October 2017

1. Influenza vaccine in egg-allergic recipients: Task force on practice parameters in USA
2. Azithromycin for 48 weeks in persistent asthma
3. From wheezing to Asthma : Risk factors in children
4. Severe Nasal Polyposis and Mepolizumab    
5. Novel formulation of inhaled sodium cromoglycate in Chronic Cough and Interstitial Pulmonary Fibrosis

I. Influenza vaccine in egg-allergic recipients:
Task force on practice parameters in USA
Allergy/Immunology PubMed 2017. Health Ministry :France

A large number of studies have reported inactivated influenza vaccine IIV to be safe for egg-allergy recipients. Special precautions such as pre-vaccine skin testing or stepwise challenge are unnecessary and may constitute a barrier to immunization. It is even the case for the live-attenuated influenza vaccine LAIV, recommended once the concerns regarding its efficacy have been resolved. So vaccine providers should not ask about the egg allergy status of recipients on influenza vaccine which can be administered in France by pharmacists or nurses. A 3rd type of vaccine, given by inhalation is available but not recommended by the French authorities.
PS. A IIV delivered by dissolvable microneedle patch is used in England, the safety, immunogenicity and acceptability of which is attested by a controlled trial.
II. Azithromycin for 48 weeks in persistent asthma             
P.G.Gibson et al : The Lancet 2017 390 659-668

420 Adults with uncontrolled persistent asthma despite medium-to-high dose inhaled corticosteroids plus a long-acting bronchodilator were assigned to receive Azithromycin 500mg (213 patients) or placebo (207 patients) 3 times a week for 48 weeks, in order to prevent exacerbations, in a randomized trial from Australia and New-Zealand.           Between 2009 and 2015, Azithromycin reduced asthma exacerbations compared with placebo, and significantly improved quality of life. Diarrhea was more common in treated patients (34% versus 19%).     
In conclusion: Azithromycin during a long period might be a useful add-on therapy in persistent asthma.

III. From wheezing to Asthma : Risk factors in children
M.Lukkarinen et al : JACI 2017 140 988-995

The Finish authors sought to identify risk factors, at the 1st severe wheezing episode, for current asthma 7 years after and separately for atopic and non-atopic asthma.                                                             
127 steroid-naive children were followed and all clinical factors were analyzed : At study entry, median age was 11 months , 17% were sensitized, 98% were virus positive . At 8 years 37 had current asthma: atopic 19, non-atopic 18.                                     
The risk factors for atopic asthma were: sensitization (p ≤ .001) eczema (p ≤ .014) wheezing with rhinovirus ( P≤.035).                                
For non-atopic asthma, the risk factors were: 1st wheezing due to respiratory syncytial virus / rhinovirus negative P=.001) at age less than 11 months (P=.007) parental smoking (P=.028).
So diverse phenotypes and mechanisms can be predicted by clinical markers at the time of 1st wheezing episode suggesting different early intervention strategies for secondary prevention of asthma.

IV. Severe Nasal Polyposis (SNP) and Mepolizumab (M)
Cl. Bachert et al JACI 2017140 1024-1031

Patients with eosinophilic SNP require surgery. The European authors sought to assess the efficacy and safety of M. versus Placebo. 105 adult patients received 750 mg of M (or placebo) every 4 weeks for a total of 6 doses; the primary end point was the number of patients no longer requiring surgery at week 25 of a composite of endoscopic nasal polyp score; changes in nasal symptom severity were secondary end-point.
A significantly greater proportion of patients in the M. group no longer required surgery (30% vs 10% : 16 vs 5). A significant improvement of polyposis severity was observed in M. group compared with placebo. M. safety profile was comparable.
In conclusion M. reduced need for surgery in eosinophilic and non-eosinophilic SNP.

V. Novel formulation of inhaled sodium cromoglycate (PA101) in Chronic Cough (CC) and Interstitial Pulmonary Fibrosis (IPF)
S.S.Birring et al : The Lancet Resp.Med 2017 sept. Online first.
In a randomized, double blind, proof of concept phase two trial, the authors aimed to test efficacy and safety of this PA101, delivered via a high efficiency eFlow nebuliser that achieves drug deposition in the lung, in 24 patients with IPF +CC. A similar study was designed in 27 patients with Chronic Idiopathic Cough (CIC) the 2 cohorts coming from 7 centres in UK and the Netherlands The primary end-point was change in daytime cough frequency (from acoustic recording).
The findings showed in patients with IPF that PA 101 reduced daytime cough frequency by 31% at day 14, compared with placebo.
By contrast no benefit was observed in the CIC cohort. The drug was well tolerated in the 2 cohorts. The anti-tussive mechanism of the drug is still under study.

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With our best wishes for an happy new year

Claude Molina                                  

Jacques Gayraud