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New ADA guidelines list more than 40 recommendations related to blood pressure targets, screening and diagnosis, and overall management strategies.

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Adult ADHD Challenges During COVID-19

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New Asthma Management Guidelines: A Podcast Primer

Since discovering the airways and lungs are the primary sites of 

 entry, replication, and damage researchers have attempted to administer and test drugs in these regions for efficacy.

However, trials testing oral hydroxychloroquine (oHCQ) have produced mixed results, despite having some antiviral activity in vitro (EC

A team, led by Ohad Bentur, The Rockefeller University, tested the hypothesis that aerosolized HCQ sulfate (aHCQ) is tolerable, safe, and rapidly achieves high respiratory tissue concentrations while minimizing systemic toxicity.

In the phase 1 study, aHCQ was administered with an Aerogen nebulizer to healthy volunteers to assess the overall tolerability, safety, and pharmacokinetics.

Overall, there were 10 volunteers randomized to receive either a placebo (n = 2) or aHCQ (20 mg, n = 2; 50 mg, n = 6).

All 10 patients completed the inhalation, while 6 of the 8 HCQ patients had adverse events, all of which were mild (75% transient dysgeusia; 25% dizziness).

 and FVC were essentially unchanged from baseline after 15-360 minutes and 1 and 7 days, while QT segments were minimally changed from baseline (maximum change 34 msec) after 1-6 hours and 1 and 7 days, all of which were 

Pharmacokinetics of 50 mg—Area Under the Blood Curve 0-24 hours post-inhalation was 377 

 127 ng* hr/mL, while less than 15% of the patients reported for oHCQ 200 mg.

In addition, pharmacokinetic modeling predicted initial epithelial lining fluid concentrations in excess of reported EC

s, and peak respiratory tissue concentration of 0.5 mM, decreasing to 0.01 mM at 24 hours as HCQ slowly releases into the blood.

“aHCQ was safe, well-tolerated, and appears to be sequestered in respiratory tissues,” the authors wrote. “Administering aHCQ at a fraction of oral dosing may rapidly achieve respiratory tract concentrations sufficient to inhibit SARS-CoV-2.”

 was 1 of the first potential drugs tested for efficacy against COVID-19.

Late last year, researchers found in a study of 479 patients hospitalized with respiratory symptoms of COVID-19, the treatment ultimately did not improve clinical outcomes.

In the study, patients were assigned to receive hydroxychloroquine or a placebo, with 242 in the group assigned to receive 400 mg of hydroxychloroquine twice daily for 2 doses, then 200 mg twice daily for 8 doses, and 237 assigned to receive a placebo.

They were assessed 14 days after randomization based on a 7-point scale ranging from death to discharge. No significant difference was reported between the two groups (median [interquartile range] score, 6 [4-7] vs 6 [4-7]; adjusted odds ratio, 1.02 [95% confidence interval, 0.73 to 1.42]). At 28 days, 25 patients in each group (10.4% of the hydroxychloroquine group and 10.6% of the placebo group) had died.

The study, “Phase 1 Randomized Placebo-Controlled Study in Healthy Adult Volunteers to Evaluate the Safety, Tolerability, and Pharmacokinetics of Orally Inhaled Aerosolized Hydroxychloroquine Sulfate – A Potential Treatment for COVID-19,” was published online by 

Articles

Trials testing hydroxychloroquine against COVID-19 have produced mixed results.

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Conference

Coronavirus

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Family Medicine

Early Phase Trial Results Positive for HCQ Against COVID-19

New guidelines have increased the number of parents who introduce their children at 12 months to the peanut in order to avoid any potential 

Researchers in the past have found in randomized, controlled-trials the early introduction of the peanut has shown evidence it could prevent peanut allergies.

A team, led by Victoria Soriano, BSc, Murdoch Children’s Research Institute/University of Melbourne/Centre for Food and Allergy Research (CFAR) Australia, evaluated the change in peanut allergy prevalence following changes to infant feeding practices since a pair of population-based studies conducted 10 years apart led to changes in infant feeding practices in 2016.

The research was presented in a late-breaking poster at the 

American Academy of Allergy, Asthma & Immunology (AAAAI) 2021 Annual Meeting

The researchers recruited a population-based sample of 1933 infants at 12 months old between 2018-2019 and compared the data to a sample of 5276 infants recruited 10 years early between 2007-2011. The investigators used the same sampling frame and methods and collected questionnaires on demographic and infant feeding data.

Each infant in the study sensitized underwent skin prick tests and food challenges and the investigators compared the prevalence between the 2 cohorts using direct standardization and marginal effects models. The data was adjusted for known risk factors for food allergy—parent’s country of birth, family history of allergy, dog ownership, and number of siblings.

Overall, the adjusted peanut allergy prevalence in 2018-2019 was 2.6% (95% CI, 1.9-4.0%). This was lower than the 3.1% (95% CI, 2.6-3.6%) found in the 2007-2011 cohort.

After making a further adjustment for eczema, the investigators found little difference (2.7%; 95% CI, 2.1-3.2%).

For the current study, 77.7% (95% CI, 75.7-79,5%) of infants consumed peanuts before 12 months. Of this subgroup, 2.6% were peanut allergic, compared to 4.8% of the infants who avoided peanuts until they were older than 12 months (

“We showed a 16% decrease in peanut allergy following earlier introduction of peanut; however, the prevalence of peanut allergy was still high despite the majority of infants consuming peanut within the first year,” the authors wrote.

Since the COVID-19 pandemic began, clinicians have opted for a new system of 

 introduction for infant patients at risk of developing peanut allergies.

Prior to initiation of the virtual programs infants were screened for eligibility in a private-practice allergist setting using the telehealth platform Doxy.me.

Patients were eligible if they had physician-diagnosed severe eczema, physician diagnosed egg allergy, SPT≥3 mm or ≥0.35 kU/L without prior ingestion, perceived high-risk by caregiver, or had caregiver anxiety to introduce a particular food.

During this first consultation, parents or guardians were informed about the risks and benefits of either prolonging peanut avoidance until the first in-person visit or participating in the virtually-support food introduction process.

If they chose to proceed with the program, then consent was obtained, and they were prescribed an epinephrine autoinjector and rupatadine.

The study, “Has the Prevalence of Peanut Allergy Changed Following Earlier Introduction of Peanut? The Early Nuts Study,” was published online by 

The adjusted allergy prevalence in recent years was 2.6% in infants who have been introduced to peanuts at 12 months.

Allergy

Pediatrics

Early Peanut Introduction Decreases Rates of Peanut Allergies

A survey of patients previously hospitalized for 

showed a majority were still suffering from symptoms including fatigue and changes to livelihood due to affected breathing, 6 months after their discharge.

American Academy of Allergy, Asthma & Immunology (AAAAI) 2021 Virtual Sessions

 this week, depict a small-scale perspective of necessary follow-up care for habitual symptoms that more affected COVID-19 patients may face.

The research conducted by a team of Oklahoma State University Center for Health Sciences investigators also show fluctuation in the prevalence of respiratory COVID-19 symptoms well beyond the presumed recovery phase of a patient.

Led by Ben Rossavik, DO, of the Department of Pediatrics, investigators conducted a six-month discharge survey of patients treated for RT-PCR-confirmed COVID-19 at a local tertiary center from March - August 2020.

In an accumulation of 42 patient responses, Rossavik and colleagues observed significant prevalence of fatigue (52.4%), changes in daily activities due to breathing (52.4%), shortness of breath (47.6%), change in taste and smell (42.9%) and increased much production (38.1%).

More than one-fourth of all surveyed patients reported continued issues with rhinorrhea, nasal congestion, and cough, as well.

 regarding the findings, Rossavik discussed some of the more surprising symptoms being reported by patients a half-year following their COVID-19 discharge—including multiple instances of hair loss.

Rossavik also shared perspectives collected from survey respondents, including frequent failures of memory on their COVID-19 treatment in the hospital, and experiences in physical therapy and rehabilitation.

“A lot of times, the way our model is run, people go there for a period of time, then they’re done and they go home,” Rossavik said. “But then they still complain about this inability to just walk around their house.”

The concept of COVID-19 “long-haulers” needing even bettered follow-up care and comprehensive rehabilitative services is evidenced by such feedback.

The study, “A Survey of Respiratory Symptoms Reported in Patients Following Hospitalization with COVID-19 Infection,” was presented at AAAAI 2021.

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A nNew survey results depict unexpected burdens in long-haul patients, as well as continued issues following rehabilitatio provides insight into long-term COVID-19 symptoms and complications unresolved from rehabilitation.n.

Pulmonology

Breathing Difficulty Still Common in Hospitalized COVID-19 Patients After 6 Months

Joanna S. Zeiger, MS, PhD (Canna Research Foundation)

While cannabis use has shown promise, it has been poorly studied in 

 or asthmatic patients, largely because it could lead to increased symptoms of cough and wheeze depending on the route of administration, as well as increased use of asthma medications and exacerbations.

Researchers believe short-term cannabis use can act as a bronchodilator or cause coughing or wheezing, while long-term use could cause increased respiratory symptoms.

A team, led by Joanna S. Zeiger, MS, PhD, Canna Research Foundation, determined cannabis patterns for use in asthma and allergy patients recruited through the Allergy & Asthma Network (AAN) due to a lack of information regarding cannabis in this patient population.

In the AAN Pain, Exercise, and Cannabis Experience (PEACE) Survey, the researchers recruited 489 respondents with allergies and/or asthma to complete an online survey administered on LimeSurvey between May 7, 2020 and September 7, 2020.

The researchers assessed current cannabis use by asking respondents if they’ve used cannabis, including THC or CBD within the previous 2 weeks.

The final analysis was conducted on 88 cannabis users. The investigators identified different patterns of cannabis use including frequency, duration, reasons for use, cannabinoids used, and routes of administration. Overall, 10 positive subjective effects and 12 adverse subjective effects were collected.

The majority of the patients (60.2%) were younger than 50 years old, while 72.4% of the study was female. A total of 51 patients reported current asthma, while 39.2% had uncontrolled asthma, half of which smoked cannabis and a quarter of which coughed from cannabis.

The research team determined asthma control (

 19 = uncontrolled asthma) using the Asthma Control Test and differences in demographics by asthma status, and patterns of use and subjective effects by cannabinoid type using Chi-square tests.

Overall, there were no differences found between asthma status and demographics or cannabis patterns of use.

Also found in the survey was 40.9% of physicians inquired about cannabis use, while only 37.5% of respondents wanted to discuss cannabis. In addition, the route of cannabinoid use differed by cannabinoid type was seen for smoking (

The surveys also showed differences in positive subjective effects by cannabinoid type for increased energy (

There were no significant differences for adverse events by cannabinoid used, with coughing linked with smoking cannabis. A total of 31.9% of cannabis smokers reported cough with cannabis use, while only 4.9% of cannabis non-smokers reported this outcome (

The purpose for cannabis use was medical (26.1%), recreational (34.1%), or both (39.8%) and primary cannabinoid used was tetrahydrocannabinol (33.0%), cannabidiol (19.3%), or both (47.7%).

While a minority of AAN respondents currently use the product, there were some positives, as well as adverse reactions to cannabis use.

“Most common positive cannabis effects were helps with sleep, less pain, and calm and most common cannabis adverse effects were increased appetite, anxiety, and difficulty concentrating,” the authors wrote. “Education regarding cannabis use, both its positive and adverse effects, should be discussed with patients, as well finding the safest route of administration.”

Cannabis Attitudes and Patterns of Use Among Followers of the Allergy & Asthma Network (AAN)

Common positive effects includes help with sleep, less pain, and calming influence.

Asthma

Asthma Users Weight Positives, Negatives for Cannabis Use

Biologic therapy benralizumab (Fasenra) is associated with possible elimination or maximal reduction of oral corticosteroid (OCS) use in dependent patients with 

The findings from the PONENTE Trial, presented at the 

 this weekend, evidence the AstraZeneca biologic’s benefit for reducing maintenance therapy needs in patients with severe asthma, regardless of baseline parameters including eosinophil counts.

Presented by study author Andrew Menzies-Gow, BSc, MBBS, PhD, deputy medical director at the Royal Brompton & Harefield Hospitals in the UK, the PONENTE data showed benralizumab’s influence on OCS dose reduction among 598 participants to receive at least 1 dose of the monoclonal antibody.

Mean patient age was 53.3 years old, with a majority being female (64%) and White (80.6%). A majority of patients were taking ≥5 mg OCS daily (67.7%) at baseline; 84.4% had suffered an exacerbation in the prior 12 months. Eosinophil levels at baseline varied from <150 (20.8%), ≥150 to <300 (43.7%), to ≥300 cells/mcL (35.5%).

Investigators administered benralizumab throughout the induction and OCS-reduction phases of the trial, by 30 mg subcutaneous injection every 4 weeks for 3 dosages, then every 8 weeks thereafter.

At study’s end, 62.2% (95% CI, 58.18–66.11) of patients had eliminated OCS use.Another 80.6% (95% CI, 77.20–83.70) eliminated use or reduced the daily dosage to ≤5 mg if instances of adrenal insufficiency prevented further reduction.

Another 91.3% (95% CI, 88.75–93.44) of patients achieved a daily ≤5 mg OCS dosage, regardless of the cause for stopping the reduction.

 during AAAAI 2021, Menzies-Gow discussed his team’s findings and their indication for benralizumab’s benefit for lessened OCS dependency in severe asthma.

“If you looked across the globe, depending on where you are, somewhere between 20% and 50% of severe asthmatics are stuck on OCS, so this is a big clinical problem,” he explained.

The study, “Elimination of Oral Corticosteroids (OCS) with Benralizumab Treatment in OCS-Dependent Asthmatics Using a Rapid, Personalized Algorithm: The PONENTE Trial,” was presented at AAAAI 2021.

An interview with a study author on new interpretations of biologic asthma benefit.

PONENTE: Benralizumab Reduces Oral Corticosteroid Use in Severe Asthmatics

A discussion on continued research into the first regulated treatment for pediatric peanut allergy.

Internal Medicine

PALFORZIA at 3 Years: New Data Show Sustained Peanut Immunotherapy Benefit, Safety

Treatment showed a similar effect on patients with and without baseline asthma.

Atopic Dermatitis

Dermatology

Dupilumab Gets Results Treating Pediatric Atopic Dermatitis

The indication was granted on the basis of data showing an 84% survival rate among a young pediatric population that face fatal disease severity.

Rare Disease Report®

FDA Approves Fosdenopterin for Molybdenum Cofactor Deficiency Type A

All patients in the study who tested positive for COVID-19 suffered from mild or moderate symptoms.

Vaccination

Infectious Disease

Geriatrics

MMR Vaccine Shows Some COVID-19 Protection

Researchers explore further endpoints from the SINUS-24 and SINUS-52 trials.

Dupilumab Shows Promise in Phase 3 Trials Against CRSwNP

“A high or rising white blood cell count in isolation is not a sufficient indication for C diff infection testing,” the study authors said. 

C Difficile Infection

Gastroenterology

White Blood Cell Count Elevation Not Enough for C diff Testing 

In data presented at AAAAI 2021, researchers present new data from the LIBERTY ASTHMA QUEST trial.

Dupilumab Helps Treat Uncontrolled Asthma

The authors of a research letter say a small minority of patients with diabetes have facial pain that cannot otherwise be easily explained.

Diabetes

Endocrinology

Pain

Report: Subset of Patients with Diabetes and COVID-19 Experience Craniofacial Pain

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Video Series

Managing Psoriasis Biologics During COVID-19

The injection bags will be available in 1000 mg in 100 mL doses, as well as in 500 mg in 50 mL doses.

Latest Clinical News

Early Phase Trial Results Positive for HCQ Against COVID-19

Early Peanut Introduction Decreases Rates of Peanut Allergies

Breathing Difficulty Still Common in Hospitalized COVID-19 Patients After 6 Months

Asthma Users Weight Positives, Negatives for Cannabis Use

PONENTE: Benralizumab Reduces Oral Corticosteroid Use in Severe Asthmatics