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Bellanti JA, Settipane RA. Allergic diseases in children: A continuing challenge for the Allergist-Immunologist. Allergy Asthma Proc 2024; 45:81-83. [PMID: 38449017 PMCID: PMC10926181 DOI: 10.2500/aap.2024.45.240003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
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Hansel NN, Abbott CB, Averell CM, Germain G, Laliberté F, Mahendran M, Duh MS, Settipane RA. Real-world users of triple therapy for asthma in the US. Am J Manag Care 2024; 30:74-81. [PMID: 38381542 DOI: 10.37765/ajmc.2024.89494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
OBJECTIVES For patients with asthma who remain symptomatic on a medium-dose inhaled corticosteroid/long-acting β2 agonist, addition of a long-acting muscarinic antagonist as a supplementary controller is a recommended option. However, real-world data on the characteristics and treatment patterns of these patients are limited. This study described the demographics and clinical characteristics of new users of single- or multiple-inhaler triple therapy and treatment patterns preceding triple-therapy initiation. STUDY DESIGN This retrospective cohort study used medical and pharmacy claims data from the IQVIA PharMetrics Plus database. METHODS The study population comprised adults with asthma with or without chronic obstructive pulmonary disease (COPD) initiating triple therapy with single-inhaler fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI; 100/62.5/25 μg) or multiple-inhaler triple therapy (MITT) between September 18, 2017, and September 30, 2019. Demographics, clinical characteristics, and treatment patterns in the 12 months preceding triple-therapy initiation were described (baseline period). RESULTS A total of 12,395 patients were included. Among FF/UMEC/VI initiators with asthma (n = 1301), the mean age was 49.0 years and 59.3% were women. During the baseline period, 81.5% of patients used controller therapy, 94.7% used rescue medications, and 42.0% reported at least 1 asthma-related exacerbation; the annual mean exacerbation rate was 0.96. Similar trends were observed among patients with asthma initiating MITT and patients with comorbid asthma-COPD initiating FF/UMEC/VI or MITT. CONCLUSION In real-world practice, triple therapy is often utilized following other asthma controller medication use. High disease burden, as evidenced by substantial use of rescue medications and continued asthma-related exacerbations, suggests that patients may not have achieved adequate asthma control prior to triple-therapy initiation.
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Bellanti JA, Settipane RA. Unraveling allergic, pseudoallergic, and idiosyncratic complexities of hypersensitivity reactions to NSAIDs. Allergy Asthma Proc 2024; 45:1-4. [PMID: 38151741 PMCID: PMC10762648 DOI: 10.2500/aap.2024.45.230086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
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Hanania NA, Settipane RA, Khoury S, Shaikh A, Dotiwala Z, Casciano J, Foggs MB. Adding tiotropium or long-acting β2-agonists to inhaled corticosteroids: Asthma-related exacerbation risk and healthcare resource utilization. Allergy Asthma Proc 2023; 44:413-421. [PMID: 37919843 DOI: 10.2500/aap.2023.44.230060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
Background: Based on current clinical guidelines, long-acting β2-agonists (LABA) are frequently prescribed before long-acting muscarinic antagonists (LAMA) as an add-on to inhaled corticosteroids (ICS) in uncontrolled asthma. However, there is insufficient real-world evidence that supports this therapeutic approach. Objective: The objective was to compare asthma exacerbations and healthcare resource utilization in patients with asthma using the LAMA tiotropium bromide (Tio) or a LABA as an add-on to ICS (ICS + Tio or ICS/LABA) in a real-world setting. Methods: This retrospective, observational study included patients aged ≥12 years with asthma diagnoses identified in a U.S. longitudinal claims database (October 2015 to August 2020). The ICS + Tio and ICS/LABA cohorts were 1:2 propensity score matched for baseline variables. Outcomes were compared in the postmatched cohorts, and the risk of exacerbation was evaluated by using Kaplan-Meier curves. Results: After propensity score matching, there were 633 and 1266 patients in the ICS + Tio and ICS/LABA cohorts, respectively. The proportion of patients who experienced a severe or a moderate-or-severe exacerbation during follow-up was similar between the ICS + Tio versus ICS/LABA cohorts (4% versus 3%, p = 0.472, and 50% versus 45%, p = 0.050, respectively). The mean time to first severe (ICS + Tio 43.8 days versus ICS/LABA 49.4 days, p = 0.758) and moderate-or-severe exacerbation (ICS + Tio 65.8 days versus ICS/LABA 58.9 days, p = 0.474) was not statistically different between cohorts. The treatments had no effect on the risk of severe exacerbation, although it was 36% lower in ICS + Tio users than in ICS/LABA users (hazard ratio 0.64 [95% confidence interval, 0.22-1.84]). All-cause and asthma-related average monthly healthcare resource utilization were comparable between the treatments for hospitalizations and emergency department visits but were significantly greater in the ICS + Tio cohort than in the ICS/LABA cohort for asthma-related outpatient visits (p < 0.0001). Conclusion: This study provides real-world evidence that ICS + Tio may be a valid alternative when ICS/LABA cannot be used as first-line treatment for asthma maintenance therapy.
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Affiliation(s)
- Nicola A Hanania
- From the Section of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, Texas
| | - Russell A Settipane
- Allergy and Asthma Center and Alpert Medical School of Brown University, East Providence, Rhode Island
| | - Samir Khoury
- Clinical Development and Medical Affairs, Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, Connecticut
| | - Asif Shaikh
- Clinical Development and Medical Affairs, Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, Connecticut
| | | | | | - Michael B Foggs
- Division of Allergy and Immunology, Advocate Health Care, Chicago, Illinois
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Bellanti JA, Settipane RA. Navigating the uncharted waters of chronic urticaria: A perplexing challenge for the allergist-immunologist. Allergy Asthma Proc 2023; 44:379-381. [PMID: 37919849 PMCID: PMC10629373 DOI: 10.2500/aap.2023.44.230067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
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Bellanti JA, Settipane RA. The challenge of neurologic disease for the allergist/immunologist. Allergy Asthma Proc 2023; 44:293-295. [PMID: 37641220 PMCID: PMC10476496 DOI: 10.2500/aap.2023.44.230053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
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Bellanti JA, Settipane RA. A trajectory of the FDA approval of the first vaccine targeting RSV: A greek tragedy with a happy ending. Allergy Asthma Proc 2023; 44:217-219. [PMID: 37480204 PMCID: PMC10362968 DOI: 10.2500/aap.2023.44.230037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2023]
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Nguyen AT, Settipane RA. Erratum to "A potpourri of summer allergic environmental disorders" [Ann Allergy Asthma Immunol 130 (2023) 415-418]. Ann Allergy Asthma Immunol 2023; 130:823. [PMID: 37270228 DOI: 10.1016/j.anai.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Ashley T Nguyen
- Brown University Warren Alpert Medical School, Providence, Rhode Island
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Bellanti JA, Settipane RA. A tribute to allergy and immunology fellowship training program directors and to the fellows they train. Allergy Asthma Proc 2023; 44:155-157. [PMID: 37160753 PMCID: PMC10165681 DOI: 10.2500/aap.2023.44.230017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
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Bellanti JA, Settipane RA. The complexities of allergic diseases continue to challenge the allergist-immunologist. Allergy Asthma Proc 2023; 44:87-89. [PMID: 36872449 PMCID: PMC9999436 DOI: 10.2500/aap.2023.44.230002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
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Gall R, Jain N, Soong W, Settipane RA, Xia C, Zhang Y, Haselkorn T, Jacob-Nara JA, Siddiqui S. Dupilumab-Treated Patients with Asthma in the Real World: The RAPID Global Registry. Adv Ther 2023; 40:1292-1298. [PMID: 36626107 PMCID: PMC9988992 DOI: 10.1007/s12325-022-02399-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 12/01/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Dupilumab, a fully human monoclonal antibody, blocks the shared receptor component for interleukin-4 and interleukin-13, key and central drivers of type 2 inflammation. In clinical studies, dupilumab reduced the risk of severe asthma exacerbations, and improved forced expiratory volume in 1 s and quality of life in patients with uncontrolled moderate-to-severe asthma. OBJECTIVES The objectives of RAPID (NCT04287621) are to characterize patients with asthma initiating dupilumab in routine clinical practice and to collect information on long-term effectiveness and safety in these patients. METHODS RAPID is a global, prospective, observational registry that will enroll approximately 1000 patients (aged ≥ 12 years) with asthma from 150 sites globally. Dupilumab treatment will be initiated in routine clinical practice according to country-specific prescribing information, per physician discretion as part of routine care. Patients will be followed prospectively for up to 3 years, with postbaseline assessments at months 1 and 3, and every 3 months thereafter. PLANNED OUTCOMES Baseline data collected will include patient demographics, disease characteristics, and medication history. Patient adherence and persistence will be recorded alongside health-care resource utilization, and effectiveness of dupilumab will be assessed (clinician assessment) as per standard of care. Quality of life, asthma control, type 2 inflammatory comorbidities, work productivity, and physical activity limitation will be assessed. Incidence and severity of adverse events will be recorded. CONCLUSION RAPID is the first global registry to characterize patients beginning dupilumab treatment for asthma in clinical practice and will expand on prior clinical studies by providing real-world data. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov identifier NCT04287621.
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Affiliation(s)
- Rebecca Gall
- , 1 Rockwood Rd, Sleepy Hollow, New York, NY, 10591, USA.
| | - Neal Jain
- Arizona Allergy and Immunology Research, Gilbert, AZ, USA
| | - Weily Soong
- AllerVie Health-Alabama Allergy and Asthma Center, Birmingham, AL, USA
| | | | | | - Yi Zhang
- Regeneron Pharmaceuticals Inc, Tarrytown, NY, USA
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Nguyen AT, Settipane RA. A Potpourri of Summer Allergic Environmental Disorders. Ann Allergy Asthma Immunol 2023; 130:415-418. [PMID: 36787859 DOI: 10.1016/j.anai.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 02/06/2023] [Accepted: 02/07/2023] [Indexed: 02/16/2023]
Affiliation(s)
- Ashely T Nguyen
- Department of Medicine Brown University Warren Alpert Medical School - Providence, Rhode Island
| | - Russell A Settipane
- Department of Medicine Brown University Warren Alpert Medical School - Providence, Rhode Island.
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Gevaert P, Lee SE, Settipane RA, Wagenmann M, Msihid J, Siddiqui S, Nash S, Jacob‐Nara JA, Khan AH, Kamat S, Chuang C. Dupilumab provides early and durable improvement of symptoms in patients with chronic rhinosinusitis with nasal polyps. Clin Transl Immunology 2023; 12:e1433. [PMID: 36721661 PMCID: PMC9881398 DOI: 10.1002/cti2.1433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 11/17/2022] [Accepted: 11/24/2022] [Indexed: 01/28/2023] Open
Abstract
Objectives To evaluate within-patient symptom improvement in the dupilumab SINUS-24/-52 studies in patients with severe chronic rhinosinusitis with nasal polyps (CRSwNP) (NCT02912468/NCT02898454). Methods Patients received dupilumab 300 mg or placebo every 2 weeks for 24 (SINUS-24) or 52 weeks (SINUS-52) on background intranasal corticosteroids. Patients daily reported symptoms of nasal congestion (NC), loss of smell (LoS) and rhinorrhoea on a scale of 0-3 (0 - no symptoms, 1 - mild, 2 - moderate, 3 - severe symptoms). The proportions of patients with moderate-to-severe symptoms (score ≥ 2) at baseline who improved to no-to-mild symptoms (score ≤ 1) were determined at Weeks 2, 24 (pooled studies) and 52 (SINUS-52). Subgroups with prior sinonasal surgery and coexisting asthma were analysed. Results At baseline in the pooled intention-to-treat population (n = 724), the proportions of patients with scores ≥ 2 for NC, LoS and rhinorrhoea were 87, 94 and 64%, respectively. Significantly, more patients achieved scores ≤ 1 (no/mild symptoms) with dupilumab vs placebo for each symptom at each time point {Week 2 NC 12% vs 2% [odds ratio 8.9 (95% CI 3.0-26.3)], LoS 5% vs 1% [4.6 (1.3-16.8)], rhinorrhoea 9% vs 2% [4.8 (1.5-15.4)], all P < 0.05; Week 24 NC 54% vs 14% [8.7 (5.6-13.5)], LoS 43% vs 6% [14.4 (7.9-26.0)], rhinorrhoea 53% vs 16% [6.6 (4.1-10.9)], all P < 0.0001}. Results were similar in subgroups with prior surgery and coexisting asthma. Conclusion Significantly, more patients achieved improvement from moderate-to-severe symptoms to no-to-mild symptoms with dupilumab than placebo, regardless of prior surgery or coexisting asthma. Improvement was observed as early as Week 2 and continued through to Week 52.
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Affiliation(s)
| | - Stella E Lee
- Division of Otolaryngology—Head & Neck SurgeryBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Russell A Settipane
- Department of MedicineThe Warren Alpert Medical School of Brown UniversityProvidenceRhode IslandUSA
| | - Martin Wagenmann
- Department of OtorhinolaryngologyDüsseldorf University Hospital (UKD)DüsseldorfGermany
| | - Jérôme Msihid
- Health Economics and Value Assessment, SanofiChilly‐MazarinFrance
| | - Shahid Siddiqui
- Medical Affairs, Regeneron Pharmaceuticals Inc.TarrytownNew YorkUSA
| | - Scott Nash
- Medical Affairs, Regeneron Pharmaceuticals Inc.TarrytownNew YorkUSA
| | | | - Asif H Khan
- Global Medical Affairs, SanofiChilly‐MazarinFrance
| | - Siddhesh Kamat
- Medical Affairs, Regeneron Pharmaceuticals Inc.TarrytownNew YorkUSA
| | - Chien‐Chia Chuang
- Health Economics and Value Assessment, SanofiCambridgeMassachusettsUSA
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Bellanti JA, Settipane RA. Allergy and immunology: At the crossroad of inflammation and disease. Allergy Asthma Proc 2023; 44:1-2. [PMID: 36719695 PMCID: PMC9809180 DOI: 10.2500/aap.2023.44.220094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Bellanti JA, Settipane RA. A confluence of advanced treatment options for atopic dermatitis, eosinophilic lung diseases and chronic urticaria brought about by the revolutionary discovery of biologics and Janus kinase inhibitors. Allergy Asthma Proc 2022; 43:471-473. [PMID: 36335419 PMCID: PMC9645732 DOI: 10.2500/aap.2022.43.220081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Bellanti JA, Settipane RA. Asthma biomarkers and COVID-19 continue to dominate current medical issues. Allergy Asthma Proc 2022; 43:363-367. [PMID: 36065102 PMCID: PMC9465642 DOI: 10.2500/aap.2022.43.220062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Abstract
Clinical decision-making in allergic rhinoconjunctivitis management involves a significant degree of complexity given the number of pharmaceutical agents; the option for allergen immunotherapy (AIT); and the risk for disease advancement, including the development of asthma as well as new environmental allergic sensitivities. Given the complex array of treatment options that are currently available, there is an opportunity to use a shared decision-making (SDM) approach with associated aids and tools that facilitate the interactive participation of practitioners and patients in the SDM process. This article reviews the general constructs of SDM, the unmet need for SDM aids, the collection of patient preference data for allergic rhinoconjunctivitis, the utility of SDM aids which have been specifically created for AIT, and outlines actionable steps to implement AIT SDM in clinical practice.
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Abstract
It has been more than a decade since the most recent allergen immunotherapy (AIT) practice parameter was published and 5 years since a focused practice parameter on sublingual immunotherapy (SLIT) was issued. There is an unmet need, therefore, for a more up-to-date, concise summary of AIT to be published to provide allergy/immunology practitioners, allergy/immunology fellows-in-training, medical students, residents, and other health-care practitioners with the most current information available on AIT. The Allergen Immunotherapy Primer (AITP) is not intended to define a standard of care or to be inclusive of all proper methods of care, nor is it intended to replace or supplant established AIT practice parameters; rather, the goal of this AITP is to supplement the established practice parameters and to serve primarily as an updated tool for the practicing allergist/immunologist, allergy/immunology trainees, and health-care professionals seeking practical and concise information with regard to AIT. Primer topics include the history of AIT; descriptions of the mechanisms and biomarkers of subcutaneous immunotherapy (SCIT) and SLIT; the efficacy and safety of SCIT; the efficacy and safety of SLIT, pediatric SLIT, and SCIT; the long-term efficacy of SLIT and SCIT; long-term adherence strategies for AIT; the implications of real-world data for AIT; the role of AIT for asthma; patterns of cross-allergenicity among pollens; a practical implementation guide for optimized construction of AIT vaccines; standardization of allergen extracts; updated information on federal regulations about the United States Pharmacopeia and the compounding of allergenic extracts; an update on AIT venom immunotherapy; the advantages and disadvantages of accelerated immunotherapy regimens; the important role of shared decision-making in AIT and how it can be incorporated into the informed consent process; and a forecast of future directions in allergen immunotherapy.
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Affiliation(s)
- Joseph A. Bellanti
- From the Department of Pediatrics and Microbiology-Immunology; ,The International Center for Interdisciplinary Studies of Immunology, Georgetown University Medical Center, Washington, D.C
| | - Russell A. Settipane
- Department of Medicine at the Alpert Medical School, Brown University, Providence, Rhode Island; ,Asthma, Nasal Disease and Allergy Research Center of New England, East Providence, Rhode Island
| | - Lawrence DuBuske
- George Washington University Hospital, Washington, D.C.; and ,Immunology Research Institute of New England, Gardner, Massachusetts
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Bellanti JA, Settipane RA. Eosinophilic esophagitis: from discovery to effective treatment. Allergy Asthma Proc 2022; 43:175-177. [PMID: 35524360 DOI: 10.2500/aap.2022.43.220025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Bellanti JA, Settipane RA. Long-COVID and loss of smell: A post-COVID olfactory dysfunction that continues to challenge the allergist/immunologist. Allergy Asthma Proc 2022; 43:93-95. [PMID: 35317885 DOI: 10.2500/aap.2022.43.220008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Bellanti JA, Settipane RA. Evaluation and management of adverse reactions to the COVID-2019 vaccines. Allergy Asthma Proc 2022; 43:1-4. [PMID: 34983703 DOI: 10.2500/aap.2022.43.210118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Bellanti JA, Settipane RA. SARS-CoV-2 infection and the human immune system: A continuing journey of discovery. Allergy Asthma Proc 2021; 42:447-449. [PMID: 34871151 DOI: 10.2500/aap.2021.42.210092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Bellanti JA, Settipane RA. Vaccine preventable diseases, vaccine hesitancy, and COVID-19: A role for the allergist/immunologist. Allergy Asthma Proc 2021; 42:365-367. [PMID: 34474705 DOI: 10.2500/aap.2021.42.210070] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Bellanti JA, Settipane RA. The allergist and IgE: The realization that allergic diseases are not all IgE mediated. Allergy Asthma Proc 2021; 42:183-186. [PMID: 33980330 DOI: 10.2500/aap.2021.42.210037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Bellanti JA, Settipane RA. Hereditary angioedema again revisited. Allergy Asthma Proc 2021; 42:105-107. [PMID: 33685554 DOI: 10.2500/aap.2021.42.210009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Castaldo AJ, Riedl MA, Settipane RA, Bellanti JA. A roadmap for optimal care of the patient with hereditary angioedema. Allergy Asthma Proc 2020; 41:S01-S02. [PMID: 33109316 DOI: 10.2500/aap.2020.41.200087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
Clinical decision-making in hereditary angioedema (HAE) management involves a high degree of complexity given the number of therapeutic agents that are available and the risk for significant morbidity and potential mortality attributable to the disease. Given this complexity, there is an opportunity to develop shared decision-making (SDM) aids and/or tools that would facilitate the interactive participation of practitioners and patients in the SDM process. This article reviews the general constructs of SDM, the unmet need for SDM in HAE, and the steps necessary to create a SDM tool specific for HAE, and outlines the challenges that must be navigated to guide the establishment and widespread implementation of SDM in the management of HAE.
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Affiliation(s)
- Russell A. Settipane
- From the Warren Alpert Medical School, Alpert Medical School, Brown University, Providence, Rhode Island
| | - Don A. Bukstein
- Allergy, Asthma, and Sinus Center, Greenfield, Wisconsin; The Problem Based Learning Institute, Chesterfield, Missouri; and
| | - Marc A. Riedl
- Division of Rheumatology, Allergy, and Immunology, University of California-San Diego, California
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Abstract
<title/> Hereditary angioedema (HAE) is a rare autosomal dominant genetic disorder characterized by swelling of subcutaneous, mucosal, and submucosal tissue without associated pruritus or wheals caused by a temporary localized increase in vascular permeability. Swelling attacks primarily affect the cutaneous tissue, abdominal viscera, genitals, or airways. <title/> Reports of the prevalence of HAE C1 inhibitor (C1-INH) deficiency varies widely, from 1:50,000 to 1:100,000. The prevalence of HAE normal C1-INH is unknown but is likely much lower than HAE C1-INH. Approximately one-third of patients with recurrent angioedema without wheals have HAE. <title/> The burden of disease for patients with HAE is substantial. Attacks are unpredictable with respect to frequency, severity, and the site that swells. Laryngeal attacks can be fatal if not treated promptly and appropriately. Feelings of stress, anxiety, and depression can trigger attacks, and begin a cycle of attacks that cause anxiety that, in turn, triggers further attacks. Despite full physical recovery between attacks, patients often experience continual emotional impairment and reduced quality of life (QoL). Absenteeism from work and presenteeism at work or educational activities for patients and caregivers increase stress and reduce productivity during and between attacks. Missed opportunities for career development are common. <title/> Significant advances have been made in the past decade to expand both acute and prophylactic treatment options for patients with HAE, lowering both the disease and treatment burden, and improving the QoL of patients with HAE.
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Affiliation(s)
- William R. Lumry
- From the University of Texas Southwestern Medical School, Dallas, Texas
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Bellanti JA, Settipane RA. Allergen immunotherapy: From bench research to clinical application. Allergy Asthma Proc 2020; 41:311-313. [PMID: 32867885 DOI: 10.2500/aap.2020.41.200070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Bellanti JA, Settipane RA. The continuing "1000 faces of asthma". Allergy Asthma Proc 2020; 41:147-150. [PMID: 32375957 PMCID: PMC7201296 DOI: 10.2500/aap.2020.41.200020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Bellanti JA, Settipane RA. Stress, cytokines, depression, bone fractures, and asthma. Allergy Asthma Proc 2020; 41:73-75. [PMID: 32122442 DOI: 10.2500/aap.2020.41.200007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Bellanti JA, Settipane RA. Allergy immunotherapy: A continually evolving set of therapeutic procedures. Allergy Asthma Proc 2020; 41:1-4. [PMID: 31888776 DOI: 10.2500/aap.2020.41.190028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Settipane RA, Kreindler JL, Chung Y, Tkacz J. Evaluating direct costs and productivity losses of patients with asthma receiving GINA 4/5 therapy in the United States. Ann Allergy Asthma Immunol 2019; 123:564-572.e3. [PMID: 31494235 DOI: 10.1016/j.anai.2019.08.462] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 08/27/2019] [Accepted: 08/29/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Despite the low prevalence for all patients with asthma, those with severe disease account for a disproportionately large economic burden. OBJECTIVE To evaluate current direct health care and productivity loss costs associated with patients with asthma receiving Global Initiative for Asthma Step 4/5 therapy ("G4/5 asthma") in the United States. METHODS Asthma patients aged 12 years or older were identified in the IBM MarketScan Research Databases between January 1, 2012 and December 31, 2015. Patients were indexed on their earliest medical claim for asthma and were required to have at last 2 years of continuous eligibility. The G4/5 asthma classification required 1 or more medium- or high-dosage inhaled corticosteroids (ICS)/long-acting beta-agonist (LABA) claims, 1 or more omalizumab claims, or systemic corticosteroids covering at least 50% of the 12-month baseline period. The European Respiratory Society/American Thoracic Society criteria for severe uncontrolled asthma were modified for claims data and used to identify patients with exacerbations or high rescue medication use ("Ex/R″). Direct health care costs and productivity loss costs attributable to workplace absence or short-term or long-term disability were measured during the 12-month post-index period. RESULTS A total of 605,614 patients with asthma were identified. Annual health care costs were $4,384 greater for G4/5 asthma vs non-G4/5 patients with asthma; asthma-related costs contributed $2,183 of this difference (P < .001). Differences were primarily driven by G4/5 patients with asthma with Ex/R, whose costs were $5,019 greater than G4/5 patients without Ex/R (P < .001). For patients with 1 or more absences or short-term disability claims, G4/5 patients missed 7.2 more work hours for absence and had 3.9 more days of work lost for short-term disability than non-G4/5 patients with asthma, respectively (P < .05). CONCLUSION G4/5 patients with asthma incurred significantly greater direct and indirect costs than non-G4/5 patients with asthma. Differences were largely driven by those with Ex/R.
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Bellanti JA, Settipane RA. Peanuta non grata revisited. Allergy Asthma Proc 2019; 40:287-289. [PMID: 31514786 DOI: 10.2500/aap.2019.40.4245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Wise SK, Lin SY, Toskala E, Orlandi RR, Akdis CA, Alt JA, Azar A, Baroody FM, Bachert C, Canonica GW, Chacko T, Cingi C, Ciprandi G, Corey J, Cox LS, Creticos PS, Custovic A, Damask C, DeConde A, DelGaudio JM, Ebert CS, Eloy JA, Flanagan CE, Fokkens WJ, Franzese C, Gosepath J, Halderman A, Hamilton RG, Hoffman HJ, Hohlfeld JM, Houser SM, Hwang PH, Incorvaia C, Jarvis D, Khalid AN, Kilpeläinen M, Kingdom TT, Krouse H, Larenas‐Linnemann D, Laury AM, Lee SE, Levy JM, Luong AU, Marple BF, McCoul ED, McMains KC, Melén E, Mims JW, Moscato G, Mullol J, Nelson HS, Patadia M, Pawankar R, Pfaar O, Platt MP, Reisacher W, Rondón C, Rudmik L, Ryan M, Sastre J, Schlosser RJ, Settipane RA, Sharma HP, Sheikh A, Smith TL, Tantilipikorn P, Tversky JR, Veling MC, Wang DY, Westman M, Wickman M, Zacharek M. 国际过敏与鼻科学共识声明 : 变应性鼻炎. Int Forum Allergy Rhinol 2019. [DOI: 10.1002/alr.22073_c] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
| | | | | | | | - Cezmi A. Akdis
- Allergy/AsthmaSwiss Institute of Allergy and Asthma Research Switzerland
| | | | | | | | | | | | | | - Cemal Cingi
- OtolaryngologyEskisehir Osmangazi University Turkey
| | | | | | | | | | | | | | - Adam DeConde
- OtolaryngologyUniversity of California San Diego USA
| | | | | | | | | | | | | | - Jan Gosepath
- OtorhinolaryngologyHelios Kliniken Wiesbaden Germany
| | | | | | | | - Jens M. Hohlfeld
- Respiratory Medicine, Hannover Medical School, Airway Research Fraunhofer Institute for Toxicology and Experimental MedicineGerman Center for Lung Research Germany
| | | | | | | | | | | | | | | | | | | | | | | | | | - Amber U. Luong
- OtolaryngologyMcGovern Medical School at the University of Texas Health Science Center Houston USA
| | | | | | | | - Erik Melén
- Pediatric AllergyKarolinska Institutet Sweden
| | | | | | - Joaquim Mullol
- Otolaryngology, Universitat de BarcelonaHospital Clinic, IDIBAPS Spain
| | | | | | | | - Oliver Pfaar
- Rhinology/Allergy, Medical Faculty Mannheim, Heidelberg University Center for Rhinology and Allergology Wiesbaden Germany
| | | | | | | | | | - Matthew Ryan
- OtolaryngologyUniversity of Texas Southwestern USA
| | - Joaquin Sastre
- AllergologyHospital Universitario Fundacion Jiminez Diaz Spain
| | | | | | - Hemant P. Sharma
- Allergy/Immunology, Children's National Health SystemGeorge Washington University School of Medicine USA
| | | | | | | | | | | | - De Yun Wang
- OtolaryngologyNational University of Singapore Singapore
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Bellanti JA, Settipane RA. Innate lymphoid cells: A new family of lymphocytes with involvement from worms to allergic disease. Allergy Asthma Proc 2019; 40:135-137. [PMID: 31018887 DOI: 10.2500/aap.2019.40.4221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Bellanti JA, Settipane RA. Genetics, epigenetics, and allergic disease: A gun loaded by genetics and a trigger pulled by epigenetics. Allergy Asthma Proc 2019; 40:73-75. [PMID: 30819276 DOI: 10.2500/aap.2019.40.4206] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Bellanti JA, Settipane RA. Children are not small adults. Allergy Asthma Proc 2018; 39:261-263. [PMID: 30095390 DOI: 10.2500/aap.2018.39.4156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Bellanti JA, Settipane RA. The Floralia: A festive time for Romans and a demanding time for the allergist/immunologist. Allergy Asthma Proc 2018; 39:167-168. [PMID: 29669662 DOI: 10.2500/aap.2018.39.4141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Bellanti JA, Settipane RA. Allergic diseases: A collection of interactive immunologic disorders at the crossroads of genetics, environment, and immunity. Allergy Asthma Proc 2018; 39:83-85. [PMID: 29490765 DOI: 10.2500/aap.2018.39.4127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Wise SK, Lin SY, Toskala E, Orlandi RR, Akdis CA, Alt JA, Azar A, Baroody FM, Bachert C, Canonica GW, Chacko T, Cingi C, Ciprandi G, Corey J, Cox LS, Creticos PS, Custovic A, Damask C, DeConde A, DelGaudio JM, Ebert CS, Eloy JA, Flanagan CE, Fokkens WJ, Franzese C, Gosepath J, Halderman A, Hamilton RG, Hoffman HJ, Hohlfeld JM, Houser SM, Hwang PH, Incorvaia C, Jarvis D, Khalid AN, Kilpeläinen M, Kingdom TT, Krouse H, Larenas-Linnemann D, Laury AM, Lee SE, Levy JM, Luong AU, Marple BF, McCoul ED, McMains KC, Melén E, Mims JW, Moscato G, Mullol J, Nelson HS, Patadia M, Pawankar R, Pfaar O, Platt MP, Reisacher W, Rondón C, Rudmik L, Ryan M, Sastre J, Schlosser RJ, Settipane RA, Sharma HP, Sheikh A, Smith TL, Tantilipikorn P, Tversky JR, Veling MC, Wang DY, Westman M, Wickman M, Zacharek M. International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis. Int Forum Allergy Rhinol 2018; 8:108-352. [PMID: 29438602 PMCID: PMC7286723 DOI: 10.1002/alr.22073] [Citation(s) in RCA: 210] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 12/01/2017] [Accepted: 12/01/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Critical examination of the quality and validity of available allergic rhinitis (AR) literature is necessary to improve understanding and to appropriately translate this knowledge to clinical care of the AR patient. To evaluate the existing AR literature, international multidisciplinary experts with an interest in AR have produced the International Consensus statement on Allergy and Rhinology: Allergic Rhinitis (ICAR:AR). METHODS Using previously described methodology, specific topics were developed relating to AR. Each topic was assigned a literature review, evidence-based review (EBR), or evidence-based review with recommendations (EBRR) format as dictated by available evidence and purpose within the ICAR:AR document. Following iterative reviews of each topic, the ICAR:AR document was synthesized and reviewed by all authors for consensus. RESULTS The ICAR:AR document addresses over 100 individual topics related to AR, including diagnosis, pathophysiology, epidemiology, disease burden, risk factors for the development of AR, allergy testing modalities, treatment, and other conditions/comorbidities associated with AR. CONCLUSION This critical review of the AR literature has identified several strengths; providers can be confident that treatment decisions are supported by rigorous studies. However, there are also substantial gaps in the AR literature. These knowledge gaps should be viewed as opportunities for improvement, as often the things that we teach and the medicine that we practice are not based on the best quality evidence. This document aims to highlight the strengths and weaknesses of the AR literature to identify areas for future AR research and improved understanding.
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Affiliation(s)
| | | | | | | | - Cezmi A. Akdis
- Allergy/Asthma, Swiss Institute of Allergy and Asthma Research, Switzerland
| | | | - Antoine Azar
- Allergy/Immunology, Johns Hopkins University, USA
| | | | | | | | | | - Cemal Cingi
- Otolaryngology, Eskisehir Osmangazi University, Turkey
| | | | | | | | | | | | | | - Adam DeConde
- Otolaryngology, University of California San Diego, USA
| | | | | | | | | | | | | | - Jan Gosepath
- Otorhinolaryngology, Helios Kliniken Wiesbaden, Germany
| | | | | | | | - Jens M. Hohlfeld
- Respiratory Medicine, Hannover Medical School, Airway Research Fraunhofer Institute for Toxicology and Experimental Medicine, German Center for Lung Research, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | | - Amber U. Luong
- Otolaryngology, McGovern Medical School at the University of Texas Health Science Center Houston, USA
| | | | | | | | - Erik Melén
- Pediatric Allergy, Karolinska Institutet, Sweden
| | | | | | - Joaquim Mullol
- Otolaryngology, Universitat de Barcelona, Hospital Clinic, IDIBAPS, Spain
| | | | | | | | - Oliver Pfaar
- Rhinology/Allergy, Medical Faculty Mannheim, Heidelberg University, Center for Rhinology and Allergology, Wiesbaden, Germany
| | | | | | - Carmen Rondón
- Allergy, Regional University Hospital of Málaga, Spain
| | - Luke Rudmik
- Otolaryngology, University of Calgary, Canada
| | - Matthew Ryan
- Otolaryngology, University of Texas Southwestern, USA
| | - Joaquin Sastre
- Allergology, Hospital Universitario Fundacion Jiminez Diaz, Spain
| | | | | | - Hemant P. Sharma
- Allergy/Immunology, Children's National Health System, George Washington University School of Medicine, USA
| | | | | | | | | | | | - De Yun Wang
- Otolaryngology, National University of Singapore, Singapore
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