1
|
Ciprandi G, Licari A, Tosca MA, Miraglia Del Giudice M, Belloni Fortina A, Marseglia GL. An updated reappraisal of dupilumab in children and adolescents with moderate-severe atopic dermatitis. Pediatr Allergy Immunol 2024; 35:e14181. [PMID: 38934228 DOI: 10.1111/pai.14181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 06/06/2024] [Accepted: 06/10/2024] [Indexed: 06/28/2024]
Abstract
Atopic dermatitis (AD) is still a demanding challenge in clinical practice. Type 2 inflammation is the most common inflammatory pathway in children and adolescents with AD. Anti-inflammatory drugs, mainly corticosteroids (CS) and immunomodulant agents are the primary therapeutic approach to dampening type 2 inflammation. However, AD patients may require long-term high CS doses or drug combinations with possibly significant adverse effects to achieve and maintain disease control. In this regard, the advent of biologics constituted a breakthrough in managing this condition. Dupilumab is a monoclonal antibody directed against the IL-4 receptor α-subunit (IL-4Rα), antagonizing both IL-4 and IL-13 and is approved for pediatric severe AD. This review presents and discusses the most recent published studies on dupilumab in children and adolescents with AD. There is convincing evidence that dupilumab is safe and effective in managing AD. It can reduce skin lesions and associated itching, reduce the need for additional medications, and improve disease control and quality of life. However, a thorough diagnostic pathway is mandatory, especially considering the different AD phenotypes. The ideal eligible candidate is a child or adolescent with AD requiring systemic treatment because of severe clinical manifestations and impaired quality of life.
Collapse
Affiliation(s)
| | - Amelia Licari
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | | | - Michele Miraglia Del Giudice
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Anna Belloni Fortina
- Pediatric Dermatology Unit, Department of Women's and Child's Health (SDB), University of Padua, Padua, Italy
| | - Gian Luigi Marseglia
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| |
Collapse
|
2
|
Skrek S, Mahé E. Atopic dermatitis and psoriasis in children and SARS-CoV-2 infection. Differences in the impact of the infection on these two dermatoses, and of the dermatoses on the infection. Ann Dermatol Venereol 2024; 151:103242. [PMID: 38309056 DOI: 10.1016/j.annder.2023.103242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/05/2023] [Accepted: 09/27/2023] [Indexed: 02/05/2024]
Affiliation(s)
- S Skrek
- Department of Dermatology, Hôpital Victor Dupouy, 69 rue du Lieutenant-Colonel Prud'hon, 95100 Argenteuil, France
| | - E Mahé
- Department of Dermatology, Hôpital Victor Dupouy, 69 rue du Lieutenant-Colonel Prud'hon, 95100 Argenteuil, France.
| |
Collapse
|
3
|
Ne CKH, Suaini NHA, Aung WT, Ong KGS, Samuel M, Tham EH. Impact of COVID-19 pandemic on adults and children with atopic dermatitis and food allergy: Systematic review. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. GLOBAL 2024; 3:100181. [PMID: 38026506 PMCID: PMC10665685 DOI: 10.1016/j.jacig.2023.100181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 07/26/2023] [Accepted: 08/09/2023] [Indexed: 12/01/2023]
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic caused significant disruptions to health care services and health impacts on patients with atopic dermatitis (AD) and/or food allergy (FA). Objective We evaluated the impact of the COVID-19 pandemic and disease on AD/FA patients. Methods A comprehensive systematic literature search was conducted from December 2019 to 2022. Screening and data extraction were done following the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines, and the Mixed Methods Appraisal Tool, or MMAT, was used to assess risk of bias. Results In total, 159 studies were included. Five of 7 studies reported no significant changes in overall incidence or prevalence of AD during the pandemic, although some studies noted an increase in the elderly and infants. Telehealth served as an effective alternative to face-to-face consultations, with mixed levels of patient and provider satisfaction. Dissatisfaction was most marked in patients with more severe disease, who thought that their disease was inadequately managed through telemedicine. Higher levels of general anxiety were recorded in both AD/FA patients and caregivers, and it was more pronounced in patients with severe disease. Most studies reported no significant differences in postvaccination adverse effects in AD patients; however, results were more varied in FA patients. Conclusion Our review identified the impact of COVID-19 pandemic- and disease-driven changes on AD/FA patients. Telemedicine is uniquely suited to manage atopic diseases, and hybrid care may be a suitable approach even in the postpandemic era. COVID-19 vaccines and biologics can be safely administered to patients with atopic diseases, with appropriate patient education to ensure continued care for high-risk patients.
Collapse
Affiliation(s)
| | - Noor Hidayatul Aini Suaini
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A∗STAR), Singapore, Republic of Singapore
| | - Win Thu Aung
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore
| | | | - Miny Samuel
- Research Support Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore
| | - Elizabeth Huiwen Tham
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A∗STAR), Singapore, Republic of Singapore
- Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore
- Khoo Teck Puat-National University Children’s Medical Institute, National University Health System (NUHS), Singapore, Republic of Singapore
| |
Collapse
|
4
|
Ao G, Li T, Nasr B, Wang Y, Tran C, Chen M. The effect of dupilumab on clinical outcomes in patients with COVID-19: A meta-analysis. J Infect 2023; 87:e107-e109. [PMID: 38251473 DOI: 10.1016/j.jinf.2023.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 10/23/2023] [Indexed: 01/23/2024]
Affiliation(s)
- Guangyu Ao
- Department of Nephrology, Chengdu First People's Hospital, Chengdu, Sichuan, China
| | - Toni Li
- Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, Canada
| | - Basma Nasr
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian 116011, Liaoning, China
| | - Yushu Wang
- Chengdu West China Clinical Research Center, Chengdu, Sichuan, China
| | - Carolyn Tran
- Schulich School of Medicine & Dentistry, Western University, London, Canada
| | - Min Chen
- Department of Nephrology, Chengdu First People's Hospital, Chengdu, Sichuan, China.
| |
Collapse
|
5
|
Kocatürk E, Abrams EM, Maurer M, Mitri J, Oppenheimer J, Vestergaard C, Zein J. COVID-19 and Its Impact on Common Diseases in the Allergy Clinics. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:3289-3303. [PMID: 37660731 DOI: 10.1016/j.jaip.2023.08.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 08/18/2023] [Accepted: 08/25/2023] [Indexed: 09/05/2023]
Abstract
Coronavirus disease 2019 (COVID-19) is a highly contagious viral disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It has various effects on asthma, allergic rhinitis, atopic dermatitis, and urticaria and may change the course of the disease depending on the severity of the infection and control status of the disease. Conversely, these diseases may also impact the course of COVID-19. Patients with chronic urticaria and atopic dermatitis may have COVID-19-induced disease exacerbations and biological treatments reduce the risk of exacerbations. Poor asthma control is linked to severe COVID-19 while allergic asthma is associated with lower risk of death and a lower rate of hospitalization due to COVID-19 compared with nonallergic asthma. The use of intranasal corticosteroids is associated with lower rates of hospitalization due to COVID-19 in patients with allergic rhinitis, whereas the effect of inhaled corticosteroids is confounded by asthma severity. These observations reinforce the importance of keeping allergic diseases under control during pandemics. The use of biologicals during COVID-19 is generally regarded as safe, but more evidence is needed. The pandemic substantially changed the management of allergic disorders such as home implementation of various biologicals, allergen immunotherapy, food introduction, and increased use of telemedicine and even home management of anaphylaxis to reduce emergency department burden and reduce risk of infection. Physicians need to be aware of the potential impact of COVID-19 on allergic diseases and educate their patients on the importance of continuing prescribed medications and adhering to their treatment plans to maintain optimal control of their disease.
Collapse
Affiliation(s)
- Emek Kocatürk
- Department of Dermatology, Koç University School of Medicine, Istanbul, Turkey; Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany.
| | - Elissa M Abrams
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, MB, Canada; Department of Pediatrics, Division of Allergy and Immunology, University of British Columbia, Vancouver, BC, Canada
| | - Marcus Maurer
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany.
| | - Jad Mitri
- Department of Medicine, Saint Elizabeth Medical Center, Boston, Mass
| | - John Oppenheimer
- UMDNJ-Rutgers Department of Medicine, Division of Allergy and Immunology, Newark, NJ
| | | | - Joe Zein
- The Respiratory Institute, The Cleveland Clinic, Cleveland, Ohio
| |
Collapse
|
6
|
Sasson J, Moreau GB, Petri WA. The role of interleukin 13 and the type 2 immune pathway in COVID-19: A review. Ann Allergy Asthma Immunol 2023; 130:727-732. [PMID: 36924937 PMCID: PMC10014128 DOI: 10.1016/j.anai.2023.03.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 02/23/2023] [Accepted: 03/06/2023] [Indexed: 03/16/2023]
Abstract
Although much has been learned about severe acute respiratory syndrome coronavirus 2 since December 2019, uneven global vaccine distribution, rapid viral spread, and variant evasion of preventative measures have led to its persistence in the population for the foreseeable future. Additional therapies are needed to support patients through their acute, immune-mediated disease process that continues to lead to considerable morbidity and mortality. Data revealing the involvement of type 2 immune pathway in acute coronavirus disease 2019 and post-recovery conditions represent a potential additional area for intervention. Herein, we review the current understanding of interleukin 13 in acute severe acute respiratory syndrome coronavirus 2 infection, the clinical outcomes associated with type 2 immune processes, and the impact of type 2 blockade on acute and long-term coronavirus disease 2019 conditions.
Collapse
Affiliation(s)
- Jennifer Sasson
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
| | - G Brett Moreau
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
| | - William A Petri
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia; Department of Microbiology, Immunology and Cancer Biology, University of Virginia School of Medicine, Charlottesville, Virginia; Department of Pathology, University of Virginia Health System, Charlottesville, Virginia.
| |
Collapse
|