by a Study-Level Meta-Analysis

Findings  In this dose-response meta-analysis that included 9 randomized clinical trials and 2980 patients, compared with placebo, use of gefapixant (45 mg orally twice daily) reduced cough frequency by 17.6%, decreased cough severity by 6.2 mm on the 100-mm visual analog scale, and improved cough quality of life by 1 point on the Leicester Cough Questionnaire (score range, 3-21). Patients treated with gefapixant (45 mg orally twice daily) had, however, a 32% increase in taste-related adverse events compared with placebo.

Meaning  Gefapixant may provide benefit to some patients with refractory or unexplained chronic cough, but the magnitude is likely small and the risk of adverse events, particularly taste-related, remains substantial.

From MASK-air® and SILAM to CATALYSE (Climate Action to Advance HeaLthY Societies in Europe)

Sousa-Pinto B, Palamarchuk Y, Leemann L et al. J Investig Allergol Clin Immunol. 2023 Jul 26:0. doi: 10.18176/jiaci.0923. 

Abstract:

Taylor diagram of air quality predictions by CAMS models.

Plant species vary under different climate conditions and the distribution of pollen in the air and their trends can be used to assess the impact of climate change on public health. In 2015, MASK-air® (Mobile Airways Sentinel networK for rhinitis and asthma) was launched as a project of the European Innovation Partnership on Active and Healthy Ageing (EIP-on-AHA, DG Santé and DG CONNECT). This project aimed to develop a warning system to inform patients about the pollen season onset. SILAM (System for Integrated modeLling of Atmospheric composition), a global-to-meso-scale dispersion model was developed by the Finnish Meteorological Institute (FMI). It provides quantitative information on atmospheric pollution of anthropogenic and natural origins, particularly on allergenic pollens. POLLAR (Impact of Air Pollution on Asthma and Rhinitis, EIT Health) has combined MASK-air clinical data with SILAM forecasts.

Cost-effectiveness analysis of baricitinib versus dupilumab for moderate to severe atopic dermatitis: an Italian healthcare system perspective.

Johansson E, Giovannitti M, Mezzetti M, Lu N, Sabatino S.  J Med Econ. 2023 Sep 7:1-23. doi: 10.1080/13696998.2023.2255495. 

Abstract

Aims

To assess, within the Italian healthcare system, the cost-effectiveness of baricitinib versus dupilumab, both in combination with topical corticosteroids (TCS), in adults with moderate to severe atopic dermatitis (AD) who are eligible for but have failed, have contraindications to, or cannot tolerate ciclosporin.

Materials and methods

Using the perspective of the Italian healthcare payer, direct medical costs associated with each intervention were estimated over a lifetime horizon. A Markov cohort model utilized the proportions of patients with ≥75% improvement Eczema Area and Severity Index obtained from clinical trials.

The Unified Airway Hypothesis: Evidence From Specific Intervention With Anti–IL-5 Biologic Therapy

Bachert C, Luong AU, Gevaert P, Mullol J, Smith SG, Silver J, Sousa AR, Howarth PH, Benson VS, Mayer B, Chan RH, Busse WW. J Allergy Clin Immunol Pract VOLUME 11, ISSUE 9, P2630-2641, SEPTEMBER 2023 (Open Access)

The roles of eosinophils in tissue remodeling in diseases of the unified airway,
including severe eosinophilic asthma, CRSwNP, and NSAID-ERD.

The unified airway hypothesis proposes that upper and lower airway diseases reflect a single pathological process manifesting in different locations within the airway. Functional, epidemiological, and pathological evidence has supported this well-established hypothesis for some time. However, literature on the pathobiologic roles/therapeutic targeting of eosinophils and IL-5 in upper and lower airway diseases (including asthma, chronic rhinosinusitis with nasal polyps [CRSwNP], and nonsteroidal anti-inflammatory drug-exacerbated respiratory disease) has recently emerged. This narrative review revisits the unified airway hypothesis by searching the scientific literature for recent learnings and clinical trial/real-world data that provide a novel perspective on its relevance for clinicians.

Smell improvement in chronic rhinosinusitis with nasal polyps with monoclonal antibodies: a systematic review

Barroso B, Valverde-Monge M, Betancor D, Gómez-López A, Villalobos-Vildas C, González-Cano B, Sastre J. J Investig Allergol Clin Immunol 2023; Vol. 33(6) doi: 10.18176/jiaci.0939


Abstract
Background: Smell impairment is more commonly related to chronic rhinosinusitis with nasal polyps (CRSwNP) than without, especially given associated asthma and/or NSAID-exacerbated respiratory disease and type 2 inflammation. Therapeutic options include intranasal and systemic corticosteroids, surgery and, more recently, biological therapy. We summarize current knowledge on the effect of biologics on olfaction in patients with CRSwNP.

Methods: We performed a systematic search of the PubMed and Cochrane databases from January 2001 to June 2022. Inclusion criteria were: adult patients with CRS treated with dupilumab, omalizumab, mepolizumab, benralizumab or reslizumab; studies published in English reporting outcomes in sense of smell using a psychophysical and/or subjective tools. Exclusion criteria covered reports that did not assess CRSwNP, smell loss evaluated with a different method according to mentioned inclusion criteria, review articles and expert opinion. No source of funding is available.