Allergy and Clinical Immunology

Race and Asthma Outcomes in Older Adults: Results from the National Asthma Survey Publication date: Available online 5 February 2020 Source: The Journal of Allergy and Clinical Immunology: In Practice Author(s): Nicole M. Cremer, Alan P. Baptist Background The number of older adults with asthma continues to rise, yet the effects of race and ethnicity on asthma outcomes in this population are unknown. Objective To characterize the effect of race and ethnicity on asthma outcomes in a large national sample of older adults and to identify factors that are associated with disparities found. Methods Data from the 2015 Behavioral Risk Factor Surveillance Survey and Asthma Call-Back Survey were analyzed. Respondents were included if they had a current asthma diagnosis, were aged ≥55, and self-identified as non-Hispanic white, African American, or Hispanic. Demographic variables, health care access, comorbidities, and asthma history were correlated with asthma outcomes (health care utilization and asthma control). Asthma outcome variables were further analyzed using multivariable logistic regression. Results A total of 4700 individuals were included. Compared with non-Hispanic white respondents, African American and Hispanic respondents had lower incomes, greater impaired access to health care due to cost, and increased reliance on rescue medications. After controlling for factors including income, education, comorbidities, and health insurance, African American and Hispanic respondents were twice as likely to visit the emergency room (ER) for asthma (P < .001 for both) and 40% less likely to report uncontrolled daytime symptoms (P = .002 and .008). Conclusions Racial differences in asthma outcomes persist despite controlling for multiple social determinants of health and access to health insurance through Medicare. Minority patients were more likely to visit the ER but less likely to report frequent daytime symptoms. These findings indicate that comprehensive strategies to address assessment, monitoring, and treatment are needed to decrease health disparities.

Persistence of sinonasal disease despite mepolizumab Publication date: Available online 4 February 2020 Source: The Journal of Allergy and Clinical Immunology: In Practice Author(s): Nicholas R. Rowan, Robert M. Naclerio Abstract The treatment paradigm for the management of chronic rhinosinusitis with nasal polyposis (CRSwNP) is currently undergoing a rapid evolution with the development of monoclonal antibody therapies targeted at type 2 inflammatory pathways. The use of these biologic therapies in asthmatic patients, and more recently, patients with CRSwNP has produced promising results, especially for patients with severe disease. Many questions regarding the appropriate timing of these medications, whether or not these new treatment strategies should be used as a monotherapy or in conjunction with traditional therapies such as sinus surgery, the role of appropriate phenotyping, and identification of biomarkers, remain unanswered. We herein present a case of a patient with severe eosinophilic asthma and comorbid CRSwNP who failed to achieve control of his respiratory symptomology and ultimately progressed to sinus surgery despite treatment with an anti-interleukin 5 monoclonal antibody therapy (mepolizumab). Consideration is given to the mechanistic underpinnings of the reported patient’s failure. This case highlights the need for further understanding of the optimal usage of these novel therapeutics in the management of CRSwNP and in the need to better understand the pathophysiology of CRSwNP.

Soluble FcεRI, IgE, and tryptase as potential biomarkers of rapid desensitizations for platin IgE sensitized cancer patients Publication date: Available online 4 February 2020 Source: The Journal of Allergy and Clinical Immunology: In Practice Author(s): Sherezade Moñino-Romero, Leticia de las Vecillas, Leila A. Alenazy, Marina Labella, Zsolt Szépfalusi, Edda Fiebiger, Mariana C. Castells Graphical abstract

Dupilumab Efficacy in Patients with Uncontrolled, Moderate-to-Severe Allergic Asthma Publication date: February 2020 Source: The Journal of Allergy and Clinical Immunology: In Practice, Volume 8, Issue 2 Author(s): Jonathan Corren, Mario Castro, Thomas O'Riordan, Nicola A. Hanania, Ian D. Pavord, Santiago Quirce, Bradley E. Chipps, Sally E. Wenzel, Karthinathan Thangavelu, Megan S. Rice, Sivan Harel, Alexandre Jagerschmidt, Asif H. Khan, Siddhesh Kamat, Jaman Maroni, Paul Rowe, Yufang Lu, Nikhil Amin, Gianluca Pirozzi, Marcella Ruddy Background Dupilumab blocks the shared receptor component for IL-4 and IL-13, key drivers of type 2 inflammation, including IgE-mediated allergic inflammation in asthma. In the LIBERTY ASTHMA QUEST (NCT02414854) study, dupilumab reduced severe asthma exacerbations and improved forced expiratory volume in 1 second (FEV1) in patients with uncontrolled, moderate-to-severe asthma with greater efficacy observed in patients with elevated type 2 inflammatory biomarkers (blood eosinophils and fractional exhaled nitric oxide) at baseline. Objective We assessed dupilumab's effect on key asthma outcomes in QUEST patients with/without evidence of allergic asthma (total serum IgE ≥30 IU/mL and ≥1 perennial aeroallergen-specific IgE ≥0.35 kU/L at baseline). Methods Severe exacerbation rates and change from baseline in FEV1, asthma control, and markers of type 2 inflammation during the 52-week treatment period were assessed. Results In the allergic asthma subgroup (n = 1083), dupilumab 200/300 mg every 2 weeks versus placebo reduced severe asthma exacerbation rates (−36.9%/−45.5%; both P < .01), improved FEV1 at week 12 (0.13 L/0.16 L; both P < .001; improvements were evident by the first evaluation at week 2) with greater efficacy observed in patients with elevated type 2 inflammatory biomarkers at baseline, and improved asthma control. Dupilumab treatment also resulted in rapid and sustained reductions in type 2 inflammatory biomarkers. Comparable results were observed in patients without evidence of allergic asthma (n = 819). Conclusion Dupilumab reduced severe exacerbation rates, improved FEV1 and asthma control, and suppressed type 2 inflammatory biomarkers in patients with uncontrolled, moderate-to-severe asthma with or without evidence of allergic asthma, highlighting the key role of IL-4 and IL-13 in airway inflammation.

Reply Publication date: February 2020 Source: The Journal of Allergy and Clinical Immunology: In Practice, Volume 8, Issue 2 Author(s): Jonathan Corren

Allergic burden and response to dupilumab Publication date: February 2020 Source: The Journal of Allergy and Clinical Immunology: In Practice, Volume 8, Issue 2 Author(s): Brian Lipworth, Rory Chan, Chris Kuo

European Society of Clinical Microbiology and Infectious Diseases Study Group for Infections in Compromised Hosts: Guidelines for Infectious and Immunological Complications of Targeted and Biological Therapies Publication date: February 2020 Source: The Journal of Allergy and Clinical Immunology: In Practice, Volume 8, Issue 2 Author(s): Melissa D. Gans, Manish Ramesh

CME Exam: Delayed Food Reaction Unresponsive to Epinephrine: A Difficult Case of FPIES Publication date: February 2020 Source: The Journal of Allergy and Clinical Immunology: In Practice, Volume 8, Issue 2 Author(s):

Delayed Food Reaction Unresponsive to Epinephrine: A Difficult Case of FPIES Publication date: February 2020 Source: The Journal of Allergy and Clinical Immunology: In Practice, Volume 8, Issue 2 Author(s): Joseph Cafone, Matthew Greenhawt, Gita Ram

Association between the longitudinal course of AD, sleep disturbance, and overall health in US children Publication date: February 2020 Source: The Journal of Allergy and Clinical Immunology: In Practice, Volume 8, Issue 2 Author(s): Costner McKenzie, Amy S. Paller, Anna Fishbein, Jonathan I. Silverberg