ImportanceAsthma is a multifactorial disease composed of endotypes with varying risk profiles and outcomes. African Americans experience a high burden of asthma and of psychosocial stress, including racial discrimination. It is unknown which endotypes of asthma are vulnerable to racial/ethnic discrimination.ObjectiveWe examined the association between self-reported racial/ethnic discrimination and bronchodilator response (BDR) among African American youth with asthma ages 8 to 21 years (n = 576) and whether this association varies with tumor necrosis factor alpha (TNF-α) level.Materials and methodsSelf-reported racial/ethnic discrimination was assessed by a modified Experiences of Discrimination questionnaire as none or any. Using spirometry, BDR was specified as the mean percentage change in forced expiratory volume in one second before and after albuterol administration. TNF-α was specified as high/low levels based on our study population mean. Linear regression was used to examine the association between self-reported racial/ethnic discrimination and BDR adjusted for selected characteristics. An interaction term between TNF-α levels and self-reported racial/ethnic discrimination was tested in the final model.ResultsAlmost half of participants (48.8%) reported racial/ethnic discrimination. The mean percent BDR was higher among participants reporting racial/ethnic discrimination than among those who did not (10.8 versus 8.9, p = 0.006). After adjustment, participants reporting racial/ethnic discrimination had a 1.7 (95% CI: 0.36–3.03) higher BDR mean than those not reporting racial/ethnic discrimination. However, we found heterogeneity of this association according to TNF-α levels (p-interaction = 0.040): Among individuals with TNF-α high level only, we observed a 2.78 higher BDR mean among those reporting racial/ethnic discrimination compared with those not reporting racial/ethnic discrimination (95%CI: 0.79–4.77).ConclusionsWe found BDR to be increased in participants reporting racial/ethnic discrimination and this association was limited to African American youth with TNF-α high asthma, an endotype thought to be resistant to traditional asthma medications. These results support screening for racial/ethnic discrimination in those with asthma as it may reclassify disease pathogenesis.
This cohort study assesses whether removal of a warning against use of cephalosporins in the electronic health record (EHR) of patients with penicillin allergy was associated with changes in the dispensing or administration of cephalosporins.
RATIONALE: Adults and adolescents with severe asthma who completed the SIROCCO (48 weeks) and CALIMA (56 weeks) Phase III benralizumab trials entered the safety extension BORA (NCT02258542) study. Benralizumab's continued safety and efficacy in the first year of BORA (Year 2 of treatment) have been reported (Lancet Respir Med 2019;7:46-59). We present outcomes for 2 years of benralizumab treatment for BORA adolescent patients. METHODS: SIROCCO/CALIMA study patients who received benralizumab 30 mg every 4 weeks (p-Q4W) or every 8 weeks (p-Q8W) continued their regimens in BORA (108 weeks). Placebo (p-pbo) patients were rerandomized 1:1 to benralizumab Q4W or Q8W. Primary outcome was safety. Secondary outcomes included annual asthma exacerbation rate and change from baseline in prebronchodilator forced expiratory volume in 1 second (pre-FEV 1). RESULTS: This analysis included 86 adolescents, 61 receiving Q8W and 25 receiving Q4W. Of those, 69 completed treatment (51 Q8W patients). Safety profile was consistent with previous studies (treatment-emergent adverse events [TEAEs]: Q8W: 74% [45/61], Q4W: 68% [17/25]; TEAEs leading to death or discontinuation: Q8W: none, Q4W: none [death] and 4% [1/25] [discontinuation]; serious adverse events: Q8W: 7% [4/61], Q4W: 8% [2/25]). Efficacy was consistent with previous BORA findings. With Q8W, 69% (42/61) remained exacerbation-free (p-pbo/Q8W: 62% [18/29], p-Q8W/Q8W: 75% [24/32]). Pre-FEV 1 mean change (SD) at Week 108 vs. BORA baseline were 0.327 L (0.452) (p-pbo/Q8W) and 0.323 L (0.558) (p-Q8W/Q8W). CONCLUSIONS: Safety and efficacy profiles in this 2 year extension study, representing up to 3 years of benralizumab treatment in adolescents, were consistent with previous findings.
RATIONALE: Carboplatin is chemotherapy of choice for treatment of gynecologic malignancy. Patients received multiple course therapy have increase rate of hypersensitivity reaction (HSR) up to 27%. Switch to alternative regimens may shorten progression free survival (PFS) and overall survival (OS). Rapid desensitization has been used to provide safe reintroduction of carboplatin treatment. METHODS: Retrospective review of consecutive patients experienced carboplatin HSR who visit Allergy clinic, Ramathibodhi hospital from June 2010 to June 2020 were collected. Onco-Gynecology -Allergy multidisciplinary team workflow was established in 2016 to offer rapid access to skin test (ST). Patients who had initial negative carboplatin ST were follow and repeated ST until conversion to positive or completion of carboplatin treatment. Patient's demographic data, including disease status and severity of initial HSR to carboplatin were collected. RESULTS: Seventy-one patients were included. Mean age was 57.8 years (SD 9.93). Majority of patients (80.3%) were recurrent disease, mostly on second course of carboplatin. Mean carboplatin cycle before developing initial HSR was 15.35 (range 6-42, SD 6.211). One-third of patients (38.0%) had only mild cutaneous reaction, while 18.3% had anaphylactic shock. Skin test positive was found in 55 patients (77.5%). Of 16 patients with Initial negative ST results, 6 patients changed chemotherapy regimens, while all of 10 patients who continue the same regimen converted to positive result at a median of 2.1 cycles (range 1-4). CONCLUSIONS: Multidisciplinary team approach provided rapid accessibility to ST to carboplatin. Interestingly all patients were finally converted to positive result at a median of 2.1 cycles.
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