As spring arrives and pollen season begins, the current issue of Annals of Allergy, Asthma and Immunology highlights many of the new changes that are coming to our field. As the old Bob Dylan song states, “The times they are a-changin’” for our field and practice. This month’s articles and reviews provide guidance for these changes in our treatment pathways.
There are several informative articles on food allergy in this issue that cover food allergy ladders, food allergy thresholds and shared decision-making in treating food allergy. In addition, the importance of food challenges and alternative therapies to strict avoidance in food allergy are discussed. Drs. Upton and Anagnostou cover potential benefits with the use of food ladders in quality of life and possible changes in tolerance. In a related article, Dr. Shaker and colleagues discuss alternative methods for treating acute anaphylaxis with inhaled epinephrine as compared to intramuscular epinephrine.
Newly published Practice Parameters from the Joint Task Force using GRADE and Institute of Medicine recommendations provide clear recommendations for the treatment of atopic dermatitis. Figure 1 of that paper provides a wonderful summary on intervention based on severity in one clear illustration. Drs. Samynathan and Silverberg’s review presents key points for when to use new Janus kinase (JAK) inhibitors versus biologicals in the treatment of severe atopic dermatitis. For example, patients with concomitant atopic disease might benefit from a biologic, while the patient with concomitant Th1 disease would benefit from JAK inhibitors.
Dr. Alexis and colleagues describe the use of Arbrocitinib (one of the JAK inhibitors) with differing responses based on race and ethnicity while still being effective in all groups. For example, there were more adverse events in the white and Black populations compared to the Asian group, but Hispanic and Black populations were small — indicating a need for further studies and for enrolling a more diverse population to answer important clinical questions on how skin responds differently to atopic dermatitis treatments. In an interesting perspective, Dr. Leung describes the 80-year history of atopic dermatitis manuscripts in Annals.
And, as always, if you have any comments, please consider sending a correspondence to Annals (email us at annals@ACAAI.org). We are always excited to hear how Annals has helped you improve the lives of your patients!
Jonathan Spergel, MD, PhD, FACAAI
Deputy Editor
