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Park S, Kim Y, Lee GH, Choi SA. A risk of serious anaphylatic reactions to asthma biologics: a pharmacovigilance study based on a global real-world database. Sci Rep 2023; 13:17607. [PMID: 37848636 PMCID: PMC10582024 DOI: 10.1038/s41598-023-44973-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 10/13/2023] [Indexed: 10/19/2023] Open
Abstract
Asthma is a chronic inflammatory condition that affects the lung airways. Chronic use of oral glucocorticoids in patients with severe asthma is associated with several adverse events (AEs). Biologics (omalizumab, benralizumab, mepolizumab, reslizumab, and dupilumab) have been developed as alternative therapies for the treatment of asthma. In this study, we aimed to evaluate the risk of anaphylactic reactions associated with these five biologics based on a large global database. We utilized individual case reports from the Uppsala Monitoring Center from January 1968 to December 29, 2019. A disproportionality analysis was performed over all drugs and monoclonal antibodies. Anaphylactic reactions were defined according to the "anaphylactic reaction" of the standardized MedDRA queries. Contrary to dupilumab, omalizumab, benralizumab, and mepolizumab demonstrated positive signals related to anaphylactic reactions over all drugs and monoclonal antibodies. Reslizumab, which represented only 315 cases of all AEs, requires more reports to determine its association with anaphylactic reactions. More anaphylactic reactions have been identified than are known, and most cases (96.2%) are reported to be serious. Our findings indicate that omalizumab, benralizumab, and mepolizumab for asthma treatment are associated with a high risk of anaphylactic reactions; thus, more careful monitoring in the post-administration period is recommended.
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Affiliation(s)
- Sunny Park
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Korea University, Sejong, South Korea
| | - Yeju Kim
- College of Pharmacy, Korea University, Sejong, South Korea
| | - Geon Ho Lee
- College of Pharmacy, Korea University, Sejong, South Korea
| | - Soo An Choi
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Korea University, Sejong, South Korea.
- College of Pharmacy, Korea University, Sejong, South Korea.
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2
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Furci F, Luxi N, Senna G, Trifirò G. Anaphylaxis due to antiallergic and antiasthmatic biologics. Curr Opin Allergy Clin Immunol 2023; 23:364-369. [PMID: 37555938 DOI: 10.1097/aci.0000000000000937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
PURPOSE OF REVIEW To provide a better understanding of the risk of anaphylaxis due to antiallergic and antiasthmatic biologics through an analysis of data reported in literature and in clinical trials, and by conducting a retrospective descriptive analysis of individual case safety reports on VigiBase, the WHO International Pharmacovigilance database. RECENT FINDINGS Analysis of the data, as described, demonstrated safety of the antiallergic and antiasthmatic biologics with a low incidence of anaphylaxis. SUMMARY Biologic therapies have revolutionized the treatment of many diseases, such as atopic dermatitis, nasal polyps, spontaneous chronic urticarial and severe asthma with a precise immunological action, in the sphere of precision medicine.Albeit these drugs are generally well tolerated, generating real-world evidence is crucial to re-evaluate clinically relevant adverse events, such as anaphylaxis, allowing to confirm their safety profile in particular in special populations such as paediatric patients.
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Affiliation(s)
- Fabiana Furci
- Provincial Healthcare Unit, Section of Allergy, Vibo Valentia
| | | | - Gianenrico Senna
- Department of Medicine, University of Verona
- Allergy Unit and Asthma Center, Verona University Hospital
| | - Gianluca Trifirò
- Department of Diagnostics and Public Health, Section of Pharmacology, University of Verona, Verona, Italy
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3
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Yang BG, Kim AR, Lee D, An SB, Shim YA, Jang MH. Degranulation of Mast Cells as a Target for Drug Development. Cells 2023; 12:1506. [PMID: 37296626 PMCID: PMC10253146 DOI: 10.3390/cells12111506] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 05/26/2023] [Accepted: 05/28/2023] [Indexed: 06/12/2023] Open
Abstract
Mast cells act as key effector cells of inflammatory responses through degranulation. Mast cell degranulation is induced by the activation of cell surface receptors, such as FcεRI, MRGPRX2/B2, and P2RX7. Each receptor, except FcεRI, varies in its expression pattern depending on the tissue, which contributes to their differing involvement in inflammatory responses depending on the site of occurrence. Focusing on the mechanism of allergic inflammatory responses by mast cells, this review will describe newly identified mast cell receptors in terms of their involvement in degranulation induction and patterns of tissue-specific expression. In addition, new drugs targeting mast cell degranulation for the treatment of allergy-related diseases will be introduced.
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Affiliation(s)
- Bo-Gie Yang
- Research Institute, GI Biome Inc., Seongnam 13201, Republic of Korea; (A.-R.K.); (D.L.); (S.B.A.)
| | - A-Ram Kim
- Research Institute, GI Biome Inc., Seongnam 13201, Republic of Korea; (A.-R.K.); (D.L.); (S.B.A.)
| | - Dajeong Lee
- Research Institute, GI Biome Inc., Seongnam 13201, Republic of Korea; (A.-R.K.); (D.L.); (S.B.A.)
| | - Seong Beom An
- Research Institute, GI Biome Inc., Seongnam 13201, Republic of Korea; (A.-R.K.); (D.L.); (S.B.A.)
| | - Yaein Amy Shim
- Research Institute, GI Innovation Inc., Songpa-gu, Seoul 05855, Republic of Korea;
| | - Myoung Ho Jang
- Research Institute, GI Innovation Inc., Songpa-gu, Seoul 05855, Republic of Korea;
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Sitek AN, Li JT, Pongdee T. Risks and safety of biologics: A practical guide for allergists. World Allergy Organ J 2023; 16:100737. [PMID: 36694621 PMCID: PMC9853370 DOI: 10.1016/j.waojou.2022.100737] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 12/01/2022] [Accepted: 12/08/2022] [Indexed: 01/18/2023] Open
Abstract
Biologic agents are a rapidly expanding class of medications, and several options are now available for the management of allergic and immunologic disorders. The risks of biologic therapy need to be understood in order to adequately counsel patients and appropriately monitor for potential adverse events. We sought to provide a comprehensive review of the risks and adverse effects reported for the current FDA-approved biologics used in management of allergic and immunologic disorders, including omalizumab, benralizumab, dupilumab, mepolizumab, reslizumab, tezepelumab and tralokinumab. Our review focuses on the risk of hypersensitivity reactions, pregnancy-specific considerations, risk of infection and risk of malignancy. We also highlight drug-specific adverse events and unique safety issues identified in case reports.
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Affiliation(s)
| | | | - Thanai Pongdee
- Corresponding author. Division of Allergic Diseases Mayo Clinic 200 First St SW Rochester, MN 55901
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Awad WB, Alsheyyab F, Nazer L, Mahmoud N. Delayed Anaphylaxis to Intravenous Colistin in a Critically Ill Cancer Patient: A Case Report. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2023; 16:11795476221149393. [PMID: 36654733 PMCID: PMC9841843 DOI: 10.1177/11795476221149393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 12/17/2022] [Indexed: 01/13/2023]
Abstract
Introduction Anaphylaxis is an acute, life-threatening, multi-system syndrome that has been reported with a wide range of medications. Though anaphylaxis usually has a rapid onset, we describe a patient who developed anaphylaxis to intravenous colistin after 28 days of daily administration. Case presentation A 20 years-old Caucasian male patient, with a history of relapsed acute myeloid leukemia, was transferred from the medical floor to our intensive care unit with septic shock. The source of infection was presumed to be a recto-cecal abscess and arm cellulitis. Cultures were positive for extended spectrum beta-lactamase (ESBL) and carbapenem-resistant enterobacteriaceae (CRE) Escherichia coli. for which he was receiving broad spectrum antibiotics, as well as intravenous colistin, started about 4 weeks earlier. On day 2 of ICU admission, and during the administration of colistin, the patient experienced an anaphylactic reaction. He developed hypotension requiring the initiation of norepinephrine, shortness of breath, hypoxia, tachycardia, and tachypnea. The reaction was resolved after supportive therapy but it was thought to be related to septic shock and therefore the patient continued on colistin the following day. The patient tolerated colistin for the next 3 days before developing another similar, but more severe, reaction. Colistin was discontinued and the symptoms resolved following supportive therapy. Conclusion This case highlights the importance of being aware of delayed serious reactions that may occur several weeks after initiation of drug therapy. In addition, successful re-initiation may not necessarily rule out the recurrence of such reactions and therefore close monitoring is crucial.
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Affiliation(s)
- Wedad B Awad
- Department of Pharmacy, King Hussein Cancer Center, Amman, Jordan,Wedad B Awad, Department of Pharmacy, King Hussein Cancer Center, P.O. Box 1269, Al-Jubeiha, Amman 11941, Jordan.
| | - Farah Alsheyyab
- Department of Pharmacy, King Hussein Cancer Center, Amman, Jordan
| | - Lama Nazer
- Department of Pharmacy, King Hussein Cancer Center, Amman, Jordan
| | - Naser Mahmoud
- Department of Medicine, King Hussein Cancer Center, Amman, Jordan
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Konstantinov K, Dolladille C, Gillet B, Alexandre J, Aouba A, Deshayes S, Repesse Y. Drug-associated acquired hemophilia A: an analysis based on 185 cases from the WHO pharmacovigilance database. Haemophilia 2023; 29:186-192. [PMID: 36367755 DOI: 10.1111/hae.14692] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 10/21/2022] [Accepted: 10/27/2022] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Acquired hemophilia A (AHA) is a rare autoimmune hemorrhagic disease occurring in several underlying conditions. Drug-associated AHA (D-AHA) is poorly addressed nowadays. AIM This work aims to identify and characterize which drugs are associated with AHA using the WHO global database of reported potential effects of medicinal products (VigiBase). METHODS First, we realized a disproportionality analysis using the information component (IC) to identify D-AHA in VigiBase. IC compares observed- and expected-values in order to find associations between drugs and adverse drug reactions (ADRs) using disproportionate Bayesian reporting. IC025 is the lower end of a 95% credibility interval for the IC. Then, we collected cases of drugs significantly associated with AHA from July 2004 to November 2021. RESULTS 14 drugs with IC025 > 0 were identified representing a total of 185 cases. D-AHA occurred more frequently in men (59%) than women (41%). The median (min-max) age at onset was 75 years (8-98). The median [Q1-Q3] time to onset of D-AHA from the start of the suspected drug was 30 days [9.5-73.75] and 10% of cases resulted in a fatality. The drugs associated with the highest IC025 (IC025 > 2) were Clopidogrel, Alemtuzumab, Omalizumab. This study retrieved for the first time three usually used drugs (3/14) that exhibit a significant pharmacovigilance signal for D-AHA. CONCLUSION This worldwide pharmaco-epidemiologic study updates the list of the drugs associated with AHA. The clinician should be aware of these possible severe ADR, which might require larger epidemiological and pathophysiologic studies.
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Affiliation(s)
| | - Charles Dolladille
- UNICAEN, EA4650 SEILIRM, CHU de Caen Normandie, Normandie University, Caen, France.,Department of Pharmacology, CHU de Caen Normandie, Caen, France
| | | | - Joachim Alexandre
- UNICAEN, EA4650 SEILIRM, CHU de Caen Normandie, Normandie University, Caen, France.,Department of Pharmacology, CHU de Caen Normandie, Caen, France
| | - Achille Aouba
- Department of Internal Medicine, UNICAEN, CHU de Caen Normandie, Normandie University, Caen, France
| | - Samuel Deshayes
- Department of Internal Medicine, UNICAEN, CHU de Caen Normandie, Normandie University, Caen, France
| | - Yohann Repesse
- Haematology Laboratory, CHU Caen Normandie, Caen, France.,Unicaen, Inserm, Physiopathology and Imaging of Neurological Disorders (PhIND), Normandie University, Caen, France
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7
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de Las Vecillas L, Caimmi D, Isabwe GAC, Madrigal-Burgaleta R, Soyer O, Tanno L, Vultaggio A, Giovannini M, Mori F. Hypersensitivity reactions to biologics in children. Expert Opin Biol Ther 2023; 23:61-72. [PMID: 36314361 DOI: 10.1080/14712598.2022.2142039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Hypersensitivity reactions (HSRs) have been observed with the use of biologics in children. The management of HSRs in children is mainly based on experiences from the adult population. Recently, data from different centers experienced in managing these reactions, including desensitization in children, have been published, allowing clinicians to have an appropriate global overview and compare results. AREAS COVERED This review highlights the published data on hypersensitivity reactions to biologics in children and drug desensitization protocols adapted to the pediatric population. EXPERT OPINION With regard to HSRs to biologics in children, few data are available. Compared with the adult population, there is a lack of knowledge in the endophenotypes, management and the standardization of protocols including premedication regimens in children. An international consensus is needed to provide clinicians with new insight on how to apply personalized management and to perform tailored desensitization protocols in pediatric populations. Various specialists including allergists, pediatricians, oncologists, hematologists, rheumatologists, and pharmacists, should build a multidisciplinary management team to keep pediatric patients on their best treatment options in the safest manner.
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Affiliation(s)
| | - Davide Caimmi
- Allergy Unit, Department of Pulmonology, CHU de Montpellier, Montpellier, France.,IDESP, UMR Inserm, Université de Montpellier, Montpellier, France
| | - Ghislaine Annie Clarisse Isabwe
- Division of Allergy and Clinical Immunology, Department of Medicine, McGill University Health Centre (MUHC), Montreal, QC, Canada
| | - Ricardo Madrigal-Burgaleta
- Allergy & Severe Asthma Service, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.,Drug Desensitisation Centre, Catalan Institute of Oncology/Bellvitge University Hospital, Barcelona, Spain
| | - Ozge Soyer
- Department of Pediatric Allergy, Hacettepe, University Faculty of Medicine, Ankara, Turkey
| | - Luciana Tanno
- Allergy Unit, Department of Pulmonology, CHU de Montpellier, Montpellier, France.,IDESP, UMR Inserm, Université de Montpellier, Montpellier, France.,WHO Collaborating Centre on Scientific Classification Support, Montpellier, France
| | - Alessandra Vultaggio
- Department of Biomedicine, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Mattia Giovannini
- Allergy Unit, Department of Pediatrics, Meyer Children's University Hospital, Florence, Italy
| | - Francesca Mori
- Allergy Unit, Department of Pediatrics, Meyer Children's University Hospital, Florence, Italy
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8
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Chow TG, Oppenheimer J, Joshi SR. A Review of Adverse Reactions to Biologics Used in Allergy-Immunology Practice. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:3075-3086. [PMID: 36162800 DOI: 10.1016/j.jaip.2022.09.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 02/06/2023]
Abstract
Biologic agents have become an integral therapeutic option for practicing allergists-immunologists for the management of asthma, atopic dermatitis, chronic rhinosinusitis with nasal polyps, and various immunologic conditions. As these agents vary considerably from traditional small-molecule drugs, various adverse reactions have been noted. A different approach must be used to classify these reactions beyond the classic Gell-Coombs classification system as it does not capture many of the adverse events seen with biologic therapy. This article addresses the available literature on proposed classification systems and diagnostic modalities for adverse events associated with biologics and reviews each approved agent used frequently in allergy-immunology practice.
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Affiliation(s)
- Timothy G Chow
- Division of Allergy and Immunology, Department of Internal Medicine, University of Texas Southwestern, Dallas, Texas
| | - John Oppenheimer
- Department of Internal Medicine, UMDMJ Rutgers University School of Medicine, Newark, NJ; Pulmonary and Allergy Associates, Morristown, NJ
| | - Shyam R Joshi
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Oregon Health and Science University, Portland, Ore.
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Agache I, Akdis CA, Akdis M, Brockow K, Chivato T, Giacco S, Eiwegger T, Eyerich K, Giménez‐Arnau A, Gutermuth J, Guttman‐Yassky E, Maurer M, Ogg G, Ong PY, O’Mahony L, Schwarze J, Warner A, Werfel T, Palomares O, Jutel M. EAACI Biologicals Guidelines-Omalizumab for the treatment of chronic spontaneous urticaria in adults and in the paediatric population 12-17 years old. Allergy 2022; 77:17-38. [PMID: 34324716 DOI: 10.1111/all.15030] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 07/21/2021] [Accepted: 07/25/2021] [Indexed: 12/14/2022]
Abstract
Chronic spontaneous urticaria (CSU) imposes a significant burden on patients, families and healthcare systems. Management is difficult, due to disease heterogeneity and insufficient efficacy of classical drugs such as H1 R-antihistamines. Better understanding of the mechanisms has enabled a stratified approach to the management of CSU, supporting the use of targeted treatment with omalizumab. However, many practical issues including selection of responders, the definition of response, strategies to enhance the responder rate, the duration of treatment and its regimen (in the clinic or home-based) and its cost-effectiveness still require further clarification. The EAACI Guidelines on the use of omalizumab in CSU follow the GRADE approach in formulating recommendations for each outcome. In addition, future therapeutic approaches and perspectives as well as research priorities are discussed.
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Affiliation(s)
- Ioana Agache
- Faculty of Medicine Transylvania University Brasov Romania
| | - Cezmi A. Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Davos Switzerland
- Christine‐Kühne‐Center for Allergy Research and Education (CK‐CARE Davos Switzerland
| | - Mubeccel Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Davos Switzerland
| | - Knut Brockow
- Department of Dermatology and Allergology Biederstein School of Medicine Technical University of Munich Munich Germany
| | - Tomas Chivato
- School of Medicine University CEU San Pablo Madrid Spain
| | - Stefano Giacco
- Department of Medical Sciences and Public Health University of Cagliari Cagliari Italy
| | - Thomas Eiwegger
- Translational Medicine Program, Research InstituteHospital for Sick Children Toronto ON Canada
- Department of Immunology University of Toronto Toronto ON Canada
- Karl Landsteiner University of Health Sciences Krems Austria
- Department of Paediatrics University Hospital St. Pölten Pölten Austria
| | - Kilian Eyerich
- Department of Dermatology and Allergy Biederstein Technical University of Munich Munich Germany
| | - Ana Giménez‐Arnau
- Department of Dermatology Hospital del Mar‐ Institut Mar d'Investigacions Mèdiques Universitat Autònoma de Barcelona Barcelona Spain
| | - Jan Gutermuth
- Department of Dermatology Universitair Ziekenhuis BrusselVrije Universiteit Brussel (VUB Brussels Belgium
| | - Emma Guttman‐Yassky
- Department of DermatologyIcahn School of Medicine at Mount Sinai New York New York USA
| | - Marcus Maurer
- Dermatological Allergology Allergie‐Centrum‐Charité Department of Dermatology and Allergy Charité ‐ Universitätsmedizin Berlin Berlin Germany
| | - Graham Ogg
- MRC Human Immunology Unit MRC Weatherall Institute of Molecular Medicine, Oxford NIHR Biomedical Research Centre Radcliffe Department of Medicine University of Oxford Oxford UK
| | - Peck Y. Ong
- Division of Clinical Immunology & Allergy Children’s Hospital Los Angeles Keck School of Medicine University of Southern California Los Angeles California USA
| | - Liam O’Mahony
- Departments of Medicine and Microbiology APC Microbiome Ireland University College Cork Cork Ireland
| | - Jürgen Schwarze
- Centre for Inflammation Research, Child Life and Health The University of Edinburgh Edinburgh UK
| | | | - Thomas Werfel
- Division of Immunodermatology and Allergy Research Department of Dermatology and Allergy Hannover Medical School Hannover Germany
| | - Oscar Palomares
- Department of Biochemistry and Molecular Biology Chemistry School Complutense University of Madrid Madrid Spain
| | - Marek Jutel
- Department of Clinical Immunology Wrocław Medical University Wroclaw Poland
- All‐MED Medical Research Institute Wroclaw Poland
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Packaging and Delivery of Asthma Therapeutics. Pharmaceutics 2021; 14:pharmaceutics14010092. [PMID: 35056988 PMCID: PMC8777963 DOI: 10.3390/pharmaceutics14010092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 12/27/2021] [Accepted: 12/29/2021] [Indexed: 12/11/2022] Open
Abstract
Asthma is a life-altering, chronic disease of heterogenous origin that features a complex interplay of immune and environmental signaling. Although very little progress has been made in prevention, diverse types of medications and delivery systems, including nanoscale systems, have been or are currently being developed to control airway inflammation and prevent exacerbations and fibrosis. These medications are delivered through mechanical methods, with various inhalers (with benefits and drawbacks) existing, and new types offering some variety in delivery. Of particular interest is the progress being made in nanosized materials for efficient penetration into the epithelial mucus layer and delivery into the deepest parts of the lungs. Liposomes, nanoparticles, and extracellular vesicles, both natural and synthetic, have been explored in animal models of asthma and have produced promising results. This review will summarize and synthesize the latest developments in both macro-(inhaler) and micro-sized delivery systems for the purpose of treating asthma patients.
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11
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Sandhu J, Kumar A, Gupta SK. The therapeutic role of methotrexate in chronic urticaria: A systematic review. Indian J Dermatol Venereol Leprol 2021; 88:313-321. [PMID: 34623059 DOI: 10.25259/ijdvl_1145_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 06/01/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Chronic urticaria, in many cases, has an unsatisfactory response to antihistamines. The current recommendations in urticaria do not mention the dose and duration for methotrexate. AIMS This study aims to systematically review the use/efficacy of methotrexate in chronic urticaria. METHODS A systematic search in four databases, that is, PubMed/Medline, Cochrane central, Google Scholar and Clinicaltrials.gov was done to identify studies on the use of methotrexate in chronic urticaria using key words "methotrexate [MeSH terms]" and "urticaria" or "urticaria, chronic" or "urticaria, chronic spontaneous." RESULTS Nine articles (study participants 127), including three randomized control trials, one prospective interventional trial without control, three retrospective reviews and two case reports, were identified and finally included in the systematic review. There was a paucity of literature and the three randomized control trials did not show any benefit of methotrexate over antihistamines alone. However, in studies where steroid-dependent cases were given methotrexate, marked benefit was reported with steroid-sparing effect, particularly on methotrexate dose escalation. LIMITATIONS Due to a paucity of published literature on methotrexate in urticaria, a meta-analysis could not be done. CONCLUSION In chronic recalcitrant or steroid-dependent cases, methotrexate may be a therapeutic agent of interest; however, current evidence does not point to any added advantage in efficacy over antihistamines. More evidence based on larger, well-executed randomized control trials is needed in the future to get more definitive answers.
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Affiliation(s)
- Jaspriya Sandhu
- Department of Dermatology, Venereology and Leprology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Arushi Kumar
- Department of Dermatology, Venereology and Leprology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Sunil K Gupta
- Department of Dermatology, Venereology and Leprology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
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12
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Damask C, Franzese C. Mechanisms and Practical Use of Biologic Therapies for Allergy and Asthma Indications. Otolaryngol Clin North Am 2021; 54:717-728. [PMID: 34119334 DOI: 10.1016/j.otc.2021.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This article presents a concise overview of the important aspects of the immunologic mechanisms targeted by T-helper 2-directed monoclonal antibodies, as well as their practical applications in the treatment of allergic disorders (specifically allergic rhinitis) and asthma. Several of these novel agents treat multiple diseases, so understanding their targets and the underlying disease process can aid patient selection. In addition, the particular targets of the therapeutics seem to be shifting to include not only agents that intervene against inflammatory cytokines or their receptors but also specific molecular epitopes and cellular surface proteins.
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Affiliation(s)
- Cecelia Damask
- Lake Mary Ear, Nose, Throat, and Allergy, 795 Primera Boulevard, Suite 1031, Lake Mary, FL 32746, USA
| | - Christine Franzese
- Department of Otolaryngology-Head and Neck Surgery, University of Missouri-Columbia, One Hospital Drive, Suite MA314, Columbia, MO 65212, USA.
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13
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Li L, Wang Z, Cui L, Xu Y, Guan K, Zhao B. Anaphylactic risk related to omalizumab, benralizumab, reslizumab, mepolizumab, and dupilumab. Clin Transl Allergy 2021; 11:e12038. [PMID: 34123366 PMCID: PMC8175040 DOI: 10.1002/clt2.12038] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/13/2021] [Accepted: 05/22/2021] [Indexed: 01/28/2023] Open
Abstract
Background Monoclonal antibodies (mAbs) are novel, effective therapeutics for the treatment of inadequately controlled severe asthma. Knowledge of the anaphylaxis risks related to different mAbs is essential for their appropriate and safe administration. This study aimed to evaluate the associations between different mAbs and anaphylactic reactions by applying statistical approaches to pharmacovigilance data. Methods This was a retrospective study using data from the US Food and Drug Administration Adverse Event Reporting System database from January 2004 to September 2020. A total of 2006 reports of anaphylaxis related to benralizumab, dupilumab, mepolizumab, omalizumab, and reslizumab were obtained through data mining. The clinical characteristics of the cases were analyzed, and the risk signals of anaphylactic reactions and corresponding outcomes were investigated in the five mAbs. Results The patients were mainly young and middle‐aged adults, with markedly more women than men. Omalizumab, benralizumab, reslizumab, and mepolizumab showed positive signals for anaphylaxis, while only dupilumab showed a negative signal. The risk of initial or prolonged hospitalization due to anaphylaxis was significantly higher in the benralizumab group than in the omalizumab group (42.86% vs. 28.92%, p = 0.024). Further, when anaphylaxis to omalizumab occurred, patients with asthma were more likely to have life‐threatening outcomes than those with chronic urticaria (18.0% vs. 12.9%, p = 0.022). Conclusion In the current real‐world study, the positive anaphylaxis signals related to omalizumab, benralizumab, reslizumab, and mepolizumab suggested the need for the close monitoring of patients after drug use, and dupilumab showed a negative signal for anaphylaxis.
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Affiliation(s)
- Lisha Li
- Department of Allergy Peking Union Medical College Hospital Chinese Academy of Medical Sciences & Peking Union Medical College Beijing Key Laboratory of Precision Medicine for Diagnosis and Treatment on Allergic Diseases National Clinical Research Center for Dermatologic and Immunologic Diseases Beijing China
| | - Zixi Wang
- Department of Allergy Peking Union Medical College Hospital Chinese Academy of Medical Sciences & Peking Union Medical College Beijing Key Laboratory of Precision Medicine for Diagnosis and Treatment on Allergic Diseases National Clinical Research Center for Dermatologic and Immunologic Diseases Beijing China
| | - Le Cui
- Department of Allergy Peking Union Medical College Hospital Chinese Academy of Medical Sciences & Peking Union Medical College Beijing Key Laboratory of Precision Medicine for Diagnosis and Treatment on Allergic Diseases National Clinical Research Center for Dermatologic and Immunologic Diseases Beijing China
| | - Yingyang Xu
- Department of Allergy Peking Union Medical College Hospital Chinese Academy of Medical Sciences & Peking Union Medical College Beijing Key Laboratory of Precision Medicine for Diagnosis and Treatment on Allergic Diseases National Clinical Research Center for Dermatologic and Immunologic Diseases Beijing China
| | - Kai Guan
- Department of Allergy Peking Union Medical College Hospital Chinese Academy of Medical Sciences & Peking Union Medical College Beijing Key Laboratory of Precision Medicine for Diagnosis and Treatment on Allergic Diseases National Clinical Research Center for Dermatologic and Immunologic Diseases Beijing China
| | - Bin Zhao
- Department of Pharmacy Peking Union Medical College Hospital Chinese Academy of Medical Sciences & Peking Union Medical College Beijing China
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14
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Broyles AD, Banerji A, Barmettler S, Biggs CM, Blumenthal K, Brennan PJ, Breslow RG, Brockow K, Buchheit KM, Cahill KN, Cernadas J, Chiriac AM, Crestani E, Demoly P, Dewachter P, Dilley M, Farmer JR, Foer D, Fried AJ, Garon SL, Giannetti MP, Hepner DL, Hong DI, Hsu JT, Kothari PH, Kyin T, Lax T, Lee MJ, Lee-Sarwar K, Liu A, Logsdon S, Louisias M, MacGinnitie A, Maciag M, Minnicozzi S, Norton AE, Otani IM, Park M, Patil S, Phillips EJ, Picard M, Platt CD, Rachid R, Rodriguez T, Romano A, Stone CA, Torres MJ, Verdú M, Wang AL, Wickner P, Wolfson AR, Wong JT, Yee C, Zhou J, Castells M. Practical Guidance for the Evaluation and Management of Drug Hypersensitivity: Specific Drugs. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 8:S16-S116. [PMID: 33039007 DOI: 10.1016/j.jaip.2020.08.006] [Citation(s) in RCA: 89] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 08/10/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Ana Dioun Broyles
- Division of Allergy/Immunology, Boston Children's Hospital, Boston, Mass
| | - Aleena Banerji
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, Mass
| | - Sara Barmettler
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, Mass
| | - Catherine M Biggs
- Department of Pediatrics, British Columbia Children's Hospital, University of British Columbia, Vancouver, Canada
| | - Kimberly Blumenthal
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, Mass
| | - Patrick J Brennan
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass
| | - Rebecca G Breslow
- Division of Sports Medicine, Brigham and Women's Hospital, Boston, Mass
| | - Knut Brockow
- Department of Dermatology and Allergy Biederstein, School of Medicine, Technical University of Munich, Munich, Germany
| | - Kathleen M Buchheit
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass
| | - Katherine N Cahill
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn
| | - Josefina Cernadas
- Allergology and Immunology Service, Centro Hospitalar Universitário de S.João Hospital, Porto, Portugal
| | - Anca Mirela Chiriac
- Division of Allergy, Department of Pulmonology, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, Montpellier, France
| | - Elena Crestani
- Division of Allergy/Immunology, Boston Children's Hospital, Boston, Mass
| | - Pascal Demoly
- Division of Allergy, Department of Pulmonology, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, Montpellier, France
| | - Pascale Dewachter
- Department of Anesthesiology and Intensive Care Medicine, Groupe Hospitalier Paris-Seine-Saint-Denis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Meredith Dilley
- Division of Allergy/Immunology, Boston Children's Hospital, Boston, Mass
| | - Jocelyn R Farmer
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, Mass
| | - Dinah Foer
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass
| | - Ari J Fried
- Division of Allergy/Immunology, Boston Children's Hospital, Boston, Mass
| | - Sarah L Garon
- Associated Allergists and Asthma Specialists, Chicago, Ill
| | - Matthew P Giannetti
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass
| | - David L Hepner
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Mass
| | - David I Hong
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass
| | - Joyce T Hsu
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass
| | - Parul H Kothari
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass
| | - Timothy Kyin
- Division of Asthma, Allergy & Immunology, University of Virginia, Charlottesville, Va
| | - Timothy Lax
- Division of Allergy and Inflammation, Beth Israel Deaconess Medical Center, Boston, Mass
| | - Min Jung Lee
- Allergy and Immunology at Hoag Medical Group, Newport Beach, Calif
| | - Kathleen Lee-Sarwar
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Mass
| | - Anne Liu
- Division of Allergy / Immunology, Stanford University School of Medicine, Palo Alto, Calif
| | - Stephanie Logsdon
- Division of Allergy and Immunology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Margee Louisias
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass
| | - Andrew MacGinnitie
- Division of Allergy/Immunology, Boston Children's Hospital, Boston, Mass
| | - Michelle Maciag
- Division of Allergy/Immunology, Boston Children's Hospital, Boston, Mass
| | - Samantha Minnicozzi
- Division of Allergy and Clinical Immunology, Respiratory Medicine, Department of Pediatrics, University of Virginia, Charlottesville, Va
| | - Allison E Norton
- Division of Allergy, Immunology and Pulmonology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tenn
| | - Iris M Otani
- Division of Pulmonary, Critical Care, Allergy, and Sleep, Department of Medicine, University of California, San Francisco Medical Center, San Francisco, Calif
| | - Miguel Park
- Division of Allergic Diseases, Mayo Clinic, Rochester, Minn
| | - Sarita Patil
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, Mass
| | - Elizabeth J Phillips
- Department of Medicine & Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tenn
| | - Matthieu Picard
- Division of Allergy and Clinical Immunology, Department of Medicine, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Québec, Canada
| | - Craig D Platt
- Division of Immunology, Boston Children's Hospital, Boston, Mass
| | - Rima Rachid
- Division of Immunology, Boston Children's Hospital, Boston, Mass
| | - Tito Rodriguez
- Drug Allergy Department, Al-Rashed Allergy Center, Sulaibikhat, Al-Kuwait, Kuwait
| | - Antonino Romano
- IRCCS Oasi Maria S.S., Troina, Italy & Fondazione Mediterranea G.B. Morgagni, Catania, Italy
| | - Cosby A Stone
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tenn
| | - Maria Jose Torres
- Allergy Unit and Research Group, Hospital Regional Universitario de Málaga, UMA-IBIMA-BIONAND, ARADyAL, Málaga, Spain
| | - Miriam Verdú
- Allergy Unit, Hospital Universitario de Ceuta, Ceuta, Spain
| | - Alberta L Wang
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass
| | - Paige Wickner
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass
| | - Anna R Wolfson
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, Mass
| | - Johnson T Wong
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, Mass
| | - Christina Yee
- Division of Immunology, Boston Children's Hospital, Boston, Mass
| | - Joseph Zhou
- Division of Allergy/Immunology, Boston Children's Hospital, Boston, Mass
| | - Mariana Castells
- Drug hypersensitivity and Desensitization Center, Brigham and Women's Hospital, Boston, Mass
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15
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Rama TA, Martins D, Gomes N, Pinheiro J, Nogueira A, Delgado L, Plácido JL, Coimbra A. Case Report: Mastocytosis: The Long Road to Diagnosis. Front Immunol 2021; 12:635909. [PMID: 33643319 PMCID: PMC7907169 DOI: 10.3389/fimmu.2021.635909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 01/25/2021] [Indexed: 11/15/2022] Open
Abstract
Mastocytosis is a heterogeneous group of disorders characterized by expansion and accumulation of clonal mast cells. Patients mainly present with either cutaneous lesions, anaphylaxis, or both. Its low prevalence and unusual features often hinder its diagnosis for several years. We report the case of an 18-year-old male who was referred to our department with a long-standing history of atypical skin lesions, allergic rhinitis, exercise-induced bronchoconstriction and what was believed to be food-related flushing and anaphylaxis, that was later diagnosed with mastocytosis. This case illustrates the need to consider investigating for mastocytosis when recurrent anaphylaxis is present, especially in the presence of atypical skin lesions, even if normal serum basal tryptase levels and allergic sensitization are present.
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Affiliation(s)
- Tiago Azenha Rama
- Serviço de Imunoalergologia, Centro Hospitalar Universitário São João, Porto, Portugal.,Serviço de Imunologia Básica e Clínica, Departamento de Patologia, Faculdade de Medicina, Universidade Do Porto, Porto, Portugal
| | - Diana Martins
- Serviço de Anatomia Patológica, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Nuno Gomes
- Serviço de Dermatovenereologia, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Jorge Pinheiro
- Serviço de Anatomia Patológica, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Ana Nogueira
- Serviço de Dermatovenereologia, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Luís Delgado
- Serviço de Imunoalergologia, Centro Hospitalar Universitário São João, Porto, Portugal.,Serviço de Imunologia Básica e Clínica, Departamento de Patologia, Faculdade de Medicina, Universidade Do Porto, Porto, Portugal.,CINTESIS - Centro de Investigação em Tecnologias e Serviços de Saúde, Faculdade de Medicina, Universidade Do Porto, Porto, Portugal
| | - José Luís Plácido
- Serviço de Imunoalergologia, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Alice Coimbra
- Serviço de Imunoalergologia, Centro Hospitalar Universitário São João, Porto, Portugal
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16
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Balbino B, Herviou P, Godon O, Stackowicz J, Goff ORL, Iannascoli B, Sterlin D, Brûlé S, Millot GA, Harris FM, Voronina VA, Nadeau KC, Macdonald LE, Murphy AJ, Bruhns P, Reber LL. The anti-IgE mAb omalizumab induces adverse reactions by engaging Fcγ receptors. J Clin Invest 2020; 130:1330-1335. [PMID: 31770111 DOI: 10.1172/jci129697] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 11/13/2019] [Indexed: 01/07/2023] Open
Abstract
Omalizumab is an anti-IgE monoclonal antibody (mAb) approved for the treatment of severe asthma and chronic spontaneous urticaria. Use of omalizumab is associated with reported side effects ranging from local skin inflammation at the injection site to systemic anaphylaxis. To date, the mechanisms through which omalizumab induces adverse reactions are still unknown. Here, we demonstrated that immune complexes formed between omalizumab and IgE can induce both skin inflammation and anaphylaxis through engagement of IgG receptors (FcγRs) in FcγR-humanized mice. We further developed an Fc-engineered mutant version of omalizumab, and demonstrated that this mAb is equally potent as omalizumab at blocking IgE-mediated allergic reactions, but does not induce FcγR-dependent adverse reactions. Overall, our data indicate that omalizumab can induce skin inflammation and anaphylaxis by engaging FcγRs, and demonstrate that Fc-engineered versions of the mAb could be used to reduce such adverse reactions.
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Affiliation(s)
- Bianca Balbino
- Unit of Antibodies in Therapy and Pathology, Institut Pasteur, UMR1222 INSERM, Paris, France.,Sorbonne Université, Paris, France
| | - Pauline Herviou
- Unit of Antibodies in Therapy and Pathology, Institut Pasteur, UMR1222 INSERM, Paris, France
| | - Ophélie Godon
- Unit of Antibodies in Therapy and Pathology, Institut Pasteur, UMR1222 INSERM, Paris, France
| | - Julien Stackowicz
- Unit of Antibodies in Therapy and Pathology, Institut Pasteur, UMR1222 INSERM, Paris, France.,Sorbonne Université, Paris, France
| | - Odile Richard-Le Goff
- Unit of Antibodies in Therapy and Pathology, Institut Pasteur, UMR1222 INSERM, Paris, France
| | - Bruno Iannascoli
- Unit of Antibodies in Therapy and Pathology, Institut Pasteur, UMR1222 INSERM, Paris, France
| | - Delphine Sterlin
- Unit of Antibodies in Therapy and Pathology, Institut Pasteur, UMR1222 INSERM, Paris, France.,Assistance Publique-Hôpitaux de Paris, La Pitié-Salpêtrière, Département d'Immunologie, Paris, France
| | - Sébastien Brûlé
- Plateforme de Biophysique Moléculaire, Institut Pasteur, UMR 3528 CNRS, Paris, France
| | - Gael A Millot
- Hub de Bioinformatique et Biostatistique, Département Biologie Computationnelle, Institut Pasteur, USR 3756 CNRS, Paris, France
| | - Faith M Harris
- Regeneron Pharmaceuticals Inc., Tarrytown, New York, USA
| | | | - Kari C Nadeau
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Stanford, California, USA.,Division of Pulmonary and Critical Care, Department of Medicine, Stanford University, California, USA
| | | | | | - Pierre Bruhns
- Unit of Antibodies in Therapy and Pathology, Institut Pasteur, UMR1222 INSERM, Paris, France
| | - Laurent L Reber
- Unit of Antibodies in Therapy and Pathology, Institut Pasteur, UMR1222 INSERM, Paris, France.,Center for Physiopathology of Toulouse-Purpan (CPTP), UMR 1043, University of Toulouse, INSERM CNRS, Toulouse France
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17
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Falduto GH, Pfeiffer A, Luker A, Metcalfe DD, Olivera A. Emerging mechanisms contributing to mast cell-mediated pathophysiology with therapeutic implications. Pharmacol Ther 2020; 220:107718. [PMID: 33130192 DOI: 10.1016/j.pharmthera.2020.107718] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 10/26/2020] [Indexed: 02/07/2023]
Abstract
Mast cells are tissue-resident immune cells that play key roles in the initiation and perpetuation of allergic inflammation, usually through IgE-mediated mechanisms. Mast cells are, however, evolutionary ancient immune cells that can be traced back to urochordates and before the emergence of IgE antibodies, suggesting their involvement in antibody-independent biological functions, many of which are still being characterized. Herein, we summarize recent advances in understanding the roles of mast cells in health and disease, partly through the study of emerging non-IgE receptors such as the Mas-related G protein-coupled receptor X2, implicated in pseudo-allergic reactions as well as in innate defense and neuronal sensing; the mechano-sensing adhesion G protein-coupled receptor E2, variants of which are associated with familial vibratory urticaria; and purinergic receptors, which orchestrate tissue damage responses similarly to the IL-33 receptor. Recent evidence also points toward novel mechanisms that contribute to mast cell-mediated pathophysiology. Thus, in addition to releasing preformed mediators contained in granules and synthesizing mediators de novo, mast cells also secrete extracellular vesicles, which convey biological functions. Understanding their release, composition and uptake within a variety of clinical conditions will contribute to the understanding of disease specific pathology and likely lead the way to novel therapeutic approaches. We also discuss recent advances in the development of therapies targeting mast cell activity, including the ligation of inhibitory ITIM-containing receptors, and other strategies that suppress mast cells or responses to mediators for the management of mast cell-related diseases.
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Affiliation(s)
- Guido H Falduto
- Mast Cell Biology Section, Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Annika Pfeiffer
- Mast Cell Biology Section, Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Andrea Luker
- Mast Cell Biology Section, Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Dean D Metcalfe
- Mast Cell Biology Section, Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Ana Olivera
- Mast Cell Biology Section, Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA.
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18
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Vom Hove M, Neininger MP, Bertsche T, Prenzel F. Biologicals in the Treatment of Pediatric Atopic Diseases. Handb Exp Pharmacol 2020; 261:131-151. [PMID: 32076895 DOI: 10.1007/164_2019_307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The management of atopic diseases such as severe asthma, severe atopic dermatitis, and severe food allergy in childhood is challenging. In particular, there are safety concerns regarding the use of high-dose corticosteroids. The recent development of biologicals and their approval for the treatment of children offer a new, very promising, and more personalized therapy option. Omalizumab, mepolizumab, and dupilumab are currently approved as add-on treatments of severe asthma in children and have been shown to be effective in improvement of asthma control and reduction of exacerbations. Dupilumab is the only biological approved for the treatment of atopic dermatitis in adolescents so far. It has been demonstrated to significantly improve symptoms of atopic dermatitis.However, safety data for biologicals used in atopic diseases in children and adolescents are still very limited. Biologicals are generally considered to be safe in adults. These data are often extrapolated to children. Additionally, data for long-term use are lacking. Thus, the safety profiles of those biologicals cannot yet be conclusively assessed.
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Affiliation(s)
- Maike Vom Hove
- Hospital for Children and Adolescents, Leipzig University Medical Center, Leipzig, Germany
| | - Martina P Neininger
- Drug Safety Center, Institute of Pharmacy, Leipzig University, Leipzig, Germany
| | - Thilo Bertsche
- Drug Safety Center, Institute of Pharmacy, Leipzig University, Leipzig, Germany
| | - Freerk Prenzel
- Hospital for Children and Adolescents, Leipzig University Medical Center, Leipzig, Germany.
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19
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Guntern P, Eggel A. Past, present, and future of anti-IgE biologics. Allergy 2020; 75:2491-2502. [PMID: 32249957 DOI: 10.1111/all.14308] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/09/2020] [Accepted: 03/28/2020] [Indexed: 12/31/2022]
Abstract
About 20 years after the identification of immunoglobulin E (IgE) and its key role in allergic hypersensitivity reactions against normally harmless substances, scientists have started inventing strategies to block its pathophysiological activity in 1986. The initial concept of specific IgE targeting through the use of anti-IgE antibodies has gained a lot of momentum and within a few years independent research groups have reported successful generation of first murine monoclonal anti-IgE antibodies. Subsequent generation of optimized chimeric and humanized versions of these antibodies has paved the way for the development of therapeutic anti-IgE biologicals as we know them today. With omalizumab, there is currently still only one therapeutic anti-IgE antibody approved for the treatment of allergic conditions. Since its application is limited to the treatment of moderate-to-severe persistent asthma and chronic spontaneous urticaria, major efforts have been undertaken to develop alternative anti-IgE biologicals that could potentially be used in a broader spectrum of allergic diseases. Several new drug candidates have been generated and are currently assessed in pre-clinical studies or clinical trials. In this review, we highlight the molecular properties of past and present anti-IgE biologicals and suggest concepts that might improve treatment efficacy of future drug candidates.
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Affiliation(s)
- Pascal Guntern
- Graduate School of Cellular and Biomedical Sciences University of Bern Bern Switzerland
- Department of BioMedical Research University of Bern Bern Switzerland
- Department of Rheumatology, Immunology and Allergology University Hospital Bern Bern Switzerland
| | - Alexander Eggel
- Department of BioMedical Research University of Bern Bern Switzerland
- Department of Rheumatology, Immunology and Allergology University Hospital Bern Bern Switzerland
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20
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Cox L. Biologics and Allergy Immunotherapy in the Treatment of Allergic Diseases. Immunol Allergy Clin North Am 2020; 40:687-700. [PMID: 33012328 DOI: 10.1016/j.iac.2020.06.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Allergic diseases represent some of the most chronic and costly chronic conditions. Medical management may require long-term pharmacotherapy, which is often associated with poor adherence. Although medications provide symptomatic control, they do not modify the allergic disease. Patients may prefer disease-modifying treatments that provide lasting benefits after discontinuation. To date, allergy immunotherapy is the only proved disease modification therapy associated with lasting benefits after discontinuation. However, allergy immunotherapy safety and efficacy has only been established in allergic rhinitis, mild to moderate asthma, and some patients with atopic dermatitis.
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Affiliation(s)
- Linda Cox
- 1108 South Wolcott Street, Casper, WY 82601, USA.
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21
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Jingo K, Harada N, Nishioki T, Torasawa M, Yamada T, Asao T, Takagi H, Takeshige T, Ito J, Takahashi K. Anaphylaxis to three humanized antibodies for severe asthma: a case study. Allergy Asthma Clin Immunol 2020; 16:46. [PMID: 32536947 PMCID: PMC7288423 DOI: 10.1186/s13223-020-00446-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 06/02/2020] [Indexed: 12/25/2022] Open
Abstract
Background Omalizumab, mepolizumab, benralizumab, and dupilumab are the currently available biologics used to treat asthma in Japan. Anaphylaxis following treatment with mepolizumab or benralizumab is considered rare. Case presentation We report the case of a 35-year-old woman with severe asthma, who experienced anaphylaxis following the administration of benralizumab, mepolizumab, and omalizumab, separately. The therapy with biologics was chosen to avoid the repeated use of systemic corticosteroids for asthma exacerbations. The mechanisms underlying anaphylaxis caused by these three biologics remain unclear. The patient’s asthma symptoms and lung function improved after treatment with bronchial thermoplasty. Conclusions To our knowledge, this is the first report of an asthmatic patient developing anaphylaxis after commencement of benralizumab, mepolizumab, and omalizumab therapy. These three biologics should be administered carefully, and patients should be monitored for anaphylaxis.
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Affiliation(s)
- Koichi Jingo
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, 3-1-3 Hongo, Bunkyo-ku, Tokyo, 113-8431 Japan
| | - Norihiro Harada
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, 3-1-3 Hongo, Bunkyo-ku, Tokyo, 113-8431 Japan.,Research Institute for Diseases of Old Ages, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan
| | - Toshihiko Nishioki
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, 3-1-3 Hongo, Bunkyo-ku, Tokyo, 113-8431 Japan
| | - Masahiro Torasawa
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, 3-1-3 Hongo, Bunkyo-ku, Tokyo, 113-8431 Japan
| | - Tomoko Yamada
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, 3-1-3 Hongo, Bunkyo-ku, Tokyo, 113-8431 Japan
| | - Tetsuhiko Asao
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, 3-1-3 Hongo, Bunkyo-ku, Tokyo, 113-8431 Japan
| | - Haruhi Takagi
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, 3-1-3 Hongo, Bunkyo-ku, Tokyo, 113-8431 Japan
| | - Tomohito Takeshige
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, 3-1-3 Hongo, Bunkyo-ku, Tokyo, 113-8431 Japan
| | - Jun Ito
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, 3-1-3 Hongo, Bunkyo-ku, Tokyo, 113-8431 Japan.,Clinical Research Center for Allergy and Rheumatology, National Hospital Organization, Sagamihara National Hospital, Kanagawa, Japan
| | - Kazuhisa Takahashi
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, 3-1-3 Hongo, Bunkyo-ku, Tokyo, 113-8431 Japan
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22
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Mori F, Saretta F, Bianchi A, Crisafulli G, Caimmi S, Liotti L, Bottau P, Franceschini F, Paglialunga C, Ricci G, Santoro A, Caffarelli C. Hypersensitivity Reactions to Monoclonal Antibodies in Children. MEDICINA (KAUNAS, LITHUANIA) 2020; 56:E232. [PMID: 32408641 PMCID: PMC7279169 DOI: 10.3390/medicina56050232] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 04/28/2020] [Accepted: 05/01/2020] [Indexed: 12/12/2022]
Abstract
Biologic drugs are widely used in pediatric medicine. Monoclonal antibodies (mAbs) in particular are a therapeutic option for rheumatic, autoinflammatory and oncologic diseases. Adverse drug reactions and hypersensitivity reactions (HSR) to mAbs may occur in children. Clinical presentation of HSRs to mAbs can be classified according to phenotypes in infusion-related reactions, cytokine release syndrome, both alpha type reactions and type I (IgE/non-IgE), type III, and type IV reactions, all beta-type reactions. The aim of this review is to focus on HSRs associated with the most frequent mAbs in childhood, with particular attention to beta-type reactions. When a reaction to mAbs is suspected a diagnostic work-up including in-vivo and in-vitro testing should be performed. A drug provocation test is recommended only when no alternative drugs are available. In selected patients with immediate IgE-mediated drug allergy a desensitization protocol is indicated. Despite the heavy use of mAbs in childhood, studies evaluating the reliability of diagnostic test are lacking. Although desensitization may be effective in reducing the risk of reactions in children, standardized pediatric protocols are still not available.
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Affiliation(s)
- Francesca Mori
- Allergy Unit, Meyer Children’s Hospital, 50139 Florence, Italy;
| | - Francesca Saretta
- SC Pediatria, Ospedale Latisana-Palmanova, Dipartimento Materno-Infantile Azienda Sanitaria Universitaria Friuli Centrale, 33057 Palmanova (UD), Italy;
| | | | - Giuseppe Crisafulli
- UO Allergologia, Dipartimento di Pediatria, Università di Messina, 98124 Messina, Italy;
| | - Silvia Caimmi
- Clinica Pediatrica Policlinico San Matteo, University di Pavia, 27100 Pavia, Italy;
| | - Lucia Liotti
- Pediatria, Ospedale Principi di Piemonte, 60019 Senigallia, Italy;
| | - Paolo Bottau
- Pediatria e Neonatologia, Ospedale di Imola, 40026 Imola, Italy;
| | - Fabrizio Franceschini
- UOC Pediatria, Azienda Ospedaliero-Universitaria “Ospedali Riuniti”, 60020 Ancona, Italy;
| | - Claudia Paglialunga
- UOC di Pediatria, Azienda Ospedaliera-Universitaria “Consorziale-Policlinico”, Ospedale Pediatrico Giovanni XXIII, 70123 Bari, Italy;
| | - Giampaolo Ricci
- Pediatric Unit, Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy;
| | - Angelica Santoro
- Clinica Pediatrica, Dipartimento Medicina e Chirurgia, Università di Parma, 43126 Parma, Italy;
| | - Carlo Caffarelli
- Clinica Pediatrica, Dipartimento Medicina e Chirurgia, Università di Parma, 43126 Parma, Italy;
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Dies L, Sernicola A, Magri F, Chello C, Paolino G, Carnicelli G, Faina V, Nencini F, Grieco T. A severe adverse reaction to omalizumab therapy in chronic spontaneous urticaria. Dermatol Ther 2019; 33:e13204. [DOI: 10.1111/dth.13204] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 12/18/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Laura Dies
- Department of DermatologyUniversity of Rome “Sapienza” Rome Italy
| | - Alvise Sernicola
- Department of DermatologyUniversity of Rome “Sapienza” Rome Italy
| | - Francesca Magri
- Department of DermatologyUniversity of Rome “Sapienza” Rome Italy
| | - Camilla Chello
- Department of DermatologyUniversity of Rome “Sapienza” Rome Italy
| | - Giovanni Paolino
- Department of DermatologyUniversity of Rome “Sapienza” Rome Italy
| | | | - Valentina Faina
- Department of DermatologyUniversity of Rome “Sapienza” Rome Italy
| | - Francesca Nencini
- Immunoallergology Unit, Department of BiomedicineAzienda Ospedaliero‐Universitaria Careggi Florence Italy
| | - Teresa Grieco
- Department of DermatologyUniversity of Rome “Sapienza” Rome Italy
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24
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Aberumand B, Ellis AK. Asthma and the Biologics Revolution, Part 1: Here and Now. CURRENT TREATMENT OPTIONS IN ALLERGY 2019. [DOI: 10.1007/s40521-019-00232-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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25
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Sousa J, Taborda-Barata L, Monteiro C. Biological therapy-associated adverse reactions in asthma: analysis of reporting to the Portuguese pharmacovigilance system. Expert Opin Drug Saf 2019; 19:99-106. [PMID: 31661986 DOI: 10.1080/14740338.2020.1686481] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Objectives: Biological drugs have been successfully tested in asthma, especially in the most severe forms of the disease. The goal of this study was to characterize the safety profile of biologicals used in asthma.Methods: Retrospective and descriptive analysis of spontaneous reports (SRs) involving omalizumab and mepolizumab, sent to the Portuguese Pharmacovigilance System, since market launch until October 2018.Results: A total of 127 SRs for omalizumab and 10 SRs mepolizumab were found. Most patients were female (75.6% omalizumab and 90.0% mepolizumab), and aged 18-64 years (61.4% and 50.0%, respectively). 71.7% of the reports for omalizumab were serious, with 2 cases of anaphylaxis, 12 malignant neoplasms and 2 abortions. Only 20.0% of the reports for mepolizumab were considered serious. A total of 391 adverse drug reactions (ADRs) for omalizumab and 20 ADRs for mepolizumab were found. Most reported ADRs belonged to System organ class (SOC) groups: 'respiratory, thoracic and mediastinal disorders' and 'investigations', for omalizumab; 'musculoskeletal and connective tissue disorders' and 'general disorders and administration site conditions' for mepolizumab.Conclusion: Over the years, there was an increasing trend of SRs with these biological drugs. However, it is necessary to continue to develop educational programs in order to get a better reporting system.
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Affiliation(s)
- José Sousa
- Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal
| | - Luís Taborda-Barata
- Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal.,UFBI - Pharmacovigilance Unit of Beira Interior, University of Beira Interior, Covilhã, Portugal.,Department of Immunoallergology, Cova da Beira University Hospital Centre, Covilhã, Portugal
| | - Cristina Monteiro
- UFBI - Pharmacovigilance Unit of Beira Interior, University of Beira Interior, Covilhã, Portugal
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26
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Shaker M, Briggs A, Dbouk A, Dutille E, Oppenheimer J, Greenhawt M. Estimation of Health and Economic Benefits of Clinic Versus Home Administration of Omalizumab and Mepolizumab. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 8:565-572. [PMID: 31626991 DOI: 10.1016/j.jaip.2019.09.037] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 09/16/2019] [Accepted: 09/25/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Biologic therapy is a paradigm-shifting management strategy for many patients with asthma and chronic urticaria, but concerns for therapy-associated anaphylaxis may limit access to these therapies for patients unable to travel to medical clinics. OBJECTIVE To characterize the cost-effectiveness of in-clinic versus at-home biologic therapy with omalizumab and mepolizumab. METHODS Economic evaluation using microsimulations was performed from societal and health care sector perspectives for patients with asthma or chronic spontaneous urticaria receiving omalizumab or mepolizumab in an allergy clinic, primary care provider (PCP) office, or at home over a 1-year time horizon (12 injections per year in each base case with sensitivity analysis to 24 injections per year). Travel times and distances were applied to a population attending a tertiary care allergy clinic in Northern New England receiving omalizumab or mepolizumab, using a willingness-to-pay value of $10 million per death prevented and in-clinic administration reducing anaphylaxis fatality and hospitalization 10- to100-fold. Deterministic and probabilistic sensitivity analyses were performed. RESULTS One-way allergy clinic travel distances significantly exceeded local PCP offices (49 miles, 95% CI, 42-56, vs 12 miles, 95% CI, 10-15). In the omalizumab societal analysis, annual PCP and allergy clinic administration cost $1369.14 (mean) ± $51.33 (SD) and $1916.68 ± $40.86, respectively. Small reductions in medication-related fatalities with in-clinic administration were offset by the potential increase in automobile fatalities resulting from traveling to the allergy clinic (14.6 ± 15.0 per million person-years for this strategy). Compared with at-home administration, in-clinic omalizumab administration was not cost-effective, with an incremental cost-effectiveness ratio of $500,648,430 (PCP), and with allergy clinic administration dominated by higher costs and automobile-related fatalities. Routine mepolizumab clinic administration was dominated by at-home administration unless anaphylaxis rates or self-administration teaching costs were high. CONCLUSIONS For many patients, at-home administration of omalizumab or mepolizumab may be a cost-effective strategy.
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Affiliation(s)
- Marcus Shaker
- Dartmouth-Hitchcock Medical Center, Section of Allergy and Immunology, Lebanon, NH; Dartmouth Geisel School of Medicine, Hanover, NH.
| | - Aaron Briggs
- Dartmouth Geisel School of Medicine, Hanover, NH
| | - Ahmad Dbouk
- Dartmouth Geisel School of Medicine, Hanover, NH
| | - Emily Dutille
- Dartmouth-Hitchcock Medical Center, Section of Allergy and Immunology, Lebanon, NH; Dartmouth Geisel School of Medicine, Hanover, NH
| | | | - Matthew Greenhawt
- Children's Hospital Colorado, University of Colorado School of Medicine, Section of Allergy and Immunology, Food Challenge and Research Unit, Aurora, Colo
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27
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Shinee T, Sutikno B, Abdullah B. The use of biologics in children with allergic rhinitis and chronic rhinosinusitis: Current updates. Pediatr Investig 2019; 3:165-172. [PMID: 32851312 PMCID: PMC7331348 DOI: 10.1002/ped4.12146] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 07/23/2019] [Indexed: 01/25/2023] Open
Abstract
The therapeutic goals of the treatment of allergic rhinitis (AR) and chronic rhinosinusitis (CRS) are symptom relief, avoiding complications, and improving quality of life. In the treatment of AR and CRS, several limitations of currently prescribed medicines have been identified. Antihistamine administration (both oral and topical) together with intranasal corticosteroids bring relief to the majority of patients, but their dependency on the medications and a necessity to maintain strict compliance with regular medication regimes pose a challenge. Immunotherapeutic agents are an option in some patients, but polysensitized patients, the risk of anaphylaxis, and the need for daily administration for years are limiting it from becoming the main therapy modality. Immunotherapy in any form requires commitment by the patient, which renders adherence and compliance issues particularly relevant. The procedure involved are generally time-consuming and entail an associated risk of severe adverse reactions. The use of biologics could overcome the limitations of other therapeutic modalities. They could be used as a monotherapy or combined with pre-existing medications. The benefits of targeted therapy include less adverse effects and optimal efficacy. The aim of the present review was to investigate the collective literature to date pertaining to the role of biologics in managing children with AR and CRS.
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Affiliation(s)
- Tan Shinee
- Department of Otorhinolaryngology Head & Neck SurgeryHospital TawauSabahMalaysia
| | - Budi Sutikno
- Department of Otorhinolaryngology Head and Neck SurgeryAirlangga UniversitySchool of Medicine/Dr Soetomo General HospitalSurabayaIndonesia
| | - Baharudin Abdullah
- Department of Otorhinolaryngology Head & Neck SurgerySchool of Medical Sciences, Universiti Sains Malaysia Health Campus16150Kubang KerianKelantanMalaysia
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29
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Abrams EM, Becker AB, Szefler SJ. Current State and Future of Biologic Therapies in the Treatment of Asthma in Children. PEDIATRIC ALLERGY IMMUNOLOGY AND PULMONOLOGY 2018; 31:119-131. [PMID: 30283711 DOI: 10.1089/ped.2018.0901] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 07/26/2018] [Indexed: 02/06/2023]
Abstract
There is increasing recognition of phenotypic variability in pediatric asthma, providing the opportunity for a more personalized approach to therapy. Increasingly biologic therapies, in particular those targeting the "allergic" (or T helper 2) pathway, are being considered for children with severe asthma. However, there is a great deal of variability in the extent these biologic therapies have been studied in children, as well as efficacy of results thus far. The goal of this article is to review the mechanism of action, efficacy, and potential predictive and monitoring biomarkers of the biologic medications focusing on the pediatric population, in an effort to establish a more personalized approach to asthma in the pediatric population for the 21st century.
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Affiliation(s)
- Elissa M Abrams
- Section of Allergy and Clinical Immunology, Department of Pediatrics, University of Manitoba, Winnipeg, Canada
| | - Allan B Becker
- Section of Allergy and Clinical Immunology, Department of Pediatrics, University of Manitoba, Winnipeg, Canada
| | - Stanley J Szefler
- Department of Pediatrics, Section of Pulmonary Medicine, Breathing Institute, University of Colorado School of Medicine, Aurora, Colorado
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30
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Role of biologics targeting type 2 airway inflammation in asthma: what have we learned so far? Curr Opin Pulm Med 2018; 23:3-11. [PMID: 27820746 DOI: 10.1097/mcp.0000000000000343] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Severe asthma is a heterogeneous syndrome that can be classified into distinct phenotypes and endotypes. In the type 2 (T2)-high endotype, multiple cytokines are produced that lead to eosinophilic inflammation. These cytokines and their receptors are targets for biologic therapies in patients with severe asthma who do not respond well to standard therapy with inhaled corticosteroids. RECENT FINDINGS In the last decade, an increasing number of biologic therapies have been developed targeting T2 inflammation. Clinical trials of therapies targeting immunoglobulin E as well as the T2 cytokines interleukin (IL)-4, IL-5, and IL-13 have demonstrated that these treatments improve asthma-related clinical outcomes and/or have steroid-sparing properties. The use of biomarkers of T2 inflammation can help to identify the subset of patients in whom these therapies may be most efficacious. Multiple biologic agents that are directed at other targets are currently in development, including thymic stromal lymphopoietin (TSLP), prostaglandin (PG)D2 receptor, IL-25, and IL-33. SUMMARY Biologics are emerging as a key component of severe asthma management. In patients with T2-high severe asthma, the addition of treatments targeting immunoglobulin E and IL-5 to standard therapy may lead to improvement in clinical outcomes. Other biologic therapies have shown promising preliminary results and need to be studied in further clinical trials. These biologic therapies in conjunction with biomarkers will lead to tailored therapy for asthma.
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31
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Wise SK, Lin SY, Toskala E, Orlandi RR, Akdis CA, Alt JA, Azar A, Baroody FM, Bachert C, Canonica GW, Chacko T, Cingi C, Ciprandi G, Corey J, Cox LS, Creticos PS, Custovic A, Damask C, DeConde A, DelGaudio JM, Ebert CS, Eloy JA, Flanagan CE, Fokkens WJ, Franzese C, Gosepath J, Halderman A, Hamilton RG, Hoffman HJ, Hohlfeld JM, Houser SM, Hwang PH, Incorvaia C, Jarvis D, Khalid AN, Kilpeläinen M, Kingdom TT, Krouse H, Larenas-Linnemann D, Laury AM, Lee SE, Levy JM, Luong AU, Marple BF, McCoul ED, McMains KC, Melén E, Mims JW, Moscato G, Mullol J, Nelson HS, Patadia M, Pawankar R, Pfaar O, Platt MP, Reisacher W, Rondón C, Rudmik L, Ryan M, Sastre J, Schlosser RJ, Settipane RA, Sharma HP, Sheikh A, Smith TL, Tantilipikorn P, Tversky JR, Veling MC, Wang DY, Westman M, Wickman M, Zacharek M. International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis. Int Forum Allergy Rhinol 2018; 8:108-352. [PMID: 29438602 PMCID: PMC7286723 DOI: 10.1002/alr.22073] [Citation(s) in RCA: 217] [Impact Index Per Article: 36.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 12/01/2017] [Accepted: 12/01/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Critical examination of the quality and validity of available allergic rhinitis (AR) literature is necessary to improve understanding and to appropriately translate this knowledge to clinical care of the AR patient. To evaluate the existing AR literature, international multidisciplinary experts with an interest in AR have produced the International Consensus statement on Allergy and Rhinology: Allergic Rhinitis (ICAR:AR). METHODS Using previously described methodology, specific topics were developed relating to AR. Each topic was assigned a literature review, evidence-based review (EBR), or evidence-based review with recommendations (EBRR) format as dictated by available evidence and purpose within the ICAR:AR document. Following iterative reviews of each topic, the ICAR:AR document was synthesized and reviewed by all authors for consensus. RESULTS The ICAR:AR document addresses over 100 individual topics related to AR, including diagnosis, pathophysiology, epidemiology, disease burden, risk factors for the development of AR, allergy testing modalities, treatment, and other conditions/comorbidities associated with AR. CONCLUSION This critical review of the AR literature has identified several strengths; providers can be confident that treatment decisions are supported by rigorous studies. However, there are also substantial gaps in the AR literature. These knowledge gaps should be viewed as opportunities for improvement, as often the things that we teach and the medicine that we practice are not based on the best quality evidence. This document aims to highlight the strengths and weaknesses of the AR literature to identify areas for future AR research and improved understanding.
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Affiliation(s)
| | | | | | | | - Cezmi A. Akdis
- Allergy/Asthma, Swiss Institute of Allergy and Asthma Research, Switzerland
| | | | - Antoine Azar
- Allergy/Immunology, Johns Hopkins University, USA
| | | | | | | | | | - Cemal Cingi
- Otolaryngology, Eskisehir Osmangazi University, Turkey
| | | | | | | | | | | | | | - Adam DeConde
- Otolaryngology, University of California San Diego, USA
| | | | | | | | | | | | | | - Jan Gosepath
- Otorhinolaryngology, Helios Kliniken Wiesbaden, Germany
| | | | | | | | - Jens M. Hohlfeld
- Respiratory Medicine, Hannover Medical School, Airway Research Fraunhofer Institute for Toxicology and Experimental Medicine, German Center for Lung Research, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | | - Amber U. Luong
- Otolaryngology, McGovern Medical School at the University of Texas Health Science Center Houston, USA
| | | | | | | | - Erik Melén
- Pediatric Allergy, Karolinska Institutet, Sweden
| | | | | | - Joaquim Mullol
- Otolaryngology, Universitat de Barcelona, Hospital Clinic, IDIBAPS, Spain
| | | | | | | | - Oliver Pfaar
- Rhinology/Allergy, Medical Faculty Mannheim, Heidelberg University, Center for Rhinology and Allergology, Wiesbaden, Germany
| | | | | | - Carmen Rondón
- Allergy, Regional University Hospital of Málaga, Spain
| | - Luke Rudmik
- Otolaryngology, University of Calgary, Canada
| | - Matthew Ryan
- Otolaryngology, University of Texas Southwestern, USA
| | - Joaquin Sastre
- Allergology, Hospital Universitario Fundacion Jiminez Diaz, Spain
| | | | | | - Hemant P. Sharma
- Allergy/Immunology, Children's National Health System, George Washington University School of Medicine, USA
| | | | | | | | | | | | - De Yun Wang
- Otolaryngology, National University of Singapore, Singapore
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Abstract
Asthma is the most common chronic disease in children. As suggested by international guidelines, the main goals of asthma treatment are symptoms control and lung function preservation, through a stepwise and control-based approach. The first line therapy based on inhaled corticosteroids may fail to reach control in more than one third of patients, especially adolescents, and in these lung function and quality of life may progressively worsen. Treatment with omalizumab, the first anti-immunoglobulin E recombinant humanized monoclonal antibody, has been definitely approved in pediatric uncontrolled asthma. In this review, we discuss the mechanisms and potential roles of emerging therapies for pediatric severe asthma. Novel biologic drugs (i.e., dupilumab, mepolizumab, reslizumab, and benralizumab) seem to be promising in reducing annual exacerbation rates and steroid-use in glucocorticoid-dependent cases, but available data are few and limited to adolescents and adults. Evidences on the use of the muscarinic antagonist tiotropium as controller medication in pediatric settings are progressively growing, sustaining an application as asthma maintenance treatment in children aged >6 years and in preschool children with persistent asthmatic symptoms, but well powered trials are needed to confirm its safety and efficacy. New inhaled corticosteroids (i.e., ciclesonide and mometasone) are effective as once-daily controller therapy, but long-term studies in the different pediatric ages are needed to compare effectiveness and safety to usual treatments. At present, the role of macrolides in pediatric severe asthma is controversial and their administration is not recommended routinely, but may be considered in children with neutrophilic asthma for reducing daily oral steroids administration and improving lung function. Despite the availability of several novel therapeutic strategies for uncontrolled asthma, future trials targeted at specific pediatric age subgroups are needed to support evidences of safety and efficacy also in children.
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Affiliation(s)
- Marco Maglione
- Department of Translational Medical Sciences, Federico II University, Naples, Italy.,Department of Pediatrics, Federico II University, Naples, Italy
| | - Marco Poeta
- Department of Translational Medical Sciences, Federico II University, Naples, Italy.,Department of Pediatrics, Federico II University, Naples, Italy
| | - Francesca Santamaria
- Department of Translational Medical Sciences, Federico II University, Naples, Italy.,Department of Pediatrics, Federico II University, Naples, Italy
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Draikiwicz S, Oppenheimer J. What is the current role of biologics in the management of patients with severe refractory asthma? Ann Allergy Asthma Immunol 2017; 116:383-7. [PMID: 27153737 DOI: 10.1016/j.anai.2016.03.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 03/16/2016] [Accepted: 03/17/2016] [Indexed: 02/04/2023]
Affiliation(s)
- Steven Draikiwicz
- Rutgers University, New Jersey Medical School, Livingston, New Jersey.
| | - John Oppenheimer
- Rutgers University, New Jersey Medical School, Livingston, New Jersey
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34
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Lieberman PL, Jones I, Rajwanshi R, Rosén K, Umetsu DT. Anaphylaxis associated with omalizumab administration: Risk factors and patient characteristics. J Allergy Clin Immunol 2017; 140:1734-1736.e4. [DOI: 10.1016/j.jaci.2017.07.013] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 06/16/2017] [Accepted: 07/10/2017] [Indexed: 11/17/2022]
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36
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Barnig C, Baron-Thurotte A, Barbaud A, Beaudouin E, de Blay F, Bonniaud P, Demoly P, Deschildre A, Didier A, Drouet M, Just J, Lavaud F, Mailhol C, Metz-Favre C, Neukirch C, Petit N, Perotin JM, Ponvert C, Sauvage C, Magnan A, Birnbaum J. Recommandations de la Société Française d’Allergologie. Indications des actes allergologiques en Hôpital de Jour. REVUE FRANCAISE D ALLERGOLOGIE 2017. [DOI: 10.1016/j.reval.2017.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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37
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Mitchell PD, El-Gammal AI, O'Byrne PM. Anti-IgE and Biologic Approaches for the Treatment of Asthma. Handb Exp Pharmacol 2017; 237:131-152. [PMID: 27864676 DOI: 10.1007/164_2016_65] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Current asthma treatments are effective for the majority of patients with mild-to-moderate disease. However, in those with more severe refractory asthma, agents other than inhaled corticosteroids and beta-agonists are needed both to better manage this group of patients and to avoid the side effects of high-dose corticosteroids and the social and personal hardship endured. Several biological pathways have been targeted over the last 20 years, and this research has resulted in pharmacological approaches to attempt to better treat patients with severe refractory asthma. The flagship of the biologics, the anti-IgE monoclonal antibody, omalizumab, has proven efficacious in selected subgroups of asthma patients. Tailoring asthma treatments to suit specific subtypes of asthma patients is in keeping with ideals of personalized medicine. Research in the complex interplay of allergens, epithelial host defenses, cytokines, and innate and adaptive immunity interactions has allowed better understanding of the mechanics of allergy and inflammation in asthma. As a result, new biologic treatments have been developed that target several different phenotypes and endotypes in asthma. As knowledge of the efficacy of these biological agents in asthma emerges, as well as the type of patients in whom they are most beneficial, the movement toward personalized asthma treatment will follow.
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Affiliation(s)
- Patrick D Mitchell
- Firestone Institute for Respiratory Health and the Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Amani I El-Gammal
- Firestone Institute for Respiratory Health and the Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Paul M O'Byrne
- Firestone Institute for Respiratory Health and the Department of Medicine, McMaster University, Hamilton, ON, Canada.
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38
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Chipps BE, Lanier B, Milgrom H, Deschildre A, Hedlin G, Szefler SJ, Kattan M, Kianifard F, Ortiz B, Haselkorn T, Iqbal A, Rosén K, Trzaskoma B, Busse WW. Omalizumab in children with uncontrolled allergic asthma: Review of clinical trial and real-world experience. J Allergy Clin Immunol 2017; 139:1431-1444. [PMID: 28477722 DOI: 10.1016/j.jaci.2017.03.002] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 02/27/2017] [Accepted: 03/08/2017] [Indexed: 02/04/2023]
Abstract
Asthma is one of the most common chronic diseases of childhood. Allergen sensitization and high frequencies of comorbid allergic diseases are characteristic of severe asthma in children. Omalizumab, an anti-IgE mAb, is the first targeted biologic therapeutic approved for the treatment of moderate-to-severe persistent allergic asthma (AA) that remains uncontrolled despite high-dose inhaled corticosteroids plus other controller medications. Since its initial licensing for use in adults and adolescents 12 years of age and older, the clinical efficacy, safety, and tolerability of omalizumab have been demonstrated in several published clinical trials in children aged 6 to less than 12 years with moderate-to-severe AA. These studies supported the approval of the pediatric indication (use in children aged ≥6 years) by the European Medicines Agency in 2009 and the US Food and Drug Administration in 2016. After this most recent change in licensing, we review the outcomes from clinical trials in children with persistent AA receiving omalizumab therapy and observational studies from the past 7 years of clinical experience in Europe. Data sources were identified by using PubMed in 2016. Guidelines and management recommendations and materials from the recent US Food and Drug Administration's Pediatric Advisory Committee meeting are also reviewed.
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Affiliation(s)
- Bradley E Chipps
- Capital Allergy and Respiratory Disease Center, Sacramento, Calif.
| | - Bob Lanier
- Department of Pediatrics, University of North Texas, Fort Worth, Tex
| | | | - Antoine Deschildre
- Pneumologie Pédiatrique, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - Gunilla Hedlin
- Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden; Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Stanley J Szefler
- Department of Pediatrics, Breathing Institute, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colo
| | - Meyer Kattan
- Pediatric Pulmonary Division, Columbia University Medical Center, New York, NY
| | | | | | | | | | | | | | - William W Busse
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care, University of Wisconsin School of Medicine and Public Health, Madison, Wis
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39
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Chiem J, Ivanova I, Parker A, Krengel W, Jimenez N. Anaphylactic reaction to tranexamic acid in an adolescent undergoing posterior spinal fusion. Paediatr Anaesth 2017; 27:774-775. [PMID: 28321954 DOI: 10.1111/pan.13141] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/08/2017] [Indexed: 11/26/2022]
Abstract
Tranexamic acid is an anti-fibrinolytic agent frequently used in pediatric surgery. Common side effects include nausea, flushing, and headache, but in rare instances, it may produce anaphylaxis; with only one previously reported case in a 72-year-old man. We report a case of a delayed anaphylactic reaction in a pediatric patient undergoing posterior spine fusion; and discuss the intraoperative management of the acute event, immunologic confirmation, and subsequent anesthetic approach.
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Affiliation(s)
- Jennifer Chiem
- Department of Anesthesiology and Pain Medicine, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | - Iskra Ivanova
- Department of Anesthesiology and Pain Medicine, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | - Andrew Parker
- Department of Immunology, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | - Walter Krengel
- Department of Orthopedic Surgery, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | - Nathalia Jimenez
- Department of Anesthesiology and Pain Medicine, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
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40
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Picard M, Galvão VR. Current Knowledge and Management of Hypersensitivity Reactions to Monoclonal Antibodies. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2017; 5:600-609. [DOI: 10.1016/j.jaip.2016.12.001] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 11/19/2016] [Accepted: 12/02/2016] [Indexed: 12/23/2022]
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41
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Giménez-Arnau AM, Toubi E, Marsland AM, Maurer M. Clinical management of urticaria using omalizumab: the first licensed biological therapy available for chronic spontaneous urticaria. J Eur Acad Dermatol Venereol 2017; 30 Suppl 5:25-32. [PMID: 27286500 DOI: 10.1111/jdv.13697] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 03/31/2016] [Indexed: 11/26/2022]
Abstract
This supplement reports proceedings of the second international Global Urticaria Forum, which was held in Berlin, Germany in November 2015. Omalizumab is approved for the treatment of chronic spontaneous urticaria (CSU) in adult and adolescent (12 years and above) patients with inadequate response to/who remain symptomatic despite H1 -antihistamine treatment, and has demonstrated good efficacy and safety in the clinical trial setting. Real-life clinical experience with omalizumab can be explored to address important practical questions relating to its use in CSU patients. Some experts have proposed that a consensus algorithm, covering various aspects to consider when using omalizumab in real-life clinical practice for the management of CSU, could answer many of these questions.
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Affiliation(s)
- A M Giménez-Arnau
- Department of Dermatology, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - E Toubi
- Division of Allergy and Clinical Immunology, Bnai-Zion Medical Center, Haifa, Israel
| | - A M Marsland
- Salford Royal NHS Foundation Trust, Manchester Academic Health Science Center, University of Manchester, Manchester, UK
| | - M Maurer
- Department of Dermatology and Allergy, Allergie-Centrum-Charité, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Anaphylactic reactions associated with omalizumab administration: Analysis of a case-control study. J Allergy Clin Immunol 2016; 138:913-915.e2. [DOI: 10.1016/j.jaci.2016.03.030] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 03/04/2016] [Accepted: 03/15/2016] [Indexed: 11/23/2022]
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43
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Mitchell PD, El-Gammal AI, O'Byrne PM. Emerging monoclonal antibodies as targeted innovative therapeutic approaches to asthma. Clin Pharmacol Ther 2015; 99:38-48. [PMID: 26502193 DOI: 10.1002/cpt.284] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 10/16/2015] [Accepted: 10/20/2015] [Indexed: 12/16/2022]
Abstract
Asthma is characterized by discordant responses among cells of the adaptive and innate immune systems. This interplay involves a complex pattern of cytokine-driven processes resulting in cell migration and recruitment, inflammation, and proliferative states. The significant majority of asthmatic patients respond well to conventional inhaled treatments. However, about 5% of asthmatics have severe refractory asthma and account for 50% of the health expenditure on asthma. Human(ized) monoclonal antibodies (hMabs) targeting inflammatory pathways are promising therapeutic agents in asthma management. The anti-IgE hMab omalizumab was the first biologic treatment approved for the treatment of allergic asthma. Potential future strategies and targets include interleukin (IL)-5, IL-4, and IL-13, anti-TSLP, IL-25, and IL-33. hMabs targeting IL-5 have shown great promise in severe refractory asthma with a persisting eosinophilia, and clinical trials with hMabs against IL-13 and IL4Rα have also shown clinical benefit. Studies of hMabs against other cytokines in severe asthma are under way.
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Affiliation(s)
- P D Mitchell
- Firestone Institute of Respiratory Health and the Department of Medicine, Michael G DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - A I El-Gammal
- Firestone Institute of Respiratory Health and the Department of Medicine, Michael G DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - P M O'Byrne
- Firestone Institute of Respiratory Health and the Department of Medicine, Michael G DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
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Gönül M, Özenergün Bittacı A, Ergin C. Omalizumab-induced triphasic anaphylaxis in a patient with chronic spontaneous urticaria. J Eur Acad Dermatol Venereol 2015; 30:e135-e136. [PMID: 26446412 DOI: 10.1111/jdv.13439] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- M Gönül
- Dermatology Clinic, Ankara Dışkapı Yıldırım Beyazıt Education and Research Hospital, Ankara, Turkey
| | - A Özenergün Bittacı
- Dermatology Clinic, Ankara Dışkapı Yıldırım Beyazıt Education and Research Hospital, Ankara, Turkey
| | - C Ergin
- Dermatology Clinic, Ankara Dışkapı Yıldırım Beyazıt Education and Research Hospital, Ankara, Turkey.
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Baker DL, Nakamura GR, Lowman HB, Fischer SK. Evaluation of IgE Antibodies to Omalizumab (Xolair®) and Their Potential Correlation to Anaphylaxis. AAPS JOURNAL 2015; 18:115-23. [PMID: 26340860 DOI: 10.1208/s12248-015-9821-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 08/18/2015] [Indexed: 02/03/2023]
Abstract
Omalizumab (Xolair®) is a recombinant humanized monoclonal antibody that selectively binds to human immunoglobulin E (IgE). Omalizumab is used to treat IgE-mediated diseases such as chronic idiopathic urticaria (CIU) and moderate to severe allergic asthma. In pre-marketing clinical trials in patients with asthma, anaphylaxis was reported in 3 of 3,507 (0.1%) patients. In post-marketing spontaneous reports, the frequency of anaphylaxis attributed to omalizumab use was estimated to be at least 0.2% of patients based on an estimated exposure of about 57,300 patients from June 2003 through December 2006. To better understand the risk of anaphylaxis in patients with allergic asthma receiving omalizumab, a post-marketing pharmacosurveillance study was initiated in 2009. As part of this study, an assay was developed to detect antibodies of IgE isotype to omalizumab. Serum samples from patients in the study were evaluated using this assay. Our results indicated that there was no observable correlation between either anaphylaxis or skin test reactivity and the presence of antibodies of IgE isotype to omalizumab. Here, we discuss the development of this assay as well as the results of the immunogenicity assessment.
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Affiliation(s)
- Dana L Baker
- Department of Assay Development and Technology, Genentech, Inc., 1 DNA Way, South San Francisco, California, 94080, USA
| | - Gerald R Nakamura
- Department of Assay Development and Technology, Genentech, Inc., 1 DNA Way, South San Francisco, California, 94080, USA
| | - Henry B Lowman
- Department of Assay Development and Technology, Genentech, Inc., 1 DNA Way, South San Francisco, California, 94080, USA
| | - Saloumeh Kadkhodayan Fischer
- Department of Assay Development and Technology, Genentech, Inc., 1 DNA Way, South San Francisco, California, 94080, USA.
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Shtessel M, Toh J, Gavrilova T. Anaphylaxis as a delayed reaction of methimazole therapy. Ann Allergy Asthma Immunol 2015; 115:245-7. [PMID: 26162569 DOI: 10.1016/j.anai.2015.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2015] [Revised: 06/06/2015] [Accepted: 06/11/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Maria Shtessel
- Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York.
| | - Jennifer Toh
- Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
| | - Tatyana Gavrilova
- Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
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Sakatani A, Doi Y, Matsuda T, Sasai Y, Nishida N, Sakamoto M, Uenoyama N, Matsumoto Y, Kinoshita K. Protracted anaphylaxis developed after peginterferon α-2a administration for chronic hepatitis C. World J Gastroenterol 2015; 21:2826-2829. [PMID: 25759556 PMCID: PMC4351238 DOI: 10.3748/wjg.v21.i9.2826] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 09/02/2014] [Accepted: 12/01/2014] [Indexed: 02/06/2023] Open
Abstract
Peginterferon is a key drug used to treat chronic viral hepatitis that is known for causing various side effects. Side effects occurring immediately after administration include headache, nausea, and influenza-like symptoms, such as fever and joint pain. However, reports of anaphylactic shock are extremely rare. Here we report a patient with protracted anaphylaxis who suffered shock symptoms after peginterferon α-2a administration for chronic hepatitis C. Although the patient improved temporarily with shock treatment, symptoms of anaphylaxis recurred. As peginterferon is often administered on an outpatient basis, it is important to recognize life-threatening side effects that may develop in a protracted manner.
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Hypersensitivity to Biological Agents—Updated Diagnosis, Management, and Treatment. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2015; 3:175-85; quiz 186. [DOI: 10.1016/j.jaip.2014.12.006] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 12/11/2014] [Accepted: 12/15/2014] [Indexed: 01/17/2023]
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Lowe PJ, Georgiou P, Canvin J. Revision of omalizumab dosing table for dosing every 4 instead of 2 weeks for specific ranges of bodyweight and baseline IgE. Regul Toxicol Pharmacol 2014; 71:68-77. [PMID: 25497995 DOI: 10.1016/j.yrtph.2014.12.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 12/01/2014] [Accepted: 12/02/2014] [Indexed: 11/26/2022]
Abstract
The dosing level and frequency of omalizumab are guided by a dosing table based on total serum immunoglobulin E (IgE) and bodyweight. Using a validated, mathematical simulation model (based on concentration data from 8 studies), we evaluated the impact of a revised omalizumab dosing table (every 4 weeks dosing regimen) on the pharmacokinetic and pharmacodynamic profiles of free and total IgE. Safety analysis, in patients with high levels of exposure to omalizumab, was done using data from the clinical and post-marketing databases. The model accurately predicted observed omalizumab, free and total IgE concentrations. After reaching steady-state, the average increase in exposure was 10%, even for patients with the highest concentrations at the upper 97.5th percentile. Free IgE suppression slightly increased in the initial phase, and slightly reduced at the trough of the dosing cycle, but average suppression remained similar for both regimens. The safety profile of omalizumab was similar for patients receiving higher or lower doses. Thus, doubling the dose of omalizumab, in a subset of patients receiving 225-300 mg of omalizumab (every 2 weeks dosing regimen) can efficiently suppress free IgE without compromising safety or efficacy.
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Affiliation(s)
| | | | - Janice Canvin
- Novartis Pharmaceuticals UK Limited, Horsham, West Sussex, UK
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50
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Savitz J, Geaney C, Banks TA. A case of anaphylaxis to palivizumab. Ann Allergy Asthma Immunol 2014; 113:236-7. [PMID: 25065351 DOI: 10.1016/j.anai.2014.06.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 06/04/2014] [Accepted: 06/05/2014] [Indexed: 11/26/2022]
Affiliation(s)
- Julia Savitz
- Department of Allergy/Immunology and Immunizations, Walter Reed National Military Medical Center, Bethesda, Maryland.
| | - Casey Geaney
- Department of Allergy/Immunology and Immunizations, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Taylor A Banks
- Department of Allergy/Immunology and Immunizations, Walter Reed National Military Medical Center, Bethesda, Maryland
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