A Practical Guide to Using Oral JAK Inhibitors for Atopic Dermatitis from the International Eczema Council

Haag C, Alexis A, Aoki V, Bissonnette R et al.  Br J Dermatol. 2024 Sep 10:ljae342. doi: 10.1093/bjd/ljae342. 

Abstract

Background

Janus kinase inhibitors (JAKinibs) have the potential to dramatically alter the landscape of atopic dermatitis (AD) management due to their promising efficacy results from phase 3 trials and rapid onset of action. However, JAKinibs are not without risk, and their use is not appropriate for all AD patients, making this a medication class that dermatologists should understand and consider when treating patients with moderate-to-severe AD.

Objective

This consensus expert opinion statement from the International Eczema Council (IEC) provides a pragmatic approach to prescribing JAKinibs, including choosing appropriate patients, dosing, clinical and lab monitoring, as well as long-term use.

Methods

An international cohort of authors from the IEC with expertise in JAKinibs selected topics of interest and were formed into authorship groups covering 10 subsections. The groups performed topic-specific literature reviews, consulted up-to-date adverse event (AE) data, referred to product labels and provided analysis and expert opinion.

Cord Blood Serum Levels of IL-31 and CCL17, Cutaneous Markers, and Development of Atopic Dermatitis

D'Erme AM, Fidanzi C, Bevilacqua M, Bieber T, Tuoni C, Paolicchi A, Franzini M, Morganti R, Papadia F, Janowska A, Dini V, Romanelli M.  JAMA Dermatol. 2024 Sep 11:e243178. doi: 10.1001/jamadermatol.2024.3178. 

Key Points

Question  Which are the possible cutaneous and serological markers that can be used to predict the development of atopic dermatitis (AD) in infants?

Findings  In this observational study, serum biomarkers, transepidermal water loss, and hydration rate of 40 infants were evaluated. There were statistically significant higher CCL17 and IL-31 cord blood serum levels in the infants who developed AD, and anterior cubital fossa transepidermal water loss values at 1, 6, and 12 months of age were also considerably higher in infants who developed AD.

Meaning  AD is a chronic skin disease for which some identifiable cutaneous or serological markers may be capable of predicting its development.

Abstract

Importance  Atopic dermatitis (AD) is the most prevalent chronic skin condition characterized by inflammation and itching. Currently, there is no reliable method for identifying which newborns might have an increased risk of developing AD.

Consensus on a Patient-Centered Definition of Atopic Dermatitis Flare

Drucker AM, Thibau IJC, Mantell B, Dainty KN, Wyke M, Smith Begolka W. JAMA Dermatol. 2024 Sep 11. doi: 10.1001/jamadermatol.2024.3054.

Key Points

Question  What components are essential to include in a patient-centered definition of an atopic dermatitis flare?

Findings  In this consensus survey study of 657 US adults with atopic dermatitis (26 completing focus groups and 631 survey participants), 12 statements were agreed on for inclusion in a patient-centered definition of flare. More than half of participants aligned with their health care practitioner on what a flare is, and most reported that a patient-centered definition would be useful when communicating with their health care practitioner.

Meaning  These findings suggest that while various definitions of atopic dermatitis flare exist, a patient-centered definition may be useful for clinical practice and research.

Abstract

Assessment of the Efficacy of the Antihistamine Drug Rupatadine Used Alone or in Combination against Mycobacteria.

Tian X, Ma W, Yusuf B, Su B, Hu J, Zhang T.  Pharmaceutics. 2024 Aug 7;16(8):1049. doi: 10.3390/pharmaceutics16081049.

Abstract

The in vivo activity of RTD against M. tuberculosis.

The emergence of drug-resistant mycobacteria has rendered many clinical drugs and regimens ineffective, imposing significant economic and healthcare burden on individuals and society. Repurposing drugs intended for treating other diseases is a time-saving, cost-effective, and efficient approach for identifying excellent antimycobacterial candidates or lead compounds. This study is the first to demonstrate that rupatadine (RTD), a drug used to treat allergic rhinitis, possesses excellent activity against mycobacteria without detectable resistance, particularly Mycobacterium tuberculosis and Mycobacterium marinum, with a minimal inhibitory concentration as low as 3.13 µg/mL.

Allergen immunotherapy effectiveness in specific nasal reactivity of children with local allergic rhinitis.

Loureiro G, Tavares B, Farinha I, Cunha F, Todo-Bom A. Eur Ann Allergy Clin Immunol. 2024 Sep 2. doi: 10.23822/EurAnnACI.1764-1489.358. 

Abstract

Background. Allergen immunotherapy (AIT) is the only disease-modifying treatment in allergy. Its efficacy has been demonstrated in the treatment of Local Allergic Rhinitis (LAR) in adults. This study intends to evaluate the effectiveness of AIT in specific nasal reactivity of paediatric patients with LAR. 

Methods. Patients diagnosed with LAR to Dermatophagoides pteronyssinus (Dp) were submitted to subcutaneous AIT (SCIT) (depigmented-polymerized Dp allergen extracts) for 3 years. Nasal allergen challenge (NACs) with Dp extract were performed before and 3 years after AIT. NAC response was assessed with peak nasal inspiratory flow (PNIF) and symptom score of Lebel. NACs were considered positive when there was a flow decrease of ≥ 20% in PNIF and a score of symptoms ≥ 3 points. Demographic data and NAC results were analysed. 

Response to NAC, before and 3 years after AIT, in patients with Dp-LAR

Results. We included 32 paediatric patients (mean age 9±3.08 years, 18 female) and 10 adult patients, (mean age 30.4±12.2 years, 7 female). The symptom score obtained at the 1st minute, 5th minute, 15th minute and 30th minute in response to NAC, were reduced after AIT.

Thoughtful prescription of inhaled medication has the potential to reduce inhaler-related greenhouse gas emissions by 85

Vartiainen V, Woodcock AA, Wilkinson A et al. BMJ Open Respir Res. 2024 Sep 1;11(1):e001782. doi: 10.1136/bmjresp-2023-001782.

Abstract

Introduction Both physicians and patients are increasingly aware of the environmental impacts of medication. The shift of treatment paradigm towards MART-treatment (Maintenance and Reliever Therapy) in asthma affects the treatment-related emissions. The carbon footprint of inhaled medication is also tied to the type of the device used. Today the most commonly used propellant-containing pressurised metered-dose inhalers (pMDIs) have a carbon footprint typically 20–40-fold higher than propellant-free dry powder inhalers (DPIs) and soft mist inhalers.

Methods We analysed the carbon footprint of inhaled medications in Europe using published life cycle analyses of marketed inhalers and comprehensive 2020 European sales data. In addition, we give an estimate on treatment-related emissions of different treatment regimens on Global Initiative for Asthma (GINA) step 2.

Estimated carbon greenhouse gas emissions from pMDI devices (CO2e) in EU,
EPA estimate for US Emissions and MCTOC estimate for global emissions
as well as estimated emissions from corresponding number of DPIs.

Results There is potential to reduce the carbon footprint of inhaled medications by 85% if DPIs are preferred over pMDIs. Emissions from pMDIs in the EU were estimated to be 4.0 megatons of carbon dioxide equivalent (MT CO2e) and this could be reduced to 0.6 MT CO2e if DPIs were used instead.

Risk of Anaphylaxis Associated with Cold Urticaria.

Bizjak, M., Rutkowski, K. & Asero, R. Curr Treat Options Allergy 11, 167–175 (2024). https://doi.org/10.1007/s40521-024-00366-9

Abstract

Purpose of review

Possible symptoms and clinical signs of anaphylaxis

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. Key diagnostic indicators for assessing ColdU and the risk of ColdA include oropharyngeal/laryngeal symptoms and positive standard local cold provocation tests.

Aspirin Desensitization in Treatment of Chronic Rhinosinusitis with Nasal Polyposis: Current Protocols and Evidence

Thiagarajan, K., Anderson, L. Curr Treat Options Allergy 11, 123–135 (2024). https://doi.org/10.1007/s40521-024-00365-w

Abstract

Purpose of Review

Aspirin-exacerbated respiratory disease (AERD), or NSAID-exacerbated respiratory disease (NERD), is a heterogeneous inflammatory syndrome characterized by Samter’s clinical triad of chronic rhinosinusitis with nasal polyposis (CRSwNP), asthma, and nonallergic hypersensitivity to all cyclooxygenase-1 (COX-1) inhibiting NSAIDs. This review focuses on randomized controlled trials and meta-analyses published on the clinical efficacy of aspirin therapy in AERD/NERD, as well as recent works published to explore the current outpatient ASA desensitization protocols in the US.

Recent Findings

Many AERD/NERD patients fail first-line therapies for treatment of asthma and CRSwNP and often need repeated sinus surgeries and frequent courses of oral corticosteroids to control symptoms.