ICON: Diagnosis and Management of Allergic Conjunctivitis Publication date: Available online 21 November 2019 Source: Annals of Allergy, Asthma & Immunology Author(s): Leonard Bielory, Luis Delgado, Constance H. Katelaris, Andrea Leonardi, Nelson Rosario, Pakit Vichyanoud Abstract: 19-09-0439R1 Ocular allergy (OA), interchangeably known as allergic conjunctivitis, is a common immunological hypersensitivity disorder affecting up to 40% of the population. OA has been increasing in frequency with symptoms of itching, redness, and swelling that significantly impacts an individual’s quality of life (QOL). OA is an often underdiagnosed and under-treated health problem as only 10% of patients with OA symptoms seek medical attention while the majority of patients manage with over the counter medications and complementary nonpharmacological remedies. The clinical course, duration, severity, and co-morbidities are varied and depend, in part, on the specific ocular tissues that are affected and on immunologic mechanism(s) involved, both local and systemic. It is frequently associated with allergic rhinitis (commonly recognized as allergic rhino conjunctivitis), and with other allergic comorbidities. The predominance of self-management increases the risk of suboptimal therapy that leads to recurrent exacerbations and the potential for development of more chronic conditions that can lead to corneal complications and interference with the visual axis. There are multiple, often co-existing etiologies, and a broad differential diagnosis for OA increasing the difficulty for arriving at the correct diagnosis(es). OA commonly overlaps with other anterior ocular disease disorders including infectious disorders and dry eye syndromes. Therefore, successful management includes overcoming the challenges of under diagnosis and even misdiagnosis by a better understanding of the subtleties of an in-depth patient history, ophthalmologic examination techniques, and diagnostic procedures which are of paramount importance in making an accurate diagnosis of OA. Appropriate cross referral between specialists (allergists, and eyecare specialists) would maximize patient care and outcomes. This would significantly improve OA management and overcome the unmet needs in global health.

Limited diagnostic value of total serum IgG4 measurements in adult patients Publication date: Available online 20 November 2019 Source: Annals of Allergy, Asthma & Immunology Author(s): Iago Carballo, Bernardo Sopeña, Mayka Freire, Carmen Vidal, Arturo Gonzalez-Quintela

Asthma: An Illustration of Health Care Disparities Publication date: Available online 19 November 2019 Source: Annals of Allergy, Asthma & Immunology Author(s): Cherie Y. Zachary, Thomas A. Scott, Michael Foggs, J. Allen Meadows

Illness perceptions in difficult to treat asthma compared with a depressed psychosis cohort Publication date: Available online 19 November 2019 Source: Annals of Allergy, Asthma & Immunology Author(s): Jodie L. Fellows, Aimee Stimpson, Hanan Hussein, Adel H. Mansur

Decades of Poor Availability of Epinephrine Auto-Injectors – Global Problems in Need of Global Solutions Publication date: Available online 18 November 2019 Source: Annals of Allergy, Asthma & Immunology Author(s): Susan Waserman, Ernie Avilla, Laurie Harada, Joni Huang, Monika Kastner

Skin Testing with Ultraheat Treated (UHT) Cow’s Milk in Children with Cow’s Milk Allergy. Publication date: Available online 18 November 2019 Source: Annals of Allergy, Asthma & Immunology Author(s): Bella Shadur, Andrew Fong, Betina Altavilla, Rebecca Anne Saad, Brynn Kevin Wainstein

Efficacy and Safety of Twice-daily and Once-daily Olopatadine-Mometasone Combination Nasal Spray for Seasonal Allergic Rhinitis Publication date: Available online 15 November 2019 Source: Annals of Allergy, Asthma & Immunology Author(s): Charles P. Andrews, Dale Mohar, Yacine Salhi, Sudeesh K. Tantry ABSTRACT BACKGROUND GSP301 is an investigational fixed-dose combination nasal spray of olopatadine hydrochloride (antihistamine) and mometasone furoate (corticosteroid). OBJECTIVE To evaluate efficacy and safety of GSP301 in patients with seasonal AR (SAR). METHODS In this phase 2, double-blind, parallel-group study, patients (≥12 years of age) with SAR were equally randomized to twice-daily GSP301 (olopatadine 665μg and mometasone 25μg), once-daily GSP301 (olopatadine 665μg and mometasone 50μg), twice-daily or once-daily olopatadine monotherapy (665μg), mometasone monotherapy (twice-daily 25μg or once-daily 50μg), or placebo for 14 days. The primary endpoint—mean change from baseline in morning and evening reflective Total Nasal Symptom Score (rTNSS)—was analyzed using ANCOVA (P<0.05=statistically significant). Average morning and evening 12-hour instantaneous TNSS (iTNSS), ocular symptoms, individual symptoms, onset of action, quality of life, and adverse events (AEs) were also assessed. RESULTS A total of 1,111 patients were randomized. Twice-daily GSP301 provided statistically significant and clinically meaningful rTNSS improvements versus placebo (P<0.001), twice-daily olopatadine (P=0.049) and mometasone (P=0.004). Similar significant improvements in iTNSS were observed with twice-daily GSP301 versus placebo (P<0.001) and twice-daily mometasone (P=0.007); improvements were not significant versus olopatadine (P=0.058). Once-daily GSP301 provided significant rTNSS and iTNSS improvements versus placebo and once-daily olopatadine (P<0.01, all) but improvements were not significant versus mometasone. Treatment-emergent AEs rates were 10.8%, 9.5%, and 8.2%, with twice-daily GSP301, once-daily GSP301, and placebo, respectively. CONCLUSION Twice-daily GSP301 treatment was efficacious and well tolerated, providing statistically significant and clinically meaningful improvements in rTNSS (primary endpoint) versus placebo and both monotherapies.

Risk factors for wheezing in primary health care settings in the tropics Publication date: Available online 15 November 2019 Source: Annals of Allergy, Asthma & Immunology Author(s): Désirée Larenas Linnemann, Sergio Romero Tapia, Cesar Virgen, Javier Mallol, Manuel Antonio Baeza Bacab, Luis García Marcos Background The "International Study of Wheezing in Infants (EISL)", is a cross-sectional, population-based study, based on ISAAC. "(Http // www.isaac.auckland.ac.nz). It uses a validated questionnaire on early wheezing and risk/protective factors. Objective To apply EISL questionnaire regarding wheezing events in 0-12months' infants with/without atopic background searching for risk-factors in the tropics. Methods Population: toddlers coming in for check-up or 12-months’ vaccination in primary health care clinics of a tropical city. Apart from child factors (i.e. day-care attendance) we evaluated home factors (i.e. air-conditioning, bathroom, carpet, >6 persons, pollution) and mother’s factors (i.e. education level, employment, cellphone). Data analysis was descriptively and case-control, with as cases atopic (AW) or nonatopic (NAW) wheezing children versus healthy controls. Wheezing-associated factors were evaluated using multivariate analysis, adjusted for the relation of AW/NAW with factors, significant in prior univariate analysis. Results 999 included toddlers. Any wheeze: 31.3%, recurrent wheeze (≥3 episodes): 12.1%. Major risk-factors for AW (OR;95%CI): smoking (11.39;2.36-54.99), common cold <3mo of life (3.72;2.59-5.36), mold (3.48;2.28-5.30), kitchen indoors (2.40;1.27-4.54) and pets (1.69;1.09-2.62); breastfeeding was almost protective. For NAW common cold and pets were risk-factors, but caesarean section (0.44;0.23-0.82), >1 sibling (0.33;0.18-0.61) and breastfeeding >3m (0.50;0.28-0.91) protective. Conclusion Wheezing is a health care burden. We found potential new risk-factors for AW, some possibly unique for tropical climates. We suggest testing several hypotheses: could early AW be reduced in the tropics attacking mold growth? enhancing cooking place ventilation? keeping pets outside? Or by postponing day-care attendance till after four months and avoiding (passive) smoking during pregnancy?

Adverse effects of TNF inhibitor in a patient with DiGeorge syndrome and juvenile idiopathic arthritis Publication date: Available online 14 November 2019 Source: Annals of Allergy, Asthma & Immunology Author(s): Mario Sestan, Nastasia Kifer, Marijan Frkovic, Ana-Marija Laskarin, Marija Jelusic

A twelve steps desensitization protocol for pediatric patients with hypersensitivity to PEG-asparaginase Publication date: Available online 14 November 2019 Source: Annals of Allergy, Asthma & Immunology Author(s): S. Concha, F. Barriga, P. Ovalle, R. Hoyos-Bachiloglu