Varying Doses of Epicutaneous Immunotherapy With Viaskin Milk vs Placebo in Children With Cow’s Milk Allergy A Randomized Clinical Trial

Petroni D, Bégin P, Bird JA, Brown-Whitehorn T, Chong HJ, Fleischer DM, Gagnon R, Jones SM, Leonard S, Makhija MM, Oriel RC, Shreffler WG, Sindher SB, Sussman GL, Yang WH, Bee KJ, Bois T, Campbell DE, Green TD, Rutault K, Sampson HA, Wood RA. JAMA Pediatr. 2024 Feb 26:e236630. doi: 10.1001/jamapediatrics.2023.6630

Key Points

Question  Was a safe and efficacious dose of Viaskin milk identified in this phase 1/2 clinical trial?

Findings  In this randomized clinical trial, a statistically significant treatment response was observed in children who received 12 months of daily epicutaneous immunotherapy (EPIT) with Viaskin milk at a dose of 300 μg compared with placebo, with no adverse safety signal observed.

Meaning  With no approved treatment for immunoglobulin E-mediated cow’s milk allergy, EPIT with Viaskin milk may be a viable therapeutic option, with potential to assess Viaskin milk in future clinical trials.

Abstract

Importance  No approved treatment exists for allergen-specific immunoglobulin E (IgE)–mediated cow’s milk allergy (CMA), a common childhood food allergy.

Objective  To assess dose, efficacy, and safety of epicutaneous immunotherapy with Viaskin milk in children with IgE-mediated CMA.

Cost-effectiveness analysis of grass pollen specific immunotherapy in children with allergic rhinitis compared to the standard of care symptomatic treatment in Portugal

Farraia M, Paciência I, Castro Mendes F, Cavaleiro Rufo J, Delgado L, Moreira A. Eur Ann Allergy Clin Immunol. 2023;55(5):212-228. doi: 10.23822/EurAnnACI.1764-1489.240.

Summary

Background. Cost-effectiveness studies evaluating allergen immunotherapy (AIT) in children are scarce. We aim to compare the cost-effectiveness of subcutaneous (SCIT) and sublingual immunotherapy (SLIT) against standard-of-care (SOC) treatment in children with grass pollen allergic rhinitis. 

Methods. We created a Markov model to compare the three strategies over a 10-year horizon. SOC was the reference to calculate the incremental cost-effectiveness ratio (ICER). Deterministic and probabilistic sensitivity analysis were used to assess models' uncertainty. 

A Perception-Based Survey on Practice Patterns Pertaining to the Diagnosis and Management of Allergic Rhinitis in India

Gupte V, Thakur G, Upadhyaya A, et al. (February 27, 2024) Cureus 16(2): e55032. doi:10.7759/cureus.55032

Abstract

Introduction: Allergic rhinitis (AR) is increasingly prevalent in India, affecting a significant portion of the population and adversely impacting their quality of life. This nationwide survey aimed to explore the perceptions and clinical preferences of Indian physicians regarding the perceived prevalence, common symptoms, and various available treatments for AR.

Methods: This cross-sectional, observational, digital questionnaire-based survey was conducted from September 2022 to March 2023, involving physicians sharing insights on prevalence rates, diagnostic approaches, medication preferences, and immunotherapy practices in AR management.

Recommended duration of therapy with different molecules

Results: A total of 1608 physicians participated in this survey. The majority of physicians (n=684, 42.5%) reported that the prevalence of AR in routine clinical practice is between 21 and 40%. Physicians also noted a substantial burden of AR with asthma (n=626, around 40%). Total IgE count was reported as a mandatory test for the diagnosis of AR by 47.5% of physicians (n=764). For the management of mild cases of seasonal or perennial AR, 980 (60.9%) physicians preferred fexofenadine as an oral antihistamine of choice. Fluticasone furoate was the preferred intranasal corticosteroid (INCS) option (67.1% of physicians (n=1079)), for the management of patients with moderate to severe AR, the most recommended duration of INCS therapy was two to four months (40.9% of physicians).

United States expert panel consensus on uniform nomenclature and diagnosis for neuropathic pruritus

Kwatra, Shawn G. MDa; Elmariah, Sarina MD, PhD, MPHb; Chisolm, Sarah MDc; Mollanazar, Nicholas MDd; Fassett, Marlys MD, PhDe; Cole, Emily F. MDc; Chen, Suephy MDf; Lerner, Ethan MD, PhDb; Berger, Timothy MDe; Yosipovitch, Gil MDg. Itch 9(1):e0073, January-March 2024. | DOI: 10.1097/itx.0000000000000073

Abstract

Importance: 

Neuropathic pruritus is a debilitating condition lacking a uniform approach to nomenclature and diagnosis.

Objective: 

A panel of dermatologist experts in pruritus was convened to develop definitions, diagnostic recommendations, and treatment guidelines for neuropathic pruritus.

Evidence review: 

A roundtable discussion of 10 experts was conducted on November 3, 2021, via the Zoom platform. This study follows the Standards for Reporting Qualitative Research reporting guidelines for qualitative studies. A systematic review of prior literature on the definition, scope, diagnostic, and treatment was performed, looking at sources of treatment from 1991 to 2021. Consensus was defined as >70% agreement for acceptance of a definition or recommendation. A draft of evidence was subjected to revision by all participants and was endorsed by all participants.

Risk prediction model construction for asthma after allergic rhinitis by blood immune T effector cells.

Wang J, Jiang T, Hu J-D.  Medicine 2024;103:8(e37287).

Abstract

Background: 

Allergic rhinitis (AR) and asthma (AS) are prevalent and frequently co-occurring respiratory diseases, with mutual influence on each other. They share similar etiology, pathogenesis, and pathological changes. Due to the anatomical continuity between the upper and lower respiratory tracts, allergic inflammation in the nasal cavity can readily propagate downwards, leading to bronchial inflammation and asthma. AR serves as a significant risk factor for AS by potentially inducing airway hyperresponsiveness in patients. Currently, there is a lack of reliable predictors for the progression from AR to AS.

Methods: 

In this exhaustive investigation, we reexamined peripheral blood single cell RNA sequencing datasets from patients with AS following AR and healthy individuals.

Benralizumab versus Mepolizumab for Eosinophilic Granulomatosis with Polyangiitis

The following article was published on NEJM.org to coincide with the #AAAAI2024 Annual Meeting

Michael E. Wechsler, M.D., M.M.Sc., Parameswaran Nair, M.D., Ph.D., Benjamin Terrier, M.D., Ph.D., Bastian Walz, M.D., Arnaud Bourdin, M.D., Ph.D., David R.W. Jayne, M.D., David J. Jackson, F.R.C.P., Ph.D., Florence Roufosse, M.D., Ph.D., Lena Börjesson Sjö, Ph.D., Ying Fan, Ph.D., Maria Jison, M.D., Christopher McCrae, Ph.D., et al., for the MANDARA Study Group* NEJM February 23, 2024 DOI: 10.1056/NEJMoa2311155

Abstract

BACKGROUND

Eosinophilic granulomatosis with polyangiitis (EGPA) is a vasculitis characterized by eosinophilic inflammation. Benralizumab, a monoclonal antibody against the interleukin-5α receptor expressed on eosinophils, may be an option for treating EGPA.

METHODS

We conducted a multicenter, double-blind, phase 3, randomized, active-controlled noninferiority trial to evaluate the efficacy and safety of benralizumab as compared with mepolizumab. Adults with relapsing or refractory EGPA who were receiving standard care were randomly assigned in a 1:1 ratio to receive benralizumab (30 mg) or mepolizumab (300 mg) subcutaneously every 4 weeks for 52 weeks. The primary end point was remission at weeks 36 and 48 (prespecified noninferiority margin, –25 percentage points). Secondary end points included the accrued duration of remission, time to first relapse, oral glucocorticoid use, eosinophil count, and safety.

IgM N-glycosylation correlates with COVID-19 severity and rate of complement deposition

Haslund-Gourley, B.S., Woloszczuk, K., Hou, J. et al.  Nat Commun 15, 404 (2024). https://doi.org/10.1038/s41467-023-44211-0

Abstract

IgM N-glycosylation analysis reveals differences in COVID-19 patients stratified by trajectory

The glycosylation of IgG plays a critical role during human severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, activating immune cells and inducing cytokine production. However, the role of IgM N-glycosylation has not been studied during human acute viral infection. The analysis of IgM N-glycosylation from healthy controls and hospitalized coronavirus disease 2019 (COVID-19) patients reveals increased high-mannose and sialylation that correlates with COVID-19 severity. These trends are confirmed within SARS-CoV-2-specific immunoglobulin N-glycan profiles.

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

Sousa-Pinto B, Palamarchuk Y, Leemann L, Jankin S, Basagaña X, Ballester J, Bedbrook A, Czarlewski W, Almeida R, Haahtela T, Haveri H, Prass M, Henriques T, Vieira RJ, Klimek L, Ollert M, Shamji MH, Jutel M, Del Giacco S, Torres MJ, Zuberbier T, Fonseca JA, Sofiev M, Anto JM, Bousquet J. J Investig Allergol Clin Immunol. 2023 Jul 26:0. doi: 10.18176/jiaci.0923.

Abstract

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.