SCIENCE

January 2020

Dear Colleagues,
The year 2020 is on the horizon and as traditionally we send you our best and sincere wishes for happiness, health, personal and professional success for you and yours.
We also thank you for your unwavering loyalty. In this respect, it appeared for us, despite our desire for diversity, originality, independence and scientific rigor, we could not avoid redundancy of certain articles evoking the main allergic diseases (asthma for instance). As we know that we are all beset with real or fake news about health and that is difficult to separate “the wheat from the chaff”, we think that it is wise to publish our updates bimonthly that is to say every 2 months and no longer monthly. If many colleagues are opposed to this frequency, we will carry out a survey for all our readers and take a suitable decision.
With our kindest regards,
Claude Molina Jacques Gayraud


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Observational cohort of adult asthma in England to investigate the unmet need and time waiting for referral to specialist

JD. Blakey et al BMJ 2019 21 11 vol 9

The study was carried out to estimate how many patients aged 18–80 years with asthma between 2007 -2015 met the referral eligibility criteria using national asthma guidelines, to identify what proportion were referred and determine the average waiting time to referral.
Eligibility for referral by the British Thoracic Society/Scottish Intercollegiate Guidelines was determined after a 3-month pharmacological therapy exposure assessment, and classed by either ‘high-dose therapies’, ‘continuous or frequent use of oral steroids’ or ‘incident eligibility’ during follow-up (continuous oral corticosteroids for more than 3 months, or ≥800 µg/day inhaled corticosteroids/long-acting β2-agonist (or three controllers).
Results 19837 patients were eligible for specialist referral during follow-up. Among them, 4% were referred, with a median waiting time of 880 days between eligibility and referral.

Conclusions: A large number of patients with asthma were eligible for specialist referral, of which a very small proportion were referred, and many experienced an excessive long waiting time before referral. The results indicate a major unmet need in asthma referral, which is a potential source of preventable harm. Implications are underlined regarding how services are organized to address this unmet need.
It is hoped that the situation has improved since the reporting period.

 



 


Peanut allergy: influence of co-factors such as exercise and sleep deprivation on reactivity threshold to allergen

S.Dua et al JACI 2019 December vol 144 6 1584-1594

Peanut allergy causes severe and fatal reactions. Current food allergen labeling does not address these risks adequately because of limited data on thresholds of reactivity and the influence of everyday /or accidental factors.
• The authors estimated peanut threshold doses for a United Kingdom population with peanut allergy and examined the effect of sleep deprivation and exercise. Baseline challenges were performed in 126 participants (mean age 28 years) in a multicenter cross over randomized study with 3 open challenge in random order with exercise after each dose, or with sleep deprivation preceding challenge and /or with no intervention.
• The results are as follows: The mean threshold was 214mg for no intervention Exercise and sleep each caused a significant reduction in reaction threshold to peanut by 45%. Mean estimated eliciting dose for 1% of the population was respectively 1.5mg for no intervention,0.5 after sleep 0.3 after exercise.
The results of this study must be accounted when advising patients, but not applicable to all countries, due to a great disparity between American and Europeans patients, and even between subjects in the different regions of Europe.

 

 


Asthma exarcebation in the context of African ancestry
NL Grossman JACI 2019 December 144 6 1524-1533

Beyond the recent controversy about black children with asthma, it is obvious that compared with white subjects, black subjects demonstrate a disproportionate burden of asthma-related morbidity, including a greater risk of exacerbations. Socioeconomic factors do not entirely account for the increased risk of exacerbations in these patients.
In this article, the American authors analyzed longitudinal data on exacerbations in 1840 subjects (24% self-reported black) with mild-to-moderate asthma from 12 National Institutes of Institute–sponsored clinical trial cohorts, including a subset with genome-wide genetic data to estimate global percentage of African ancestry. Common risk factors associated with an increased asthma exacerbation rate in both black and white subjects included a history of prior exacerbations and lower lung function; however, additional race-specific risk factors were found. It appears that self-reported race was not associated with exacerbations; however, in 161 black subjects with genetic data, higher genomic African ancestry (≥82%) associated with increased exacerbation risk.
In conclusion ancestry, genetic, and environmental factors track influence racial differences in asthma morbidity. 

 


Oral Upadacitinib(U) in adults with moderate-to-severe atopic dermatitis controlled trial
Emma Guttman-Yassky, et al Article in Press JACI 2019

There are 4 JAK in humans JAK 1, 2, 3 and TYK2, signal transducers and activators which play a role in inflammatory conditions. Their inhibitors target a broad range of Jaks: panjack or only specific selective.
U selective Janus kinase 1 inhibitor used in 167 adults with moderate-to-severe disease and inadequate control by topical treatment were enrolled from November 21, 2016, to April 20, 2017. All were randomized and analyzed for efficacy by multiple doses. In the 16-week, double-blind, placebo-controlled, parallel-group, dose-ranging portion of this 88-week trial in 8 countries, was to once-daily U oral monotherapy 7.5, 15, or 30 mg or placebo. The primary endpoint was percentage improvement in Eczema Area and Severity Index at week 16. Efficacy was analyzed by intention-to-treat in all randomized patients. Safety was analyzed in all randomized patients who received study medication,
Results: A dose-response relationship was observed for U efficacy; the 30-mg once-daily dose showed the greatest clinical benefit. Dose-limiting toxicity was not observed
Conclusion: Oral JAK inhibitors are promising treatment of Atopic Dermatitis of adults.



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A novel ointment in pediatric atopic dermatitis: A janus kinase inhibitor: delgocitinib (d)
H.Nakagawa et al JACI 2019December 1446 1575-1583

Topical d a novel JAK has been shown to be clinically efficient in adults. In a phase 2 trial young Japanese aged 2 through 15 years were randomized to receive 0.25% to .50% d ointment or vehicle ointment twice daily to 4 weeks.
The results show:
- Dermatitis and pruritus scores were significantly and rapidly improved compared with the only vehicle group
- d ointment was well tolerated during the 4 weeks
A trial of 52 weeks is now conducted in Japanese children to confirm the good results of efficacy and safety obtained in this preliminary test. JAK Inhibitors in ointment appear to be excellent therapeutic options for pediatric patients with atopic dermatitis.

 

 
Your comments and questions are welcome at the following addresses:
Claude Molina - claude.nelly.molina@orange.fr                                                     
Jacques Gayraud - gayraud65@wanadoo.fr

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Last updated 30 December 2019
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