Background Fluoroquinolone allergy is the third most commonly reported antibiotic allergy. Cross-drug reactions among fluoroquinolones remain a clinical concern, though existing studies are limited by small sample sizes and the lack of control groups. Objective This study aimed to assess the real-world frequency and risk of potential fluoroquinolone cross-drug reactions using a large healthcare database. Methods We performed a retrospective analysis using the TriNetX database in September 2025. Patients with an allergy label to ciprofloxacin, levofloxacin, or moxifloxacin who were subsequently exposed to a different fluoroquinolone were identified. Potential cross-drug reactions following second fluoroquinolone exposure were assessed based on ICD-10-CM diagnosis codes. Odds ratios for potential cross-drug reactions were calculated. Results The frequencies of potential cross-drug reactions following a second fluoroquinolones exposure were as follows: 2.6% (index allergy to ciprofloxacin, subsequent allergy to levofloxacin), 1.5% (ciprofloxacin → moxifloxacin), 2.7% (levofloxacin → ciprofloxacin), 1.3% (levofloxacin → moxifloxacin), 2.9% (moxifloxacin → ciprofloxacin), 2.9% (moxifloxacin → levofloxacin). Compared to patients without an index fluoroquinolone allergy, the odds of experiencing a potential cross-drug reactions were slightly higher in some drug pairs: 1.18 (ciprofloxacin → levofloxacin; 95% CI 1.06 – 1.31; p <0.05), 1.12 (levofloxacin → ciprofloxacin; 95% CI 1.01 – 1.23; p < 0.05), and 1.31 (moxifloxacin → ciprofloxacin; 95% CI 1.12 – 1.54; p <0.05). Conclusions Potential cross-drug reactions between ciprofloxacin, levofloxacin, and moxifloxacin were rare (∼2%) and slightly increased the odds of subsequent reaction in some drug pairs. These findings suggest class-wide avoidance may be unnecessary and support drug challenge as a safe strategy in selected patients. Interpretation of our findings should be cautious, as this is an ICD-10 code-based approach without detailed mechanisms.
In refractory nocturnal anaphylaxis, hidden allergens such as human seminal plasma allergy should be considered. Basophil activation testing using simple semen preparations may provide supportive ex vivo evidence, and in vitro fertilization provides a definitive, allergen-free route to successful pregnancy.
Background The US Food and Drug Administration recommends deferring administration of live vaccines during dupilumab treatment owing to lack of data on safety and efficacy. Understanding the safety profile of measles, mumps, and rubella (MMR) and varicella administration in children taking dupilumab is important to promote appropriate vaccination. Objective Our aim was to determine the safety of MMR and varicella immunizations during treatment with dupilumab and the impact of dupilumab on MMR and varicella vaccination rates in early childhood. Methods We performed a single-center retrospective review of children younger than 9 years who were taking dupilumab and had available vaccination records. The primary outcome measures were vaccine-associated infections, vaccine-associated adverse events, and rate of immunization. Results Of the 19 patients who received MMR and varicella immunization while taking dupilumab, none experienced severe vaccine-associated events or vaccine-associated infections. One patient reported fever and injection site reaction, and 5 reported a flare of atopic dermatitis (AD). In all, administration of 21 varicella boosters (9.7%) and 25 MMR boosters (11.5%) were delayed because the children were taking dupilumab. There was a significant delay in the age of administration of MMR boosters and varicella boosters when before– and after–dupilumab therapy rates were compared. Conclusion MMR and varicella immunization may be safe to administer to children undergoing dupilumab therapy. Pausing dupilumab therapy for administration of live vaccines may lead to flare of underlying AD. Further, dupilumab treatment in early childhood may result in decreased and/or delayed vaccination rates for MMR and varicella. Our findings support the recent recommendation that immunizations not be delayed while patients are receiving dupilumab.
Background:Social determinants of health (SDOH) and environmental triggers contribute to risk of asthma exacerbations. Electronic health record data rarely capture complete SDOH and asthma trigger information, thereby limiting comprehensive risk factor assessments absent additional data sources. Objective:We collected detailed SDOH and trigger data from patients with asthma who were identified from electronic health records to better understand modifiable risk factors contributing to risk of asthma emergency department (ED) visits. Methods:We invited patients with asthma identified through the Penn Medicine electronic health record to complete an online questionnaire covering SDOH, asthma triggers, and asthma history. Zero-inflated Poisson regression models were fit to identify factors associated with ED visits for asthma, and hierarchical agglomerative clustering was used to explore underlying patterns in the data. Results:Among 974 survey respondents, 206 reported one or more asthma-related ED visit in the last year. Nearly all SDOH and asthma trigger variables were significantly associated with asthma ED visits in univariable models, but most of these effects were strongly attenuated in multivariable regression models. The effect of race, however, remained strong in both models. Post hoc analyses showed that additionally adjusting for SDOH variables attenuated the relationships between asthma triggers and ED visits. Cluster analysis revealed that the subgroup of participants reporting highest social vulnerability and most asthma triggers also had the most asthma-related ED visits, hospitalizations, and days missed of work or school (all P < 10-4). Conclusion:Self-reported SDOH and asthma trigger data are useful to identify subpopulations at highest risk for adverse asthma outcomes.
Background:Penicillin allergy prevalence is reported in up to 10% of patients and is linked to broad-spectrum antibiotic overuse, extended hospitalizations, and higher mortality. Its prevalence has not previously been evaluated in Sweden. Objective:The aim of this study was to investigate the prevalence and characteristics of penicillin allergy labels (PALs) in the electronic medical records of 3 Swedish regions (1,088,000 inhabitants). Methods:A retrospective analysis of PALs in the electronic medical records in the Southeast Healthcare Region of Sweden and estimation of point prevalence were performed. Two nonoverlapping cohorts were defined by label complexity: a simple cohort with pre-2017, nonstandardized labels identified by keywords (n = 7,514), and a complex cohort (n = 22,736) with post-2017, standardized labels identified using Anatomical Therapeutic Chemical codes. Results:Point prevalence of PALs was 2.8% across all regions (69.6% female). Differences were noted across the 3 regions for the different phenotypes. The regional prevalences of skin symptoms were 15.9-32.2% for urticaria and angioedema, 2.4-23.8% for maculopapular or undefined rash, and 4.9-7.6% for flushing. Severe reactions were rare (3.0-6.9%). Mild nonallergic symptoms appeared in 1.9-2.0%, with unclear symptoms in 24.4-64.7%. The most prevalent culprits were narrow-spectrum penicillins (32.9-48.1%). Multidrug-resistant bacteria were significantly more prevalent in all regions among patients with a PAL (Östergötland, P = .03, Jönköping, P < .001 and Kalmar, P = .049). Conclusion:Overall, 2.8% of the study population carried a PAL. Labels need to be better documented: Up to two thirds lacked sufficient information to determine the phenotype and other characteristics of the reactions. Moreover, antimicrobial resistance was more prevalent among patients with a PAL.
A 37-year-old renal transplant candidate experienced recurrent perioperative anaphylaxis during induction. Skin testing during a comprehensive allergy evaluation identified chlorhexidine allergy. After chlorhexidine avoidance and use of povidone iodine, the patient subsequently underwent successful renal transplantation without complications.
Background Evidence on real-world adherence to asthma biologic therapies and the relevance to clinical outcomes in asthma is limited. Objective To evaluate biologic use patterns and the relationships between adherence, clinical and healthcare resource utilization (HCRU) outcomes, and economic burden in patients with asthma. Methods This was a retrospective observational study using Optum’s de-identified Market Clarity Data (Optum® Market Clarity) from 2007–2023, in adults in the US with an asthma diagnosis in the 12 months prior to first biologic dose (index date) who had ≥12 months’ follow-up. Medication possession ratio (MPR; number of doses taken/dosing intervals) and group-based trajectory modeling (GBTM) identified distinct patient adherence patterns and assessed impact on exacerbations, HCRU and costs (all-cause/asthma-related). Results Overall, 10,088 eligible patients were included in the MPR analysis; 54.7% discontinued treatment, 5.2% were minimally adherent, 20.3% were partially adherent, and 19.8% were adherent. Of these, 9553 did not switch biologic during follow-up and were included in the GBTM analysis. For patients with ≥1 follow-up dose (n=8151), MPRs revealed suboptimal biologic adherence (average range: 40.6–64.0%). GBTM identified seven adherence clusters, with distinct adherence trajectories categorized from highest to lowest levels of biologic adherence. Patients with the highest adherence generally demonstrated the best outcomes. In patients in less adherent groups, increases were seen in exacerbations defined by asthma-related hospitalizations, all-cause HCRU, and all-cause healthcare costs. HCRU and asthma-related costs were generally lower for patients with the highest adherence. Conclusions Treatment adherence was consistently associated with better all-cause and asthma-related outcomes, highlighting the importance of biologic adherence in patients with asthma.
Background:Atopic dermatitis (AD) is a chronic inflammatory skin disease marked by severe itching and eczematous lesions, primarily driven by immune system dysregulation. Current treatments largely focus on symptom relief rather than addressing underlying immune dysfunction. The parasitic nematode Toxocara canis secretes excretory-secretory proteins, among which C-type lectin (CTL) has notable immunomodulatory properties that may offer a novel therapeutic approach for AD. Objective:We sought to evaluate the therapeutic potential of T canis recombinant CTL (rCTL) in a BALB/c mouse model of AD. Methods:Thirty-five mice were divided into 7 groups; all except from the normal control group were sensitized and challenged with 2,4-dinitrochlorobenzene to induce AD-like symptoms. Treatment groups received rCTL, topical or injected dexamethasone, or bacterial lysate. The prevention group was pretreated with rCTL (subcutaneously and intraperitoneally) before 2,4-dinitrochlorobenzene exposure. Dermatitis severity was assessed biweekly, and pruritus was quantified through blinded video analysis of scratching behavior. Serum IgE levels were measured via ELISA, and histopathologic analyses examined epidermal and dermal changes. Results:T canis rCTL significantly reduced dermatitis severity, pruritic behavior, and serum IgE compared with controls, including in dexamethasone-treated groups (P < .05). Histology revealed reduced epidermal thickening and decreased inflammatory cell infiltration in rCTL-treated mice, indicating effective suppression of allergic inflammation. The prevention achieved by rCTL was modest and not highly effective. Conclusions:T canis rCTL shows promising immunomodulatory effects, improving both clinical and histopathologic features of AD in mice. These findings highlight rCTL's potential as a novel immunotherapeutic agent, warranting further mechanistic and long-term studies to confirm clinical applicability.
Hypersensitivity to RhD immune globulin (RhIG) used to prevent hemolytic disease of the fetus and newborn is rare. We present the management of a patient with a history of reaction to RhIG, including prenatal assessment and postnatal provision of RhIG.
Background Eosinophilic esophagitis is an eosinophil-rich type 2 inflammatory disease with increasing global prevalence. Multicenter randomized trials are critical, but use of certain cutting-edge techniques, such as single-cell sequencing, can be challenging owing to a requisite need for immediate tissue processing. Methods We performed a pilot single-cell RNA sequencing (scRNA-seq) study using single esophageal biopsy samples in 3 processing protocols. Biopsy samples were processed as (1) fresh, (2) immediately frozen, or (3) frozen after dispersion to single cells. scRNA-seq was performed using 10× Genomics to understand cell type preservation despite freezing. Results Biopsy samples from 4 patients were processed with 1 or more of each of the fresh and frozen protocols. Comparison of the scRNA-seq profiles of frozen samples with those obtained using the criterion standard of fresh biopsy samples demonstrated that epithelial and mast cell transcriptomes were preserved in frozen dispersed cells and frozen tissues. Lymphocytes, myeloid cells, endothelial cells, and fibroblasts were present in all of the fresh samples. Fibroblast, myeloid, and endothelial cells were lost in immediately frozen tissue but relatively preserved in tissue dispersed to single cells and then frozen. All 9 epithelial cell clusters present in the fresh samples were preserved in dispersed frozen cells but variably retrieved from directly frozen tissue. Conclusion Single esophageal biopsy specimens can be used successfully in scRNA-Seq when samples are dispersed and frozen as single cells. Myeloid cell, endothelial cell, and fibroblast transcriptomes, as well as nondifferentiated epithelial cell transcriptomes, are not preserved when tissue samples are frozen without initial dispersion to single cells.
Background:There are limited data on allergy evaluation following suspected periprocedural hypersensitivity reactions, and skin testing for these reactions is not yet validated. Objective:We sought to describe the epidemiology of periprocedural reactions and safety and effectiveness of allergy testing in a contemporary US patient cohort. Methods:We performed a retrospective cohort study of adult patients evaluated at a tertiary-care academic center for presumed periprocedural hypersensitivity reaction from March 2013 to June 2023. We examined patient demographics, index reactions, tryptase levels, skin testing results, and tolerance of subsequent anesthesia. Results:Over 10 years, 74 patients underwent comprehensive allergy evaluation. Testing was positive in 30% (22/74). The most common culprits included antibiotics (10, 45%), local anesthetics (3, 14%), and neuromuscular blocking agents (3, 14%). Of 29 patients who received subsequent anesthesia, 28 (97%) didn't have reactions. Patients with perioperative anaphylaxis were more likely to have positive testing compared to patients with low-grade reactions (63% vs 9%, P < .001). Fifty-one percent (19/37) of patients tested within ≤6 months of index reaction had positive testing, versus 11% (4/38) tested at >6 months (P < .001). Conclusion:Periprocedural allergy testing was safe and effective in preventing future reactions. Testing was more likely to be positive if performed within 6 months of hypersensitivity reaction and in patients with high-grade index reactions. Antibiotics were the most common culprits; emerging agents like chlorhexidine and sugammadex were also identified. The landscape of POA is evolving, and formal US guidelines are needed to guide clinicians in evaluation.
Background The skin prick test (SPT) is a standard method for identifying allergic sensitization. However, pain and needle phobia often compromise pediatric compliance. Microneedle devices offer a minimally invasive alternative to conventional lancets. Objective We evaluated the agreement, diagnostic accuracy, and patient tolerability of a novel microneedle compared to a lancet for SPT. Methods Subjects with allergic rhinitis underwent SPT using both devices with Dermatophagoides pteronyssinus (Dp) extract, histamine, and saline controls. Net mean wheal diameters (MWD) were calculated by subtracting the saline MWD from the Dp and histamine MWDs. Agreement was assessed by Bland-Altman analysis and Cohen kappa (k), diagnostic performance by receiver operating characteristic analysis, and pain by a visual analog scale. Results Of 150 subjects (aged 8-60 years), 53.3% were sensitized to Dp. Both devices produced significantly larger Dp and histamine MWDs than saline MWD (P < .001). Median [interquartile range] Dp MWD was smaller with microneedle (2 [0-8.13] mm) than lancet (4 [0-12.5 mm], P < .001). For net Dp MWD, Bland-Altman analysis indicated a mean bias of −2.1 mm for microneedle, with 93.3% within the limits of agreement. With lancet used as the reference, the microneedle had an area under the curve of 0.904. At a 3 mm cutoff, sensitivity was 82.5%, specificity 94.3%, and accuracy 86%. Interdevice concordance was good (k = 0.76). Median pain scores were significantly lower for microneedle (2.5 [0-9]) compared to lancet (8.0 [1-26], P < .001). Conclusion The microneedle demonstrates high diagnostic performance and good concordance with the standard lancet while significantly reducing pain, thus supporting its utility in pediatric and needle-averse populations.
Background:Local lipid metabolism contributes to immune homeostasis in the nasal mucosa and the pathogenesis of chronic rhinosinusitis. However, lipid mediator networks underlying eosinophilic chronic rhinosinusitis (ECRS) remain poorly defined. Objective:To characterize fatty acid-derived lipid mediator profiles in nasal polyps (NPs) from patients with and without ECRS and identify pathways associated with eosinophilic inflammation. Methods:Lipidomic profiling was performed using LC-MS/MS on NP tissues from patients with ECRS (n = 4) and without ECRS (n = 4). A total of 158 ω-6 and ω-3 fatty acid-derived lipid mediators were quantified. Arachidonate 15-lipoxygenase (ALOX15) pathway activity was evaluated by quantitative PCR and ELISA. Results:ECRS NPs displayed a distinct lipidomic signature compared with non-ECRS NPs. ECRS NPs exhibited increased levels of proinflammatory ω-6 fatty acid metabolites, including 15-hydroxyeicosatetraenoic acid (15-HETE) and 13-hydroxyoctadecadienoic acid, along with elevated ALOX15 pathway products and higher ALOX15 mRNA expression. Anti-inflammatory specialized proresolving mediators, such as lipoxin A4, were also elevated within the ω-6 pathway, and lipoxin A4 levels correlated with 15-HETE levels. These patterns indicate the concurrent activation of pro- and anti-inflammatory pathways, with a predominance of ALOX15-driven ω-6 metabolites in ECRS. In contrast, the ω-3 fatty acid pathway showed only modest increases in 14,15-DiHETE and resolvin D2, suggesting a limited compensatory resolution response compared with the robust ALOX15-dependent ω-6 activity. Conclusions:ECRS NPs exhibit a skewed lipid mediator profile characterized by enhanced ALOX15-dependent ω-6 metabolism and insufficient resolution activity. This imbalance may underlie persistent type 2 inflammation in ECRS and suggests that targeting the 15-lipoxygenase pathway may offer therapeutic benefits.
Background There are substantial questions concerning the epidemiology and demographics of eosinophilic gastrointestinal disorders (EGID). We queried TriNetX, a large electronic medical record database, to assess EGID demographics. Objectives Our objective for this study was to characterize the prevalence, demographic features, disease overlap, and treatment patterns of patients with EGID using a large multicenter electronic health record database. Methods TriNetX, a deidentified patient database derived from 92 health care organizations and a total population of 129,260,452 patients, was queried for EGID. Cases were identified by ICD codes (eosinophilic esophagitis [EoE] K20, eosinophilic gastritis/enteritis [EoG/EoN] K52.81, eosinophilic colitis [EoC] K52.82) and endoscopy occurrence. Demographic and clinical characteristics were analyzed. Results We identified 77,726 EoE, 6,554 EoG/EoN, and 2,898 EoC cases. Prevalence was approximately 1:1,673, 1:19,842, and 1:44,873, respectively. Multiple EGID occurred in 5% of all patients but in 47% of those with EoG/EoN. EGID was most common in non-Hispanic White individuals (79%). Male predominance was observed in EoE (59%) but not EoG/EoN (46%) or EoC (45%). Mean patient ages at query were 39, 31, and 40 years for EoE, EoG/EoN, and EoC, respectively (P < .0001). The most prescribed medications were proton pump inhibitors for EoE, antiemetics and corticosteroids for EoG/EoN, and corticosteroids for EoC. Conclusions We identified the largest reported population of patients with EGID (77,726 cases); our findings substantiate their rarity (0.002-0.5% prevalence), male predominance limited to EoE, substantial co-occurrence of multiple EGID, and distinct age distribution of EoG/EoN. The identified cohort and approaches provide opportunities for further research.
Background Addition of the long-acting muscarinic antagonist umeclidinium (UMEC) to the inhaled corticosteroid/long-acting β2-agonist (ICS/LABA) combination fluticasone furoate/vilanterol (FF/VI) improved lung function in adults with uncontrolled moderate to severe asthma in the CAPTAIN (Clinical study of Asthma Patients receiving Triple therapy through A single INhaler) study; however, the impact on symptoms requires further investigation. Objective We sought to evaluate the effect of adding UMEC to FF/VI on asthma symptoms. Methods The CAPTAIN study was a phase IIIA, randomized, controlled, 24- to 52-week study of patients with uncontrolled moderate to severe asthma despite ICS/LABA receiving once-daily single-inhaler FF/VI (100/25 or 200/25 μg) or FF/UMEC/VI (100/31.25/25, 100/62.5/25, 200/31.25/25, or 200/62.5/25 μg). Here, we compare the effect of pooled FF/UMEC 62.5/VI (100/62.5/25 and 200/62.5/25 μg) versus FF/VI (100/25 and 200/25 μg) on symptom control using prespecified analyses of change from baseline in Evaluating Respiratory Symptoms in Asthma (E-RS: Asthma) total and domain scores, and proportion of patients meeting an E-RS: Asthma total score responder threshold. We also performed post hoc analyses assessing the impact of baseline type 2 inflammation status on treatment response. Results Least-squares mean (95% CI) reductions from baseline in E-RS: Asthma total score exceeded the minimum clinically important difference (−2.0 units) and were numerically greater with FF/UMEC 62.5/VI (−2.89 [−3.15 to −2.64]; n = 814) versus FF/VI (−2.47 [−2.73 to −2.22]; n = 813). The proportion of responders (45% [n = 360] vs 41% [n = 327]) and odds of response (odds ratio, 1.18 [95% CI, 0.96 to 1.45]) were numerically greater with FF/UMEC 62.5/VI versus FF/VI. Similar trends were observed irrespective of type 2 status. Conclusions Patients with symptomatic asthma may benefit from optimized treatment interventions, such as adding a long-acting muscarinic antagonist to ICS/LABA.
Background:Although long-term prophylaxis (LTP) reduces attack frequency in hereditary angioedema, patients may experience breakthrough attacks. Oral sebetralstat demonstrated favorable safety and efficacy compared with placebo in the randomized phase 3 KONFIDENT trial (NCT05259917), including in patients receiving LTP. The safety and effectiveness of sebetralstat in participants receiving LTP are being assessed in the KONFIDENT-S open-label extension study (NCT05505916). Objective:This interim analysis of the KONFIDENT-S study evaluated long-term safety and effectiveness of oral sebetralstat 600 mg for attacks of hereditary angioedema with C1-inhibitor deficiency in participants receiving LTP with lanadelumab, berotralstat, or C1 inhibitor. Methods:Efficacy end points included times to beginning of symptom relief, reduction in severity, and complete attack resolution. Results:As of September 14, 2024, 35 participants receiving LTP experienced a mean ± standard deviation of 1.7 ± 1.5 attacks per month and treated 382 attacks with sebetralstat (1.3 ± 1.1 sebetralstat-treated attacks per month). Median (interquartile range) time from attack recognition to sebetralstat administration was 6 (1-40) minutes; time to beginning of symptom relief was 1.3 (0.8 to 3.8) hours, time to reduction in severity was 4.2 (1.3 to >12) hours, and time to complete attack resolution was 14.8 (4.6 to >24) hours. Effectiveness was similar for participants receiving berotralstat, lanadelumab, or C1 inhibitor. No serious or severe treatment-related treatment-emergent adverse events were reported. Conclusion:Sebetralstat was well tolerated and enabled early on-demand treatment of attacks in patients with hereditary angioedema with C1-inhibitor deficiency receiving LTP. Treatment of breakthrough attacks with sebetralstat resulted in rapid symptom relief, reduction in attack severity, and complete attack resolution, regardless of LTP mechanism of action.
Background:As the prevalence of asthma, allergic rhinitis (AR), and atopic dermatitis (AD) rises globally, it is important to determine the prevalence of these diseases in different geographic regions to identify potential modifiable risk factors. Objective:We sought to determine the prevalence of asthma, AR, and AD in Sri Lankan children living in different climatic and geographical regions and to identify host and environmental risk factors. Methods:We recruited 5043 children (51.9% girls) age 10 to 19 years from 9 districts representing Sri Lanka using stratified multistage cluster sampling. Data were collected using the International Society for Allergies and Asthma in Childhood questionnaire for children. Statistical significance was estimated using Fisher exact and χ2 tests for association. Results:Prevalence of asthma, AR, and AD was 8.25%, 10.01%, and 2.8%, respectively. Children living in urban areas and children with higher body mass index were significantly more likely to have asthma. Children living in households that used cow dung for floors and clay/wattle and daub for walls were less likely to have asthma and AR, but not AD. The prevalence of asthma was higher in children living in houses with tiled floors (P = .03) and in which gas was used for cooking (P < .05), whereas prevalence of AR was significantly higher in households with domestic animals. Conclusion:The presence of other allergic diseases, BMI, and urbanicity together with certain environmental conditions was associated with the prevalence of these diseases. Therefore, environmental modification as well as lifestyle interventions may help to reduce the prevalence of these allergic diseases.
Background:Clinical remission is an important treatment goal in severe asthma; however, durable remission frameworks generally require sustained disease control over longer periods. Whether dupilumab induces an early response toward this goal in real-world practice remains unclear. Objective:We sought to evaluate early response toward clinical remission at 24 weeks after dupilumab initiation and to identify baseline factors associated with this outcome. Methods:In this multicenter, prospective cohort at 13 Japanese institutions, adults with severe asthma treated with dupilumab were followed for 24 weeks. Given the limited observation period, an early response toward clinical remission was defined as meeting modified 4-component remission-oriented criteria: Asthma Control Test score 20 or higher, FEV1 % predicted 80% or higher at week 24, no exacerbations, and no oral corticosteroid use (weeks 16-24). Multivariable logistic regression identified baseline factors associated with this outcome, and receiver-operating characteristic analysis evaluated baseline fractional exhaled nitric oxide (Feno). Results:Of 103 enrolled patients, 70 had complete data; 38 (54.3%; 95% CI, 41.9%-66.3%) met the modified remission-oriented criteria at week 24. Higher baseline Feno, higher FEV1 % predicted, and absence of maintenance oral corticosteroid use were associated with this outcome. Baseline Feno showed modest discrimination (area under the curve, 0.65; 95% CI, 0.51-0.78). Conclusions:Approximately half of the patients met the modified remission-oriented criteria at 24 weeks after dupilumab initiation, representing an early response toward clinical remission rather than sustained clinical remission itself. Baseline Feno and lung function may help identify patients more likely to show this response.
