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Contact allergens for the allergist

Fonacier, Luz; Frankel, David; Mawhirt, Stephanie
OBJECTIVE:The objective of this article is to provide an overview and describe typically encountered skin contact allergens implicated in allergic contact dermatitis (ACD). DATA SOURCES/METHODS:Published literature obtained through textbooks, online PubMed, and Google Scholar database searches, author photography, and adapted figures were used. STUDY SELECTIONS/METHODS:Studies on the evaluation of ACD and specific skin contact allergens were selected, with a focus on original research articles and clinical reviews. RESULTS:Major classifications of common contact allergens include the following: (1) fragrances, (2) preservatives, (3) excipients, (4) rubber chemicals, (5) textile dyes, (6) topical medications, and (6) metals and other biomedical device components. The dermatitis distribution can aid in identifying the suspected contact allergen culprit. Certain contact allergens have features that are important to consider in the patch testing (PT) interpretation; these include possible irritant reactions, false-negative reactions or missed detection, and delayed reactions. Fragrances, preservatives, and excipients are culprits in personal products and facial or neck dermatitis. Patch testing with fragrances, preservatives, and patient-supplied products requires careful interpretation. Hand or foot dermatitis may be attributed to rubber chemicals or textile dyes. The management of topical corticosteroid contact allergy is guided on the basis of structural group classifications. Metal sensitization has been associated with dermatitis or biomedical device complications. CONCLUSION/CONCLUSIONS:Each skin contact allergen has unique characteristics with regard to the dermatitis clinical presentation and potential PT nuances. These features are critical to recognize in the evaluation of ACD and PT interpretation and clinical relevance, leading to an accurate diagnosis.
PMID: 35346877
ISSN: 1534-4436
CID: 5205952

Phase 3 Efficacy and Safety of Abrocitinib in Adults with Moderate-to-Severe Atopic Dermatitis After Switching from Dupilumab (JADE EXTEND)

Shi, Vivian Y; Bhutani, Tina; Fonacier, Luz; Deleuran, Mette; Shumack, Stephen; Valdez, Hernan; Zhang, Fan; Chan, Gary L; Cameron, Michael C; Yin, Natalie C
BACKGROUND:Abrocitinib efficacy by prior dupilumab response status in patients with moderate-to-severe atopic dermatitis (AD) has not previously been assessed in phase 3 studies. OBJECTIVE:Examine efficacy and safety of abrocitinib among patients who received prior dupilumab. METHODS:Patients with moderate-to-severe AD received abrocitinib 200 mg or 100 mg once-daily in JADE EXTEND (phase 3 extension) after dupilumab in double-blind, placebo-controlled phase 3 JADE COMPARE. RESULTS:Among prior dupilumab responders, ≥75% improvement in Eczema Area and Severity Index (EASI-75) was achieved in 93.5% and 90.2% of patients who received 12 weeks of abrocitinib 200 mg and 100 mg, respectively; ≥4-point improvement in Peak Pruritus Numerical Rating Scale (PP-NRS4) was achieved in 89.7% and 81.6%, respectively. Among prior dupilumab nonresponders, EASI-75 was achieved with abrocitinib 200 mg and 100 mg in 80.0% and 67.7% and PP-NRS4 in 77.3% and 37.8%, respectively. Most common adverse events among abrocitinib-treated patients were nasopharyngitis, nausea, acne, and headache. Conjunctivitis occurred less frequently with abrocitinib in comparison to prior dupilumab. LIMITATIONS/CONCLUSIONS:Short-term, 12-week analysis; no placebo arm. CONCLUSION/CONCLUSIONS:Efficacy and safety profile of abrocitinib in JADE EXTEND supports the role of abrocitinib as a treatment for patients with moderate-to-severe AD, regardless of prior dupilumab response status.
PMID: 35439608
ISSN: 1097-6787
CID: 5218282

The international EAACI/GA²LEN/EuroGuiDerm/APAAACI guideline for the definition, classification, diagnosis, and management of urticaria

Zuberbier, Torsten; Abdul Latiff, Amir Hamzah; Abuzakouk, Mohamed; Aquilina, Susan; Asero, Riccardo; Baker, Diane; Ballmer-Weber, Barbara; Bangert, Christine; Ben-Shoshan, Moshe; Bernstein, Jonathan A; Bindslev-Jensen, Carsten; Brockow, Knut; Brzoza, Zenon; Chong Neto, Herberto Jose; Church, Martin K; Criado, Paulo R; Danilycheva, Inna V; Dressler, Corinna; Ensina, Luis Felipe; Fonacier, Luz; Gaskins, Matthew; Gáspár, Krisztian; Gelincik, Aslı; Giménez-Arnau, Ana; Godse, Kiran; Gonçalo, Margarida; Grattan, Clive; Grosber, Martine; Hamelmann, Eckard; Hébert, Jacques; Hide, Michihiro; Kaplan, Allen; Kapp, Alexander; Kessel, Aharon; Kocatürk, Emek; Kulthanan, Kanokvalai; Larenas-Linnemann, Désirée; Lauerma, Antti; Leslie, Tabi A; Magerl, Markus; Makris, Michael; Meshkova, Raisa Y; Metz, Martin; Micallef, Daniel; Mortz, Charlotte G; Nast, Alexander; Oude-Elberink, Hanneke; Pawankar, Ruby; Pigatto, Paolo D; Ratti Sisa, Hector; Rojo Gutiérrez, María Isabel; Saini, Sarbjit S; Schmid-Grendelmeier, Peter; Sekerel, Bulent E; Siebenhaar, Frank; Siiskonen, Hanna; Soria, Angele; Staubach-Renz, Petra; Stingeni, Luca; Sussman, Gordon; Szegedi, Andrea; Thomsen, Simon Francis; Vadasz, Zahava; Vestergaard, Christian; Wedi, Bettina; Zhao, Zuotao; Maurer, Marcus
This update and revision of the international guideline for urticaria was developed following the methods recommended by Cochrane and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group. It is a joint initiative of the Dermatology Section of the European Academy of Allergology and Clinical Immunology (EAACI), the Global Allergy and Asthma European Network (GA²LEN) and its Urticaria and Angioedema Centers of Reference and Excellence (UCAREs and ACAREs), the European Dermatology Forum (EDF; EuroGuiDerm), and the Asia Pacific Association of Allergy, Asthma and Clinical Immunology with the participation of 64 delegates of 50 national and international societies and from 31 countries. The consensus conference was held on 3 December 2020. This guideline was acknowledged and accepted by the European Union of Medical Specialists (UEMS). Urticaria is a frequent, mast cell-driven disease that presents with wheals, angioedema, or both. The lifetime prevalence for acute urticaria is approximately 20%. Chronic spontaneous or inducible urticaria is disabling, impairs quality of life, and affects performance at work and school. This updated version of the international guideline for urticaria covers the definition and classification of urticaria and outlines expert-guided and evidence-based diagnostic and therapeutic approaches for the different subtypes of urticaria.
PMID: 34536239
ISSN: 1398-9995
CID: 5072122

Contact dermatitis due to personal protective equipment use and hygiene practices during the COVID-19 pandemic: A systematic review of case reports

Sarfraz, Zouina; Sarfraz, Azza; Sarfraz, Muzna; Felix, Miguel; Bernstein, Jonathan A; Fonacier, Luz; Cherrez-Ojeda, Ivan
Background/UNASSIGNED:Prolonged use of personal protective equipment (PPE) may lead to contact dermatitis during the coronavirus disease 19 (COVID-19) pandemic. This paper aims to identify the causative factors of contact dermatitis from PPE and hygiene practices. Methods/UNASSIGNED:The search was conducted adhering to PRISMA 2020 guidelines. A Delphi process was employed to ensure that the aims of this study were met. PubMed and Web of Science databases were systematically searched through September 12, 2021, using search terms: Contact dermatitis, case report, covid-19. The findings were tabulated as author/year, gender, age, presentation, cause, dermatological diagnosis, testing modality, provided treatment, symptom resolution (time in days), prognosis, and follow-up. Results/UNASSIGNED:The mean age of all individuals was 29.75 years, with 75% females. All cases presented with erythema, with 62.5% reporting pruritus and 37.5% reporting burning facial symptoms. Surgical masks and hand-hygiene products (37.5%) were the most commonly reported causative agent with 25% due to KN95/FFP type 2 use. Allergic contact dermatitis (50%) and irritant contact dermatitis (25%) were common diagnoses. Treatments included creams, emollients, and desloratadine, with restriction of irritant-causing factors. The prognosis was generally good among the cases, with 62.5% presenting complete resolution within a week and 12.5% showing moderate improvement at the fourth month after discontinuing use. Conclusion/UNASSIGNED:This study finds pertinent links between PPE use and contact dermatitis during the COVID-19 pandemic. While many cases are bound to go underreported in literature, well-designed, large-scale studies in the future may help promote these associations in a more comprehensive manner.
PMID: 35039780
ISSN: 2049-0801
CID: 5147472

Allergic and Nonallergic Covid-19 Vaccine Adverse Reactions in Hospital Employees [Meeting Abstract]

Jin, H; Diaz, A M; Phillips, M; Akerman, M; Cohan, C; Salvati, S; Wilkenfeld, M; Fonacier, L
Rationale: Allergic and non-allergic adverse reactions (ARs) to Covid-19 vaccine (Cov19V) have been reported. Understanding the characteristics of Cov19V ARs, particularly those that are allergic in nature, may help us to better counsel patients who are at risk of developing a vaccine AR.
Method(s): We performed a retrospective chart review of ARs voluntarily reported to our Occupational Health Services following Cov19V at a multi-site academic medical center between December 2020-June 2021.
Result(s): 464 Cov19V ARs among 71,281 vaccine doses given (0.65%) were reported. 57 ARs (12.3%) were determined to be allergic (10 after the second dose), 356 were nonallergic, and 51 (11.0%) were undetermined. Of the 47 first-dose allergic ARs, 30 (63.8%) received a second dose, 16 did not complete the vaccine series, and 1 had no data. 3 employees received an alternative Cov19V. Of the 356 nonallergic ARs, 110 were following second dose, 2 were following Janssen, and 4 had no data. 228 of first dose reactions (95.0%, 228/240) completed the vaccine series. 22/57 (38.6%) allergic ARs versus 38/356 (10.7%) nonallergic ARs required ER transfer. More allergic ARs were categorized as moderate/severe (80.7%, 46/57) than nonallergic ARs (66.3%, 236/356).
Conclusion(s): Cov19V ARs are extremely uncommon with nonallergic AR more common than allergic. A vast majority of ARs, allergic or nonallergic, are able to receive subsequent Cov19V. Employees with allergic ARs were less likely to receive a second Cov19V and more frequently required emergent medical evaluation compared to those with nonallergic ARs.
ISSN: 1097-6825
CID: 5157442

Interpreting the relationship between pruritus and quality of life in patients with moderate-to-severe atopic dermatitis: A post-hoc analysis of JADE MONO-1 and JADE MONO-2 [Meeting Abstract]

Gooderham, M J; Yosipovitch, G; Stander, S; Fonacier, L; Szepietowski, J C; Deleuran, M; Girolomoni, G; Bushmakin, A G; Cappelleri, J C; Watkins, M; Feeney, C; Valdez, H; Rojo, R; DiBonaventura, M; Myers, D E
Atopic dermatitis (AD) is a chronic inflammatory skin disease associated with intense pruritus. It has a profound impact on health-related quality of life (HRQoL). In two identical phase III studies [JADE MONO-1 (NCT03349060) and JADE MONO-2 (NCT03575871)] abrocitinib, a Janus kinase 1 selective inhibitor, was shown rapidly to reduce pruritus in patients with moderate-to-severe AD vs. placebo. This post-hoc analysis of the JADE MONO-1 and MONO-2 trials aimed to quantify the relationship between pruritus severity and HRQoL in patients with moderate-to-severe AD. Adults (aged >= 18years) with moderate-to-severe AD [affected body surface area >= 10%; Eczema Area and Severity Index (EASI) score >= 16; Investigator's Global Assessment (IGA) score >= 3; Peak Pruritus Numerical Rating Scale (PP-NRS; the PP-NRS is used with permission of Regeneron Pharmaceuticals, Inc., and Sanofi) score >= 4] were randomly assigned 2: 2: 1 to receive once-daily abrocitinib 200mg or 100mg or placebo for 12weeks. Pruritus severity was assessed using the PP-NRS daily during the first 2weeks of the study, then as single measurements at weeks 4, 8 and 12. Disease-specific HRQoL was assessed using the Dermatology Life Quality Index (DLQI) at baseline and at weeks 2, 4, 8 and 12, and general HRQoL was assessed using the Short Form-36 Heath Survey Version 2 (SF-36v2; Medical Outcomes Trust) at baseline and at week 12. Data from the abrocitinib and placebo arms were pooled. A repeated-measures longitudinal model was used to estimate the relationship between HRQoL (outcome) and pruritus (using PP-NRS as the predictor). The outcome was either one of the eight SF-36 domains or two summary scores (Physical Functioning, Role Physical, Bodily Pain, General Health, Vitality, Social Functioning, Role Emotional, Mental Health, Physical Component Summary, or Mental Component Summary) or DLQI total score. SF-36 norm-based standardized T scores (with a mean of 50 and an SD of 10 reflecting normative scores for the US general population) were used. To assess the validity of the linear approximation of the relationship between predictor and outcome, the model was also implemented with the PP-NRS as a categorical variable, which does not impose any functional relationship between predictor and outcome. Data from 654 and 642 patients were available for the DLQI and SF-36 analyses, respectively. Approximately linear relationships were found between PP-NRS scores and either measure of HRQoL indicating a direct association between severity of itch and dermatology HRQoL (via DLQI) or general HRQoL (via SF-36v2). A 3-point improvement in PP-NRS score corresponded, on average, to a clinically meaningful 4.7-point change in DLQI score; PP-NRS scores of 0, 1-2, 3-5 and >= 6 were associated with no, small, moderate and very large effects of their disease on HRQoL (as assessed by DLQI), respectively (Figure1). A 3-point improvement in PP-NRS corresponded, on average, to clinically important changes in the Role Physical (3.9 points), Bodily Pain (5.6 points) and Physical Component Summary (3.9 points) domains of SF-36, whereas a 4-point improvement in PP-NRS score was associated with clinically important change in Social Functioning (5.4 points); PP-NRS scores >= 1 were associated with SF-36 scores higher than US general population norms adjusted for age and sex for all SF-36 domains except General Health, whereas PP-NRS scores > 5 were associated with lower than US general population norms adjusted for age and sex for all domains. In this post-hoc analysis, pooled data from JADE MONO-1 and MONO-2 showed that severity of itch was strongly associated with HRQoL in patients with moderate-to-severe AD. Moreover, although the current threshold for clinically meaningful change in studies to investigate abrocitinib is a 4-point improvement in PP-NRS score, these results suggest that a 3-point change may be sufficient for clinically meaningful improvement in HRQoL as measured by the DLQI and the Role Physical and Bodily Pain domains and Physical Component Summary score of the SF-36
ISSN: 1365-2133
CID: 5180402

Efficacy of abrocitinib monotherapy for the treatment of moderate-to-severe atopic dermatitis by race [Meeting Abstract]

Alexis, A F; Silverberg, J I; Rice, Z P; Armstrong, A W; Desai, S R; Fonacier, L; Kabashima, K; Levenberg, M; Biswas, P; Rojo, Cella R; Chan, G L
Atopic dermatitis (AD) disproportionately affects Asian and Black/African American individuals, compared to white individuals in the US population. In addition, clinical manifestations of AD can differ by skin type. Therefore, it is important to understand the effectiveness of AD treatments in individuals with different skin types. The objective of this study was to compare the efficacy of abrocitinib, an oral, once-daily Janus kinase 1 selective inhibitor, among study participants of different skin types. This post-hoc analysis included data pooled from two phase III studies [NCT03349060 (JADE MONO-1) and NCT03575871 (JADE MONO-2)] and one phase IIb study (NCT02780167). In all three studies, participants aged >= 12years (phase III studies) or aged >= 18years (phase II study) with moderate-to-severe AD were randomly assigned to receive oral abrocitinib 200mg, abrocitinib 100mg or placebo once daily for 12weeks. Endpoints were the proportion of patients who achieved Investigator's Global Assessment (IGA) response [clear (0) or almost clear (1) with >= 2 grade improvement], >= 75% improvement in Eczema Area and Severity Index (EASI-75) score, 4-point improvement in Peak Pruritus Numeric Rating Scale (PP-NRS4; the PP-NRS is used with permission of Regeneron Pharmaceuticals, Inc., and Sanofi) and >= 75% improvement in SCORing Atopic Dermatitis (SCORAD-75) score at week 12. Patients self-reported their racial subgroup. This analysis included data from white, Asian and black participants. The statistical difference between treatment groups and placebo were assessed using the Cochran-Mantel-Haenszel test. In this study, abrocitinib 200mg or 100mg or placebo was administered to white (232, 254 and 142, respectively), black (30, 31 and 22) and Asian (85, 80 and 39) participants. At week 12, IGA response was significantly greater in participants receiving abrocitinib 200mg or 100mg vs. placebo in white (43.1% and 24.4% vs. 8.8%, both P<0.001), black (27.6% and 35.5% vs. 0%, both P<0.01) and Asian participants (37.6% and 30.4% vs. 10.3%, both P<0.05). Similar results were observed in white and Asian participants for EASI-75 [white: 64.3% and 39.2% vs. 12.5%; Asian: 61.2% and 48.1% vs. 12.8% (all P<0.001)], PP-NRS4 [white: 61.2% and 38.2% vs. 16.8%; Asian: 49.3% and 47.8% vs. 8.6% (all P<0.001)] and SCORAD-75 [62.5% and 37.4% vs. 20.8% (both P<0.01); 60.5% and 43.1% vs. 22.2% (both P<0.05)]. EASI-75 response was significantly different from that with placebo (13.6%) in black participants receiving 100mg (48.4%) but not 200mg abrocitinib (37.9%). PP-NRS4 and SCORAD-75 responses were numerically greater but not significantly different in black participants receiving abrocitinib 200mg or 100mg vs. placebo (PP-NRS4: 39.3% and 53.8% vs. 28.6%; SCORAD-75: 56.5% and 47.8% vs. 33.3%). For each of the different skin types, participants taking abrocitinib had a significant improvement with abrocitinib vs. placebo for patient-reported outcomes (PROs), including Dermatology Life Quality Index and Patient-Oriented Eczema Measure scores. Rates of adverse events (AEs) were numerically higher in with 200-mg and 100-mg treatment vs. placebo arm and were greater in white (75.4% and 69.7% vs. 60.6%) and black participants (66.7% and 74.2% vs. 45.5%) than in Asian participants (64.7% and 58.8% vs. 41.0%); study discontinuation because of AEs also occurred more with white (6.9%, 8.7% and 13.4%, respectively) and black (10.0%, 6.5% and 18.2%, respectively) participants than with Asian participants (3.5%, 3.8% and 5.1%, respectively); study discontinuation occurred more frequently in the placebo arm and across all racial subgroups, presumably because of uncontrolled AD. In this post-hoc analysis, monotherapy with abrocitinib 200mg or 100mg was more effective than placebo in improving moderate-to-severe AD in white, black and Asian participants, as measured by IGA response and PROs; similar results were observed for >= 75% improvement in Eczema Area and Severity Index, PP-NRS4 and >= 75% decrease in SCORing AD (SCORAD-75) but were only statistically significant in white and Asian participants. The rate of AEs was higher in white and black participants than in Asian participants, but discontinuation rates for treatment were low across all racial subgroups. Lower clinical efficacy and absence of dose response in participants with black skin might be a result of the relatively small population with black skin included in the analysis. Greater representation of participants with black skin in future studies is warranted
ISSN: 1365-2133
CID: 5180412

Taking Advantage of our EMR to Take Better Care of our Allergic Rhinitis Patients [Meeting Abstract]

Feldman, Eleanor; Fonacier, Luz; Banta, Erin; Mawhirt, Stephanie; Schneider, Amanda
ISSN: 0091-6749
CID: 4820622

Pruritus, Sleep, and Productivity: A Post Hoc Analysis of Abrocitinib Versus Placebo in Patients With Moderate-to-Severe Atopic Dermatitis (AD) From JADE MONO-2 [Meeting Abstract]

Yosipovitch, Gil; Fonacier, Luz; Stander, Sonja; Su, John; Gooderham, Melinda; Szepietowski, Jacek; Deleuran, Mette; Girolomoni, Giampiero; Biswas, Pinaki; Feeney, Claire; Valdez, Hernan; Rojo, Ricardo; Thorpe, Andrew; Chan, Gary; Cappelleri, Joseph; DiBonaventura, Marco; Myers, Daniela
ISSN: 0091-6749
CID: 4821192

Real Time Assessment of Steroid Use in Patients with Atopic Dermatitis [Meeting Abstract]

Sani, Sonam; Mawhirt, Stephanie; Banta, Erin; Schneider, Amanda; Fonacier, Luz
ISSN: 0091-6749
CID: 4821182