Atopic dermatitis (eczema) guidelines: 2023 American Academy of Allergy, Asthma and Immunology/American College of Allergy, Asthma and Immunology Joint Task Force on Practice …

Objective:To provide procedure-specific estimates of symptomatic venous thromboembolism (VTE) and major bleeding after abdominal surgery.Background:The use of pharmacological thromboprophylaxis represents a trade-off that depends on VTE and bleeding risks that vary between procedures; their magnitude remains uncertain.Methods:We identified observational studies reporting procedure-specific risks of symptomatic VTE or major bleeding after abdominal surgery, adjusted the reported estimates for thromboprophylaxis and length of follow-up, and estimated cumulative incidence at 4 weeks postsurgery, stratified by VTE risk groups, and rated evidence certainty.Results:

We report the short-and long-term results of the SOLIDARITY Finland on mortality and other patient-important outcomes in patients hospitalised for COVID-19. Between 08/2021 and 03/2023, we randomised 156 patients in 15 hospitals. In the imatinib group, 7.2% of patients had died at 30 days and 13.3% at 1 year and in the standard of care group 4.1% and 8.3%(adjusted HR at 30 days 1.09, 95% CI 0.23-5.07). In a meta-analysis of randomised trials of imatinib versus standard of care (n= 732), allocation to imatinib was associated with a mortality risk ratio of 0.73 (95% CI 0.32-1.63). At 1-year, self-reported recovery occurred in 79.0% in imatinib and in 88.3% in standard of care (RR 0.91, 95% CI 0.78-1.06). Of the 21 potential long COVID symptoms, patients often reported moderate or major bother from fatigue (24%), sleeping problems (19%) and memory difficulties (17%). We found no convincing difference between imatinib and standard of care groups in quality of life or symptom outcomes. The evidence raises serious doubts regarding the benefit of imatinib in reducing mortality, improving recovery and preventing potential long COVID symptoms when given to patients hospitalised for COVID-19.

JAMA

To the Editor Although sometimes considered the pinnacle of scientific evidence, meta-analyses can be problematic. Combining outcomes from heterogeneous trials performed in different settings or populations may give results directly applicable to few. Conclusions are also beholden to methodological design, often discordant from those of subsequent randomized clinical trials. 1 Such may be the case with the recently published dose-response meta-analysis of studies examining efficacy and tolerability of gefapixant for refractory or unexplained chronic cough. 2 Because gefapixant is the first novel efficacious therapy for refractory and unexplained chronic cough, its development involved changes in study design and participant inclusion criteria as well as drug formulation. 3 Four drug formulations were ultimately tested, with maximum bioavailability achieved for the formulation used in the phase 3 trials, such that …

New England Journal of Medicine

Background Food allergies are common and are associated with substantial morbidity; the only approved treatment is oral immunotherapy for peanut allergy. Methods In this trial, we assessed whether omalizumab, a monoclonal anti-IgE antibody, would be effective and safe as monotherapy in patients with multiple food allergies. Persons 1 to 55 years of age who were allergic to peanuts and at least two other trial-specified foods (cashew, milk, egg, walnut, wheat, and hazelnut) were screened. Inclusion required a reaction to a food challenge of 100 mg or less of peanut protein and 300 mg or less of the two other foods. Participants were randomly assigned, in a 2:1 ratio, to receive omalizumab or placebo administered subcutaneously (with the dose based on weight and IgE levels) every 2 to 4 weeks for 16 to 20 weeks, after which the challenges were repeated. The primary end point was ingestion of peanut …

The Lancet

Their stated aim is to summarise the “benefits and harms of weight-lowering drugs”, but the main findings and discussion focus on weight loss, without due consideration to the scarcity of evidence for benefits to health and wellbeing. For instance, quality of life and depression data are reported as low quality or insufficient, and there is no mention of the absence of long-term cardiovascular outcomes. A review on long-term effects of weight-reducing pharmacotherapy included only one trial with cardiovascular outcomes; it found no benefit.

Journal of Critical Care

IntroductionThe objective of this study was to create a definition of patient-important upper gastrointestinal bleeding during critical illness as an outcome for a randomized trial.DesignThis was a sequential mixed-methods qualitative-dominant multi-center study with an instrument-building aim. In semi-structured individual interviews or focus groups we elicited views from survivors of critical illness and family members of patients in the intensive care unit (ICU) regarding which features indicate important gastrointestinal bleeding. Quantitative demographic characteristics were collected. We analyzed qualitative data using inductive content analysis to develop a definition for patient-important upper gastrointestinal bleeding.SettingCanada and the United States.Participants51 ICU survivors and family members of ICU patients.ResultsParticipants considered gastrointestinal bleeding to be important if it resulted in death …

Annals of Allergy, Asthma & Immunology

Food allergies affect an estimated 8% of the US population and have risen significantly in the past 20 years. 1 IgE− mediated reactions to food can range from simple urticaria to life-threatening anaphylaxis. The only treatment was the avoidance of the allergen and treatment of allergic reactions with epinephrine until 2020 when an oral immunotherapy (OIT) product (Palforzia [Stallergenes Greer, Boston, Massachusetts]) was approved for the treatment of peanut allergy. 2 There was no approved treatment by the US Food and Drug Administration for other foods or multiple foods until the recent approval of omalizumab for any food allergy for patients aged 1 year or older with the appropriate total IgE and weight. In the pivotal trial, Wood et al 3 reported in a randomized, placebo-controlled study that 67% of patients on omalizumab tolerated a single dose of 600 mg (1044 mg cumulative dose) or greater of peanut …

Journal of Allergy and Clinical Immunology

MethodsWe analyzed all consecutive OFCs done at one tertiary hospital and nine community clinics between January 1, 2018 to December 30, 2022. Eligible patients underwent an OFC to a single food allergen. Local ethics boards approved the study. We report preliminary findings of a subsample of participants.ResultsOf 450 out of 3380 total patients identified from 9 out of the 10 study sites, age was bimodally distributed with 314 children (less than 18 years old) being a mean (SD) age of 6.37 (5.45) years and 136 adults being 42.29 (17.70) years old. The most common food challenged were peanuts in children (n= 57, 18%) and shrimp in adults (n= 20, 15%). 18%(n= 80) of all participants reacted during their OFC. 29 required oral antihistamines meanwhile 4 required epinephrine administration. No serious adverse events occurred.ConclusionsIn this preliminary subsample of the overall cohort, 4 out of 5 …

Journal of Allergy and Clinical Immunology

MethodsSixty-seven adult subjects enrolled at URMC as part of Atopic Dermatitis Research Network Registry (ADRN02) were classified as mild (n= 33; EASI≤ 7) or severe (n= 34; EASI≥ 20). Serum proteomic analysis was performed using Olink Explore 3072. Differentially expressed proteins (DEPs, mild vs severe) were identified using independent t-tests and False Discovery Rate correction (FDR). HPAStainR and StringDB were used for enrichment pathway analysis. Pearson Correlation analyses determine associations of biomarkers with relevant clinical parameters (FDR≤ 0.05 and r≥ 0.6).Results469 DEPs (FDR≤ 0.05) were identified between mild and severe AD, with 46 downregulated and 423 upregulated in severe cases. HPAStainR matched 233 of DEPs in the “Skin Epidermal” category. StringDB of the DEPs revealed significant (FDR≤ 0.01) association with terms related to cornification, protease …

Food allergy in atopic dermatitis is mediated by complex immune interactions between genetics, diet, environment, and the microbiome. When contact between inflamed skin and food antigens occurs, contact hypersensitivity can develop. Consequently, systemic contact dermatitis (SCD) can occur after ingestion of allergenic foods or food additives in the setting of a Th2 response with CLA-positive T cells, triggering dermatitis where skin resident memory lymphocytes reside. This phenomenon explains food-triggered dermatitis. Atopy patch tests (APTs) detect sensitization to food proteins responsible for SCD, which in turn can be confirmed by oral food challenge with delayed interpretation. We summarize the literature on using APTs to identify foods for oral challenge with dermatitis as an outcome. In dermatitis patients at risk for Th2 skewing based on a history of childhood-onset flexural dermatitis, shared decision …

MethodsWe systematically identified randomized controlled trials addressing systemic treatments for AD from inception to July 8, 2023 from MEDLINE, EMBASE, CENTRAL, Web of Science, and GREAT. We performed Bayesian random-effects network meta-analyses on AD severity, itch severity, sleep disturbance, AD-related quality of life, AD exacerbations, and adverse events. We used GRADE to rate the certainty of the evidence. A multidisciplinary panel including patient partners determined thresholds for patient-important benefits and harms.ResultsWe analyzed 154 trials enrolling 29,831 patients (pediatrics and adults) and evaluated 78 unique interventions over a median 13 weeks (range 1–52). High-dose upadacitinib was among the most effective in improving multiple patient-important outcomes, but among the most harmful. High-dose abrocitinib and low-dose upadacitinib were of intermediate …

Most current algorithms for multivariate time series classification tend to overlook the correlations between time series of different variables. In this research, we propose a framework that leverages Eigen-entropy along with a cumulative moving window to derive time series signatures to support the classification task. These signatures are enumerations of correlations among different time series considering the temporal nature of the dataset. To manage dataset's dynamic nature, we employ preprocessing with dense multi scale entropy. Consequently, the proposed framework, Eigen-entropy-based Time Series Signatures, captures correlations among multivariate time series without losing its temporal and dynamic aspects. The efficacy of our algorithm is assessed using six binary datasets sourced from the University of East Anglia (UEA), in addition to a publicly available sepsis dataset and an institutional sepsis dataset from the Mayo Clinic. We employ recall as a metric for evaluation against the baseline algorithm, Dependent Dynamic Time Warping with 1 Nearest Neighbor. Our algorithm outperforms the baseline algorithm for UEA datasets in terms of recall with an average value of 10% across all datasets, and by 38% for an institutional sepsis dataset. For the public sepsis dataset, the performance of our algorithm is comparable to the baseline algorithm.

Topical corticosteroids (TCSs) are the most widely used treatment for atopic dermatitis (AD), but they can have adverse effects such as skin atrophy, telangiectasias, and hypopigmentation, especially with prolonged use of higher potency steroids. Many patients also have a fear of using TCSs, known as “corticophobia.” With the development of biologics and Janus kinase inhibitors, a nonsteroidal approach to the treatment of AD may be possible and may be preferred by certain patients. Given what is known about these nonsteroidal therapies, we propose a structured treatment ladder and action plan that can guide clinicians and patients on the use of these therapies for the treatment of AD. The ladder divides nonsteroidal medication classes into treatments for exacerbation versus maintenance therapies in an escalating order of increasing potential for adverse effects, both real and perceived. This treatment …

Atopic dermatitis (AD) has a complex pathogenesis that leads to the characteristic itchy, eczematous skin findings. Treatment of AD is aimed at alleviating symptoms, preventing exacerbations and infections, and minimizing long-term risks. Treatment depends on the extent and severity of the AD but almost always includes topical therapies as a first line and often in addition to other treatments. These topicals include a variety of moisturizers and non-pharmacologic preparations, steroids, crisaborole, and calcineurin inhibitors, as well as a topical Janus kinase (JAK) inhibitor. Each has strengths and weaknesses in terms of efficacy, accessibility, and safety/tolerability. Given the heterogeneity of AD, it is important to be able to call upon a variety of topical therapies to meet individual needs.

Journal of Allergy and Clinical Immunology

MethodsWe conducted a retrospective review of patients aged 4-8 years, treated with dupilumab and the age of measles, mumps, rubella (MMR) and varicella dose 2 vaccine administration (IRB 19-016617). Data extracted from electronic medical records included demographics, immunization administration, and dupilumab history.Results162 children were identified to be on dupilumab, of which 114 were included in final analyses. The average age of our population was 5.7 years and the average age of initiation of dupilumab was 4.7 years. Dupilumab was initiated for atopic dermatitis (AD)(n= 107), asthma (n= 5), eosinophilic esophagitis (EoE)(n= 1), and EoE+ asthma (n= 1).

Clinics in Dermatology

ConclusionsAI-powered language models perform adequately on dermatology CME questions but do not consistently achieve the passing score required to receive credit. AI developers may wish to target procedural questions to push AI's performance into the passing range. AI is still a valuable resource for CME. Limitations of this study include a relatively small number of questions (N= 100) and categories of questions (N= 10). The external validity of ChatGPT and Claude's performance may vary considering the number of questions asked.

JAAD International

BackgroundEmpirical decisions to select therapies for psoriasis (PSO) and atopic dermatitis (AD) can lead to delays in disease control and increased healthcare costs. However, routine molecular testing for AD and PSO are lacking.ObjectiveTo examine 1) how clinicians choose systemic therapies for patients with PSO and AD without molecular testing and 2) to determine how often the current approach leads to patients switching medications.MethodsA 20-question survey designed to assess clinician strategies for systemic treatment of AD and PSO was made available to attendees of a national dermatology conference in 2022.ResultsClinicians participating in the survey (265/414, 64% response rate) ranked “reported efficacy” as the most important factor governing treatment choice (P<.001). However, 62% (165/265) of clinicians estimated that two or more systemic medications were typically required to achieve …

MethodsWe systematically identified randomized controlled trials addressing topical treatments for AD from MEDLINE, EMBASE, CENTRAL, CINAHL, LILACS, ICTRP, and GREAT to July 8, 2023. We excluded split-body trials. We performed Bayesian random-effects network meta-analyses on AD severity, itch severity, sleep disturbance, AD-related quality of life, AD exacerbations, and harms. We used GRADE to rate certainty of evidence. A multidisciplinary panel including patient partners determined thresholds for patient-important benefits and harms.ResultsWe analyzed 235 trials enrolling 46,315 patients (pediatrics and adults) and evaluated 69 unique interventions over a median 4 weeks for induction and 16 weeks for maintenance (overall range 1–156). To gain AD control, pimecrolimus improved the most outcomes, while tacrolimus, moderatepotency corticosteroids, delgocitinib, and ruxolitinib had …

Annals of Allergy, Asthma & Immunology

BackgroundPost-traumatic stress disorder (PTSD) is a major risk factor for increased asthma morbidity among World Trade Center (WTC) workers.ObjectiveTo investigate whether differences in perception of airflow limitation mediate the association of PTSD with worse asthma control in WTC workers.MethodsWe collected data from WTC workers on asthma control (Asthma Control Questionnaire and Asthma Quality of Life Questionnaire) and daily peak expiratory flow (PEF) measures over 6 weeks. Perception of airway limitation was assessed by comparing guessed vs actual PEF values. Post-traumatic stress disorder was diagnosed using the Structured Clinical Interview. We used unadjusted and adjusted models to compare PEF and perception measures in WTC workers with PTSD with those of workers without PTSD.ResultsOverall, 25% of 224 participants had PTSD. Post-traumatic stress disorder was …

Annals of Allergy, Asthma & Immunology

BackgroundGuidance addressing atopic dermatitis (AD) management, last issued in 2012 by the American Academy of Allergy, Asthma and Immunology/American College of Allergy, Asthma and Immunology Joint Task Force, requires updating as a result of new treatments and improved guideline and evidence synthesis methodology.ObjectiveTo produce evidence-based guidelines that support patients, clinicians, and other decision-makers in the optimal treatment of AD.MethodsA multidisciplinary guideline panel consisting of patients and caregivers, AD experts (dermatology and allergy/immunology), primary care practitioners (family medicine, pediatrics, internal medicine), and allied health professionals (psychology, pharmacy, nursing) convened, prioritized equity, diversity, and inclusiveness, and implemented management strategies to minimize influence of conflicts of interest. The Evidence in Allergy Group …

Annals of Allergy, Asthma & Immunology

Dr Lipworth reports non-financial support (equipment) from GSK; grants, personal fees (consulting, talks and advisory board), other support (attending ATS and ERS) and from AstraZeneca; personal fees (talks and consulting) from Sanofi, personal fees (consulting, talks and advisory board) from Circassia in relation to the submitted work; grants, personal fees (consulting, talks, advisory board), other support (attending ERS) from Teva, personal fees (talks and consulting), grants and other support (attending ERS and BTS) from Chiesi,

Annals of Allergy, Asthma & Immunology

Dr Lipworth reports non-financial support (equipment) from GSK; grants, personal fees (consulting, talks and advisory board), other support (attending ATS and ERS) and from AstraZeneca; personal fees (talks and consulting) from Sanofi, personal fees (consulting, talks and advisory board) from Circassia in relation to the submitted work; grants, personal fees (consulting, talks, advisory board), other support (attending ERS) from Teva, personal fees (talks and consulting), grants and other support (attending ERS and BTS) from Chiesi,

Annals of Allergy, Asthma & Immunology

AH, antihistamine; BTK, Bruton’s tyrosine kinase; CSU, chronic spontaneous urticaria; FcεRI, high-affinity IgE receptor; H1, histamine-1; Ig, immunoglobulin; LYN, LCK/YES novel tyrosine kinase; SYK, spleen tyrosine kinase. 1. Guillen-Aguinaga S, et al. British J Derm. 2016; 175: 1153-1165. 2. ClinicalTrials. gov. NCT05030311. Accessed September 15, 2023. https://classic. clinicaltrials. gov/ct2/show/NCT05030311. 3. ClinicalTrials. gov. NCT05032157. Accessed September 15, 2023. https://classic. clinicaltrials. gov/ct2/show/NCT05032157

Annals of Allergy, Asthma & Immunology

BackgroundThe Asian American (AsA) population is heterogenous and rapidly growing; however, little is known regarding childhood asthma burden among AsA ethnic groups. The relation between obesity and asthma in AsA ethnic groups also remains unclear.ObjectiveTo evaluate asthma prevalence and the relation of obesity to asthma risk among children in 7 AsA ethnic groups.MethodsWe analyzed data from the California Health Interview Survey from 2011 to 2020. AsA ethnicities were self-reported. Body mass index z-scores, calculated from self-reported height/weight, were used to categorize children by obesity status, based on body mass index-for-age growth charts. Prevalence of self-reported lifetime doctor-diagnosed asthma and asthma attack in the last 12 months was calculated. We performed multivariable logistic regressions adjusting for age and sex.ResultsOf 34,146 survey respondents, 12.2% non …

Annals of Allergy, Asthma & Immunology

It is widely accepted and rigorously evidenced that topical corticosteroids (TCS) are effective treatments for atopic dermatitis (AD). Although TCS are known to have various adverse effects, including skin atrophy, telangiectasia, and perioral dermatitis, clear instructions from prescribers on how and where to apply and when to taper or stop use can mitigate these risks, in addition to close monitoring by the prescribing clinician before refilling prescriptions. An emphasis on the basics of AD management, such as liberal emollient use, can reduce the requirement for TCS. 1 One of the most divisive and debated adverse effects of TCS is topical steroid withdrawal (TSW). First described in 1969, the last 15 years have seen a sharp increase in publications mentioning TSW in the medical literature. There has also been a trend in coverage and discussion of the condition across social media alongside the topic of steroid …

Annals of Allergy, Asthma & Immunology

IntroductionRemibrutinib (LOU064) is an oral, highly selective Bruton's Tyrosine Kinase (BTK) inhibitor that offers fast disease control in chronic spontaneous urticaria (CSU) patients who remain symptomatic despite H1-antihistamines. Remibrutinib showed high selectivity and potency in vitro, with the potential to minimize off-target effects. Here, we report the safety profile of remibrutinib from its completed Phase 2 clinical trials, including participants with long-term treatment.MethodsSafety data of remibrutinib from its completed Phase 2 studies across a range of immune-mediated conditions (CSU, Sjögren syndrome (SjS), asthma) were analyzed. Safety assessments comprised adverse events (AEs), including serious and AEs of special interest (AESI), vital signs, electrocardiograms, and laboratory parameters.ResultsAnalysis of safety data across completed Phase 2 clinical trials in CSU, SjS and asthma showed …

Annals of Allergy, Asthma & Immunology

BackgroundGuidance addressing atopic dermatitis (AD) management, last issued in 2012 by the American Academy of Allergy, Asthma and Immunology/American College of Allergy, Asthma and Immunology Joint Task Force, requires updating as a result of new treatments and improved guideline and evidence synthesis methodology.ObjectiveTo produce evidence-based guidelines that support patients, clinicians, and other decision-makers in the optimal treatment of AD.MethodsA multidisciplinary guideline panel consisting of patients and caregivers, AD experts (dermatology and allergy/immunology), primary care practitioners (family medicine, pediatrics, internal medicine), and allied health professionals (psychology, pharmacy, nursing) convened, prioritized equity, diversity, and inclusiveness, and implemented management strategies to minimize influence of conflicts of interest. The Evidence in Allergy Group …

Annals of Allergy, Asthma & Immunology

Food allergies affect an estimated 8% of the US population and have risen significantly in the past 20 years. 1 IgE− mediated reactions to food can range from simple urticaria to life-threatening anaphylaxis. The only treatment was the avoidance of the allergen and treatment of allergic reactions with epinephrine until 2020 when an oral immunotherapy (OIT) product (Palforzia [Stallergenes Greer, Boston, Massachusetts]) was approved for the treatment of peanut allergy. 2 There was no approved treatment by the US Food and Drug Administration for other foods or multiple foods until the recent approval of omalizumab for any food allergy for patients aged 1 year or older with the appropriate total IgE and weight. In the pivotal trial, Wood et al 3 reported in a randomized, placebo-controlled study that 67% of patients on omalizumab tolerated a single dose of 600 mg (1044 mg cumulative dose) or greater of peanut …

Annals of Allergy, Asthma & Immunology

BackgroundThe relationship between underlying type 2 inflammation and immune response to COVID-19 is unclear.ObjectiveAssessing relationships between allergic conditions and COVID-19 susceptibility and outcomes.MethodsIn the Optum® database, adult patients with and without major allergic conditions (asthma, atopic dermatitis [AD], allergic rhinitis [AR], food allergy, anaphylaxis, eosinophilic esophagitis [EoE]) and patients with and without severe asthma/AD were identified. Adjusted incidence rate ratios (aIRR) for COVID-19 were compared among patients with vs without allergic conditions or severe asthma/AD vs non-severe asthma/AD during 4/1/2020–12/31/2020. Among patients with COVID-19, adjusted hazard ratios (aHR) of 30-day COVID-19-related hospitalization/all-cause mortality were estimated for the same comparisons during 4/1/2020–3/31/2022.ResultsPatients with (N = 1,273,231 …

Annals of Allergy, Asthma & Immunology

BackgroundAlpha-gal syndrome (AGS) is an allergy to galactose-α-1,3-galactose (alpha-gal), a carbohydrate found in most mammals. Evidence indicates that AGS develops following a tick bite, and in the United States, AGS is most associated with bites from Amblyomma americanum (lone star tick); however, not all persons bitten by ticks develop clinical AGS.ObjectiveThis study investigated intrinsic risk factors associated with the development of AGS.MethodsWe performed a case-control study among adults presenting for diagnosis or management of AGS at an allergy clinic in North Carolina during 2019–2020 and compared them to controls enrolled from two nearby internal medicine clinics. A questionnaire gathered epidemiologic and tick exposure data and blood was obtained for alpha-gal specific IgE (sIgE) and other testing.ResultsThe 82 enrolled case patients and 191 controls did not differ significantly by …

Annals of Allergy, Asthma & Immunology

Fungal sensitization and allergy are complex topics with many unanswered questions in terms of pathophysiology and unmet needs in clinical and laboratory practice. In recent years, advances in taxonomy, exposome science, and fungus− host interactions at the molecular level have been achieved. Letovsky et al 1 took advantage of these to analyze a vast database of real-world IgE testing results. The contribution of their findings to clinical practice is expected to support more accurate diagnosis of fungal sensitization and allergy, thus improving the management of an array of type 2-related chronic inflammatory diseases. Moreover, their findings brought undisputable real-world support for the clinical deployment of molecular allergen-assisted diagnosis of fungal sensitization. Allergic sensitization to fungi, defined as the demonstration of fungi-binding specific IgE, is a diagnostic biomarker of fungal allergy in …

Annals of Allergy, Asthma & Immunology

BackgroundAllergic rhinitis (AR) is a common respiratory disease encompassing a variety of phenotypes. Patients can be sensitized to one or more allergens. There are indications that polysensitization is associated with more severe disease. However, the extent to which the level of sensitization is associated to clinical disease variability, underlying the distinct nature of AR from AR+ conjunctivitis or AR+ asthma, is not known.ObjectiveThe aim of this study was to evaluate phenotypical differences between mono- and poly-sensitized patients with AR and to quantify their symptomatic variability.Methods565 patients with a confirmed diagnosis of AR were included in this cross-sectional study. 155 were mono-sensitized and 410 poly-sensitized. Interactions between sensitization levels and reporting of different symptoms of AR and co-morbidities, disease duration and impact, were assessed. Furthermore, patients …

Annals of Allergy, Asthma & Immunology

BackgroundSeasonal variability could influence asthma exacerbations. Dupilumab, a fully human monoclonal antibody, blocks the shared receptor component for interleukin (IL)-4/IL-13, key and central drivers of type 2 inflammation. In the 52-week QUEST study (NCT02414854), add-on dupilumab every 2 weeks vs placebo significantly reduced exacerbations and improved prebronchodilator forced expiratory volume in 1 second in patients with uncontrolled, moderate-to-severe asthma. TRAVERSE (NCT02134028), the open-label QUEST extension study, enrolled patients with moderate-to-severe asthma to investigate long-term safety and efficacy of dupilumab, including patients who previously received placebo that initiated dupilumab therapy.ObjectiveTo investigate long-term dupilumab efficacy in reducing exacerbations across yearly seasons in patients with type 2 inflammatory asthma with and without clinical …

Annals of Allergy, Asthma & Immunology

BackgroundAsthma in older adults is associated with increased morbidity and mortality compared with asthma in younger patients. Fixed airflow obstruction (FAO) is associated with decreased survival in younger patients, but its significance remains unclear in older adults with asthma.ObjectiveTo identify risk factors and outcomes related to FAO in older adults with asthma.MethodsSubjects older than 55 years with a physician diagnosis of persistent asthma were evaluated. Collected data included participant demographic information, medications, asthma exacerbations, Asthma Control Test (ACT) score, Asthma Quality of Life (AQLQ) score, comorbidities, spirometry, atopic status, and fractional exhaled nitric oxide. Clinical characteristics and outcomes associated with FAO (defined as post-bronchodilator ratio of forced expiratory volume in 1 second to forced vital capacity ≤70%) were assessed.ResultsA total of …

Annals of Allergy, Asthma & Immunology

BackgroundResponse to abrocitinib treatment for moderate-to-severe atopic dermatitis (AD) has not been evaluated across racial and ethnic subpopulations.ObjectiveTo assess the efficacy and safety of abrocitinib on the basis of patient race, ethnicity, and Fitzpatrick skin type (FST).MethodsData were pooled post hoc from patients treated with abrocitinib 200 mg, 100 mg, or placebo in 3 monotherapy trials (NCT02780167, NCT03349060, and NCT03575871). Race and ethnicity were self-reported; FST was determined by study investigators. Evaluations through Week 12 include the following: (1) Investigator's Global Assessment of clear or almost-clear skin; (2) greater than or equal to 75% improvement in Eczema Area and Severity Index or SCORing AD; (3) a greater-than-or-equal-to 4-point improvement in Peak Pruritus Numerical Rating Scale score; (4) least squares mean changes in Dermatology Life Quality …

Annals of Allergy, Asthma & Immunology

BackgroundAllergic rhinitis (AR) is a common respiratory disease encompassing a variety of phenotypes. Patients can be sensitized to one or more allergens. There are indications that polysensitization is associated with more severe disease. However, the extent to which the level of sensitization is associated to clinical disease variability, underlying the distinct nature of AR from AR+ conjunctivitis or AR+ asthma, is not known.ObjectiveThe aim of this study was to evaluate phenotypical differences between mono- and poly-sensitized patients with AR and to quantify their symptomatic variability.Methods565 patients with a confirmed diagnosis of AR were included in this cross-sectional study. 155 were mono-sensitized and 410 poly-sensitized. Interactions between sensitization levels and reporting of different symptoms of AR and co-morbidities, disease duration and impact, were assessed. Furthermore, patients …

Annals of Allergy, Asthma & Immunology

BackgroundAllergic rhinitis (AR) is a common respiratory disease encompassing a variety of phenotypes. Patients can be sensitized to one or more allergens. There are indications that polysensitization is associated with more severe disease. However, the extent to which the level of sensitization is associated to clinical disease variability, underlying the distinct nature of AR from AR+ conjunctivitis or AR+ asthma, is not known.ObjectiveThe aim of this study was to evaluate phenotypical differences between mono- and poly-sensitized patients with AR and to quantify their symptomatic variability.Methods565 patients with a confirmed diagnosis of AR were included in this cross-sectional study. 155 were mono-sensitized and 410 poly-sensitized. Interactions between sensitization levels and reporting of different symptoms of AR and co-morbidities, disease duration and impact, were assessed. Furthermore, patients …

Annals of Allergy, Asthma & Immunology

BackgroundAsthma in older adults is associated with increased morbidity and mortality compared with asthma in younger patients. Fixed airflow obstruction (FAO) is associated with decreased survival in younger patients, but its significance remains unclear in older adults with asthma.ObjectiveTo identify risk factors and outcomes related to FAO in older adults with asthma.MethodsSubjects older than 55 years with a physician diagnosis of persistent asthma were evaluated. Collected data included participant demographic information, medications, asthma exacerbations, Asthma Control Test (ACT) score, Asthma Quality of Life (AQLQ) score, comorbidities, spirometry, atopic status, and fractional exhaled nitric oxide. Clinical characteristics and outcomes associated with FAO (defined as post-bronchodilator ratio of forced expiratory volume in 1 second to forced vital capacity ≤70%) were assessed.ResultsA total of …