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Medical Journal Review

October 2019

WAO Reviews – Editors' Choice

The Editors’ Choice comes to you from Juan Carlos Ivancevich, MD, WAO Web Managing Editor, and summary author, John J. Oppenheimer, MD, FACAAI, FAAAAI, WAO Reviews Editor. They select articles for their importance to clinicians who care for patients with asthma and allergic/immunologic diseases, and whenever possible, for their accessibility to everyone.

A real-world study evaluating adequacy of Existing Systemic Treatments for patients with moderate-to-severe Atopic Dermatitis (QUEST-AD): Baseline treatment patterns and unmet needs assessment
Wei W, Ghorayeb E, Andria M, Walter V, Schnitzer J et al.
Annals of Allergy Asthma & Immunology 2019;123(4):381-388. doi: 10.1016/j.anai.2019.07.008.

Real-world treatment patterns and un-met needs of adults with moderate-to-severe atopic dermatitis (AD) receiving systemic therapies are poorly understood. Thus, the goal of this study was to evaluate unmet needs in patients with moderate-to-severe AD treated with systemic therapies identified from the Optum Research Database. Patients completed a survey which examined symptoms, treatment, and QoL. Eight hundred and one participants were included (mean age, 45.2 years; 71.8% female). In the 12 months before baseline survey, 38.3% reported no remission from AD. In the month before baseline survey, 63.6%used topical corticosteroids, and 81.3% of patients experienced 1 or more flares. Not surprisingly, patients experiencing flares reported worse Patient-Orientated Eczema Measure, Peak Pruritus Numeric Rating Scale, and Dermatology Life Quality Index scores, lower treatment satisfaction, and greater work productivity loss than patients without flares (all P<.001), and those with severe AD reported worse POEM, Peak Pruritus NRS, and DLQI, lower treatment satisfaction, and greater work productivity loss than patients with moderate AD (all P<.001).

Association between pulmonary function and asthma symptoms
Sullivan PW, Ghushchyan VH, Marvel J, Barrett YC, Fuhlbrigge AL
JACI: In Practice 2019;7(7):2319-2325. doi: 10.1016/j.jaip.2019.04.019.

Reports vary on the association between FEV1% predicted and asthma control instruments, evaluating symptoms. In this study Sullivan and colleagues explored the association between FEV1%pred and Asthma Control Questionnaire (ACQ) scores in a managed-care population with persistent asthma through a retrospective analysis of survey responses and spirometry results of patients (aged‡12 years) with persistent asthma from the Observational Study of Asthma Control and Outcomes. In this study, patients received 4 identical surveys including the 5-item ACQ (ACQ-5)/6-item ACQ (ACQ-6) and completed spirometry in parallel. The authors found a weak and statistically insignificant association between FEV1%pred and ACQ-5/ACQ-6 scores in unadjusted models, which suggests a high degree of unexplained variation between these measures. Overall, these results support the use of both symptoms and pulmonary function, rather than relying on one measure alone, to assess asthma control in clinical care and outcomes studies.

Contraindications to immunotherapy: A Global approach
Pitsios C, Tsoumani M, Bilò MB, Sturm GJ, Rodríguez Del Río P et al.
Clinical and Translational Allergy 2019;9:45. doi: 10.1186/s13601-019-0285-4.

Presently allergy immunotherapy (AIT) contraindications are mainly based on case reports, case-series, or expert opinion, as evidence-based information is limited. The aim of this review was to describe existing guidelines on contraindications to AIT and to highlight differences between them. Although a large heterogeneity among the various recommendations on contraindications was noted, common contraindications were seen, including: lack of adherence, pregnancy before the start of AIT, the use of beta-blockers, certain age groups, uncontrolled asthma, autoimmune diseases and malignancies. As noted by the authors, the decision to prescribe AIT is always balancing potential risk vs benefit.

Distribution of nickel and chromium containing particles from tattoo needle wear in humans and its possible impact on allergic reactions
Schreiver I, Hesse B, Seim C, Castillo-Michel H, Anklamm L et al.
Particle and Fibre Toxicology 2019;16(1):33. doi: 10.1186/s12989-019-0317-1.

Allergic reactions to tattoos are among the most common side effects of this procedure. Although tattoo needles contain high amounts of sensitizing elements like nickel (Ni) and chromium (Cr), their influence on metal deposition in skin has never been investigated. In this paper the authors report the deposition of nano- and micrometer sized tattoo needle wear particles in human skin that translocate. While prior work reported nickel, contamination of iron pigments was suspected to be responsible for nickel-driven tattoo allergies. The evidence from this study clearly points to an additional entry of nickel to both skin and lymph nodes originating from tattoo needle wear. Certainly, this should be of concern, and it reinforces the need for more research.

Prevalence and clinical associations of wheezes and crackles in the general population: the Tromsø study
Aviles-Solis JC, Jácome C, Davidsen A, Einarsen R, Vanbelle S et al.
BMC Pulmonary Medicine 2019;19(1):173. doi: 10.1186/s12890-019-0928-1.

Wheezes and crackles are well-known signs of lung diseases, but they can also be heard in healthy adults; however, the prevalence in a general population has been sparsely described. This study examined the prevalence of wheezes and crackles in a large general adult population and explored associations with self-reported disease, smoking status and lung function. In a group of over 4000 subjects, 28% of individuals had wheezes or crackles. The age-standardized prevalence of wheezing was 18.6% in women and 15.3% in men, and of crackles, 10.8 and 9.4%, respectively. Wheezing was most commonly found during expiration and crackles during inspiration. Significant predictors of expiratory wheezes in multivariable analyses were age (10 years increase - OR 1.18, 95%CI 1.09–1.30), female gender (1.45, 1.2–1.8), self-reported asthma (1.36, 1.00–1.83), and current smoking (1.70, 1.28–2.23). The most important predictors of inspiratory crackles were age (1.76, 1.57–1.99), current smoking, (1.94, 1.40–2.69), mMRC≥2 (1.79, 1.18–2.65),SpO2(0.88, 0.81–0.96), and FEV1Z-score (0.86, 0.77–0.95).