The Monthly choice - May 2016
Claude MOLINA* & Jacques GAYRAUD**
1. Chronic RhinoSinusitis, Cluster analysis and Prediction of treatment outcomes An American survey.
2. CRS dissected : Inflammatory endotypes based on cluster analysis of biomarkers.
3. Epicutaneous Immunotherapy for the treatment of Peanut Allergy using the Viaskin-patch: Safety: Phase1.
4. Anaphylaxis in Children and adolescents: The European registry.
5. Mycoplasma Pneumoniae and Asthma.
1) Chronic RhinoSinusitis (CRS) Cluster analysis and Prediction of treatment outcomes An American survey.
(Z.M.Soler JACI April 2016 137 4 1054-1062)
Simplified discriminant analysis based on unsupervised clustering has identified novel phenotypic subgroups of CRS. A prospective study of 690 patients with data on demographics co-morbidities, questionnaire-test with 22 items, age, objective disease measures with olfactory testing, computed tomography, and endoscopy scoring, allowed to separate patients in five clusters and set-up a prognosis in patients choosing surgery versus continued medical management.
At 18 months of follow-up 3 common variables: age, sino-nasal outcome test-22 and missed productivity were able to provide information regarding prognostication of the disease, according to surgery (3 clusters) or medical treatment (2 clusters).
2) CRS dissected : Inflammatory endotypes based on cluster analysis of biomarkers
(P.Tomassen et al JACI May 2016137 5 1449-1456)
Current phenotyping of CRS into CRS with and without Polyposis, do not adequately reflect the pathophysiology and diversity of clinical cases. So, the European authors using cluster method with biological markers compared to clinical phenotypes, identified inflammatory endotypes.
In a survey of 173 patients recruited in 10 specialty centers, they discerned 10 clusters with 3 major endotypes based on Th2 markers according to the high or moderate severity of the RSC and associated with low to high co-morbid prevalence of Asthma; whereas Th1 and Th 17 related inflammation has little effect on disease severity . In conclusion distinct CRS clusters with inflammatory markers provide an accurate description of mechanisms involved in diverse phenotypes.
3) Epicutaneous Immunotherapy (EPIT) for the treatment of Peanut Allergy (PA) using the Viaskin-patch: Safety: Phase1.
(SM.Jones et al JACI 2016 137 4 1258-1261.e10)
EPIT has shown promise in animal studies and in single pilot study about efficacy .( H.A.Sampson et al JACI February 2016 137 2 supplement AB 408).
The purpose of this research is to evaluate the safety and tolerability when the new patch is applied on intact skin.
100 subjects (80 receiving active treatment and 20 Placebo, age 6 to 50, including 70 adults and children with non-severe PA and 30 adults severe PA were enrolled in a DBPC phase 1 study at 5 clinical sites in USA. Viaskin patches with low doses: 20, 100µg progressing on to the next escalation in non-severe adult cohorts (children did not receive the 500µ dose) by using an interactive web based response system. The safety and tolerability were assessed by the presence of adverse events. The findings revealed that the novel Viaskin delivery system is safe and well tolerated with high adherence by study participants
4) Anaphylaxis (A) in Children and adolescents: The European registry
(L.BGrabenenrich et al JACI 2016 April 137 4 1128-1137)
Between 2007 and 2015, 1970 patients, younger than 18 years, and coming from 90 allergy centers in 10 European countries were recorded and identified as severe allergic reactions. Most incidents occurred in private homes (46%) and outdoors (19%). One-third of patients have experienced A. previously.
Food items were the most frequent elicitors (cow’s milk and hen’s egg in the first 2 years, hazelnut and cashew in pre-school age children, peanut at all ages) followed by insect venom (19%) then drug induced up to age 10 years.
The symptoms are well known: vomiting and cough in the first decade, throat tightness dizziness later in life, skin diseases at all ages (urticaria, angioedema, erythema).
30% of cases were lay treated (often by a teacher) of which 10% with epinephrine auto-injector. Emergency treatment with epinephrine increased between 2011 and 2014 (12 to 25 %).
26 patients 1,3%) were admitted in intensive care unit. 5 deaths were to deplore.
Still in children, measurement of Tryptase levels may be useful in cases of mild or late reactions as in the Canadian clinical report (S.De Shryver et al JACI 2016 401138-1142).
5) Mycoplasma Pneumoniae (MP) and Asthma (A)
JJ. Yeh & al JACI April 137 4 1017-1023 & P.Giavina-Bianchi & J.Kalil 1024-1025
Identifying 1591 cases of MP during the 2000-2008 period, matched with 6364 patients without MP infection from the general population, according to age, sex, and index year, the Taiwan authors found in the cohort MP an higher risk of incident A. than those without it. The adjusted hazard ratio for Asthma was of 3,35. The risk was higher in male patients, in those with co-morbidities including atopic disorders, or late-onset A., those treated by corticoids, and within the less than 2 years follow-up after MP infection. In conclusion, this study showed that incident cases of early-onset and late-onset Asthma are closely related to MP infection, even in non atopic patients.
As underlined by Italian authors, in their comment, MP infection and A. present a 2-way interaction, MP may induce bronchial inflammation and exacerbation, conversely if Asthma comes first it may favor infection, but in this study MP appears as an independent risk factor for incident Asthma.
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