Diagnosis and management of eosinophilic esophagitis

Milli Gupta and Michelle Grinman. CMAJ February 05, 2024 196 (4) E121-E128; DOI: https://doi.org/10.1503/cmaj.230378

KEY POINTS

Eosinophilic esophagitis is a chronic inflammatory disease of both children and adults, for which incidence and prevalence is rising worldwide; the condition is most common among young males with a history of atopy.

The pathophysiology involves an incompletely understood interaction of antigen exposures with host factors, including esophageal-specific genetic variations.

Adults with eosinophilic esophagitis commonly present with recurrent dysphagia and food bolus impaction, which may be masked by compensating behaviours, whereas children more often present with feeding problems, abdominal pain and vomiting.

Diagnosis of eosinophilic esophagitis is based on clinical history as well as eosinophilic-predominant inflammation on histological examination of biopsies taken at endoscopy.

Food Allergen Immunotherapy in the Treatment of Patients with IgE-Mediated Food Allergy

Turkalj M, Miletić Gospić A, Višekruna Džidić I, Banić I. Medicina (Kaunas). 2024 Jan 9;60(1):121. doi: 10.3390/medicina60010121. 

Abstract

The prevalence of allergic diseases, including food allergy, is increasing, especially in developed countries. Implementation of an elimination diet is not a sufficient therapeutic strategy in patients with food allergy, whose quality of life is significantly impaired. In recent years, new effective therapeutic strategies have been developed, such as the application of oral, sublingual, and epicutaneous immunotherapy. Oral immunotherapy is the most often applied strategy because of its effectiveness and ease of application, with an acceptable safety profile.

Adverse events of anti-IL-5 drugs in patients with eosinophilic asthma: a meta-analysis of randomized controlled trials and real-world evidence-based assessments.

Li, W., Tang, SC. & Jin, L.  BMC Pulm Med 24, 70 (2024). https://doi.org/10.1186/s12890-024-02885-2

Abstract

Background

We aimed to clarify comprehensively the safety profiles of anti-IL-5 drugs and pinpoint potential safety concerns that may arise in their post-marketing phase.

Methods

Two researchers conducted comprehensive searches of PubMed, EMBASE, Web of Science, and the Cochrane Library from inception to September 2022. Additionally, we investigated the FDA AE Reporting System for post-marketing adverse event (AE) reports related to anti-IL-5 drugs.

The prevalence of obstructive sleep apnea in Japanese asthma patients.

Yasuda, M., Tobino, K., Harada, N. et al. Allergy Asthma Clin Immunol 20, 10 (2024). https://doi.org/10.1186/s13223-024-00875-x

Abstract

Background

Obstructive sleep apnea (OSA) occurs more commonly in asthma patients than in the general population because these conditions share some comorbidities. In Japan, the prevalence of OSA in the general population is reported to be approximately 20%; however, few reports have described the prevalence of OSA in asthma patients. Furthermore, the characteristics of Japanese patients with OSA and asthma are not clear.

Methods

Adult asthma patients were recruited from the outpatient departments of our institution between August 31, 2017, and March 31, 2019. In all included patients, the presence and severity of OSA were evaluated by the Epworth Sleepiness Scale (ESS) and a home sleep test (HST) using portable polysomnography (PSG). The rate of coexisting OSA in asthma patients and the characteristics of those patients according to the severity of OSA were investigated.

Inborn errors of immunity in adulthood

Wang, J.J.F., Dhir, A., Hildebrand, K.J. et al. Allergy Asthma Clin Immunol 20, 6 (2024).  

Review Open access

Abstract

Inborn errors of immunity (IEIs) are a group of conditions whereby parts of the immune system are missing or dysfunctional. Once thought to primarily be a pediatric disorder, it is now estimated that more than 50% of worldwide incident IEI cases are accounted for by adults. Delayed diagnosis, late symptom onset, and IEI phenocopies can all lead to adult-onset recognition of IEIs. Lack of awareness regarding the diversity of IEI manifestations in adults contributes to diagnostic and treatment delays.

Dupilumab In Pediatric Patients With Severe Atopic Dermatitis – Video abstract

Video abstract of a review paper "Dupilumab Treatment in Pediatric Patients Aged 6–11 Years with Severe Atopic Dermatitis Whose Disease Is Not Adequately Controlled: A Review" published in the open access journal Drug Design, Development and Therapy by Michael Cork, Simon Danby, Ana B Rossi et al. Read the full paper here: https://www.dovepress.com/dupilumab-treatment-in-pediatric-patients-aged-611-years-with-severe-a-peer-reviewed-fulltext-article-DDDT

Carrageenan-Containing Nasal Spray Alleviates Allergic Symptoms in Participants with Grass Pollen Allergy: A Randomized, Controlled, Crossover Clinical Trial

Unger-Manhart N, Morokutti-Kurz M, Zieglmayer PU, Lemell P, Savli M, Zieglmayer R, Prieschl-Grassauer E. Int J Gen Med. 2024;17:419-428

Purpose: Nonpharmacological, barrier-forming nasal sprays are used to manage symptoms of allergic rhinitis. We aim to evaluate the safety and effectiveness of Callergin (investigational product, IP), a nasal spray containing barrier-forming iota-carrageenan, in the treatment of allergic rhinitis (AR).

Methods: In this randomized, controlled, crossover trial, adults with grass pollen allergy underwent a treatment sequence with IP, VisAlpin (comparator product, CP), and no treatment in random order. Treatment blocks consisted in prophylactic administration of the assigned treatment or no treatment, followed by a 3-hr allergen exposure, and were separated by a washout period of 7 days. Primary endpoint was a mean change from baseline in “Total Nasal Symptom Score” (TNSS, sum of rhinorrhea, itching, sneezing, and congestion scores) over 3 hr, recorded every 15 min during the challenge period.

Exploring the role of information and communication technologies in allergic rhinitis in specialist centers: Patient perspectives on usefulness, value, and impact on healthcare

Cherrez-Ojeda I, Bousquet J, Sarfraz Z, et al. Clin Transl Allergy. 2024;e12325. https://doi.org/10.1002/clt2.12325

Abstract

Introduction
Information and communication technologies (ICTs) improve patient-centered care and are routinely used in Allergic Rhinitis (AR), but patients' preferences and attitudes are unexplored. This study examines AR-related information preferences and ICT use by AR patients.

Methods
A survey-based cross-sectional study was carried out in Ecuador from July to September 2019 in seven centers of reference for allergic disease. Participants were 18 years or older, diagnosed with AR and had access to ICT and the Internet. Descriptive and binomial logistic regressions were performed. A value of less than 0.05 was considered statistically significant.

Results
217 patients were included. 47% (n = 102) used ICTs to learn about AR, of which 38.2% (n = 83) found it useful. Most of participants (75%, n = 164) did not think that ICTs reduce their need to see a doctor. Individuals with poorer quality of life were more likely to utilize ICTs to contact their doctor (OR 1.27, 95% CI 1.04–1.55), and more likely to be interested in AR-related content (OR 1.23, 95% CI 1.00–1.52).