Long-term lung function trajectories during dupilumab treatment remain insufficiently characterized. We characterized post-treatment FEV1 trajectories in patients with asthma who continued dupilumab for 3 years and explored whether persistent fractional exhaled nitric oxide (FeNO) was associated with a less favorable trajectory. This single-center retrospective study included 41 of 60 patients with physician-confirmed asthma who initiated dupilumab for asthma at Niigata University between March 2019 and August 2022 and continued treatment for 3 years. Post-treatment FEV1 slopes were estimated using values obtained at 4 months, 1 year, 2 years and 3 years. Decliners were defined as patients with an annual FEV1 slope more negative than − 30 mL/year. Persistent FeNO was defined as FeNO ≥ 20 ppb at ≥ 2 of the 1-, 2-, and 3-year visits. Maintenance treatment was assessed throughout follow-up, and 3-year prescription-based adherence and ICS exposure were evaluated in 38 patients with complete prescription records. Seventeen patients were classified as decliners. Both groups showed an early increase in FEV1; thereafter, FEV1 gradually decreased in decliners but remained relatively stable in non-decliners. Persistent FeNO was associated with a less favorable FEV1 slope and remained associated with decliner status after adjustment for age and baseline
Systemic capillary leak syndrome (SCLS) is a rare disorder characterized by transient plasma extravasation due to endothelial barrier dysfunction. It may occur idiopathically (ISCLS) or in association with monoclonal gammopathy (MG-CLS), a form also known as Clarkson’s disease. We describe a 39-year-old woman with a 15-year history of episodic, symmetric limb edema and profuse sweating, unresponsive to antihistamines or corticosteroids over several years. Episodes were chronic and lacked hypotension or pruritus. Laboratory workup revealed monoclonal kappa light chain gammopathy and borderline hemoconcentration. Monthly high-dose intravenous immunoglobulin (IVIG, 2 g/kg) was initiated. Improvement was noted by the fourth infusion, with complete resolution of swelling and marked reduction in sweating after five months of therapy. IVIG was well tolerated apart from mild infusion-related headache. This case illustrates that MG-CLS may present as a chronic disorder without the classic triad and may respond favorably to IVIG. In selected patients with mild or atypical presentations, a therapeutic trial of IVIG may be considered.
Abstract Background Over 90% of patients with a documented penicillin allergy are found to be incorrectly labelled when formally tested. The high incidence and lifelong impacts of an unconfirmed penicillin allergy label not only negatively impact patient outcomes, but also result in significant healthcare system costs. Therefore, we aimed to analyze the potential healthcare cost savings associated with the implementation of a provincial de-labelling initiative. Methods This was a retrospective review study using data from a provincial quality improvement de-labelling program in collaboration with BC Children’s Hospital, BC Women’s Hospital and the BC Centre for Disease Control (BCCDC) in Vancouver, Canada between 2019 and 2024. Patient populations of interest included pediatric patients, antepartum pregnant people and rural populations. Drug-cost differentials, hospitalization costs and costs associated with secondary complications was calculated based on information extracted from the program as well as reference data from existing North American and European databases from 2020 to 2025, to assess overall cost savings following implementation of the de-labelling programs. Results Amongst our special populations, including pediatric, antepartum and rural populations, we estimate lifetime savings of up to $6,581 and immediate (three-year) savings of up to $949 per patient with implementation of a penicillin allergy de-labelling program. We found that the overall lifetime savings was highest in populations with a higher risk for infection, such as peripartum populations, compared to others in their age cohort. Additionally, the largest lifetime drug cost savings were seen in our pediatric population, particularly in those less than 5 years of age. Furthermore, we highlight that local de-labelling services in remote and rural centres supported by primary care providers can further increase cost savings for rural populations with a cost differential of up to $350 per patient. Conclusions Our findings suggest that, irrespective of the population, de-labelling is associated with significant cost savings. This supports the need for more widespread implementation of penicillin allergy de-labelling programs, with a particular focus on these special populations.
Sublingual immunotherapy (SLIT) is an effective disease-modifying treatment for allergic respiratory disease. Despite its increased utilization in the United States, Real-world safety data for personalized SLIT delivered through fully remote care remain limited. This retrospective longitudinal study evaluated patients receiving personalized SLIT through a US telemedicine platform between 2020 and 2026. Patients who completed at least one survey after shipment receipt were included. Reported adverse events were graded using CTCAEv5.0. Shipment-derived exposure, capped at the administrative cutoff, was adjusted for self-reported adherence. Safety outcomes were summarized as patient-level proportion and exposure-adjusted event rates per 100 patient-years. Time to first reported adverse event was assessed (Kaplan–Meier). Cumulative incidence of adverse event-related discontinuation was compared between included and excluded cohorts (Gray’s test), with other reasons as competing events. Of 29,675 patients receiving SLIT, 13,584 (45.8
This was a single-centre, prospective cross-sectional observational study conducted between February and June 2025. Serum levels of IL-33, ST2, TNF-α, and IL-6 were quantified in patients diagnosed with allergic rhinitis (AR) and compared against healthy control subjects. This study aimed to compare serum levels of IL-33, ST2, TNF-α, and IL-6 between patients with AR and healthy controls, and to examine their association with symptom severity. A total of 81 participants diagnosed with AR were recruited from the Otolaryngology and Pulmonology Departments of the Third Affiliated Hospital of Chengdu University of Traditional Chinese Medicine (Chengdu, Sichuan, China). For comparison, 85 healthy controls were selected from the same hospital’s Physical Examination Center. Serum concentrations of IL-33/ST2, TNF-α, and IL-6 were quantified using ELISA. Spearman’s rank correlation analysis was conducted to investigate relationships between pathway components, cytokine expression, and clinical symptom severity. In comparison to the control cohort, the experimental group exhibited statistically significant elevations in the serum levels of IL-33, ST2, TNF-α, and IL-6, each of which was substantially higher than the corresponding values measured in healthy subjects (P < 0.05). Positive correlations were also found between these biomarkers and symptom severity. Aberrant activation of the IL-33/ST2 pathway, together with elevated TNF-α and IL-6 levels, is closely associated with the pathogenesis and progression of AR. Targeting this signaling axis may therefore represent a promising therapeutic strategy and support the development of objective measures for disease severity assessment.
