New research was presented at AAAAI 2022, the American Academy of Allergy, Asthma & Immunology Annual Meeting, held from February 25-28 in Phoenix and virtually. The features below highlight some of the studies emerging from the conference.
In Patients With Eosinophilic Esophagitis, Dupilumab Improves Symptoms
For a study, Marc Rothenberg, MD, PhD, and colleagues assessed the safety and efficacy of dupilumab 300 mg administered weekly or biweekly versus placebo for up to 24 weeks in adolescents and adults with eosinophilic esophagitis (EoE). More than one-half (58.8%) of patients in the dupilumab group achieved histological remission (peak esophageal intraepithelial eosinophil count of ≤6 eosinophils/hpf) at 24 weeks, compared with 6.3% of patients in the placebo group. The dupilumab group experienced least squares mean absolute changes in Dysphagia Symptom Questionnaire scores of 223.78, compared with 213.86 for the placebo group. Treatment-emergent adverse event rates were 83.8% and 70.5% in the dupilumab and placebo groups, respectively, and mostly included injection site reactions and fever.
Outcomes Improved With Omalizumab in Patients With Nasal Polyps Regardless of Asthma Status
With evidence that asthma is commonly comorbid in patients with nasal polyps, Phillippe Gevaert, MD, and colleagues sought to understand the response to omalizumab in adults with nasal polyps with and without comorbid asthma from the 28-week open-label extension (OLE) of the 24-week POLYP1/2 trials. During the OLE, patients treated with omalizumab experienced improvements in physician-measured nasal polyp scores, as well as patient-measured nasal congestion and sino-nasal outcome test (SNOT-22) scores, regardless of whether they were transitioning from placebo or omalizumab. Patients with and without asthma experienced similar outcome improvements.
HLA Genetics Impact Peanut Oral Immunotherapy Response
Expanding upon previous identification of a role played by human leukocyte antigen (HLA)-DQA1*01:02 in peanut allergy, Rasika Mathias, PhD, and colleagues conducted two oral immunotherapy (OIT) trials (IMPACT and POISED) in patients with peanut allergy. Carriers of HLA-DQA1*01:02 in the IMPACT trial were more likely to be desensitized to peanut (93%) than non-carriers (78%) and more likely to be tolerant (35%) than non-carriers (22%), while carriers in POISED were more likely to achieve sustained unresponsiveness than noncarriers. Peanut component-specific IgG4 profiles among those in the OIT arm of IMPACT (aged 12-48 months) recapitulated patterns seen in prior research, whereas no such associations were observed in POISED participants (aged 7-53). “Findings across three clinical trials implicate a role for gene-environment interactions, and support a hypothesis that age, baseline characteristics and HLA genetics may not only be an important part of a mechanism of antigen recognition fundamental to driving immune responses related to allergy protection/risk, but also potentially relevant for response to OIT,” wrote Dr. Mathias, et al.
Asthma Exacerbations Reduced With Inhaled Glucocorticoid Provision
With guideline recommendations based on studies in other populations and mostly unsuccessful previous efforts to reduce the disproportionate burden of asthma in Black and Latinx patients, Elliot Israel, MD, and colleagues compared usual care with a patient-activated, reliever-triggered inhaled glucocorticoid strategy (beclomethasone dipropionate, 80 μg) plus usual care (intervention) in randomly assigned Black and Latinx adults with moderate-to-severe asthma. Annualized rates or severe asthma exacerbations were 0.69 and 0.82 in the intervention and usual care groups, respectively (HR, 0.85). The intervention group experienced Asthma Control Test and Asthma Symptom Utility Index score increases of 3.4 and 0.12 points, respectively, compared with 2.5 and 0.08 points, respectively, in the usual care group. Annualized rates of missed days of work, school, or usual activities were 13.4 in the intervention group and 16.8 in the usual care group. Serious adverse events (12.2% overall) were evenly distributed between the groups.
Direct Oral Penicillin Challenge Safe for Even High-Risk Children
Based on findings from prior research that nine out of 10 patients with reported penicillin allergy are not truly allergic upon formal evaluation, Susan Xie, MD, and colleagues assessed risk stratification and penicillin drug provocation challenge (DPC) outcomes in patients within a penicillin allergy testing registry. Participants were deemed “no risk” (benign rash at least 1 year prior, mild somatic symptoms, or unknown/family penicillin allergy history), “low-risk” (benign rash within previous year, swelling, difficulty breathing, or reactions to all penicillins/cephalosporins), or “high-risk” (serum sickness-like reaction, anaphylaxis, severe cutaneious reaction, or prior positive penicillin skin testing or DPC). Although less than one-third of high-risk patients underwent DPCs, compared with more than one-half of no- and low-risk patients, tolerance rates were greater than 90% for all risk tiers, including 94% of high-risk patients who underwent DPCs. “By demonstrating that a large proportion of pediatric patients with traditionally high-risk reaction histories are actually non-allergic when challenged, we can safely consider more patients for penicillin allergy de-labeling,” said Dr. Xie.