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Asero R. Mechanisms of histamine release from mast cells beyond the high affinity IgE receptor in severe chronic spontaneous urticaria. Immunol Lett 2024; 265:1-4. [PMID: 38042500 DOI: 10.1016/j.imlet.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 11/23/2023] [Accepted: 11/29/2023] [Indexed: 12/04/2023]
Abstract
There is growing evidence suggesting that in a subset of patients with severe chronic urticaria [CSU] mast cells are activated via mechanisms that bypass the high affinity IgE receptor. This might explain why some patients do not respond at all to anti-IgE therapy [omalizumab]. The present article reviews the pathogenic mechanisms able to lead to histamine release from mast cells described so far in patients with CSU. These include the activation of the coagulation cascade, the activation of the complement system, the activation of the MRGPRX2 receptor, and the platelet activating factor vicious circle. The article suggests some possible interpretations for the clinical events occurring in this specific subset of patients.
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Affiliation(s)
- Riccardo Asero
- Ambulatorio di Allergologia, Clinica San Carlo, Via Ospedale 21, 20037 Paderno Dugnano (MI), Italy.
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2
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Izquierdo I, Casas L, Cabrera S, Fernandez A. How to handle off-label prescriptions of rupatadine, a second-generation antihistamine and PAF antagonist: a review. Drugs Context 2024; 13:2023-9-5. [PMID: 38264404 PMCID: PMC10803124 DOI: 10.7573/dic.2023-9-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 12/04/2023] [Indexed: 01/25/2024] Open
Abstract
The off-label use of second-generation antihistamines, used outside of the formal indications authorized by regulatory authorities, in different age groups, doses or in special populations, is very common for many allergic, autoimmune and dermatological diseases. The off-label use of rupatadine (a second-generation antihistamine with PAF antagonist activity) in these conditions is reviewed here, including in combination with immunotherapy in the treatment of food allergy or allergic rhinitis, at high doses in chronic urticaria, and with prescriptions of less common but challenging conditions such as skin pruritus or mast cell activation disorders like mastocytosis. Rupatadine use is reviewed herein to confirm if its off-label management is supported by well-designed clinical trials or by published real-world cases. This review will contribute to increasing compliance and achieving better results in clinical practice. Off-label use of rupatadine should be left to the discretion of the prescribing healthcare professional after careful clinical evaluation.
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Affiliation(s)
- Iñaki Izquierdo
- Medical Advice Department, BIOHORM S.L., Palau-Solità i Plegamans, Barcelona, Spain
| | - Laia Casas
- Clinical & Preclinical Development, Strategy and Innovation Department, BIOHORM S.L., Palau-Solità i Plegamans, Barcelona, Spain
| | - Susana Cabrera
- Pharmacovigilance Department, NOUCOR HEALTH, S.A., Palau-Solità i Plegamans, Barcelona, Spain
| | - Alberto Fernandez
- Pharmacovigilance Department, NOUCOR HEALTH, S.A., Palau-Solità i Plegamans, Barcelona, Spain
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3
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Weller K, Gimenez-Arnau AM, Baron J, Brehler R, Ferrer M, Groffik A, Grundmann S, Jakob T, Labrador-Horrillo M, Müller S, Staubach P, Wurpts G, Metz M, Maurer M. Efficacy and safety of on-demand versus daily rupatadine in chronic spontaneous urticaria: A randomized trial. Allergy 2024; 79:93-103. [PMID: 37597162 DOI: 10.1111/all.15854] [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: 04/11/2023] [Revised: 05/25/2023] [Accepted: 06/16/2023] [Indexed: 08/21/2023]
Abstract
BACKGROUND Non-sedating H1 -antihistamines (nsAH) are the most commonly used treatment for chronic spontaneous urticaria (CSU). Many patients use them as on-demand (OD) therapy rather than a maintenance treatment. Here, we compared OD versus daily maintenance treatment with the nsAH rupatadine, assessed the efficacy of rupatadine updosing, and investigated potential long-term disease-modifying effects. METHODS This multicenter, randomized study consisted of 2 weeks of screening, 8 weeks of double-blind treatment, and 6 weeks of treatment-free follow-up (OD allowed). Adult patients were randomized to 10 mg rupatadine OD or 10 mg rupatadine daily. At Week 4, if patients did not have a complete response, they switched from 10 to 20 mg rupatadine daily or underwent sham updosing (patients on 10 mg rupatadine OD). The primary aim was to compare CSU disease activity at the end of follow-up between daily versus OD. Additionally, we assessed the efficacy of rupatadine updosing. Major outcomes were disease activity, CSU-related quality of life (QoL), and disease control. RESULTS At Week 4, disease activity and QoL significantly improved in daily versus OD-treated patients. Updosing of rupatadine did not improve the mean disease activity, but the number of complete responders increased during updosing from 5% to 22%. At the end of follow-up, the disease activity of patients treated OD versus daily was not significantly different. CONCLUSIONS Daily rupatadine treatment significantly improved CSU disease activity and QoL during treatment versus OD treatment but not after discontinuation of rupatadine, indicating the benefits of a daily maintenance nsAH schedule.
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Affiliation(s)
- Karsten Weller
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Ana Maria Gimenez-Arnau
- Department of Dermatology, Hospital del Mar, IMIM, Universitat Pompeu Fabra, Barcelona, Spain
| | - Jens Baron
- Department of Dermatology and Allergy, University Hospital, RWTH Aachen, Aachen, Germany
| | - Randolf Brehler
- Department of Dermatology, University Hospital Muenster, Muenster, Germany
| | - Marta Ferrer
- Department of Allergy, Clinica Universidad de Navarra, Pamplona, Spain
- RICORS Red De Enfermedades Inflamatorias (REI)-RD21/0002/0028, Madrid, Spain
| | - Adriane Groffik
- Department of Dermatology, University Medical Center Mainz, Mainz, Germany
| | | | - Thilo Jakob
- Department of Dermatology and Allergy, University Medical Center, Justus Liebig University Gießen, Giessen, Germany
| | - Moisés Labrador-Horrillo
- Allergy Department, Hospital Universitario Vall d'Hebron, VHIR, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Sabine Müller
- Department of Dermatology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Petra Staubach
- Department of Dermatology and Allergy, University Medical Center, Mainz, Germany
| | - Gerda Wurpts
- Clinic for Dermatology and Allergology, Aachen Comprehensive Allergy Center (ACAC), Uniklinik RWTH Aachen, Aachen, Germany
| | - Martin Metz
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Marcus Maurer
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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4
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Fisher GW, Travers JB, Rohan CA. Rosacea pathogenesis and therapeutics: current treatments and a look at future targets. Front Med (Lausanne) 2023; 10:1292722. [PMID: 38193038 PMCID: PMC10773789 DOI: 10.3389/fmed.2023.1292722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 11/28/2023] [Indexed: 01/10/2024] Open
Abstract
Rosacea is a chronic inflammatory skin condition associated with a significant health and economic burden from costs and loss of productivity due to seeking medical treatment. The disease encompasses multiple phenotypic manifestations involving a complex and multi-variate pathogenesis. Although the pathophysiology of rosacea is not completely understood, ongoing research is continually elucidating its mechanisms. In this review, current concepts of rosacea pathogenesis will be addressed which involve skin barrier and permeability dysfunction, the innate and adaptive immune systems, and the neurovascular system. More specifically, the cathelicidin pathway, transient potential receptor channels, mast cells, and the NLRP3 inflammasome pathway are various targets of current pharmacologic regimens. Future therapies may seek different mechanisms to act on current treatment targets, like the potential use of JAK/STAT inhibitors in ameliorating skin barrier dysfunction or TLR antagonists in alleviating cathelicidin mediated inflammation. Other potential treatments aim for entirely different molecular targets such as microvesicle particle mediated local and systemic inflammation. Ultimately rosacea is associated with a significant health and economic burden which warrants deeper research into its pathogenesis and resultant new treatment discovery.
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Affiliation(s)
- Garrett W. Fisher
- Departments of Pharmacology and Toxicology, Boonshoft School of Medicine at Wright State University, Dayton, OH, United States
| | - Jeffrey B. Travers
- Departments of Pharmacology and Toxicology, Boonshoft School of Medicine at Wright State University, Dayton, OH, United States
- Dermatology, Boonshoft School of Medicine at Wright State University, Dayton, OH, United States
- Department of Medicine (Dermatology), Dayton Veterans Administration Medical Center, Dayton, OH, United States
| | - Craig A. Rohan
- Departments of Pharmacology and Toxicology, Boonshoft School of Medicine at Wright State University, Dayton, OH, United States
- Dermatology, Boonshoft School of Medicine at Wright State University, Dayton, OH, United States
- Department of Medicine (Dermatology), Dayton Veterans Administration Medical Center, Dayton, OH, United States
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5
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Pałgan K, Tretyn A. Platelet-activating factor as an endogenous cofactor of food anaphylaxis. Biofactors 2023; 49:976-983. [PMID: 37203358 DOI: 10.1002/biof.1956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 03/02/2023] [Indexed: 05/20/2023]
Abstract
Anaphylaxis is a severe, acute, life-threatening generalized or systemic hypersensitivity reaction. The incidence of anaphylaxis is increasing worldwide, with medications and food contributing to most cases. Physical exercise, acute infections, drugs, alcohol, and menstruation are the external cofactors associated with more severe systemic reaction. The aim of this review is to show that platelet-activating factor contributes to the development of severe anaphylactic reaction, and even to anaphylactic shock.
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Affiliation(s)
- Krzysztof Pałgan
- Department of Allergology, Clinical Immunology and Internal Diseases, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Andrzej Tretyn
- Faculty of Biological and Veterinary Sciences, Nicolaus Copernicus University, Toruń, Poland
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6
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Jiang Z, Jiang X, Chen A, He W. Platelet activation: a promoter for psoriasis and its comorbidity, cardiovascular disease. Front Immunol 2023; 14:1238647. [PMID: 37654493 PMCID: PMC10465348 DOI: 10.3389/fimmu.2023.1238647] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 07/31/2023] [Indexed: 09/02/2023] Open
Abstract
Psoriasis is a chronic inflammatory skin disease with a prevalence of 0.14% to 1.99%. The underlying pathology is mainly driven by the abnormal immune responses including activation of Th1, Th17, Th22 cells and secretion of cytokines. Patients with psoriasis are more likely to develop cardiovascular disease (CVD) which has been well recognized as a comorbidity of psoriasis. As mediators of hemostasis and thromboinflammation, platelets play an important part in CVD. However, less is known about their pathophysiological contribution to psoriasis and psoriasis-associated CVD. A comprehensive understanding of the role of platelet activation in psoriasis might pave the path for more accurate prediction of cardiovascular (CV) risk and provide new strategies for psoriasis management, which alleviates the increased CV burden associated with psoriasis. Here we review the available evidence about the biomarkers and mechanisms of platelet activation in psoriasis and the role of platelet activation in intriguing the common comorbidity, CVD. We further discussed the implications and efficacy of antiplatelet therapies in the treatment of psoriasis and prevention of psoriasis-associated CVD.
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Affiliation(s)
- Ziqi Jiang
- Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaoran Jiang
- The First Clinical College, Chongqing Medical University, Chongqing, China
| | - Aijun Chen
- Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wenyan He
- Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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7
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Kaplan A, Lebwohl M, Giménez-Arnau AM, Hide M, Armstrong AW, Maurer M. Chronic spontaneous urticaria: Focus on pathophysiology to unlock treatment advances. Allergy 2023; 78:389-401. [PMID: 36448493 DOI: 10.1111/all.15603] [Citation(s) in RCA: 35] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 11/10/2022] [Accepted: 11/14/2022] [Indexed: 12/05/2022]
Abstract
Chronic spontaneous urticaria (CSU) is a debilitating skin disease characterized by intensely itchy wheals, angioedema, or both. Symptoms recur spontaneously, on a near-daily basis, over >6 weeks; many patients experience flare-ups over several years and, consequently, reduced quality of life. Differences between the inflammatory profiles of the skin of CSU patients (wheals and nonlesional sites) and healthy controls indicate that key drivers such as mast cells, eosinophils, and basophils interact, release vasoactive mediators, and prime the skin, leaving patients predisposed to symptoms. Many cytokines and chemokines involved in these inflammatory networks and their corresponding intracellular signaling cascades have been identified. These insights informed the development of therapies such as omalizumab, dupilumab, and Bruton's tyrosine kinase (BTK) inhibitors, marking a renewed focus on pathogenesis in CSU clinical research. Despite progress, current therapies provide symptomatic control but do not appear to redress the inflammatory balance in the skin permanently. A deeper understanding of CSU pathogenesis will permit a more targeted approach to developing novel treatments with curative intent. Here, we review what is known about the pathogenesis of CSU and consider how this can be used to identify rational targets to improve patient care further.
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Affiliation(s)
- Allen Kaplan
- Division of Pulmonary and Critical Care Medicine, Allergy and Clinical Immunology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Mark Lebwohl
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ana M Giménez-Arnau
- Department of Dermatology, Hospital del Mar, Institut Mar D'Investigacions Mediques, Universitat Autònoma and Universitat Pompeu Fabra, Barcelona, Spain
| | - Michihiro Hide
- Department of Dermatology, Hiroshima Citizens Hospital and Department of Dermatology, Hiroshima University, Hiroshima, Japan
| | - April W Armstrong
- Department of Dermatology, University of Southern California, Los Angeles, California, USA
| | - Marcus Maurer
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
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8
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Urticaria and Angioedema: Understanding Complex Pathomechanisms to Facilitate Patient Communication, Disease Management, and Future Treatment. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:94-106. [PMID: 36610760 DOI: 10.1016/j.jaip.2022.11.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 10/29/2022] [Accepted: 11/01/2022] [Indexed: 01/06/2023]
Abstract
Chronic spontaneous urticaria (CSU) is primarily a T2-dominant disease with a complex genetic background. Skin mast cell activation can be induced not only via the IgE-FcεRI axis but also from several other distinct mechanisms, molecules, and receptors involved in CSU onset, persistence, and exacerbation. These include autoallergy, autoimmunity, central or peripheral neuroimmune dysregulation, activation of both extrinsic and intrinsic coagulation pathways, and microbial infections. Besides mast cells, recent reports suggest the active and direct involvement of basophils and eosinophils. Several biological characteristics or biomarkers have been linked with CSU's known endotypes and may help forecast therapeutic responses. The introduction of biologic therapy for CSU has been a major advance in the last 10 years. The cornerstone of angioedema (AE) pathogenesis is increased vascular permeability and plasma leakage into the deeper dermis and subcutis, either mediated by histamine or bradykinin (BK). C1-inhibitor deficiency, hereditary or acquired, is the primary cause of BK-mediated AE due to increased plasma BK concentration. Other complex conditions have been identified, with some likely involving contact system dysregulation and other putative mechanisms related to vascular endothelial dysfunction. The approval of multiple hereditary-AE-specific therapies for both prevention and acute attacks has revolutionized treatment of this disease. Any new knowledge of the pathogenesis of CSU and AE offers the opportunity to improve patient information, physician-patient communication, prediction of therapeutic responses, selection of precise tailor-made treatment for each patient, and exploration of novel treatment options for those who do not achieve disease control with current medications.
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9
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Andrades E, Clarós M, Torres JV, Nonell L, González M, Curto-Barredo L, Rozas-Muñoz E, Gimeno R, Barranco C, Pujol RM, Izquierdo I, Giménez-Arnau AM. New transcriptome and clinical findings of platelet-activating factor in chronic spontaneous urticaria: Pathogenic and treatment relevance. Biofactors 2022; 48:1284-1294. [PMID: 35927787 DOI: 10.1002/biof.1880] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 06/15/2022] [Indexed: 12/24/2022]
Abstract
The objective of the study was to assess the pathogenic and treatment relevance of Platelet Activating factor (PAF) in chronic spontaneous urticaria (CSU). The expression and cellular location of PAF receptor (PAFR) and serum levels of PAF and PAF acetylhydrolase (PAF-AH) in patients with moderate/severe CSU (n = 45) and healthy controls (HCs, n = 17) were studied. Skin samples from the active wheal (LS-CSU, 13 samples for qPCR and 33 for immunohistochemistry) and non-lesional skin (NLS-CSU, 13 samples) of CSU patients and HCs (13 samples and 5 for immunohistochemistry) were analyzed. Serum PAF and PAF-AH levels were measured by ELISA and compared between HC (10 samples) and CSU patients (25 samples) and, among them, between those refractory and non-refractory to second-generation H1 -antihistamines (sgAH). PAFR mRNA expression was significantly higher in LS-CSU versus HCs (p = 0.014). PAFR positive staining in immunohistochemistry was mainly found in the epidermal basal layer in HCs, whereas it was broadly present along the epidermis in LS-CSU samples. Endothelial cells showed PAFR expression exclusively in LS-CSU and NLS-CSU samples. PAFR expression was observed in the nerves of HC, LS-CSU, and NLS-CSU samples. Double PAFR/CD43 expression showed that T-lymphocytes were the main cell type from the wheal inflammatory infiltrate expressing PAFR. A significantly lower PAF-AH/PAF ratio was observed in sgAH non-responders versus responders (6.1 vs. 12.6; p = 0.049). Our study confirms that PAF is a mediator of wheal pathogenesis in CSU. The significantly lower PAF-AH/PAF ratio in sgAH non-responders vs responders suggests that PAF could be a potential biomarker of sgAH refractoriness.
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Affiliation(s)
- Evelyn Andrades
- Department of Dermatology, Hospital del Mar, Universitat Autònoma de Barcelona and Universitat Pompeu Fabra, Barcelona, Spain
- Group of Inflammatory and Neoplastic Dermatological Diseases, Institut Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - Miquel Clarós
- Microarray Analysis Service, Institut Mar d'Investigacions Mèdiques, Barcelona, Spain
| | | | - Lara Nonell
- Bioinformatics Unit, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Mónica González
- Department of Pathology, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Laia Curto-Barredo
- Department of Dermatology, Hospital del Mar, Universitat Autònoma de Barcelona and Universitat Pompeu Fabra, Barcelona, Spain
- Group of Inflammatory and Neoplastic Dermatological Diseases, Institut Mar d'Investigacions Mèdiques, Barcelona, Spain
| | | | - Ramon Gimeno
- Department of Immunology, Hospital del Mar-Institut Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - Carlos Barranco
- Department of Pathology, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ramon M Pujol
- Department of Dermatology, Hospital del Mar, Universitat Autònoma de Barcelona and Universitat Pompeu Fabra, Barcelona, Spain
- Group of Inflammatory and Neoplastic Dermatological Diseases, Institut Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - Iñaki Izquierdo
- Departament of Clinical Development & Medical Advice, Biohorm SL Palau-Solità i Plegamans, Barcelona, Spain
| | - Ana M Giménez-Arnau
- Department of Dermatology, Hospital del Mar, Universitat Autònoma de Barcelona and Universitat Pompeu Fabra, Barcelona, Spain
- Group of Inflammatory and Neoplastic Dermatological Diseases, Institut Mar d'Investigacions Mèdiques, Barcelona, Spain
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10
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Theoharides TC, Antonopoulou S, Demopoulos CA. Platelet activating factor: Have we been missing the forest for the trees? Biofactors 2022; 48:1184-1188. [PMID: 36300767 DOI: 10.1002/biof.1908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 10/05/2022] [Indexed: 01/19/2023]
Affiliation(s)
- Theoharis C Theoharides
- Institute of Neuro-Immune Medicine, Nova Southeastern University, Clearwater, Florida, USA
- Department of Immunology, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Smaragdi Antonopoulou
- Laboratory of Biology, Biochemistry and Microbiology, Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Constantinos A Demopoulos
- Laboratory of Biochemistry, Faculty of Chemistry, National & Kapodistrian University, Athens, Greece
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11
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Wang Z, Franke K, Zuberbier T, Babina M. Cytokine Stimulation via MRGPRX2 Occurs with Lower Potency than by FcεRI-aggregation but with Similar Dependence on the ERK1/2 Module in Human Skin Mast Cells. J Invest Dermatol 2021; 142:414-424.e8. [PMID: 34329659 DOI: 10.1016/j.jid.2021.07.153] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 07/04/2021] [Accepted: 07/06/2021] [Indexed: 12/17/2022]
Abstract
Skin mast cells (MCs) contribute to chronic dermatoses that partially rely on MC-derived cytokines. The discovery of MRGPRX2 explains MC-dependent symptoms independently of FcεRI-activation. Here, we investigated whether MRGPRX2 can elicit cytokines, determined its relative potency versus FcεRI and addressed the underlying mechanisms. MRGPRX2-activation by compound 48/80 or Substance P on skin MCs induced TNF-α, IL-8, IL-13, CCL1, CCL2 mRNA and protein, yet induction was typically reduced compared with FcεRI-crosslinking. Generally, cytokine secretion required de-novo-synthesis with maximum accumulation at ≈8 h. Addressing key kinases revealed robust, rapid (1 min), and lasting (30 min) phosphorylation of ERK1/2 following MRGPRX2-ligation, while pp38, and pAKT signals were weaker, and pJNK hardly detectable. The kinase spectrum following FcεRI-aggregation was comparable, but responses considerably delayed. The MEK/ERK pathway was essential for all cytokines examined and four inhibitors of this module gave complete suppression. Variable and weaker contribution was found for PI3K>JNK>p38. Strikingly, cytokine profiles and signaling prerequisites were similar for MRGPRX2 and FcεRI and likely mainly dictated by the MC subset. Collectively, in skin MCs, the physiological producers of MRGPRX2, agonist binding elicits cytokines, yet less efficiently than FcεRI-aggregation. MRGPRX2-associated inflammation may thus be less tissue-destructive than responses to allergic challenge.
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Affiliation(s)
- Zhao Wang
- Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Department of Dermatology, The Second Affiliated Hospital, Northwest Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Kristin Franke
- Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Torsten Zuberbier
- Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Magda Babina
- Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
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12
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Ali H. Revisiting the role of MRGPRX2 on hypersensitivity reactions to neuromuscular blocking drugs. Curr Opin Immunol 2021; 72:65-71. [PMID: 33857758 DOI: 10.1016/j.coi.2021.03.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/09/2021] [Accepted: 03/16/2021] [Indexed: 01/23/2023]
Abstract
Anaphylaxis is caused by a variety of triggers including Food and Drug Administration (FDA)-approved antibiotics, contrast media and neuromuscular blocking drugs (NMBDs). Traditionally, drug-induced anaphylaxis was thought to result mainly from IgE-mediated histamine release from mast cells. Recently, a G protein-coupled receptor known as MRGPRX2 has been identified and shown to be highly expressed on human skin but not lung mast cells. The demonstration that many NMBDs induce degranulation in human mast cells via MRGPRX2 led to the idea that this receptor contributes to NMBD-induced hypersensitivity reactions. However, other studies have raised doubts regarding its role in drug-induced hypersensitivity. This review discusses the current status and controversy on MRGPRX2's role on NMBD-induced hypersensitivity.
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Affiliation(s)
- Hydar Ali
- Department of Basic and Translational Sciences, University of Pennsylvania, School of Dental Medicine, 240 South 40th Street, Philadelphia, PA 19104, USA.
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13
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Babina M, Wang Z, Roy S, Guhl S, Franke K, Artuc M, Ali H, Zuberbier T. MRGPRX2 Is the Codeine Receptor of Human Skin Mast Cells: Desensitization through β-Arrestin and Lack of Correlation with the FcεRI Pathway. J Invest Dermatol 2020; 141:1286-1296.e4. [PMID: 33058860 DOI: 10.1016/j.jid.2020.09.017] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 08/23/2020] [Accepted: 09/17/2020] [Indexed: 12/28/2022]
Abstract
Codeine stimulates skin mast cells and is therefore used in skin tests and as an inducer of experimental itch. MRGPRX2 responds to various drugs, including opioids, to elicit pseudoallergic reactions, but whether it represents the main opiate receptor of skin mast cells remains unknown. By combining a number of approaches, including the silencing of MRGPRX2, we now report that MRGPRX2 is indeed the dominant codeine receptor of dermal mast cells. Activation by codeine displayed profound subject variability and correlated with secretion elicited by compound 48/80 or substance P but not by FcεRI aggregation. Degranulation by codeine was attenuated by stem cell factor, whereas the opposite was found for FcεRI. Compound 48/80 or codeine alone was able to achieve maximum MRGPRX2 activation. MRGPRX2 was rapidly internalized on codeine binding in a β-arrestin-1‒dependent manner. Codeine-triggered β-arrestin activation was also established by the Tango assay. Prestimulation with MRGPRX2 agonists (but not C3a or FcεRI aggregation) resulted in refractoriness to further stimulation by the same or another MRGPRX2 ligand (cross desensitization). This was duplicated in a cell line (RBL-MRGPRX2). Collectively, codeine degranulates skin mast cells through MRGPRX2, at which it acts as a balanced ligand. It has yet to be determined whether codeine-induced refractoriness could be exploited to desensitize MRGPRX2 to prevent severe pseudoallergic reactions.
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Affiliation(s)
- Magda Babina
- Department of Dermatology and Allergy, Allergy Center Charité, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
| | - Zhao Wang
- Department of Dermatology and Allergy, Allergy Center Charité, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Saptarshi Roy
- Department of Basic and Translational Sciences, School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sven Guhl
- Department of Dermatology and Allergy, Allergy Center Charité, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Kristin Franke
- Department of Dermatology and Allergy, Allergy Center Charité, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Metin Artuc
- Department of Dermatology and Allergy, Allergy Center Charité, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Hydar Ali
- Department of Basic and Translational Sciences, School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Torsten Zuberbier
- Department of Dermatology and Allergy, Allergy Center Charité, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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14
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Shaker MS, Wallace DV, Golden DBK, Oppenheimer J, Bernstein JA, Campbell RL, Dinakar C, Ellis A, Greenhawt M, Khan DA, Lang DM, Lang ES, Lieberman JA, Portnoy J, Rank MA, Stukus DR, Wang J, Riblet N, Bobrownicki AMP, Bontrager T, Dusin J, Foley J, Frederick B, Fregene E, Hellerstedt S, Hassan F, Hess K, Horner C, Huntington K, Kasireddy P, Keeler D, Kim B, Lieberman P, Lindhorst E, McEnany F, Milbank J, Murphy H, Pando O, Patel AK, Ratliff N, Rhodes R, Robertson K, Scott H, Snell A, Sullivan R, Trivedi V, Wickham A, Shaker MS, Wallace DV, Shaker MS, Wallace DV, Bernstein JA, Campbell RL, Dinakar C, Ellis A, Golden DBK, Greenhawt M, Lieberman JA, Rank MA, Stukus DR, Wang J, Shaker MS, Wallace DV, Golden DBK, Bernstein JA, Dinakar C, Ellis A, Greenhawt M, Horner C, Khan DA, Lieberman JA, Oppenheimer J, Rank MA, Shaker MS, Stukus DR, Wang J. Anaphylaxis-a 2020 practice parameter update, systematic review, and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) analysis. J Allergy Clin Immunol 2020; 145:1082-1123. [PMID: 32001253 DOI: 10.1016/j.jaci.2020.01.017] [Citation(s) in RCA: 355] [Impact Index Per Article: 88.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 12/21/2019] [Accepted: 01/02/2020] [Indexed: 12/18/2022]
Abstract
Anaphylaxis is an acute, potential life-threatening systemic allergic reaction that may have a wide range of clinical manifestations. Severe anaphylaxis and/or the need for repeated doses of epinephrine to treat anaphylaxis are risk factors for biphasic anaphylaxis. Antihistamines and/or glucocorticoids are not reliable interventions to prevent biphasic anaphylaxis, although evidence supports a role for antihistamine and/or glucocorticoid premedication in specific chemotherapy protocols and rush aeroallergen immunotherapy. Evidence is lacking to support the role of antihistamines and/or glucocorticoid routine premedication in patients receiving low- or iso-osmolar contrast material to prevent recurrent radiocontrast media anaphylaxis. Epinephrine is the first-line pharmacotherapy for uniphasic and/or biphasic anaphylaxis. After diagnosis and treatment of anaphylaxis, all patients should be kept under observation until symptoms have fully resolved. All patients with anaphylaxis should receive education on anaphylaxis and risk of recurrence, trigger avoidance, self-injectable epinephrine education, referral to an allergist, and be educated about thresholds for further care.
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Affiliation(s)
- Marcus S Shaker
- Section of Allergy and Clinical Immunology, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH.
| | - Dana V Wallace
- Nova Southeastern Allopathic Medical School, Fort Lauderdale, Fla
| | - David B K Golden
- Division of Allergy-Clinical Immunology, Johns Hopkins University, Baltimore, Md
| | - John Oppenheimer
- Department of Internal Medicine, Pulmonary and Allergy, University of Medicine and Dentistry of New Jersey-Rutgers New Jersey Medical School and Pulmonary and Allergy Associates, Morristown, NJ
| | - Jonathan A Bernstein
- Department of Internal Medicine, Division of Immunology, Allergy Section, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | | - Chitra Dinakar
- Allergy, Asthma, and Immunodeficiency, Division of Pulmonary, Allergy, and Critical Care Medicine, Stanford University School of Medicine, Stanford, Calif
| | - Anne Ellis
- Division of Allergy and Immunology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Matthew Greenhawt
- Section of Allergy and Immunology, Children's Hospital Colorado, University of Colorado School of Medicine, Denver, Colo
| | - David A Khan
- Department of Internal Medicine, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas, Tex
| | - David M Lang
- Department of Allergy and Clinical Immunology, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio
| | - Eddy S Lang
- Department of Emergency Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Jay A Lieberman
- Department of Pediatrics, The University of Tennessee Health Science Center, Memphis, Tenn
| | - Jay Portnoy
- Pediatric Allergy and Immunology, Children's Mercy Hospital, Kansas City School of Medicine, Kansas City, Mo
| | - Matthew A Rank
- Division of Allergy, Asthma, and Clinical Immunology, Mayo Clinic in Arizona, Scottsdale, Ariz
| | - David R Stukus
- Division of Allergy and Immunology, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio
| | - Julie Wang
- Division of Allergy and Immunology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Natalie Riblet
- The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH
| | | | - Teresa Bontrager
- Office of Evidence-Based Practice, Children's Mercy Hospital, Kansas City, Mo
| | - Jarrod Dusin
- Office of Evidence-Based Practice, Children's Mercy Hospital, Kansas City, Mo
| | - Jennifer Foley
- Office of Evidence-Based Practice, Children's Mercy Hospital, Kansas City, Mo
| | - Becky Frederick
- Office of Evidence-Based Practice, Children's Mercy Hospital, Kansas City, Mo
| | - Eyitemi Fregene
- The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH
| | - Sage Hellerstedt
- The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH
| | - Ferdaus Hassan
- Office of Evidence-Based Practice, Children's Mercy Hospital, Kansas City, Mo
| | - Kori Hess
- Office of Evidence-Based Practice, Children's Mercy Hospital, Kansas City, Mo
| | - Caroline Horner
- Department of Pediatrics, Division of Allergy, Immunology, and Pulmonary Medicine, Washington University School of Medicine, St. Louis, Mo
| | - Kelly Huntington
- Office of Evidence-Based Practice, Children's Mercy Hospital, Kansas City, Mo
| | - Poojita Kasireddy
- The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH
| | - David Keeler
- Office of Evidence-Based Practice, Children's Mercy Hospital, Kansas City, Mo
| | - Bertha Kim
- The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH
| | - Phil Lieberman
- Department of Pediatrics, The University of Tennessee Health Science Center, Memphis, Tenn
| | - Erin Lindhorst
- Office of Evidence-Based Practice, Children's Mercy Hospital, Kansas City, Mo
| | - Fiona McEnany
- The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH
| | - Jennifer Milbank
- The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH
| | - Helen Murphy
- Office of Evidence-Based Practice, Children's Mercy Hospital, Kansas City, Mo
| | - Oriana Pando
- The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH
| | - Ami K Patel
- The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH
| | - Nicole Ratliff
- Office of Evidence-Based Practice, Children's Mercy Hospital, Kansas City, Mo
| | - Robert Rhodes
- Office of Evidence-Based Practice, Children's Mercy Hospital, Kansas City, Mo
| | - Kim Robertson
- Office of Evidence-Based Practice, Children's Mercy Hospital, Kansas City, Mo
| | - Hope Scott
- Office of Evidence-Based Practice, Children's Mercy Hospital, Kansas City, Mo
| | - Audrey Snell
- Office of Evidence-Based Practice, Children's Mercy Hospital, Kansas City, Mo
| | - Rhonda Sullivan
- Office of Evidence-Based Practice, Children's Mercy Hospital, Kansas City, Mo
| | - Varahi Trivedi
- The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH
| | - Azadeh Wickham
- Office of Evidence-Based Practice, Children's Mercy Hospital, Kansas City, Mo
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15
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Zhu YQ, Wang DQ, Liu B, Hu Y, Shen YY, Xu JH, Tang H. Wheat-dependent exercise-induced anaphylaxis in Chinese people: a clinical research on 33 cases with antigenic analysis of wheat proteins. Clin Exp Dermatol 2019; 45:56-62. [PMID: 31267575 DOI: 10.1111/ced.14035] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Wheat-dependent exercise-induced anaphylaxis (WDEIA) is a severe allergic condition in which wheat ingestion together followed by physical exercise induces anaphylaxis. For patients with WDEIA, omega-5 gliadin is considered to be one of the major allergens. AIM To analyse the clinical features and allergen spectrum of WDEIA and to investigate the relationship between WDEIA and serum levels of platelet-activating factor (PAF), interleukin (IL)-9 and IL-33. METHODS Medical histories and conditions of WDEIA cases were collected and summarized, with allergen tests of wheat proteins measured at the same visit. Of the 33 patients enrolled, 13 also had serum levels of PAF, IL-9 and IL-33 measured. The healthy control (HC) group consisted of 13 healthy individuals, who also underwent both the wheat-protein allergen tests and the inflammatory-mediator tests. RESULTS All patients experienced severe allergic reaction during exercise after wheat ingestion. Manifestations of WDEIA included facial oedema, generalized urticaria and respiratory symptoms. Unconsciousness was also observed in 21 cases. In the patient group, 57.6% were confirmed as hypersensitive to glyceraldehyde-3-phosphate dehydrogenase (GAPDH), while 54.5% were allergic to omega-5 gliadin. PAF concentration was significantly higher in patients with WDEIA compared with HCs, whereas there was no significant difference in IL-9 or IL-33 between the two groups. CONCLUSIONS WDEIA is a rare type of anaphylaxis. GAPDH and omega-5 gliadin may be the most common allergy-causing wheat proteins for Chinese people. PAF may be associated with the onset and development of WDEIA.
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Affiliation(s)
- Y-Q Zhu
- Department of Dermatology, Huashan Hospital affiliated to Fudan University, No. 12, Wulumuqi Zhong Rd, Shanghai, 200040, China
| | - D-Q Wang
- Department of Dermatology, Huashan Hospital affiliated to Fudan University, No. 12, Wulumuqi Zhong Rd, Shanghai, 200040, China
| | - B Liu
- Department of Dermatology, The Fifth People's Hospital of Shanghai affiliated to Fudan University, No. 128, Ruili Rd, Shanghai, 200040, China
| | - Y Hu
- Department of Dermatology, Huashan Hospital affiliated to Fudan University, No. 12, Wulumuqi Zhong Rd, Shanghai, 200040, China
| | - Y-Y Shen
- Department of Dermatology, Huashan Hospital affiliated to Fudan University, No. 12, Wulumuqi Zhong Rd, Shanghai, 200040, China
| | - J-H Xu
- Department of Dermatology, Huashan Hospital affiliated to Fudan University, No. 12, Wulumuqi Zhong Rd, Shanghai, 200040, China
| | - H Tang
- Department of Dermatology, Huashan Hospital affiliated to Fudan University, No. 12, Wulumuqi Zhong Rd, Shanghai, 200040, China
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16
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Baumann KY, Church MK, Clough GF, Quist SR, Schmelz M, Skov PS, Anderson CD, Tannert LK, Giménez-Arnau AM, Frischbutter S, Scheffel J, Maurer M. Skin microdialysis: methods, applications and future opportunities-an EAACI position paper. Clin Transl Allergy 2019; 9:24. [PMID: 31007896 PMCID: PMC6456961 DOI: 10.1186/s13601-019-0262-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 03/25/2019] [Indexed: 12/20/2022] Open
Abstract
Skin microdialysis (SMD) is a versatile sampling technique that can be used to recover soluble endogenous and exogenous molecules from the extracellular compartment of human skin. Due to its minimally invasive character, SMD can be applied in both clinical and preclinical settings. Despite being available since the 1990s, the technique has still not reached its full potential use as a tool to explore pathophysiological mechanisms of allergic and inflammatory reactions in the skin. Therefore, an EAACI Task Force on SMD was formed to disseminate knowledge about the technique and its many applications. This position paper from the task force provides an overview of the current use of SMD in the investigation of the pathogenesis of chronic inflammatory skin diseases, such as atopic dermatitis, chronic urticaria, psoriasis, and in studies of cutaneous events during type 1 hypersensitivity reactions. Furthermore, this paper covers drug hypersensitivity, UVB-induced- and neurogenic inflammation, and drug penetration investigated by SMD. The aim of this paper is to encourage the use of SMD and to make the technique easily accessible by providing an overview of methodology and applications, supported by standardized operating procedures for SMD in vivo and ex vivo.
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Affiliation(s)
- Katrine Y Baumann
- RefLab ApS, Copenhagen, Denmark.,2Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Martin K Church
- 3Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | | | - Sven Roy Quist
- 5Clinic of Dermatology, Otto-von-Guericke University, Magdeburg, Germany.,Skin Center MDZ, Mainz, Germany
| | - Martin Schmelz
- 7Department of Experimental Pain Research, CBTM, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Per Stahl Skov
- RefLab ApS, Copenhagen, Denmark.,8Odense Research Center for Anaphylaxis (ORCA), Department of Dermatology and Allergy Center, Odense University Hospital, Odense, Denmark
| | - Chris D Anderson
- 9Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Line Kring Tannert
- 8Odense Research Center for Anaphylaxis (ORCA), Department of Dermatology and Allergy Center, Odense University Hospital, Odense, Denmark
| | - Ana Maria Giménez-Arnau
- 10Department of Dermatology, Hospital del Mar, Institut Mar d'Investigacions Mèdiques, Universitat Autònoma, Barcelona, Spain
| | - Stefan Frischbutter
- 3Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Jörg Scheffel
- 3Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Marcus Maurer
- 3Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
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17
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Hashimoto T, Rosen JD, Sanders KM, Yosipovitch G. Possible roles of basophils in chronic itch. Exp Dermatol 2018; 28:1373-1379. [PMID: 29894005 DOI: 10.1111/exd.13705] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2018] [Indexed: 12/27/2022]
Abstract
Basophils are blood granulocytes and normally constitute <1% of blood peripheral leucocytes. Basophils share some morphological and functional similarities with mast cells, and basophils were once regarded as redundant and negligible circulating mast cells. However, recent studies reveal the indispensable roles of basophils in various diseases, including allergic and pruritic diseases. Basophils may be involved in itch through the mediation of a Th2 immune response, interaction with other cells in the skin and secretion of a wide variety of itch-related mediators, for example histamine, cytokines and chemokines (IL-4, IL-13, IL-31 and TSLP), proteases (cathepsin S), prostaglandins (PGE2 and PGD2), substance P and platelet-activating factor. Not only pruritic skin diseases (eg, atopic dermatitis, irritant contact dermatitis, chronic urticaria, prurigo, papulo-erythroderma of Ofuji, eosinophilic pustular folliculitis, scabies, tick bites and bullous pemphigoid) but also pruritic systemic diseases (eg, primary sclerosing cholangitis and polycythemia vera) may be affected by basophils.
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Affiliation(s)
- Takashi Hashimoto
- Department of Dermatology and Cutaneous Surgery, Miami Itch Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jordan D Rosen
- Department of Dermatology and Cutaneous Surgery, Miami Itch Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Kristen M Sanders
- Department of Dermatology and Cutaneous Surgery, Miami Itch Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Gil Yosipovitch
- Department of Dermatology and Cutaneous Surgery, Miami Itch Center, University of Miami Miller School of Medicine, Miami, FL, USA
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18
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Siebenhaar F, Sander B, Ho LHT, Ellrich A, Maurer M, Weller K. Development and validation of the mastocytosis activity score. Allergy 2018; 73:1489-1496. [PMID: 29405310 DOI: 10.1111/all.13425] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Mastocytosis is a heterogeneous disease characterized by a clonal expansion of mast cells in various organs. The vast majority of patients suffer from signs and symptoms caused by mediator release from mast cells. Although the disease burden is high, there is currently no specific and validated instrument to measure and monitor signs and symptoms in patients with mastocytosis. OBJECTIVE To develop and validate a disease-specific tool to measure and monitor the activity of signs and symptoms in patients with mastocytosis, the Mastocytosis Activity Score (MAS). METHODS Nineteen potential MAS items were developed in a combined approach consisting of semi-structured patient interviews, expert input and literature research. Item selection was performed by impact analysis with 76 patients followed by a review for face validity. The resulting MAS was tested for validity, reliability and influence factors. In parallel, a US American English version of the MAS was developed. RESULTS A total of 68 mastocytosis patients took part in the MAS validation study. The final 9-item MAS was found to have a three-domain structure ("skin," "gastrointestinal tract" and "other"), a valid total score and an excellent test-retest reliability. Multiple regression analysis revealed that disease duration, age or gender is not a significant determinant of the MAS results. CONCLUSIONS The MAS is a disease-specific, valid and reliable patient-reported outcome measure for adult patients with cutaneous and indolent systemic mastocytosis. It may serve as a valuable tool to measure and monitor mastocytosis activity, both, in clinical trials and in routine care.
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Affiliation(s)
- F. Siebenhaar
- Interdisciplinary Mastocytosis Center Charité; Department of Dermatology and Allergy; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - B. Sander
- Interdisciplinary Mastocytosis Center Charité; Department of Dermatology and Allergy; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - L. H. T. Ho
- Interdisciplinary Mastocytosis Center Charité; Department of Dermatology and Allergy; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - A. Ellrich
- Interdisciplinary Mastocytosis Center Charité; Department of Dermatology and Allergy; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - M. Maurer
- Interdisciplinary Mastocytosis Center Charité; Department of Dermatology and Allergy; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - K. Weller
- Interdisciplinary Mastocytosis Center Charité; Department of Dermatology and Allergy; Charité - Universitätsmedizin Berlin; Berlin Germany
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19
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Reber LL, Hernandez JD, Galli SJ. The pathophysiology of anaphylaxis. J Allergy Clin Immunol 2017; 140:335-348. [PMID: 28780941 PMCID: PMC5657389 DOI: 10.1016/j.jaci.2017.06.003] [Citation(s) in RCA: 265] [Impact Index Per Article: 37.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 06/12/2017] [Accepted: 06/14/2017] [Indexed: 01/14/2023]
Abstract
Anaphylaxis is a severe systemic hypersensitivity reaction that is rapid in onset; characterized by life-threatening airway, breathing, and/or circulatory problems; and usually associated with skin and mucosal changes. Because it can be triggered in some persons by minute amounts of antigen (eg, certain foods or single insect stings), anaphylaxis can be considered the most aberrant example of an imbalance between the cost and benefit of an immune response. This review will describe current understanding of the immunopathogenesis and pathophysiology of anaphylaxis, focusing on the roles of IgE and IgG antibodies, immune effector cells, and mediators thought to contribute to examples of the disorder. Evidence from studies of anaphylaxis in human subjects will be discussed, as well as insights gained from analyses of animal models, including mice genetically deficient in the antibodies, antibody receptors, effector cells, or mediators implicated in anaphylaxis and mice that have been "humanized" for some of these elements. We also review possible host factors that might influence the occurrence or severity of anaphylaxis. Finally, we will speculate about anaphylaxis from an evolutionary perspective and argue that, in the context of severe envenomation by arthropods or reptiles, anaphylaxis might even provide a survival advantage.
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Affiliation(s)
- Laurent L Reber
- Department of Immunology, Unit of Antibodies in Therapy and Pathology, Institut Pasteur, Paris, France; Institut National de la Santé et de la Recherche Médicale, Paris, France; Department of Pathology, Stanford University School of Medicine, Stanford, Calif; Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, Calif
| | - Joseph D Hernandez
- Department of Pediatrics, Division of Allergy, Immunology and Rheumatology, Stanford University School of Medicine, Stanford, Calif
| | - Stephen J Galli
- Department of Pathology, Stanford University School of Medicine, Stanford, Calif; Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, Calif; Department of Microbiology and Immunology, Stanford University School of Medicine, Stanford, Calif.
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20
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Urticaria and Angioedema: an Update on Classification and Pathogenesis. Clin Rev Allergy Immunol 2017; 54:88-101. [DOI: 10.1007/s12016-017-8628-1] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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21
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Watanabe M, Osada H, Shimizu S, Goto S, Nagai M, Shirai J, Sasaki K, Shimoda M, Itoh H, Ohmori K. Characterization of platelet-activating factor-induced cutaneous edema and erythema in dogs. Am J Vet Res 2017; 77:969-75. [PMID: 27580108 DOI: 10.2460/ajvr.77.9.969] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To characterize platelet-activating factor (PAF)-induced edema and erythema in the skin of dogs and compare those reactions with histamine-induced cutaneous reactions. ANIMALS 6 healthy Beagles. PROCEDURES Experiments were performed at ≥ 2-week intervals. Each dog received ID injections (5 μg/site) of PAF C16, PAF C18, lyso-PAF, and histamine. Edema (mean diameter) and erythema scores (none, mild, moderate, or severe) were assessed 30 minutes after the injections. Dogs received ID injections of PAF and histamine each with various concentrations of WEB 2086 (PAF receptor antagonist) or underwent ID testing with PAF and histamine before and 3 hours after oral administration of cetirizine hydrochloride or prednisolone (at 2 doses each). RESULTS ID injections of PAF C16 and PAF C18, but not lyso-PAF, induced comparable levels of edema and erythema. The PAF-induced edema and erythema peaked at 30 minutes and lasted for 6 hours after the injection; histamine-induced edema and erythema peaked at 30 minutes and lasted for 3 hours after the injection. Edema sizes and erythema scores were significantly smaller and lower, respectively, for PAF than for histamine. The WEB 2086 inhibited PAF-induced but not histamine-induced edema and erythema. Cetirizine slightly, but significantly, repressed PAF-induced edema and erythema as well as histamine-induced cutaneous reactions. Prednisolone suppressed both PAF-induced and histamine-induced edema and erythema. CONCLUSIONS AND CLINICAL RELEVANCE In canine skin, the duration of PAF-induced inflammation was longer than that of histamine-induced inflammation. The PAF- and histamine-induced cutaneous reactions were effectively suppressed by oral administration of prednisolone. The importance of PAF in dogs with anaphylaxis and allergic disorders warrants further investigation.
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22
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Erdő F, Hashimoto N, Karvaly G, Nakamichi N, Kato Y. Critical evaluation and methodological positioning of the transdermal microdialysis technique. A review. J Control Release 2016; 233:147-61. [DOI: 10.1016/j.jconrel.2016.05.035] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 05/10/2016] [Accepted: 05/13/2016] [Indexed: 01/28/2023]
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23
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Siebenhaar F, von Tschirnhaus E, Hartmann K, Rabenhorst A, Staubach P, Peveling-Oberhag A, Wagner N, Martus P, Carter MC, Metcalfe DD, Church MK, Maurer M, Weller K. Development and validation of the mastocytosis quality of life questionnaire: MC-QoL. Allergy 2016; 71:869-77. [PMID: 26797792 DOI: 10.1111/all.12842] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND Mastocytosis is a heterogeneous disease characterized by a clonal expansion of mast cells in various organs. The vast majority of patients affected suffer from signs and symptoms caused by mediator release from mast cells. Although the disease burden is high, there is currently no specific instrument to measure health-related quality of life (HRQoL) impairment in patients with mastocytosis. OBJECTIVE The aim of this study was to develop and validate a disease-specific tool to assess HRQoL impairment in patients with cutaneous and indolent systemic mastocytosis, the Mastocytosis Quality of Life Questionnaire (MC-QoL). METHODS Sixty-two potential MC-QoL items were developed in a combined approach consisting of semi-structured patient interviews, expert input and literature research. Item selection was performed by impact analysis with 76 patients and a final review for face validity. The resulting MC-QoL was tested for validity, reliability and influence factors. In parallel, an US American-English version of the MC-QoL was developed. RESULTS A total of 158 patients (41 CM, 41 MIS and 76 ISM) took part in the MC-QoL validation study. The final 27-item questionnaire was found to have a four-domain structure ('symptoms', 'emotions', 'social life/functioning' and 'skin'), a valid total score and an excellent test-retest reliability. Multiple regression analysis revealed disease duration, but not age, gender or skin involvement to be a significant determinant of HRQoL impairment in mastocytosis. CONCLUSIONS The MC-QoL is the first disease-specific HRQoL questionnaire for adult patients with cutaneous and indolent systemic mastocytosis. This short, validated and reliable instrument will serve as a valuable tool in future clinical studies and in routine patient care.
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Affiliation(s)
- F. Siebenhaar
- Department of Dermatology and Allergy; Interdisciplinary Mastocytosis Center Charité; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - E. von Tschirnhaus
- Department of Dermatology and Allergy; Interdisciplinary Mastocytosis Center Charité; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - K. Hartmann
- Department of Dermatology; University of Lübeck; Lübeck Germany
| | - A. Rabenhorst
- Department of Dermatology; University of Cologne; Cologne Germany
| | - P. Staubach
- Department of Dermatology; University Medical Center Mainz; Mainz Germany
| | | | - N. Wagner
- Department of Dermatology; Clinical Center Darmstadt; Darmstadt Germany
| | - P. Martus
- Department of Medical Biostatistics; Universitätsklinikum Tübingen; Tübingen Germany
| | - M. C. Carter
- Laboratory of Allergic Diseases; National Institute of Allergy and Infectious Diseases; National Institutes of Health; Bethesda MD USA
| | - D. D. Metcalfe
- Laboratory of Allergic Diseases; National Institute of Allergy and Infectious Diseases; National Institutes of Health; Bethesda MD USA
| | - M. K. Church
- Department of Dermatology and Allergy; Interdisciplinary Mastocytosis Center Charité; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - M. Maurer
- Department of Dermatology and Allergy; Interdisciplinary Mastocytosis Center Charité; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - K. Weller
- Department of Dermatology and Allergy; Interdisciplinary Mastocytosis Center Charité; Charité - Universitätsmedizin Berlin; Berlin Germany
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24
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Ng CL, Wang DY. Latest developments in allergic rhinitis in Allergy for clinicians and researchers. Allergy 2015; 70:1521-30. [PMID: 26443244 DOI: 10.1111/all.12782] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2015] [Indexed: 02/06/2023]
Abstract
Research efforts in allergic rhinitis have always been intense. Over the past 3 years, numerous breakthroughs in basic science and clinical research have been made, augmenting our understanding of this condition that afflicts a significant proportion of the global population. New epidemiological findings, novel insights into the molecular and cellular mechanisms of allergy, enhancement of current developmental theories, new concepts of the goals and endpoints of management, and latest therapeutic modalities that includes the harnessing of information technology and big data are some areas where important advances were made. We attempt to bring you a summary of the key research advances made in the field of allergic rhinitis from 2013 to 2015.
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Affiliation(s)
- C. L. Ng
- Department of Otolaryngology; Yong Loo Lin School of Medicine; National University of Singapore; National University Health System; Singapore City Singapore
| | - D. Y. Wang
- Department of Otolaryngology; Yong Loo Lin School of Medicine; National University of Singapore; National University Health System; Singapore City Singapore
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25
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Metz M, Weller K, Neumeister C, Izquierdo I, Bödeker RH, Schwantes U, Maurer M. Rupatadine in Established Treatment Schemes Improves Chronic Spontaneous Urticaria Symptoms and Patients' Quality of Life: a Prospective, Non-interventional Trial. Dermatol Ther (Heidelb) 2015; 5:217-230. [PMID: 26591001 PMCID: PMC4674450 DOI: 10.1007/s13555-015-0089-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Indexed: 11/10/2022] Open
Abstract
Introduction Chronic spontaneous urticaria (CSU) is a common and hard to treat condition associated with a substantial negative impact on patients’ quality of life (QoL). Clinical studies have shown that rupatadine is effective and safe in the treatment of CSU, but data from routine clinical care are scarce. Therefore, we assessed the effectiveness and tolerability of rupatadine in established dosages on CSU activity and patients’ QoL in a routine daily practice setting. Methods This was an open, prospective, non-interventional study performed in 146 dermatological practices in Germany. CSU patients for whom treatment with rupatadine was indicated were eligible to participate. Key symptoms of urticaria activity and their impact on patients’ QoL were assessed at the beginning and the end of treatment. Adverse events (AEs) and withdrawals, as well as the dosage regimens chosen, were documented. Patients and physicians were requested to rate effectiveness and tolerability of therapy at the final visit. All statistical analyses were descriptive. Results The majority of the 660 patients screened to be treated (median age 44 years, IQR = 31–59 years, n = 654) received rupatadine 10 mg tablets once (477 patients) or twice (105 patients) daily for a median time of 28 days. After treatment, 93.2% of the patients (606/650) reported a clear overall improvement of symptoms. Rupatadine significantly reduced the urticaria activity score (UAS7) as well as the frequency and severity of existing angioedema episodes. Similarly all domains of the urticaria-specific QoL questionnaire (CU-Q2oL) were markedly improved. The majority of physicians and patients rated rupatadine treatment as effective and well tolerated. There were 39 (5.9%) early treatment withdrawals, and 21 patients (3.2%) experienced AEs. Conclusion Rupatadine when given according to the routine treating schemes improves symptoms and CU-Q2oL of CSU patients; the drug is also safe and well tolerated. Funding Dr. R. Pfleger GmbH. Electronic supplementary material The online version of this article (doi:10.1007/s13555-015-0089-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Martin Metz
- Department of Dermatology and Allergy, Allergy-Centre-Charité, Charité-University Hospital Berlin, Berlin, Germany
| | - Karsten Weller
- Department of Dermatology and Allergy, Allergy-Centre-Charité, Charité-University Hospital Berlin, Berlin, Germany
| | - Claudia Neumeister
- Department of Medical Science/Clinical Research, Dr. R. Pfleger GmbH, Bamberg, Germany
| | - Iñaki Izquierdo
- Department of Clinical Research, Uriach Group, Barcelona, Spain
| | - Rolf-Hasso Bödeker
- Department of Statistics, Institute for Medical Informatics, University Clinic Giessen, Giessen, Germany
| | - Ulrich Schwantes
- Department of Medical Science/Clinical Research, Dr. R. Pfleger GmbH, Bamberg, Germany.
| | - Marcus Maurer
- Department of Dermatology and Allergy, Allergy-Centre-Charité, Charité-University Hospital Berlin, Berlin, Germany
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Mullol J, Bousquet J, Bachert C, Canonica GW, Giménez-Arnau A, Kowalski ML, Simons FER, Maurer M, Ryan D, Scadding G. Update on rupatadine in the management of allergic disorders. Allergy 2015; 70 Suppl 100:1-24. [PMID: 25491409 DOI: 10.1111/all.12531] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2014] [Indexed: 12/27/2022]
Abstract
In a review of rupatadine published in 2008, the primary focus was on its role as an antihistamine, with a thorough evaluation of its pharmacology and interaction with histamine H1 -receptors. At the time, however, evidence was already emerging of a broader mechanism of action for rupatadine involving other mediators implicated in the inflammatory cascade. Over the past few years, the role of platelet-activating factor (PAF) as a potent mediator involved in the hypersensitivity-type allergic reaction has gained greater recognition. Rupatadine has dual affinity for histamine H1 -receptors and PAF receptors. In view of the Allergic Rhinitis and its Impact on Asthma group's call for oral antihistamines to exhibit additive anti-allergic/anti-inflammatory properties, further exploration of rupatadine's anti-PAF effects was a logical step forward. New studies have demonstrated that rupatadine inhibits PAF effects in nasal airways and produces a greater reduction in nasal symptoms than levocetirizine. A meta-analysis involving more than 2500 patients has consolidated the clinical evidence for rupatadine in allergic rhinoconjunctivitis in adults and children (level of evidence Ia, recommendation A). Other recent advances include observational studies of rupatadine in everyday clinical practice situations and approval of a new formulation (1 mg/ml oral solution) for use in children. In this reappraisal, we revisit some key properties and pivotal clinical studies of rupatadine and examine new clinical data in more detail including studies that measured health-related quality of life and studies that investigated the efficacy and safety of rupatadine in other indications such as acquired cold urticaria, mosquito bite allergy and mastocytosis.
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Affiliation(s)
- J. Mullol
- Unitat de Rinologia i Clínica de l'Olfacte; Servei d'ORL; Hospital Clínic; Clinical & Experimental Respiratory Immunoallergy; IDIBAPS; Barcelona Spain
| | - J. Bousquet
- University Hôpital Arnaud de Villeneuve and INSERM; Montpellier France
| | - C. Bachert
- Department of Oto-Rhino-Laryngology; Upper Airway Research Laboratory (URL); Ghent University Hospital; Ghent Belgium
| | - G. W. Canonica
- Department of Internal Medicine; Respiratory Diseases and Allergy Clinic; University of Genoa; Genoa Italy
| | - A. Giménez-Arnau
- Department of Dermatology; Hospital del Mar; Universitat Autònoma; Barcelona Spain
| | - M. L. Kowalski
- Department of Immunology, Rheumatology and Allergy; Medical University of Lodz; Lodz Poland
| | - F. E. R. Simons
- Department of Pediatrics and Child Health, and Department of Immunology; University of Manitoba; Winnipeg Canada
| | - M. Maurer
- Department of Dermatology and Allergy; Allergie-Centrum-Charité; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - D. Ryan
- University of Edinburgh; Edinburgh UK
| | - G. Scadding
- Department of Allergy and Rhinology; Royal National Throat, Nose and Ear Hospital; London UK
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Abstract
Skin diseases with an allergic background such as atopic dermatitis, allergic contact dermatitis, and urticaria are very common. Moreover, diseases arising from a dysfunction of immune cells and/or their products often manifest with skin symptoms. This review aims to summarize recently published articles in order to highlight novel research findings, clinical trial results, and current guidelines on disease management. In recent years, an immense progress has been made in understanding the link between skin barrier dysfunction and allergic sensitization initiating the atopic march. In consequence, new strategies for treatment and prevention have been developed. Novel pathogenic insights, for example, into urticaria, angioedema, mastocytosis, led to the development of new therapeutic approaches and their implementation in daily patient care. By understanding distinct pathomechanisms, for example, the role of IL-1, novel entities such as autoinflammatory diseases have been described. Considerable effort has been made to improve and harmonize patient management as documented in several guidelines and position papers.
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Affiliation(s)
- C. Schlapbach
- Department of Dermatology, Inselspital; Bern University Hospital; University of Bern; Bern Switzerland
| | - D. Simon
- Department of Dermatology, Inselspital; Bern University Hospital; University of Bern; Bern Switzerland
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Sahu RP, Rezania S, Ocana JA, DaSilva-Arnold SC, Bradish JR, Richey JD, Warren SJ, Rashid B, Travers JB, Konger RL. Topical application of a platelet activating factor receptor agonist suppresses phorbol ester-induced acute and chronic inflammation and has cancer chemopreventive activity in mouse skin. PLoS One 2014; 9:e111608. [PMID: 25375862 PMCID: PMC4222871 DOI: 10.1371/journal.pone.0111608] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 10/02/2014] [Indexed: 12/21/2022] Open
Abstract
Platelet activating factor (PAF) has long been associated with acute edema and inflammatory responses. PAF acts by binding to a specific G-protein coupled receptor (PAF-R, Ptafr). However, the role of chronic PAF-R activation on sustained inflammatory responses has been largely ignored. We recently demonstrated that mice lacking the PAF-R (Ptafr-/- mice) exhibit increased cutaneous tumorigenesis in response to a two-stage chemical carcinogenesis protocol. Ptafr-/- mice also exhibited increased chronic inflammation in response to phorbol ester application. In this present study, we demonstrate that topical application of the non-hydrolysable PAF mimetic (carbamoyl-PAF (CPAF)), exerts a potent, dose-dependent, and short-lived edema response in WT mice, but not Ptafr -/- mice or mice deficient in c-Kit (c-KitW-sh/W-sh mice). Using an ear inflammation model, co-administration of topical CPAF treatment resulted in a paradoxical decrease in both acute ear thickness changes associated with a single PMA application, as well as the sustained inflammation associated with chronic repetitive PMA applications. Moreover, mice treated topically with CPAF also exhibited a significant reduction in chemical carcinogenesis. The ability of CPAF to suppress acute and chronic inflammatory changes in response to PMA application(s) was PAF-R dependent, as CPAF had no effect on basal or PMA-induced inflammation in Ptafr-/- mice. Moreover, c-Kit appears to be necessary for the anti-inflammatory effects of CPAF, as CPAF had no observable effect in c-KitW-sh/W-sh mice. These data provide additional evidence that PAF-R activation exerts complex immunomodulatory effects in a model of chronic inflammation that is relevant to neoplastic development.
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Affiliation(s)
- Ravi P. Sahu
- Departments of Pathology & Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, 46202, United States of America
| | - Samin Rezania
- Departments of Pathology & Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, 46202, United States of America
| | - Jesus A. Ocana
- Department of Dermatology, Indiana University School of Medicine, Indianapolis, IN, 46202, United States of America
| | - Sonia C. DaSilva-Arnold
- Departments of Pathology & Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, 46202, United States of America
- Department of Dermatology, Indiana University School of Medicine, Indianapolis, IN, 46202, United States of America
| | - Joshua R. Bradish
- Departments of Pathology & Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, 46202, United States of America
| | - Justin D. Richey
- Departments of Pathology & Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, 46202, United States of America
| | - Simon J. Warren
- Departments of Pathology & Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, 46202, United States of America
| | - Badri Rashid
- Departments of Pathology & Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, 46202, United States of America
| | - Jeffrey B. Travers
- Department of Dermatology, Indiana University School of Medicine, Indianapolis, IN, 46202, United States of America
- Richard L. Roudebush Veterans Administration Medical Center, Indianapolis, IN, 46202, United States of America
| | - Raymond L. Konger
- Departments of Pathology & Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, 46202, United States of America
- Department of Dermatology, Indiana University School of Medicine, Indianapolis, IN, 46202, United States of America
- * E-mail:
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Palikhe S, Palikhe NS, Kim SH, Yoo HS, Shin YS, Park HS. Elevated platelet activation in patients with chronic urticaria: a comparison between aspirin-intolerant and aspirin-tolerant groups. Ann Allergy Asthma Immunol 2014; 113:276-81. [PMID: 25037610 DOI: 10.1016/j.anai.2014.06.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Revised: 05/26/2014] [Accepted: 06/16/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Platelets are actively involved in immune inflammatory processes that release inflammatory mediators. Platelet activation has been reported in various inflammatory diseases; however, few studies have described platelet involvement in chronic urticaria (CU). OBJECTIVE To investigate platelet-activation markers, namely P2Y12 receptor and P-selectin expression, and soluble P-selectin level in patients with aspirin-intolerant CU (AICU) and aspirin-tolerant CU (ATCU). METHODS Forty-eight patients with CU and 25 normal controls were enrolled in this study. Aspirin intolerance in patients with CU was confirmed by an oral provocation test. P2Y12 and P-selectin expressions on platelets were measured using flow cytometry; soluble P-selectin level in plasma was measured by enzyme-linked immunosorbent assay. To study the functional effects of aspirin, platelets were treated with aspirin (2 mmol/L) and the expressions of P2Y12 and P-selectin were compared between the AICU and ATCU groups. RESULTS The expression of P2Y12 was significantly higher in patients with CU compared with controls, whereas no significant difference was noted in the expression of P-selectin level. The levels were not significantly different according to urticaria symptom score, symptom control status, and aspirin intolerance. Soluble P-selectin level was significantly higher in the AICU group than in the ATCU group compared with controls. Aspirin did not significantly suppress P2Y12 and P-selectin expressions on platelets in the AICU group, whereas significant suppression was noted in the ATCU group. CONCLUSION These findings suggest that increased platelet activation contributes to skin inflammation in patients with AICU and those with ATCU. The functional difference of platelets in response to aspirin may contribute to persistent skin inflammation in patients with AICU.
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Affiliation(s)
- Sailesh Palikhe
- Department of Biomedical Sciences, Graduate School of Ajou University, Suwon, Korea; Department of Allergy and Clinical Immunology, Ajou University, School of Medicine, Suwon, South Korea
| | - Nami Shrestha Palikhe
- Pulmonary Research Group, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Seung-Hyun Kim
- Department of Allergy and Clinical Immunology, Ajou University, School of Medicine, Suwon, South Korea
| | - Hye-Soo Yoo
- Department of Biomedical Sciences, Graduate School of Ajou University, Suwon, Korea
| | - Yoo Seob Shin
- Department of Biomedical Sciences, Graduate School of Ajou University, Suwon, Korea
| | - Hae-Sim Park
- Department of Biomedical Sciences, Graduate School of Ajou University, Suwon, Korea; Department of Allergy and Clinical Immunology, Ajou University, School of Medicine, Suwon, South Korea.
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Kubanov AA, Chikin VV. The benefit of H2 receptors antagonist Rupatadine in treatment for urticaria. VESTNIK DERMATOLOGII I VENEROLOGII 2014. [DOI: 10.25208/0042-4609-2014-90-3-116-120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Second generation antihistamine drugs are mainly used for the therapy of patients suffering from urticaria; however, they are efficient in 45-60% of cases only. New drugs for treatment of urticaria need to be developed and implemented, and second generation antihistamine drug Rupatadine is one of them. At the same time, Rupatadine efficiently inhibits the inflammatory action of the platelet-activating factor. Due to its double action, Rupatadine used perorally in the dose of 10 mg once a day is an efficient drug for treatment of urticaria, and its safety was confirmed by clinical trials.
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Rupatadine effectively prevents the histamine-induced up regulation of histamine H1R and bradykinin B2R receptor gene expression in the rat paw. Pharmacol Rep 2014; 66:952-5. [PMID: 25443720 DOI: 10.1016/j.pharep.2014.06.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 05/14/2014] [Accepted: 06/05/2014] [Indexed: 11/21/2022]
Abstract
BACKGROUND Activation of histamine H1 receptor (H1R) is a well-known hallmark of allergic and inflammatory pathology. Both types of bradykinin receptors (B1R and B2R) are also known to contribute significantly to the latter and some sort of functional interaction between them and H1R has been alluded to in the past. Here we use an experimental model of rat paw oedema formation to examine the effect of exogenously added histamine on the gene expression of H1R and bradykinin receptors B1R and B2R, alone or in combination to rupatadine, a second generation antihistamine agent. METHODS Histamine-induced oedema formation was monitored with a plethysmometer. The gene expression of H1R, B1R and B2R was analyzed with both conventional and real-time PCR. Rupatadine fumarate was used in pure form and administered intraperitoneally, prior to histamine injection into the paw. Microscopy of haematoxylin and eosin-stained sections of paw tissue was used to examine effects on tissue architecture. RESULTS Histamine injection into the paw resulted in significant up regulation of H1R and B2R without inducing significant cellular infiltration, but appears to affect less the expression of B1R. Rupatadine was, under the conditions used in this study, very effective in preventing this effect and in suppressing oedema formation through its antihistamine action. CONCLUSION Rupatadine has a suppressing effect on H1R and B2R gene expression which could add to its efficacy towards allergy and allergy-like conditions.
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32
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Rupatadine for the treatment of allergic rhinitis and urticaria: a look at the clinical data. ACTA ACUST UNITED AC 2014. [DOI: 10.4155/cli.14.26] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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