1
|
Núñez R, Doña I, Cornejo-García JA. Predictive models and applicability of artificial intelligence-based approaches in drug allergy. Curr Opin Allergy Clin Immunol 2024; 24:189-194. [PMID: 38814733 DOI: 10.1097/aci.0000000000001002] [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: 06/01/2024]
Abstract
PURPOSE OF REVIEW Drug allergy is responsible for a huge burden on public healthcare systems, representing in some instances a threat for patient's life. Diagnosis is complex due to the heterogeneity of clinical phenotypes and mechanisms involved, the limitations of in vitro tests, and the associated risk to in vivo tests. Predictive models, including those using recent advances in artificial intelligence, may circumvent these drawbacks, leading to an appropriate classification of patients and improving their management in clinical settings. RECENT FINDINGS Scores and predictive models to assess drug allergy development, including patient risk stratification, are scarce and usually apply logistic regression analysis. Over recent years, different methods encompassed under the general umbrella of artificial intelligence, including machine and deep learning, and artificial neural networks, are emerging as powerful tools to provide reliable and optimal models for clinical diagnosis, prediction, and precision medicine in different types of drug allergy. SUMMARY This review provides general concepts and current evidence supporting the potential utility of predictive models and artificial intelligence branches in drug allergy diagnosis.
Collapse
Affiliation(s)
- Rafael Núñez
- Allergy Research Group, Biomedical Research Institute of Malaga (IBIMA)-BIONAND Platform
| | - Inmaculada Doña
- Allergy Research Group, Biomedical Research Institute of Malaga (IBIMA)-BIONAND Platform
- Allergy Unit, Malaga Regional University Hospital, Malaga
- Inflammatory Diseases Network (RICORS, RD21/0002/0008, Instituto de Salud Carlos III), Málaga, Spain
| | - José Antonio Cornejo-García
- Allergy Research Group, Biomedical Research Institute of Malaga (IBIMA)-BIONAND Platform
- Allergy Unit, Malaga Regional University Hospital, Malaga
- Inflammatory Diseases Network (RICORS, RD21/0002/0008, Instituto de Salud Carlos III), Málaga, Spain
| |
Collapse
|
2
|
Fernandez-Santamaria R, Ariza A, Bogas G, Salas M, Calvo-Serrano S, Frecha C, Mayorga C, Torres MJ, Fernandez TD. Involvement of autologous myeloid dendritic cells in the evaluation of immediate hypersensitivity reactions to betalactams. Clin Immunol 2024; 262:110166. [PMID: 38432423 DOI: 10.1016/j.clim.2024.110166] [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: 09/29/2023] [Revised: 02/01/2024] [Accepted: 02/26/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Amoxicillin (AX) and clavulanic acid (CLV) are the betalactam antibiotics (BLs) most used to treat bacterial infections, although they can trigger immediate hypersensitivity reactions (IDHRs). The maturation analysis of monocyte-derived dendritic cells (moDCs) and their capacity to induce proliferative response of lymphocytes are useful to test the sensitisation to a drug, although without optimal sensitivity. Nevertheless, this can be improved using directly isolated DCs such as myeloid DCs (mDCs). METHODS mDCs and moDCs were obtained from 28 allergic patients (AP), 14 to AX, 14 to CLV and from 10 healthy controls (HC). The expression of CCR7, CD40, CD80, CD83, and CD86 was analysed after stimulation with both BLs. We measured the capacity of these pre-primed DCs to induce drug-specific activation of different lymphocyte subpopulations, CD3+, CD4+, CD8+, CD4+Th1, and CD4+Th2, by flow cytometry. RESULTS Higher expression of CCR7, CD40, CD80, CD83, and CD86 was observed on mDCs compared to moDCs from AP after stimulating with the culprit BL. Similarly, mDCs induced higher proliferative response, mainly of CD4+Th2 cells, compared to moDCs, reaching up to 67% of positive results with AX, whereas of only 25% with CLV. CONCLUSIONS mDCs from selective AP efficiently recognise the culprit drug which trigger the IDHR. mDCs also trigger proliferation of lymphocytes, mainly those with a Th2 cytokine pattern, although these responses depend on the nature of the drug, mimicking the patient's reaction.
Collapse
Affiliation(s)
- Ruben Fernandez-Santamaria
- Allergy Research Group, IBIMA Plataforma BIONAND, Málaga, Spain; Departamento de Medicina, Universidad de Málaga-UMA, Málaga, Spain
| | - Adriana Ariza
- Allergy Research Group, IBIMA Plataforma BIONAND, Málaga, Spain; Allergy Unit, Hospital Regional Universitario de Málaga-ARADyAL, Málaga, Spain.
| | - Gador Bogas
- Allergy Research Group, IBIMA Plataforma BIONAND, Málaga, Spain; Allergy Unit, Hospital Regional Universitario de Málaga-ARADyAL, Málaga, Spain
| | - Maria Salas
- Allergy Research Group, IBIMA Plataforma BIONAND, Málaga, Spain; Allergy Unit, Hospital Regional Universitario de Málaga-ARADyAL, Málaga, Spain
| | - Silvia Calvo-Serrano
- Allergy Research Group, IBIMA Plataforma BIONAND, Málaga, Spain; Departamento de Medicina, Universidad de Málaga-UMA, Málaga, Spain
| | - Cecilia Frecha
- Allergy Research Group, IBIMA Plataforma BIONAND, Málaga, Spain
| | - Cristobalina Mayorga
- Allergy Research Group, IBIMA Plataforma BIONAND, Málaga, Spain; Allergy Unit, Hospital Regional Universitario de Málaga-ARADyAL, Málaga, Spain
| | - Maria Jose Torres
- Allergy Research Group, IBIMA Plataforma BIONAND, Málaga, Spain; Departamento de Medicina, Universidad de Málaga-UMA, Málaga, Spain; Allergy Unit, Hospital Regional Universitario de Málaga-ARADyAL, Málaga, Spain
| | - Tahia Diana Fernandez
- Allergy Research Group, IBIMA Plataforma BIONAND, Málaga, Spain; Departamento de Biología Celular, Genética y Fisiología, Universidad de Málaga-UMA, Málaga, Spain
| |
Collapse
|
3
|
Sáenz de Santa María R, Bogas G, Labella M, Ariza A, Salas M, Doña I, Torres MJ. Approach for delabeling beta-lactam allergy in children. FRONTIERS IN ALLERGY 2023; 4:1298335. [PMID: 38033918 PMCID: PMC10684789 DOI: 10.3389/falgy.2023.1298335] [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: 09/21/2023] [Accepted: 10/24/2023] [Indexed: 12/02/2023] Open
Abstract
A considerable number of pediatric patients treated with beta-lactam (BL) antibiotics develop delayed onset of skin rashes during the course of treatment. Although the most frequent cause of these symptoms is infectious, many cases are labeled as allergic reactions to these drugs. BL allergy labels could have a negative impact, as they imply avoidance of this group of drugs and the use of second-line antibiotics, leading to a potential increase in adverse effects and the utilization of less effective therapies. This constitutes a major public health concern and economic burden, as the use of broad-spectrum antibiotics can result in multidrug-resistant organisms and prolonged hospital stays. Therefore, it is crucial to delabel patients during childhood to avoid false labeling in adult life. Although the label of BL allergy is among the most frequent causes of allergy referral, its management remains controversial, and new diagnostic perspectives are changing the paradigm of managing BL allergies in children. Traditionally, drug provocation testing (DPT) was exclusively performed in patients who had previously obtained negative results from skin tests (STs). However, the sensitivity of STs is low, and the role of in vitro testing in the pediatric population is not well defined. Recent studies have demonstrated the safety of direct DPT without prior ST or serum tests for pediatric patients who report a low-risk reaction to BLs, which is cost-effective. However, there is still a debate on the optimal allergic workup to be performed in children with a benign immediate reaction and the management of children with severe cutaneous adverse drug reactions. In this review, we will discuss the impact of the label of BL allergy and the role of the different tools currently available to efficiently address BL allergy delabeling in children.
Collapse
Affiliation(s)
- R. Sáenz de Santa María
- Allergy Unit, Hospital Regional Universitario de Málaga, Hospital Civil, Málaga, Spain
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Civil, Málaga, Spain
| | - G. Bogas
- Allergy Unit, Hospital Regional Universitario de Málaga, Hospital Civil, Málaga, Spain
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Civil, Málaga, Spain
| | - M. Labella
- Allergy Unit, Hospital Regional Universitario de Málaga, Hospital Civil, Málaga, Spain
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Civil, Málaga, Spain
| | - A. Ariza
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Civil, Málaga, Spain
| | - M. Salas
- Allergy Unit, Hospital Regional Universitario de Málaga, Hospital Civil, Málaga, Spain
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Civil, Málaga, Spain
| | - I. Doña
- Allergy Unit, Hospital Regional Universitario de Málaga, Hospital Civil, Málaga, Spain
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Civil, Málaga, Spain
| | - M. J. Torres
- Allergy Unit, Hospital Regional Universitario de Málaga, Hospital Civil, Málaga, Spain
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Civil, Málaga, Spain
- Nanostructures for Diagnosing and Treatment of Allergic Diseases Laboratory, Andalusian Center for Nanomedicine and Biotechnology-BIONAND, Parque Tecnológico de Andalucía, Málaga, Spain
- Departamento de Medicina, Universidad de Málaga, Facultad de Medicina, Málaga, Spain
| |
Collapse
|
4
|
Celik GE, Guloglu Karatas D, Aydin O, Dogu F, Ikinciogullari A. Diagnostic utility of basophil CD203c expression in β-lactam allergy. Allergy Asthma Proc 2023; 44:200-207. [PMID: 37160747 DOI: 10.2500/aap.2023.44.230013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Background: A diagnosis of immunoglobulin E (IgE) mediated reactions to β-lactam (BL) antibiotics is still challenging because of the limited availability of skin-prick test (SPT), and standardization issues, particularly with newer BLs, are still ongoing. Because encouraging data are increasingly emerging in the use of basophil activation tests in the diagnosis of IgE-mediated drug hypersensitivity reactions, in this study, we aimed to determine CD203c expression, a basophil surface marker, in the diagnosis of IgE-mediated hypersensitivity to BL antibiotics. Methods: This study included two groups of subjects. The first group (group 1) (n = 20) included patients with a diagnosis of IgE-mediated allergy to BLs as confirmed through STs or drug provocation tests, and the control group consisted of healthy volunteers (group 2) (n = 24). Expression of CD203c by flow cytometry was studied in samples stimulated by two different concentrations of six different BL antibiotics. A stimulation index ≥ 2 was considered a positive response. Results: The study groups had comparable age and sex distribution. In the entire group, the sensitivity and specificity of CD203c were 29.4% (5 out of 17) and 82.6% (19 out of 23), respectively. When considering the single reactors, two among four patients who were allergic to amoxicillin demonstrated upregulation of CD203c with amoxicillin, which makes 50% sensitivity. The specificity was 100%. Conclusion: Our data demonstrated that assessment of CD203c in the diagnosis of IgE-mediated reactions to BLs provided encouraging results, particularly with amoxicillin allergy. However, this finding needs to be verified in a larger number of cases.
Collapse
Affiliation(s)
- Gulfem Elif Celik
- From the, Department of Chest Diseases, Division of Immunology and Allergy, Ankara, Turkey, and
| | | | - Omur Aydin
- From the, Department of Chest Diseases, Division of Immunology and Allergy, Ankara, Turkey, and
| | - Figen Dogu
- Department of Pediatric Immunology and Allergy, Ankara, Turkey
| | | |
Collapse
|
5
|
Doña I, Guidolin L, Bogas G, Olivieri E, Labella M, Schiappoli M, Sáenz de Santa María R, Dama A, Salas M, Senna G, Bonadonna P, Torres MJ. Resensitization in suspected penicillin allergy. Allergy 2023; 78:214-224. [PMID: 36067012 PMCID: PMC10087608 DOI: 10.1111/all.15508] [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: 05/04/2022] [Revised: 07/29/2022] [Accepted: 08/08/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND The diagnosis of allergic reactions to penicillins (AR-PEN) is very complex as there is a loss of sensitization over time, which leads to negative skin tests (STs) and specific IgE in serum, and even to tolerance to the drug involved. However, STs may become positive after subsequent exposure to the culprit drug (resensitization), with the risk of inducing potentially severe reactions. The exact rate of resensitization to penicillins is unknown, ranging from 0% to 27.9% in published studies. OBJECTIVES To analyze the rate of resensitization in patients with suggestive AR-PEN by repeating STs (retest) after an initial evaluation (IE). MATERIAL AND METHODS Patients with suspected AR-PEN were prospectively evaluated between 2017 and 2020. They underwent STs, and a randomized group also underwent a drug provocation test (DPT) with the culprit. Only patients with negative STs and/or DPT were included. All included cases were retested by STs at 2-8 weeks. RESULTS A total of 545 patients were included: 296 reporting immediate reactions (IRs) and 249 non-immediate reactions (NIRs). Eighty (14.7%) cases had positive results in retest (RT+): 63 (21.3%) IRs and 17 (6.8%) NIRs (p < 0.0001). The rate of RT+ was higher in anaphylaxis compared with all other reactions (45.8% vs 9.1%, p < 0.0001). The risk of RT+ was higher from the fifth week after IE (OR: 4.64, CI: 2.1-11.6; p < 0.001) and increased with the patient's age (OR: 1.02; CI: 1.01-1.04; p = 0.009). CONCLUSIONS Due to the high rate of resensitization, retest should be included in the diagnostic algorithm of IRs to penicillins after an initial negative study, especially in anaphylaxis, to avoid potentially severe reactions after subsequent prescriptions of these drugs.
Collapse
Affiliation(s)
- Inmaculada Doña
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain.,Allergy Unit, Hospital Regional Universitario de Málaga, Málaga, Spain
| | | | - Gádor Bogas
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain.,Allergy Unit, Hospital Regional Universitario de Málaga, Málaga, Spain
| | | | - Marina Labella
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain.,Allergy Unit, Hospital Regional Universitario de Málaga, Málaga, Spain
| | | | - Rocío Sáenz de Santa María
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain.,Allergy Unit, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Annarita Dama
- Allergy Unit, Verona University Hospital, Verona, Italy
| | - María Salas
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain.,Allergy Unit, Hospital Regional Universitario de Málaga, Málaga, Spain
| | | | | | - María José Torres
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain.,Allergy Unit, Hospital Regional Universitario de Málaga, Málaga, Spain.,Departamento de Medicina, Universidad de Málaga, Málaga, Spain.,Andalusian Center for Nanomedicine and Biotechnology-BIONAND, Málaga, Spain
| |
Collapse
|
6
|
Ariza A, Jaruthamsophon K, Meng X, Labella M, Adair K, Tailor A, Sukasem C, Whitaker P, Peckham D, Pirmohamed M, Torres MJ, Naisbitt DJ. Shared Clavulanate and Tazobactam Antigenic Determinants Activate T-Cells from Hypersensitive Patients. Chem Res Toxicol 2022; 35:2122-2132. [PMID: 36137197 PMCID: PMC9682523 DOI: 10.1021/acs.chemrestox.2c00231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
β-Lactamase inhibitors such as clavulanic acid and tazobactam were developed to overcome β-lactam antibiotic resistance. Hypersensitivity reactions to these drugs have not been studied in detail, and the antigenic determinants that activate T-cells have not been defined. The objectives of this study were to (i) characterize clavulanate- and tazobactam-responsive T-cells from hypersensitive patients, (ii) explore clavulanate and tazobactam T-cell crossreactivity, and (iii) define the antigenic determinants that contribute to T-cell reactivity. Antigen specificity, pathways of T-cell activation, and crossreactivity with clavulanate- and tazobactam-specific T-cell clones were assessed by proliferation and cytokine release assays. Antigenic determinants were analyzed by mass spectrometry-based proteomics methods. Clavulanate- and tazobactam-responsive CD4+ T-cell clones were stimulated to proliferate and secrete IFN-γ in an MHC class II-restricted and dose-dependent manner. T-cell activation with clavulanate- and tazobactam was dependent on antigen presenting cells because their fixation prevented the T-cell response. Strong crossreactivity was observed between clavulanate- and tazobactam-T-cells; however, neither drug activated β-lactam antibiotic-responsive T-cells. Mass spectrometric analysis revealed that both compounds form multiple antigenic determinants with lysine residues on proteins, including an overlapping aldehyde and hydrated aldehyde adduct with mass additions of 70 and 88 Da, respectively. Collectively, these data show that although clavulanate and tazobactam are structurally distinct, the antigenic determinants formed by both drugs overlap, which explains the observed T-cell cross-reactivity.
Collapse
Affiliation(s)
- Adriana Ariza
- Allergy
Research Group, Instituto de Investigación
Biomédica de Málaga-IBIMA, 29009 Málaga, Spain
| | - Kanoot Jaruthamsophon
- Department
of Pharmacology and Therapeutics, Institute of Systems, Molecular,
and Integrative Biology, University of Liverpool, Liverpool L69 3GE, U.K.,Division
of Pharmacogenomics and Personalized Medicine, Department of Pathology,
Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Xiaoli Meng
- Department
of Pharmacology and Therapeutics, Institute of Systems, Molecular,
and Integrative Biology, University of Liverpool, Liverpool L69 3GE, U.K.
| | - Marina Labella
- Allergy
Research Group, Instituto de Investigación
Biomédica de Málaga-IBIMA, 29009 Málaga, Spain,Allergy
Unit, Hospital Regional Universitario de
Málaga, 29009 Málaga, Spain
| | - Kareena Adair
- Department
of Pharmacology and Therapeutics, Institute of Systems, Molecular,
and Integrative Biology, University of Liverpool, Liverpool L69 3GE, U.K.
| | - Arun Tailor
- Department
of Pharmacology and Therapeutics, Institute of Systems, Molecular,
and Integrative Biology, University of Liverpool, Liverpool L69 3GE, U.K.
| | - Chonlaphat Sukasem
- Division
of Pharmacogenomics and Personalized Medicine, Department of Pathology,
Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Paul Whitaker
- Bradford
Teaching Hospitals NHS Trust, Bradford BD9 6DA, U.K.
| | - Daniel Peckham
- Regional
Adult Cystic Fibrosis Unit, St James’s
University Hospital, Leeds LS9 7TF, U.K.
| | - Munir Pirmohamed
- Department
of Pharmacology and Therapeutics, Institute of Systems, Molecular,
and Integrative Biology, University of Liverpool, Liverpool L69 3GE, U.K.
| | - María José Torres
- Allergy
Research Group, Instituto de Investigación
Biomédica de Málaga-IBIMA, 29009 Málaga, Spain,Allergy
Unit, Hospital Regional Universitario de
Málaga, 29009 Málaga, Spain,Andalusian
Center for Nanomedicine and Biotechnology-BIONAND, 29590 Málaga, Spain,Departamento
de Medicina, Universidad de Málaga, 29071 Málaga, Spain
| | - Dean John Naisbitt
- Department
of Pharmacology and Therapeutics, Institute of Systems, Molecular,
and Integrative Biology, University of Liverpool, Liverpool L69 3GE, U.K.,. Tel.: 0044 151 7945346
| |
Collapse
|
7
|
Fernandez‐Santamaria R, Bogas G, Montañez MI, Ariza A, Salas M, Cespedes JA, Labella M, Paris JL, Perez‐Sanchez N, Perez‐Inestrosa E, Vida Y, Fernandez TD, Mayorga C, Torres MJ. Synthetic antigenic determinants of clavulanic acid induce dendritic cell maturation and specific T cell proliferation in patients with immediate hypersensitivity reactions. Allergy 2022; 77:3070-3083. [PMID: 35611454 PMCID: PMC9796838 DOI: 10.1111/all.15383] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 04/19/2022] [Accepted: 05/04/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND Immediate drug hypersensitivity reactions (IDHRs) to clavulanic acid (CLV) have increased in the last decades due to a higher consumption alongside amoxicillin (AX). Due to its chemical instability, diagnostic procedures to evaluate IDHRs to CLV are difficult, and current in vitro assays do not have an optimal sensitivity. The inclusion of the specific metabolites after CLV degradation, which are efficiently recognised by the immune system, could help to improve sensitivity of in vitro tests. METHODS Recognition by dendritic cells (DCs) of CLV and the synthetic analogues of two of its hypothesised antigenic determinants (ADs) was evaluated by flow cytometry in 27 allergic patients (AP) and healthy controls (HC). Their ability to trigger the proliferation of T cells was also analysed by flow cytometry. RESULTS The inclusion of synthetic analogues of CLV ADs, significantly increased the expression of maturation markers on DCs from AP compared to HC. A different recognition pattern could be observed with each AD, and, therefore, the inclusion of both ADs achieves an improved sensitivity. The addition of synthetic ADs analogues increased the proliferative response of CD4+ Th2 compared to the addition of native CLV. The combination of results from both ADs increased the sensitivity of proliferative assays from 19% to 65% with a specificity higher than 90%. CONCLUSIONS Synthetic ADs from CLV are efficiently recognised by DCs with ability to activate CD4+ Th2 cells from AP. The combination of analogues from both ADs, significantly increased the sensitivity of DC maturation and T-cell proliferation compared to native CLV.
Collapse
Affiliation(s)
- Ruben Fernandez‐Santamaria
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga‐IBIMA‐ARADyALMálagaSpain,Departmento de Medicina, Universidad de Málaga‐UMAMálagaSpain
| | - Gador Bogas
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga‐IBIMA‐ARADyALMálagaSpain,Allergy Unit, Hospital Regional Universitario de Málaga‐HRUMMálagaSpain
| | - Maria Isabel Montañez
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga‐IBIMA‐ARADyALMálagaSpain,Departamento de Química Orgánica, Universidad de Málaga‐UMAMálagaSpain,Nanostructures for Diagnosing and Treatment of Allergic Diseases Laboratory, Centro Andaluz de Nanomedicina y Biotecnología‐BIONANDMálagaSpain
| | - Adriana Ariza
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga‐IBIMA‐ARADyALMálagaSpain
| | - Maria Salas
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga‐IBIMA‐ARADyALMálagaSpain,Allergy Unit, Hospital Regional Universitario de Málaga‐HRUMMálagaSpain
| | - Jose Antonio Cespedes
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga‐IBIMA‐ARADyALMálagaSpain,Departmento de Medicina, Universidad de Málaga‐UMAMálagaSpain
| | - Marina Labella
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga‐IBIMA‐ARADyALMálagaSpain,Allergy Unit, Hospital Regional Universitario de Málaga‐HRUMMálagaSpain
| | - Juan Luis Paris
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga‐IBIMA‐ARADyALMálagaSpain,Nanostructures for Diagnosing and Treatment of Allergic Diseases Laboratory, Centro Andaluz de Nanomedicina y Biotecnología‐BIONANDMálagaSpain
| | - Natalia Perez‐Sanchez
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga‐IBIMA‐ARADyALMálagaSpain,Allergy Unit, Hospital Regional Universitario de Málaga‐HRUMMálagaSpain
| | - Ezequiel Perez‐Inestrosa
- Departamento de Química Orgánica, Universidad de Málaga‐UMAMálagaSpain,Nanostructures for Diagnosing and Treatment of Allergic Diseases Laboratory, Centro Andaluz de Nanomedicina y Biotecnología‐BIONANDMálagaSpain
| | - Yolanda Vida
- Departamento de Química Orgánica, Universidad de Málaga‐UMAMálagaSpain,Nanostructures for Diagnosing and Treatment of Allergic Diseases Laboratory, Centro Andaluz de Nanomedicina y Biotecnología‐BIONANDMálagaSpain
| | - Tahia D. Fernandez
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga‐IBIMA‐ARADyALMálagaSpain,Departamento de Biología Celular, Genética y Fisiología, Universidad de Málaga‐UMAMálagaSpain
| | - Cristobalina Mayorga
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga‐IBIMA‐ARADyALMálagaSpain,Allergy Unit, Hospital Regional Universitario de Málaga‐HRUMMálagaSpain,Nanostructures for Diagnosing and Treatment of Allergic Diseases Laboratory, Centro Andaluz de Nanomedicina y Biotecnología‐BIONANDMálagaSpain
| | - Maria Jose Torres
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga‐IBIMA‐ARADyALMálagaSpain,Departmento de Medicina, Universidad de Málaga‐UMAMálagaSpain,Allergy Unit, Hospital Regional Universitario de Málaga‐HRUMMálagaSpain,Nanostructures for Diagnosing and Treatment of Allergic Diseases Laboratory, Centro Andaluz de Nanomedicina y Biotecnología‐BIONANDMálagaSpain
| |
Collapse
|
8
|
Gil-Ocaña V, Jimenez IM, Mayorga C, Doña I, Céspedes JA, Montañez MI, Vida Y, Torres MJ, Perez-Inestrosa E. Multiepitope Dendrimeric Antigen-Silica Particle Composites as Nano-Based Platforms for Specific Recognition of IgEs. Front Immunol 2021; 12:750109. [PMID: 34925325 PMCID: PMC8678411 DOI: 10.3389/fimmu.2021.750109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 11/08/2021] [Indexed: 12/22/2022] Open
Abstract
β-lactam antibiotics (BLs) are the drugs most frequently involved in drug hypersensitivity reactions. However, current in vitro diagnostic tests have limited sensitivity, partly due to a poor understanding of in vivo drug–protein conjugates that both induce the reactions and are immunologically recognized. Dendrimeric Antigen-Silica particle composites (DeAn@SiO2), consisting on nanoparticles decorated with BL-DeAns are promising candidates for improving the in vitro clinical diagnostic practice. In this nano-inspired system biology, the synthetic dendrimer plays the role of the natural carrier protein, emulating its haptenation by drugs and amplifying the multivalence. Herein, we present the design and synthesis of new multivalent mono- and bi-epitope DeAn@SiO2, using amoxicillin and/or benzylpenicillin allergenic determinants as ligands. The homogeneous composition of nanoparticles provides high reproducibility and quality, which is critical for in vitro applications. The suitable functionalization of nanoparticles allows the anchoring of DeAn, minimizing the nonspecific interactions and facilitating the effective exposure to specific IgE; while the larger interaction area increments the likelihood of capturing specific IgE. This achievement is particularly important for improving sensitivity of current immunoassays since IgE levels in BL allergic patients are very low. Our data suggest that these new nano-based platforms provide a suitable tool for testing IgE recognition to more than one BL simultaneously. Immunochemical studies evidence that mono and bi-epitope DeAn@SiO2 composites could potentially allow the diagnosis of patients allergic to any of these drugs with a single test. These organic–inorganic hybrid materials represent the basis for the development of a single screening for BL-allergies.
Collapse
Affiliation(s)
- Violeta Gil-Ocaña
- Universidad de Málaga-Instituto de Investigación Biomédica de Málaga (IBIMA), Dpto. Química Orgánica, Campus de Teatinos s/n, Málaga, Spain.,Centro Andaluz de Nanomedicina y Biotecnología-BIONAND, Parque Tecnológico de Andalucía, Málaga, Spain
| | - Isabel M Jimenez
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain.,Allergy Unit, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Cristobalina Mayorga
- Centro Andaluz de Nanomedicina y Biotecnología-BIONAND, Parque Tecnológico de Andalucía, Málaga, Spain.,Allergy Research Group, Instituto de Investigación Biomédica de Málaga-Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain.,Allergy Unit, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Inmaculada Doña
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain.,Allergy Unit, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Jose Antonio Céspedes
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| | - Maria I Montañez
- Centro Andaluz de Nanomedicina y Biotecnología-BIONAND, Parque Tecnológico de Andalucía, Málaga, Spain.,Allergy Research Group, Instituto de Investigación Biomédica de Málaga-Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| | - Yolanda Vida
- Universidad de Málaga-Instituto de Investigación Biomédica de Málaga (IBIMA), Dpto. Química Orgánica, Campus de Teatinos s/n, Málaga, Spain.,Centro Andaluz de Nanomedicina y Biotecnología-BIONAND, Parque Tecnológico de Andalucía, Málaga, Spain
| | - Maria J Torres
- Centro Andaluz de Nanomedicina y Biotecnología-BIONAND, Parque Tecnológico de Andalucía, Málaga, Spain.,Allergy Research Group, Instituto de Investigación Biomédica de Málaga-Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain.,Allergy Unit, Hospital Regional Universitario de Málaga, Málaga, Spain.,Universidad de Málaga-Instituto de Investigación Biomédica de Málaga (IBIMA), Dpto. Medicina, Campus de Teatinos s/n, Málaga, Spain
| | - Ezequiel Perez-Inestrosa
- Universidad de Málaga-Instituto de Investigación Biomédica de Málaga (IBIMA), Dpto. Química Orgánica, Campus de Teatinos s/n, Málaga, Spain.,Centro Andaluz de Nanomedicina y Biotecnología-BIONAND, Parque Tecnológico de Andalucía, Málaga, Spain
| |
Collapse
|
9
|
Ogulur I, Pat Y, Ardicli O, Barletta E, Cevhertas L, Fernandez‐Santamaria R, Huang M, Bel Imam M, Koch J, Ma S, Maurer DJ, Mitamura Y, Peng Y, Radzikowska U, Rinaldi AO, Rodriguez‐Coira J, Satitsuksanoa P, Schneider SR, Wallimann A, Zhakparov D, Ziadlou R, Brüggen M, Veen W, Sokolowska M, Baerenfaller K, Zhang L, Akdis M, Akdis CA. Advances and highlights in biomarkers of allergic diseases. Allergy 2021; 76:3659-3686. [PMID: 34519063 PMCID: PMC9292545 DOI: 10.1111/all.15089] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 05/19/2021] [Accepted: 09/08/2021] [Indexed: 12/16/2022]
Abstract
During the past years, there has been a global outbreak of allergic diseases, presenting a considerable medical and socioeconomical burden. A large fraction of allergic diseases is characterized by a type 2 immune response involving Th2 cells, type 2 innate lymphoid cells, eosinophils, mast cells, and M2 macrophages. Biomarkers are valuable parameters for precision medicine as they provide information on the disease endotypes, clusters, precision diagnoses, identification of therapeutic targets, and monitoring of treatment efficacies. The availability of powerful omics technologies, together with integrated data analysis and network‐based approaches can help the identification of clinically useful biomarkers. These biomarkers need to be accurately quantified using robust and reproducible methods, such as reliable and point‐of‐care systems. Ideally, samples should be collected using quick, cost‐efficient and noninvasive methods. In recent years, a plethora of research has been directed toward finding novel biomarkers of allergic diseases. Promising biomarkers of type 2 allergic diseases include sputum eosinophils, serum periostin and exhaled nitric oxide. Several other biomarkers, such as pro‐inflammatory mediators, miRNAs, eicosanoid molecules, epithelial barrier integrity, and microbiota changes are useful for diagnosis and monitoring of allergic diseases and can be quantified in serum, body fluids and exhaled air. Herein, we review recent studies on biomarkers for the diagnosis and treatment of asthma, chronic urticaria, atopic dermatitis, allergic rhinitis, chronic rhinosinusitis, food allergies, anaphylaxis, drug hypersensitivity and allergen immunotherapy. In addition, we discuss COVID‐19 and allergic diseases within the perspective of biomarkers and recommendations on the management of allergic and asthmatic patients during the COVID‐19 pandemic.
Collapse
|
10
|
Tesfaye A, Rodríguez‐Nogales A, Benedé S, Fernández TD, Paris JL, Rodriguez MJ, Jiménez‐Sánchez IM, Bogas G, Mayorga C, Torres MJ, Montañez MI. Nanoarchitectures for efficient IgE cross-linking on effector cells to study amoxicillin allergy. Allergy 2021; 76:3183-3193. [PMID: 33784407 PMCID: PMC8518075 DOI: 10.1111/all.14834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/28/2021] [Accepted: 03/14/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Amoxicillin (AX) is nowadays the β-lactam that more frequently induces immediate allergic reactions. Nevertheless, diagnosis of AX allergy is occasionally challenging due to risky in vivo tests and non-optimal sensitivity of in vitro tests. AX requires protein haptenation to form multivalent conjugates with increased size to be immunogenic. Knowing adduct structural features for promoting effector cell activation would help to improve in vitro tests. We aimed to identify the optimal structural requirement in specific cellular degranulation to AX using well-precised nanoarchitectures of different lengths. METHOD We constructed eight Bidendron Antigens (BiAns) based on polyethylene glycol (PEG) linkers of different lengths (600-12,000 Da), end-coupled with polyamidoamine dendrons that were terminally multi-functionalized with amoxicilloyl (AXO). In vitro IgE recognition was studied by competitive radioallergosorbent test (RAST) and antibody-nanoarchitecture complexes by transmission electron microscopy (TEM). Their allergenic activity was evaluated using bone marrow-derived mast cells (MCs) passively sensitized with mouse monoclonal IgE against AX and humanized RBL-2H3 cells sensitized with polyclonal antibodies from sera of AX-allergic patients. RESULTS All BiAns were recognized by AX-sIgE. Dose-dependent activation responses were observed in both cellular assays, only with longer structures, containing spacers in the range of PEG 6000-12,000 Da. Consistently, greater proportion of immunocomplexes and number of antibodies per complex for longer BiAns were visualized by TEM. CONCLUSIONS BiAns are valuable platforms to study the mechanism of effector cell activation. These nanomolecular tools have demonstrated the importance of the adduct size to promote effector cell activation in AX allergy, which will impact for improving in vitro diagnostics.
Collapse
Affiliation(s)
- Amene Tesfaye
- Andalusian Centre for Nanomedicine and Biotechnology‐BIONANDMálagaSpain
- Allergy Research GroupInstituto de Investigación Biomédica de Málaga‐IBIMAMálagaSpain
| | - Alba Rodríguez‐Nogales
- Andalusian Centre for Nanomedicine and Biotechnology‐BIONANDMálagaSpain
- Allergy Research GroupInstituto de Investigación Biomédica de Málaga‐IBIMAMálagaSpain
| | - Sara Benedé
- Instituto de Investigación en Ciencias de la Alimentación (CIALCSIC‐UAM)MadridSpain
| | - Tahía D. Fernández
- Allergy Research GroupInstituto de Investigación Biomédica de Málaga‐IBIMAMálagaSpain
- Departamento de Biología Celular Genética y FisiologíaFacultad de CienciasUniversidad de MálagaMálagaSpain
| | - Juan L. Paris
- Andalusian Centre for Nanomedicine and Biotechnology‐BIONANDMálagaSpain
- Allergy Research GroupInstituto de Investigación Biomédica de Málaga‐IBIMAMálagaSpain
| | - Maria J. Rodriguez
- Andalusian Centre for Nanomedicine and Biotechnology‐BIONANDMálagaSpain
- Allergy Research GroupInstituto de Investigación Biomédica de Málaga‐IBIMAMálagaSpain
| | - Isabel M. Jiménez‐Sánchez
- Andalusian Centre for Nanomedicine and Biotechnology‐BIONANDMálagaSpain
- Allergy Research GroupInstituto de Investigación Biomédica de Málaga‐IBIMAMálagaSpain
| | - Gador Bogas
- Allergy Research GroupInstituto de Investigación Biomédica de Málaga‐IBIMAMálagaSpain
- Allergy UnitHospital Regional Universitario de MálagaMálagaSpain
| | - Cristobalina Mayorga
- Andalusian Centre for Nanomedicine and Biotechnology‐BIONANDMálagaSpain
- Allergy Research GroupInstituto de Investigación Biomédica de Málaga‐IBIMAMálagaSpain
- Allergy UnitHospital Regional Universitario de MálagaMálagaSpain
| | - María J. Torres
- Andalusian Centre for Nanomedicine and Biotechnology‐BIONANDMálagaSpain
- Allergy Research GroupInstituto de Investigación Biomédica de Málaga‐IBIMAMálagaSpain
- Allergy UnitHospital Regional Universitario de MálagaMálagaSpain
- Departamento de MedicinaFacultad de MedicinaUniversidad de MálagaMálagaSpain
| | - María I. Montañez
- Andalusian Centre for Nanomedicine and Biotechnology‐BIONANDMálagaSpain
- Allergy Research GroupInstituto de Investigación Biomédica de Málaga‐IBIMAMálagaSpain
| |
Collapse
|
11
|
Bogas G, Doña I, Dionicio J, Fernández TD, Mayorga C, Boteanu C, Montañez MI, Al-Ahmad M, Rondón C, Moreno E, Laguna JJ, Torres MJ. Diagnostic Approach of Hypersensitivity Reactions to Cefazolin in a Large Prospective Cohort. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:4421-4430.e4. [PMID: 34464750 DOI: 10.1016/j.jaip.2021.08.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 07/29/2021] [Accepted: 08/11/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND Cefazolin is a common trigger of perioperative anaphylaxis. The diagnostic approach is controversial because the optimal concentration for skin testing is uncertain, drug provocation tests (DPTs) are contraindicated in severe reactions, and in vitro tests are not thoroughly validated. OBJECTIVE We aimed to characterize a large number of patients reporting cefazolin allergic reactions and to analyze the diagnostic role of in vivo and in vitro tests. METHODS We prospectively evaluated patients with suspicion for allergic reactions to cefazolin by clinical history, skin tests (STs), and, if negative, DPT. In a subgroup of patients, basophil activation test (BAT) and radioallergosorbent test were done before allergologic workup was performed and the final diagnosis was achieved. RESULTS We evaluated 184 patients, 76 of whom were confirmed as allergic (41.3%), 90 were nonallergic (48.9%), and 18 were nonconfirmed (9.8%). All patients reporting anaphylactic shock and most reporting anaphylaxis were confirmed to be allergic (P < .001). Forty allergic patients (52.6%) were confirmed by STs, 22 by DPT (28.9%), and 14 by clinical history (18.4%). All subjects manifesting exanthemas and pruritus were nonallergic. The BAT sensitivity was 66.7% when CD63 and CD203c were combined as activation markers. Six of 8 patients with negative STs and positive DPT had a positive BAT. CONCLUSIONS Patients allergic to cefazolin often reported severe immediate-type reactions. Skin tests enabled a diagnosis in half of patients when using cefazolin at 20 mg/mL. Unfortunately, DPT could not be performed in all patients owing to reaction severity, which makes BAT a promising diagnostic tool. Further research is needed to clarify the underlying mechanisms, especially in severe reactions.
Collapse
Affiliation(s)
- Gador Bogas
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA-ARADyAL, Málaga, Spain; Allergy Unit, Hospital Regional Universitario de Málaga-ARADyAL, Málaga, Spain
| | - Inmaculada Doña
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA-ARADyAL, Málaga, Spain; Allergy Unit, Hospital Regional Universitario de Málaga-ARADyAL, Málaga, Spain
| | | | - Tahia D Fernández
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA-ARADyAL, Málaga, Spain; Department of Cell Biology, Genetics, and Physiology, Universidad de Málaga, Málaga, Spain
| | - Cristobalina Mayorga
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA-ARADyAL, Málaga, Spain; Allergy Unit, Hospital Regional Universitario de Málaga-ARADyAL, Málaga, Spain; Andalusian Center for Nanomedicine and Biotechnology-BIONAND, Málaga, Spain
| | - Cosmin Boteanu
- Allergy Section, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
| | - María I Montañez
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA-ARADyAL, Málaga, Spain; Andalusian Center for Nanomedicine and Biotechnology-BIONAND, Málaga, Spain
| | - Mona Al-Ahmad
- Al Rashed Allergy Centre, Ministry of Health, Kuwait; Microbiology Department, Faculty of Medicine, Kuwait University, Kuwait
| | - Carmen Rondón
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA-ARADyAL, Málaga, Spain; Allergy Unit, Hospital Regional Universitario de Málaga-ARADyAL, Málaga, Spain
| | - Esther Moreno
- Allergy Service, University Hospital of Salamanca., Salamanca, Spain
| | - Jose J Laguna
- Allergy Unit, Hospital de la Cruz Roja, Madrid, Spain; Faculty of Medicine, Universidad Alfonso X El Sabio, Madrid, Spain
| | - Maria J Torres
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA-ARADyAL, Málaga, Spain; Allergy Unit, Hospital de la Cruz Roja, Madrid, Spain; Andalusian Center for Nanomedicine and Biotechnology-BIONAND, Málaga, Spain; Department of Medicine, Universidad de Málaga, Málaga, Spain.
| |
Collapse
|
12
|
Ghozzi H, Bahloul N, Ben Hmida M, Hakim A, Kammoun S, Zeghal K, Ben Mahmoud L. [Management of immediate hypersensitivity to β-lactams: Retrospective study in Sfax pharmacovigilance centre]. Therapie 2021; 77:375-378. [PMID: 33906739 DOI: 10.1016/j.therap.2021.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 03/13/2021] [Accepted: 04/06/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Hanène Ghozzi
- Centre régional de pharmacovigilance de Sfax, 3029 Sfax, Tunisie.
| | - Najla Bahloul
- Service de pneumologie, Unité d'allergologie, CHU Hedi-Chaker, 3029 Sfax, Tunisie
| | - Mariem Ben Hmida
- Service de médecine préventive, CHU Hedi-Chaker, Faculté de médecine, Université de Sfax, 3029 Sfax, Tunisie
| | - Ahmed Hakim
- Centre régional de pharmacovigilance de Sfax, 3029 Sfax, Tunisie
| | - Samy Kammoun
- Service de pneumologie, Unité d'allergologie, CHU Hedi-Chaker, 3029 Sfax, Tunisie
| | - Khaled Zeghal
- Centre régional de pharmacovigilance de Sfax, 3029 Sfax, Tunisie
| | | |
Collapse
|
13
|
Hammond S, Thomson P, Meng X, Naisbitt D. In-Vitro Approaches to Predict and Study T-Cell Mediated Hypersensitivity to Drugs. Front Immunol 2021; 12:630530. [PMID: 33927714 PMCID: PMC8076677 DOI: 10.3389/fimmu.2021.630530] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 03/17/2021] [Indexed: 01/11/2023] Open
Abstract
Mitigating the risk of drug hypersensitivity reactions is an important facet of a given pharmaceutical, with poor performance in this area of safety often leading to warnings, restrictions and withdrawals. In the last 50 years, efforts to diagnose, manage, and circumvent these obscure, iatrogenic diseases have resulted in the development of assays at all stages of a drugs lifespan. Indeed, this begins with intelligent lead compound selection/design to minimize the existence of deleterious chemical reactivity through exclusion of ominous structural moieties. Preclinical studies then investigate how compounds interact with biological systems, with emphasis placed on modeling immunological/toxicological liabilities. During clinical use, competent and accurate diagnoses are sought to effectively manage patients with such ailments, and pharmacovigilance datasets can be used for stratification of patient populations in order to optimise safety profiles. Herein, an overview of some of the in-vitro approaches to predict intrinsic immunogenicity of drugs and diagnose culprit drugs in allergic patients after exposure is detailed, with current perspectives and opportunities provided.
Collapse
Affiliation(s)
- Sean Hammond
- MRC Centre for Drug Safety Science, Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, United Kingdom
- ApconiX, Alderley Park, Alderley Edge, United Kingdom
| | - Paul Thomson
- MRC Centre for Drug Safety Science, Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, United Kingdom
| | - Xiaoli Meng
- MRC Centre for Drug Safety Science, Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, United Kingdom
| | - Dean Naisbitt
- MRC Centre for Drug Safety Science, Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, United Kingdom
| |
Collapse
|
14
|
Martin‐Serrano A, Perez‐Inestrosa E, Mayorga C, Torres MJ, Montañez MI. Recent patents in allergy and immunology: New pyrazinones for the diagnosis of allergies to aminocephalosporins. Allergy 2021; 76:1288-1291. [PMID: 33247441 DOI: 10.1111/all.14673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 11/03/2020] [Accepted: 11/23/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Angela Martin‐Serrano
- Allergy Research Group Instituto de Investigación Biomédica de Málaga‐IBIMA Málaga Spain
- Nanostructures for Diagnosing and Treatment of Allergic Diseases Laboratory Andalusian Center for Nanomedicine and Biotechnology‐BIONAND Málaga Spain
| | - Ezequiel Perez‐Inestrosa
- Nanostructures for Diagnosing and Treatment of Allergic Diseases Laboratory Andalusian Center for Nanomedicine and Biotechnology‐BIONAND Málaga Spain
- Departamento de Quımica Organica Universidad de Malaga‐IBIMA Málaga Spain
| | - Cristobalina Mayorga
- Allergy Research Group Instituto de Investigación Biomédica de Málaga‐IBIMA Málaga Spain
- Nanostructures for Diagnosing and Treatment of Allergic Diseases Laboratory Andalusian Center for Nanomedicine and Biotechnology‐BIONAND Málaga Spain
- Allergy Unit Hospital Regional Universitario de Málaga Málaga Spain
| | - María José Torres
- Allergy Research Group Instituto de Investigación Biomédica de Málaga‐IBIMA Málaga Spain
- Nanostructures for Diagnosing and Treatment of Allergic Diseases Laboratory Andalusian Center for Nanomedicine and Biotechnology‐BIONAND Málaga Spain
- Allergy Unit Hospital Regional Universitario de Málaga Málaga Spain
- Departamento de Medicina Facultad de Medicina Universidad de Málaga Málaga Spain
| | - Maria Isabel Montañez
- Allergy Research Group Instituto de Investigación Biomédica de Málaga‐IBIMA Málaga Spain
- Nanostructures for Diagnosing and Treatment of Allergic Diseases Laboratory Andalusian Center for Nanomedicine and Biotechnology‐BIONAND Málaga Spain
| |
Collapse
|
15
|
Mayorga C, Montañez MI, Najera F, Bogas G, Fernandez TD, Gil DR, Palacios R, Torres MJ, Vida Y, Perez-Inestrosa E. The Role of Benzylpenicilloyl Epimers in Specific IgE Recognition. Front Pharmacol 2021; 12:585890. [PMID: 33716734 PMCID: PMC7952312 DOI: 10.3389/fphar.2021.585890] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 01/13/2021] [Indexed: 11/13/2022] Open
Abstract
The high prevalence of allergy to β-lactam antibiotics is a worldwide issue. Accuracy of diagnostic methods is important to prove tolerance or allergy, with skin test considered the best validated in vivo method for diagnosing immediate reactions to β-lactams. Although drug provocation test is the reference standard, it cannot be performed in highly risk reactions or in those with positive skin tests. For skin tests, the inclusion of major and minor determinants of benzylpenicillin (BP) is recommended. Commercial skin test reagents have changed along time, including as minor determinants benzylpenicillin, benzylpenicilloate (BPO), and benzylpenilloate (PO). Major determinants consists of multivalent conjugates of benzylpenicilloyl coupled through amide bond to a carrier polymer, such as penicilloyl-polylysine (PPL) or benzylpenicilloyl-octalysine (BP-OL). The chemical stability of such reagents has influenced the evolution of the composition of the commercial kits, as this requirement is necessary for improving the quality and standardization of the product. In this work, we provide a detailed study of the chemical stability of BP determinants. We observed that those structures suffer from an epimerization process in C-5 at different rates. Butylamine-Benzylpenicilloyl conjugates (5R,6R)-Bu-BPO and (5S,6R)-Bu-BPO were selected as a simple model for mayor determinant to evaluate the role of the different epimers in the immunoreactivity with sera from penicillin-allergic patients. In vitro immunoassays indicate that any change in the chemical structure of the antigenic determinant of BP significantly affects IgE recognition. The inclusion of stereochemically pure compounds or mixtures may have important implications for both the reproducibility and sensitivity of in vivo and in vitro diagnostic tests.
Collapse
Affiliation(s)
- Cristobalina Mayorga
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain
- Allergy Unit, Hospital Regional Universitario de Málaga, Málaga, Spain
- Centro Andaluz de Nanomedicina y Biotecnología-BIONAND, Parque Tecnológico de Andalucía, Málaga, Spain
| | - Maria I. Montañez
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain
- Centro Andaluz de Nanomedicina y Biotecnología-BIONAND, Parque Tecnológico de Andalucía, Málaga, Spain
| | - Francisco Najera
- Centro Andaluz de Nanomedicina y Biotecnología-BIONAND, Parque Tecnológico de Andalucía, Málaga, Spain
- Universidad de Málaga-IBIMA Departamento de Química Orgánica, Málaga, Spain
| | - Gador Bogas
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain
- Allergy Unit, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Tahía D. Fernandez
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain
- Universidad de Málaga-IBIMA, Departamento de Biología celular, Genética y Fisiología, Málaga, Spain
| | | | | | - Maria J. Torres
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain
- Allergy Unit, Hospital Regional Universitario de Málaga, Málaga, Spain
- Centro Andaluz de Nanomedicina y Biotecnología-BIONAND, Parque Tecnológico de Andalucía, Málaga, Spain
- Universidad de Málaga-IBIMA, Departamento de Medicina, Málaga, Spain
| | - Yolanda Vida
- Centro Andaluz de Nanomedicina y Biotecnología-BIONAND, Parque Tecnológico de Andalucía, Málaga, Spain
- Universidad de Málaga-IBIMA Departamento de Química Orgánica, Málaga, Spain
| | - Ezequiel Perez-Inestrosa
- Centro Andaluz de Nanomedicina y Biotecnología-BIONAND, Parque Tecnológico de Andalucía, Málaga, Spain
- Universidad de Málaga-IBIMA Departamento de Química Orgánica, Málaga, Spain
| |
Collapse
|
16
|
Martín-Serrano Á, Gonzalez-Morena JM, Barbero N, Ariza A, Sánchez Gómez FJ, Pérez-Inestrosa E, Pérez-Sala D, Torres MJ, Montañez MI. Biotin-Labelled Clavulanic Acid to Identify Proteins Target for Haptenation in Serum: Implications in Allergy Studies. Front Pharmacol 2021; 11:594755. [PMID: 33442385 PMCID: PMC7797785 DOI: 10.3389/fphar.2020.594755] [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: 08/14/2020] [Accepted: 10/06/2020] [Indexed: 12/19/2022] Open
Abstract
Clavulanic acid (CLV) and amoxicillin, frequently administered in combination, can be independently involved in allergic reactions. Protein haptenation with β-lactams is considered necessary to activate the immune system. The aim of this study was to assess the suitability of biotinylated analogues of CLV as probes to study protein haptenation by this β-lactam. Two synthetic approaches afforded the labeling of CLV through esterification of its carboxylic group with a biotin moiety, via either direct binding (CLV-B) or tetraethylenglycol linker (CLV-TEG-B). The second analogue offered advantages as solubility in aqueous solution and potential lower steric hindrance for both intended interactions, with the protein and with avidin. NMR reactivity studies showed that both CLV and CLV-TEG-B reacts through β-lactam ring opening by aliphatic amino nitrogen, however with different stability of resulting conjugates. Unlike CLV conjugates, that promoted the decomposition of clavulanate fragment, the conjugates obtained with the CLV-TEG-B remained linked, as a whole structure including biotin, to nucleophile and showed a better stability. This was a desired key feature to allow CLV-TEG-B conjugated protein detection at great sensitivity. We have used biotin detection and mass spectrometry (MS) to detect the haptenation of human serum albumin (HSA) and human serum proteins. MS of conjugates showed that HSA could be modified by CLV-TEG-B. Remarkably, HSA preincubation with CLV excess only reduced moderately the incorporation of CLV-TEG-B, which could be attributed to different protein interferences. The CLV-TEG-B fragment with opened β-lactam was detected bound to the 404-430HSA peptide of the treated protein. Incubation of human serum with CLV-TEG-B resulted in the haptenation of several proteins that were identified by 2D-electrophoresis and peptide mass fingerprinting as HSA, haptoglobin, and heavy and light chains of immunoglobulins. Taken together, our results show that tagged-CLV keeps some of the CLV features. Moreover, although we observe a different behavior in the conjugate stability and in the site of protein modification, the similar reactivity indicates that it could constitute a valuable tool to identify protein targets for haptenation by CLV with high sensitivity to get insights into the activation of the immune system by CLV and mechanisms involved in β-lactams allergy.
Collapse
Affiliation(s)
- Ángela Martín-Serrano
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain.,Centro Andaluz de Nanomedicina y Biotecnología-BIONAND, Málaga, Spain
| | - Juan M Gonzalez-Morena
- Department of Structural and Chemical Biology, Centro de Investigaciones Biológicas Margarita Salas (CSIC), Madrid, Spain
| | - Nekane Barbero
- Centro Andaluz de Nanomedicina y Biotecnología-BIONAND, Málaga, Spain.,Department Química Orgánica, Universidad de Málaga-IBIMA, Málaga, Spain
| | - Adriana Ariza
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain
| | - Francisco J Sánchez Gómez
- Department of Structural and Chemical Biology, Centro de Investigaciones Biológicas Margarita Salas (CSIC), Madrid, Spain
| | - Ezequiel Pérez-Inestrosa
- Centro Andaluz de Nanomedicina y Biotecnología-BIONAND, Málaga, Spain.,Department Química Orgánica, Universidad de Málaga-IBIMA, Málaga, Spain
| | - Dolores Pérez-Sala
- Department of Structural and Chemical Biology, Centro de Investigaciones Biológicas Margarita Salas (CSIC), Madrid, Spain
| | - Maria J Torres
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain.,Centro Andaluz de Nanomedicina y Biotecnología-BIONAND, Málaga, Spain.,Allergy Unit, Hospital Regional Universitario de Málaga, Málaga, Spain.,Department of Medicina, Universidad de Málaga, Málaga, Spain
| | - María I Montañez
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain.,Centro Andaluz de Nanomedicina y Biotecnología-BIONAND, Málaga, Spain
| |
Collapse
|
17
|
Hur GY, Park HS. Clinical Characteristics of NSAID-induced Blended Reaction. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2021; 13:171-172. [PMID: 33474853 PMCID: PMC7840881 DOI: 10.4168/aair.2021.13.2.171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 12/18/2020] [Indexed: 11/20/2022]
Affiliation(s)
- Gyu Young Hur
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Hae Sim Park
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea.
| |
Collapse
|
18
|
Bogas G, Mayorga C, Martín-Serrano Á, Fernández-Santamaría R, Jiménez-Sánchez IM, Ariza A, Barrionuevo E, Posadas T, Salas M, Fernández TD, Torres MJ, Montañez MI. Penicillin and cephalosporin cross-reactivity: role of side chain and synthetic cefadroxil epitopes. Clin Transl Allergy 2020; 10:57. [PMID: 33292516 PMCID: PMC7716594 DOI: 10.1186/s13601-020-00368-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 11/27/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Analysis of cross-reactivity is necessary for prescribing safe cephalosporins for penicillin allergic patients. Amoxicillin (AX) is the betalactam most often involved in immediate hypersensitivity reactions (IHRs), and cefadroxil (CX) the most likely cephalosporin to cross-react with AX, since they share the same R1 side chain, unlike cefuroxime (CO), with a structurally different R1. We aimed to analyse cross-reactivity with CX and CO in patients with confirmed IHRs to AX, including sIgE recognition to AX, CX, CO, and novel synthetic determinants of CX. METHODS Fifty-four patients with confirmed IHRs to AX based on skin test (ST) and/or drug provocation test (DPT) were included. Serum sIgE to AX and benzylpenicillin was determined by Radioallergosorbent test (RAST). Two potential determinants of CX, involving intact or modified R1 structure, with open betalactam ring, were synthesised and sIgE evaluated by RAST inhibition assay. RESULTS Tolerance to CX (Group A) was observed in 64.8% cases and cross-reactivity in 35.2% cases (Group B). Cross-reactivity with CO was only found in 1.8% cases from Group B. ST to CX showed a negative predictive value of 94.6%. RAST inhibition assays showed higher recognition to CX as well as to both synthetic determinants (66% of positive cases) in Group B. CONCLUSIONS Cross-reactivity with CX in AX allergic patients is 35%, being ST not enough for prediction. R1, although critical for recognition, is not the unique factor. The synthetic determinants of CX, 1-(HOPhG-Ser-Bu) and 2-(pyrazinone) are promising tools for determining in vitro cross-reactivity to CX in AX allergic patients.
Collapse
Grants
- PI12/02529, PI15/01206, PI18/00095, RETIC ARADYAL RD16/0006/0001 Instituto de Salud Carlos III
- CP15/00103, PI17/01237 Instituto de Salud Carlos III
- JR18/00054 Instituto de Salud Carlos III
- CD17/0146 Instituto de Salud Carlos III
- CTS-06603 Consejería de Economía, Innovación, Ciencia y Empleo, Junta de Andalucía (ES)
- C-0044-2012 SAS2013 Consejería de Salud, Junta de Andalucía
- PI-0699-2011, PI-0179-2014 Consejería de Salud, Junta de Andalucía
- PE-0172-2018 Consejería de Salud, Junta de Andalucía
- PE-0172-2018 Consejería de Salud, Junta de Andalucía
Collapse
Affiliation(s)
- Gador Bogas
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Civil, 29009 Málaga, Spain
- Allergy Unit, Hospital Regional Universitario de Málaga, Hospital Civil, 29009 Málaga, Spain
| | - Cristobalina Mayorga
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Civil, 29009 Málaga, Spain
- Allergy Unit, Hospital Regional Universitario de Málaga, Hospital Civil, 29009 Málaga, Spain
- Nanostructures for Diagnosing and Treatment of Allergic Diseases Laboratory, Andalusian Center for Nanomedicine and Biotechnology-BIONAND, Parque Tecnológico de Andalucía, 29590 Málaga, Spain
| | - Ángela Martín-Serrano
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Civil, 29009 Málaga, Spain
- Nanostructures for Diagnosing and Treatment of Allergic Diseases Laboratory, Andalusian Center for Nanomedicine and Biotechnology-BIONAND, Parque Tecnológico de Andalucía, 29590 Málaga, Spain
| | - Rubén Fernández-Santamaría
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Civil, 29009 Málaga, Spain
| | - Isabel M. Jiménez-Sánchez
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Civil, 29009 Málaga, Spain
- Nanostructures for Diagnosing and Treatment of Allergic Diseases Laboratory, Andalusian Center for Nanomedicine and Biotechnology-BIONAND, Parque Tecnológico de Andalucía, 29590 Málaga, Spain
| | - Adriana Ariza
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Civil, 29009 Málaga, Spain
| | - Esther Barrionuevo
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Civil, 29009 Málaga, Spain
- Allergy Unit, Hospital Regional Universitario de Málaga, Hospital Civil, 29009 Málaga, Spain
| | - Teresa Posadas
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Civil, 29009 Málaga, Spain
- Allergy Unit, Hospital Regional Universitario de Málaga, Hospital Civil, 29009 Málaga, Spain
| | - María Salas
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Civil, 29009 Málaga, Spain
- Allergy Unit, Hospital Regional Universitario de Málaga, Hospital Civil, 29009 Málaga, Spain
| | - Tahía Diana Fernández
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Civil, 29009 Málaga, Spain
- Departamento de Biología Celular, Genética y Fisiología, Universidad de Málaga, 29071 Málaga, Spain
| | - María José Torres
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Civil, 29009 Málaga, Spain
- Allergy Unit, Hospital Regional Universitario de Málaga, Hospital Civil, 29009 Málaga, Spain
- Nanostructures for Diagnosing and Treatment of Allergic Diseases Laboratory, Andalusian Center for Nanomedicine and Biotechnology-BIONAND, Parque Tecnológico de Andalucía, 29590 Málaga, Spain
- Departamento de Medicina, Universidad de Málaga, Facultad de Medicina, 29071 Málaga, Spain
| | - María Isabel Montañez
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Civil, 29009 Málaga, Spain
- Nanostructures for Diagnosing and Treatment of Allergic Diseases Laboratory, Andalusian Center for Nanomedicine and Biotechnology-BIONAND, Parque Tecnológico de Andalucía, 29590 Málaga, Spain
| |
Collapse
|
19
|
Breiteneder H, Peng Y, Agache I, Diamant Z, Eiwegger T, Fokkens WJ, Traidl‐Hoffmann C, Nadeau K, O'Hehir RE, O'Mahony L, Pfaar O, Torres MJ, Wang D, Zhang L, Akdis CA. Biomarkers for diagnosis and prediction of therapy responses in allergic diseases and asthma. Allergy 2020; 75:3039-3068. [PMID: 32893900 PMCID: PMC7756301 DOI: 10.1111/all.14582] [Citation(s) in RCA: 103] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 08/25/2020] [Accepted: 08/27/2020] [Indexed: 02/06/2023]
Abstract
Modern health care requires a proactive and individualized response to diseases, combining precision diagnosis and personalized treatment. Accordingly, the approach to patients with allergic diseases encompasses novel developments in the area of personalized medicine, disease phenotyping and endotyping, and the development and application of reliable biomarkers. A detailed clinical history and physical examination followed by the detection of IgE immunoreactivity against specific allergens still represents the state of the art. However, nowadays, further emphasis focuses on the optimization of diagnostic and therapeutic standards and a large number of studies have been investigating the biomarkers of allergic diseases, including asthma, atopic dermatitis, allergic rhinitis, food allergy, urticaria and anaphylaxis. Various biomarkers have been developed by omics technologies, some of which lead to a better classification of distinct phenotypes or endotypes. The introduction of biologicals to clinical practice increases the need for biomarkers for patient selection, prediction of outcomes and monitoring, to allow for an adequate choice of the duration of these costly and long‐lasting therapies. Escalating healthcare costs together with questions about the efficacy of the current management of allergic diseases require further development of a biomarker‐driven approach. Here, we review biomarkers in diagnosis and treatment of asthma, atopic dermatitis, allergic rhinitis, viral infections, chronic rhinosinusitis, food allergy, drug hypersensitivity and allergen immunotherapy with a special emphasis on specific IgE, the microbiome and the epithelial barrier. In addition, EAACI guidelines on biologicals are discussed within the perspective of biomarkers.
Collapse
Affiliation(s)
- Heimo Breiteneder
- Institute of Pathophysiology and Allergy Research Medical University of Vienna Vienna Austria
| | - Ya‐Qi Peng
- Swiss Institute of Allergy and Asthma Research (SIAF) University Zurich Davos Switzerland
- CK CARE Christine Kühne Center for Allergy Research and Education Davos Switzerland
- Otorhinolaryngology Hospital The First Affiliated Hospital Sun Yat‐Sen University Guangzhou China
| | - Ioana Agache
- Department of Allergy and Clinical Immunology Faculty of Medicine Transylvania University of Brasov Brasov Romania
| | - Zuzana Diamant
- Department of Respiratory Medicine & Allergology Institute for Clinical Science Skane University Hospital Lund University Lund Sweden
- Department of Respiratory Medicine First Faculty of Medicine Charles University and Thomayer Hospital Prague Czech Republic
- Department of Clinical Pharmacy & Pharmacology University of GroningenUniversity Medical Center Groningen Groningen Netherlands
| | - Thomas Eiwegger
- Translational Medicine Program, Research Institute Hospital for Sick Children Toronto ON Canada
- Department of Immunology University of Toronto Toronto ON Canada
- Division of Immunology and Allergy Food Allergy and Anaphylaxis Program The Hospital for Sick Children Departments of Paediatrics and Immunology University of Toronto Toronto ON Canada
| | - Wytske J. Fokkens
- Department of Otorhinolaryngology Amsterdam University Medical Centres Amsterdam The Netherlands
| | - Claudia Traidl‐Hoffmann
- CK CARE Christine Kühne Center for Allergy Research and Education Davos Switzerland
- Chair and Institute of Environmental Medicine UNIKA‐T Technical University of Munich and Helmholtz Zentrum München Augsburg Germany
- ZIEL ‐ Institute for Food & Health Technical University of Munich Freising‐Weihenstephan Germany
| | - Kari Nadeau
- Sean N. Parker Center for Allergy & Asthma Research Stanford University Stanford CA USA
| | - Robyn E. O'Hehir
- Department of Allergy, immunology and Respiratory Medicine Central Clinical School Monash University Melbourne Vic. Australia
- Allergy, Asthma and Clinical Immunology Service Alfred Health Melbourne Vic. Australia
| | - Liam O'Mahony
- Departments of Medicine and Microbiology APC Microbiome Ireland National University of Ireland Cork Ireland
| | - Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery Section of Rhinology and Allergy University Hospital MarburgPhilipps‐Universität Marburg Marburg Germany
| | - Maria J. Torres
- Allergy Unit Regional University Hospital of Malaga‐IBIMA‐UMA‐ARADyAL Malaga Spain
| | - De‐Yun Wang
- Department of Otolaryngology Yong Loo Lin School of Medicine National University of Singapore Singapore Singapore
| | - Luo Zhang
- Department of Otolaryngology Head and Neck Surgery and Department of Allergy Beijing TongRen Hospital Beijing China
| | - Cezmi A. Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF) University Zurich Davos Switzerland
- CK CARE Christine Kühne Center for Allergy Research and Education Davos Switzerland
| |
Collapse
|
20
|
Stingeni L, Bianchi L, Tramontana M, Pigatto PD, Patruno C, Corazza M, Foti C, Fabbrocini G, Micali G, Romita P, Napolitano M, Hansel K. Skin tests in the diagnosis of adverse drug reactions. GIORN ITAL DERMAT V 2020; 155:602-621. [DOI: 10.23736/s0392-0488.20.06698-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
|
21
|
Ariza A, Fernández-Santamaría R, Meng X, Salas M, Ogese MO, Tailor A, Bogas G, Torres MJ, Naisbitt DJ. Characterization of amoxicillin and clavulanic acid specific T-cell clones from patients with immediate drug hypersensitivity. Allergy 2020; 75:2562-2573. [PMID: 32246774 DOI: 10.1111/all.14298] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 02/18/2020] [Accepted: 03/07/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Betalactam (BL) antibiotics are the most common cause of drug hypersensitivity. Amoxicillin (AX), which is often prescribed alongside clavulanic acid (Clav), is the most common elicitor. The aim of this study was to determine whether AX and Clav-responsive T-cells are detectable in patients with immediate hypersensitivity to AX-Clav, to assess whether these T-cells display the same specificity as that detected in skin and provocation testing, and to explore T-cell activation pathways. METHODS Drug-specific T-cell clones were generated from immediate hypersensitive patients´ blood by serial dilution and repetitive mitogen stimulation. Antigen specificity was assessed by measurement of proliferation and cytokine release. CD4+ /CD8+ phenotype and chemokine receptor expression were analyzed by flow cytometry. RESULTS 110 AX-specific and 96 Clav-specific T-cell clones were generated from seven patients with positive skin test to either AX or Clav. Proliferation of AX- and Clav-specific clones was dose-dependent, and no cross-reactivity was observed. AX- and Clav-specific clones required antigen-presenting cells to proliferate, and drugs were presented to CD4+ and CD8+ T-cells by MHC class-II and I, respectively. A higher secretion of IL-13 and IL-5 was detected in presence of the culprit drug compared with the alternative drug. Clones expressed CD69, CCR4, CXCR3, and CCR10. CONCLUSIONS Our study details the antigen specificity and phenotype of T-cell clones generated from patients with AX-Clav-induced immediate hypersensitivity diagnosed by positive skin test. AX- and Clav-specific clones were generated from patients irrespective of whether AX or Clav was the culprit, although differences in cytokine secretion were observed.
Collapse
Affiliation(s)
- Adriana Ariza
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain
| | | | - Xiaoli Meng
- Department of Molecular and Clinical Pharmacology, MRC Centre for Drug Safety Science, University of Liverpool, Liverpool, UK
| | - María Salas
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain
- Allergy Unit, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Monday O Ogese
- Department of Molecular and Clinical Pharmacology, MRC Centre for Drug Safety Science, University of Liverpool, Liverpool, UK
| | - Arun Tailor
- Department of Molecular and Clinical Pharmacology, MRC Centre for Drug Safety Science, University of Liverpool, Liverpool, UK
| | - Gádor Bogas
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain
- Allergy Unit, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - María José Torres
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain
- Allergy Unit, Hospital Regional Universitario de Málaga, Málaga, Spain
- Nanostructures for Diagnosing and Treatment of Allergic Diseases Laboratory, Andalusian Center for Nanomedicine and Biotechnology-BIONAND, Parque Tecnológico de Andalucía, Málaga, Spain
- Departamento de Medicina, Facultad de Medicina, Universidad de Málaga, Málaga, Spain
| | - Dean J Naisbitt
- Department of Molecular and Clinical Pharmacology, MRC Centre for Drug Safety Science, University of Liverpool, Liverpool, UK
| |
Collapse
|
22
|
Akdis CA. Allergy: New editorial team, innovative content and achievements after two years. Allergy 2020; 75:740-742. [PMID: 31899539 DOI: 10.1111/all.14173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 12/31/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Cezmi A. Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Davos Switzerland
| |
Collapse
|
23
|
Importance of Diagnostics Prior to Desensitization in New Drug Hypersensitivity: Chemotherapeutics and Biologicals. CURRENT TREATMENT OPTIONS IN ALLERGY 2020. [DOI: 10.1007/s40521-020-00238-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
|
24
|
Yeung WYW, Park HS. Update on the Management of Nonsteroidal Anti-Inflammatory Drug Hypersensitivity. Yonsei Med J 2020; 61:4-14. [PMID: 31887794 PMCID: PMC6938782 DOI: 10.3349/ymj.2020.61.1.4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 11/01/2019] [Indexed: 12/19/2022] Open
Abstract
The clinical phenotypes of nonsteroidal anti-inflammatory drug (NSAID) hypersensitivity are heterogeneous with various presentations including time of symptom onset, organ involvements, and underlying pathophysiology. Having a correct diagnosis can be challenging. Understanding their respective mechanisms as well as developing a comprehensive classification and diagnostic algorithm are pivotal for appropriate management strategy. Treatment modalities are based on the subtypes and severity of hypersensitivity reactions. Insights into the phenotypes and endotypes of hypersensitivity reactions enable personalized management in patients with suboptimal control of disease. This review updated the recent evidence of pathophysiology, classification, diagnostic algorithm, and management of NSAID hypersensitivity reactions.
Collapse
Affiliation(s)
- Wan Yin Winnie Yeung
- Division of Rheumatology, Department of Internal Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - Hae Sim Park
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Ajou University Medical Center, Suwon, Korea.
| |
Collapse
|