A prospective observational study correlating possible novel biomarkers with disease severity and antihistamine response in chronic spontaneous urticaria

Bhatia D, Mehta H, Bishnoi A, Srivastava N, Vinay K, Parsad D, Kumaran MS. Asia Pac Allergy. 2024 Mar;14(1):5-11. doi: 10.5415/apallergy.0000000000000132.

Abstract

Background:

Role of complement fraction 5a (C5a), interleukin (IL)-9, and apolipoprotein (apo) A-IV as biomarkers of disease severity and antihistamine response in chronic spontaneous urticaria (CSU) remains elusive.

Objective:

To identify the role of C5a, IL-9, and apo A-IV as potential biomarkers in predicting disease severity and antihistamine response in CSU patients.

Methods:

This was a prospective observational study of 95 patients and 42 controls. Serum analysis of C5a, IL-9, and apo A-IV was done using enyzme linked immunosorbent assay kits. Also, serum IgE and anti-thyroid peroxidase (TPO) levels were assessed in all patients. All patients were started on oral levocetirizine 5 mg at baseline and dose was titrated upwards to maximum of 20 mg based on response. Patients were categorized into antihistamine responders or nonresponders as per their disease response.

The autologous serum skin test (ASST) predicts the response to anti-IgE treatment in Chronic Spontaneous Urticaria patients: a prospective study

Palladino A, Villani F, Pinter E, Visentini M, Asero R. Eur Ann Allergy Clin Immunol. 2024 Mar 14. doi: 10.23822/EurAnnACI.1764-1489.337.

Abstract

Background. Chronic spontaneous urticaria (CSU), characterized by recurrent itchy wheals and angioedema for > 6 weeks, is a quite common disease that may heavily impair the quality of life. Omalizumab, an anti-IgE mAb, has much improved the management of CSU but patients' response to the drug may vary and predictive markers are still largely missing. We investigated the predictive value of the autologous serum skin test (ASST) on omalizumab response. 

Methods. 15 patients with severe CSU eligible for omalizumab treatment were prospectively studied submitting them to ASST and to complete blood count, D-dimer, anti-thyroid peroxidase antibodies, and total IgE measurement before the start of the treatment. 

Summary table of the differences between the means of the two
groups of patients divided according to the response to therapy.

Results. 14/15 (93%) responded brilliantly to omalizumab at 3 months assessment. 7 responded in less than 1 month ("early responders") and 7 only after multiple administrations ("late responders"). Of 9 patients scoring positive on ASST, 7 (78%) were late, and 2 (22%) early responders to omalizumab (p = 0.021).

Pharmacists’ Attitudes Towards Long-Term Use of Nasal Decongestants: A Cross-Sectional Study

Mokhatrish MM, Almatrafi SD, Aldrees TM, Aldriweesh TA, AlGhamdi FM, Al-Dosary AS, Alhumaydani NK, Aldakkan OZ, Alrudian N, Ali AH.  J Multidiscip Healthc. 2024;17:1079-1090
https://doi.org/10.2147/JMDH.S451835

Background: Rhinitis medicamentosa is a nonallergic inflammation of the nasal mucosa caused by topical decongestants overuse. It mainly affects young and middle-aged adults. Therefore, the aim of this study was to investigate the attitudes of pharmacists regarding the utilization of over-the-counter intranasal decongestants.

Methods: An online cross-sectional study was conducted from November 2021 to January 2022. The target population of the study included pharmacists who work in community pharmacies in Saudi Arabia. Binary logistic regression analysis was used to identify predictors of having positive attitude towards controlling the use of decongestant.

Most prevalent symptoms of patients asking for NDs.

Results: A total of 220 participants were included in this study. Around 15.0% of them reported that ND come with a physician prescription. The majority of the participants (87.3%) reported that the less than 5 days is the maximum safe duration for the use of NDs. Overall, the study participants demonstrated moderately positive attitude towards controlling the use of decongestant with a mean attitude score of 2.5 (standard deviation: 1.2) out of 5; which represents 50.0% of the maximum score.

Component-specific clusters for diagnosis and prediction of allergic airway diseases

Howard R, Fontanella S, Simpson A, Murray CS, Custovic A, Rattray M. Clin Exp Allergy. 2024; 00: 1-11. doi:10.1111/cea.14468

Abstract

Background

Previous studies which applied machine learning on multiplex component-resolved diagnostics arrays identified clusters of allergen components which are biologically plausible and reflect the sources of allergenic proteins and their structural homogeneity. Sensitization to different clusters is associated with different clinical outcomes.

Objective

To investigate whether within different allergen component sensitization clusters, the internal within-cluster sensitization structure, including the number of c-sIgE responses and their distinct patterns, alters the risk of clinical expression of symptoms.

Methods

In a previous analysis in a population-based birth cohort, by clustering component-specific (c-s)IgEs, we derived allergen component clusters from infancy to adolescence. In the current analysis, we defined each subject's within-cluster sensitization structure which captured the total number of c-sIgE responses in each cluster and intra-cluster sensitization patterns.

The Role of Extracellular Vesicles in Atopic Dermatitis.

Harvey-Seutcheu, C.; Hopkins, G.; Fairclough, L.C.  Int. J. Mol. Sci. 2024, 25, 3255. https://doi.org/10.3390/ijms25063255

Abstract

Summary of cells of origin, characteristics, and effects of S. aureus-,
 M. sympodialis-, and mast cell-derived EVs. 

Atopic dermatitis, or eczema, is the most common chronic skin disorder, characterized by red and pruritic lesions. Its etiology is multifaceted, involving an interplay of factors, such as the allergic immune response, skin barrier dysfunction, and dysbiosis of the skin microbiota. Recent studies have explored the role of extracellular vesicles (EVs), which are lipid bilayer-delimitated particles released by all cells, in atopic dermatitis. Examination of the available literature identified that most studies investigated EVs released by Staphylococcus aureus, which were found to impact the skin barrier and promote the release of cytokines that contribute to atopic dermatitis development.

Allergic Rhinitis A Review

Jonathan A. Bernstein, Joshua S. Bernstein, Richika Makol et al.

JAMA. 2024;331(10):866-877. doi:10.1001/jama.2024.0530

Abstract

Importance  

Allergic rhinitis affects an estimated 15% of the US population (approximately 50 million individuals) and is associated with the presence of asthma, eczema, chronic or recurrent sinusitis, cough, and both tension and migraine headaches.

The Pathogenesis of Allergic Rhinitis

Observations  

Allergic rhinitis occurs when disruption of the epithelial barrier allows allergens to penetrate the mucosal epithelium of nasal passages, inducing a T-helper type 2 inflammatory response and production of allergen-specific IgE. Allergic rhinitis typically presents with symptoms of nasal congestion, rhinorrhea, postnasal drainage, sneezing, and itching of the eyes, nose, and throat. In an international study, the most common symptoms of allergic rhinitis were rhinorrhea (90.38%) and nasal congestion (94.23%). Patients with nonallergic rhinitis present primarily with nasal congestion and postnasal drainage frequently associated with sinus pressure, ear plugging, muffled sounds and pain, and eustachian tube dysfunction that is less responsive to nasal corticosteroids. Patients with seasonal allergic rhinitis typically have physical examination findings of edematous and pale turbinates. Patients with perennial allergic rhinitis typically have erythematous and inflamed turbinates with serous secretions that appear similar to other forms of chronic rhinitis at physical examination. Patients with nonallergic rhinitis have negative test results for specific IgE aeroallergens.

Introduction of a penicillin allergy de-labelling program with direct oral challenge and its effects on utilization of beta-lactam antimicrobials: a multicenter retrospective parallel cohort study

Mir, A., Lanoue, D., Zanichelli, V. et al. Allergy Asthma Clin Immunol 20, 20 (2024). https://doi.org/10.1186/s13223-024-00877-9

Abstract

Background

Self-reported penicillin allergy labels are common and often inaccurate after assessment. These labels can lead to reduced use of first-line beta-lactam antibiotics and worse outcomes. We measured the impact of a previously performed inpatient proactive systematic penicillin allergy de-labelling program on subsequent antibiotic use. This prior program included assessment, risk-stratification, and low risk direct oral amoxicillin challenge.

Methods

Schematic representation of the de-labelling implementation program

We performed a retrospective comparison of parallel cohorts from two separate tertiary care hospital campuses in Ottawa, Canada across two penicillin de-labelling intervention periods across April 15th to April 30th, 2021, and February 15th to March 8th, 2022. Outcomes, including penicillin allergy labelling and antibiotic use, were collected for the index admission and the subsequent 6-month period. Descriptive statistics and multivariate regression analyses were performed.

Results

A total of 368 patients with penicillin allergy label were included across two campuses and study periods. 24 (13.8%) patients in the intervention groups had sustained penicillin allergy label removal at 30 days from admission vs. 3 (1.5%) in the non-intervention group (p < 0.001).

Documentation of comorbidities, lifestyle factors, and asthma management during primary care scheduled asthma contacts.

Takala, J., Vähätalo, I., Tuomisto, L.E. et al.  npj Prim. Care Respir. Med. 34, 2 (2024). https://doi.org/10.1038/s41533-024-00360-3

Abstract

Green colour describes the performed assessment that were implemented
well, yellow colour describes moderate implementation,
and the orange describes the measures that are poorly implemented. 

Systematically assessing asthma during follow-up contacts is important to accomplish comprehensive treatment. No previous long-term studies exist on how comorbidities, lifestyle factors, and asthma management details are documented in scheduled asthma contacts in primary health care (PHC). We showed comorbidities and lifestyle factors were poorly documented in PHC in this real-life, 12-year, follow-up study. Documented information on rhinitis was found in 8.9% and BMI, overweight, or obesity in ≤1.5% of the 542 scheduled asthma contacts.