Real-world association between systemic corticosteroid exposure and complications in US patients with severe asthma

Research - Open access

Thomas B Casale, Thomas Corbridge, Guillaume Germain, François Laliberté, Sean D MacKnight, Julien Boudreau, Mei S Duh & Arijita Deb. Allergy, Asthma & Clinical Immunology volume 20, Article number: 25 (2024)

Abstract

Background

Systemic corticosteroid (SCS) use remains widespread among patients with severe asthma, despite associated complications.

Objective

Evaluate the association between cumulative SCS exposure and SCS-related complications in severe asthma.

Methods

This retrospective, longitudinal study used claims data from the Optum Clinformatics Data Mart database (GSK ID: 214469). Eligible patients (≥ 12 years old) had an asthma diagnosis and were divided into two cohorts: SCS use and non/burst-SCS use. Patients in the SCS use cohort had a claim for a daily prednisone-equivalent dose ≥ 5 mg SCS following ≥ 6 months of continuous SCS use; those in the non/burst-SCS cohort had no evidence of continuous SCS use and had a non-SCS controller/rescue medication initiation claim. For each cohort, the date of the qualifying claim was the index date. SCS users were further stratified by SCS use during each quarter of follow-up: low (≤ 6 mg/day), medium (> 6–12 mg/day), high (> 12 mg/day), and continuous high (≥ 20 mg/day for 90 days).

IgE to cyclophilins in pollen allergic children: epidemiological, clinical and diagnostic relevance of a neglected panallergen

Matricardi PM, Potapova E, Panetta V et al. J Allergy Clin Immunol. 2024 Mar 19:S0091-6749(24)00235-5. doi: 10.1016/j.jaci.2024.01.030.

Abstract

Background: - Cyclophilins are ubiquitous panallergens whose epidemiological, diagnostic, and clinical relevance is largely unknown and whose sensitization is rarely examined in routine allergy practice. The aim of this study was to investigate the epidemiological, diagnostic, and clinical relevance of cyclophilin in seasonal allergic rhinitis and its comorbidities.

Methods: - We examined a random sample (25%, n 253) of 1263 Italian children affected by seasonal allergic rhinitis from the "Panallergen in Pediatrics" (PAN-PED) cohort. Patients' disease phenotype had been already fully characterized through questionnaires (ARIA), skin prick tests (ALK), IgE tests to extracts, major and cross-reactive allergenic molecules of a comprehensive variety of allergenic pollen (immunoCAP), and carbohydrate cross-reacting determinants (CCD) (NOVEOS).

Graphical Abstract

We also performed nested studies of sensitization prevalence, correlation and allergen extract inhibition in patients (A) sensitized to birch pollen extract but lacking IgE to Bet v 1, Bet v 2, and Bet v 4, (74/1263) or with the highest serum level of IgE to Bet v 1 (26 within 1263), and (B) in patients with sensitization to extracts of ragweed (18), mugwort (18), pellitory (20), Plantago (19), and plane tree (20), but not to their respective major allergenic molecule, profilins and polcalcins. IgE to cyclophilin was detected with recombinant Bet v 7 (ImmunoCAP) and extract inhibition tests were performed with the same rBet v 7.

The role of molecular diagnosis in anaphylactic patients with dual or triple-sensitization to Hymenoptera venoms

Bemanian, M.H., Shokouhi Shoormasti, R., Arshi, S. et al.  Allergy Asthma Clin Immunol 20, 22 (2024). https://doi.org/10.1186/s13223-024-00885-9

Abstract

Background

The poly-sensitization to Hymenoptera venom makes it difficult to select genuine allergens for immunotherapy and increases patients’ costs. The objective of this study was to determine the culprit allergen in dual or triple-sensitized patients to three Hymenoptera venoms through molecular diagnosis and evaluating the results of incorporating the molecular diagnosis with skin tests.

Methods

Thirty-two patients with anaphylactic reactions and dual or triple-sensitization to Hymenoptera venoms in skin tests entered this study. IgE-sensitization to whole extracts and molecules of Apis mellifera (Api m), Vespula vulgaris (Ves v), and Polistes dominulus (Pol d) was evaluated utilizing ALEX or ImmunoCAP.

Results

A Wheal diameter of intradermal test for Hymenoptera venoms according to anaphylaxis grades. 
B The specific IgE concentration to allergenic extracts and molecules of Hymenoptera venoms
according to anaphylaxis grades

Twenty-nine patients (90.6%) were male. IgE-sensitization to at least one of the allergenic molecules related to Apis mellifera, Vespula vulgaris, and Polistes dominulus was seen in 59.4, 53.1, and 21.9%, respectively. Among 32 patients, 14 (43.8) and 8 (25%), were mono-sensitized to Api m and Ves v components in ALEX, respectively. Double sensitization to Hymenoptera was identified in 18.8% of patients in ALEX.

Navigating Food Allergies: Advances in Diagnosis and Treatment Strategies

Peddi N, Muppalla S, Sreenivasulu H, et al. Cureus 16(3): e56823. doi:10.7759/cureus.56823

Abstract

Food allergy is a major health concern worldwide, encompassing both immunologic and non-immunologic reactions. This review thoroughly examines the pathophysiology, clinical manifestations, and treatment options for various types of food allergies. Immunologic food allergies, including IgE-mediated reactions such as oral allergy syndrome and systemic anaphylaxis, pose various diagnostic and management challenges. Non-IgE-mediated reactions such as food protein-induced enterocolitis syndrome, dermatitis herpetiformis, and proctocolitis necessitate individualized patient care. In addition, mixed reactions such as eosinophilic esophagitis and atopic dermatitis complicate the clinical picture.

Lupin, a potential "hidden" food anaphylaxis allergen: An alert from the Allergy-Vigilance Network®.

Pouessel G, Sabouraud-Leclerc D, Beaumont P, Divaret-Chauveau A, Bradatan E, Dumond P, Karaca Y, Renaudin JM, Metz-Favre C, Delalande D, Correard AK, Tscheiller S, Van der Brempt X. Allergy. 2024 Mar 22. doi: 10.1111/all.16107.

To the Editor,

Lupin is a legume considered as an emerging food allergen, but the true prevalence of lupin allergy is not known.1 Due to the increasing consumption of lupin and its potential cross-reactivity with peanut, the Allergy-Vigilance Network® (AVN) aimed to report lupin-induced anaphylaxis cases and compare their main characteristics to other foods (See Data S1 for Material and Methods).

Main characteristics of 62 patients with a lupin-induced anaphylaxis
recorded by the Allergy-Vigilance Network® and comparisons by age groups

Of the 2708 cases of food-induced anaphylaxis documented by AVN (2002-2020), 62 (2.3%) cases were induced by lupin and cases are presented by time periods and according to total number of food-induced anaphylaxis cases (Figure S1). The main characteristics of these 62 cases (mean age: 32.1 years [SD: 21.4], 35% in children <18 years, 66% in females) are presented.

Current Understanding of Immune Thrombocytopenia: A Review of Pathogenesis and Treatment Options

Mititelu A, Onisâi MC, Roșca A, Vlădăreanu AM. Int J Mol Sci. 2024 Feb 10;25(4):2163. doi: 10.3390/ijms25042163. 

Abstract

Pathogenesis of immune thrombocytopenia and targets for drug action

The management of immune thrombocytopenia (ITP) and the prediction of patient response to therapy still represent a significant and constant challenge in hematology. ITP is a heterogeneous disease with an unpredictable evolution. Although the pathogenesis of ITP is currently better known and its etiology has been extensively studied, up to 75% of adult patients with ITP may develop chronicity, which represents a significant burden on patients’ quality of life. A major risk of ITP is bleeding, but knowledge on the exact relationship between the degree of thrombocytopenia and bleeding symptoms, especially at a lower platelet count, is lacking. The actual management of ITP is based on immune suppression (corticosteroids and intravenous immunoglobulins), or the use of thrombopoietin receptor agonists (TPO-RAs), rituximab, or spleen tyrosine kinase (Syk) inhibitors.

Determinants of immunoglobulin G responses to respiratory syncytial virus and rhinovirus in children and adults

Guillien A, Niespodziana K, Mauclin M, Boudier A, Varraso R, Leynaert B, Dumas O, Le Moual N, Schlederer T, Bajic M, Borochova K, Errhalt P, Vernet R, Nadif R, Bousquet J, Bouzigon E, Valenta R, Siroux V.  Front Immunol. 2024 Mar 4;15:1355214. doi: 10.3389/fimmu.2024.1355214.

Abstract

Introduction: Exposure to respiratory viruses is a significant cause of morbidity and affects virus-specific antibody levels. Little is known about determinants associated with immune response to these viruses. We aimed to investigate the determinants of respiratory syncytial virus (RSV)- and rhinovirus (RV)- specific IgG responses in both children and adults.

Methods: The study is based on the EGEA cohort, composed of 530 samples of children in EGEA1 (1991-95) and 1241 samples of adults in EGEA2 (2003-07). Cumulative RV-specific IgG levels (species A, B and C) and IgG levels to RSV-G protein were measured by using micro-array technoloy. Multiple linear mixed models (random effect to account for familial dependence) were performed to assess associations between age, sex, body mass index (BMI), tobacco smoke exposure and season of blood sampling with RSV-and RV-specific IgG levels.

Associations of RSV and RV-specific IgG levels with personal determinants and seasons
of blood sampling in children (EGEA1, n=531) and adults (EGEA2, n=1241). 

Results: In children (11.1 ± 2.8 years old, 57% boys), higher RV-specific IgG levels were associated with older age (only for RV-B), female sex and lower BMI, while only older age was associated with higher RSV-specific IgG levels.

Comparison of the therapeutic effects of medication therapy, specific immunotherapy and anti-IgE (Omalizumab) in patients with hay fever.

Tang R, Lyu X, Hou Y, Yang Y, Fu G, Zhu L, Xue L, Li H, Wang R. Front Immunol. 2024 Feb 28;15:1363034. doi: 10.3389/fimmu.2024.1363034. 

Background: Hay fever, characterized by seasonal allergic reactions, poses a significant health challenge. Existing therapies encompass standard drug regimens, biological agents, and specific immunotherapy. This study aims to assess and compare the effectiveness of anti-IgE (omalizumab), medication therapy, and subcutaneous immunotherapy (SCIT) for hay fever.

Methods: Conducted as a retrospective cohort study, this research involved 98 outpatient hay fever patients who underwent routine medication, omalizumab treatment, or SCIT before the onset of the spring pollen season. A follow-up was performed one month after the start of the pollen season. The comprehensive symptoms and drug scores were used to evaluate patients with different intervention methods, facilitating a comparative analysis of therapeutic outcomes.

VAS score, symptom score, and medication score before and after treatment of three therapies
on hay fever patients.

Results: Compared with before treatment, the symptoms of patients treated with the three methods were all significantly relieved, and the medication score were significantly reduced. Patients treated with omalizumab demonstrated higher symptoms and medication scores than SCIT group before treatment, but similar scores after treatment, which were both lower than medicine treatment group.