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Nomura Y, Okubo K, Nakamura T, Sawaki S, Kitagou H, Idei N, Kaneko S, Kobayashi S, Tanaka Y, Okamoto Y. Long-term treatment of Japanese cedar pollinosis with Japanese cedar pollen SLIT drops and persistence of treatment effect: A post-marketing clinical trial. Allergol Int 2021; 70:96-104. [PMID: 32653209 DOI: 10.1016/j.alit.2020.05.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 05/10/2020] [Accepted: 05/15/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND There have been no reports of treatment effect persistence after long-term sublingual immunotherapy (SLIT) in patients with Japanese cedar (JC) pollinosis. Therefore, we conducted a post-marketing clinical trial to investigate the efficacy, safety, and effect persistence of JC pollen SLIT drops after approximately 3 years of treatment. METHODS This was an open-label trial of 233 patients with JC pollinosis who were treated with JC pollen SLIT drops for approximately 3 years (2015-2017) and followed-up for an additional 2 years (2018-2019). Efficacy and effect persistence were evaluated using nasal and ocular symptom scores, daily use of rescue medication, and Japanese Rhinoconjunctivitis Quality of Life Questionnaire scores recorded during the JC pollen dispersal season of each year. Safety was evaluated by monitoring adverse events and adverse drug reactions. RESULTS The mean combined total nasal symptom and medication score (range 0-18) during the peak symptom periods of 2015 through 2019 were 5.47 ± 3.38, 4.52 ± 3.13, 3.58 ± 2.63, 5.28 ± 4.01, and 6.83 ± 4.65, respectively. The percentage of patients who used no rescue medications during the same periods was 64.8%, 75.2%, 80.3%, 63.7%, and 50.3%, respectively. A total of 138 adverse drug reaction incidents were recorded in 73 of the 233 patients (31.3%), of which 134 incidents (97.1%) were mild in severity. CONCLUSIONS JC pollen SLIT drops demonstrated treatment duration-dependent efficacy with effects that persisted for 2 years after cessation of treatment. The drug had a favorable safety profile over the 5-year study period.
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Janssens NS, van Ouwerkerk L, Gerth van Wijk R, Karim F. Acute systemic reactions to sublingual immunotherapy for house dust mite. Allergy 2020; 75:2962-2963. [PMID: 32449962 PMCID: PMC7687263 DOI: 10.1111/all.14417] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 05/11/2020] [Accepted: 05/18/2020] [Indexed: 01/24/2023]
Affiliation(s)
- Nicky S Janssens
- Department of Internal Medicine, Groene Hart Hospital, Gouda, the Netherlands
| | - Lotte van Ouwerkerk
- Department of Internal Medicine, Groene Hart Hospital, Gouda, the Netherlands
| | - Roy Gerth van Wijk
- Department of Internal Medicine, Section Allergy and Clinical Immunology, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Faiz Karim
- Department of Internal Medicine, Groene Hart Hospital, Gouda, the Netherlands.,Department of Internal Medicine, Section Allergy and Clinical Immunology, Erasmus Medical Centre, Rotterdam, the Netherlands
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Wongteerayanee C, Tanticharoenwiwat P, Rutrakool N, Senavonge A, Jeekungwal N, Pacharn P, Vichyanond P. Feasibility of a 3-step protocol of wheat oral immunotherapy in children with severe wheat allergy. Asia Pac Allergy 2020; 10:e38. [PMID: 33178563 PMCID: PMC7610086 DOI: 10.5415/apallergy.2020.10.e38] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 10/19/2020] [Indexed: 11/25/2022] Open
Abstract
Background Wheat allergy is not an uncommon event among Thai children. Despite strict avoidance, some patients developed reactions after accidental exposure to minute amount of wheat and thus disturbed their quality of life. Wheat oral immunotherapy (OIT) has been reported to be an alternative treatment for such patients. Objective We designed a new 3-step wheat OIT protocol for treatment of severe wheat allergy in Thai patients. The feasibility of the protocol is evaluated and is reported here in this paper. Methods We retrospectively reviewed medical records of 26 patients who had undergone wheat OIT during a 30-month period. The 3-step protocol consisted of an initial phase of double-blind, placebo-controlled food challenge (DBPCFC) and initiation of OIT, a build-up phase, and a maintenance phase. Patient retention in the protocol was the main outcome for this feasibility study. Adverse effects during OIT were recorded. Correlation between serum specific IgE (SpIgE) to wheat and eliciting dose in phase I was determined. Results Fourteen females and 12 males with a median age of 6 years were studied. Their median age when wheat allergy began was 8 months. Median SpIgE to wheat was high (198 kUA/L). All patients developed reactions during DBPCFC with 17 of 26 patients had moderate to severe reactions required adrenaline injections. Median of eliciting dose of wheat was exceedingly low, i.e., 20 mg of wheat protein. At the end of the study, 23 of 26 patients (88%) were still in the study. Adverse reactions during the build-up phase was frequent (13 patients, 50%), with adrenaline required in 6 occasions. Six patients reached maintenance phase. Conclusion The new 3-step wheat OIT protocol was feasible in these highly wheat-sensitized patients. Despite a high retention rate, a high rate of adverse effects was observed both during DBPCFC and build-up phases.
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Affiliation(s)
| | | | - Nuntanut Rutrakool
- Samitivej Allergy Institute (SAI), Samitivej Thonburi Hospital, Bangkok, Thailand
| | - Anchalee Senavonge
- Samitivej Allergy Institute (SAI), Samitivej Thonburi Hospital, Bangkok, Thailand
| | - Nivat Jeekungwal
- Samitivej Allergy Institute (SAI), Samitivej Thonburi Hospital, Bangkok, Thailand
| | - Punchama Pacharn
- Samitivej Allergy Institute (SAI), Samitivej Thonburi Hospital, Bangkok, Thailand.,Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand
| | - Pakit Vichyanond
- Samitivej Allergy Institute (SAI), Samitivej Thonburi Hospital, Bangkok, Thailand.,Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand
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Two Different Composite Markers Predict Severity and Threshold Dose in Peanut Allergy. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 9:275-282.e1. [PMID: 33038591 DOI: 10.1016/j.jaip.2020.09.043] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 09/17/2020] [Accepted: 09/18/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Safe and cost-effective biological surrogate markers to evaluate the severity and threshold dose of peanut allergy (PA) reactions during an oral food challenge (OFC) are lacking. OBJECTIVE To evaluate biological markers associated with the severity and threshold dose of an allergic reaction during an OFC in a population of children with PA. METHODS Demographic and biological parameters of children with peanut OFC and basophil activation test (BAT) results were collected. Patients were stratified into 2 severity groups (mild-to-moderate and severe) and 2 cumulative threshold dose groups: low (LCTG) ≤100 mg crushed peanut and high >100 mg. RESULTS Among the 68 children included, there was a 96% concordance between the OFC and BAT result for the diagnosis of PA. Of the 56 children with a positive OFC and BAT to peanut (median age: 8.8 years), the severity of an allergic reaction and the cumulative threshold dose were not correlated (P = .24). Higher Ara h 2-specific IgE and FcεRI-positive control values were both associated with severe reactions to peanut. Combining these 2 markers led to a 92% sensitivity (84%-97%) and an 82% specificity (71%-89%) for severe reactions in all subjects. For children in the LCTG, a 4-variable composite marker, including age, normalized basophil sensitivity (EC50), and FcεRI- and fMLP-positive control values, resulted in a 97% sensitivity (89%-99%) and 61% specificity (49%-71%). CONCLUSION Distinct composite markers including BAT allergen-specific and non-allergen-specific parameters appear to be associated with severity and cumulative threshold dose in children with PA.
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Cardona V, Ansotegui IJ, Ebisawa M, El-Gamal Y, Fernandez Rivas M, Fineman S, Geller M, Gonzalez-Estrada A, Greenberger PA, Sanchez Borges M, Senna G, Sheikh A, Tanno LK, Thong BY, Turner PJ, Worm M. World allergy organization anaphylaxis guidance 2020. World Allergy Organ J 2020; 13:100472. [PMID: 33204386 PMCID: PMC7607509 DOI: 10.1016/j.waojou.2020.100472] [Citation(s) in RCA: 435] [Impact Index Per Article: 108.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 09/03/2020] [Indexed: 12/16/2022] Open
Abstract
Anaphylaxis is the most severe clinical presentation of acute systemic allergic reactions. The occurrence of anaphylaxis has increased in recent years, and subsequently, there is a need to continue disseminating knowledge on the diagnosis and management, so every healthcare professional is prepared to deal with such emergencies. The rationale of this updated position document is the need to keep guidance aligned with the current state of the art of knowledge in anaphylaxis management. The World Allergy Organization (WAO) anaphylaxis guidelines were published in 2011, and the current guidance adopts their major indications, incorporating some novel changes. Intramuscular epinephrine (adrenaline) continues to be the first-line treatment for anaphylaxis. Nevertheless, its use remains suboptimal. After an anaphylaxis occurrence, patients should be referred to a specialist to assess the potential cause and to be educated on prevention of recurrences and self-management. The limited availability of epinephrine auto-injectors remains a major problem in many countries, as well as their affordability for some patients.
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Affiliation(s)
- Victoria Cardona
- Allergy Section, Department of Internal Medicine, Hospital Vall d’Hebron, and ARADyAL research network, Barcelona, Spain
| | - Ignacio J. Ansotegui
- Department of Allergy and Immunology, Hospital Quironsalud Bizkaia, Bilbao, Spain
| | - Motohiro Ebisawa
- Department of Allergy, Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, Kanagawa, Japan
| | - Yehia El-Gamal
- Pediatric Allergy and Immunology Unit, Ain Shams University, Cairo, Egypt
| | | | - Stanley Fineman
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Mario Geller
- Division of Medicine, Academy of Medicine of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Alexei Gonzalez-Estrada
- Division of Pulmonary, Allergy and Sleep Medicine, Department of Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Paul A. Greenberger
- Division of Allergy-Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Mario Sanchez Borges
- Allergy and Clinical Immunology Department, Centro Médico Docente La Trinidad and Clinica El Ávila, Caracas, Venezuela
| | - Gianenrico Senna
- Asthma Center and Allergy Unit, Verona University and General Hospital, Verona, Italy
| | - Aziz Sheikh
- Allergy and Respiratory Research Group, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Luciana Kase Tanno
- Hospital Sírio Libanês, Brazil andUniversity Hospital of Montpellier, São Paulo, Montpellier, and Sorbonne Université, INSERM Paris, France, and WHO Collaborating Centre on Scientific Classification Support Montpellier, and WHO ICD-11 Medical and Scientific Advisory Committee Geneva, Switzerland
| | - Bernard Y. Thong
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore
| | - Paul J. Turner
- National Heart Lung Institute, Imperial College London and Discipline of Paediatrics and Child Health, School of Medicine, University of Sydney, Sydney, Australia
| | - Margitta Worm
- Department of Dermatology and Allergology, Charite-Universitätsmedizin, Berlin, Germany
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56
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Ogura K, Yanagida N, Sato S, Imai T, Ito K, Kando N, Ikeda M, Shibata R, Murakami Y, Fujisawa T, Nagao M, Kawamoto N, Kondo N, Urisu A, Tsuge I, Kondo Y, Sugai K, Uchida O, Urashima M, Taniguchi M, Ebisawa M. Evaluation of oral immunotherapy efficacy and safety by maintenance dose dependency: A multicenter randomized study. World Allergy Organ J 2020; 13:100463. [PMID: 33024480 PMCID: PMC7527748 DOI: 10.1016/j.waojou.2020.100463] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Revised: 08/27/2020] [Accepted: 08/31/2020] [Indexed: 12/03/2022] Open
Abstract
Background Generally, oral immunotherapy (OIT) aims for daily administration. Recently, the efficacy of treatment with OIT at a low dose has been reported. However, the optimal dose and the evaluation of dose-dependent OIT outcome have not been described. Methods A multicenter, parallel, open-labeled, prospective, non-placebo controlled, randomized study enrolled 101 Japanese patients for treatment with OIT. We hypothesized that target dose OIT would induce short-term unresponsiveness (StU) earlier than reduced dose OIT. StU was defined as no response to 6200 mg whole egg, 3400 mg milk, and 2600 mg wheat protein, as evaluated by oral food challenge after 2-week ingestion cessation. To compare the two doses of OIT efficacy, the maximum ingestion doses during the maintenance phase of OIT were divided into 100%-dose or 25%-dose groups against their target StU dose, respectively. A total of 51 patients were assigned to the 100%-dose group [hen's egg (HE) = 26, cow's milk (CM) = 13, wheat = 12] and 50 to the 25%-dose group (HE = 25, CM = 13, wheat = 12). Primary outcome was established by comparing StU at 1 year. Secondary outcome was StU at 2 years and established by comparing allergic symptoms and immunological changes. Results The year 1 StU rates (%) for the 100%- and 25%-dose groups were 26.9 vs. 20.0 (HE), 7.7 vs. 15.4 (CM), and 50.0 vs. 16.7 (wheat), respectively. The year 2 StU rates were 30.8 vs. 36.0 (HE), 7.7 vs. 23.1 (CM), and 58.3 vs. 58.3 (wheat), respectively. There were no statistically significant differences in StU between years 1 and 2. The total allergic symptom rate in the 25%-dose group was lower than that in the 100%-dose group for egg, milk, and wheat. Antigen-specific IgE levels for egg-white, milk, and wheat decreased at 12 months. Conclusions Reduced maintenance dose of egg OIT showed similar therapeutic efficacy to the target dose. However, we were not able to clearly demonstrate the efficacy, particularly for milk and wheat. Reducing the maintenance dose for eggs, milk, and wheat may effectively lower the symptoms associated with their consumption compared to the target OIT dose. Furthermore, aggressive reduction of the maintenance dose might be important for milk and wheat, compared to the 25%-dose OIT. Trial registration UMIN000009373, Multicenter Oral Immunotherapy for Hen's Egg, Cow's Milk, and Wheat-Allergic Children at Outpatient Clinic.
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Key Words
- CM, cow’s milk
- Desensitization
- Dose-response relationship
- EPIT, epicutaneous immunotherapy
- FA, food allergy
- Food hypersensitivity
- HE, hens’ egg
- Immunotherapy
- OFC, oral food challenge
- OIT, oral immunotherapy
- SLIT, sublingual immunotherapy
- SU, sustained unresponsiveness
- StU, short-term unresponsiveness
- sIgE, specific immunoglobulin E
- sIgG, specific immunoglobulin G
- sIgG4, specific immunoglobulin G4
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Affiliation(s)
- Kiyotake Ogura
- Department of Pediatrics, National Hospital Organization, Sagamihara National Hospital, Kanagawa, Japan.,Course of Allergy and Clinical Immunology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Noriyuki Yanagida
- Department of Pediatrics, National Hospital Organization, Sagamihara National Hospital, Kanagawa, Japan
| | - Sakura Sato
- Course of Allergy and Clinical Immunology, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Department of Allergy, Clinical Research Center for Allergy and Rheumatology, National Hospital Organization, Sagamihara National Hospital, Kanagawa, Japan
| | - Takanori Imai
- Department of Pediatrics, Showa University School of Medicine, Tokyo, Japan
| | - Komei Ito
- Department of Allergy, Aichi Children's Health and Medical Center, Aichi, Japan
| | - Naoyuki Kando
- Department of Allergy, Aichi Children's Health and Medical Center, Aichi, Japan
| | - Masanori Ikeda
- Department of Pediatrics, National Hospital Organization, Fukuyama Medical Center, Hiroshima, Japan.,Department of Pediatric Acute Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Rumiko Shibata
- Department of Pediatrics, National Hospital Organization, Fukuoka National Hospital, Fukuoka, Japan
| | - Yoko Murakami
- Department of Pediatrics, National Hospital Organization, Fukuoka National Hospital, Fukuoka, Japan
| | - Takao Fujisawa
- Institute for Clinical Research, National Hospital Organization, Mie National Hospital, Mie, Japan
| | - Mizuho Nagao
- Institute for Clinical Research, National Hospital Organization, Mie National Hospital, Mie, Japan
| | - Norio Kawamoto
- Department of Pediatrics, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Naomi Kondo
- Department of Pediatrics, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Atsuo Urisu
- Department of Pediatrics, Fujita Health University, The Second Teaching Hospital, Aichi, Japan
| | - Ikuya Tsuge
- Department of Pediatrics, Fujita Health University, The Second Teaching Hospital, Aichi, Japan
| | - Yasuto Kondo
- Department of Pediatrics, Fujita Health University, The Second Teaching Hospital, Aichi, Japan
| | - Kazuko Sugai
- Department of Pediatrics, National Hospital Organization, Yokohama Medical Center, Kanagawa, Japan
| | - Osamu Uchida
- Department of Pediatrics, National Hospital Organization, Yokohama Medical Center, Kanagawa, Japan
| | - Mitsuyoshi Urashima
- Division of Molecular Epidemiology, The Jikei University School of Medicine, Tokyo, Japan
| | - Masami Taniguchi
- Course of Allergy and Clinical Immunology, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Department of Allergy, Clinical Research Center for Allergy and Rheumatology, National Hospital Organization, Sagamihara National Hospital, Kanagawa, Japan
| | - Motohiro Ebisawa
- Course of Allergy and Clinical Immunology, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Department of Allergy, Clinical Research Center for Allergy and Rheumatology, National Hospital Organization, Sagamihara National Hospital, Kanagawa, Japan
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Herrmann I, Loft KE, Olivry T. Shortened immunotherapy dose-escalation saves time, but is it safe? A case-control study comparing the rates of adverse reactions between conventional and fast-escalation subcutaneous immunotherapy protocols during the induction phase. Vet Dermatol 2020; 31:454-e120. [PMID: 32940395 DOI: 10.1111/vde.12892] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Allergen immunotherapy (AIT) is the only intervention believed to change the course of atopic diseases. As dogs appear to have fewer severe adverse events (AEs) compared to people receiving AIT, a prolonged dose-escalation induction phase might not be needed. OBJECTIVES To report the incidence and characteristics of AEs induced by a fast-escalation subcutaneous immunotherapy (f-SCIT) protocol compared to a conventional (c-SCIT) regimen. ANIMALS One hundred dogs treated with either f- SCIT (Centre 1, 50 dogs) or c-SCIT (Centre 2, 50 dogs). METHODS AND MATERIALS A case-control study retrospectively evaluating AEs during the induction of AIT. We determined the incidence and type of AEs in each SCIT group; we also assessed factors such as self-limitation and the need for AE-associated protocol changes. RESULTS Twelve of 100 dogs (12%) developed a SCIT-attributable AE during the induction phase, with one dog having a local and 11 having systemic reactions (nine Grade I, two Grade II, none of grades III or IV). Dogs treated with the f-SCIT had a significantly higher rate of AEs (11 of 50; 22%) compared to those receiving the c-SCIT (one of 50; 2%). Most of the AEs (10 of 11; 91%) in the f-SCIT group were mild and self-limiting. CONCLUSIONS AND CLINICAL IMPORTANCE The induction phase of f-SCIT is simpler, and the maintenance phase is reached faster than that of the c-SCIT. Despite its higher rate of AEs than with the c-SCIT regimen, the majority of f-SCIT-associated AEs were mild and self-limiting. Whether or not this f-SCIT protocol leads to a faster time-to-efficacy needs to be determined.
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Affiliation(s)
- Ina Herrmann
- Department of Clinical Sciences, College of Veterinary Medicine, NC State University, 1060 William Moore Drive, Raleigh, NC, 27607, USA
| | - Klaus E Loft
- MSPCA Angell Memorial Hospital, 350 South Huntington Avenue, Boston, MA, 02130, USA
| | - Thierry Olivry
- Department of Clinical Sciences, College of Veterinary Medicine, NC State University, 1060 William Moore Drive, Raleigh, NC, 27607, USA
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58
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Dribin TE, Sampson HA, Camargo CA, Brousseau DC, Spergel JM, Neuman MI, Shaker M, Campbell RL, Michelson KA, Rudders SA, Assa'ad AH, Risma KA, Castells M, Schneider LC, Wang J, Lee J, Mistry RD, Vyles D, Vaughn LM, Schumacher DJ, Witry JK, Viswanathan S, Page EM, Schnadower D. Persistent, refractory, and biphasic anaphylaxis: A multidisciplinary Delphi study. J Allergy Clin Immunol 2020; 146:1089-1096. [PMID: 32853640 DOI: 10.1016/j.jaci.2020.08.015] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/17/2020] [Accepted: 08/07/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND The use of inconsistent definitions for anaphylaxis outcomes limits our understanding of the natural history and epidemiology of anaphylaxis, hindering clinical practice and research efforts. OBJECTIVE Our aim was to develop consensus definitions for clinically relevant anaphylaxis outcomes by utilizing a multidisciplinary group of clinical and research experts in anaphylaxis. METHODS Using Delphi methodology, we developed agenda topics and drafted questions to review during monthly conference calls. Through online surveys, a 19-member panel consisting of experts in allergy and/or immunology and emergency medicine rated their level of agreement with the appropriateness of statements on a scale of 1 to 9. A median value of 1.0 to 3.4 was considered inappropriate, a median value of 3.5 to 6.9 was considered uncertain, and a median value of 7.0 to 9.0 was considered appropriate. A disagreement index was then calculated, with values less than 1.0 categorized as "consensus reached." If consensus was not reached after the initial survey, subsequent surveys incorporating the aggregate de-identified responses from prior surveys were sent to panel members. This process was repeated until consensus was reached or 4 survey rounds had been completed, after which the question was categorized as "no consensus reached." RESULTS The panel developed outcome definitions for persistent, refractory, and biphasic anaphylaxis, as well as for persistent and biphasic nonanaphylactic reactions. There was also consensus among panel members regarding the need to develop an anaphylaxis severity grading system. CONCLUSION Dissemination and application of these definitions in clinical care and research will help standardize the terminology used to describe anaphylaxis outcomes and serve as the foundation for future research, including research aimed at development of an anaphylaxis severity grading system.
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Affiliation(s)
- Timothy E Dribin
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.
| | - Hugh A Sampson
- Division of Allergy and Immunology, Icahn School of Medicine at Mount Sinai, New York
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - David C Brousseau
- Section of Pediatric Emergency Medicine, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wis
| | - Jonathan M Spergel
- Division of Allergy and Immunology, Children's Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pa
| | - Mark I Neuman
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass
| | - Marcus Shaker
- Dartmouth Geisel School of Medicine, Hanover, NH; Dartmouth-Hitchcock Medical Center, Hanover, NH
| | | | - Kenneth A Michelson
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass
| | - Susan A Rudders
- Division of Immunology, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass
| | - Amal H Assa'ad
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Kimberly A Risma
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Mariana Castells
- Division of Allergy and Clinical Immunology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Lynda C Schneider
- Division of Immunology, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass
| | - Julie Wang
- Division of Allergy and Immunology, Icahn School of Medicine at Mount Sinai, New York
| | - Juhee Lee
- Division of Allergy and Immunology, Children's Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pa
| | - Rakesh D Mistry
- Section of Emergency Medicine, Department of Pediatrics, Children's Hospital Colorado, Aurora, Colo
| | - David Vyles
- Section of Pediatric Emergency Medicine, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wis
| | - Lisa M Vaughn
- Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Daniel J Schumacher
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - John K Witry
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Shiv Viswanathan
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - David Schnadower
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
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59
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Lou H, Huang Y, Ouyang Y, Zhang Y, Xi L, Chu X, Wang Y, Wang C, Zhang L. Artemisia annua-sublingual immunotherapy for seasonal allergic rhinitis: A randomized controlled trial. Allergy 2020; 75:2026-2036. [PMID: 32030780 DOI: 10.1111/all.14218] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 11/17/2019] [Accepted: 12/08/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Artemisia annua is an important autumnal pollen allergen for seasonal allergic rhinitis (SAR) in northern China. To date, no study has investigated allergen immunotherapy with A annua. We aimed to investigate the efficacy and mechanisms underlying A annua-sublingual immunotherapy (SLIT). METHODS This was a randomized, double-blind, placebo-controlled phase III clinical trial involving 71 SAR patients, randomized to SLIT with A annua extract (n = 47) or placebo (n = 24) for 32 weeks. Total nasal symptom score (TNSS; primary clinical end point) was evaluated at baseline (peak pollen phase (PPP) in the previous year), initiation of A annua-SLIT, 1st PPP during SLIT, end of SLIT and 2nd PPP during follow-up. Blood samples and nasal secretions were collected at beginning and after SLIT for assessment of T cells and inflammatory mediators. Safety was assessed according to adverse events (AEs) reported. RESULTS Artemisia annua-SLIT significantly reduced TNSS to a greater level from baseline (from 9.45 ± 1.68 to 6.16 ± 2.27) than placebo (from 9.29 ± 2.09 to 9.05 ± 2.40) at the 1st PPP (P < .001) and sustained the improvement in symptoms throughout to the 2nd PPP. Preseasonal A annua-SLIT for 16 weeks significantly decreased Th2 cells, increased nTreg and Tr1 cells in blood; and increased cystatin 1 (CST1) in nasal secretion after 16 and 32 weeks compared with pretreatment. Overall, 17/47 patients experienced mild local AEs and 2 patients mild systemic AEs, after A annua-SLIT. CONCLUSION Artemisia annua-SLIT is an efficacious and safe treatment in patients with A annua SAR.
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Affiliation(s)
- Hongfei Lou
- Department of Otolaryngology Head and Neck Surgery Beijing TongRen Hospital Capital Medical University Beijing China
- Beijing Key Laboratory of Nasal Disease Beijing Institute of Otolaryngology Beijing China
| | - Yanran Huang
- Department of Otolaryngology Head and Neck Surgery Beijing TongRen Hospital Capital Medical University Beijing China
- Beijing Key Laboratory of Nasal Disease Beijing Institute of Otolaryngology Beijing China
| | - Yuhui Ouyang
- Beijing Key Laboratory of Nasal Disease Beijing Institute of Otolaryngology Beijing China
- Department of Allergy Beijing TongRen Hospital Capital Medical University Beijing China
| | - Yuan Zhang
- Beijing Key Laboratory of Nasal Disease Beijing Institute of Otolaryngology Beijing China
- Department of Allergy Beijing TongRen Hospital Capital Medical University Beijing China
| | - Lin Xi
- Beijing Key Laboratory of Nasal Disease Beijing Institute of Otolaryngology Beijing China
- Department of Allergy Beijing TongRen Hospital Capital Medical University Beijing China
| | - Xiaohan Chu
- Department of Otolaryngology Head and Neck Surgery Beijing TongRen Hospital Capital Medical University Beijing China
- Beijing Key Laboratory of Nasal Disease Beijing Institute of Otolaryngology Beijing China
| | - Yang Wang
- Beijing Key Laboratory of Nasal Disease Beijing Institute of Otolaryngology Beijing China
| | - Chengshuo Wang
- Department of Otolaryngology Head and Neck Surgery Beijing TongRen Hospital Capital Medical University Beijing China
- Beijing Key Laboratory of Nasal Disease Beijing Institute of Otolaryngology Beijing China
| | - Luo Zhang
- Department of Otolaryngology Head and Neck Surgery Beijing TongRen Hospital Capital Medical University Beijing China
- Beijing Key Laboratory of Nasal Disease Beijing Institute of Otolaryngology Beijing China
- Department of Allergy Beijing TongRen Hospital Capital Medical University Beijing China
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Park KH, Oh EY, Han H, Kim JD, Kim SJ, Jeong KY, Kim JH, Park CO, Kim SR, Lee JH, Jeong DH, Yong TS, Lee KH, Park JW. Efficacy of transdermal immunotherapy with biodegradable microneedle patches in a murine asthma model. Clin Exp Allergy 2020; 50:1084-1092. [PMID: 32557846 DOI: 10.1111/cea.13688] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 05/21/2020] [Accepted: 06/08/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND House dust mite (HDM) is a well-known cause of asthma. Allergen-specific immunotherapy (AIT) can only modify the natural course of the disease. Conventional routes of HDM AIT are subcutaneous or sublingual. Subcutaneous immunotherapy (SCIT) has a disadvantage of systemic hypersensitive reaction, and the sublingual immunotherapy has a disadvantage of local allergic reaction and low drug adherence. OBJECTIVE To overcome the weak points of conventional AIT, we developed a HDM loaded biodegradable microneedle patch (MNP) for transdermal immunotherapy (TDIT). We aim to demonstrate the efficacy of TDIT in murine asthma model triggered by HDM compared with conventional SCIT. METHODS To make HDM asthma mouse model, 5-week-old BALB/c female mice were sensitized and challenged by intranasal administration of HDM. The mice were divided into 5 groups: sham, asthma, low (10 µg) and high dose (100 µg) SCIT, and TDIT (10 µg). To make HDM loaded MNP, droplet-born air blowing method was used. Airway hyperresponsiveness and allergic inflammation markers were analysed by bronchoalveolar lavage fluid, immunohistochemistry, serum immunoglobulin (Ig) analysis, and lung cytokine assays. RESULTS Airway hyperresponsiveness was ameliorated by TDIT. Eosinophilic inflammation in bronchoalveolar lavage was improved without adverse reactions. Reduction of Th2 (IL-4, IL-5, and IL-13) cytokines, and HDM-specific IgE, induction of Treg (IL-10, TGF-β), Th1 (IFN-γ) cytokines were observed. Eosinophilic infiltration, goblet cell hyperplasia, and subepithelial fibrosis were also alleviated by TDIT. These changes were more significant in the TDIT group than in subcutaneous AIT group. CONCLUSION In conclusion, HDM loaded biodegradable TDIT is a novel treatment option to treat asthma which showed more effectiveness and may have better safety profiles than conventional SCIT.
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Affiliation(s)
- Kyung Hee Park
- Division of Allergy and Immunology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea.,Institute of Allergy, Yonsei University College of Medicine, Seoul, South Korea
| | - Eun Yi Oh
- Institute of Allergy, Yonsei University College of Medicine, Seoul, South Korea
| | - Heejae Han
- Institute of Allergy, Yonsei University College of Medicine, Seoul, South Korea
| | - Jung Dong Kim
- Raphas, Seoul, South Korea.,Prolagen, Seoul, South Korea
| | | | - Kyoung Yong Jeong
- Institute of Allergy, Yonsei University College of Medicine, Seoul, South Korea
| | - Ji Hye Kim
- Department of Dermatology & Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Chang Ook Park
- Division of Allergy and Immunology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea.,Institute of Allergy, Yonsei University College of Medicine, Seoul, South Korea.,Department of Dermatology & Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Sung-Ryeol Kim
- Division of Allergy and Immunology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea.,Institute of Allergy, Yonsei University College of Medicine, Seoul, South Korea
| | - Jae-Hyun Lee
- Division of Allergy and Immunology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea.,Institute of Allergy, Yonsei University College of Medicine, Seoul, South Korea
| | - Do Hyeon Jeong
- Raphas, Seoul, South Korea.,Prolagen, Seoul, South Korea
| | - Tai-Soon Yong
- Department of Environmental Medical Biology, Institute of Tropical Medicine, Arthropods of Medical Importance Resource Bank, Yonsei University College of Medicine, Seoul, South Korea
| | - Kwang Hoon Lee
- Prolagen, Seoul, South Korea.,Department of Dermatology & Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Jung-Won Park
- Division of Allergy and Immunology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea.,Institute of Allergy, Yonsei University College of Medicine, Seoul, South Korea.,Prolagen, Seoul, South Korea
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61
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Spergel ZC, Kennedy K, Alfaro MKC, Dorris SL, Capucilli P. What constitutes a severe food allergy reaction? Ann Allergy Asthma Immunol 2020; 125:347-349. [PMID: 32497712 DOI: 10.1016/j.anai.2020.05.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/07/2020] [Accepted: 05/25/2020] [Indexed: 01/02/2023]
Affiliation(s)
| | - Katie Kennedy
- Division of Allergy & Immunology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Maria K C Alfaro
- Division of Allergy & Immunology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Stacy L Dorris
- Division of Allergy, Immunology, and Pulmonary Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Peter Capucilli
- Division of Allergy & Immunology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
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Castro-Almarales RL, Ronquillo-Díaz M, Álvarez-Castelló M, Rodríguez-Canosa J, González-León M, Enríquez-Domínguez I, Navarro-Viltre BI, Mateo-Morejón M, Oliva-Díaz Y, Ramírez-González W, Cox L, Labrada-Rosado A. Subcutaneous allergen immunotherapy for asthma: A randomized, double-blind, placebo-controlled study with a standardized Blomia tropicalis vaccine. World Allergy Organ J 2020; 13:100098. [PMID: 32308779 PMCID: PMC7155230 DOI: 10.1016/j.waojou.2020.100098] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 11/14/2019] [Accepted: 11/22/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Sensitization to Blomia tropicalis (Bt) is very frequent in the tropics, and particularly in Cuba, being a significant cause of allergic asthma. Allergen immunotherapy (AIT) with Bt can be a therapeutic option, however, placebo-controlled clinical trials have not been reported. OBJECTIVE To assess the therapeutic effect and safety of AIT for asthma using a standardized allergen vaccine of B. tropicalis by subcutaneous route, in allergic asthmatic patients exposed and sensitized to this mite species. METHODS A double-blind, placebo-controlled Phase II trial was conducted in 35 adults (18 with treatment and 17 with placebo), with mild to moderate asthma, predominantly sensitized to Bt. AIT was administered subcutaneously in increasing doses from 4 to 6000 Biological Units using a locally manufactured standardized extract (BIOCEN, Cuba). Patient assessment was performed using symptom-medication score (SMS), peak expiratory flow and skin reactivity relative to Histamine as measured by skin prick test (SPT). RESULTS The 12-month treatment achieved a significant (p < 0.001) decrease of SMS. Symptom score showed only 41% (CI: 26-61) of placebo values, whereas medication was 34.5% (22.4%-63.3%). Treatment was regarded clinically effective in 67% of patients (OR 32; 95%CI: 17 to 102). The effect size on symptoms and medication was higher than has been reported with equivalent allergen dosages of D. pteronyssinus and D. siboney in Cuban asthmatic patients. Skin reactivity to Bt was also significantly reduced (p = 0.0001), increasing 148-fold the allergen threshold to elicit a positive skin test. This desensitization effect was specific to Bt and did not modify the reactivity to Dermatophagoides. The change of specific skin reactivity was significantly (p < 0.05) correlated to clinical improvement. All adverse events were local with a frequency of 2.4% of injections. CONCLUSIONS Subcutaneous AIT with Blomia tropicalis was effective and safe in asthmatic adults exposed and sensitized to this mite species in a tropical environment. TRIAL REGISTRATION Cuban Public Registry of Clinical Trials: RPCEC00000026 (WHO International Clinical Trial Registry Platform ICTRP).
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Key Words
- AIT, Allergen immunotherapy
- ALK, Denmark-based pharmaceutical company
- BIOCEN, National Center of Bioproducts
- BU, Biological Units
- BU/mL, Biological units per milliliter
- Blo t, Mayor allegen of Blomia tropicalis
- Blomia tropicalis
- Bt, Blomia tropicalis or B. tropicalis
- CECMED, Center for State Control of Drugs, Equipment and Medical Devices
- Ch10, Allergen specific reactivity calculated relative to the Histamine HC 10 mg/mL
- Clinical trial
- Dp or D, pteronyssinus: Dermatophagoides pteronyssinus
- Ds or D, siboney: Dermatophagoides siboney
- HDM SCIT, Immunotherpy Subcutaneous with allergens of House Dust Mite
- HDM, House Dust Mite
- OCI, Overall clinical improvement
- PEF, Peak Expiratory Flow
- SM, Symptom and Medication
- SMD, Standard Mean Difference
- Standardized allergen extract
- Subcutaneous immunotherapy
- VALERGEN-BT, Standardized allergen extract of Blomia tropicalis
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Affiliation(s)
- Raúl Lázaro Castro-Almarales
- Second Degree Specialist in Allergy and Integral General Medicine, Master in Transmissible Diseases, Auxiliary Professor, “General Calixto García” University Hospital, Havana University of Medical Science. Auxiliary Researcher, National Center of Bioproducts, Bejucal, Mayabeque, Cuba
| | - Mercedes Ronquillo-Díaz
- Second Degree Specialist in Allergy, Master in Occupational Health, Auxiliary Professor, “General Calixto García” University Hospital, Allergy and Immunology Service, Havana University of Medical Science, Cuba
| | - Mirta Álvarez-Castelló
- Second Degree Specialist in Allergy, Auxiliary Professor and Researcher, “General Calixto García” University Hospital, Allergy and Immunology Service, Havana University of Medical Science, Cuba
| | - José Rodríguez-Canosa
- Second Degree Specialist in Allergy, Master in Transmissible Diseases, Auxiliary Professor, “General Calixto García” University Hospital, Allergy and Immunology Service, Havana University of Medical Science, Cuba
| | - Mayda González-León
- Second Degree Specialist in Integral General Medicine, Master in Natural and Traditional Medicine, Teaching Polyclinic “Pedro Fonseca Álvarez”, Havana, Cuba
| | - Irene Enríquez-Domínguez
- First Degree Specialist in Allergy and Integral General Medicine, Master in Child Integral Care, “General Calixto García” University Hospital, Allergy and Immunology Service, Havana, Cuba
| | | | - Maytee Mateo-Morejón
- Master in Biotechnology, National Center of Bioproducts, Allergens Department, Bejucal, Mayabeque, Cuba
| | - Yunia Oliva-Díaz
- National Center of Bioproducts, Allergen Department, Bejucal, Mayabeque, Cuba
| | - Wendy Ramírez-González
- Master in Biochemistry, National Center of Bioproducts, Allergens Department, Bejucal, Mayabeque, Cuba
| | - Linda Cox
- Allergy & Asthma Center, Fort Lauderdale, Florida, USA
| | - Alexis Labrada-Rosado
- Full Researcher, Research and Development Director, National Center of Bioproducts, Bejucal, Mayabeque, Cuba
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Sokol WN. Grasshopper sensitization in patients allergic to crustaceans, mites, and cockroaches: Should grasshopper-containing products carry a warning? Ann Allergy Asthma Immunol 2020; 124:518-520. [PMID: 32119977 DOI: 10.1016/j.anai.2020.02.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 02/13/2020] [Accepted: 02/18/2020] [Indexed: 11/18/2022]
Affiliation(s)
- William N Sokol
- Medicine Division of Allergy, University California College of Medicine, Newport Beach, California.
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Cox LS, Nowak-Wegrzyn A. Leaps and Bounds in Allergen Immunotherapy. Immunol Allergy Clin North Am 2020; 40:xv-xvii. [DOI: 10.1016/j.iac.2019.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Jarkvist J, Salehi C, Akin C, Gülen T. Venom immunotherapy in patients with clonal mast cell disorders: IgG4 correlates with protection. Allergy 2020; 75:169-177. [PMID: 31306487 DOI: 10.1111/all.13980] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 05/09/2019] [Accepted: 05/26/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND Patients with clonal mast cell disorders (cMCD), systemic mastocytosis (SM) and monoclonal mast cell activation syndrome (MMAS), represent an increased risk for Hymenoptera venom anaphylaxis (HVA). Lifelong venom immunotherapy (VIT) is recommended; however, its efficacy and safety are controversial. Hence, we sought to evaluate the efficacy and safety of VIT in HVA patients with cMCD. METHODS A retrospective study was conducted among 46 patients with Vespula venom allergy who had experienced severe HVA, 32 cMCD (22 with SM and 10 with MMAS) and 14 controls. There were no differences between cMCD patients and controls in age (58 vs 66) and duration of VIT (47 vs 48 months), respectively. RESULTS During VIT, 11 (34%) cMCD patients experienced adverse reactions (ARs) (7% in controls), including 1 anaphylaxis. There were 23 re-stings in 17 (53%) patients during VIT. Of episodes, four (17%) presented with anaphylaxis, 14 (60%) presented with local reaction, and five (23%) were asymptomatic. In 11 episodes (48%), the patient did not take epinephrine, of these 8 (73%) presented with local reaction, and 3 (27%) were asymptomatic. Patient-based protection from anaphylaxis was 76% (4/17) in cMCD vs. 100% in controls during VIT. The venom-specific IgG4 concentrations increased during VIT (P < .001) although tryptase and IgE were unaltered. CONCLUSION Both safety and efficacy of VIT in cMCD patients were slightly reduced than controls. Severe ARs were rare. The elevated IgG4 levels may be a biomarker for efficacy of VIT in cMCD patients, as it correlates with protection from re-stings.
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Affiliation(s)
- Jesper Jarkvist
- Department of Respiratory Medicine and Allergy Karolinska University Hospital Huddinge Stockholm Sweden
- Immunology and Allergy Unit, Department of Medicine Solna Karolinska Institutet, and Karolinska University Hospital Stockholm Sweden
| | - Clara Salehi
- Department of Respiratory Medicine and Allergy Karolinska University Hospital Huddinge Stockholm Sweden
| | - Cem Akin
- Division of Allergy and Clinical Immunology, Department of Internal Medicine University of Michigan Health System Ann Arbor MI USA
| | - Theo Gülen
- Department of Respiratory Medicine and Allergy Karolinska University Hospital Huddinge Stockholm Sweden
- Immunology and Allergy Unit, Department of Medicine Solna Karolinska Institutet, and Karolinska University Hospital Stockholm Sweden
- Mastocytosis Center Karolinska Karolinska Institutet and Karolinska University Hospital Stockholm Sweden
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66
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Lee Y, Chang HY, Kim SH, Yang MS, Koh YI, Kang HR, Choi JH, Kim CW, Park HK, Kim JH, Nam YH, Kim TB, Hur GY, Jung JW, Park KH, Kim MA, Kim J, Yoon J, Ye YM. A Prospective Observation of Psychological Distress in Patients With Anaphylaxis. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2020; 12:496-506. [PMID: 32141262 PMCID: PMC7061156 DOI: 10.4168/aair.2020.12.3.496] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 12/29/2019] [Accepted: 01/07/2020] [Indexed: 02/01/2023]
Abstract
Purpose Anaphylaxis is an immediate allergic reaction characterized by potentially life-threatening, severe, systemic manifestations. While studies have evaluated links between serious illness and posttraumatic stress disorder (PTSD), few have investigated PTSD after anaphylaxis in adults. We sought to investigate the psychosocial burden of recent anaphylaxis in Korean adults. Methods A total of 203 (mean age of 44 years, 120 females) patients with anaphylaxis were recruited from 15 university hospitals in Korea. Questionnaires, including the Impact of Event Scale-Revised-Korean version (IES-R-K), the Korean version of the Beck Anxiety Inventory (K-BAI), and the Korean version of the Beck Depression Inventory (K-BDI), were administered. Demographic characteristics, causes and clinical features of anaphylaxis, and serum inflammatory markers, including tryptase, platelet-activating factor, interleukin-6, tumor necrosis factor-α, and C-reactive protein, were evaluated. Results PTSD (IES-R-K ≥ 25) was noted in 84 (41.4%) patients with anaphylaxis. Of them, 56.0% had severe PTSD (IES-R-K ≥ 40). Additionally, 23.2% and 28.1% of the patients had anxiety (K-BAI ≥ 22) and depression (K-BDI ≥ 17), respectively. IES-R-K was significantly correlated with both K-BAI (r = 0.609, P < 0.0001) and K-BDI (r = 0.550, P < 0.0001). Among the inflammatory mediators, tryptase levels were lower in patients exhibiting PTSD; meanwhile, platelet-activating factor levels were lower in patients exhibiting anxiety and depression while recovering from anaphylaxis. In multivariate analysis, K-BAI and K-BDI were identified as major predictive variables of PTSD in patients with anaphylaxis. Conclusions In patients with anaphylaxis, we found a remarkably high prevalence of PTSD and associated psychological distresses, including anxiety and depression. Physicians ought to be aware of the potential for psychological distress in anaphylactic patients and to consider psychological evaluation.
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Affiliation(s)
- Youngsoo Lee
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Hyoung Yoon Chang
- Department of Psychiatry and Behavioral Sciences, Ajou University School of Medicine, Suwon, Korea
| | - Sang Ha Kim
- Department of Internal Medicine, Wonju Severance Christian Hospital, Wonju, Korea
| | - Min Suk Yang
- Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Young Il Koh
- Division of Allergy, Asthma, and Clinical Immunology, Chonnam National University Medical School, Gwangju, Korea
| | - Hye Ryun Kang
- Division of Allergy and Clinical Immunology, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong Hee Choi
- Division of Pulmonary, Allergy, and Critical Care Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Cheol Woo Kim
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Hye Kyung Park
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Joo Hee Kim
- Division of Pulmonary, Allergy, and Critical Care Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Young Hee Nam
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Tae Bum Kim
- Department of Allergy and Clinical Immunology, Asan Medical Center, Seoul, Korea
| | - Gyu Young Hur
- Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Jae Woo Jung
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Kyung Hee Park
- Division of Allergy and Immunology, Yonsei University College of Medicine, Seoul, Korea
| | - Mi Ae Kim
- Division of Pulmonary, Allergy and Critical Care Medicine, CHA University, Seongnam, Korea
| | - Jiwoong Kim
- Clinical Trial Center, Ajou University Hospital, Suwon, Korea
| | - Jiwon Yoon
- Clinical Trial Center, Ajou University Hospital, Suwon, Korea
| | - Young Min Ye
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea.
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Leigh H, Harðardottir H, Schöffmann G, Panti A. Suspected anaphylaxis after intravenous administration of cefuroxime (Zinacef) in two dogs, with descriptions of arterial blood gas abnormalities over time. VETERINARY RECORD CASE REPORTS 2019. [DOI: 10.1136/vetreccr-2019-000922] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Hannah Leigh
- College of Medicine and Veterinary MedicineThe University of EdinburghEdinburghUK
| | - Hulda Harðardottir
- College of Medicine and Veterinary MedicineThe University of EdinburghEdinburghUK
| | - Gudrun Schöffmann
- College of Medicine and Veterinary MedicineThe University of EdinburghEdinburghUK
| | - Ambra Panti
- College of Medicine and Veterinary MedicineThe University of EdinburghEdinburghUK
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69
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Vázquez-Cortés S, Jaqueti P, Arasi S, Machinena A, Alvaro-Lozano M, Fernández-Rivas M. Safety of Food Oral Immunotherapy: What We Know, and What We Need to Learn. Immunol Allergy Clin North Am 2019; 40:111-133. [PMID: 31761113 DOI: 10.1016/j.iac.2019.09.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Oral immunotherapy (OIT) for food allergy entails a risk of adverse reactions, including anaphylaxis. This safety concern is the major barrier for OIT to become a therapeutic option in clinical practice. The high heterogeneity in safety reporting of OIT studies prevents setting the safety profile accurately. An international consensus is needed to facilitate the analysis of large pooled clinical data with homogeneous safety reporting, that together with integrated omics, and patients/families' opinions, may help stratify the patients' risk and needs, and help developing safe(r) individualized care pathways. This will give OIT the right place in the food allergy therapy.
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Affiliation(s)
- Sonia Vázquez-Cortés
- Allergy Department, Hospital Clinico San Carlos, IdISSC, ARADyAL, Prof. Martin Lagos s/n, Madrid 28040, Spain
| | - Paloma Jaqueti
- Allergy Department, Hospital Clinico San Carlos, IdISSC, Prof. Martin Lagos s/n, Madrid 28040, Spain
| | - Stefania Arasi
- Pediatric Allergology Unit, Department of Pediatric Medicine, Bambino Gesù Children's Research Hospital (IRCCS), Piazza S. Onofrio, Rome 00161, Italy
| | - Adrianna Machinena
- Allergy and Clinical Immunology Department, Hospital Sant Joan de Deu, Secció d'Al-lergia i Immunologia Clínica, Passeig Sant Joan de Déu 2, Esplugues de Llobregat, Barcelona 08590, Spain
| | - Montserrat Alvaro-Lozano
- Allergy and Clinical Immunology Department, Hospital Sant Joan de Deu, Secció d'Al-lergia i Immunologia Clínica, Passeig Sant Joan de Déu 2, Esplugues de Llobregat, Barcelona 08590, Spain
| | - Montserrat Fernández-Rivas
- Allergy Department, Hospital Clinico San Carlos, Medicine UCM, IdISSC, ARADyAL, Prof. Martin Lagos s/n, Madrid 28040, Spain.
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Chan AWM, Luk WP, Fung LH, Lee TH. The effectiveness of sublingual immunotherapy for house dust mite-induced allergic rhinitis and its co-morbid conditions. Immunotherapy 2019; 11:1387-1397. [PMID: 31608757 DOI: 10.2217/imt-2019-0093] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: We investigated sublingual immunotherapy for mite-induced allergic rhinitis and its comorbid allergic conditions. Patients & methods: A prospective case-controlled study of 120 patients (case = 80, control = 40) over 12 months. Results: There was 53.6% reduction in total rhinitis symptom score (p < 0.0001), but not in controls (-7.3%, p = 0.99). The total symptom scores for concurrent asthma decreased from 17.79 to 8.8 (p < 0.0001); for allergic conjunctivitis from 20.89 to 10.0 (p = 0.0002); for atopic dermatitis from 46.40 to 29.38 (p = 0.0004) and 74.6% of patients weaned off nasal topical steroids. The treatment-related adverse reactions were mild and self-limiting. Conclusion: Though sublingual immunotherapy may be more expensive than conventional treatments, it was an adjunctive therapy that improved not only the outcomes for allergic rhinitis, but also its comorbid allergic conditions.
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Affiliation(s)
- Alson Wai-Ming Chan
- Allergy Centre, Hong Kong Sanatorium & Hospital, 2 Village Road, Happy Valley, Hong Kong, China
| | - Wing Pan Luk
- Medical Physics & Research Department, Hong Kong Sanatorium & Hospital, 2 Village Road, Happy Valley, Hong Kong, China
| | - Ling Hiu Fung
- Medical Physics & Research Department, Hong Kong Sanatorium & Hospital, 2 Village Road, Happy Valley, Hong Kong, China
| | - Tak Hong Lee
- Allergy Centre, Hong Kong Sanatorium & Hospital, 2 Village Road, Happy Valley, Hong Kong, China
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Yonekura S, Gotoh M, Kaneko S, Kanazawa K, Takeuji Y, Okubo K, Okamoto Y. Treatment duration-dependent efficacy of Japanese cedar pollen sublingual immunotherapy: Evaluation of a phase II/III trial over three pollen dispersal seasons. Allergol Int 2019; 68:494-505. [PMID: 31257168 DOI: 10.1016/j.alit.2019.05.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 04/22/2019] [Accepted: 05/03/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND We conducted a randomized, placebo-controlled, double-blind clinical trial to investigate the optimal dose and long-term efficacy and safety of Japanese cedar (JC) pollen tablets for SLIT (JapicCTI-142579). Here, we report details of the effects of the JC pollen SLIT tablet on rhinitis and conjunctivitis symptoms over three pollen dispersal seasons. METHODS A total of 1042 JC pollinosis patients (aged 5-64 years) were randomized to receive tablets containing placebo (P), 2000, 5000, or 10,000 Japanese allergy units (JAU) of JC pollen for 15 months to identify an optimal dose. Patients receiving P (n = 240) and the optimal dose (5000 JAU; A, n = 236) were then randomized to receive P or A for an additional 18 months (AA, AP, PA, and PP groups, allocation ratio 2:1:1:2). Nasal and ocular symptoms, rescue medication use, and quality of life (QOL) were assessed on quantitative scales. RESULTS In the second and third seasons, the AA, AP, and PA groups exhibited significantly better improvements in nasal, ocular, and medication scores compared with the PP group in the order AA > AP > PA > PP during the second season and AA > PA > AP > PP during the third season. Rescue medication use and QOL scores were also significantly better in the AA, AP, and PA groups compared with the PP group. CONCLUSIONS The JC pollen SLIT tablet relieved nasal and ocular symptoms and medication use and improved QOL in a treatment duration-dependent manner. Continuous dosing regimens appear to enhance the efficacy of the drug.
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Affiliation(s)
- Syuji Yonekura
- Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Minoru Gotoh
- Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Shinya Kaneko
- Department of Clinical Development, Torii Pharmaceutical Co., Ltd, Tokyo, Japan
| | - Keishi Kanazawa
- Department of Clinical Development, Torii Pharmaceutical Co., Ltd, Tokyo, Japan
| | - Yoshie Takeuji
- Department of Clinical Development, Torii Pharmaceutical Co., Ltd, Tokyo, Japan.
| | - Kimihiro Okubo
- Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Yoshitaka Okamoto
- Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
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Blazowski L, Majak P, Kurzawa R, Kuna P, Jerzynska J. Food allergy endotype with high risk of severe anaphylaxis in children-Monosensitization to cashew 2S albumin Ana o 3. Allergy 2019; 74:1945-1955. [PMID: 31131460 DOI: 10.1111/all.13810] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 01/30/2019] [Accepted: 02/10/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Food allergy in children can be life-threatening. Component-resolved diagnostics approach to food anaphylaxis is rarely assessed in children. The aim of the study was to identify the food allergen components as the triggers responsible for severe anaphylaxis, with regard to characteristics and associated risks, among children in a large, population-based setting. METHODS Two hundred and seventy-one children who were hospitalized due to systemic allergic reaction (SAR) and food anaphylaxis were recruited. Medical history was assessed, and culprit allergen source and anaphylaxis severity grade were established. Specific IgE to 112 allergen components using multiplex ImmunoCAP ISAC immunoassay and specific IgE to hazelnut, Cor a 14, and cashew, Ana o 3, using singleplex ImmunoCAP immunoassay were determined. RESULTS We analyzed data from 237 SAR/anaphylaxis in 237 children. Trigger at allergen component level was defined for every episode. The most common triggers of SAR/anaphylaxis were seeds (50.6%), among them, the storage proteins. Anaphylaxis triggered by Ana o 3, 2S albumin from cashews (aOR = 15.0; 95% CI: 3.27 to 73.47); Tri a 19 from wheat (aOR = 9.93; 95% CI: 1.73 to 56.97); and Cor a 9 from hazelnut (aOR = 6.53; 95% CI: 1.16 to 36.72) had the worst clinical presentation including cardiovascular and severe respiratory symptoms (grade IV-V vs I-III in Cox scale). Thirteen out of 237 (5.5%) SAR/anaphylaxis patients were triggered by Ana o 3. Almost 82% of patients with severe Ana o 3 anaphylaxis were sensitized only to this component and had no concomitant food sensitization. CONCLUSION Monosensitization to Ana o 3 is, irrespective of other parameters, connected with high risk of severe anaphylaxis.
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Affiliation(s)
- Lukasz Blazowski
- Department of Allergology National Research Institute of Tuberculosis and Lung Diseases Rabka‐Zdroj Poland
- Faculty of Medicine University of Rzeszow Rzeszow Poland
- Pediatric and Allergology Department Specialist Hospital Jaslo Poland
| | - Pawel Majak
- Department of Internal Medicine, Asthma and Allergy Medical University of Lodz Lodz Poland
| | - Ryszard Kurzawa
- Department of Allergology National Research Institute of Tuberculosis and Lung Diseases Rabka‐Zdroj Poland
- Institute of Health Science, Podhale State College of Applied Sciences Nowy Targ Poland
| | - Piotr Kuna
- Department of Internal Medicine, Asthma and Allergy Medical University of Lodz Lodz Poland
| | - Joanna Jerzynska
- Department of Pediatrics and Allergy Medical University of Lodz Lodz Poland
- Copernicus Memorial Hospital Lodz Poland
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Abstract
PURPOSE OF REVIEW Food allergy symptoms may involve a wide variety of organs (skin, gastrointestinal tract, and eyes) and systems (respiratory, circulatory, and neurological). They are often associated. Their severity ranges from mild to potentially life-threatening reactions and the presentation from acute to chronic. RECENT FINDINGS Food allergies have been the focus of multiple studies, position papers, and guidelines in recent years. They have defined an approach in classifying symptoms as mild to anaphylactic, distinguishing objective from subjective symptoms, and describing their heterogeneity, specific phenotypes or syndromes (e.g., lipid transfer protein syndrome or pollen food syndrome). Cofactors can also influence food allergy reactions. Symptoms of non-IgE-gastrointestinal food allergies, illustrated by eosinophilic esophagitis and food-protein-induced enterocolitis syndrome, are also now better understood and defined. Improvement in the knowledge of food allergy symptoms is crucial for correct diagnosis and a personalized treatment approach. SUMMARY Through a better description and understanding of symptoms, the diversity of food allergies is now better known. The next step is to harmonize symptom assessment not only for clinicians but also for patients, researchers, and public health stakeholders, to describe food allergy phenotypes and their underlying mechanisms and endotypes, to develop targeted management.
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Long-Term Efficacy and Dose-Finding Trial of Japanese Cedar Pollen Sublingual Immunotherapy Tablet. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 7:1287-1297.e8. [DOI: 10.1016/j.jaip.2018.11.044] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 10/17/2018] [Accepted: 11/26/2018] [Indexed: 12/23/2022]
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Wheat allergy in patients with recurrent urticaria. World Allergy Organ J 2019; 12:100013. [PMID: 30937139 PMCID: PMC6439404 DOI: 10.1016/j.waojou.2019.100013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 12/03/2018] [Accepted: 01/08/2019] [Indexed: 12/03/2022] Open
Abstract
Background Clinical observation revealed that most of wheat-induced anaphylaxis (WIA)/wheat-dependent exercise-induced anaphylaxis (WDEIA) patients showed a history of recurrent urticaria. We aim to determine the association between recurrent urticaria and anaphylaxis in wheat allergy. Methods Population-based cohort study involved patients with WIA (n = 193, including WDEIA n = 104), recurrent urticaria (n = 177), non-wheat-related anaphylaxis (n = 584), atopic disease (excluding anaphylaxis, n = 221) and healthy control (n = 95) from 2009 to 2016. Detailed course of urticaria and anaphylaxis were obtained from medical records and following-up questionnaire. Serum IgE specific to wheat, gluten and ω-5 gliadin and skin prick test to wheat were examined. Clinical and laboratory data were statistically analyzed. Results In recurrent urticaria patients, wheat allergy was not rare, and 6.8% (n = 12) was diagnosed as wheat-induced urticaria. Patients with WIA/WDEIA had higher prevalence of recurrent urticaria history than those with non-wheat-related anaphylaxis (164/193, 84.9% vs 85/584, 14.5%), and 70.4% of them (136/193) had recurrent urticaria prior to their first anaphylactic attack. Among patients with WIA/WDEIA and previous urticaria, 46.3% experienced an exacerbation of urticaria. The value of serum specific IgE to ω-5 gliadin was significantly higher in patients with WIA/WDEIA than those with wheat-induced urticaria. Conclusions We recommend screening wheat allergy in recurrent urticaria to identify patients who have a potential risk to develop severe reactions earlier.
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Boehm T, Reiter B, Ristl R, Petroczi K, Sperr W, Stimpfl T, Valent P, Jilma B. Massive release of the histamine-degrading enzyme diamine oxidase during severe anaphylaxis in mastocytosis patients. Allergy 2019; 74:583-593. [PMID: 30418682 PMCID: PMC6590243 DOI: 10.1111/all.13663] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 10/12/2018] [Accepted: 10/18/2018] [Indexed: 12/19/2022]
Abstract
Background Histaminolytic activity mediated by diamine oxidase (DAO) is present in plasma after induction of severe anaphylaxis in rats, guinea pigs, and rabbits. Heparin released during mast cell degranulation in the gastrointestinal tract might liberate DAO from heparin‐sensitive storage sites. DAO release during anaphylaxis has not been demonstrated in humans. Methods Plasma DAO, tryptase, and histamine concentrations of four severe anaphylaxis events were determined at multiple serial time points in two patients with systemic mastocytosis. The histamine degradation rates were measured in anaphylaxis samples and in pregnancy sera and plasma with comparable DAO concentrations. Results Mean DAO (132 ng/mL) and tryptase (304 ng/mL) concentrations increased 187‐ and 4.0‐fold, respectively, over baseline values (DAO 0.7 ng/mL, tryptase 76 ng/mL) during severe anaphylaxis. Under non‐anaphylaxis conditions, DAO concentrations were not elevated in 29 mastocytosis patients compared to healthy volunteers and there was no correlation between DAO and tryptase levels in mastocytosis patients. The histamine degradation rate of DAO in plasma from mastocytosis patients during anaphylaxis is severely compromised compared to DAO from pregnancy samples. Conclusion During severe anaphylaxis in mastocytosis patients, DAO is likely released from heparin‐sensitive gastrointestinal storage sites. The measured concentrations can degrade histamine, but DAO activity is compromised compared to pregnancy samples. For accurate histamine measurements during anaphylaxis, DAO inhibition is essential to inhibit further histamine degradation after blood withdrawal. Determination of DAO antigen levels might be of clinical value to improve the diagnosis of mast cell activation.
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Affiliation(s)
- Thomas Boehm
- Department of Clinical Pharmacology; Medical University of Vienna; Vienna Austria
| | - Birgit Reiter
- Analytical Toxicology; Clinical Institute of Laboratory Medicine; Medical University of Vienna; Vienna Austria
| | - Robin Ristl
- Section for Medical Statistics (IMS); Center of Medical Statistics; Informatics and Intelligent Systems; Medical University of Vienna; Vienna Austria
| | - Karin Petroczi
- Department of Clinical Pharmacology; Medical University of Vienna; Vienna Austria
| | - Wolfgang Sperr
- Department of Internal Medicine I; Division of Hematology & Hemostaseology and Ludwig Boltzmann Cluster Oncology; Medical University of Vienna; Vienna Austria
| | - Thomas Stimpfl
- Analytical Toxicology; Clinical Institute of Laboratory Medicine; Medical University of Vienna; Vienna Austria
| | - Peter Valent
- Department of Internal Medicine I; Division of Hematology & Hemostaseology and Ludwig Boltzmann Cluster Oncology; Medical University of Vienna; Vienna Austria
| | - Bernd Jilma
- Department of Clinical Pharmacology; Medical University of Vienna; Vienna Austria
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Szari S, Wong PH, Crisp HC, Champoux E, Rans TS, Coop CA. Evaluation of tryptase after subcutaneous immunotherapy-associated systemic reactions. Ann Allergy Asthma Immunol 2019; 122:413-415.e1. [PMID: 30684737 DOI: 10.1016/j.anai.2019.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 01/08/2019] [Accepted: 01/10/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Sofia Szari
- Allergy/Immunology Clinic, Wilford Hall Medical Center, Lackland AFB, Texas.
| | - Priscilla H Wong
- Allergy/Immunology Clinic, Wilford Hall Medical Center, Lackland AFB, Texas
| | - Howard C Crisp
- Allergy/Immunology Clinic, Wilford Hall Medical Center, Lackland AFB, Texas
| | - Edward Champoux
- Allergy/Immunology Clinic, Wilford Hall Medical Center, Lackland AFB, Texas
| | - Tonya S Rans
- Allergy/Immunology Clinic, Wilford Hall Medical Center, Lackland AFB, Texas
| | - Christopher A Coop
- Allergy/Immunology Clinic, Wilford Hall Medical Center, Lackland AFB, Texas
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Comparison of International Systemic Adverse Reactions Due to Allergen Immunotherapy. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 7:1298-1305.e3. [PMID: 30557714 DOI: 10.1016/j.jaip.2018.12.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 11/01/2018] [Accepted: 12/03/2018] [Indexed: 01/05/2023]
Abstract
BACKGROUND Several classifications of systemic adverse reactions (SARs) during allergen immunotherapy have been proposed, but the comparison of their usefulness in daily clinical practice is lacking. OBJECTIVE The present post hoc analysis was aimed at investigating the practicality of the most relevant international classifications proposed by the European Academy of Allergology and Clinical Immunology (EAACI), the American Academy of Asthma, Allergology and Clinical Immunology/American College of Allergy, Asthma and Immunology (AAAACI/ACAAI), and the World Allergy Organization (WAO) using data provided by the longitudinal European Survey on Adverse Systemic Reactions in Allergen Immunotherapy (EASSI) based on daily clinical practice in 3 countries in Europe. METHODS One hundred nine SARs over 4363 allergen immunotherapy courses were classified as mild (n = 78 [71.5%]), moderate (n = 27 [24.8%]), and severe (n = 4 [3.7%]) by EASSI-doctors, which served as a criterion standard. Every SAR was further classified according to the following grading systems: EAACI 2006 Grading System (EAACI2006), WAO 2010 Grading System (WAO2010), WAO 2017 Grading System (WAO2017), and AAAAI/ACAAI Grading System. All SAR rankings were also cross-compared among each other (Kendall correlation coefficient Tau-b). In general, a low epinephrine use was identified, severe reactions occurred within 15 minutes, and milder reactions were skin only. RESULTS The analysis indicated disparities in mild and moderate SARs in the different grading systems. The correlation between EASSI-severity and EAACI2006, WAO2010, WAO2017, and AAAAI/ACAAI Grading System was 0.639, 0.502, 0.315, and 0.663, respectively (P < .001 in all cases). However, correlation of severe reactions was good. The best correlation with the onset of the reaction and the number of System Organ Class involved were detected in WAO grading systems. CONCLUSIONS Despite having a lower correlation than EAACI and AAAAI/ACAAI, the WAO grading appears to provide a moderate correlation among these classifications. The analysis might help to inform clinicians and investigators on selecting the most appropriate classification.
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Masuyama K, Okamoto Y, Okamiya K, Azuma R, Fujinami T, Riis B, Ohashi-Doi K, Natsui K, Imai T, Okubo K. Efficacy and safety of SQ house dust mite sublingual immunotherapy-tablet in Japanese children. Allergy 2018; 73:2352-2363. [PMID: 30043449 DOI: 10.1111/all.13544] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 05/30/2018] [Accepted: 06/01/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND The SQ house dust mite (HDM) sublingual immunotherapy (SLIT)-tablet (TO-203, Torii, Japan/ALK, Denmark) treatment has been effective against respiratory allergic diseases in patients aged ≥12 years during European, Japanese, and North American trials. This trial was conducted to investigate the efficacy and safety of this treatment in Japanese children (5-17 years) with moderate-to-severe HDM allergic rhinitis (AR). METHODS In this randomized, double-blind, placebo-controlled trial, 458 Japanese children were randomly assigned to a daily SQ HDM SLIT-tablet [10 000 Japanese Allergy Unit (JAU), equivalent to 6 SQ-HDM in Europe and the US] or placebo (1:1) treatment for 1 year. Inclusion required an AR symptom score of ≥7 on at least 7 days during a 14-day run-in period while symptomatic treatment was withdrawn. The primary endpoint was the total combined rhinitis score (TCRS) comprising AR symptom and medication scores during the last 8 weeks of the treatment period. RESULTS The analysis of primary endpoint demonstrated statistically significant absolute reduction in TCRS of 1.22 with a relative difference of 23% (95% confidence interval, 14% to 31%) in the 10 000 JAU compared with placebo. Predefined stratified analyses revealed the same degree of efficacy of 1.11 (P = 0.002), 21% (8% to 32%) and 1.36 (P = 0.001), 26% (11% to 38%), respectively, in pediatric (5-11 years) and adolescent subjects (12-17 years). The treatment was well tolerated by both pediatric and adolescent subjects. CONCLUSION This trial, for the first time, demonstrated the efficacy and safety of the HDM SLIT-tablet in pediatric patients with moderate-to-severe HDM AR (JapicCTI-152953).
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Affiliation(s)
- Keisuke Masuyama
- Department of Otorhinolaryngology, Head and Neck Surgery; Graduate School of Medicine; Yamanashi University; Yamanashi Japan
| | - Yoshitaka Okamoto
- Department of Otolaryngology, Head and Neck Surgery; Graduate School of Medicine; Chiba University; Chiba Japan
| | | | | | | | | | | | | | - Toru Imai
- Association of Pollen Information of Japan; Tokyo Japan
| | - Kimihiro Okubo
- Department of Otolaryngology, Head and Neck Surgery; Graduate School of Medicine; Nippon Medical School; Tokyo Japan
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Pita JS, Azevedo J, Fernandes RA, Loureiro C, Bom AT. Immediate-hypersensitivity reactions to proton pump inhibitors: Experience in a medical department. Ann Allergy Asthma Immunol 2018; 122:204-205. [PMID: 30465856 DOI: 10.1016/j.anai.2018.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 10/17/2018] [Accepted: 11/12/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Joana Sofia Pita
- Allergy and Clinical Immunology Department, Coimbra's Universitary Hospital Centre, Coimbra, Portugal.
| | - João Azevedo
- Allergy and Clinical Immunology Department, Coimbra's Universitary Hospital Centre, Coimbra, Portugal
| | - Rosa-Anita Fernandes
- Allergy and Clinical Immunology Department, Coimbra's Universitary Hospital Centre, Coimbra, Portugal
| | - Carlos Loureiro
- Allergy and Clinical Immunology Department, Coimbra's Universitary Hospital Centre, Coimbra, Portugal
| | - Ana Todo Bom
- Allergy and Clinical Immunology Department, Coimbra's Universitary Hospital Centre, Coimbra, Portugal
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Intralymphatic immunotherapy with 2 concomitant allergens, birch and grass: A randomized, double-blind, placebo-controlled trial. J Allergy Clin Immunol 2018; 142:1338-1341.e9. [DOI: 10.1016/j.jaci.2018.05.030] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 05/03/2018] [Accepted: 05/25/2018] [Indexed: 12/14/2022]
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Exploring the Diagnosis and Profile of Cannabis Allergy. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 7:983-989.e5. [PMID: 30273677 DOI: 10.1016/j.jaip.2018.09.017] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 08/17/2018] [Accepted: 09/15/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Cannabis allergy (CA) has mainly been attributed to Can s 3, the nonspecific lipid transfer protein (nsLTP) of Cannabis sativa. Nevertheless, standardized diagnostic tests are lacking and research on CA is scarce. OBJECTIVE To explore the performance of 5 cannabis diagnostic tests and the phenotypic profile of CA. METHODS A total of 120 patients with CA were included and stratified according to the nature of their cannabis-related symptoms; 62 healthy and 189 atopic controls were included. Specific IgE (sIgE) hemp, sIgE and basophil activation test (BAT) with a recombinant Can s 3 protein from Cannabis sativa (rCan s 3), BAT with a crude cannabis extract, and a skin prick test (SPT) with an nCan s 3-rich cannabis extract were performed. Clinical information was based on patient history and a standardized questionnaire. RESULTS First, up to 72% of CA reporting likely-anaphylaxis (CA-A) are Can s 3 sensitized. Actually, the Can s 3-based diagnostic tests show the best combination of positive and negative predictive values, 80% and 60%, respectively. sIgE hemp displays 82% sensitivity but only 32% specificity. Secondly, Can s 3+CA reported significantly more cofactor-mediated reactions and displayed significantly more sensitizations to other nsLTPs than Can s 3-CA. Finally, the highest prevalence of systemic reactions to plant-derived foods was seen in CA-A, namely 72%. CONCLUSIONS The most effective and practical tests to confirm CA are the SPT with an nCan s 3-rich extract and the sIgE rCan s 3. Can s 3 sensitization entails a risk of systemic reactions to plant-derived foods and cofactor-mediated reactions. However, as Can s 3 sensitization is not absolute, other cannabis allergens probably play a role.
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Abstract
Allergen-specific immunotherapy is a potentially disease-modifying therapy that is effective for the treatment of allergic rhinitis/conjunctivitis, allergic asthma and stinging insect hypersensitivity. However, despite its proven efficacy in these conditions, it is frequently underutilized in Canada. The decision to proceed with allergen-specific immunotherapy should be made on a case-by-case basis, taking into account individual patient factors, such as the degree to which symptoms can be reduced by avoidance measures and pharmacological therapy, the amount and type of medication required to control symptoms, the adverse effects of pharmacological treatment, and patient preferences. Since this form of therapy carries a risk of anaphylactic reactions, it should only be prescribed by physicians who are adequately trained in the treatment of allergic conditions. Furthermore, for subcutaneous therapy, injections must be given under medical supervision in clinics that are equipped to manage anaphylaxis. In this article, the authors review the indications and contraindications, patient selection criteria, and details regarding the administration, safety and efficacy of allergen-specific immunotherapy.
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Affiliation(s)
- William Moote
- 1Division of Clinical Immunology & Allergy, Western University, London, ON Canada
| | - Harold Kim
- 1Division of Clinical Immunology & Allergy, Western University, London, ON Canada.,2McMaster University, Hamilton, ON Canada
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Westermann-Clark E, Pepper AN, Lockey RF. Economic considerations in the treatment of systemic allergic reactions. J Asthma Allergy 2018; 11:153-158. [PMID: 29950874 PMCID: PMC6016598 DOI: 10.2147/jaa.s159851] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Epinephrine is a life-saving medication used to treat systemic allergic reactions including anaphylaxis. Epinephrine autoinjectors (EAIs) are expensive and worldwide availability is limited. Epinephrine prefilled syringes and epinephrine kits are potentially lower-cost alternatives to EAIs. Advantages, disadvantages, and costs of available products are discussed. The socioeconomic factors impacting access to EAIs are described.
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Affiliation(s)
- Emma Westermann-Clark
- Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida Morsani College of Medicine.,James A. Haley Veterans Affairs Hospital, Tampa, FL, USA
| | - Amber N Pepper
- Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida Morsani College of Medicine.,James A. Haley Veterans Affairs Hospital, Tampa, FL, USA
| | - Richard F Lockey
- Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida Morsani College of Medicine.,James A. Haley Veterans Affairs Hospital, Tampa, FL, USA
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Appel MY, Nachshon L, Elizur A, Levy MB, Katz Y, Goldberg MR. Evaluation of the basophil activation test and skin prick testing for the diagnosis of sesame food allergy. Clin Exp Allergy 2018; 48:1025-1034. [DOI: 10.1111/cea.13174] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 04/30/2018] [Accepted: 05/01/2018] [Indexed: 11/29/2022]
Affiliation(s)
- M. Y. Appel
- Institute of Allergy, Immunology and Pediatric Pulmonology Assaf‐Harofeh Medical Center Zerifin Israel
| | - L. Nachshon
- Institute of Allergy, Immunology and Pediatric Pulmonology Assaf‐Harofeh Medical Center Zerifin Israel
| | - A. Elizur
- Institute of Allergy, Immunology and Pediatric Pulmonology Assaf‐Harofeh Medical Center Zerifin Israel
- Department of Pediatrics Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - M. B. Levy
- Institute of Allergy, Immunology and Pediatric Pulmonology Assaf‐Harofeh Medical Center Zerifin Israel
| | - Y. Katz
- Department of Pediatrics Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - M. R. Goldberg
- Institute of Allergy, Immunology and Pediatric Pulmonology Assaf‐Harofeh Medical Center Zerifin Israel
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Schatz M, Sicherer SH, Zeiger RS. The Journal of Allergy and Clinical Immunology: In Practice 2017 Year in Review. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 6:328-352. [PMID: 29397373 DOI: 10.1016/j.jaip.2017.12.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 12/19/2017] [Indexed: 12/29/2022]
Abstract
An impressive number of clinically impactful studies and reviews were published in The Journal of Allergy and Clinical Immunology: In Practice in 2017. As a service to our readers, the editors provide this Year in Review article to highlight and contextualize the advances published over the past year. We include information from articles on asthma, allergic rhinitis, rhinosinusitis, immunotherapy, atopic dermatitis, contact dermatitis, food allergy, anaphylaxis, drug hypersensitivity, urticarial/angioedema, eosinophilic disorders, and immunodeficiency. Within each topic, epidemiologic findings are presented, relevant aspects of prevention are described, and diagnostic and therapeutic advances are enumerated. Treatments discussed include behavioral therapy, allergen avoidance therapy, positive and negative effects of pharmacologic therapy, and various forms of immunologic and desensitization management. We hope this review will help readers consolidate and use this extensive and practical knowledge for the benefit of patients.
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Affiliation(s)
- Michael Schatz
- Department of Allergy, Kaiser Permanente Southern California, San Diego, Calif.
| | - Scott H Sicherer
- Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Robert S Zeiger
- Department of Allergy, Kaiser Permanente Southern California, San Diego, Calif
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Abunada T, Al-Nesf MA, Thalib L, Kurdi R, Khalil S, ElKassem W, Mobayed HM, Zayed H. Anaphylaxis triggers in a large tertiary care hospital in Qatar: a retrospective study. World Allergy Organ J 2018; 11:20. [PMID: 30214658 PMCID: PMC6122634 DOI: 10.1186/s40413-018-0200-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 07/26/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Anaphylaxis is a serious allergic disease that may lead to death if not immediately recognized and treated. Triggers of anaphylaxis including food, drugs, and insect stings can vary widely. The incidence of anaphylaxis seems to be affected by age, sex, atopy, and geographic location. This study aims to examine the common triggers of anaphylaxis in Qatar. METHODS A total of 1068 electronic medical records were audited using power chart system: 446 from the medical coding system of anaphylaxis and 622 from the epinephrine auto-injectors (EAIs) dispensed during January 2012-December 2017. RESULTS Of 1068 patients, 574 (53.5%) had anaphylaxis; male to female ratio was 1.2, and 300 patients (77.9%) were less than 10 years old. The common triggers were food (n = 316, 55.0%), insect stings (n = 161, 28.0%), and drugs (n = 103, 17.9%). Common anaphylaxis food triggers were nuts (n = 173, 30.1%), eggs (n = 89, 15.5%), and seafood (n = 72, 12.5%), and common anaphylaxis medication triggers were antibiotics (n = 49, 8.5%) and nonsteroidal anti-inflammatory drugs (n = 30, 5.2%). Interestingly, 135 anaphylactic patients (23.5%) were due to black ant stings. The anaphylaxis triggers varied significantly between children and adults. Among children (less than 10 years), three quarters of the events were triggered by food (223, 74.3%) while among adults (20-55 years), insect stings (n = 59, 43.0%) and drugs (n = 44, 32.0%) were dominant. DISCUSSION This is the first national study stratifying anaphylaxis triggers among different age groups in Qatar. This study will serve as a guide for clinical practice in allergy clinics in Qatar and will help to assess future trends of anaphylaxis in Qatar.
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Affiliation(s)
- Taghreed Abunada
- 0000 0004 0634 1084grid.412603.2Biomedical Science Department, College of Health Science, Qatar University, P.O. Box 2713, Doha, Qatar
| | - Maryam Ali Al-Nesf
- 0000 0004 0571 546Xgrid.413548.fAllergy and Immunology Unit, Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar
| | - Lukman Thalib
- 0000 0004 0634 1084grid.412603.2College of Health Science, Qatar University, P.O. Box 2713, Doha, Qatar
| | - Rana Kurdi
- 0000 0004 0634 1084grid.412603.2Department, College of Health Science, Qatar University, P.O. Box 2713, Doha, Qatar
| | - Sally Khalil
- 0000 0004 0571 546Xgrid.413548.fAllergy & Clinical Immunology Unit, Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar
| | - Wessam ElKassem
- 0000 0004 0571 546Xgrid.413548.fPharmacy Department, Women’s Hospital, Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar
| | - Hassan M. Mobayed
- 0000 0004 0571 546Xgrid.413548.fHamad Medical Corporation, P.O. Box 3050, Doha, Qatar
| | - Hatem Zayed
- 0000 0004 0634 1084grid.412603.2Biomedical Science Department, College of Health Science, Qatar University, P.O. Box 2713, Doha, Qatar
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Leung TF. In-season Dosage Adjustment for Pollen Subcutaneous Immunotherapy: The Controversy Continues. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2017; 5:1440-1441. [DOI: 10.1016/j.jaip.2017.05.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 05/24/2017] [Indexed: 01/20/2023]
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Allergen Immunotherapy Clinical Trial Outcomes and Design: Working Toward Harmonization of Methods and Principles. Curr Allergy Asthma Rep 2017; 17:18. [PMID: 28293909 DOI: 10.1007/s11882-017-0687-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Progress has been made in the harmonization of efficacy and safety outcome measures for allergen immunotherapy (AIT) trials, but unresolved issues still remain. Furthermore, there are discrepancies in recommendations from professional medical societies and regulatory agencies regarding requirements for AIT trials. In this article, we reviewed published recommendations and current data from recent clinical trials, as well as the criteria applied by regulatory authorities for approval of AIT products, to provide updated considerations for conducting phase 3 AIT trials. Topics discussed include analysis of outcomes and trial designs for pediatric and asthma indications, as well as trial designs for perennial allergic rhinoconjunctivitis. In addition, the need for harmonization of safety reporting is emphasized. Considerations presented in this article may further effort to find common ground among professional medical societies and government agencies in developing future recommendations for AIT trial design.
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91
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Wasan A, Nanda A. Systemic reaction to timothy grass pollen sublingual immunotherapy. Ann Allergy Asthma Immunol 2017; 118:732-733. [PMID: 28457642 DOI: 10.1016/j.anai.2017.03.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 03/15/2017] [Accepted: 03/28/2017] [Indexed: 12/24/2022]
Affiliation(s)
| | - Anil Nanda
- Asthma and Allergy Center, Lewisville and Flower Mound, Texas; Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas, Texas.
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92
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Allergen-Specific Immunotherapy for Respiratory Allergy in Children: Unmet Needs and Future Goals. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2017; 5:946-950. [PMID: 28389302 DOI: 10.1016/j.jaip.2017.01.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 12/15/2016] [Accepted: 01/19/2017] [Indexed: 12/20/2022]
Abstract
Allergen-specific immunotherapy for the treatment of respiratory allergy is currently supported, at least for selected products, by evidence of efficacy and effectiveness in the pediatric age. However, unmet needs remain in terms of administration regimens, duration of treatment, biomarkers, and preventive effects. These knowledge gaps need to be urgently addressed to provide pediatricians and pediatric allergists with more definite recommendations for the use of this treatment in children. This article critically appraises the most relevant debated issues on allergen-specific immunotherapy in children, focusing on allergen standardization procedures, heterogeneity of clinical studies, and regulatory and pharmacoeconomic aspects.
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93
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Bernstein DI, Bardelas JA, Svanholm Fogh B, Kaur A, Li Z, Nolte H. A practical guide to the sublingual immunotherapy tablet adverse event profile: implications for clinical practice. Postgrad Med 2017; 129:590-597. [PMID: 28326906 DOI: 10.1080/00325481.2017.1302306] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVES Treatment with allergy immunotherapy improves allergic rhinoconjunctivitis, but can also improve comorbidities associated with allergic rhinitis such as asthma. Sublingual immunotherapy (SLIT)-tablets are a convenient and efficacious method of allergy immunotherapy. They are self-administered after the first tablet has been provided under medical supervision. Therapy may elicit local reactions or, rarely, systemic allergic reactions. The objective of this report is to inform healthcare practitioners about the safety and tolerability profile of SLIT-tablets and use this information to provide practical guidance that may inform patients regarding potential adverse reactions and how to manage them. METHODS Pooled analyses of safety data from completed randomized, multicenter, double-blind, placebo-controlled phase 2 and phase 3 US and EU trials of timothy grass, short ragweed, and SQ house dust mite SLIT-tablets were conducted to characterize safety and tolerability. RESULTS SLIT-tablets are generally well tolerated. No life-threatening events, serious systemic allergic reactions, or events that compromised the airway have been reported. The most common treatment-related adverse events (AEs) are oral site reactions, most of which begin on day 1 of treatment, recur for less than 2 weeks, and resolve after approximately 30-60 minutes. Systemic allergic reactions have been managed with conventional pharmacotherapy. Reactions treated with epinephrine are uncommon, but have been reported. Treatment of AEs, treatment discontinuation considerations, and patient FAQs regarding SLIT-tablet safety/tolerability are discussed. CONCLUSIONS This report gives healthcare providers valuable information to educate patients regarding what to expect in terms of SLIT-tablet safety and tolerability. Practical guidance is also provided to ensure proper treatment of any adverse reactions.
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Affiliation(s)
- David I Bernstein
- a Bernstein Clinical Research Center and Department of Medicine and Environmental Health , University of Cincinnati , Cincinnati , OH , USA
| | - Jose A Bardelas
- b Allergy and Asthma Center of North Carolina , High Point , NC , USA
| | | | | | - Ziliang Li
- d Merck & Co., Inc. , Kenilworth , NJ , USA
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Cox LS. Sublingual Immunotherapy: Historical Perspective and Practical Guidance. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2017; 5:63-65. [DOI: 10.1016/j.jaip.2016.11.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 11/16/2016] [Indexed: 02/06/2023]
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Epstein TG, Calabria C, Cox LS, Dreborg S. Current Evidence on Safety and Practical Considerations for Administration of Sublingual Allergen Immunotherapy (SLIT) in the United States. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2016; 5:34-40.e2. [PMID: 27815065 DOI: 10.1016/j.jaip.2016.09.017] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 09/06/2016] [Accepted: 09/13/2016] [Indexed: 12/17/2022]
Abstract
Liquid sublingual allergen immunotherapy (SLIT) has been used off-label for decades, and Food and Drug Administration (FDA)-approved grass and ragweed SLIT tablets have been available in the United States since 2014. Potentially life-threatening events from SLIT do occur, although they appear to be very rare, especially for FDA-approved products. Practice guidelines that incorporate safety precautions regarding the use of SLIT in the United States are needed. This clinical commentary attempts to address unresolved issues including controversy regarding the FDA mandate for the prescription of epinephrine autoinjectors for patients on SLIT; how to approach polysensitized patients; optimal timing and duration of SLIT administration; how to address gaps in therapy; whether antihistamines can prevent local reactions, if certain patient populations (such as persistent asthmatics) should not receive SLIT; and when to instruct patients to self-administer epinephrine. Key points are that physicians should focus on educating patients regarding: (1) when not to administer SLIT; (2) how to recognize a potentially serious allergic reaction to SLIT; and (3) when to administer epinephrine and seek emergency care.
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Affiliation(s)
- Tolly G Epstein
- Division of Immunology, Allergy, and Rheumatology, Department of Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio.
| | | | - Linda S Cox
- University of Miami Miller School of Medicine at Holy Cross Hospital, Ft. Lauderdale, Fla
| | - Sten Dreborg
- Department of Pediatric Allergy, Women's and Children's Health, University of Uppsala, Uppsala, Sweden
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