“I've got you under my skin”: A challenge for both the allergist and the patient

“I've Got You Under My Skin”

The song written by Cole Porter in 1936 and introduced in the Eleanor Powell MGM musical “Born to Dance,” symbolizes the challenge of allergic diseases that affect this organ system for both the allergist and the patient.

The cutaneous system is one of the organ systems commonly afflicted by allergic and immunologic disorders and is not only most apparent on physical examination but often manifests as a constellation of comorbid allergic diseases. This issue features three articles that add to our clinical knowledge of allergic skin disease. In an epidemiologic case-control study, Magen et al.¹ investigated the prevalence of dermatologic disease in patients with selective immunoglobulin A deficiency. They reported that this deficiency is characterized by a higher prevalence of atopic dermatitis, chronic spontaneous urticaria, and acne. Mannucci et al.² delved deeper into the pathophysiology of allergic and inflammatory skin disorders, and shared their insights derived from a literature search on the role of miRNA involvement on inflammatory skin disorders, including atopic dermatitis, allergic contact dermatitis, eczema, and toxic epidermal necrolysis. Drucker³ provided a comprehensive review of the burden of illness, quality of life, and associated complications of atopic dermatitis. This inclusive report underscores the importance of having a complete understanding of the burden of atopic dermatitis for the clinician and the patient and parents entrusted to the clinician's care. Because of the importance of this article and its clinically useful implications, it was chosen for this issue's “For the Patient” section. This segment, found in the final pages of the print version of this issue and also available online, consists of a one-page article synopsis written in a readily comprehensible fashion to help patients better understand the content of the full article.

This issue also features three articles on the topic of asthma, a disorder frequently associated with atopic dermatitis. Hamzavi Abedi et al.⁴ conducted a retrospective chart review of 100 children with difficult-to-control asthma compared with control groups and reported a significant association between severe persistent difficult-to-control asthma and obesity, age, and race. In a genetic analysis of six common single nucleotide polymorphisms of gasdermin B obtained from 572 patients with asthma, including 165 with aspirin-exacerbated respiratory disease, Kim et al.⁵ reported finding strong associations between gasdermin B polymorphisms and the presence of aspirin-exacerbated respiratory disease, suggestive of potential causality. When turning the focus to treatment, LaForce et al.⁶ provided a comprehensive report regarding a large, phase III, double-blind, parallel-group study designed to evaluate the efficacy and safety of albuterol MDPI versus placebo MDPI in children. They reported that, in children with persistent asthma, albuterol MDPI improved pulmonary function significantly better than placebo MDPI over 3 weeks of treatment, with clinical efficacy evident within 5 minutes of dosing and maintained for >2 hours.

In expanding the focus on children, three articles included in this issue deal with pediatric anaphylaxis and food allergies. In the first article, Misirlioglu et al.⁷ characterized the clinical features of 63 children who manifest anaphylaxis. In a questionnaire-based survey of 202 parents, Ogg et al.⁸ aimed to evaluate factors associated with parents' perceived risk of food-induced anaphylaxis. Parent education, affect, and possession of an epinephrine autoinjector were identified as factors associated with a heightened perceived risk of future anaphylaxis. Based on these findings, the authors wisely counseled clinicians to consider recommending counseling services directed at these parental issues. In the final food allergy article, Yilmaz et al.⁹ studied 64 infants diagnosed with food protein–induced enterocolitis syndrome or food protein–induced allergic proctocolitis, with the goal of comparing the clinical and laboratory features of these two conditions. They reported that cow's milk is the most common trigger of food protein–induced allergic proctocolitis and food protein—induced enterocolitis syndrome. Although the age of onset of symptoms seemed to be earlier in food protein–induced allergic proctocolitis, the resolution age was similar with the caveat that the resolution age may be later in food protein–induced enterocolitis syndrome if the trigger is solid food.

In continuing the pediatric theme, Berger et al.¹⁰ provided a review of allergic conjunctivitis designed to guide pediatric health care professionals in the optimal diagnosis and management of AC in these pediatric patients. Rounding out this issue is another installment of the Clinical Pearls & Pitfalls section of the Proceedings authored by Noh and Magpantay¹¹ that focused on the hypereosinophilic syndrome. The authors presented a case report of hypereosinophilic syndrome, followed by a robust discussion of the clinical characteristics, diagnosis, and management of this perplexing and sometimes challenging disorder. The Clinical Pearls & Pitfalls section is directed primarily for the practicing allergist, clinical immunologist, and fellow-in-training.

In summary, the collection of articles found within the pages of this issue provides further insight into important allergic, cutaneous, and respiratory disorders that afflict patients whom the allergist-immunologist serves. These articles highlight how both the beneficial and adverse effects of therapy continue to challenge the allergist/immunologist in decision-making and therapy. In keeping with the overall mission of the Proceedings, which is to distribute timely information regarding advancements in the knowledge and practice of allergy, asthma, and immunology to clinicians entrusted with the care of patients, it is our hope that the articles found within this issue will help foster enhanced patient management and outcomes. On behalf of the editorial board, we hope you enjoy the diversity of literature offered in this issue of the Proceedings.