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Recognizing and Managing Allergic Contact Dermatitis: Focus on Major Allergens
Fonacier, Luz; Uter, Wolfgang; Johansen, Jeanne Duus
Patch testing is the reference standard for the diagnosis of allergic contact dermatitis. Identification and avoidance of culprit allergens are essential in the treatment of this disease. Each year, new allergens are identified as emerging or important. The authors discuss allergens that are common, enduring, emergent, incompletely recognized, and controversial for the practicing allergist and dermatologist. This Clinical Management Review will encompass a review of fragrances, preservatives, rubber, acrylates, metals, and medications; their common sources of exposure; controversies in diagnosis and patch testing; management and how to avoid those allergens. This review will also include practical aspects of diagnosis and management and will provide resources that can be used as guidance for physicians and patients on nickel, methylchloroisothiazolinone/methylisothiazolinone, and fragrance, the most common allergens positive on patch testing.
PMID: 38768899
ISSN: 2213-2201
CID: 5689632
Definition, acronyms, nomenclature, and classification of angioedema (DANCE): AAAAI, ACAAI, ACARE, and APAAACI DANCE consensus
Reshef, Avner; Buttgereit, Thomas; Betschel, Stephen D; Caballero, Teresa; Farkas, Henriette; Grumach, Anete S; Hide, Michihiro; Jindal, Ankur K; Longhurst, Hilary; Peter, Jonathan; Riedl, Marc A; Zhi, Yuxiang; Aberer, Werner; Abuzakouk, Mohamed; Al Farsi, Tariq; Al Sukaiti, Nashat; Al-Ahmad, Mona; Altrichter, Sabine; Aygören-Pürsün, Emel; Baeza, Maria Luisa; Bara, Noemi Anna; Bauer, Andrea; Bernstein, Jonathan A; Boccon-Gibod, Isabelle; Bonnekoh, Hanna; Bouillet, Laurence; Brzoza, Zenon; Bygum, Anette; Calderon, Oscar; de Albuquerque Campos, Regis; Campos Romero, Freya Helena; Cancian, Mauro; Chong-Neto, Herberto Jose; Christoff, George; Cimbollek, Stefan; Cohn, Danny M; Craig, Timothy; Danilycheva, Inna; Darlenski, Razvigor; Du-Thanh, Aurélie; Ensina, Luis Felipe; Fomina, Daria; Fonacier, Luz; Fukunaga, Atsushi; Gelincik, Asli; Giavina-Bianchi, Pedro; Godse, Kiran; Gompels, Mark; Goncalo, Margarida; Gotua, Maia; Guidos-Fogelbach, Guillermo; Guilarte, Mar; Kasperska-Zajac, Alicja; Katelaris, Constance H; Kinaciyan, Tamar; Kolkhir, Pavel; Kulthanan, Kanokvalai; Kurowski, Marcin; Latysheva, Elena; Lauerma, Antti; Launay, David; Lleonart, Ramon; Lumry, William; Malbran, Alejandro; Ali, Ramzy Mohammed; Nasr, Iman; Nieto-Martinez, Sandra; Parisi, Claudio; Pawankar, Ruby; Piñero-Saavedra, Macarena; Popov, Todor A; Porebski, Grzegorz; Prieto Garcia, Alicia; Pyatilova, Polina; Rudenko, Michael; Sekerel, Bulent Enis; Serpa, Faradiba Sarquis; Sheikh, Farrukh; Siebenhaar, Frank; Soria, Angèle; Staevska, Maria; Staubach, Petra; Stobiecki, Marcin; Thomsen, Simon Francis; Triggiani, Massimo; Valerieva, Anna; Valle, Solange; Van Dinh, Nguyen; Vera Ayala, Carolina Elisa; Zalewska-Janowska, Anna; Zanichelli, Andrea; Magerl, Markus; Maurer, Marcus
BACKGROUND:Angioedema (AE) manifests with intermittent, localized, self-limiting swelling of the subcutaneous and/or submucosal tissue. AE is heterogeneous, can be hereditary or acquired, may occur only once or be recurrent, may exhibit wheals or not, and may be due to mast cell mediators, bradykinin, or other mechanisms. Several different taxonomic systems are currently used, making it difficult to compare the results of studies, develop multicenter collaboration, and harmonize AE treatment. OBJECTIVE:We developed a consensus on the definition, acronyms, nomenclature, and classification of AE (DANCE). METHODS:The initiative involved 91 experts from 35 countries and was endorsed by 53 scientific and medical societies, and patient organizations. A consensus was reached by online discussion and voting using the Delphi process over a period of 16 months (June 2021 to November 2022). RESULTS:The DANCE initiative resulted in an international consensus on the definition, classification, and terminology of AE. The new consensus classification features 5 types and endotypes of AE and a harmonized vocabulary of abbreviations/acronyms. CONCLUSION/CONCLUSIONS:The DANCE classification complements current clinical guidelines and expert consensus recommendations on the diagnostic assessment and treatment of AE. DANCE does not replace current clinical guidelines, and expert consensus algorithms and should not be misconstrued in a way that affects reimbursement of medicines prescribed by physicians using sound clinical judgment. We anticipate that this new AE taxonomy and nomenclature will harmonize and facilitate AE research and clinical studies, thereby improving patient care.
PMID: 38670233
ISSN: 1097-6825
CID: 5657862
Methylisothiazolinone-containing paint contributing to mucocutaneous and cutaneous symptoms: A case of aerosolized allergic contact dermatitis
Roellke, Emma; Fonacier, Luz; Banta, Erin
PMID: 38705271
ISSN: 1534-4436
CID: 5658292
Abrocitinib efficacy and safety in moderate-to-severe atopic dermatitis by race, ethnicity, and Fitzpatrick skin type
Alexis, Andrew F; Silverberg, Jonathan I; Rice, Zakiya P; Armstrong, April W; Desai, Seemal R; Fonacier, Luz; Kabashima, Kenji; Biswas, Pinaki; Cella, Ricardo Rojo; Chan, Gary L; Levenberg, Mark
BACKGROUND:Response to abrocitinib treatment for moderate-to-severe atopic dermatitis (AD) has not been evaluated across racial and ethnic subpopulations. OBJECTIVE:To assess the efficacy and safety of abrocitinib on the basis of patient race, ethnicity, and Fitzpatrick skin type (FST). METHODS:Data were pooled post hoc from patients treated with abrocitinib 200 mg, 100 mg, or placebo in 3 monotherapy trials (NCT02780167, NCT03349060, and NCT03575871). Race and ethnicity were self-reported; FST was determined by study investigators. Evaluations through Week 12 include the following: (1) Investigator's Global Assessment of clear or almost-clear skin; (2) greater than or equal to 75% improvement in Eczema Area and Severity Index or SCORing AD; (3) a greater-than-or-equal-to 4-point improvement in Peak Pruritus Numerical Rating Scale score; (4) least squares mean changes in Dermatology Life Quality Index and Patient-Oriented Eczema Measure scores; and (5) treatment-emergent adverse events. RESULTS:The sample comprised 628 White, 204 Asian, and 83 Black patients; 37 were Hispanic or Latino; 624 had FST I to III and 320 had FST IV to VI. Treatment with either abrocitinib dose was associated with greater proportions of patients achieving Investigator's Global Assessment of clear or almost-clear skin, ≥ 75% improvement in Eczema Area and Severity Index, ≥ 75% improvement in SCORing AD, and a ≥ 4-point improvement in Peak Pruritus Numerical Rating Scale, or greater score changes from baseline in Dermatology Life Quality Index and Patient-Oriented Eczema Measure vs placebo regardless of race, ethnicity, or FST. Dose-response was most prominent in White patients. In Black patients, the effects of the 2 doses were similar. Treatment-emergent adverse events were more common in White and Black than in Asian patients. CONCLUSION:Abrocitinib was more efficacious than placebo across the racial and ethnic groups and ranges of phototypes analyzed. Studies with increased representation of populations of color are warranted to elucidate potential variations in response across diverse populations. TRIAL REGISTRATION:Clinicaltrials.gov Identifier: NCT02780167 (phase 2b), NCT03349060 (phase 3 MONO-1), and NCT03575871 (phase 3 MONO-2).
PMID: 37949351
ISSN: 1534-4436
CID: 5722942
Interpreting the Relationship Among Itch, Sleep, and Work Productivity in Patients with Moderate-to-Severe Atopic Dermatitis: A Post Hoc Analysis of JADE MONO-2
Yosipovitch, Gil; Gooderham, Melinda J; Ständer, Sonja; Fonacier, Luz; Szepietowski, Jacek C; Deleuran, Mette; Girolomoni, Giampiero; Su, John C; Bushmakin, Andrew G; Cappelleri, Joseph C; Feeney, Claire; Chan, Gary; Thorpe, Andrew J; Valdez, Hernan; Biswas, Pinaki; Rojo, Ricardo; DiBonaventura, Marco; Myers, Daniela E
BACKGROUND:Abrocitinib, an oral, once-daily Janus kinase 1-selective inhibitor, improved itch severity, sleep, and work productivity versus placebo in patients with moderate-to-severe atopic dermatitis. OBJECTIVE:The aim of this study was to investigate relationships among itch, sleep, and work productivity in the phase III JADE MONO-2 clinical trial. METHODS:A repeated-measures longitudinal model was used to examine relationships between itch (using the Peak Pruritus Numerical Rating Scale [PP-NRS] or Nighttime Itch Scale [NTIS]) and sleep disturbance/loss (using the Patient-Oriented Eczema Measure sleep item and SCORing AD Sleep Loss Visual Analog Scale) and, separately, between itch and work productivity (using the Work Productivity and Activity Impairment-Atopic Dermatitis Version 2.0 questionnaire). Mediation modelling was used to investigate the effect of treatment (abrocitinib vs placebo) on work impairment via improvements in itch and sleep. RESULTS:The relationships between itch/sleep and itch/work productivity were approximately linear. PP-NRS scores of 0, 4-6, and 10 were associated with 0 days, 3-4 days, and 7 days per week of disturbed sleep, respectively. PP-NRS or NTIS scores of 0-1, 4-5, and 10 were associated with 0-10%, 20-30%, and >50% overall work impairment, respectively. Seventy-five percent of the effect of abrocitinib on reducing work impairment was indirectly mediated by improvement in itch, followed by sleep. CONCLUSION/CONCLUSIONS:These results quantitatively demonstrate that reducing itch severity is associated with improvements in sleep and work productivity. Empirical evidence for the mechanism of action of abrocitinib showed that itch severity is improved, which reduces sleep loss/sleep disruption and, in turn, improves work productivity. CLINICAL TRIAL REGISTRATION/BACKGROUND:NCT03575871.
PMID: 37624488
ISSN: 1179-1888
CID: 5599002
Coronavirus disease 2019 vaccine skin testing and graded challenges in vaccine-hesitant patients
Heffes-Doon, Ari; Horne, Nathanael; Okpara, Chinyere; Akerman, Meredith; Fonacier, Luz
PMCID:10079592
PMID: 37031774
ISSN: 1534-4436
CID: 5502732
Atopic dermatitis yardstick update
Boguniewicz, Mark; Fonacier, Luz; Guttman-Yassky, Emma; Ong, Peck Y; Silverberg, Jonathan I
PMID: 36931465
ISSN: 1534-4436
CID: 5462662
Proposed solutions by the American College of Allergy, Asthma, and Immunology and advocacy experts to address racial disparities in atopic dermatitis and food allergy
Corbett, Mark; Allen, Abby; Bobo, Nichole; Foggs, Michael B; Fonacier, Luz S; Gupta, Ruchi; Kowalsky, Rachel; Martinez, Erin; Begolka, Wendy Smith; Zachary, Cherie; Blaiss, Michael S
Atopic dermatitis (AD) and food allergies are more prevalent and more severe in people with skin of color than White individuals. The American College of Allergy, Asthma, and Immunology (ACAAI) sought to understand the effects of racial disparities among patients with skin of color with AD and food allergies. The ACAAI surveyed its members (N = 200 completed), conducted interviews with health care providers and advocacy leaders, and hosted a roundtable to explore the challenges of diagnosis and management of AD and food allergies in people with skin of color and to discuss potential solutions. Most of the survey respondents (68%) agreed that racial disparities make it difficult for people with skin of color to receive adequate treatment for AD and food allergies. The interviews and roundtable identified access to care, burden of costs, policies and infrastructure that limit access to safe foods and patient education, and inadequate research involving people with skin of color as obstacles to care. Proposed solutions included identifying ways to recruit more people with skin of color into clinical trials and medical school, educating health care providers about diagnosis and treating AD and food allergy in people with skin of color, improving access to safe foods, creating and disseminating culturally appropriate materials for patients, and working toward longer appointment times for patients who need them. Challenges in AD and food allergy in persons with skin of color were identified by the ACAAI members. Solutions to these challenges were proposed to inspire actions to mitigate racial disparities in AD and food allergy.
PMID: 36538973
ISSN: 1534-4436
CID: 5431862
Persistent Penicillin Allergy Label in Pharmacies after Penicillin Allergy De-labeling [Meeting Abstract]
Diaz, A M; Fonacier, L; Stern, H; Mawhirt, S; Banta, E; Sani, S
Rationale: Carrying a penicillin allergy label is associated with increased healthcare costs and adverse events. De-labeling a penicillin allergy can optimize antimicrobial stewardship and improve patient care.
Method(s): We performed an IRB-approved retrospective study of patients over 11 years-old, who were de-labeled of penicillin allergy (negative skin testing and aminopenicillin oral challenge) in our clinic between May 2019 and May 2022. Patients had their penicillin allergy removed from our electronic medical record (EMR) and were given a wallet card denoting results. A letter with fax confirmation of receipt was sent to both primary care physician and pharmacy. EMR review and phone interviews with patients and pharmacies were subsequently conducted to determine penicillin allergy status and antibiotic prescribing patterns.
Result(s): A total of 78 charts were reviewed: 68 underwent phone interviews, 9 were lost to follow up, and 1 was deceased. From these charts, 77 (99%) remained de-labeled in our EMR, whereas 24 (31%) had an active penicillin allergy listed in their pharmacy. Out of 68 patients interviewed, 66 (97%) recalled a negative penicillin allergy result, 30 (44%) took penicillins since de-labeling, 31 (46%) were not prescribed penicillins, 4 (6%) avoided penicillins, while 3 (4%) reported unknown antibiotic use.
Conclusion(s): This study demonstrates that our pencillin de-labeling protocol is effective in maintaining a non-allergic status and allowing for subsequent penicillin administration. However, the discrepancy in allergy records between our EMR and patients' pharmacies exemplifies the need to identify barriers in universally de-labeling patients.
Copyright
EMBASE:2022489344
ISSN: 1097-6825
CID: 5509742
Cutaneous Adverse Reactions Associated with COVID-19 Vaccination [Meeting Abstract]
Jin, H; Fonacier, L; Rosenblum, J
Rationale: Adverse reactions following COVID-19 vaccination are common. We sought to characterize the most common cutaneous manifestations following COVID-19 vaccine administration and identify potential predictive factors.
Method(s): A retrospective chart review was conducted for patients seen in the allergy clinic between December 2020 and May 2021 for COVID-19 vaccine counseling. Details of reactions to either mRNA COVID-19 vaccine were noted. Cutaneous findings were defined as any local reaction including pain, redness or swelling, or generalized rash.
Result(s): Twenty-four patients out of 115 patients (20.9%) had any type of cutaneous reaction after vaccination. Most were female (n=21, 87.5%). Seven of these 24 patients had a local reaction alone. Two patients had immediate onset of generalized pruritus and rash (1 of these patients had symptom resolution by the next morning, the other resolved 8 days post-vaccination). Four patients (16.7%) had a delayed (>6 hours after vaccination) generalized pruritic rash, three of which resolved within 2 weeks and one resolved after 6 weeks. Four patients with a history of chronic urticaria (CU) had a flare of urticaria following vaccination beginning 1-2 days later. One additional patient with CU had delayed pruritus only. One patient developed urticaria 1 day after receiving vaccination with persistence of urticaria beyond 6 weeks.
Conclusion(s): Cutaneous ARs were common (20%) following COVID-19 vaccination. Most rashes were delayed and resolved within 2 weeks with no additional sequelae. In this cohort, patients with a history of CU were seen to have flares of symptoms following vaccination. Cutaneous reactions were more commonly seen in women.
Copyright
EMBASE:2022488648
ISSN: 1097-6825
CID: 5509752