The journal of allergy and clinical immunology. In practice
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J Allergy Clin Immunol Pract · Nov 2019
Meta AnalysisCross-Reactivity to Cephalosporins and Carbapenems in Penicillin-Allergic Patients: Two Systematic Reviews and Meta-Analyses.
There is no recent systematic review on the risk of cross-reactivity to cephalosporins and carbapenems in penicillin-allergic patients despite many new studies on the subject. All past reviews have several limitations such as not including any patient with a T-cell-mediated penicillin allergy. ⋯ Although it remains possible that these meta-analyses overestimated the risk of cross-reactivity, clinicians should consider the increased risk of cross-reactivity associated with aminocephalosporins, and to a lesser extent with intermediate-similarity-score cephalosporins, compared with the very low risk associated with low-similarity-score cephalosporins and all carbapenems when using beta-lactams in patients with a suspected or proven penicillin allergy.
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J Allergy Clin Immunol Pract · Nov 2019
Associations Between Inflammatory Endotypes and Clinical Presentations in Chronic Rhinosinusitis.
Chronic rhinosinusitis (CRS) is a heterogeneous disease characterized by mucosal inflammation in the nose and paranasal sinuses. Inflammation in CRS is also heterogeneous and is mainly characterized by type 2 (T2) inflammation, but subsets of patients show type 1 (T1) and type 3 (T3) inflammation. Whether inflammatory endotypes are associated with clinical phenotypes has yet to be explored in detail. ⋯ Clinical presentations are directly associated with inflammatory endotypes in CRS. Identification of inflammatory endotypes may allow for more precise and personalized medical treatments in CRS.
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The telemedicine industry and adoption of services have grown exponentially in the last 5 years, and the market is expected to reach more than $130 billion by 2025. Most US health institutions and hospital systems are currently using some form of telehealth, and more than 90% of health care executives surveyed across the United States have virtual care on their roadmap for growth. Telemedicine has been proposed as a way to expand the reach of allergy services and allow more patients to manage their disease with an allergy specialist. ⋯ Remote monitoring, specialist second opinions, and synchronous and asynchronous encounters offer opportunities to streamline routine care, especially as smart hardware such as digital inhalers hit the market and reimbursement for telehealth services evolve. To date, allergy care has been a significant area of interest for direct-to-consumer telemedicine solutions, although the care has mainly been offered by nonallergists. Quality assurance and adherence to evidence-based standards, particularly in the self-pay direct-to-consumer space, warrant attention.
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J Allergy Clin Immunol Pract · Nov 2019
Inhaler Technique in Low-Income, Inner-City Adults with Uncontrolled Asthma.
Poor inhaler technique has been shown to be associated with less asthma control and increased health care utilization. Little is known about the impact of inhaler technique on the most vulnerable patients. ⋯ In this group of patients with uncontrolled asthma, visually assessed inhaler technique was adequate in more than one-half. Although incorrect inhaler technique is generally common and must be routinely addressed, this study suggests that other factors that lead to poor control must be identified.
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J Allergy Clin Immunol Pract · Nov 2019
Proportion of Severe Asthma Patients Eligible for Mepolizumab Therapy by Age and Age of Onset of Asthma.
Mepolizumab is an anti-IL-5 antibody approved for the treatment of severe eosinophilic asthma. However, the prevalence of patients with severe asthma eligible for mepolizumab remains unknown, especially among children. ⋯ A smaller percentage of children with severe asthma were eligible for mepolizumab compared with their adult peers. Severe AoA has distinct phenotypic features that favor treatment with mepolizumab, including greater eosinophilia and nasal polyposis, in contrast to CoA, which appears to have fewer features of type 2 mucosal inflammation.