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.

Food-dependent exercise-induced allergic reactions in Lipid Transfer Protein (LTP) hypersensitive subjects: new data and a critical reappraisal

Scala E, Villella V, Asero R. Eur Ann Allergy Clin Immunol. 2024 Mar 6. doi: 10.23822/EurAnnACI.1764-1489.334. 

Summary

Background Lipid transfer protein is the main cause of both primary food allergy and food-dependent exercise-induced allergic reactions (FDEIAR) in Italy. What characterizes LTP-hypersensitive patients with FDEIAR is still unclear. We investigated the key characteristics of LTP-hypersensitive patients with or without FDEIAR in a large cohort of individuals sensitized to this allergen.

Methods 1,203 food-allergic patients, diagnosed on the basis of unequivocal clinical history and presence of circulating food allergen-specific IgE were studied. Serum IgE reactivity was assessed using the Allergen ExplorerALEX® system (Macroarray Diagnostics, Vienna, Austria).

Computerized Clinical Decision Support To Prevent Medication Errors and Adverse Drug Events: Rapid Review.

Syrowatka A, Motala A, Lawson E, Shekelle P. 2024 Feb. In: Making Healthcare Safer IV: A Continuous Updating of Patient Safety Harms and Practices Agency for Healthcare Research and Quality (US); 2023 Jul–.2024 Feb

Excerpt

Objectives: To assess the evidence on the effects of computerized clinical decision support systems (CDSSs) on the prevention of medication errors and adverse drug events, related implementation outcomes such as rates of medication alert overrides, and unintended consequences of use. We also summarized the literature around the effective implementation of a CDSS.

Methods: We followed the rapid review processes of the Agency for Healthcare Research and Quality Evidence-based Practice Center Program. We queried PubMed and the Cochrane Library to locate relevant systematic reviews and primary studies published from 2015 to April 2023, supplemented by a targeted review of the grey literature. We narratively synthesized the evidence and assessed the overall strength of evidence for the outcomes of interest. The protocol for the review has been registered in PROSPERO (CRD42023449710).

Intranasal corticosteroids reduced acute rhinosinusitis in children with allergic rhinitis: A nested case–control study

Lin CL, Lee KH, Huang WT, Hsieh LC, Wang CM. J Microbiol Immunol Infect. 2024 Feb;57(1):175-183. doi: 10.1016/j.jmii.2023.11.005.

Abstract

Background

Children with allergic rhinitis (AR) have substantially more acute rhinosinusitis than children without AR. We evaluated whether intranasal corticosteroids (INCS), second-generation antihistamines (SGH), and/or intranasal antihistamines (INH) for AR affect acute rhinosinusitis in children with AR aged 2–18 years.

Methods

Flow chart of participant enrollment.

By using the National Health Research Institutes Database 2005 of Taiwan, a cohort of patients with AR aged 2–18 years treated with AR medications between 2002 and 2018 was made, within which a nested case–control study was performed. Risk settings for acute rhinosinusitis cases matched controls for age, sex, and comorbidities. Current users of INCS, INH, and/or SGH were compared with remote and recent users of any AR medications and current users of INCS with and without SGH were compared with current users of SGH.

Advancing Treatment in Atopic Dermatitis: A Comprehensive Review of Clinical Efficacy, Safety, and Comparative Insights Into Corticosteroids, Calcineurin Inhibitors, and Phosphodiesterase-4 Inhibitors as Topical Therapies

Hernandez T D, Aleman S J, Bao-Loc-Trung M, et al. Cureus 16(3): e55393. doi:10.7759/cureus.55393

Abstract

Atopic dermatitis (AD) is a pervasive and multifaceted dermatological disorder causing daily distress to afflicted individuals worldwide. This comprehensive review synthesizes the historical and contemporary advancements in therapeutic strategies, offering a critical analysis of their efficacy, safety profiles, and adaptability. The enduring role of topical corticosteroids in managing AD is examined, acknowledging their potent anti-inflammatory properties alongside their potential adverse side effects, particularly in extended usage. The article explores the utilization of topical calcineurin inhibitors like tacrolimus and pimecrolimus, highlighting their novel anti-inflammatory pathways while also scrutinizing concerns over potential malignancies that relegate them to second-line therapy.

Comparative studies of PDE4 inhibitors, calcineurin inhibitors, and topical
corticosteroids in the pharmacological management of atopic dermatitis