Dupilumab-Induced Bilateral Cicatricial Ectropion in Real Life Publication date: Available online 12 November 2019 Source: The Journal of Allergy and Clinical Immunology: In Practice Author(s): Eustachio Nettis, Silvana Guerriero, Lucia Masciopinto, Elisabetta Di Leo, Luigi Macchia

Using skin prick test to sesame paste in the diagnosis of sesame seed allergy Publication date: Available online 12 November 2019 Source: The Journal of Allergy and Clinical Immunology: In Practice Author(s): Larisa Epov, Jenny Garkaby, Meital Almog, Orly Ben-or, Vered Schichter-konfino, Ori toker, Ellen Bamberger, Aharon Kessel

Specific IgE as the best predictor of the outcome of challenges to baked milk and baked egg Publication date: Available online 11 November 2019 Source: The Journal of Allergy and Clinical Immunology: In Practice Author(s): Rachel De Boer, Natalia Cartledge, Sophia Lazenby, Aurelio Tobias, Susan Chan, Adam T. Fox, Alexandra F. Santos

Clinical characterization and predictors of IOS-defined small airway dysfunction in asthma. Publication date: Available online 11 November 2019 Source: The Journal of Allergy and Clinical Immunology: In Practice Author(s): Marcello Cottini, Anita Licini, Carlo Lombardi, Alvise Berti Abstract Background The involvement of small airways has recently gained greater recognition in asthma. Impulse oscillometry (IOS) is a simple and noninvasive method based on the forced oscillation technique, for the detection of small airway dysfunction (SAD). Objective We aimed to identify the predictors of SAD in an unselected sample of 400 patients with physician-diagnosed asthma. Methods All patients underwent standard spirometry and IOS at the first visit, and were stratified by the presence of SAD defined by IOS (fall in resistance from 5 to 20 Hz [R5–R20]>0.07kPa×s×L–1). Univariable and multivariable analyses and classification-tree method were used to analyze cross-sectional relationships between clinical variables and outcome (SAD). Results SAD was present in 62% of the cohort. Subjects with SAD showed a less well-controlled asthma, according to the Global Initiative for Asthma (GINA) definition, and a higher mean inhaled corticosteroid (ICS) dosage use compared to subjects without SAD (both p<0.001). Increased FeNO (OR 2.05, 95% CI 1.14-3.70), female sex (OR 2.27, 95% CI 1.29-4.06), smoking (OR 3.06, 95% CI 1.60-6.05), older age (OR 3.08, 95% CI 1.77-5.49), asthma-related night awakenings (OR 3.34, 95% CI 1.85-6.17), overweight (OR 3.64, 95% CI 1.99-6.85) and exercise-induced asthma symptoms (EIA) (OR 6.39, 95% CI 3.65-11.45) resulted independent predictors of SAD. Classification-tree analysis confirmed that EIA, overweight, asthma-related night awakenings, smoking and older age have potential for clinical use in distinguishing patients with SAD from those without it. Conclusion We identified predictors of SAD and showed that especially EIA, overweight, asthma-related night awakenings, smoking, and older age were strongly associated with SAD.

An Observed Serving Dose May Not Be Necessary Following a Standard Divided Dose FPIES Oral Food Challenge (OFC) Publication date: Available online 11 November 2019 Source: The Journal of Allergy and Clinical Immunology: In Practice Author(s): Mariam W. Guenther, Maria Crain, Christopher P. Parrish, J. Andrew Bird

A bad cough: delayed cutaneous hypersensitivity caused by pholcodine. Publication date: Available online 11 November 2019 Source: The Journal of Allergy and Clinical Immunology: In Practice Author(s): Van Acker Julie, Ebo Didier, Faber Margriet, Sabato Vito, Suys Erwin, Coghe Marjan, Aerts Olivier

Distinct clinical characteristics of boys and girls with eosinophilic esophagitis Publication date: Available online 11 November 2019 Source: The Journal of Allergy and Clinical Immunology: In Practice Author(s): Elizabeth A. Erwin, Aishwarya Navalpakam, Ruchi Singla, Joshua Bolender, Lisa J. Workman, Thomas A.E. Platts-Mills

Children with Asthma have Fixed Airway Obstruction through Childhood Unaffected by Exacerbations Publication date: Available online 9 November 2019 Source: The Journal of Allergy and Clinical Immunology: In Practice Author(s): Henrik W. Hallas, Bo L.K. Chawes, Lambang Arianto, Morten A. Rasmussen, Asja Kunøe, Jakob Stokholm, Klaus Bønnelykke, Hans Bisgaard Abstract Background Children with asthma may have a disease course with or without exacerbations, but the relationship between exacerbations and lung function development is poorly understood. Objective To compare lung function trajectories from birth till adolescence in asthmatic children with and without exacerbations. Methods Children with asthma from the Copenhagen Prospective Studies on Asthma in Childhood2000 (COPSAC2000) birth cohort had lung function and bronchial reactivity assessed repeatedly from 1mo to 13yrs. Exacerbations were diagnosed at the COPSAC clinic defined as symptoms requiring hospitalization, oral or high-dose inhaled corticosteroid treatment. Mixed models were applied to analyze lung function trajectories. Results Children with asthma with exacerbations (N=50) had a trajectory of increased, fixed airway obstruction compared to children without exacerbations (N=47): z-score difference in airway resistance (sRawz), (95% CI): +0.34(+0.03;+0.66), p=0.03, and maximal mid-expiratory flow (MMEFz): -0.41(-0.69;-0.13), p=0.004, but no differences in forced expiratory volume (FEVz): -0.14(-0.41;+0.13), p=0.29, or bronchial reactivity to methacholine (PDz): +0.08(-0.26;+0.42), p=0.65. This did not change comparing lung function trajectories before and after exacerbations: z-score difference (95% CI) sRawz: -0.04(-0.35;0.27), p=0.80; MMEFz: 0.01(-0.02;0.04), p=0.55; FEVz: 0.02(-0.02;0.05), p=0.42; and PDz: -0.01(-0.06;0.05), p=0.88. Conclusion Children with asthma with exacerbations compared to asthma children without exacerbations are characterized by increased airway obstruction since infancy through childhood. The airway obstruction is a fixed trajectory without progression due to exacerbations, suggesting that exacerbations are a consequence rather than a cause of diminished airway caliber in childhood.

Predicting the response to bronchial thermoplasty Publication date: Available online 8 November 2019 Source: The Journal of Allergy and Clinical Immunology: In Practice Author(s): David Langton, Wei Wang, Joy Sha, Alvin Ing, David Fielding, Nicole Hersch, Virginia Plummer, Francis Thien Abstract Background Whilst it is established that not all patients respond to bronchial thermoplasty (BT), the factors that predict response/non-response are largely unknown. Objectives The aim of this study was to identify baseline factors that predict clinical response. Methods The records of 77 consecutive patients entered into the Australian Bronchial Thermoplasty Register were examined for baseline clinical characteristics, and outcomes measured at 6 and 12 months post BT, such as change in the Asthma Control Questionnaire (ACQ), exacerbation frequency, the requirement for short acting reliever medication (SABA) and oral corticosteroids, and improvement in spirometry. Results This was a cohort of severe asthmatics: aged 57.7±11.4 yrs, 57.1% female, 53.2% of patient taking maintenance oral steroids, 43% having been treated with a monoclonal antibody, mean FEV1 of 55.8±19.8%predicted.BT resulted in an improvement in ACQ from 3.2±1.0 at baseline to 1.6±1.1 at 6 months (p<0.001). Exacerbation frequency in the previous 6 months reduced from 3.7±3.3 to 0.7±1.2 (p<0.001). SABA requirement reduced from 9.3±7.1 puffs/day to 3.5±6.0 (p<0.001), and 48.8% of patients were weaned completely off oral steroids. A significant improvement in FEV1 was observed.Using multiple linear regression models, baseline ACQ strongly predicted improvement in ACQ (p<0.001). Patients with an exacerbation frequency greater than twice in the previous 6 months, showed the greatest reduction in exacerbations (-5.3±2.8, p<0.001). Patients using more than 10 puffs/day of SABA experienced the greatest reduction in SABA requirement (-12.4±10.5 puffs, p<0.001). Conclusion The most severely afflicted patients had the greatest improvements in ACQ, exacerbation frequency and medication requirement.

“Real world assessment of asthma control and severity in children, adolescents, and adults with asthma: Relationships to care settings and co-morbidities” Publication date: Available online 7 November 2019 Source: The Journal of Allergy and Clinical Immunology: In Practice Author(s): Sharmilee M. Nyenhuis, Esra Akkoyun, Li Liu, Michael Schatz, Thomas B. Casale Abstract: Background Little is known about how patient-level factors and care settings relate to asthma outcomes in real-world settings. Objective We therefore examined the rates and relative contributions of co-morbidities and care settings in terms of asthma severity and control among pediatric and adolescent/adult patients in a large national sample. Methods We examined de-identified patient data from 28,508 unique encounters documented in the Asthma IQ database, obtaining patient level factors (demographics, asthma characteristics, co-morbidities), care setting (primary care physician [PCP] versus specialist physician [Allergist or Pulmonologist]), and guideline-defined levels of asthma control/severity. Rates of co-morbidities were identified by asthma severity and control and by care setting. We calculated odds ratios (ORs) for asthma control and severity based on each co-morbidity. Results Baseline demographic data indicated that patients seen by specialists versus PCPs, were older, and had more severe and poorly controlled asthma (p<0.05). Patients cared for by specialists also had more comorbid conditions, including gastroesophageal reflux disease (GERD; p<0.01), rhinosinusitis (p<0.01) and obstructive sleep apnea (OSA; Adolescents/Adults only: p<0.01). GERD, smoke exposure, depression (adolescents/adults), rhinosinusitis (children) and African American race, were associated with uncontrolled asthma. Smoke exposure (children), rhinosinsitis, and African American race, were associated with severe disease. Conclusions We identified several demographics and co-morbidities that are independently associated with the specialist care setting, persistent asthma and poor asthma control. Awareness of these relationships may be helpful for clinicians caring for asthma patients.