Journal of Allergy and Clinical Immunology in Practice

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BACKGROUND: Idiopathic mast cell activation syndrome (iMCAS) is characterised by severe, episodic systemic mast cell (MC) activation and mediator-related symptoms, event-related increase in serum tryptase levels and response to MC-targeted therapies, in the absence of underlying IgE-mediated allergy or clonal MC disorder. Studies indicating its prevalence using evidence-based diagnostic criteria are currently lacking. OBJECTIVE: The present study aimed to assess prevalence, as well as clinical and laboratory features of patients with iMCAS...

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BACKGROUND: Digital health tools have been shown to help address challenges in asthma control, including inhaler technique, treatment adherence and short-acting beta2 -agonist overuse. The maintenance and reliever Digihaler System (DS) comprises two Digihaler inhalers (fluticasone propionate/salmeterol and albuterol) with an associated patient App and web-based Dashboard. Clinicians can review patients' inhaler use and Digihaler inhalation parameter data to support clinical decision-making...

BACKGROUND: Breathing pattern disorder (BPD) reflects altered biomechanical patterns of breathing that drive breathing difficulty and commonly accompanies difficult-to-treat asthma. Diagnosis of BPD has no gold standard, but Nijmegen Questionnaire (NQ) >23 is commonly used. OBJECTIVES: We sought to advance clinical characterisation of BPD and better understand clinical utility of NQ in difficult asthma, in patients from the Wessex AsThma CoHort of difficult asthma (WATCH) study...

BACKGROUND: Peanut introduction guidelines recommend that infants with severe eczema and/or egg allergy consume 6 grams peanut protein weekly to prevent peanut allergy. Rates of new peanut allergy after introduction and adherence remain under study. OBJECTIVE: To determine compliance with peanut introduction guidelines, rates of new peanut allergy, and reasons for discontinuation of peanut consumption in a cohort of high-risk infants. METHODS: A prospective cohort of 4-11 month-old high-risk infants (defined as moderate-severe eczema or non-peanut food allergy or a first degree relative with peanut allergy) with no prior peanut exposure who were determined to not be peanut allergic were recommended to introduce 6 grams of peanut protein weekly...

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Allergen immunotherapy (AIT) is a disease modifying treatment for IgE mediated allergies reducing disease burden and symptoms in patients with allergic rhinitis, with or without asthma. The growing evidence that AIT also has the potential to facilitate achieving asthma control in patients with allergic asthma resulted in its acknowledgement by international bodies (GINA and EAACI) as add-on treatment for mild/moderate asthma. Although there have been promising developments in biomarkers for patient selection and for AIT efficacy evaluation in asthma patients, a lot more data are still required...

The landscape of food allergy (FA) treatment is poised for a paradigm shift with the emergence of biologic therapies. The FDA approval of a standardized peanut Powder for oral immunotherapy (OIT) in 2020 marked a milestone, signaling a departure from allergen avoidance toward proactive treatment strategies. While OIT has been proven effective in desensitizing patients to specific allergens, there are several limitations such as lacking standardization, a long-time commitment to achieve maintenance, and adverse events...

Rural health disparities are well-documented and continue to jeopardize the long-term health and wellness for the millions of individuals who live in rural America. The disparities observed between urban and rural residents encompass numerous morbidity and mortality measures for several chronic diseases and have been referred to as the "rural mortality penalty." Although the unmet health needs of rural communities are widely acknowledged, little is known about rural health disparities in allergies, asthma, and immunologic diseases...

Disparities in environmental and social determinants of health (DOH) are associated with morbidity in atopic dermatitis (AD). The socioecological model (SEM) is a framework that can be applied to better understand how DOH impacts patients with AD. We include a case scenario of a remote Indigenous patient reflective of real-world situations of living with AD and examine relevant impact, gaps in knowledge, and further research needs. This review highlights a variety of social and environmental exposures as important DOH which must be addressed to achieve optimal management in AD...

BACKGROUND: Patients with chronic spontaneous urticaria (CSU) can have comorbid inducible urticaria (CIndU). How comorbid CIndU affects patients and their CSU is largely unclear. OBJECTIVE: To compare CSU patients with and without comorbid CIndUs for differences in demographic features, clinical characteristics, and laboratory markers. MATERIAL AND METHODS: We analysed 708 CSU patients of our Urticaria Center of Reference and Excellence (UCARE) enrolled in CURE, the chronic urticaria registry...

BACKGROUND: There is currently no standardized duration of drug provocation test (DPT) for confirming/delabeling beta-lactam hypersensitivity reaction (BL-HSR). OBJECTIVES: This meta-analysis and systematic review aimed to investigate the added diagnostic value of extended-day over single-day DPT for confirming/delabeling BL-HSR in adults and children. METHODS: The MEDLINE, EMBASE, Web of Science, and CINAHL online databases were searched from inception to 15 March 2023 for studies that performed extended-day DPT to confirm/delabel BL-HSR...

Allergen-specific immunotherapy (AIT) remains the only disease-modifying treatment for IgE-mediated allergic diseases such as allergic rhinitis (AR). It can provide long-term clinical benefits when given for three years or longer. Mechanisms of immune tolerance induction by AIT are underscored by the modulation of several compartments within the immune system. These include repair of disruption in epithelial barrier integrity, modulation of the innate immune compartment that includes regulatory dendritic cells (DCreg) and innate lymphoid cells (ILCreg), and adaptive immune compartments such as induction of regulatory T and B cells...

No abstract text is available yet for this article.

No abstract text is available yet for this article.

No abstract text is available yet for this article.

No abstract text is available yet for this article.

BACKGROUND: There is no consensus method to identify anaphylaxis in sublingual immunotherapy (SLIT) trials. Standardized MedDRA Queries (SMQs) are standardized groupings of MedDRA terms used in drug safety monitoring. OBJECTIVE: To develop a method to identify potential anaphylaxis in SLIT-tablet trials using SMQ searches and case definitions of anaphylaxis adopted from the National Institute of Allergy and Infectious Disease. METHODS: The SMQ search tool contained 2 criteria including treatment-emergent adverse events (AEs): 1) narrow MedDRA terms related to anaphylaxis, and 2) all AEs with broad MedDRA terms from at least 2 of 3 categories (respiratory/skin/cardiovascular) occurring on the same day...

BACKGROUND: A maintenance oral corticosteroid (OCS) in addition to high-dose inhaled corticosteroids plus long-acting β2-agonists in severe asthmatics leads to long-term adverse events (AEs). OCS-sparing agents are of high priority. OBJECTIVE: This network meta-analysis (NMA) assessed biologics' comparative efficacy and safety in OCS-dependent asthmatics. METHODS: A systematic search was performed through PubMed, Scopus, EMBASE, the Cochrane Center of Controlled Trials, and Google Scholar for randomized controlled trials (RCTs) that addressed the efficacy and safety of biologics compared with placebo in OCS-dependent asthmatics from inception to July 2023...