Patient-Reported Outcome Measures in Atopic Dermatitis and Chronic Urticaria are Underused in Clinical Practice

Cherrez-Ojeda I, Bousquet J, Giménez-Arnau A et al.  J Allergy Clin Immunol Pract. 2024 Apr 9:S2213-2198(24)00349-0. doi: 10.1016/j.jaip.2024.03.050. 

Abstract

Background: Patient-reported outcome measures (PROMs) are validated and standardized tools that complement physician evaluations and guide treatment decisions. PROMs are crucial for monitoring atopic dermatitis (AD) and chronic urticaria (CU) in clinical practice, but there are unmet needs and knowledge gaps regarding their use in clinical practice.

Objective: We investigated the global real-world use of AD and CU PROMs in allergology and dermatology clinics as well as their associated local and regional networks.

Methods: Across 72 specialized allergy and dermatology centers and their local and regional networks, 2,534 physicians in 73 countries completed a 53-item questionnaire on the use of PROMs for AD and CU.

Results: Of 2,534 physicians, 1,308 were aware of PROMs. Of these, 14% and 15% used PROMs for AD and CU, respectively. Half of physicians who use PROMs do so only "rarely" or "sometimes". AD and CU PROM usage is associated with being female, younger, and a dermatologist. POSCORAD and UAS were the most utilized PROMs for AD and CU, respectively.

An integrated molecular risk score early in life for subsequent childhood asthma risk

Böck A, Urner K, Eckert JK et al.  Clin Exp Allergy. 2024 Mar 31. doi: 10.1111/cea.14475. 

Abstract

Background

Numerous children present with early wheeze symptoms, yet solely a subgroup develops childhood asthma. Early identification of children at risk is key for clinical monitoring, timely patient-tailored treatment, and preventing chronic, severe sequelae. For early prediction of childhood asthma, we aimed to define an integrated risk score combining established risk factors with genome-wide molecular markers at birth, complemented by subsequent clinical symptoms/diagnoses (wheezing, atopic dermatitis, food allergy).

Methods

Three longitudinal birth cohorts (PAULINA/PAULCHEN, n = 190 + 93 = 283, PASTURE, n = 1133) were used to predict childhood asthma (age 5–11) including epidemiological characteristics and molecular markers: genotype, DNA methylation and mRNA expression (RNASeq/NanoString). Apparent (ap) and optimism-corrected (oc) performance (AUC/R2) was assessed leveraging evidence from independent studies (Naïve-Bayes approach) combined with high-dimensional logistic regression models (LASSO).

Results

Asthma prediction with epidemiological characteristics at birth (maternal asthma, sex, farm environment) yielded an ocAUC = 0.65. Inclusion of molecular markers as predictors resulted in an improvement in apparent prediction performance, however, for optimism-corrected performance only a moderate increase was observed (upto ocAUC = 0.68).

COVID-19 and Asthma Onset in Children

James P. Senter, Laura K. Aisenberg, Jesse W. Dudley, Xianqun Luan, Jing Huang, Chén C. Kenyon, David A. Hill. Pediatrics 2024; e2023064615. 10.1542/peds.2023-064615

ABSTRACT

BACKGROUND AND OBJECTIVES:

Respiratory viral infections increase risk of asthma in infants and children. Infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus can cause severe lung inflammation and prolonged respiratory symptoms. We sought to determine whether SARS-CoV-2 infection modified pediatric incident asthma risk.

METHODS:

This retrospective cohort study examined children ages 1 to 16 within the Children’s Hospital of Philadelphia Care Network who received polymerase chain reaction (PCR) testing for SARS-CoV-2 between March 1, 2020 and February 28, 2021. Multivariable Cox regression models assessed the hazard ratio of new asthma diagnosis between SARS-CoV-2 PCR positive and SARS-CoV-2 PCR negative groups within an 18-month observation window. Models were adjusted for demographic characteristics, socioeconomic variables, and atopic comorbidities.

RESULTS:

Kaplan-Meier survival curves comparing adjusted asthma-free survival between
SARS-CoV-2 positive and SARS-CoV-2 negative groups.

There were 27 423 subjects included in the study. In adjusted analyses, SARS-CoV-2 PCR positivity had no significant effect on the hazard of new asthma diagnosis (hazard ratio [HR]: 0.96; P = .79). Black race (HR: 1.49; P = .004), food allergies (HR: 1.26; P = .025), and allergic rhinitis (HR: 2.30; P < .001) significantly increased the hazard of new asthma diagnosis. Preterm birth (HR: 1.48; P = .005) and BMI (HR: 1.13; P < .001) significantly increased the hazard of new asthma diagnosis for children <5 years old.

Preventive allergen immunotherapy with inhalant allergens in children

Dwivedi V, Kopanja S, Schmidthaler K, Sieber J et al. Allergy. 2024 Apr 8. doi: 10.1111/all.16115. 

REVIEW - Open Access

Abstract

The efficacy and safety of preventive allergen immunotherapy (pAIT) in children are currently under investigation. Here, we provide an overview of pAIT with respiratory allergens concerning the prevention of new sensitizations, allergic disease onset and progression as well as further immunomodulatory effects.

Process of study selection

Three databases were searched for clinical pAIT studies in children. Selected publications were reviewed for preventive outcomes according to prevention level (primary, secondary, and tertiary), allergen type, administration route, dose, and treatment duration. The primary prevention approach appears safe but showed no allergen-specific effect on new sensitizations. Secondary prevention seems feasible and may induce regulatory T cell-mediated immunotolerance. The number of studies at these prevention levels is limited.

Exercise-induced bronchoconstriction, allergy and sports in children

Klain A, Giovannini M, Pecoraro L et al.  Ital J Pediatr. 2024 Mar 13;50(1):47. doi: 10.1186/s13052-024-01594-0.

Abstract

EIB pathogenesis and the central role of atopy

Exercise-induced bronchoconstriction (EIB) is characterized by the narrowing of airways during or after physical activity, leading to symptoms such as wheezing, coughing, and shortness of breath. Distinguishing between EIB and exercise-induced asthma (EIA) is essential, given their divergent therapeutic and prognostic considerations. EIB has been increasingly recognized as a significant concern in pediatric athletes. Moreover, studies indicate a noteworthy prevalence of EIB in children with atopic predispositions, unveiling a potential link between allergic sensitivities and exercise-induced respiratory symptoms, underpinned by an inflammatory reaction caused by mechanical, environmental, and genetic factors.

Emerging and Novel Elicitors of Anaphylaxis: Collegium Internationale Allergologicum Update 2024

Treudler R. Emerging and Novel Elicitors of Anaphylaxis: Collegium Internationale Allergologicum Update 2024. Int Arch Allergy Immunol. 2024 Mar 25:1-9. doi: 10.1159/000537958.

Abstract

Background: 

Anaphylaxis represents the most severe end of the spectrum of allergic reactions. Frequent elicitors of anaphylaxis are insects, foods, and drugs. This paper summarizes recent development with regard to emerging and novel elicitors of anaphylaxis.

Summary: 

Allergens in selected plant foods with increasing importance in anaphylaxis cases

Food allergens on the rise include pulses (like pea, chickpea), seeds (hemp, chia), nuts (cashew), pseudograins (buckwheat, quinoa), fruits, and microalgae. Novel foods are foods that were not consumed to any significant extent in the European Union before May 1997, which includes four edible insects (mealworm, migratory locust, house cricket, and buffalo worm). Recent investigations have pointed out the risk of anaphylaxis associated with the consumption of yellow mealworm for people allergic to shellfish and house dust mites.

Predicting the Outcome of Pediatric Oral Food Challenges for Determining Tolerance Development

Kim H, Jeong K, Park M et al.  Allergy Asthma Immunol Res. 2024 Mar;16(2):179-190. doi: 10.4168/aair.2024.16.2.179.

Abstract

Purpose: Despite the risk of anaphylaxis, oral food challenges (OFCs) are performed clinically for various indications, particularly to confirm tolerance development. This study aimed to assess OFCs by relevant indications and build an outcome prediction model to help determine when to perform OFCs in children who are likely to have developed immune tolerance.

Methods: In total, 432 pediatric OFCs were retrospectively analyzed according to indications. Clinical characteristics, serum total immunoglobulin (Ig) E, blood eosinophils, and specific IgE and IgG4 levels for food allergens were noted and compared. Machine learning was utilized to select the most important variables in determining the passage of the OFCs, and prediction models were constructed using the selected variables.

Distribution of oral food challenge results based on age
and food-specific immunoglobulin E for egg white and cow’s milk. 

Results: OFCs were most commonly performed to confirm tolerance development (number, %; 267, 61.8%). The most common food allergens tested were egg (191, 44.2%) and milk (135, 31.3%).

Poor rhinitis and asthma control is associated with decreased health-related quality-of-life and utilities: A MASK-air study

Vieira RJ, Leemann L, Briggs A et al. J Allergy Clin Immunol Pract. 2024 Mar 30:S2213-2198(24)00329-5. doi: 10.1016/j.jaip.2024.03.036.

Highlights box:

What is already known about this topic?

National estimates of patients' quality-of-life based on control of asthma/allergic rhinitis are lacking. Real-world data may provide insights into quality-of-life of patients with asthma/allergic rhinitis and improve the ability to provide care to these patients.

What does this article add to our knowledge?

This study provides country-specific estimates (per disease control level) for quality-of-life in patients with allergic rhinitis or asthma across multiple European countries, using EQ-5D utility index scores and EQ-5D visual analogue scale.

How does this study impact current management guidelines?

This study points to the importance of achieving a good rhinitis and asthma control.

It also provides insights into patients’ preferences regarding different control levels and comorbid status, which are essential for guideline development.

Abstract

Background

Allergic rhinitis (AR) and asthma may impact health-related quality-of-life. However, national estimates on the quality-of-life of patients with AR or asthma are lacking.