Biologic use and treatment patterns in patients with chronic rhinosinusitis with nasal polyps: a US real-world study

Silver, J., Packnett, E., Park, J. et al. Allergy Asthma Clin Immunol 19, 104 (2023). https://doi.org/10.1186/s13223-023-00855-7

Abstract

Background

Several biologics are now approved in the US as add-on treatments for chronic rhinosinusitus with nasal polyps (CRSwNP). This cross-sectional, retrospective, real-world study aimed to characterize treatment patterns and identify predictors of biologic use among patients with CRSwNP.

Methods

Adults in the Merative MarketScan Commercial and Medicare Supplemental Databases with medical claims for CRSwNP were identified June 2018–June 2019 (identification period [IP]). Patient characteristics were collated in the IP and treatment pattern data during the IP plus the following year (July 2019–June 2020; observation period [OP]). Data were stratified by sinus surgery and biologic use.

Results

Of the 5997 eligible patients identified (58% male, mean age 48.1 years), 10.7% (n = 642) used biologics during the OP. More biologic users had common respiratory conditions than non-users, particularly asthma (89.1% vs 35.0%; P < 0.001). Biologic users had fewer diagnostic services but more drug-related services than non-users. Only 11.6% of patients who had sinus surgery used biologics, with most (56.1%) having their first biologic dose before sinus surgery and 12.5% ≤ 30 days after. Oral corticosteroid (OCS) use was higher in biologic users than non-users (all patients: 68.8% vs 42.5%; P < 0.001) and in those with/without sinus surgery. Comorbidities, prior OCS/doxycycline use, and age (< 65 years) increased the odds of biologic use, with asthma increasing the odds 5.46 times (P < 0.001).

Conclusions

Biologic use was more common before first/next sinus surgery and in patients with high unmet need, elucidating predictors of biologic use that could be used in clinical practice.

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Risk of Paradoxical Eczema in Patients Receiving Biologics for Psoriasis

Al-Janabi A, Alabas OA, Yiu ZZN, et al.  JAMA Dermatol. Published online December 06, 2023. doi:10.1001/jamadermatol.2023.4846

Key Points

Question  What factors are associated with paradoxical eczema occurring in patients with psoriasis treated with biologics?

Findings  In this cohort study of 24 997 biologic exposures in 13 699 patients with psoriasis, risk of paradoxical eczema was lowest in patients receiving interleukin 23 inhibitors compared with other biologic classes. Increasing age, history of atopic dermatitis, and history of hay fever were associated with higher risk of paradoxical eczema; risk was lower in males.

Meaning  The findings suggest that interleukin 23 inhibitors could be considered in patients with psoriasis with factors associated with paradoxical eczema.

Abstract

Importance  Biologics used for plaque psoriasis have been reported to be associated with an atopic dermatitis (AD) phenotype, or paradoxical eczema, in some patients. The risk factors for this are unknown.

Objective  To explore risk of paradoxical eczema by biologic class and identify factors associated with paradoxical eczema.

CRUSE – What the first 100 days have taught us

Neisinger S, Pinto BS, Ramanauskaite A, Bousquet J, Weller K, Metz M, Magerl M, Kocatürk E, Ojeda IC, Gimenez-Arnau AM, Maurer M. Qatar Med J. 2023 Nov 19;2023(2):14. doi: 10.5339/qmj.2023.sqac.14. 

Abstract

Introduction: Health apps play an increasing role in everyday healthcare, especially for chronic diseases. The Chronic Urticaria Self Evaluation (CRUSE) is a new mobile health app for chronic spontaneous urticaria (CSU) patients, which replaces disease tracking via paper and pen, thus making disease monitoring more convenient, increasing tracking compliance, and improving data quality and access.

Methods: CRUSE enables patients to complete patient-reported outcome measures on their smartphone and send the results, along with current medication and pictures, to their treating physician via email. CRUSE captures the urticaria (UAS) and angioedema activity (AAS) scores and the urticaria and angioedema control tests (UCT and AECT). In this work, a descriptive analysis of CRUSE users and reported days was performed. The global network of Urticaria Centers of Reference and Excellence (UCARE) provides the app and its data.

Diagnostic validity of specific immunoglobulin E levels to alpha-gal in alpha-gal syndrome: a cross-sectional analysis

Germán-Sánchez, A., Alonso-Llamazares, A., García-González, F. et al. Allergy Asthma Clin Immunol 19, 102 (2023).

Abstract

Background

The diagnosis of Alpha-gal Syndrome (AGS) is based on the presence of symptoms after being exposed to potential sources of alpha-gal together with values ​​of specific IgE (sIgE) to alpha-gal ≥ 0.1 kUA/L or ≥ 0.35 kUA/L. The aim of this study was to evaluate the diagnostic validity of sIgE levels to alpha-gal ≥ 0.1 kUA/L for identifying AGS.

Methods

This was a cross-sectional analysis of adult patients with available data on sIgE levels to alpha-gal, classified into two groups according to the presence (Group 1) or absence (Group 2) of symptoms after being exposed to potential sources of alpha-gal.

Developing and validating clinical models to identify candidates for allergic rhinitis pre-exposure prophylaxis

Wenting Luo, Xiangqing Hou, Yun Sun, Hong Zhang, Huali Ren, Xiangping Ma, Guoping Li, Yongmei Yu, Jianxin Sun, Huajie Wu, Jing Wu, Ruifen Zhong, Siqin Wang, Zhenan Li, Yan Zhao, Liting Wu, Xianhui Zheng, Miaoyuan Xu, Qingyuan Ye, Chuangli Hao & Baoqing Sun (2023) Annals of Medicine, 55:2, DOI: 10.1080/07853890.2023.2287188

Abstract

Purpose: Few risk-forecasting models of allergic rhinitis (AR) exist that may aid AR pre-exposure prophylaxis (PrEP) in clinical practice. Therefore, this study aimed to develop and validate an effective clinical model for identifying candidates for AR PrEP using a routine medical questionnaire.

Methods: This study was conducted in 10 Chinese provinces with 13 medical centers (n = 877) between 2019 and 2021. Clinical characteristics and exposure history were collected via face-to-face interviews. Well-trained physicians diagnosed patients with AR based on skin prick test results and clinical performance. The least absolute shrinkage and selection operator model was used to identify potential risk factors for AR, and the logistic regression model was used to construct the risk-forecasting model.

Prevalence and Socioeconomic Impact of Allergic Rhinitis Among Ear, Nose, and Throat Patients of a Tertiary Hospital

Appiah-Thompson P, Amuquandoh A (December 01, 2023) Cureus 15(12): e49768. doi:10.7759/cureus.49768

Abstract

Objectives: The objectives of this study were to establish the demographic factors of allergic rhinitis patients taking part in the study, to gain insight into the common symptoms experienced by patients with allergic rhinitis, to know the common allergens or triggers that lead to the symptoms of allergic rhinitis and to determine the prevalence of other comorbidities associated with allergic rhinitis.

Methods: The study was a cross-sectional hospital-based study encompassing both quantitative and qualitative features of the participants involved.

Angiotensin-Converting Enzyme Inhibitors and Other Medications Associated With Angioedema

Landry L, Witten T, Anwar A I, et al. (November 23, 2023)  Cureus 15(11): e49306. doi:10.7759/cureus.49306

Abstract

Angioedema is a localized swelling of the dermis, subcutaneous tissues, and/or submucosal tissues caused by fluid extravasation into these tissues. Angioedema is associated with certain vasoactive molecules and is typically mediated by histamine or bradykinin. It manifests clinically as facial edema, swelling of the extremities and urogenital area, and potential involvement of the larynx, leading to dyspnea and inspiratory stridor, which can become life-threatening. Histamine-mediated angioedema is associated with urticaria and pruritus and will show classic signs of allergic (type 1 hypersensitivity) reactions. Bradykinin-mediated angioedema is often familial (hereditary angioedema) and is more often associated with gastrointestinal symptoms (abdominal pain, nausea, vomiting, diarrhea), edema of the extremities and trunk, and a lack of urticaria and pruritus.

Human placental extract suppresses mast cell activation and induces mast cell apoptosis

Wu, T., He, J., Yan, S. et al. Allergy Asthma Clin Immunol 19, 98 (2023). https://doi.org/10.1186/s13223-023-00850-y

Abstract

Background

Human placental extract (HPE) has been documented to facilitate the healing of certain disorders including allergy. However, the effects of HPE on the functionality of mast cells, a critical cell type in allergic diseases, have not been reported.

Methods

To investigate the effects of HPE on the regulation of allergy with respect to the biological functions of mast cells, the mast cell line C57 or HMC-1 cells were treated with HPE followed by the assessment of cell proliferation, apoptosis, activation, chemotaxis and phagocytosis. Mouse peritoneal mast cells were also investigated for their responses to induction of apoptosis by HPE in vivo.