Atopic disease occurs in solid organ transplant recipients with an increasingly recognized frequency. The time course for the development of these atopic diseases in liver transplantation has not been described. The objective was to characterize the atopic manifestations of children receiving chronic immunosuppression after orthotopic liver transplantation (OLT). Chart review and follow-up questionnaire were utilized for 176 OLT pediatric recipients at a single institution for manifestations of allergic disease. Atopic disease was present in 25 (14.2%) patients. Median age at transplant was 16 months with a median follow-up of 63 months. Food allergy and non-food related atopic symptoms presented at a median of 11.5 (IQR, 6-28) and 19 (IQR, 5-41) months post-transplantation, respectively. The median age at transplant of the non-atopic children was 72 months, higher than patients with atopy (p < 0.001). Food allergy and atopic skin disease symptoms were present in 40% and 56% of cases, respectively. Asthma, allergic rhinitis, or both were found in 66% of cases. The onset of symptoms of food allergy and eczema (median, 12 months post-transplantation) preceded symptoms of allergic rhinitis and asthma. (median of 27 and 30 months post-transplantation, respectively). Atopy occurs in ∼14% of pediatric liver transplant recipients, with manifestations including food allergy, eczema, allergic rhinitis, and asthma.

RationaleSevere asthma is a heterogeneous disease in which patients have diverse clinical characteristics and biomarkers, like eosinophils and IgE. It is important to understand their relationship in a severe asthma population. The IDEAL (Identification and Description of Severe Asthma Patients in a Cross-Sectional Study) study aimed to identify the proportion of patients with severe asthma who could be eligible for an anti IL-5 (mepolizumab) or anti-IgE (omalizumab) directed treatment, and those who may be eligible for either therapy.MethodsIDEAL, an observational study included subjects aged ≥12 years with severe asthma defined according to ATS/ERS guidelines by treatment with high-dose ICS plus additional controller(s) for ≥12 months. Assessments included spirometry, a blood sample, and symptom/burden of illness questionnaires. Eligibility to mepolizumab and omalizumab were defined according to SMC advice (2016) and NICE MTA guidance (2013), which has been adopted in Scotland, respectively. Mepolizumab eligibility is defined as per SMC advice: patients who have eosinophils of at least 150 cells per microlitre (0.15 x 109/L) at initiation of treatment and have had at least four asthma exacerbations in the preceding year or are receiving maintenance treatment with oral corticosteroids. Omalizumab eligibility (NICE MTA guidance) is defined as evidence of severe persistent allergic asthma and need for continuous or frequent treatment with oral corticosteroids (defined as 4 or more courses in the previous year), and meeting bodyweight and IgE criteria for omalizumab treatment.Results748 subjects with severe asthma were enrolled in the study of which 670 met analysis criteria. After exclusion of subjects currently treated with omalizumab (n = 168), 502 subjects were included in this post-hoc analysis (mean age = 50.9 years; 62% female). 60 subjects (12% [95% Exact CI: 9.2–15.1%]) were eligible for mepolizumab (SMC advice) and 16 (3.2% [1.8–5.1]) were eligible for omalizumab (NICE MTA guidance). Among the 60 mepolizumab eligible subjects, 10 (16.7% [8.3–28.5%]) were also eligible for omalizumab.ConclusionsThis is the first cross-sectional study providing estimation of the proportion of severe asthma patients eligible for biologic therapy in accordance with Scottish guidance, indicating 12% mepolizumab-eligible and 3.2% omalizumab-eligible patients with limited overlap.Funding GSK; 201722

RationaleSevere asthma (SA) patients are a heterogeneous population with diverse clinical characteristics and biomarkers, including eosinophils and IgE. It is of clinical relevance to understand the relationship between different severe asthma phenotypes and thus eligibility for biologic therapies. The IDEAL study (Identification and Description of Severe Asthma Patients in a Cross-Sectional Study) aimed to define the proportion of patients in England and Wales who are eligible for anti IL-5 (mepolizumab) or anti-IgE (omalizumab) targeted therapy, and those who may be eligible for both, given current NICE guidance.MethodsIDEAL, an observational study, included SA subjects aged ≥12 years defined according to ATS/ERS guidelines by treatment with high-dose ICS plus additional controller(s) for ≥12 months. A post hoc analysis of IDEAL was conducted to identify eligibility to mepolizumab and omalizumab in accordance with current NICE guidance for each. Mepolizumab eligibility was defined as per NICE guidance: ‘severe refractory eosinophilic asthma patients who have eosinophils≥300 cells/microlitre (0.30 × 109/L) or more in the previous 12 months and have had ≥4 asthma exacerbations needing systemic corticosteroids in the previous 12 months, or have had continuous oral corticosteroids of at least the equivalent of prednisolone 5 mg per day for the previous 6 months’. Omalizumab eligibility defined as ‘evidence of severe persistent allergic asthma and need for continuous or frequent treatment with oral corticosteroids (defined as ≥4 courses in the previous year), and meeting bodyweight and IgE criteria for omalizumab treatment’.ResultsOf 748 SA subjects enrolled in the study, 670 met the analysis criteria and were included in this post-hoc analysis (mean age=50.9 years; 62% female). 90 subjects (13%) were eligible for mepolizumab and 184 (27%) were eligible for omalizumab. Of the 90 mepolizumab eligible patients, 31 (5%) were receiving omalizumab therapy, while of the remaining 59 (9%) patients not on a biologic 11 (2%) were also eligible for omalizumab.ConclusionsThis is the first cross-sectional study providing estimation of the proportion of SA patients eligible for biologic therapy in accordance with NICE guidance, indicating 13% mepolizumab-eligibility and 27% omalizumab-eligibility with limited overlap. (Funded by GSK; 2 01 722.)