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3. WAO-ARIA consensus on chronic cough – Part III

Author

Philip W. Rouadi, Samar A. Idriss, Jean Bousquet, Tanya M. Laidlaw, Cecilio R. Azar, Mona S. Al-Ahmad, Anahi Yañez, Maryam Ali Y. Al-Nesf, Talal M. Nsouli, Sami L. Bahna, Eliane Abou-Jaoude, Fares H. Zaitoun, Usamah M. Hadi, Peter W. Hellings, Glenis K. Scadding, Peter K. Smith, Mario Morais-Almeida, René Maximiliano Gómez, Sandra N. Gonzalez Diaz, Ludger Klimek, Georges S. Juvelekian, Moussa A. Riachy, Giorgio Walter Canonica, David Peden, Gary W.K. Wong, James Sublett, Jonathan A. Bernstein, Lianglu Wang, Luciana K. Tanno, Manana Chikhladze, Michael Levin, Yoon-Seok Chang, Bryan L. Martin, Luis Caraballo, Adnan Custovic, Jose Antonio Ortego-Martell, Olivia J.Ly Lesslar, Erika Jensen-Jarolim, Motohiro Ebisawa, Alessandro Fiocchi, Ignacio J. Ansotegui, Beirut Eye & ENT Specialist Hospital (BESH), Eye & Ear Hospital [Beirut], Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL), Charité - UniversitätsMedizin = Charité - University Hospital [Berlin], Berlin Institute of Health (BIH), Contre les MAladies Chroniques pour un VIeillissement Actif en Languedoc-Roussillon (MACVIA-LR), Université Montpellier 1 (UM1)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Hospitalier Universitaire de Nîmes (CHU Nîmes)-Centre National de la Recherche Scientifique (CNRS)-European Innovation Partnership on Active and Healthy Ageing Reference Site (EIP on AHA), Commission Européenne-Commission Européenne-Organisation Mondiale de la Santé / World Health Organization Office (OMS / WHO)-Université de Montpellier (UM), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Brigham and Women’s Hospital [Boston, MA], Harvard Medical School [Boston] (HMS), American University of Beirut Faculty of Medicine and Medical Center (AUB), Middle East Institute of Health, Clemenceau Medical Center (CMC), Kuwait University, Investigaciones en Alergia y Enfermedades Respiratorias (InAER), Hamad Medical Corporation [Doha, Qatar], International Cough Institute (ICI), Louisiana State University (LSU), LAU Medical Center-Rizk Hospital, University Hospitals Leuven [Leuven], Department of Microbiology, Immunology and Transplantation [Leuven], Catholic University of Leuven - Katholieke Universiteit Leuven (KU Leuven), Ghent University Hospital, Academic Medical Center - Academisch Medisch Centrum [Amsterdam] (AMC), University of Amsterdam [Amsterdam] (UvA), The Royal National Throat, Nose and Ear Hospital, Griffith University [Brisbane], Hospital CUF Descobertas, Facultad de Ciencias de la Salud [Salta], Universidad Nacional de Salta (UNSA), Universidad Autonoma de Nuevo Leon [Mexique] (UANL), Center for Rhinology and Allergology Wiesbaden, University Hospital Mannheim, Saint George Hospital University Medical Center [UOB LIBAN], University of Balamand [Liban] (UOB), Hôtel-Dieu de France (HDF), Université Saint-Joseph de Beyrouth (USJ), Humanitas Clinical and Research Center [Rozzano, Milan, Italy], UNC School of Medicine, The Chinese University of Hong Kong [Hong Kong], University of Louisville School of Medicine, University of Cincinnati College of Medicine, Peking Union Medical College Hospital [Beijing] (PUMCH), Institut Desbrest de santé publique (IDESP), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), World Health Organisation (WHO), Organisation Mondiale de la Santé / World Health Organization Office (OMS / WHO), Akaki Tsereteli State University, University of Cape Town, Seoul National University Bundang Hospital (SNUBH), The Ohio State University Wexner Medical Center., University of Cartagena, National Heart and Lung Institute [London] (NHLI), Imperial College London-Royal Brompton and Harefield NHS Foundation Trust, Universidad Autónoma del Estado de Hidalgo (UAEH), LifeSpan medicine, Medizinische Universität Wien = Medical University of Vienna, Messerli Research Institute, University of Veterinary Medicine Vienna, Medical University Vienna, University of Vienna [Vienna]-University of Vienna [Vienna]-Medical University Vienna, University of Vienna [Vienna]-University of Vienna [Vienna], Sagamihara National Hospital [Kanagawa, Japan], Bambino Gesù Children’s Hospital [Rome, Italy], Hospital Quirónsalud Bizkaia [Bilbao], and Salvy-Córdoba, Nathalie

Subjects
EXHALED NITRIC-OXIDE, Pulmonary and Respiratory Medicine, Cough specialty care, Chronic cough management, Allergy, AIRWAY INFLAMMATION, Upper airway cough syndrome, Immunology, MUCOSAL EOSINOPHILIC INFLAMMATION, GASTROESOPHAGEAL-REFLUX DISEASE, INHALED CORTICOSTEROIDS, Lower airway disease, Speech therapy, QUALITY-OF-LIFE, CHEST GUIDELINE, Immunology and Allergy, [SDV.IMM.ALL]Life Sciences [q-bio]/Immunology/Allergology, Neuromodulators, VARIANT ASTHMA, Cough primary care, Science & Technology, CLINICAL-PRACTICE GUIDELINE, Reflux cough, REFRACTORY CHRONIC COUGH, Life Sciences & Biomedicine, [SDV.IMM.ALL] Life Sciences [q-bio]/Immunology/Allergology
Abstract

BACKGROUND: Chronic cough management necessitates a clear integrated care pathway approach. Primary care physicians initially encounter the majority of chronic cough patients, yet their role in proper management can prove challenging due to limited access to advanced diagnostic testing. A multidisciplinary approach involving otolaryngologists and chest physicians, allergists, and gastroenterologists, among others, is central to the optimal diagnosis and treatment of conditions which underly or worsen cough. These include infectious and inflammatory, upper and lower airway pathologies, or gastro-esophageal reflux. Despite the wide armamentarium of ancillary testing conducted in cough multidisciplinary care, such management can improve cough but seldom resolves it completely. This can be due partly to the limited data on the role of tests (eg, spirometry, exhaled nitric oxide), as well as classical pharmacotherapy conducted in multidisciplinary specialties for chronic cough. Other important factors include presence of multiple concomitant cough trigger mechanisms and the central neuronal complexity of chronic cough. Subsequent management conducted by cough specialists aims at control of cough refractory to prior interventions and includes cough-specific behavioral counseling and pharmacotherapy with neuromodulators, among others. Preliminary data on the role of neuromodulators in a proof-of-concept manner are encouraging but lack strong evidence on efficacy and safety. OBJECTIVES: The World Allergy Organization (WAO)/Allergic Rhinitis and its Impact on Asthma (ARIA) Joint Committee on Chronic Cough reviewed the recent literature on management of chronic cough in primary, multidisciplinary, and cough-specialty care. Knowledge gaps in diagnostic testing, classical and neuromodulator pharmacotherapy, in addition to behavioral therapy of chronic cough were also analyzed. OUTCOMES: This third part of the WAO/ARIA consensus on chronic cough suggests a management algorithm of chronic cough in an integrated care pathway approach. Insights into the inherent limitations of multidisciplinary cough diagnostic testing, efficacy and safety of currently available antitussive pharmacotherapy, or the recently recognized behavioral therapy, can significantly improve the standards of care in patients with chronic cough. ispartof: WORLD ALLERGY ORGANIZATION JOURNAL vol:15 issue:5 ispartof: location:United States status: published

Published
2022

4. WAO-ARIA consensus on chronic cough – Part 1

Author

Philip W. Rouadi, Samar A. Idriss, Jean Bousquet, Tanya M. Laidlaw, Cecilio R. Azar, Mona Sulaiman AL-Ahmad, Anahí Yáñez, Maryam Ali Y. AL-Nesf, Talal M. Nsouli, Sami L. Bahna, Eliane Abou-Jaoude, Fares H. Zaitoun, Usamah M. Hadi, Peter W. Hellings, Glenis K. Scadding, Peter K. Smith, Mario Morais-Almeida, R. Maximiliano Gómez, Sandra N. González Díaz, Ludger Klimek, Georges S. Juvelekian, Moussa A. Riachy, Giorgio Walter Canonica, David Peden, Gary W.K. Wong, James Sublett, Jonathan A. Bernstein, Lianglu Wang, Luciana Kase Tanno, Manana Chikhladze, Michael Levin, Yoon-Seok Chang, Bryan L. Martin, Luis Caraballo, Adnan Custovic, José Antonio Ortega-Martell, Erika Jensen-Jarolim, Motohiro Ebisawa, Alessandro Fiocchi, Ignacio J. Ansotegui, Salvy-Córdoba, Nathalie, Beirut Eye & ENT Specialist Hospital (BESH), Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL), Charité - UniversitätsMedizin = Charité - University Hospital [Berlin], Berlin Institute of Health (BIH), Contre les MAladies Chroniques pour un VIeillissement Actif en Languedoc-Roussillon (MACVIA-LR), Université Montpellier 1 (UM1)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Hospitalier Universitaire de Nîmes (CHU Nîmes)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS)-European Innovation Partnership on Active and Healthy Ageing Reference Site (EIP on AHA), Commission Européenne-Commission Européenne-Organisation Mondiale de la Santé / World Health Organization Office (OMS / WHO), Université de Montpellier (UM), Brigham and Women’s Hospital [Boston, MA], Harvard Medical School [Boston] (HMS), American University of Beirut Faculty of Medicine and Medical Center (AUB), Middle East Institute of Health, Clemenceau Medical Center (CMC), Kuwait University, Investigaciones en Alergia y Enfermedades Respiratorias (InAER), Hamad Medical Corporation [Doha, Qatar], International Cough Institute (ICI), Louisiana State University (LSU), LAU Medical Center-Rizk Hospital, VIB-KU Leuven Center for Microbiology [Leuven, Belgium], Catholic University of Leuven - Katholieke Universiteit Leuven (KU Leuven), University Hospitals Leuven [Leuven], Ghent University Hospital, Academic Medical Center - Academisch Medisch Centrum [Amsterdam] (AMC), University of Amsterdam [Amsterdam] (UvA), The Royal National TNE Hospital, University College of London [London] (UCL), Griffith University [Brisbane], Hospital CUF Descobertas, Catholic University of Salta, Universidad Autonoma de Nuevo Leon [Mexique] (UANL), Center for Rhinology and Allergology Wiesbaden, University Hospital Mannheim, Saint George Hospital University Medical Center [UOB LIBAN], University of Balamand [Liban] (UOB), Hôtel-Dieu de France (HDF), Université Saint-Joseph de Beyrouth (USJ), Istituto Clinico Humanitas [Milan] (IRCCS Milan), Humanitas University [Milan] (Hunimed), University of North Carolina [Chapel Hill] (UNC), University of North Carolina System (UNC), The Chinese University of Hong Kong [Hong Kong], University of Louisville School of Medicine, University of Cincinnati College of Medicine, Peking Union Medical College Hospital [Beijing] (PUMCH), Institut Desbrest de santé publique (IDESP), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Organisation Mondiale de la Santé / World Health Organization Office (OMS / WHO), Akaki Tsereteli State University, University of Cape Town, Seoul National University Hospital, The Ohio State University Wexner Medical Center., University of Cartagena, Imperial College London, Universidad Autónoma del Estado de Hidalgo (UAEH), Medizinische Universität Wien = Medical University of Vienna, Messerli Research Institute, University of Veterinary Medicine Vienna, Medical University Vienna, University of Vienna [Vienna]-University of Vienna [Vienna]-Medical University Vienna, University of Vienna [Vienna]-University of Vienna [Vienna], Sagamihara National Hospital [Kanagawa, Japan], Bambino Gesù Children’s Hospital [Rome, Italy], and Hospital Quirónsalud Bizkaia [Bilbao]

Subjects
Pulmonary and Respiratory Medicine, Allergy, [SDV.IMM] Life Sciences [q-bio]/Immunology, Immunology, INDUCED ENHANCEMENT, ION-CHANNEL, Pathogenesis, [SDV.MHEP.PSR]Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract, Article, PAIN HYPERSENSITIVITY, HYPERSENSITIVITY SYNDROME, CENTRAL SENSITIZATION, Chronic cough, TRP channel, Immunology and Allergy, Science & Technology, THERAPEUTIC TARGET, Chemoreceptors, RECEPTOR SUBTYPES, [SDV.MHEP.HEG]Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology, RC581-607, GENE-RELATED PEPTIDE, [SDV.MHEP.HEG] Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology, respiratory tract diseases, P2X3, DISTINCT POPULATIONS, [SDV.MHEP.PSR] Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract, [SDV.IMM]Life Sciences [q-bio]/Immunology, CENTRAL MECHANISMS, Immunologic diseases. Allergy, Life Sciences & Biomedicine, Mechanoreceptors
Abstract

BACKGROUND: Cough features a complex peripheral and central neuronal network. The function of the chemosensitive and stretch (afferent) cough receptors is well described but partly understood. It is speculated that chronic cough reflects a neurogenic inflammation of the cough reflex, which becomes hypersensitive. This is mediated by neuromediators, cytokines, inflammatory cells, and a differential expression of neuronal (chemo/stretch) receptors, such as transient receptor potential (TRP) and purinergic P2X ion channels; yet the overall interaction of these mediators in neurogenic inflammation of cough pathways remains unclear. OBJECTIVES: The World Allergy Organization/Allergic Rhinitis and its Impact on Asthma (WAO/ARIA) Joint Committee on Chronic Cough reviewed the current literature on neuroanatomy and pathophysiology of chronic cough. The role of TRP ion channels in pathogenic mechanisms of the hypersensitive cough reflex was also examined. OUTCOMES: Chemoreceptors are better studied in cough neuronal pathways compared to stretch receptors, likely due to their anatomical overabundance in the respiratory tract, but also their distinctive functional properties. Central pathways are important in suppressive mechanisms and behavioral/affective aspects of chronic cough. Current evidence strongly suggests neurogenic inflammation induces a hypersensitive cough reflex marked by increased expression of neuromediators, mast cells, and eosinophils, among others. TRP ion channels, mainly TRP V1/A1, are important in the pathogenesis of chronic cough due to their role in mediating chemosensitivity to various endogenous and exogenous triggers, as well as a crosstalk between neurogenic and inflammatory pathways in cough-associated airways diseases. ispartof: WORLD ALLERGY ORGANIZATION JOURNAL vol:14 issue:12 ispartof: location:United States status: published

Published
2021

5. Neuropsychiatric side reactions of leukotriene receptor antagonist, antihistamine, and inhaled corticosteroid: A real-world analysis of the Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS)

Author

Kai Guan, Jia Yin, Le Cui, Sainan Bian, Zixi Wang, Bin Zhao, Lianglu Wang, Yingyang Xu, and Lisha Li

Subjects
Pulmonary and Respiratory Medicine, Drug, medicine.medical_specialty, medicine.medical_treatment, media_common.quotation_subject, Immunology, Leukotriene receptor antagonist, Article, Antihistamine, Neuropsychiatric event, Adverse Event Reporting System, Inhaled corticosteroid, Internal medicine, Case fatality rate, medicine, Immunology and Allergy, Montelukast, media_common, Leukotriene receptor, business.industry, Mortality rate, Odds ratio, RC581-607, Immunologic diseases. Allergy, business, medicine.drug
Abstract

Background There are limited real-world studies on the differences in leukotriene receptor antagonists (LTRA), H1-antihistamines (H1-AH), and inhaled corticosteroids (ICS) associated neuropsychiatric events. In this study, we aimed to analyze the characteristics of drug associated neuropsychiatric events, and compare the differences among different drug categories. Methods Disproportionality analysis and Bayesian analysis were used in data mining to identify suspected neuropsychiatric events associated with LTRA, H1-AH, and ICS based on the United States Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS) from January 2004 to September 2020. Demographic information, time interval to onset, and death rates of LTRA, H1-AH, and ICS-associated neuropsychiatric events were also analyzed. Results A total of 9475 neuropsychiatric events were identified. The number of neuropsychiatric events related to LTRA, H1-AH, and ICS were 5201 (54.89%), 3226 (34.05%), and 1048 (11.06%), respectively. LTRA related neuropsychiatric events were more common in patients aged 4–6 years (18.66%). H1-AH and ICS related neuropsychiatric events were more common in patients aged 18–44 years (29.92%) and older than 65 years (30.60%), respectively. Montelukast was highly associated with neuropsychiatric events, with a high reporting odds ratio (ROR). Most neuropsychiatric symptoms occurred within the first 10 days after drug initiation (78.63% for LTRA, 91.39% for H1-AH, and 84.07% for ICS). The death rate due to neuropsychiatric events of first generation H1-AH was significantly higher than that of LTRA and ICS (p Conclusions LTRA associated neuropsychiatric events reported in FAERS were most frequent in 4 to 6-year-old children. Most reported cases occurred within the first 10 days after drug initiation. The second generation H1-AH was relatively safe for neuropsychiatric events compared with the first generation. The fatality rate due to first generation H1-AH associated neuropsychiatric events was higher than that of LTRA and ICS. More attention should be paid to specific patients treated with LTRA and H1-AH.

Published
2021

6. WAO-ARIA consensus on chronic cough - Part II: Phenotypes and mechanisms of abnormal cough presentation — Updates in COVID-19

Author

Lianglu Wang, Sami L. Bahna, Luis Caraballo, Jean Bousquet, David B. Peden, Sandra Nora González Díaz, Luciana Kase Tanno, Georges S. Juvelekian, Giorgio Walter Canonica, Ludger Klimek, Ignacio J. Ansotegui, Yoon-Seok Chang, Jose Antonio Ortego-Martell, Adnan Custovic, Moussa A. Riachy, Bryan Martin, Samar A. Idriss, Peter K. Smith, Gary W.K. Wong, René Maximiliano Gómez, Erika Jensen-Jarolim, Mona Al-Ahmad, Tanya M. Laidlaw, Jonathan A. Bernstein, Cecilio Azar, Philip W. Rouadi, Alessandro Fiocchi, Michael Levin, Eliane Abou-Jaoude, Motohiro Ebisawa, Talal M. Nsouli, Mário Morais-Almeida, Usamah Hadi, Maryam Ali Al-Nesf, Fares Zaitoun, Glenis Scadding, James L. Sublett, Manana Chikhladze, Anahí Yáñez, Peter Hellings, Beirut Eye & ENT Specialist Hospital (BESH), Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL), Charité - UniversitätsMedizin = Charité - University Hospital [Berlin], Berlin Institute of Health (BIH), Contre les MAladies Chroniques pour un VIeillissement Actif en Languedoc-Roussillon (MACVIA-LR), Université Montpellier 1 (UM1)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Hospitalier Universitaire de Nîmes (CHU Nîmes)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS)-European Innovation Partnership on Active and Healthy Ageing Reference Site (EIP on AHA), Commission Européenne-Commission Européenne-Organisation Mondiale de la Santé / World Health Organization Office (OMS / WHO), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Brigham and Women’s Hospital [Boston, MA], Harvard Medical School [Boston] (HMS), American University of Beirut [Beyrouth] (AUB), Middle East Institute of Health, Clemenceau Medical Center (CMC), Kuwait University, Investigaciones en Alergia y Enfermedades Respiratorias (InAER), Hamad Medical Corporation [Doha, Qatar], International Cough Institute (ICI), Louisiana State University (LSU), LAU Medical Center-Rizk Hospital, American University of Beirut Faculty of Medicine and Medical Center (AUB), Department of Microbiology, Immunology and Transplantation [Leuven], Catholic University of Leuven - Katholieke Universiteit Leuven (KU Leuven), University Hospitals Leuven [Leuven], Ghent University Hospital, Academic Medical Center - Academisch Medisch Centrum [Amsterdam] (AMC), University of Amsterdam [Amsterdam] (UvA), The Royal National Throat, Nose and Ear Hospital [London, UK], University College of London [London] (UCL), Griffith University [Brisbane], Hospital CUF Descobertas, Catholic University of Salta, Universidad Autonoma de Nuevo Leon [Mexique] (UANL), Center for Rhinology and Allergology Wiesbaden, University Hospital Mannheim, Saint George Hospital University Medical Center [UOB LIBAN], University of Balamand [Liban] (UOB), Hôtel-Dieu de France (HDF), Université Saint-Joseph de Beyrouth (USJ), Humanitas Clinical and Research Center [Rozzano, Milan, Italy], University of North Carolina [Chapel Hill] (UNC), University of North Carolina System (UNC), The Chinese University of Hong Kong [Hong Kong], University of Louisville, University of Cincinnati College of Medicine, Peking Union Medical College Hospital [Beijing] (PUMCH), Institut Desbrest de santé publique (IDESP), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), World Health Organisation (WHO), Organisation Mondiale de la Santé / World Health Organization Office (OMS / WHO), Akaki Tsereteli State University, University of Cape Town, Seoul National University Bundang Hospital (SNUBH), The Ohio State University Wexner Medical Center., University of Cartagena, Imperial College London, Universidad Autónoma del Estado de Hidalgo (UAEH), Medizinische Universität Wien = Medical University of Vienna, Sagamihara National Hospital [Kanagawa, Japan], Bambino Gesù Children’s Hospital [Rome, Italy], Hospital Quirónsalud Bizkaia [Bilbao], and Salvy-Córdoba, Nathalie

Subjects
Pulmonary and Respiratory Medicine, Allergy, Upper airway cough syndrome, medicine.medical_treatment, Cough reflex, Immunology, GASTROESOPHAGEAL-REFLUX DISEASE, AIRWAY COUGH, Lower airway disease, OBSTRUCTIVE PULMONARY-DISEASE, [SDV.MHEP.PSR]Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract, TRP CHANNELS, Article, CLINICAL CHARACTERISTICS, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, CHEST GUIDELINE, medicine, Immunology and Allergy, Continuous positive airway pressure, VARIANT ASTHMA, Cough phenotypes, COPD, Science & Technology, POSTNASAL-DRIP-SYNDROME, business.industry, Type 2 inflammation, RC581-607, medicine.disease, Obstructive sleep apnea, respiratory tract diseases, ALLERGIC RHINITIS, Chronic cough, Upper respiratory tract infection, BRONCHIAL HYPERRESPONSIVENESS, [SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, GERD, Reflex, [SDV.MHEP.PSR] Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract, Multifactorial cough, Immunologic diseases. Allergy, medicine.symptom, business, Life Sciences & Biomedicine, COVID 19, Reflux-cough
Abstract

BACKGROUND: Chronic cough can be triggered by respiratory and non-respiratory tract illnesses originating mainly from the upper and lower airways, and the GI tract (ie, reflux). Recent findings suggest it can also be a prominent feature in obstructive sleep apnea (OSA), laryngeal hyperresponsiveness, and COVID-19. The classification of chronic cough is constantly updated but lacks clear definition. Epidemiological data on the prevalence of chronic cough are informative but highly variable. The underlying mechanism of chronic cough is a neurogenic inflammation of the cough reflex which becomes hypersensitive, thus the term hypersensitive cough reflex (HCR). A current challenge is to decipher how various infectious and inflammatory airway diseases and esophageal reflux, among others, modulate HCR. OBJECTIVES: The World Allergy Organization/Allergic Rhinitis and its Impact on Asthma (WAO/ARIA) Joint Committee on Chronic Cough reviewed the current literature on classification, epidemiology, presenting features, and mechanistic pathways of chronic cough in airway- and reflux-related cough phenotypes, OSA, and COVID-19. The interplay of cough reflex sensitivity with other pathogenic mechanisms inherent to airway and reflux-related inflammatory conditions was also analyzed. OUTCOMES: Currently, it is difficult to clearly ascertain true prevalence rates in epidemiological studies of chronic cough phenotypes. This is likely due to lack of standardized objective measures needed for cough classification and frequent coexistence of multi-organ cough origins. Notwithstanding, we emphasize the important role of HCR as a mechanistic trigger in airway- and reflux-related cough phenotypes. Other concomitant mechanisms can also modulate HCR, including type2/Th1/Th2 inflammation, presence or absence of deep inspiration-bronchoprotective reflex (lower airways), tissue remodeling, and likely cough plasticity, among others. ispartof: WORLD ALLERGY ORGANIZATION JOURNAL vol:14 issue:12 ispartof: location:United States status: published

Published
2021

7. Expert consensus on the use of omalizumab in chronic urticaria in China

Author

Zuotao Zhao, Tao Cai, Hong Chen, Liuqing Chen, Yudi Chen, Xiang Gao, Xinghua Gao, Songmei Geng, Yinshi Guo, Fei Hao, Guodong Hao, Yan Hu, Hongzhong Jin, Zhehu Jin, Chengxin Li, Haili Li, Jie Li, Yanming Li, Yunsheng Liang, Guanghui Liu, Qiang Liu, Hai Long, Lin Ma, Yuanyuan Shang, Yuxin Song, Zhiqiang Song, Xiangyang Su, Haijing Sui, Qing Sun, Yuemei Sun, Jianping Tang, Xunliang Tong, Huiying Wang, Gang Wang, Lianglu Wang, Siqin Wang, Li Xiang, Ting Xiao, Zhiqiang Xie, Leping Ye, Yongmei Yu, Chunlei Zhang, Litao Zhang, Shuchen Zhang, Rui Zheng, Lili Zhi, Wei Zhou, Ying Zou, and Marcus Maurer

Subjects
Pulmonary and Respiratory Medicine, China, Chronic inducible urticaria, Immunology, Treatment algorithm, Immunology and Allergy, Omalizumab, Immunologic diseases. Allergy, RC581-607, Chronic spontaneous urticaria, Article
Abstract

Chronic urticaria (CU) is a debilitating skin disease that lasts for more than 6 weeks with wheals and/or angioedema, including chronic spontaneous urticaria (CSU) and chronic inducible urticaria (CIndU). In China, the prevalence of this disease is high, more than 1%, and on the rise. CU has a major impact on the quality of life (QoL) of patients who frequently experience sleep disturbance, depression, and anxiety. Nearly one-third of patients with CSU, in China, are resistant to second-generation H1-antihistamines (sgAHs), even at a fourfold dose (second line; off-label). Omalizumab is approved for the treatment of CSU treatment in Europe and shows remarkable efficacy and safety. In China, regulatory approval for the use of omalizumab is pending, and its use in clinical practice varies widely. Consensus on omalizumab CU treatment in China is urgently needed. The aim of this article is to propose a practical omalizumab treatment algorithm for the management of antihistamine-resistant CSU and CIndU in adults and special population including children and adolescents, and pregnant or breast feeding women, to guide daily clinical practice in China. In the development of this consensus, an expert group including mainly dermatologists, allergists, but also pulmonologists, ENTs, immunologists, and pediatricians in Allergic Disease Prevention and Control Committee, Chinese Preventive Medicine Association, reviewed the existing evidence and developed consensus on the use of omalizumab in CU patients from China. The goal of this consensus is to assist clinicians in making rational decisions in the management of refractory CU with omalizumab. The key clinical questions covered by the treatment algorithm are: 1) Omalizumab treatment routine strategy in both CSU and CIndU patients; 2) Recommended dose and treatment duration for different age stratification; 3) Treatment duration for CU patients with other allergic comorbidities; 4) Recommendation on omalizumab stopping strategy.

Published
2021

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