Background: Asthma is characterized by chronic airway inflammation, which has traditionally been evaluated primarily for functional impairment. In contrast, relatively little attention has been paid to local heat generation within the airways. Objective: This study aimed to explore expiratory thermal dynamics in patients with asthma by assessing exhaled air temperature and expiratory heat flux (the rate of heat transfer per unit area). Methods: We developed a novel device incorporating an exhaled air temperature sensor and a heat flux meter, enabling real-time graphical visualization of expiratory thermal dynamics. Expiratory heat flux and the rate of increase in exhaled air temperature per unit volume of vital capacity were measured in a single-session assessment in healthy control subjects (n = 30) and patients with asthma (n = 27) prospectively enrolled in this exploratory cross-sectional study. Results: Preliminary experiments demonstrated that expiratory heat flux was less influenced by oral temperature and smoking status than exhaled air temperature alone. Although the maximum exhaled air temperature did not differ significantly between patients with asthma and controls, both expiratory heat flux and the rate of temperature increase per unit volume of vital capacity were significantly higher in patients with asthma than in healthy subjects. Conclusion: These findings indicate that expiratory heat flux, together with dynamic changes in exhaled air temperature, reflects altered expiratory thermal dynamics in asthma. Noninvasive assessment of these thermal parameters may complement existing physiological measures and provide novel pathophysiological insights into allergic airway diseases.
Background: Penicillin allergy labels (PALs) are common and are associated with the use of alternative antibiotics, increased healthcare costs, and poorer clinical outcomes. Data on the prevalence and characteristics of PALs among hospitalized patients in Latin America remain limited. Objective: The study aimed to determine the prevalence of PALs and stratify the risk of true penicillin allergy among hospitalized adults. Methods: Data were collected through direct patient interviews and medical record review. Among patients with a PAL, the PAL was obtained by patient self-report; characteristics of the reported allergic reaction were recorded, and risk was assessed using the PEN-FAST clinical decision rule. Multivariable logistic regression was performed to identify factors associated with a PAL. Results: Among 872 patients, 65 had a PAL (7.5%; 95% confidence interval, 5.8%–9.5%). Of these, 21.5% reported a reaction within the previous 5 years, 26.2% had a history of angioedema or anaphylaxis, no severe cutaneous adverse reactions were identified, and 21.5% required medical attention. Most patients were classified as very low/low risk (89.2%), whereas only 4.6% were categorized as high risk. Female sex (adjusted odds ratio [aOR], 2.25; P = 0.004), age ≥50 years (aOR, 1.90; P = 0.019), hypothyroidism (aOR, 3.75; P = 0.006), and antibiotic use within the previous 3 months (aOR, 1.82; P = 0.032) were associated with a PAL. Conclusion: Fewer than 10% of hospitalized adults carried a PAL, and nearly 90% were classified as very low or low risk, suggesting that many may be candidates for penicillin allergy evaluation and potential delabeling.
Background: Telemedicine has become an essential tool in healthcare, providing an alternative platform for managing chronic diseases. While telemedicine has shown patient satisfaction in general dermatology, limited research has focused on its effectiveness and satisfaction specifically for chronic spontaneous urticaria. Objectives: The study aimed to compare disease activity and quality of life in chronic spontaneous urticaria patients managed via telemedicine versus in-person visits and to assess patient satisfaction with telemedicine. Methods: A prospective study was conducted with 50 chronic spontaneous urticaria patients, equally divided into telemedicine and in-person groups. Disease activity and control were evaluated using the Urticaria Activity Score 7. Quality of life was measured using the Thai Chronic Urticaria Quality of Life Questionnaire, and satisfaction was assessed using the Telehealth Usability Questionnaire. Results: At baseline, the mean Urticaria Activity Score 7 was 11.68 ± 9.19 in the telemedicine group and 7.60 ± 7.69 in the in-person group ( P = 0.095), with 11/25 (44.0%) and 14/25 (56.0%) achieving disease control, respectively ( P = 0.396). After 24 weeks, disease control was observed in 24/25 (96.0%) in the telemedicine group and 20/25 (80.0%) in the in-person group ( P = 0.189). Comparable improvements were observed in Thai Chronic Urticaria Quality of Life Questionnaire ( P = 0.806). Satisfaction with telemedicine was high, with a mean Telehealth Usability Questionnaire score of 4.66 ± 0.26. Conclusion: Telemedicine is a feasible and effective alternative for the management of chronic spontaneous urticaria, providing disease control and quality of life improvements that were noninferior to in-person care, with high patient satisfaction.
Chronic mucocutaneous candidiasis (CMC) is a clinical phenotype resulting from several distinct inborn errors of immunity that is commonly caused by STAT1 gain-of-function (GOF) mutations. Variants within the transactivation domain (TAD) are rare, representing a small minority of STAT1-GOF cases. We report a 2-year-old girl with refractory onychomycosis and oral and cutaneous candidiasis, carrying a heterozygous STAT1 TAD variant, p.(Thr720Ile). This variant has been reported previously in an adult with CMC and functionally characterized, with increased phosphorylated STAT1 following stimulation and reduced circulating Th17 cells. However, the precise biochemical mechanism by which TAD variants produce this remains less well-defined. This report highlights a rare TAD variant of CMC that initially presented with features resembling inverse psoriasis, emphasizing the role of early genetic diagnosis in coordinating long-term surveillance for malignant, autoimmune, and vascular comorbidities.
Background: In the MERAK study, stapokibart (an anti-IL-4Rα mAb) as an add-on treatment did not demonstrate statistical significance in improving the primary endpoint in the overall population of patients with moderate-to-severe uncontrolled seasonal allergic rhinitis (SAR). Objective: This study aimed to investigate biomarkers that can identify patients who may experience enhanced benefit from the add-on use of stapokibart. Methods: Patients were randomized 1:1:1 to stapokibart 600–300 mg once weekly, stapokibart 600–300 mg every 2 weeks, or placebo once weekly for a 4-week treatment period. The primary endpoint was the mean change from baseline in the daily reflective total nasal symptom score during 2-week treatment. Levels of prespecified biomarkers involved in the pathogenesis of SAR were determined in nasal brushings, nasal secretions, and peripheral blood samples of participants. This post hoc analysis assessed the efficacy and safety of stapokibart based on biomarker-defined subgroups. Biomarker subgroups in which patients demonstrated statistically significant improvements in the primary efficacy endpoint after treatment with stapokibart (both dose regimens compared with placebo) were considered to be of stratification value. Results: Among the biomarkers we screened, baseline nasal brushing arachidonate 15-lipoxygenase ( ALOX15 ) was the only biomarker that met the predefined criteria of a biomarker with stratification significance. In patients with a baseline nasal brushing ALOX15 mRNA level ≥median, significant improvements in nasal and ocular symptoms and quality of life were seen in patients on stapokibart compared with those on placebo. However, in patients with a nasal brushing ALOX15 mRNA level Conclusion: In patients with moderate-to-severe uncontrolled SAR, those with higher nasal brushing ALOX15 mRNA levels benefit more from stapokibart as an add-on treatment in ameliorating symptoms and improving quality of life.
