Multidisciplinary Management of Pediatric Chronic Rhinosinusitis with Nasal Polyposis

Oh, E., Miller, J.E. & Lee, J.T. Curr Treat Options Allergy 11, 34–48 (2024). https://doi.org/10.1007/s40521-024-00362-z

Abstract

Purpose of review

This review explores the comprehensive management and treatment strategies for pediatric chronic rhinosinusitis with nasal polyps (CRSwNP). It addresses questions regarding the efficacy and safety of both current treatments and emerging therapies. Additionally, this paper examines the diagnostic challenges in pediatric CRSwNP, particularly its distinct presentations and characteristics compared to those in adults.

Recent findings

Current research highlights various approaches for treating pediatric CRSwNP. Intranasal corticosteroids are found to be effective in managing symptoms, while oral corticosteroids are used to manage severe cases.

Satisfaction, Qol and adherence of patients allergic to dust mites and/or pollens undergoing sublingual immunotherapy.

Garrido-Fernández S, Fernández DG, López GS, Mar Escribano Rodríguez MD, Delgado VM, Iglesias-Souto J, Castro Gómez C, Bòria EV, Hernández-Peña J, Sánchez-López J. Immunotherapy. 2024 Jun 18:1-12. doi: 10.1080/1750743X.2024.2347828.

Abstract

Aim: Sublingual immunotherapy (SLIT) changes history of allergic respiratory disease (ARD). However, adherence is a barrier for optimal outcomes. Patients & methods: In the QUALI study, 859 patients with house-dust mite (HDM) and/or pollen induced ARD uncontrolled with symptomatic treatment and undergoing SLIT for at least 6 months or including one pre-coseason (pollen) were collected. 

Allergic respiratory disease evolution following
sublingual immunotherapy.

Results & conclusion: SLIT significantly improved allergic rhinoconjunctivitis (ARC) and asthma symptom control, leading to reduced medication, meaningful health-related quality of life gain, improved nasal, ocular and bronchial symptoms and everyday life activities. Patients were highly satisfied and most of them adhered to SLIT, being forgetfulness the main non-adherence motive. SLIT is a quick effective treatment against persistent moderate-to-severe symptoms in ARC and asthma but it should been improve forgetfulness, as non-adherence reason.

Plain language summary

Sublingual immunotherapy (SLIT) has really changed how we deal with allergic respiratory disease. But there's a catch: sticking to the treatment can be tough.

In the QUALI study, we looked at 859 patients dealing with dust mite and/or pollen allergies who were not getting relief from the usual treatments. We put them on SLIT for at least 6 months or during pollen season.

This treatment made a big difference. Symptoms got better, people needed less medication and they felt better in their day-to-day lives. Most patients were happy with the treatment and stuck to it well, but some forgot sometimes.

In short, SLIT works fast and works well for moderate to severe allergies and asthma. But we need to help people remember to stick with it.

Eosinophil-associated diseases: the Allergist's and Clinical Immunologist's perspective

Marra AM, Rossi CM, Piga MA, Moroncini G, Bilò MB. Eur Ann Allergy Clin Immunol. 2024 Mar 28. doi: 10.23822/EurAnnACI.1764-1489.339. 

Abstract 

Eosinophil-associated diseases (EADs) refer to heterogeneous conditions in which eosinophils are believed to play critical pathological roles. They encompass common respiratory conditions, such as asthma, chronic rhinosinusitis with nasal polyps (CRSwNP), less common primary eosinophilic disorders of gastrointestinal tract, and rare conditions including eosinophilic granulomatosis with polyangiitis (EGPA) and hypereosinophilic syndrome (HES).

A literature search was carried out in January 2024 in the MEDLINE and Scopus databases using the PubMed search engine (PubMed, National Library of Medicine, Bethesda, MD). We focused on blood eosinophilia and hypereosinophilia. A diagnostic workup is proposed. From allergist’s point of view, we focused the review on 4 groups of eosinophilic disorders of specific interest.

High Serum Allergen-Specific IgE of House Dust Mite in Predicting the Risk of Comorbidity in Children with Allergic Conjunctivitis

Tang XJ, He JT, Liu Q, Liu E, Chen L.  J Asthma Allergy. 2024;17:601-609  https://doi.org/10.2147/JAA.S467671

Purpose: To investigate the patterns of allergens in allergic conjunctivitis (AC) and the association with allergic comorbidity.

Methods: This retrospective cross-sectional study enrolled 2972 children with AC. Clinical data, including sex, age, allergic comorbidities (allergic asthma, allergic rhinitis, and atopic dermatitis), and serum allergen-specific immunoglobulin E (sIgE), were collected from the electronic medical record (EMR). The categorical variables were compared with the chi-square test. The characteristics of allergens in children of different ages and comorbidities were analyzed by trend chi-square. The sensitivity level of HDM associated with AC and comorbidities was assessed by odds ratios (ORs) with 95% confidence intervals of logistic regression analysis.

Risk of Anaphylaxis Associated with Cold Urticaria

Bizjak, M., Rutkowski, K. & Asero, R. Curr Treat Options Allergy (2024). https://doi.org/10.1007/s40521-024-00366-9

Abstract

Purpose of review

Cold-induced anaphylaxis (ColdA) is a poorly understood form of anaphylaxis that occurs in patients with cold urticaria (ColdU). This comprehensive review aims to deepen the understanding of ColdA. It emphasizes the identification of high-risk ColdU patients susceptible to ColdA and provides recommendations for their effective management.

Recent findings

Recent studies, including the large international COLD-CE study, have identified clinical features of ColdU patients associated with increased ColdA risk. These individuals can now be recognized through routine clinical assessments.

COFAITH and COMFA: A Collective Roadmap for Past and Future Food Allergy Clinical Trials and Observational Research on Interventions

Protudjer, J. ., Munblit, D., Apfelbacher, C., Marchisotto, M., Cook, E., Capper, I., Rodríguez Del Río, P. and Comberiati, P. (2024) Clin Exp Allergy. https://doi.org/10.1111/cea.14522

Abbreviations

COFAITH: clinical outcomes of efficacy in food allergen immunotherapy trials

COMFA: core outcome measures for food allergy

Summary

• Recent initiatives explored food allergy outcome harmonisation, for existing immunotherapy trials and future clinical trials.

• Outcomes common to both initiatives included desensitisation, sustained unresponsiveness/remission, quality of life and allergic symptoms.

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Management of Refractory Anaphylaxis: An Overview of Current Guidelines

Pouessel, G., Dribin, T., Tacquard, C., Tanno, L., Cardona, V., Worm, M., Deschildre, A., Muraro, A., Garvey, L. and Turner, P. (2024) Clin Exp Allergy. https://doi.org/10.1111/cea.14514

ABSTRACT

In this review, we compare different refractory anaphylaxis (RA) management guidelines focusing on cardiovascular involvement and best practice recommendations, discuss postulated pathogenic mechanisms underlining RA and highlight knowledge gaps and research priorities. There is a paucity of data supporting existing management guidelines.

First- and second-line treatment of refractory anaphylaxis
according to the current guidelines. IV, intravenous.

Therapeutic recommendations include the need for the timely administration of appropriate doses of aggressive fluid resuscitation and intravenous (IV) adrenaline in RA. The preferred second-line vasopressor (noradrenaline, vasopressin, metaraminol and dopamine) is unknown. Most guidelines recommend IV glucagon for patients on beta-blockers, despite a lack of evidence.

Unraveling determinants of severe anaphylaxis — A cluster analysis from a large national hospitalization database

Luciana Kase Tanno , Pham Thao Van Luong, Megane Dieval, Caroline Dunoyer, Nicolas Molinari, Isabella Annesi-Maesano, Pascal Demoly. Journal of Allergy and Hypersensitivity Diseases Volume 1, January–March 2024, 100004

Abstract

Background

Understanding potential risk factors and phenotypes at-risk of anaphylaxis can tailor public health actions to prevent avoidable deaths. Therefore, our aim was to explore patterns of hospital admissions diagnosed with anaphylaxis in France from 2012 to 2021, across different age groups, using the national French hospital database and to evaluate potential determinants to propose phenotypes at-risk, with a particular view to severe cases.

Methods

This is a descriptive study, using data from the French Program for the Medicalization of Information Systems, from 2012 to 2021. We included all patients hospitalized for anaphylaxis using International Classification of Diseases (ICD)-10 codes listed as a primary diagnosis.