Increased rates of APOs are associated with rheumatic diseases like SLE, rheumatoid arthritis (RA), and dermatomyositis, but little is known about pregnancy outcomes among patients with ASDs. Therefore, researchers conducted a case-control study to assess the frequency of APOs among women with ASDs.

Data were taken from the TriNetX United States Collaborative Network database and included patients aged between 15 to 44 years who were pregnant, from January 1, 2016, to December 31, 2021.

Patients with ASDs were propensity score matched 1:1 with members of two control groups for comparison: 1) healthy patients without ASDs, RA, or SLE and 2) individuals with RA or SLE who were considered members of the disease-control group.

The study included 3654 patients with ASDs and 3654 members of the control groups (2147 patients with SLE and 889 with RA).

Patients with ASDs were at greater risk of experiencing spontaneous abortion and preeclampsia/eclampsia compared with members of the healthy control group.

Specifically, the risk for spontaneous abortion was 1.5 times higher among patients with ASDs than in the healthy control group (P <.001), while the risk for preeclampsia/eclampsia was 1.2 times higher among patients with ASDs compared with the healthy control group (P =.04).

Compared against women with SLE, women with ASDs were less likely to experience preeclampsia/eclampsia, have a preterm birth, experience preterm premature rupture of membranes (PPROM), or have a fetus with intrauterine growth restriction (IUGR).

Specifically, the risk for preeclampsia/eclampsia was 0.7 times lower (P =.001), the risk of delivering preterm was 0.5 times lower (P <.001), the risk for PPROM was 0.6 times lower (P =.004), and the risk of having a fetus with IUGR was 0.6 times lower (P <.001) among women with ASDs vs women with SLE.

Women with ASDs were more 1.2 times more likely to experience a spontaneous abortion than women with SLE (P =.003). Patients with ASDs and RA were at similar risk for APOs.

The study authors concluded, “These results suggest that patients with ASDs have increased rates of adverse pregnancy outcomes compared to healthy controls and are similar in risk to RA. In contrast, those with SLE have a greater frequency of APOs indicating that all these groups may benefit from multidisciplinary care with maternal-fetal medicine specialists.”

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

Anaphylaxis Management

Astepro^® Allergy (azelastine HCI 0.15%) is now available over-the-counter (OTC) for the temporary relief of nasal congestion, runny nose, sneezing and itchy nose due to hay fever or other upper respiratory allergies in adults and children 6 years of age and older.

Astepro Allergy is the first OTC steroid-free antihistamine nasal spray for indoor and outdoor allergies. Each nasal spray delivers 0.137mL solution containing 205.5mcg of azelastine hydrochloride, an H₁-receptor antagonist. The product may be administered once daily or twice daily and provides relief for up to 24 hours.

Due to the risk of somnolence associated with the use of azelastine, the label for Astepro Allergy warns consumers to avoid alcoholic drinks and to be cautious when driving a motor vehicle or operating machinery. Additionally, consumers should avoid sedatives or tranquilizers when using the product.

Astepro Allergy is supplied in 22-, 60-, 120-, 200-, and 240 (2×120 spray)-metered spray bottles. 

Azelastine HCl nasal spray 0.1% (137mcg/spray) will remain prescription based for seasonal allergic rhinitis and vasomotor rhinitis.

References

1. Astepro^® Allergy, first and only steroid-free antihistamine nasal spray now available over-the-counter. News release. Bayer. Accessed July 12, 2022. https://www.businesswire.com/news/home/20220712005124/en/Astepro%C2%AE-Allergy-First-and-Only-Steroid-Free-Antihistamine-Nasal-Spray-Now-Available-Over-the-Counter
2. Products: Astepro Allergy. Astepro Allergy. Accessed July 12, 2022. https://www.asteproallergy.com/products/astepro-allergy-nasal-spray

HealthDay News — The asthma drug fluticasone furoate is yet another medication that does not work for mild-to-moderate COVID-19, a new study finds. The study was published online July 13 in medRxiv, which publishes studies before they have been peer-reviewed.

“There was no evidence of improvement in time to recovery or reduction in hospitalizations in participants who took fluticasone furoate versus those who took a placebo,” lead researcher Adrian Hernandez, MD, executive director of the Duke Clinical Research Institute in Durham, North Carolina, said in a Duke news release.

The finding comes from a nationwide study of nearly 5000 participants that continues to evaluate the potential benefit of existing drugs to treat mild-to-moderate COVID-19. Fluticasone furoate is one of three US Food and Drug Administration-approved repurposed medications currently being tested against COVID-19.

Fluticasone furoate is an inhaled corticosteroid used to treat asthma, but it is not approved to treat COVID-19. This drug was tested because corticosteroids had seemed potentially beneficial for treating COVID-19 among nonhospitalized patients. Based on the findings, fluticasone furoate should not be used to treat COVID-19, the researchers stressed.

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Asthma exacerbations and systemic corticosteroid (SCS) prescriptions are significantly reduced in patients who receive dupilumab vs patients who receive omalizumab, benralizumab, or mepolizumab, according to study findings presented at the American College of Allergy, Asthma & Immunology (ACAAI) Annual Scientific Meeting, held from November 10 to 14, 2022, in Louisville, Kentucky.

Researchers conducted an exploratory review and analysis of US electronic medical record (EMR) data that included patients (N=5361) aged at least 12 years with an asthma diagnosis. Participants initiated dupilumab (n=2138), omalizumab (n=1313), benralizumab (n=918), or mepolizumab (n=992) between November 2018 and September 2020 and had 12 months pre- and post-index data. The primary outcome was to compare dupilumab, benralizumab, and mepolizumab in patients with at least 2 pre-index exacerbations.

Each of the comparison cohorts had inverse probability treatment weighting applied. Negative binomial regression models were used to analyze asthma exacerbations and SCS prescription orders. The researchers performed pairwise comparisons between dupilumab and omalizumab, benralizumab, or mepolizumab. Potential residual confounding in all models was adjusted for with doubly robust estimation.

At least 2 exacerbations in dupilumab (825), benralizumab (461), and mepolizumab (451) were observed among all patients during the pre-index period. The number of patients receiving omalizumab with at least 2 exacerbations pre-index was not mentioned. Dupilumab significantly reduced exacerbations in the post-index period (P <.0001) by 44% vs omalizumab, 24% vs benralizumab, and 28% vs mepolizumab.

There was a significant reduction in SCS prescriptions in the post-index period with dupilumab treatment by 28% vs omalizumab, 16% vs benralizumab, and 25% vs mepolizumab. Limitations of the study include the use of EMR data.

The study authors conclude, “This exploratory EMR study demonstrated a significantly greater reduction in asthma exacerbations and SCS prescription in patients prescribed with dupilumab vs those on omalizumab, benralizumab, or mepolizumab.”

Reference

Bleecker E, Blaiss M, Jacob-Nara J, et al. Real-world effectiveness of dupilumab and other biologics on asthma exacerbations and steroid prescriptions: US-ADVANTAGE Study. Ann Allergy Asthma Immunol. 2022;125(5):S38. doi:10.1016/j.anai.2022.08.611

HealthDay News — Children conceived with infertility treatment have an elevated risk for asthma and atopic conditions in early and middle childhood, according to a study published online April 21 in Human Reproduction.

Kristen J. Polinski, PhD, from the Eunice Kennedy Shriver National Institute of Child Health and Human Development in Bethesda, Maryland, and colleagues analyzed singletons and multiples born between 2008 and 2010 (5034 mothers and 6171 children) with follow-up until 2019 (2056 children in the middle childhood follow-up).

The researchers found that children conceived with any infertility treatment had an increased risk for persistent wheeze by age 3 years (relative risk [RR], 1.66; 95% CI, 1.17 to 2.33) when adjusting for parental atopy and other risk factors, compared with children conceived without treatment. Children conceived with treatment were more likely to have current asthma between ages 7 and 9 years (RR, 1.30; 95% CI, 0.98 to 1.71), as well as eczema (RR, 1.77; 95% CI, 1.25 to 2.49) and prescription of allergy-related medications (RR, 1.45; 95% CI, 1.06 to 1.99). When examining associations by infertility treatment type, effect sizes were similar.

“Our findings of similar effect sizes by infertility treatment type suggest either shared biological process of inducing ovulation leading to fetal exposure to supraphysiological hormone levels or underlying parental subfertility may contribute to risk,” the authors write.

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HealthDay News — Azithromycin helps improve asthma control and reduce exacerbations in children with poorly controlled asthma, according to a study published in the June issue of CHEST.

Jagat Jeevan Ghimire, MD, from All India Institute of Medical Sciences in New Delhi, and colleagues randomly assigned 120 children (5 to 15 years of age) with poorly controlled asthma to receive azithromycin 3 times weekly for 3 months along with standard treatment or standard treatment alone.

The researchers found that the numbers of children with well-controlled asthma according to Global Initiative for Asthma guidelines were 41 of 56 in the azithromycin group vs 10 of 56 in the control groups. The azithromycin group had a lower median number of exacerbations requiring emergency visit and steroid use (zero vs one). There was no difference observed between the groups for fractional exhaled nitric oxide level, spirometry parameters, positive throat swab results, or adverse effects.

“The beneficial effect of azithromycin was similar in children with eosinophilic versus noneosinophilic asthma and those 5 to 11 years of age and those 12 years of age or older,” the authors write.

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The CHRONICLE study (ClinicalTrials.gov Identifier: NCT03373045) is an ongoing, non-interventional, prospective, cohort study of adults with severe asthma who are currently receiving care from a specialist physician. Patients were eligible for the study if they had severe asthma for at least 12 months, were uncontrolled while receiving high-dose inhaled corticosteroids with additional controllers, and/or required systemic corticosteroids or monoclonal antibody therapy. 

To better understand the effectiveness of biologic therapy on patients with severe asthma, the researchers examined data from patients enrolled from February 2018 to February 2023 who had started a biologic. Annualized asthma exacerbation rates were compared by age group (18-49, 50-64, ≥65 years) and by biologic type (anti-immunoglobulin E [IgE] vs other biologics [anti-interleukin-5/5R/4Rs or antithymic stromal lymphopoietin]) 6 months before and after initiation of treatment. 

Results showed annualized asthma exacerbation rates were reduced in all age groups 6 months after compared with 6 months before initiating a biologic. Exacerbation rate reductions were found to trend higher among patients who received other biologics compared with those who received anti-IgE, respectively:

• 18 to 49 years of age: 61% (P <.0001) vs 40% 
• 50 to 64 years of age: 52% (P <.0001) vs 49% (P <.01)
• ≥65 years of age: 58% (P <.0001) vs 51%

Study authors concluded that “Biologic use improved asthma outcomes in adult patients with [severe asthma] in all age groups, without evidence of reduced effectiveness in older age. A trend of slightly reduced effectiveness of anti-IgE vs other biologics was observed.”

Disclosure: Some of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

Lianne Soller, PhD, from the University of British Columbia in Vancouver, Canada, and colleagues assessed the safety of multifood SLIT in 188 pediatric patients (aged 4 to 18 years) and the effectiveness of bypassing oral immunotherapy (OIT) buildup with an initial phase of SLIT.

The researchers found that 4 patients received epinephrine (2.10%) during buildup (2mg protein SLIT maintenance over the course of 3 to 5 visits) and went to the emergency department, although none experienced grade 4 (severe) reaction. Twenty patients had 50 low-dose oral food challenges to 300mg protein, with 70% of the oral food challenges successful in bypassing OIT buildup.

“Allergists are often quite burdened by the oral immunotherapy buildup phase, where a patient may require 11 or more visits to the clinic,” coauthor Edmond Chan, MD, also from the University of British Columbia, said in a statement. “In our clinic, we are starting to do more home-based approaches because the demand for medical appointments that would allow supervision far outstrips the supply. Our SLIT data suggests that home-based SLIT buildup is safe.”

Several authors disclosed ties to the pharmaceutical industry.

Abstract/Full Text

HealthDay News — Children’s asthma appears to be increasing in states that have legalized cannabis, according to a study published online December 30 in Preventive Medicine.

Renee D. Goodwin, PhD, from the City University of New York in New York City, and colleagues examined the relationship between cannabis legalization for medical or recreational use and the state-level prevalence of asthma among children in the US. The analysis included data from the National Survey on Children’s Health (2011 to 2019).

The researchers observed a statistically significant decrease of 1.1% in the prevalence of pediatric asthma from 2011-2012 to 2018-2019. Overall reductions in asthma over time were generally greater in states with no cannabis legalization when adjusting for sociodemographic characteristics, but the rate of decline did not differ statistically by recreational or medical legalization status. The prevalence of asthma increased among youth ages 12 to 17 years old (2018 to 2019 difference-in-difference [DID], 2.56) and youth in some minoritized race/ethnicity identity groups (2016 to 2017 DID, 3.88; 2018 to 2019 DID, 4.45) in states with recreational legalization, relative to 2011 to 2012 and to states where cannabis is illegal at the state level.

“Critical next steps in this line of research include examining whether secondhand cannabis smoke is associated with increases in asthma morbidity, such as symptom frequency, use of rescue medicines, impairment (e.g., missed school), and emergency medical services, to provide insight into the extent to which increased exposure to secondhand cannabis smoke is affecting youth health and functioning across domains,” the authors write.

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(HealthDay News) — In two January data briefs published by the U.S. Centers for Disease Control and Prevention National Center for Health Statistics, data are presented regarding the prevalence of seasonal allergy, eczema, and food allergy among children and adults in 2021.

Benjamin Zablotsky, PhD, from the National Center for Health Statistics in Hyattsville, Maryland, and colleagues used data from the 2021 National Health Interview Survey (NHIS) to describe the percentage of children who had diagnosed seasonal allergy, eczema, or food allergy. The researchers found that 18.9%, 10.8% and 5.8% had a seasonal allergy, eczema, and a food allergy, respectively, in 2021. The likelihood of having a seasonal allergy was higher for boys than girls (20.0% vs 17.7%). There was variation observed by age in the percentage of children with eczema (10.4%, 12.1%, and 9.8% in children aged 0 to 5, 6 to 11, and 12 to 17 years, respectively). The likelihood of having a food allergy was increased for non-Hispanic Black versus non-Hispanic White and Hispanic children.

Amanda E. Ng, MPH, and Peter Boersma, MPH, both from the National Center for Health Statistics, used 2021 NHIS data to describe the prevalence of seasonal allergy, eczema, or food allergy among adults. The researchers found that 25.7%, 7.3%, and 6.2% of adults had a seasonal allergy, eczema, and a food allergy, respectively, in 2021. Compared with Hispanic, non-Hispanic Black, and non-Hispanic Asian adults, the percentage of adults with a seasonal allergy was higher in non-Hispanic White adults. Women were more likely than men to have eczema (8.9% vs 5.7%). With increasing age, the prevalence of food allergy decreased.

“For all three allergies, women were more likely than men to have a diagnosed allergy,” Ng and Boersma write.

Data Brief – Children

Data Brief – Adults

The popularity of ChatGPT, an artificial intelligence (AI) chatbot, left researchers from the Cleveland Clinic wondering about its reliability as a medical information provider. To assess its capabilities, the researchers asked the chatbot to provide information on the prevalence, symptoms, diagnostic tests, management and prevention of drug allergies. The DISCERN instrument was used to assess the quality of the information provided by the chatbot and 4 reviewers were tasked with determining whether the AI answers matched the AAAAI/ACAAI drug allergy guidelines.

Results showed ChatGPT provided fair to good quality information (DISCERN score of 3.44/5) with 76% of the information matching guideline recommendations. “Fleiss κ score was 0.65, which represented substantial agreement between the graders of ChatGPT responses,” the authors added.

However, the chatbot failed when it came to providing accurate sources, with 60% consisting of expired web pages. Twenty-seven percent of the sources consisted of irrelevant or inaccurate links and 13% included nonspecific links.

“Artificial intelligence ChatGPT information on drug allergies appeared to reflect the currently accepted Allergy/Immunology guidelines but the chatbot was an unreliable source of information due to errors in all of the provided sources,” the authors concluded.