Publications by authors named "Mitchell H Grayson"

94 Publications

The Risk of Allergic Reaction to SARS-CoV-2 Vaccines and Recommended Evaluation and Management: A Systematic Review, Meta-analysis, GRADE Assessment, and International Consensus Approach.

J Allergy Clin Immunol Pract 2021 Jun 18. Epub 2021 Jun 18.

Department of Paediatrics, Royal College of Surgeons, Dublin, Ireland.

Concerns for anaphylaxis may hamper SARS-CoV-2 immunization efforts. We convened a multi-disciplinary group of international experts in anaphylaxis comprised of allergy, infectious disease, emergency medicine, and front-line clinicians to systematically develop recommendations regarding SARS-CoV-2 vaccine immediate allergic reactions. Medline, EMBASE, Web of Science, the WHO global coronavirus database, and the grey literature (inception-March 19, 2021) were systematically searched. Paired reviewers independently selected studies addressing anaphylaxis after SARS-CoV-2 vaccination, polyethylene glycol (PEG) and polysorbate allergy, and accuracy of allergy testing for SARS-CoV-2 vaccine allergy. Random effects models synthesized the data to inform recommendations based on the GRADE approach, agreed upon using a modified Delphi panel. The incidence of SARS-CoV-2 vaccine anaphylaxis is 7.91 cases/million (n=41,000,000 vaccinations, 95%CI 4.02-15.59; 26 studies, moderate certainty), the prevalence of PEG allergy is 103 cases/million (95%CI 88-120; 2 studies, very low certainty), and the sensitivity for PEG skin testing is poor though specificity is high (15 studies, very low certainty). We recommend vaccination over either no vaccination or performing SARS-CoV-2 vaccine/excipient screening allergy testing for individuals without history of a severe allergic reaction to the SARS-CoV-2 vaccine/excipient, and a shared decision-making paradigm in consultation with an allergy specialist for individuals with a history of a severe allergic reaction to the SARS-CoV-2 vaccine/excipient. We recommend further research to clarify SARS-CoV-2 vaccine/vaccine excipient testing utility in individuals potentially allergic to SARS-CoV2 vaccines or their excipients.
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http://dx.doi.org/10.1016/j.jaip.2021.06.006DOI Listing
June 2021

Do germinal centers protect most of us from becoming allergic?

Ann Allergy Asthma Immunol 2021 Jun 5. Epub 2021 Jun 5.

Division of Allergy and Immunology, Department of Pediatrics, Nationwide Children's Hospital - The Ohio State University College of Medicine, Columbus, Ohio USA; Principal Investigator, Center for Clinical and Translational Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio USA. Electronic address:

Objective: To review the literature and discuss a hypothesis as to why most people do not become allergic. This hypothesis is dependent upon three main components. (1) Airborne allergens (for example from pollen or mites) are weak antigens that induce a B-cell response only in immunologically most reactive subjects (i.e., atopic). (2) A roadblock to production of IgE is the TH2/IL-4 requirement for class switch to IgE. (3) Activated germinal centers prevent the formation of mature IgE-switched B-cells, creating a second roadblock to IgE production.

Data Sources: Transgenic reporter mice and a cross-sectional human cohort.

Study Selections: From the mouse studies we selected the data on histology and tissue-derived cell suspensions published by several groups in 2011-2014. From the human cohort we selected our published micro-array data on the levels of allergenspecific IgE and IgG in serum.

Results: The immune response to airborne atopic allergens entails both IgE and IgG antibodies rather than just an IgG or IgE response. However, as expected for an immune response without mature germinal centers, the specific IgG levels will be very low, typically in the ng/ml range.

Conclusion: Control of IgE production is not just through TH2/IL-4 mediated class switch. Recent studies suggest that mature germinal centers are likely to provide protection against the development of allergy to airborne allergens, as well. This may explain why allergen exposure does not induce allergen-specific IgE in everyone.
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http://dx.doi.org/10.1016/j.anai.2021.06.002DOI Listing
June 2021

AAAAI funding opportunities.

J Allergy Clin Immunol 2021 May 27. Epub 2021 May 27.

Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio. Electronic address:

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http://dx.doi.org/10.1016/j.jaci.2021.05.019DOI Listing
May 2021

Circulating inflammatory biomarkers in adolescents: evidence of interactions between chronic pain and obesity.

Pain Rep 2021 1;6(1):e916. Epub 2021 Apr 1.

Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI, USA.

Introduction: The negative effects of chronic pain and obesity are compounded in those with both conditions. Despite this, little research has focused on the pathophysiology in pediatric samples.

Objective: To examine the effects of comorbid chronic pain and obesity on the concentration of circulating inflammatory biomarkers.

Methods: We used a multiple-cohort observational design, with 4 groups defined by the presence or absence of obesity and chronic pain: healthy controls, chronic pain alone, obesity alone, as well as chronic pain and obesity. Biomarkers measured were leptin, adiponectin, leptin/adiponectin ratio (primary outcome), tumor necrosis factor-alpha, interleukin 6, and C-reactive protein (CRP).

Results: Data on 125 adolescents (13-17 years) were analyzed. In females, there was an interaction between chronic pain and obesity such that leptin and CRP were higher in the chronic pain and obesity group than in chronic pain or obesity alone. Within the chronic pain and obesity group, biomarkers were correlated with worsened pain attributes, and females reported worse pain than males. The highest levels of interleukin 6 and CRP were found in youth with elevated weight and functional disability. We conclude that in adolescents, chronic pain and obesity interact to cause dysregulation of the inflammatory system, and this effect is more pronounced in females.

Conclusion: The augmented levels of inflammatory biomarkers are associated with pain and functional disability, and may be an early marker of future pain and disability.
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http://dx.doi.org/10.1097/PR9.0000000000000916DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8104468PMC
April 2021

The evidence is in that asthma is not associated with severe coronavirus disease 2019.

Ann Allergy Asthma Immunol 2021 05;126(5):451-452

Division of Allergy and Immunology, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio; Center for Clinical and Translational Research, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio. Electronic address:

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http://dx.doi.org/10.1016/j.anai.2021.02.023DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8087450PMC
May 2021

Prepping for a pandemic.

Ann Allergy Asthma Immunol 2021 04;126(4):313

Division of Allergy and Immunology, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, 700 Children's Drive, Columbus, Ohio 43205. Electronic address:

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http://dx.doi.org/10.1016/j.anai.2021.01.026DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7994107PMC
April 2021

Evidence from mice that immunoglobulin E deficiency does not drive spontaneous malignancy.

Ann Allergy Asthma Immunol 2021 03;126(3):309

Division of Allergy and Immunology, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio. Electronic address:

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http://dx.doi.org/10.1016/j.anai.2021.01.008DOI Listing
March 2021

Severity of COVID-19 in hospitalized patients with and without atopic disease.

World Allergy Organ J 2021 Feb 9;14(2):100508. Epub 2021 Jan 9.

Division of Allergy and Immunology, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, USA.

Background: Data from the 2009 influenza pandemic suggested asthma might protect from severe disease in hospitalized patients. Asthma does not appear to increase risk for hospitalization or mortality with COVID-19.

Objective: This study was undertaken to see if atopy actually protected those hospitalized with COVID-19.

Methods: Retrospective chart review on all patients testing positive for SARS-CoV-2 over 2 months at a major adult and pediatric tertiary referral center hospital. Charts were evaluated for history of atopic disease, as were the need for ICU admission, requirement for supplemental oxygen and/or intubation, and in hospital mortality.

Results: No significant differences in outcomes for patients (n = 275) based on atopic disease were noted: ICU admission, 43% versus 44.7% (atopic versus no atopic disease, respectively; p = 0.84); supplemental oxygen use, 79.1% versus 73.6% (p = 0.36); intubation rate, 35.8% versus 36.5% (p = 0.92); and mortality rate, 13.4% versus 20.7% (p = 0.19). More patients with atopic disease had COPD listed as a diagnosis in their chart (38.8% versus 17.3%, p < 0.001). COPD was associated with an increased rate of ICU admission (aOR = 2.22 (1.15, 4.30) p = 0.02) and intubation (aOR = 2.05 (1.07, 3.92) p = 0.03). After adjusting for COPD, patients with atopic disease had a trend for reduced mortality (aOR 0.55 (0.23, 1.28), p = 0.16), but those with asthma did not (p > 0.2).

Conclusion: Severity of COVID-19 in hospitalized patients does not differ based on atopic status. However, adjusting for presence of COPD led to a suggestion of possible reduced severity in patients with atopy but not asthma.
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http://dx.doi.org/10.1016/j.waojou.2021.100508DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7820556PMC
February 2021

Asthma, severe acute respiratory syndrome coronavirus-2 and coronavirus disease 2019.

Curr Opin Allergy Clin Immunol 2021 Apr;21(2):182-187

Division of Allergy/Immunology, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA.

Purpose Of Review: In December 2019, a novel respiratory illness caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first described and named coronavirus disease 2019 (COVID-19). Although the knowledge base surrounding COVID-19 and SARS-CoV-2 has grown rapidly, significant gaps in our knowledge remain and inaccurate information continues to circulate. This review will discuss the interaction between asthma and COVID-19 to provide a comprehensive understanding based on the currently available published data.

Recent Findings: Non-SARS human coronaviruses (HCoVs) are a significant cause of asthma exacerbations, but SARS-CoV-2 does not appear to exacerbate asthma. Data thus far strongly suggest that patients with asthma are at no increased risk of infection with SARS-CoV-2 or more severe disease if infected with COVID-19. Although the data are extremely limited on inhaled corticosteroids and biologic medications, there remain no data suggesting that these therapeutics positively or negatively impact the severity or outcome of COVID-19.

Summary: Data are rapidly evolving regarding COVID-19 and asthma. At this time, asthma does not appear to positively or negatively affect outcomes of COVID-19; however, it is imperative that practitioners keep abreast of the changing literature as we await a vaccine and control of this pandemic.
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http://dx.doi.org/10.1097/ACI.0000000000000720DOI Listing
April 2021

Comparing respiratory syncytial virus and rhinovirus in development of post-viral airway disease.

J Asthma 2020 Dec 21:1-11. Epub 2020 Dec 21.

Division of Allergy and Immunology, Department of Pediatrics, Nationwide Children's Hospital - The Ohio State University College of Medicine, Columbus, OH, USA.

Objective: Respiratory syncytial virus RSV) and rhinovirus (RV) are common viral infections that may result in post-viral airway/atopic disease. By understanding the antiviral immune response involved, and the mechanisms that translate/associate with post-viral airway disease, further research can be directed to potential treatments that affect these mechanisms.

Data Sources: Utilized peer-reviewed manuscripts listed in PubMed that had relevance to RSV/RV and development of atopic/airway disease in both humans and mice.

Study Selections: Studies that explained the mechanisms behind antiviral response were selected.

Results: RSV infections have been associated with post-viral airway disease primarily in those without preexisting atopy; however, the mechanistic link connecting the viral infection with atopy is less clear. Mouse models (in particular those using Sendai virus, a virus related to RSV) provide a potential mechanistic pathway that may explain the linkage between RSV and post-viral airway disease. RV infection also can drive post-viral airway disease, but unlike RSV, this seems to occur only in those with preexisting atopy. Studies explore this link by demonstrating an impaired interferon response in atopic individuals, which may make them more susceptible to development of post-viral airway disease with RV infection.

Conclusion: Both RSV and RV are associated with a risk for developing post-viral airway disease and atopy. However, the mechanisms that connect these viruses with post-viral disease appear to be disparate, suggesting that treatments to prevent post-viral airway disease may need to be specific to the viral etiology.
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http://dx.doi.org/10.1080/02770903.2020.1862186DOI Listing
December 2020

Primary prevention: Vaccines and the allergist-immunologist's role.

Ann Allergy Asthma Immunol 2020 07;125(1)

Division of Allergy and Immunology, Nationwide Children's Hospital - The Ohio State University College of Medicine, Columbus, Ohio. Electronic address:

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http://dx.doi.org/10.1016/j.anai.2020.03.031DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7302771PMC
July 2020

A Phased Approach to Resuming Suspended Allergy/Immunology Clinical Services.

J Allergy Clin Immunol Pract 2020 Jul - Aug;8(7):2125-2134. Epub 2020 May 22.

Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo. Electronic address:

In early 2020, the first US and Canadian cases of the novel severe acute respiratory syndrome coronavirus 2 infection were detected. In the ensuing months, there has been rapid spread of the infection. In March 2020, in response to the virus, state/provincial and local governments instituted shelter-in-place orders, and nonessential ambulatory care was significantly curtailed, including allergy/immunology services. With rates of new infections and fatalities potentially reaching a plateau and/or declining, restrictions on provision of routine ambulatory care are lifting, and there is a need to help guide the allergy/immunology clinician on how to reinitiate services. Given the fact that coronavirus disease 2019 will circulate within our communities for months or longer, we present a flexible, algorithmic best-practices planning approach on how to prioritize services, in 4 stratified phases of reopening according to community risk level, as well as highlight key considerations for how to safely do so. The decisions on what services to offer and how fast to proceed are left to the discretion of the individual clinician and practice, operating in accordance with state and local ordinances with respect to the level of nonessential ambulatory care that can be provided. Clear communication with staff and patients before and after all changes should be incorporated into this new paradigm on continual change, given the movement may be forward and even backward through the phases because this is an evolving situation.
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http://dx.doi.org/10.1016/j.jaip.2020.05.012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7242939PMC
July 2020

Establishing Standardized Documentation for Anaphylaxis Treatment in a Tertiary Care Pediatric Allergy Clinic.

Pediatr Qual Saf 2020 Mar-Apr;5(2):e261. Epub 2020 Feb 15.

Division of Allergy and Immunology, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio.

Introduction: Anaphylaxis is a potentially life-threatening allergic reaction. Common allergy clinic procedures, including oral food challenges and subcutaneous immunotherapy, carry a risk of anaphylaxis, the treatment for which is epinephrine. Our goal was to develop a standardized process for the management and documentation of allergic reactions that occur in a tertiary care pediatric allergy clinic.

Methods: This was a single institution quality improvement pilot study. A multidisciplinary team from the allergy department designed, implemented, and studied the use of a standardized form for the documentation and treatment of allergic reactions within the clinic.

Results: A standardized form was developed based on evidence-based guidelines for the management of allergic reactions and included space for documentation. Both clinic providers and staff approved the form. One year after the introduction, we reached 100% adherence for the use of the form in visits during which a patient experienced a severe allergic reaction requiring epinephrine. Two patients required transfer to the emergency room; the quality improvement form was utilized in these cases to document treatment and assist with the hand-off to emergency room personnel before transfer.

Conclusions: We successfully implemented a standardized form for the treatment and documentation of anaphylaxis within our allergy clinic. The next steps focus on further integrating this form into the electronic medical record, determining compliance with evidence-based management of anaphylaxis, and formally assessing the use of the form as a handoff tool in the event of patient transfer.
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http://dx.doi.org/10.1097/pq9.0000000000000261DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7190245PMC
February 2020

Chemokine CCL28 Is a Potent Therapeutic Agent for Oropharyngeal Candidiasis.

Antimicrob Agents Chemother 2020 07 22;64(8). Epub 2020 Jul 22.

Department of Pediatrics, Division of Infectious Disease, Medical College of Wisconsin, Milwaukee, Wisconsin, USA

is a commensal organism that causes life-threatening or life-altering opportunistic infections. Treatment of infections is limited by the paucity of antifungal drug classes. Naturally occurring antimicrobial peptides are promising agents for drug development. CCL28 is a CC chemokine that is abundant in saliva and has antimicrobial activity. In this study, we examine the killing capacity of CCL28 in oropharyngeal candidiasis as well as the spectrum and mechanism of anti- activity. In the mouse model of oropharyngeal candidiasis, application of wild-type CCL28 reduces oral fungal burden in severely immunodeficient mice without causing excessive inflammation or altering tissue neutrophil recruitment. CCL28 is effective against multiple clinical strains of Polyamine protein transporters are not required for CCL28 anti- activity. Both structured and unstructured CCL28 proteins show rapid and sustained fungicidal activity that is superior to that of clinical antifungal agents. Application of wild-type CCL28 to results in membrane disruption as measured by solute movement, enzyme leakage, and induction of negative Gaussian curvature on model membranes. Membrane disruption is reduced in CCL28 lacking the functional C-terminal tail. Our results strongly suggest that CCL28 can exert antifungal activity in part via membrane permeation and has potential for development as an anti- therapeutic agent without inflammatory side effects.
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http://dx.doi.org/10.1128/AAC.00210-20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7526824PMC
July 2020

Here come the omics!

Ann Allergy Asthma Immunol 2019 12;123(6):531

Division of Allergy, Asthma, and Clinical Immunology, Department of Medicine, The University of Mississippi Medical Center, Jackson, Mississippi.

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http://dx.doi.org/10.1016/j.anai.2019.10.011DOI Listing
December 2019

Effect of cysteinyl leukotriene receptor 1 blockade on aeroallergen-induced nasal recruitment of CD49d expressing neutrophils.

Ann Allergy Asthma Immunol 2019 11 3;123(5):508-511.e1. Epub 2019 Sep 3.

Division of Allergy and Immunology, Department of Pediatrics Nationwide Children's Hospital and The Ohio State University Columbus, Ohio; Center for Clinical and Translational Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio. Electronic address:

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http://dx.doi.org/10.1016/j.anai.2019.08.019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6825584PMC
November 2019

Risk factors with epinephrine use: 5-year review of in clinic pediatric allergic reactions.

Ann Allergy Asthma Immunol 2019 10 17;123(4):406-407. Epub 2019 Jul 17.

Division of Allergy and Immunology, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio. Electronic address:

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http://dx.doi.org/10.1016/j.anai.2019.07.007DOI Listing
October 2019

The Complicated Dance of Infections and Asthma.

Immunol Allergy Clin North Am 2019 08 22;39(3):xv-xvi. Epub 2019 May 22.

Division of Allergy and Immunology, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, 700 Children's Drive, Columbus, OH 43205, USA. Electronic address:

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http://dx.doi.org/10.1016/j.iac.2019.04.002DOI Listing
August 2019

Epidemiology of Infections and Development of Asthma.

Immunol Allergy Clin North Am 2019 08 30;39(3):297-307. Epub 2019 Apr 30.

Center for Translational and Clinical Research, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA; Biomedical Sciences Graduate Program, The Ohio State University College of Medicine, Columbus, OH, USA; Division of Allergy and Immunology, Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA. Electronic address:

Asthma and allergic diseases have become more prevalent, although the reasons for this increase in disease burden are not known. Understanding why these diseases have become more common requires knowledge of the disease pathogenesis. Multiple studies have identified respiratory viral infections and atypical bacteria as potential etiologic agents underlying the development of asthma (and possibly allergies). This review discusses the epidemiology and potential mechanistic studies that provide links between these infectious agents and the development (and exacerbation) of asthma. These studies provide insight into the increase in disease prevalence and have identified potential targets for future therapeutic intervention.
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http://dx.doi.org/10.1016/j.iac.2019.03.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6625524PMC
August 2019

Asthma and viral infections: An intricate relationship.

Ann Allergy Asthma Immunol 2019 10 2;123(4):352-358. Epub 2019 Jul 2.

Division of Allergy and Immunology, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio.

Objective: To synthesize available data related to the complex associations among viral infections, atopy, and asthma.

Data Sources: Key historical articles, articles highlighted in our recent review of most significant recent asthma advancements, and findings from several birth cohorts related to asthma and viral infections were reviewed. In addition, PubMed was searched for review articles and original research related to the associations between viral infection and asthma, using the search words asthma, viral infections, atopy, development of asthma, rhinovirus (RV), and respiratory syncytial virus (RSV).

Study Selections: Articles were selected based on novelty and relevance to our topic of interest, the role of asthma and viral infections, and possible mechanisms to explain the association.

Results: There is a large body of evidence demonstrating a link between early viral infections (especially RV and RSV) and asthma inception and exacerbations. RV-induced wheezing is an important risk factor for asthma only when atopy is present, with much evidence supporting the idea that sensitization is a risk factor for early RV-induced wheezing, which in turn is a risk factor for asthma. RSV, on the other hand, is a more important risk factor for nonatopic asthma, with severe infections conferring greater risk.

Conclusion: There are important differences in the development of atopic and nonatopic asthma, with several proposed mechanisms explaining the association between viral infections and the development of asthma and asthma exacerbations. Understanding these complex associations is important for developing asthma prevention strategies and targeted asthma therapies.
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http://dx.doi.org/10.1016/j.anai.2019.06.020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7111180PMC
October 2019

Pain Is a Common and Burdensome Symptom of Atopic Dermatitis in United States Adults.

J Allergy Clin Immunol Pract 2019 Nov - Dec;7(8):2699-2706.e7. Epub 2019 Jun 20.

Clinical Immunology and Allergy, Children's Hospital Los Angeles, University of Southern California, Keck School of Medicine, Los Angeles, Calif.

Background: Atopic dermatitis (AD) is associated with skin pain. However, little is known about the prevalence and associations of pain in AD.

Objective: To characterize the frequency, intensity, characteristics, and associations of pain from AD.

Methods: A cross-sectional, US population internet survey-based study of 602 adults with AD from the AD in America Study was performed (modified UK Working Party Criteria).

Results: Overall, 365 (61%) reported pain from AD, with 199 (33%) experiencing pain at least once per week and 30 (5%) with pain daily. Among those with AD pain, 22% reported worst pain intensity ≥7. The frequency and intensity of AD pain were associated with Patient-Oriented Scoring Atopic Dermatitis (PO-SCORAD), PO-SCORAD itch and sleep, and Patient-Oriented Eczema Measure (P ≤ .004 for all). Among those experiencing AD pain, 179 (48%) reported pain occurring only after frequent scratching, 156 (42%) reported intermittent pain, and 27 (11%) reported constant pain throughout the day. AD pain was most commonly associated with open areas caused by scratching (27%) and fissures in the skin (27%), followed by inflamed red skin (25%), with only a minority reporting pain mostly caused by burning from creams or ointments (10%). Mild AD was associated with more pain from scratching, whereas severe AD was associated with more constant pain and pain from inflamed skin.

Conclusions: Pain is a distinct symptom in AD, with heterogeneous frequency, characteristics, intensity, and quality of life impact. Pain was related to scratching, fissures, and/or inflamed red skin, and least from burning from topical medications. Skin pain should be assessed in patients with AD and monitoring treatment response.
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http://dx.doi.org/10.1016/j.jaip.2019.05.055DOI Listing
October 2020

Validation and Interpretation of Short Form 12 and Comparison with Dermatology Life Quality Index in Atopic Dermatitis in Adults.

J Invest Dermatol 2019 10 19;139(10):2090-2097.e3. Epub 2019 Apr 19.

Oregon Health & Science University, Portland, Oregon, USA.

Quality-of-life assessments are not standardized in atopic dermatitis (AD). We sought to determine the validity of the Short Form (SF)-12, a generic quality-of-life assessment, in AD and compare its measurement properties with the Dermatology Life Quality Index (DLQI). A cross-sectional, population-based study of 3,495 adults was performed, including 602 adults who met the modified United Kingdom Working Party Criteria for AD. The SF-12 mental component score and the SF-Six Dimension (SF-6D) had a strong correlation with each other and moderate inverse correlations with the Patient-Oriented Eczema Measure, the Patient-Oriented Scoring Atopic Dermatitis, the Patient-Oriented Scoring Atopic Dermatitis-itch, the Patient-Oriented Scoring Atopic Dermatitis-sleep, and the Numerical Rating Scale of pain (Pearson correlations, P < 0.0001 for all). The SF-12 mental component score and the SF-6D showed good discriminant validity as judged by the analysis of variance and receiver operating curves. The SF-12 physical component score had weak correlations with AD severity assessments and poor discriminant validity. The DLQI had better convergent and discriminant validity than the SF-12. The SF-12 and the DLQI showed good internal consistency (Cronbach alpha, 0.89 and 0.94, respectively). Differential item functioning was found for items in the SF-12 and the DLQI. Floor effects were observed for the DLQI but not for the SF-12 mental component score, the SF-12 physical component score, and the SF-6D. Severity thresholds were selected. In conclusion, the SF-12 mental component score and the SF-6D showed good validity in AD but inferior construct validity compared with the DLQI.
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http://dx.doi.org/10.1016/j.jid.2019.03.1152DOI Listing
October 2019

Life-long learning and the American Board of Allergy and Immunology: Practice improvement comes of age.

Ann Allergy Asthma Immunol 2019 07 22;123(1):6-8. Epub 2019 Mar 22.

Division of Allergy and Immunology, Department of Pediatrics, Kravis Children's Hospital, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, New York.

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http://dx.doi.org/10.1016/j.anai.2019.03.015DOI Listing
July 2019

Atopic Dermatitis in US Adults: From Population to Health Care Utilization.

J Allergy Clin Immunol Pract 2019 May - Jun;7(5):1524-1532.e2. Epub 2019 Jan 14.

Oregon Health & Science University, Portland, Ore.

Background: Little is known about the predictors of health care utilization among US adults with atopic dermatitis (AD).

Objective: To determine the proportion and predictors of utilization in outpatient, urgent care, emergency department (ED), and hospital settings in US adults with AD.

Methods: A cross-sectional, population-based study of 3495 adults was performed. AD was determined using modified United Kingdom Working Party criteria. AD severity was assessed using the Patient-Oriented Eczema Measure (POEM), the Patient-Oriented Scoring AD (PO-SCORAD), and the Numeric Rating Scale (NRS)-itch. Weighted frequency and prevalence (95% CIs) of utilization were determined.

Results: Overall, 10.42% (95% CI, 8.55%-12.28%; weighted frequency, 25,844,871) reported a diagnosis of AD or eczema, 7.39% (95% CI, 5.81%-8.97%; weighted frequency, 18,324,869) met United Kingdom Working Party criteria, and 3.56% (95% CI, 2.40%-4.72%; weighted frequency, 8,830,095) met both. A total of 31.8% (2,711,690) had a severe score for POEM, PO-SCORAD, and/or NRS-itch, with 4.0% (337,586) having severe scores for all 3. Outpatient utilization for AD was low for mild disease (29.3%-34.7%) and increased by severity (moderate: 36.2%-49.8%; severe: 50.6%-86.6%). Timeliness of appointments, expenses, and insurance coverage were also predictors of outpatient utilization. Severe POEM, PO-SCORAD, and/or NRS-itch were associated with being uninsured, not having full prescription coverage, AD prescriptions being denied by insurers, and costs of AD medications being problematic. One in 10 adults with AD had 1 or more urgent care, ED, or hospital visit in the past year. Urgent care or ED visits were significantly more common among blacks and Hispanics, those with lower household income, those with lower education level, and those with AD prescriptions being denied by the insurance company.

Conclusions: Adults with AD had low rates of outpatient and high rates of urgent care, ED, and hospital visits. The major predictor of outpatient utilization for AD care was AD severity. Racial/ethnic, socioeconomic, and/or health care disparities reduce outpatient utilization and increase urgent care, ED, and hospital utilization.
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http://dx.doi.org/10.1016/j.jaip.2019.01.005DOI Listing
August 2020

Health Utility Scores of Atopic Dermatitis in US Adults.

J Allergy Clin Immunol Pract 2019 04 8;7(4):1246-1252.e1. Epub 2018 Dec 8.

Oregon Health and Science University, Portland, Ore.

Background: The impact of atopic dermatitis (AD) on health-related quality of life and health utility in the US adult population is not well established.

Objective: To determine the health utilities and quality-adjusted life-years (QALYs) lost in adults with AD versus without AD in the US population.

Methods: A cross-sectional, population-based study of 3495 adults was performed. AD was determined using modified UK diagnostic criteria for AD. AD severity was assessed using self-reported global AD severity, the Patient-Oriented Eczema Measure, the Patient-Oriented Scoring AD, and the Patient-Oriented Scoring AD itch and sleep. Six-dimensional health state short form (SF-6D) health utility scores and total QALY loss were assessed.

Results: The mean SF-6D score was lower in adults with AD compared with healthy adults (0.69 [95% CI, 0.68-0.70] versus 0.79 [95% CI, 0.77-0.79]). In particular, those with moderate-to-severe AD (mean, 0.53-0.66) had similar or lower SF-6D scores compared with those with all other self-reported disorders examined, except autoimmune disorders. Adults with AD and atopic comorbidities had significantly lower SF-6D scores compared with those without atopic comorbidities. Among the 7 disorders examined, AD was associated with higher total QALY loss than autoimmune disorders, diabetes, food allergy, and heart disease in both males and females. The largest QALY loss was for moderate AD in females and mild AD in males.

Conclusions: Moderate-to-severe AD is associated with significant decrements of health utility in the US population. These data illustrate the heavy societal burden of moderate and severe AD and provide important insight for prioritization of resource allocation and cost-effectiveness research.
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http://dx.doi.org/10.1016/j.jaip.2018.11.043DOI Listing
April 2019

Atopic Dermatitis in America Study: A Cross-Sectional Study Examining the Prevalence and Disease Burden of Atopic Dermatitis in the US Adult Population.

J Invest Dermatol 2019 03 30;139(3):583-590. Epub 2018 Oct 30.

Children's Hospital Los Angeles, University of Southern California, Keck School of Medicine, Los Angeles, California, USA.

Population-based estimates on the prevalence of atopic dermatitis in adults vary widely. The objectives of this study were to determine the prevalence of atopic dermatitis in the population of the United States, the distribution of disease severity, and its impact on health-related quality of life. Among 1,278 participating adults, the prevalence (95% confidence interval) of atopic dermatitis was 7.3% (5.9-8.8). Overall, 60.1% (56.1-64.1) of participants were classified as having mild, 28.9% (25.3-32.7) as having moderate, and 11% as having severe (8.6-13.7) disease. Patients with atopic dermatitis and those with more severe disease had higher scores in the dermatology life quality index (mean [standard deviation] for AD patients = 4.71 [6.44] vs. control individuals = 0.97 [2.12]) (P < 0.001) and the hospital anxiety (mean [standard deviation] for AD patients = 7.03 [4.80] vs. control individuals = 4.73 [4.8]) and depression (mean, [standard deviation] for AD patients = 5.83 [4.54] vs. control individuals = 3.62 [3.61]) scales, indicating a worse impact on quality of life and an increased likelihood of anxiety or depression. Based on our prevalence estimates, 16.5 million adults would have a diagnosis of atopic dermatitis, with 6.6 million meeting criteria for moderate to severe disease. Our study confirms the high prevalence and disease burden of atopic dermatitis in this population.
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http://dx.doi.org/10.1016/j.jid.2018.08.028DOI Listing
March 2019

Post-viral atopic airway disease: pathogenesis and potential avenues for intervention.

Expert Rev Clin Immunol 2019 01 3;15(1):49-58. Epub 2018 Nov 3.

a Division of Allergy and Immunology , Nationwide Children's Hospital - The Ohio State University College of Medicine , Columbus , OH , USA.

: In early childhood, wheezing due to lower respiratory tract illness is often associated with infection by commonly known respiratory viruses such as respiratory syncytial virus (RSV) and human rhinovirus (RV). How respiratory viral infections lead to wheeze and/or asthma is an area of active research. : This review provides an updated summary of the published information on the development of post-viral induced atopy and asthma and the mechanisms involved. We focus on the contribution of animal models in identifying pathways that may contribute to atopy and asthma following respiratory virus infection, different polymorphisms that have been associated with asthma development, and current options for disease management and potential future interventions. : Currently there are no prophylactic therapies that prevent infants infected with respiratory viruses from developing asthma or atopy. Neither are there curative therapies for patients with asthma. Therefore, a better understanding of genetic factors and other associated biomarkers in respiratory viral induced pathogenesis is important for developing effective personalized therapies.
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http://dx.doi.org/10.1080/1744666X.2019.1541737DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6486879PMC
January 2019

Advances in asthma in 2017: Mechanisms, biologics, and genetics.

J Allergy Clin Immunol 2018 11 11;142(5):1423-1436. Epub 2018 Sep 11.

Section of Allergy and Immunology, Division of Pulmonary Allergy Critical Care Medicine, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pa.

This review summarizes some of the most significant advances in asthma research over the past year. We first focus on novel discoveries in the mechanism of asthma development and exacerbation. This is followed by a discussion of potential new biomarkers, including the use of radiographic markers of disease. Several new biologics have become available to the clinician in the past year, and we summarize these advances and how they can influence the clinical delivery of asthma care. After this, important findings in the genetics of asthma and heterogeneity in phenotypes of the disease are explored, as is the role the environment plays in shaping the development and exacerbation of asthma. Finally, we conclude with a discussion of advances in health literacy and how they will affect asthma care.
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http://dx.doi.org/10.1016/j.jaci.2018.08.033DOI Listing
November 2018