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Reshef A, Buttgereit T, Betschel SD, Caballero T, Farkas H, Grumach AS, Hide M, Jindal AK, Longhurst H, Peter J, Riedl MA, Zhi Y, Aberer W, Abuzakouk M, Al Farsi T, Al Sukaiti N, Al-Ahmad M, Altrichter S, Aygören-Pürsün E, Baeza ML, Bara NA, Bauer A, Bernstein JA, Boccon-Gibod I, Bonnekoh H, Bouillet L, Brzoza Z, Bygum A, Calderon O, de Albuquerque Campos R, Campos Romero FH, Cancian M, Chong-Neto HJ, Christoff G, Cimbollek S, Cohn DM, Craig T, Danilycheva I, Darlenski R, Du-Thanh A, Ensina LF, Fomina D, Fonacier L, Fukunaga A, Gelincik A, Giavina-Bianchi P, Godse K, Gompels M, Goncalo M, Gotua M, Guidos-Fogelbach G, Guilarte M, Kasperska-Zajac A, Katelaris CH, Kinaciyan T, Kolkhir P, Kulthanan K, Kurowski M, Latysheva E, Lauerma A, Launay D, Lleonhart R, Lumry W, Malbran A, Ali RM, Nasr I, Nieto-Martinez S, Parisi C, Pawankar R, Piñero-Saavedra M, Popov TA, Porebski G, Prieto Garcia A, Pyatilova P, Rudenko M, Sekerel BE, Serpa FS, Sheikh F, Siebenhaar F, Soria A, Staevska M, Staubach P, Stobiecki M, Thomsen SF, Triggiani M, Valerieva A, Valle S, Van Dinh N, Vera Ayala CE, Zalewska-Janowska A, Zanichelli A, Magerl M, Maurer M. The Definition, Acronyms, Nomenclature, and Classification of Angioedema: AAAAI, ACAAI, ACARE, and APAACI DANCE Consensus. J Allergy Clin Immunol 2024:S0091-6749(24)00407-X. [PMID: 38670233 DOI: 10.1016/j.jaci.2024.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/24/2024] [Accepted: 03/04/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Angioedema (AE) manifests with intermittent, localized, self-limiting swelling of the subcutaneous and/or submucosal tissue. AE is heterogeneous, can be hereditary or acquired, occurs only once or be recurrent, with or without wheals, due to mast cell mediators, bradykinin or other mechanisms. Currently, different taxonomic systems are used, making it difficult to compare the results of studies, develop multicenter collaboration, and harmonize treatments of AE patients. OBJECTIVE To develop a consensus on the definition, acronyms, nomenclature, and classification of angioedema (DANCE). METHODS The initiative involved 91 experts from 35 countries and was endorsed by 53 scientific, medical societies, and patient organizations. A consensus was reached by online discussion and voting using the Delphi process over a period of 16 months (June 2021 to November 2022). RESULTS The DANCE initiative resulted in an international consensus on the definition, classification and terminology of AE. The new consensus classification features five types and endotypes of AE and a harmonized vocabulary of abbreviations and acronyms. CONCLUSION The DANCE classification complements current clinical guidelines and expert consensus recommendations on the diagnostic workup and treatment of AE. DANCE does not replace current clinical guidelines and expert consensus algorithms and should not be misconstrued in a way that affects reimbursement of medicines prescribed by a physician using sound clinical judgment. We anticipate that the new AE taxonomy and nomenclature will harmonize and facilitate AE research and clinical studies, thereby improving patient care.
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Affiliation(s)
- Avner Reshef
- Angioedema Research Center, Barzilai University Medical Center, Ashkelon, Israel.
| | - Thomas Buttgereit
- Angioedema Center of Reference and Excellence (ACARE), 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, Immunology and Allergology, Berlin, Germany
| | - Stephen D Betschel
- Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Teresa Caballero
- Department of Allergy, La Paz University Hospital, Hospital La Paz Institute for Health Research (IdiPAZ - Group 44), Biomedical Research Network on Rare Diseases (CIBERER U754), Madrid, Spain; NRC Institute of Immunology FMBA of Russia, Moscow, Russia
| | - Henriette Farkas
- Hungarian Angioedema Center of Reference and Excellence, Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary
| | - Anete S Grumach
- Clinical Immunology, University Center Faculdade de Medicina do ABC, Santo André, SP, Brazil
| | - Michihiro Hide
- Department of Dermatology, Institute of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Ankur K Jindal
- Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Hilary Longhurst
- Department of Medicine, University of Auckland and Department of Immunology, Auckland City Hospital, Auckland, New Zealand
| | - Jonathan Peter
- Division of Allergy and Clinical Immunology, Department of Medicine, University of Cape Town, Cape Town, South Africa; Allergy and Immunology Unit, University of Cape Town Lung Institute, Cape Town, South Africa
| | - Marc A Riedl
- Division of Rheumatology, Allergy, and Immunology, University of California San Diego, La Jolla, California, USA
| | - Yuxiang Zhi
- Department of Allergy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Werner Aberer
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | - Mohamed Abuzakouk
- Allergy and Immunology, Respiratory Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Tariq Al Farsi
- Department of Pediatric allergy and clinical immunology, The Royal Hospital, Muscat, Oman
| | - Nashat Al Sukaiti
- Department of Pediatric allergy and clinical immunology, The Royal Hospital, Muscat, Oman
| | - Mona Al-Ahmad
- Microbiology Department, College of Medicine, Kuwait University
| | - Sabine Altrichter
- Klinik für Dermatologie und Venerologie, Kepler Uniklinikum, Linz, Austria
| | - Emel Aygören-Pürsün
- Department of Pediatrics, University Hospital Frankfurt, Goethe University Frankfurt, Germany
| | - Maria Luisa Baeza
- Allergy Department, Hospital General Universitario Gregorio Marañón, Biomedical Research Network on Rare Diseases-U761, Institute for Health Research, Gregorio Marañón
| | - Noemi Anna Bara
- Romanian Hereditary Angioedema Expertise Centre, Centrul Clinic Mediquest, Sangeorgiu de Mures, Romania
| | - Andrea Bauer
- Department of Dermatology, University Hospital Carl Gustav Carus, Technical University Dresden, Germany
| | - Jonathan A Bernstein
- University of Cincinnati College of Medicine, Department of Internal Medicine, Division of Rheumatology, Allergy and Immunology, Cincinnati, OH, USA
| | | | - Hanna Bonnekoh
- Angioedema Center of Reference and Excellence (ACARE), 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, Immunology and Allergology, Berlin, Germany
| | - Laurence Bouillet
- National Reference Center of Angioedema CREAK, Grenoble, France; Internal medicine department, Grenoble university hospital, France
| | - Zenon Brzoza
- Department of Internal Diseases with Division of Allergology, Institute of Medical Sciences, University of Opole, Opole, Poland
| | - Anette Bygum
- Department of Clinical Genetics, Odense University Hospital, Odense, Denmark; Clinical Institute, University of Southern Denmark, Odense, Denmark
| | | | | | - Freya Helena Campos Romero
- Department of Allergy and Clinical Immunology, Hospital Central Sur Alta Especialidad, Mexico City, Mexico City, Mexico
| | - Mauro Cancian
- Departmental Unit of Allergology, University Hospital of Padua, Padua, Italy
| | - Herberto Jose Chong-Neto
- Serviço de Alergia e Imunologia, Complexo Hospital de Clinicas, Universidade Federal do Paraná, Curitiba, Brazil
| | - George Christoff
- Excelsior Medical Centre, Sofia, Bulgaria; Medical University - Sofia, Bulgaria
| | | | - Danny M Cohn
- Amsterdam UMC, department of Vascular Medicine, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, the Netherlands
| | - Timothy Craig
- Department of Pediatrics, Pennsylvania State University, Hershey, Pennsylvania, USA
| | | | - Razvigor Darlenski
- Department of dermatovenereology, Trakia University-Stara Zagora, Bulgaria
| | - Aurélie Du-Thanh
- ACARE, Département de dermatologie, Centre Hospitalier Universitaire de Montpellier; Montpellier, France
| | | | - Daria Fomina
- Moscow City Research and Practical Center of Allergoloy and Immunology, Clinical Hospital No 52, Moscow Healthcare Department, Moscow, Russia
| | - Luz Fonacier
- New York University-Long Island School of Medicine, Mineola, New York, USA, Past President ACAAI
| | - Atsushi Fukunaga
- Department of Dermatology, Division of Medicine for Function and Morphology of Sensory Organs, Faculty of Medicine, Osaka Medical and Pharmaceutical University
| | - Asli Gelincik
- Division of Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Türkiye
| | - Pedro Giavina-Bianchi
- Division of Clinical lmmunology and Allergy, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Kiran Godse
- Dr. D. Y. Patil Medical College and Hospital, Navi Mumbai, Maharashtra, India
| | - Mark Gompels
- ACARE, Department of Immunology, North Bristol NHS Trust, Bristol, United Kingdom
| | - Margarida Goncalo
- Department of Dermatology, Coimbra Hospital and University Center, and Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Maia Gotua
- Center of Allergy and Immunology, Tbilisi, Georgia; David Tvildiani Medical University, Tbilisi, Georgia
| | | | - Mar Guilarte
- Allergy Department, Hospital Universitari Vall d'Hebron. Vall d'Hebron Research Institute (VHIR). Barcelona, Spain
| | - Alicja Kasperska-Zajac
- European Center for Diagnosis and Treatment of Urticaria and Angioedema and Department of Clinical Allergology and Urticaria, Medical University of Silesia in Katowice, Katowice, Poland
| | | | - Tamar Kinaciyan
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Pavel Kolkhir
- Angioedema Center of Reference and Excellence (ACARE), 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, Immunology and Allergology, Berlin, Germany
| | - Kanokvalai Kulthanan
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Marcin Kurowski
- Department of Immunology and Allergy, Medical University of Lodz, Poland
| | - Elena Latysheva
- NRC Institute of Immunology FMBA of Russia, Moscow, Russia; Pirogov Russian National Research Medical University, Moscow, Russia
| | - Antti Lauerma
- Department of Dermatology, Skin and Allergy Hospital, Helsinki University Hospital, Helsinki, Finland
| | - David Launay
- Univ. Lille, Inserm, CHU Lille, Service de Médecine Interne et Immunologie Clinique, Centre de référence des angioedemes à kinine (CREAK), U1286 - INFINITE - Institute for Translational Research in Inflammation, F-59000 Lille, France
| | - Ramon Lleonhart
- Allergology Department, Hospital Universitari Bellvitge, IDIBILL Research Institute. L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - Alejandro Malbran
- Unidad de alergia, asma e inmunología clínica, Buenos Aires, Argentina
| | - Ramzy Mohammed Ali
- Allergy and Immunology Division, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Iman Nasr
- Immunology and Allergy department, The Royal Hospital, Muscat, Oman
| | - Sandra Nieto-Martinez
- Unidad de Genética de la Nutrición, Instituto Nacional de Pediatría, Mexico City, Mexico. Mexican Hereditary Angioedema Association. Latin American Hereditary Angioedema Association
| | - Claudio Parisi
- Pediatric and Adult Allergy Sections of the Italian Hospital of Buenos Aires
| | | | | | - Todor A Popov
- University Hospital Sv. Ivan Rilski, Sofia, Bulgaria
| | - Grzegorz Porebski
- Department of Clinical and Environmental Allergology, Jagiellonian University Medical College, Krakow, Poland
| | - Alicia Prieto Garcia
- Department of Allergy, Gregorio Marañón University Hospital, Gregorio Marañón Health Research Institute (IiSGM), Madrid, Spain
| | - Polina Pyatilova
- Angioedema Center of Reference and Excellence (ACARE), 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, Immunology and Allergology, Berlin, Germany
| | | | | | - Faradiba Sarquis Serpa
- Angioedema and Urticaria Reference Center, Hospital Santa Casa de Misericórdia de Vitória, Vitória, Espirito Santo, Brazil
| | | | - Frank Siebenhaar
- Angioedema Center of Reference and Excellence (ACARE), 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, Immunology and Allergology, Berlin, Germany
| | - Angèle Soria
- Médecine Sorbonne Université, Service de Dermatologie et Allergologie, hôpital Tenon, Assistance Publique Hôpitaux de Paris, 4 rue de la Chine, 75020 Paris, France
| | - Maria Staevska
- Department of Allergology, Medical University of Sofia, Clinic of Allergology, University Hospital "Alexandrovska", Sofia, Bulgaria
| | - Petra Staubach
- ACARE, Department of Dermatology, University Medical Center Mainz, Germany
| | - Marcin Stobiecki
- Department of Clinical and Environmental Allergology, Jagiellonian University Medical College, Krakow, Poland
| | | | - Massimo Triggiani
- Division of Allergy and Clinical Immunology University of Salerno, Salerno, Italy
| | - Anna Valerieva
- Department of Allergology, Medical University of Sofia, Clinic of Allergology, University Hospital "Alexandrovska", Sofia, Bulgaria
| | | | - Nguyen Van Dinh
- Respiratory - Allergy and Clinical Immunology Unit, Department of General Internal Medicine, Vinmec Healthcare System, Hanoi, Vietnam
| | - Carolina Elisa Vera Ayala
- Angioedema Center of Reference and Excellence (ACARE), 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, Immunology and Allergology, Berlin, Germany
| | - Anna Zalewska-Janowska
- Department of Psychodermatology, Chair of Pulmonology, Rheumatology and Clinical Immunology, Medical University of Lodz, Poland
| | - Andrea Zanichelli
- Department of Biomedical Sciences for Health, Universita degli Studi di Milano, Milan, Italy; Operative Unit of Medicine, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Markus Magerl
- Angioedema Center of Reference and Excellence (ACARE), 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, Immunology and Allergology, Berlin, Germany
| | - Marcus Maurer
- Angioedema Center of Reference and Excellence (ACARE), 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, Immunology and Allergology, Berlin, Germany
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Petersen RS, Fijen LM, Apfelbacher C, Magerl M, Weller K, Aberer W, Adatia A, Audhya P, Bara NA, Betschel S, Boccon-Gibod I, Bouillet L, Brodszki N, Busse PJ, Buttgereit T, Bygum A, Cancian M, Craig T, Csuka D, Farkas H, Fomina D, Gil-Serrano J, Gompels M, Fogelbach GG, Guilarte M, Hide M, Kiani-Alikhan S, Kinaciyan T, Lenten A, Lleonart R, Longhurst H, Lumry WR, Malbran A, Malinauskiene L, Matta Campos JJ, Mendivil J, Nieto-Martinez SA, Peter JG, Porebski G, Reshef A, Riedl M, Valerieva A, Waserman S, Maurer M, Cohn DM. A core outcome set for efficacy of acute treatment of hereditary angioedema. J Allergy Clin Immunol Pract 2024:S2213-2198(24)00391-X. [PMID: 38609017 DOI: 10.1016/j.jaip.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 03/12/2024] [Accepted: 04/02/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND Clinical trials investigating drugs for acute treatment of hereditary angioedema attacks have assessed many different outcomes. This heterogeneity limits comparability of trial results and may lead to selective outcome reporting bias and a high burden on trial participants. OBJECTIVE To achieve consensus on a Core Outcome Set comprising key outcomes that should ideally be utilized in all clinical efficacy trials involving acute treatment of hereditary angioedema attacks. METHODS A Delphi consensus study was conducted involving all relevant parties: hereditary angioedema patients, hereditary angioedema expert clinicians and clinical researchers, pharmaceutical companies, and regulatory bodies. Two internet-based survey rounds were conducted. In round 1, panelists indicated the importance of individual outcomes used in clinical trials on a 9-point Likert scale. Based on these results, a core outcome set was developed and voted on by panelists in round 2. RESULTS Fifty-eight worldwide panelists completed both rounds. The first round demonstrated high importance scores and substantial agreement among the panelists. In the second round, a consensus of ≥90% was achieved on a core outcome set consisting of five key outcomes: change in overall symptom severity at one predetermined time point between 15 minutes and 4 hours after treatment, time to end of progression of all symptoms, need for rescue medication during the entire attack, impairment of daily activities, and treatment satisfaction. CONCLUSION This international study obtained a high level of consensus on a core outcome set for acute treatment of hereditary angioedema attacks consisting of five key outcomes.
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Affiliation(s)
- Remy S Petersen
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Lauré M Fijen
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Christian Apfelbacher
- Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Markus Magerl
- Angioedema Center of Reference and Excellence (ACARE), 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, Immunology and Allergology, Berlin, Germany
| | - Karsten Weller
- Angioedema Center of Reference and Excellence (ACARE), 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, Immunology and Allergology, Berlin, Germany
| | - Werner Aberer
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | - Adil Adatia
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Paul Audhya
- KalVista Pharmaceuticals, Cambridge, Massachusetts, USA
| | - Noémi-Anna Bara
- Romanian Hereditary Angioedema Expertise Centre, Mediquest Clinical Research Center, Sangeorgiu de Mures, Romania
| | - Stephen Betschel
- Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Isabelle Boccon-Gibod
- National Reference Center for Angioedema (CREAK), Angioedema Center of Reference and Excellence (ACARE), CHU Grenoble Alpes, France
| | - Laurence Bouillet
- National Reference Center for Angioedema (CREAK), Angioedema Center of Reference and Excellence (ACARE), CHU Grenoble Alpes, France; Univ. Grenoble Alpes, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, CHU Grenoble Alpes, TIMC, 38000 Grenoble, France
| | - Nicholas Brodszki
- Department of Pediatric Immunology, Childrens Hospital, Skåne University Hospital, Lund, Sweden
| | - Paula J Busse
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Thomas Buttgereit
- Angioedema Center of Reference and Excellence (ACARE), 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, Immunology and Allergology, Berlin, Germany
| | - Anette Bygum
- Clinical Institute, University of Southern Denmark, Odense, Denmark
| | - Mauro Cancian
- Department of Systems Medicine, University Hospital of Padua, Padua, Italy
| | - Timothy Craig
- Allergy, Asthma and Immunology, Department of Medicine and Pediatrics, Penn State University, Hershey, PA, USA
| | - Dorottya Csuka
- Department of Internal Medicine and Haematology, Hungarian Angioedema Center of Reference and Excellence (ACARE), Semmelweis University, Budapest, Hungary
| | - Henriette Farkas
- Department of Internal Medicine and Haematology, Hungarian Angioedema Center of Reference and Excellence (ACARE), Semmelweis University, Budapest, Hungary
| | - Daria Fomina
- Urticaria Center of Reference and Excellence (UCARE), Moscow Research and Clinical Center of Allergy and Immunology, Clinical City Hospital 52 , Russia; Sechenov University, Moscow, Russia; Astana Medical University, Kazakhstan
| | - Johana Gil-Serrano
- Allergy Section Department, Department of Internal Medicine, Hospital Universitari Vall d' Hebron, Barcelona, Spain; Allergy Research Unit, Allergy Department, Institut de Recerca Vall d', Hebron (VHIR). Universitat Autònoma de Barcelona, Spain
| | - Mark Gompels
- Clinical Immunology, North Bristol NHS Trust, Bristol, United Kingdom
| | | | - Mar Guilarte
- Allergy Section Department, Department of Internal Medicine, Hospital Universitari Vall d' Hebron, Barcelona, Spain; Allergy Research Unit, Allergy Department, Institut de Recerca Vall d', Hebron (VHIR). Universitat Autònoma de Barcelona, Spain
| | - Michihiro Hide
- Department of Dermatology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | | | - Tamar Kinaciyan
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | | | - Ramon Lleonart
- Allergology Department, Hospital Universitari de Bellvitge, Institut de Recerca IDIBELL L'Hospitalet de Llobregat, Barcelona, Spain
| | - Hilary Longhurst
- Department of Immunology, Auckland District Health Board and Department of Medicine, University of Auckland, Auckland, New Zealand
| | - William R Lumry
- Internal Medicine, Allergy Division, University of Texas Health Science Center, Dallas, TX, United States
| | - Alejandro Malbran
- Unidad de Alergia, Asma e Inmunologia Clinica, Buenos Aires, Argentina
| | - Laura Malinauskiene
- Vilnius University, Medical Faculty, Clinic of Chest Diseases, Immunology and Allergology, VUH Santaros Klinikos, Department of Pulmonology and Allergology, Vilnius, Lithuania
| | | | - Joan Mendivil
- Head Evidence & Outcomes Research, Pharvaris GmbH, Switzerland
| | | | - Jonathan G Peter
- Division of Allergy and Clinical Immunology, Groote Schuur Hospital, University of Cape Town & Allergy and Immunology Unit, University of Cape Town Lung Institute
| | - Grzegorz Porebski
- Department of Clinical and Environmental Allergology, Jagiellonian University Medical College, Krakow, Poland
| | - Avner Reshef
- Angioedema Center, Barzilai University Medical Center, Ashkelon, Israel
| | - Marc Riedl
- Division of Rheumatology, Allergy and Immunology, University of California San Diego, La Jolla, CA, USA
| | - Anna Valerieva
- Department of Allergology, Medical University of Sofia & ACARE Bulgaria (University Hospital "Alexandrovska"), Sofia, Bulgaria
| | - Susan Waserman
- Department of Medicine, McMaster University, Hamilton, ON Canada
| | - Marcus Maurer
- Angioedema Center of Reference and Excellence (ACARE), 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, Immunology and Allergology, Berlin, Germany
| | - Danny M Cohn
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
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Zanichelli A, Senter R, Merlo A, Gidaro A, Popescu Janu V, Cogliati CB, Cancian M. Comorbidities in Angioedema Due to C1-Inhibitor Deficiency: An Italian Survey. J Allergy Clin Immunol Pract 2024; 12:1029-1036. [PMID: 38182098 DOI: 10.1016/j.jaip.2023.12.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 11/28/2023] [Accepted: 12/26/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND Hereditary angioedema (HAE) due to C1-inhibitor (C1-INH) deficiency is characterized by unpredictable recurrent episodes of swelling affecting the skin and the mucosa tissues, including gastrointestinal tract and/or oropharyngeal-laryngeal mucosae. Long-term prophylaxis (LTP) is used to prevent attacks. OBJECTIVE Because C1-INH plays a pivotal role in several biological pathways, we investigated the possible association of comorbidities with C1-INH deficiency and the use of LTP with attenuated androgens (AA) or tranexamic acid (TXA). METHODS This retrospective cohort study involved adult patients with HAE referred to Milan and Padua angioedema centers in the period 1979-2021. A qualitative comparison was performed to analyze comorbidities versus general population. The incidence of comorbidities was evaluated during LTP with AA or TXA versus patients without LTP. RESULTS A total of 446 patients were studied. A greater prevalence among patients was found for heart diseases (9.6% vs 4.8%), acute myocardial infarction (5.6% vs 1.4%), hepatitis C virus infection (10.5% vs 2.5%), and appendectomy (15.9% vs 4.3%). In patients taking AA, a greater incidence was found for hypertension (22.8% vs 10.8%; odds ratio [OR]: 2.02), hypercholesterolemia (19.5% vs 5.3%; OR: 3.97), diabetes mellitus (5% vs 1.4%; OR: 3.21), hepatic angioma (4.4% vs 0.7%; OR: 8.35), and focal nodular hyperplasia (2.5% vs 0.4%; OR: 6.9). No association between TXA and comorbidities was found. CONCLUSION In this large patient population with a rare disease followed for up to a 43-year period, we found a greater prevalence of comorbidities hitherto unreported in the literature and an association between comorbidities and LTP with AA.
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Affiliation(s)
- Andrea Zanichelli
- Operative Unit of Medicine, Angioedema Center, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy; Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.
| | - Riccardo Senter
- Department of Systems Medicine, University Hospital of Padua, Padua, Italy
| | - Andrea Merlo
- Internal Medicine, Department of Biomedical and Clinical Sciences, Luigi Sacco Hospital, ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy
| | - Antonio Gidaro
- Internal Medicine, Department of Biomedical and Clinical Sciences, Luigi Sacco Hospital, ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy
| | - Valentina Popescu Janu
- Internal Medicine, Department of Biomedical and Clinical Sciences, Luigi Sacco Hospital, ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy
| | - Chiara Beatrice Cogliati
- Internal Medicine, Department of Biomedical and Clinical Sciences, Luigi Sacco Hospital, ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy
| | - Mauro Cancian
- Department of Systems Medicine, University Hospital of Padua, Padua, Italy
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Parente R, Sartorio S, Brussino L, De Pasquale T, Zoli A, Agolini S, Di Agosta E, Quattrocchi P, Borrelli P, Bignardi D, Petraroli A, Senter R, Popescu Janu V, Cogliati C, Guarino MD, Rossi O, Firinu D, Pucci S, Spadaro G, Triggiani M, Cancian M, Zanichelli A. Multicentric Observational Study on Safety and Tolerability of COVID-19 Vaccines in Patients with Angioedema with C1 Inhibitor Deficiency: Data from Italian Network on Hereditary and Acquired Angioedema (ITACA). Vaccines (Basel) 2023; 11:vaccines11040852. [PMID: 37112764 PMCID: PMC10145557 DOI: 10.3390/vaccines11040852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 04/11/2023] [Accepted: 04/14/2023] [Indexed: 04/29/2023] Open
Abstract
Angioedema due to C1 inhibitor deficiency (AE-C1-INH) is a rare disease characterized by recurrent and unpredictable attacks of angioedema. Multiple trigger factors, including trauma, emotional stress, infectious diseases, and drugs, could elicit angioedema attacks. The aim of this study was to collect data on the safety and tolerability of COVID-19 vaccines in a population of patients affected by AE-C1-INH. Adult patients with AE-C1-INH, followed by Reference Centers belonging to the Italian Network for Hereditary and Acquired Angioedema (ITACA), were enrolled in this study. Patients received nucleoside-modified mRNA vaccines and vaccines with adenovirus vectors. Data on acute attacks developed in the 72 h following COVID-19 vaccinations were collected. The frequency of attacks in the 6 months after the COVID-19 vaccination was compared with the rate of attacks registered in the 6 months before the first vaccination. Between December 2020 and June 2022, 208 patients (118 females) with AE-C1-INH received COVID-19 vaccines. A total of 529 doses of the COVID-19 vaccine were administered, and the majority of patients received mRNA vaccines. Forty-eight attacks of angioedema (9%) occurred within 72 h following COVID-19 vaccinations. About half of the attacks were abdominal. Attacks were successfully treated with on-demand therapy. No hospitalizations were registered. There was no increase in the monthly attack rate following the vaccination. The most common adverse reactions were pain at the site of injection and fever. Our results show that adult patients with angioedema due to C1 inhibitor deficiency can be safely vaccinated against SARS-CoV-2 in a controlled medical setting and should always have available on-demand therapies.
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Affiliation(s)
- Roberta Parente
- Division of Allergy and Clinical Immunology, University of Salerno, 84131 Salerno, Italy
| | - Silvio Sartorio
- Referral Centre for Systemic Autoimmune Diseases, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico di Milano, 20122 Milan, Italy
| | - Luisa Brussino
- Allergy and Clinical Immunology Unit, Department of Medical Sciences, University of Torino & Mauriziano Hospital, 10128 Torino, Italy
| | | | - Alessandra Zoli
- SOD Immunologia Clinica, Azienda Ospedaliera Universitaria Ospedali Riuniti di Ancona, 60126 Ancona, Italy
| | - Stefano Agolini
- SOD Immunologia Clinica, Azienda Ospedaliera Universitaria Ospedali Riuniti di Ancona, 60126 Ancona, Italy
| | - Ester Di Agosta
- Immunoallergology Unit, University Hospital of Careggi, 50141 Florence, Italy
| | - Paolina Quattrocchi
- Department of Clinical and Experimental Medicine, School and Operative Unit of Allergy and Clinical Immunology, University of Messina, 98125 Messina, Italy
| | - Paolo Borrelli
- SSD Dermatologia e Allergologia-Ospedale Beauregard, 11100 Aosta, Italy
| | - Donatella Bignardi
- Department of Medicine Integrated with the Territory, Ospedale Policlinico San Martino, IRCCS Ospedale Policlinico, Genova UO Allergologia, 16142 Genova, Italy
| | - Angelica Petraroli
- Department of Internal Medicine, Clinical Immunology, Clinical Pathology and Infectious Disease, Azienda Ospedaliera Universitaria Federico II, 80131 Napoli, Italy
| | - Riccardo Senter
- Department of Systems Medicine, University Hospital of Padua, 35126 Padua, Italy
| | | | - Chiara Cogliati
- Internal Medicine, L Sacco Hospital, ASST Fatebenfratelli-Sacco, 20157 Milan, Italy
- Department of Biomedical and Clinical Sciences, University of Milan, 20157 Milan, Italy
| | | | - Oliviero Rossi
- Immunoallergology Unit, University Hospital of Careggi, 50141 Florence, Italy
| | - Davide Firinu
- Division of Allergy and Clinical Immunology, University of Cagliari, 09124 Cagliari, Italy
| | | | - Giuseppe Spadaro
- Department of Internal Medicine, Clinical Immunology, Clinical Pathology and Infectious Disease, Azienda Ospedaliera Universitaria Federico II, 80131 Napoli, Italy
| | - Massimo Triggiani
- Division of Allergy and Clinical Immunology, University of Salerno, 84131 Salerno, Italy
| | - Mauro Cancian
- Department of Systems Medicine, University Hospital of Padua, 35126 Padua, Italy
| | - Andrea Zanichelli
- Operative Unit of Medicine, Angioedema Center, IRCCS Policlinico San Donato, San Donato Milanese, 20097 Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, 20097 Milan, Italy
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5
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Aygören-Pürsün E, Zanichelli A, Cohn DM, Cancian M, Hakl R, Kinaciyan T, Magerl M, Martinez-Saguer I, Stobiecki M, Farkas H, Kiani-Alikhan S, Grivcheva-Panovska V, Bernstein JA, Li HH, Longhurst HJ, Audhya PK, Smith MD, Yea CM, Maetzel A, Lee DK, Feener EP, Gower R, Lumry WR, Banerji A, Riedl MA, Maurer M. An investigational oral plasma kallikrein inhibitor for on-demand treatment of hereditary angioedema: a two-part, randomised, double-blind, placebo-controlled, crossover phase 2 trial. Lancet 2023; 401:458-469. [PMID: 36774155 DOI: 10.1016/s0140-6736(22)02406-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 09/09/2022] [Accepted: 11/16/2022] [Indexed: 02/11/2023]
Abstract
BACKGROUND Guidelines recommend effective on-demand therapy for all individuals with hereditary angioedema. We aimed to assess the novel oral plasma kallikrein inhibitor, sebetralstat, which is in development, for on-demand treatment of hereditary angioedema attacks. METHODS In this two-part phase 2 trial, individuals with type 1 or 2 hereditary angioedema aged 18 years or older were recruited from 25 sites, consisting of specialty outpatient centres, across nine countries in Europe and the USA. Individuals were eligible if they had experienced at least three hereditary angioedema attacks in the past 93 days, were not on prophylactic therapy, and had access to and the ability to self-administer conventional attack treatment. In part 1 of the trial, participants were given a single 600 mg open-label oral dose of sebetralstat to assess safety, pharmacokinetics, and pharmacodynamics of the dose. Part 2 was a randomised, double-blind, placebo-controlled, two-sequence, two-period (2 × 2) crossover trial; participants were randomly assigned (1:1) to either sequence 1, in which they were given a single dose of 600 mg of sebetralstat to treat the first eligible attack and a second dose of placebo to treat the second eligible attack, or sequence 2, in which they were given placebo to treat the first eligible attack and then 600 mg of sebetralstat to treat the second eligible attack. Participants and investigators were masked to treatment assignment. The primary endpoint was time to use of conventional attack treatment within 12 h of study drug administration, which was assessed in all participants who were randomly assigned to treatment and who received study drug for two attacks during part 2 of the study. Safety was assessed in all participants who received at least one dose of study drug, starting in part 1. This study is registered with ClinicalTrials.gov, NCT04208412, and is completed. FINDINGS Between July 2, 2019, and Dec 8, 2020, 84 individuals were screened and 68 were enrolled in part 1 and received sebetralstat (mean age 38·3 years [SD 13·2], 37 [54%] were female, 31 [46%] were male, 68 [100%] were White). 42 (62%) of 68 participants completed pharmacokinetic assessments. Sebetralstat was rapidly absorbed, with a geometric mean plasma concentration of 501 ng/mL at 15 min. In a subset of participants (n=6), plasma samples obtained from 15 min to 4 h after study drug administration had near-complete protection from ex vivo stimulated generation of plasma kallikrein and cleavage of high-molecular-weight kininogen. In part 2, all 68 participants were randomly assigned to sequence 1 (n=34) or sequence 2 (n=34). 53 (78%) of 68 participants treated two attacks (25 [74%] in the sequence 1 group and 28 [82%] in the sequence 2 group). Time to use of conventional treatment within 12 h of study drug administration was significantly longer with sebetralstat versus placebo (at quartile 1: >12 h [95% CI 9·6 to >12] vs 8·0 h [3·8 to >12]; p=0·0010). There were no serious adverse events or adverse event-related discontinuations. INTERPRETATION Oral administration of sebetralstat was well tolerated and led to rapid suppression of plasma kallikrein activity, resulting in increased time to use of conventional attack treatment and faster symptom relief versus placebo. Based on these results, a phase 3 trial to evaluate the efficacy and safety of two dose levels of sebetralstat in adolescent and adult participants with hereditary angioedema has been initiated (NCT05259917). FUNDING KalVista Pharmaceuticals.
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Affiliation(s)
- Emel Aygören-Pürsün
- Department for Children and Adolescents, University Hospital Frankfurt, Frankfurt, Germany
| | - Andrea Zanichelli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Operative Unit of Medicine, IRCCS Policlinico San Donato, Milan, Italy
| | - Danny M Cohn
- Amsterdam UMC, Department of Vascular Medicine, University of Amsterdam, Amsterdam, Netherlands
| | - Mauro Cancian
- Department of Systems Medicine, University Hospital of Padua, Padua, Italy
| | - Roman Hakl
- Department of Clinical Immunology and Allergology, St Anne's University Hospital, Brno, Czech Republic; Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Tamar Kinaciyan
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Markus Magerl
- 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
| | | | - Marcin Stobiecki
- Department of Clinical and Environmental Allergology, Jagiellonian University Medical College, Krakow, Poland
| | - Henriette Farkas
- Hungarian Angioedema Center of Reference and Excellence, Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary
| | - Sorena Kiani-Alikhan
- Barts Health NHS Trust, Department of Immunology, GA(2)LEN/HAEi Angioedema Centre of Reference and Excellence, London, UK
| | - Vesna Grivcheva-Panovska
- PHI University Clinic of Dermatology, School of Medicine, University Saints Cyril and Methodius, Skopje, North Macedonia
| | - Jonathan A Bernstein
- University of Cincinnati College of Medicine and Bernstein Clinical Research Center, Cincinnati, OH, USA
| | - H Henry Li
- Institute for Asthma and Allergy, Chevy Chase, MD, USA
| | - Hilary J Longhurst
- Department of Immunology, Auckland District Health Board and University of Auckland, Auckland, New Zealand
| | | | | | | | - Andreas Maetzel
- KalVista Pharmaceuticals, Cambridge, MA, USA; Institute of Health Policy, Management & Evaluation, University of Toronto, ON, Canada
| | | | | | | | | | - Aleena Banerji
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, MA, USA
| | - Marc A Riedl
- Division of Rheumatology, Allergy and Immunology, University of California, San Diego, La Jolla, CA, 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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6
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Cancian M, Triggianese P, Modica S, Arcoleo F, Bignardi D, Brussino L, Colangelo C, Di Agosta E, Firinu D, Guarino MD, Giardino F, Giliberti M, Montinaro V, Senter R. The impact of puberty on the onset, frequency, location, and severity of attacks in hereditary angioedema due to C1-inhibitor deficiency: A survey from the Italian Network for Hereditary and Acquired Angioedema (ITACA). Front Pediatr 2023; 11:1141073. [PMID: 37144145 PMCID: PMC10152551 DOI: 10.3389/fped.2023.1141073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 03/08/2023] [Indexed: 05/06/2023] Open
Abstract
Introduction Hereditary angioedema due to C1-inhibitor deficiency is influenced by hormonal factors, with a more severe course of disease in women. Our study aims to deepen the impact of puberty on onset, frequency, location and severity of attacks. Methods Retrospective data were collected through a semi-structured questionnaire and shared by 10 Italian reference centers of the Italian Network for Hereditary and Acquired Angioedema (ITACA). Results The proportion of symptomatic patients increased significantly after puberty (98.2% vs 83.9%, p=0.002 in males; 96.3% vs 68,4%, p<0.001 in females); the monthly mean of acute attacks was significantly higher after puberty, and this occurred both in females (median (IQR) = 0.41(2) in the three years before puberty vs 2(2.17) in the three years after, p<0.001) and in males (1(1.92) vs 1.25(1.56) respectively, p<0.001). The increase was greater in females. No significant differences were detected in attack location before and after puberty. Discussion Overall, our study confirms previous reports on a more severe phenotype in the female gender. Puberty predisposes to increased numbers of angioedema attacks, in particular in female patients.
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Affiliation(s)
- Mauro Cancian
- UOSD Allergologia, University Hospital of Padua, Padua, Italy
- Correspondence: Mauro Cancian
| | | | | | - Francesco Arcoleo
- UOC di Patologia Clinica e Immunologia, AOR Villa Sofia-Cervello, Palermo, Italy
| | | | - Luisa Brussino
- University Hospital Ordine Mauriziano di Torino, Turin, Italy
| | | | - Ester Di Agosta
- Immunoallergology unit, Careggi University Hospital, Florence, Italy
| | - Davide Firinu
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | | | - Francesco Giardino
- Azienda Ospedaliero-Universitaria Policlinico “G.Rodolico-San Marco”, Catania, Italy
| | - Marica Giliberti
- Azienda Ospedaliero-Universitaria Policlinico di Bari, Bari, Italy
| | | | - Riccardo Senter
- UOSD Allergologia, University Hospital of Padua, Padua, Italy
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7
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Maurer M, Magerl M, Betschel S, Aberer W, Ansotegui IJ, Aygören-Pürsün E, Banerji A, Bara NA, Boccon-Gibod I, Bork K, Bouillet L, Boysen HB, Brodszki N, Busse PJ, Bygum A, Caballero T, Cancian M, Castaldo A, Cohn DM, Csuka D, Farkas H, Gompels M, Gower R, Grumach AS, Guidos-Fogelbach G, Hide M, Kang HR, Kaplan AP, Katelaris C, Kiani-Alikhan S, Lei WT, Lockey R, Longhurst H, Lumry WR, MacGinnitie A, Malbran A, Saguer IM, Matta JJ, Nast A, Nguyen D, Nieto-Martinez SA, Pawankar R, Peter J, Porebski G, Prior N, Reshef A, Riedl M, Ritchie B, Sheikh FR, Smith WB, Spaeth PJ, Stobiecki M, Toubi E, Varga LA, Weller K, Zanichelli A, Zhi Y, Zuraw B, Craig T. [Not Available]. ARERUGI = [ALLERGY] 2023; 72:237-272. [PMID: 37225467 DOI: 10.15036/arerugi.72.237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Affiliation(s)
- M Maurer
- Institute of Allergology, Charité-Universitätsmedizin, Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology
| | - M Magerl
- Institute of Allergology, Charité-Universitätsmedizin, Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology
| | | | - W Aberer
- Department of Dermatology, Medical University of Graz
| | - I J Ansotegui
- Department of Allergy & Immunology, Hospital Quironsalud Bizkaia
| | - E Aygören-Pürsün
- Center for Children and Adolescents, University Hospital Frankfurt
| | - A Banerji
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital
| | - N A Bara
- Romanian Hereditary Angioedema Expertise Centre, Mediquest Clinical Research Center
| | - I Boccon-Gibod
- National Reference Center for Angioedema (CREAK), Angioedema Center of Reference and Excellence (ACARE), Grenoble Alpes University Hospital
| | - K Bork
- Department of Dermatology, University Medical Center, Johannes Gutenberg University
| | - L Bouillet
- National Reference Center for Angioedema (CREAK), Angioedema Center of Reference and Excellence (ACARE), Grenoble Alpes University Hospital
| | | | - N Brodszki
- Department of Pediatric Immunology, Childrens Hospital, Skåne University Hospital
| | - P J Busse
- Icahn School of Medicine at Mount Sinai
| | - A Bygum
- Clinical Institute, University of Southern Denmark
- Department of Clinical Genetics, Odense University Hospital
| | - T Caballero
- Allergy Department, Hospital Universitario La Paz
| | - M Cancian
- Department of Systems Medicine, University Hospital of Padua
| | | | - D M Cohn
- Department of Vascular Medicine, Amsterdam UMC/University of Amsterdam
| | - D Csuka
- Department of Internal Medicine and Haematology, Hungarian Angioedema Center of Reference and Excellence, Semmelweis University
| | - H Farkas
- Department of Internal Medicine and Haematology, Hungarian Angioedema Center of Reference and Excellence, Semmelweis University
| | - M Gompels
- Clinical Immunology, North Bristol NHS Trust
| | - R Gower
- Marycliff Clinical Research, Principle Research Solutions
| | - A S Grumach
- Clinical Immunology, Centro Universitario FMABC
| | | | - M Hide
- Department of Dermatology, Hiroshima Citizens Hospital
- Department of Dermatology, Hiroshima University
| | - H R Kang
- Department of Internal Medicine, Seoul National University College of Medicine
| | - A P Kaplan
- Division of Pulmonary, Critical Care, Allergy and Immunology, Medical University of South Carolina
| | - C Katelaris
- Department of Medicine, Campbelltown Hospital and Western Sydney University
| | | | - W T Lei
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, Mackay Memorial Hospital
| | - R Lockey
- Division of Allergy and Immunology, Department of Internal Medicine, Morsani College of Medicine, University of South Florida
| | - H Longhurst
- Department of Immunology, Auckland District Health Board and Department of Medicine, University of Auckland
| | - W R Lumry
- Internal Medicine, Allergy Division, University of Texas Health Science Center
| | - A MacGinnitie
- Division of Immunology, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School
| | - A Malbran
- Unidad de Alergia, Asma e Inmunología Clínica
| | - I M Saguer
- Pediatrics, Haemophilia Centre Rhine Main (HZRM)
| | - J J Matta
- H. Especialidades C.M.N.SXXI, I.M.S.S
| | - A Nast
- Department of Dermatology, Venereology and Allergology, Division of Evidence-Based Medicine Charité-Universitätsmedizin Berlin, corporate member of Free University of Berlin, Humboldt University of Berlin, and Berlin Institute of Health
| | - D Nguyen
- Respiratory, Allergy and Clinical Immunology Unit, Internal Medicine Department, Vinmec Healthcare System, College of Health Sciences, VinUniversity
| | | | - R Pawankar
- Department of Pediatrics, Nippon Medical School
| | - J Peter
- Division of Allergy and Clinical Immunology, University of Cape Town
- Allergy and Immunology Unit, University of Cape Town Lung Institute
| | - G Porebski
- Department of Clinical and Environmental Allergology, Jagiellonian University Medical College
| | - N Prior
- Allergy, Hospital Universitario Severo Ochoa
| | - A Reshef
- Angioderma Center, Barzilai University Medical Center
| | - M Riedl
- Division of Rheumatology, Allergy and Immunology, University of California San Diego
| | - B Ritchie
- Departments of Medicine and Medical Oncology, University of Alberta
| | - F R Sheikh
- Section of Adult Allergy & Immunology, Department of Medicine, King Faisal Specialist Hospital & Research Centre
| | - W B Smith
- Clinical Immunology and Allergy, Royal Adelaide Hospital
| | - P J Spaeth
- Institute of Pharmacology, University of Bern
| | - M Stobiecki
- Department of Clinical and Environmental Allergology, Jagiellonian University Medical College
| | - E Toubi
- Division of Allergy and Clinical Immunology, Bnai Zion Medical Center, Affiliated with Rappaport Faculty of Medicine, Technion-Israel Institute of Technology
| | - L A Varga
- Department of Internal Medicine and Haematology, Hungarian Angioedema Center of Reference and Excellence, Semmelweis University
| | - K Weller
- Institute of Allergology, Charité-Universitätsmedizin, Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology
| | - A Zanichelli
- Department of Internal Medicine, ASST Fatebenefratelli Sacco, Ospedale Luigi Sacco-University of Milan
| | - Y Zhi
- Department of Allergy and Clinical Immunology, Bejing Union Medical College Hospital & Chinese Academy of Medical Sciences
| | - B Zuraw
- University of California, San Diego
| | - T Craig
- Departments of Medicine and Pediatrics, Penn State University
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8
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Triggianese P, Senter R, Petraroli A, Zoli A, Lo Pizzo M, Bignardi D, Di Agosta E, Agolini S, Arcoleo F, Rossi O, Modica S, Greco E, Chimenti MS, Spadaro G, De Carolis C, Cancian M. Pregnancy in women with Hereditary Angioedema due to C1-inhibitor deficiency: Results from the ITACA cohort study on outcome of mothers and children with in utero exposure to plasma-derived C1-inhibitor. Front Med (Lausanne) 2022; 9:930403. [PMID: 36186797 PMCID: PMC9515414 DOI: 10.3389/fmed.2022.930403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 07/15/2022] [Indexed: 11/13/2022] Open
Abstract
Background In women with Hereditary Angioedema (HAE) due to C1-inhibitor (C1INH) deficiency (C1INH-HAE), pregnancy counseling and treatment can be challenging. Despite the evidence of the immediate favorable outcome and safety of plasma-derived (pd)C1INH concentrate, there are no data regarding any difference among women who underwent or not pdC1INH during pregnancy or on children with in utero exposure to pdC1INH. The present interview study aimed at analyzing outcome of C1INH-HAE mothers and children according to pdC1INH-exposure during pregnancies. Methods C1INH-HAE women who experienced at least 1 pregnancy were included from seven centers of the Italian Network for Hereditary and Acquired Angioedema (ITACA). The interview study retrospectively analyzed pregnancies who underwent (group 1) or not (group 2) pdC1INH. The overall goals of the study included immediate and long-term outcomes, in terms of outcomes in the time interval between pregnancy and survey. Results A total of 168 pregnancies from 87 included women were analyzed. At term delivery (>37 gestation-week, GW) has been registered in 73.8% of cases, while spontaneous abortion (SA) occurred in 14.2% of cases with a mean GW 7 ± 2. The group 1 including pdC1INH-treated pregnancies comprised a third of the cohort (51/168, time interval 1.5 ± 10.4 yrs), while the group 2 represented 69.6% (117/168, time interval 32.8 ± 14 yrs). The same prevalence of SA occurred when comparing group 1 (11.7%) with group 2 (15.4%) with a similar GW at SA. The group 1 was older at the pregnancy time and younger at the interview than the group 2 (P < 0.01 for both); moreover, the group 1 showed a higher prevalence of cesarean delivery (P < 0.0001). The overall prevalence of obstetrical syndromes was similar between two groups: however, gestational diabetes was described only in pdC1INH-untreated pregnancies. In utero pdC1INH-exposed children (n = 45) did not show differences compared with unexposed ones (n = 99) in neonatal short-term outcomes. Conclusion Through appropriate management and counseling, most of C1INH-HAE women undergo successful pregnancy and delivery. For pregnant C1INH-HAE women being treated with pdC1INH, our findings are reassuring and might lead to an improvement of both the knowledge about treatments and the experience of HAE itself.
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Affiliation(s)
- P. Triggianese
- Rheumatology, Allergology and Clinical Immunology, Department of “Medicina dei Sistemi”, University of Rome Tor Vergata, Rome, Italy
- *Correspondence: P. Triggianese
| | - R. Senter
- Department of Systems Medicine, University Hospital of Padua, Padua, Italy
| | - A. Petraroli
- Centro Interdipartimentale di Ricerca in Scienze Immunologiche di Base e Cliniche (CISI) dell'Università degli Studi di Napoli Federico II, Naples, Italy
| | - A. Zoli
- Azienda Ospedaliera Universitaria Ospedali Riuniti di Ancona, Ancona, Italy
| | - M. Lo Pizzo
- Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy
| | - D. Bignardi
- Department of Medicine Integrated With the Territory, Ospedale Policlinico San Martino, IRCCS, Genoa, Italy
| | - E. Di Agosta
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - S. Agolini
- Azienda Ospedaliera Universitaria Ospedali Riuniti di Ancona, Ancona, Italy
| | - F. Arcoleo
- Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy
| | - O. Rossi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - S. Modica
- Rheumatology, Allergology and Clinical Immunology, Department of “Medicina dei Sistemi”, University of Rome Tor Vergata, Rome, Italy
| | - E. Greco
- Rheumatology, Allergology and Clinical Immunology, Department of “Medicina dei Sistemi”, University of Rome Tor Vergata, Rome, Italy
| | - M. S. Chimenti
- Rheumatology, Allergology and Clinical Immunology, Department of “Medicina dei Sistemi”, University of Rome Tor Vergata, Rome, Italy
| | - G. Spadaro
- Centro Interdipartimentale di Ricerca in Scienze Immunologiche di Base e Cliniche (CISI) dell'Università degli Studi di Napoli Federico II, Naples, Italy
| | - C. De Carolis
- Rheumatology, Allergology and Clinical Immunology, Department of “Medicina dei Sistemi”, University of Rome Tor Vergata, Rome, Italy
| | - M. Cancian
- Department of Systems Medicine, University Hospital of Padua, Padua, Italy
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9
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Zanichelli A, Montinaro V, Triggiani M, Arcoleo F, Visigalli D, Cancian M. Emerging drugs for the treatment of hereditary angioedema due to C1-inhibitor deficiency. Expert Opin Emerg Drugs 2022; 27:103-110. [PMID: 35876094 DOI: 10.1080/14728214.2022.2105834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Hereditary angioedema due to C1-inhibitor (C1-INH-HAE) is a rare disease characterized by unpredictable swelling attacks that may be life-threatening when affecting the upper airways. Understanding the pathophysiology of HAE and the mechanism of bradykinin-mediated angioedema allowed the development of new therapies for the treatment of HAE: clinical trials are ongoing to expand the number of drugs available for on-demand treatment and prophylaxis. AREAS COVERED Authors discuss the products that have been used to treat this disease for many years and present the most recently marketed products and those which are under development. EXPERT OPINION Significant therapeutic progress has been made in HAE. In particular, drugs targeting specific molecules involved in the angioedema formation were developed and studies with new drugs are ongoing. In the coming years, more effective therapies with easier administration route options for on-demand treatment and long-term prophylaxis will be available to treat this disease and the variety of patients. Gene therapy strategies may offer a definitive treatment. High costs of current and new drugs may be a limiting factor for their availability, especially in developing countries.
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Affiliation(s)
- Andrea Zanichelli
- UOC Medicina Generale, ASST Fatebenefratelli Sacco, Ospedale Luigi Sacco-Università degli Studi di Milano, Milan, Italy
| | - Vincenzo Montinaro
- Direttore UOC Nefrologia e Dialisi, Ente Ecclesiastico - Ospedale Generale Regionale "F. Miulli", Acquaviva delle Fonti, Italy
| | - Massimo Triggiani
- Division of Allergy and Clinical Immunology, University of Salerno, Fisciano, Italy
| | - Francesco Arcoleo
- Direttore UOC Patologia Clinica, CRR Malattie Rare del Sistema Immunitario e Angioedema, Centro FCSA - Emostasi e Trombosi, Azienda Ospedaliera Villa Sofia-Cervello, Palermo, Italy
| | - Debora Visigalli
- UOC Farmacia, ASST Fatebenefratelli-Sacco, Ospedale Luigi Sacco-Università degli Studi di Milano, Milan, Italy
| | - Mauro Cancian
- Department of Systems Medicine, University Hospital of Padua, Padua, Italy
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Maurer M, Magerl M, Betschel S, Aberer W, Ansotegui IJ, Aygören-Pürsün E, Banerji A, Bara NA, Boccon-Gibod I, Bork K, Bouillet L, Boysen HB, Brodszki N, Busse PJ, Bygum A, Caballero T, Cancian M, Castaldo AJ, Cohn DM, Csuka D, Farkas H, Gompels M, Gower R, Grumach AS, Guidos-Fogelbach G, Hide M, Kang HR, Kaplan AP, Katelaris CH, Kiani-Alikhan S, Lei WT, Lockey RF, Longhurst H, Lumry W, MacGinnitie A, Malbran A, Martinez Saguer I, Matta Campos JJ, Nast A, Nguyen D, Nieto-Martinez SA, Pawankar R, Peter J, Porebski G, Prior N, Reshef A, Riedl M, Ritchie B, Sheikh FR, Smith WB, Spaeth PJ, Stobiecki M, Toubi E, Varga LA, Weller K, Zanichelli A, Zhi Y, Zuraw B, Craig T. The international WAO/EAACI guideline for the management of hereditary angioedema – The 2021 revision and update. World Allergy Organ J 2022; 15:100627. [PMID: 35497649 PMCID: PMC9023902 DOI: 10.1016/j.waojou.2022.100627] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 11/05/2021] [Accepted: 12/21/2021] [Indexed: 12/21/2022] Open
Abstract
Hereditary Angioedema (HAE) is a rare and disabling disease for which early diagnosis and effective therapy are critical. This revision and update of the global WAO/EAACI guideline on the diagnosis and management of HAE provides up-to-date guidance for the management of HAE. For this update and revision of the guideline, an international panel of experts reviewed the existing evidence, developed 28 recommendations, and established consensus by an online DELPHI process. The goal of these recommendations and guideline is to help physicians and their patients in making rational decisions in the management of HAE with deficient C1-inhibitor (type 1) and HAE with dysfunctional C1-inhibitor (type 2), by providing guidance on common and important clinical issues, such as: 1) How should HAE be diagnosed? 2) When should HAE patients receive prophylactic on top of on-demand treatment and what treatments should be used? 3) What are the goals of treatment? 4) Should HAE management be different for special HAE patient groups such as children or pregnant/breast feeding women? 5) How should HAE patients monitor their disease activity, impact, and control? It is also the intention of this guideline to help establish global standards for the management of HAE and to encourage and facilitate the use of recommended diagnostics and therapies for all patients.
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Maurer M, Magerl M, Aygören-Pürsün E, Bork K, Farkas H, Longhurst H, Kiani-Alikhan S, Bouillet L, Boccon-Gibod I, Cancian M, Zanichelli A, Launay D. Attenuated androgen discontinuation in patients with hereditary angioedema: a commented case series. Allergy Asthma Clin Immunol 2022; 18:4. [PMID: 35027083 PMCID: PMC8759255 DOI: 10.1186/s13223-021-00644-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 12/26/2021] [Indexed: 11/16/2022]
Abstract
Background Hereditary angioedema (HAE) is characterized by potentially severe and life-threatening attacks of localized swelling. Prophylactic therapies are available, including attenuated androgens. Efficacy of attenuated androgens has not been assessed in large, randomized, placebo-controlled trials and can be associated with frequent, and sometimes severe, side effects. As better tolerated targeted therapies become available, attenuated androgen withdrawal is increasingly considered by physicians and their patients with HAE. Attenuated androgens withdrawal has not been systematically studied in HAE, although examination of other disorders indicates that attenuated androgen withdrawal may result in mood disturbances and flu-like symptoms. Standardized protocols for attenuated androgen discontinuation that continue to provide control of attacks while limiting potential attenuated androgen withdrawal symptoms are not established as the outcomes of different withdrawal strategies have not been compared. We aim to describe the challenges of attenuated androgen discontinuation in patients with HAE and how these may continue into the post-androgen period. Case presentation We present a retrospective case series of 10 patients with confirmed type I HAE who have discontinued prophylactic treatment with attenuated androgens. The most common reason for attenuated androgen discontinuation was side effects. Attenuated androgens were either immediately withdrawn, tapered and/or overlapped with another treatment. The major challenge of discontinuation was the management of an increased frequency and severity of HAE attacks in some patients. Conclusions Healthcare teams need to undertake careful planning and monitoring after attenuated androgens discontinuation, and modify treatment strategies if HAE control is destabilized with an increased number of attacks. Discontinuation of attenuated androgens is definitively an option in an evolving HAE treatment landscape, and outcomes can be favourable with additional patient support and education. Supplementary Information The online version contains supplementary material available at 10.1186/s13223-021-00644-0.
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Affiliation(s)
- Marcus Maurer
- Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Angioedema Center of Reference and Excellence (ACARE), Dermatological Allergology, Allergie-Centrum-Charité, Berlin, Germany.
| | - Markus Magerl
- Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Angioedema Center of Reference and Excellence (ACARE), Dermatological Allergology, Allergie-Centrum-Charité, Berlin, Germany
| | | | - Konrad Bork
- Department of Dermatology, Johannes Gutenberg University, Mainz, Germany
| | - Henriette Farkas
- Hungarian Angioedema Center of Excellence and Reference (ACARE), Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary
| | - Hilary Longhurst
- Auckland District Health Board and University of Auckland, Auckland, New Zealand
| | - Sorena Kiani-Alikhan
- Angioedema Center of Reference and Excellence (ACARE), Barts Health NHS Trust, London, UK
| | - Laurence Bouillet
- French National Center of Reference and Excellence for Angioedema, Grenoble Alpes University Hospital, Grenoble, France
| | - Isabelle Boccon-Gibod
- French National Center of Reference and Excellence for Angioedema, Grenoble Alpes University Hospital, Grenoble, France
| | - Mauro Cancian
- Italian Network for Hereditary and Acquired Angioedema (ITACA), Interregional Center of Reference for Angioedema, University of Padova, Padova, Italy
| | - Andrea Zanichelli
- Italian National Center of Reference for Angiodema, Department of Internal Medicine, ASST Fatebenefratelli Sacco, Ospedale Luigi Sacco - Università degli Studi di Milano, Milan, Italy
| | - David Launay
- University of Lille, Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, French National Center of Reference for Angioedema, 59000, Lille, France
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12
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Maurer M, Magerl M, Betschel S, Aberer W, Ansotegui IJ, Aygören‐Pürsün E, Banerji A, Bara N, Boccon‐Gibod I, Bork K, Bouillet L, Boysen HB, Brodszki N, Busse PJ, Bygum A, Caballero T, Cancian M, Castaldo A, Cohn DM, Csuka D, Farkas H, Gompels M, Gower R, Grumach AS, Guidos‐Fogelbach G, Hide M, Kang H, Kaplan AP, Katelaris C, Kiani‐Alikhan S, Lei W, Lockey R, Longhurst H, Lumry WB, MacGinnitie A, Malbran A, Martinez Saguer I, Matta JJ, Nast A, Nguyen D, Nieto‐Martinez SA, Pawankar R, Peter J, Porebski G, Prior N, Reshef A, Riedl M, Ritchie B, Rafique Sheikh F, Smith WR, Spaeth PJ, Stobiecki M, Toubi E, Varga LA, Weller K, Zanichelli A, Zhi Y, Zuraw B, Craig T. The international WAO/EAACI guideline for the management of hereditary angioedema-The 2021 revision and update. Allergy 2022; 77:1961-1990. [PMID: 35006617 DOI: 10.1111/all.15214] [Citation(s) in RCA: 115] [Impact Index Per Article: 57.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/22/2021] [Accepted: 12/08/2021] [Indexed: 12/11/2022]
Abstract
Hereditary angioedema (HAE) is a rare and disabling disease for which early diagnosis and effective therapy are critical. This revision and update of the global WAO/EAACI guideline on the diagnosis and management of HAE provides up-to-date guidance for the management of HAE. For this update and revision of the guideline, an international panel of experts reviewed the existing evidence, developed 28 recommendations, and established consensus by an online DELPHI process. The goal of these recommendations and guideline is to help physicians and their patients in making rational decisions in the management of HAE with deficient C1 inhibitor (type 1) and HAE with dysfunctional C1 inhibitor (type 2), by providing guidance on common and important clinical issues, such as: (1) How should HAE be diagnosed? (2) When should HAE patients receive prophylactic on top of on-demand treatment and what treatments should be used? (3) What are the goals of treatment? (4) Should HAE management be different for special HAE patient groups such as children or pregnant/breast-feeding women? and (5) How should HAE patients monitor their disease activity, impact, and control? It is also the intention of this guideline to help establish global standards for the management of HAE and to encourage and facilitate the use of recommended diagnostics and therapies for all patients.
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Affiliation(s)
- Marcus Maurer
- Institute of Allergology Charité—Universitätsmedizin Berlincorporate member of Freie Universität Berlin and Humboldt‐Universität zu Berlin Berlin Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology Berlin Germany
| | - Markus Magerl
- Institute of Allergology Charité—Universitätsmedizin Berlincorporate member of Freie Universität Berlin and Humboldt‐Universität zu Berlin Berlin Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology Berlin Germany
| | | | - Werner Aberer
- Department of Dermatology Medical University of Graz Graz Austria
| | | | - Emel Aygören‐Pürsün
- Center for Children and Adolescents University Hospital Frankfurt Frankfurt Germany
| | - Aleena Banerji
- Division of Rheumatology, Allergy and Immunology Massachusetts General Hospital Boston Massachusetts USA
| | - Noémi‐Anna Bara
- Romanian Hereditary Angioedema Expertise CentreMediquest Clinical Research Center Sangeorgiu de Mures Romania
| | - Isabelle Boccon‐Gibod
- National Reference Center for Angioedema (CREAK) Angioedema Center of Reference and Excellence (ACARE) Grenoble Alpes University Hospital Grenoble France
| | - Konrad Bork
- Department of Dermatology University Medical CenterJohannes Gutenberg University Mainz Germany
| | - Laurence Bouillet
- National Reference Center for Angioedema (CREAK) Angioedema Center of Reference and Excellence (ACARE) Grenoble Alpes University Hospital Grenoble France
| | | | - Nicholas Brodszki
- Department of Pediatric Immunology Childrens HospitalSkåne University Hospital Lund Sweden
| | | | - Anette Bygum
- Clinical Institute University of Southern Denmark Odense Denmark
- Department of Clinical Genetics Odense University Hospital Odense Denmark
| | - Teresa Caballero
- Allergy Department Hospital Universitario La PazIdiPaz, CIBERER U754 Madrid Spain
| | - Mauro Cancian
- Department of Systems Medicine University Hospital of Padua Padua Italy
| | | | - Danny M. Cohn
- Department of Vascular Medicine Amsterdam UMC/University of Amsterdam Amsterdam The Netherlands
| | - Dorottya Csuka
- Department of Internal Medicine and Haematology Hungarian Angioedema Center of Reference and Excellence Semmelweis University Budapest Hungary
| | - Henriette Farkas
- Department of Internal Medicine and Haematology Hungarian Angioedema Center of Reference and Excellence Semmelweis University Budapest Hungary
| | - Mark Gompels
- Clinical Immunology North Bristol NHS Trust Bristol UK
| | - Richard Gower
- Marycliff Clinical ResearchPrinciple Research Solutions Spokane Washington USA
| | | | | | - Michihiro Hide
- Department of Dermatology Hiroshima Citizens Hospital Hiroshima Japan
- Department of Dermatology Hiroshima University Hiroshima Japan
| | - Hye‐Ryun Kang
- Department of Internal Medicine Seoul National University College of Medicine Seoul Korea
| | - Allen Phillip Kaplan
- Division of Pulmonary, Critical Care, Allergy and Immunology Medical university of South Carolina Charleston South Carolina USA
| | - Constance Katelaris
- Department of Medicine Campbelltown Hospital and Western Sydney University Sydney NSW Australia
| | | | - Wei‐Te Lei
- Division of Allergy, Immunology, and Rheumatology Department of Pediatrics Mackay Memorial Hospital Hsinchu Taiwan
| | - Richard Lockey
- Division of Allergy and Immunology Department of Internal Medicine Morsani College of MedicineUniversity of South Florida Tampa Florida USA
| | - Hilary Longhurst
- Department of Immunology Auckland District Health Board and Department of MedicineUniversity of Auckland Auckland New Zealand
| | - William B. Lumry
- Internal Medicine Allergy Division University of Texas Health Science Center Dallas Texas USA
| | - Andrew MacGinnitie
- Division of Immunology Department of Pediatrics Boston Children's HospitalHarvard Medical School Boston Massachusetts USA
| | - Alejandro Malbran
- Unidad de Alergia, Asma e Inmunología Clínica Buenos Aires Argentina
| | | | | | - Alexander Nast
- Department of Dermatology, Venereology and Allergology Division of Evidence‐Based Medicine Charité ‐ Universitätsmedizin Berlincorporate member of Free University of BerlinHumboldt University of Berlin, and Berlin Institute of Health Berlin Germany
| | - Dinh Nguyen
- Respiratory, Allergy and Clinical Immunology Unit Internal Medicine Department Vinmec Healthcare System College of Health SciencesVinUniversity Hanoi Vietnam
| | | | - Ruby Pawankar
- Department of Pediatrics Nippon Medical School Tokyo Japan
| | - Jonathan Peter
- Division of Allergy and Clinical Immunology University of Cape Town Cape Town South Africa
- Allergy and Immunology Unit University of Cape Town Lung Institute Cape Town South Africa
| | - Grzegorz Porebski
- Department of Clinical and Environmental Allergology Jagiellonian University Medical College Krakow Poland
| | - Nieves Prior
- Allergy Hospital Universitario Severo Ochoa Madrid Spain
| | - Avner Reshef
- Angioderma CenterBarzilai University Medical Center Ashkelon Israel
| | - Marc Riedl
- Division of Rheumatology, Allergy and Immunology University of California San Diego La Jolla California USA
| | - Bruce Ritchie
- Departments of Medicine and Medical Oncology University of Alberta Edmonton AB Canada
| | - Farrukh Rafique Sheikh
- Section of Adult Allergy & Immunology Department of Medicine King Faisal Specialist Hospital & Research Centre Riyadh Saudi Arabia
| | - William R. Smith
- Clinical Immunology and Allergy Royal Adelaide Hospital Adelaide SA Australia
| | - Peter J. Spaeth
- Institute of PharmacologyUniversity of Bern Bern Switzerland
| | - Marcin Stobiecki
- Department of Clinical and Environmental Allergology Jagiellonian University Medical College Krakow Poland
| | - Elias Toubi
- Division of Allergy and Clinical Immunology Bnai Zion Medical CenterAffiliated with Rappaport Faculty of MedicineTechnion‐Israel Institute of Technology Haifa Israel
| | - Lilian Agnes Varga
- Department of Internal Medicine and Haematology Hungarian Angioedema Center of Reference and Excellence Semmelweis University Budapest Hungary
| | - Karsten Weller
- Institute of Allergology Charité—Universitätsmedizin Berlincorporate member of Freie Universität Berlin and Humboldt‐Universität zu Berlin Berlin Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology Berlin Germany
| | - Andrea Zanichelli
- Department of Internal Medicine ASST Fatebenefratelli Sacco Ospedale Luigi Sacco‐University of Milan Milan Italy
| | - Yuxiang Zhi
- Department of Allergy and Clinical Immunology Bejing Union Medical College Hospital & Chinese Academy of Medical Sciences Bejing China
| | - Bruce Zuraw
- University of California, San Diego San Diego California USA
| | - Timothy Craig
- Departments of Medicine and Pediatrics Penn State University Hershey Pennsylvania USA
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Zanichelli A, Farkas H, Bouillet L, Bara N, Germenis AE, Psarros F, Varga L, Andrási N, Boccon-Gibod I, Castiglioni Roffia M, Rutkowski M, Cancian M. The Global Registry for Hereditary Angioedema due to C1-Inhibitor Deficiency. Clin Rev Allergy Immunol 2021; 61:77-83. [PMID: 33791951 PMCID: PMC8282542 DOI: 10.1007/s12016-021-08855-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2021] [Indexed: 12/05/2022]
Abstract
Hereditary angioedema (HAE) is a rare condition, mostly due to genetic deficiency of complement C1 inhibitor (C1-INH). The rarity of HAE impedes extensive data collection and assessment of the impact of certain factors known to affect the course of this disabling and life-threatening disease. Establishing a global registry could assist to overcome such issues and provides valuable patient data from different countries. The HAE Global Registry is a disease-specific registry, with web-based electronic support, where data are provided by physicians and patients through a dedicated application. We collected data between January 1, 2018, and August 31, 2020. Data on 1297 patients from 29 centers in 5 European countries were collected. At least one attack was recorded for 497 patients during the study period. Overall, 1182 patients were diagnosed with HAE type 1 and 115 with type 2. At the time of database lock, 389 patients were taking long-term prophylactic medication, 217 of which were on danazol. Most recorded attacks affected the abdomen, were generally moderate in severity, and occurred in patients who were not on prophylactic treatment (70.6%, 6244/8848). The median duration of attacks was 780 min (IQR 290-1740) in patients on prophylactic medication and 780 min (IQR 300-1920) in patients not on continuous prophylactic medication. In conclusion, the establishment of a registry for C1-INH-HAE allowed collection of a large amount of data that may help to better understand the clinical characteristics of this disease. This information may enhance patient care and guide future therapeutic decisions.
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Affiliation(s)
- Andrea Zanichelli
- Department of Internal Medicine, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital-University of Milan, Milan, Italy.
| | - Henriette Farkas
- Hungarian Angioedema Center of Reference and Excellence, Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary
| | - Laurance Bouillet
- French National Center of Reference for Angioedema, Grenoble Alpes University Hospital, Grenoble, France
| | - Noemi Bara
- Hereditary Angioedema Expertise Centre, Sangeorgiu de Mures, Romania
- Mediquest Clinical Research Centre, Sangeorgiu de Mures, Romania
| | - Anastasios E Germenis
- Department of Immunology & Histocompatibility, School of Medicine, University of Thessaly, Larissa, Greece
| | | | - Lilian Varga
- Hungarian Angioedema Center of Reference and Excellence, Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary
| | - Noemi Andrási
- Hungarian Angioedema Center of Reference and Excellence, Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary
| | - Isabelle Boccon-Gibod
- French National Center of Reference for Angioedema, Grenoble Alpes University Hospital, Grenoble, France
| | - Marco Castiglioni Roffia
- Patient Representative Member of the Associazione Volontaria Per L'angioedema Ereditario Ed Altre Forme Rare Di Angioedema A.A.E.E, Naples, Italy
| | - Michal Rutkowski
- Patient representative member of the Hereditary Angioedema International HAEi, Warsaw, Poland
| | - Mauro Cancian
- Department of Systems Medicine, University Hospital of Padua, Padua, Italy
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Galdiero MR, Maio F, Arcoleo F, Boni E, Bonzano L, Brussino L, Cancian M, Cremonte L, Del Giacco SR, De Paulis A, Detoraki A, Firinu D, Lamacchia D, Loffredo S, Nettis E, Parente R, Parronchi P, Pellacani G, Petraroli A, Rolla G, Senter R, Triggiani M, Vitiello G, Spadaro G, Bova M. Orofacial granulomatosis: Clinical and therapeutic features in an Italian cohort and review of the literature. Allergy 2021; 76:2189-2200. [PMID: 33641182 DOI: 10.1111/all.14799] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 01/16/2021] [Accepted: 01/31/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Orofacial granulomatosis (OFG) is characterized by granulomatous inflammation of the soft tissues of maxillofacial region. We explored OFG patients from 10 different Italian centers and summarized the most recent literature data. METHODS A review of patients with OFG was carried out. An extensive online literature search was performed to identify studies reporting diagnosis and management of OFG. RESULTS Thirty-nine patients were recruited between January 2018 and February 2020. Most of them (97.4%) displayed involvement of the lips, and 28.2% suffered from Melkersson-Rosenthal syndrome. Two patients received diagnosis of CD and one patient of sarcoidosis, suggesting secondary OFG. Oral aphthosis and cervical lymphadenopathy were also described. The mean diagnostic delay was 3.4 years. Histological evaluation was performed in 34/39 patients (87.2%); non-caseating granulomas were found in 73.5% of them. Neurological symptoms (28.2%), gastrointestinal symptoms in absence of overt inflammatory bowel disease (IBD) (20.5%), and atopy (35.9%) were also identified. Therapeutic approaches varied among the centers. Steroids (51.3%) were used with good or partial results. Anti-TNF-α and anti-IgE monoclonal antibodies were used in 6 (15.4%) and 1 (2.6%) patients, respectively, with variable results. Surgery was the choice for 2 patients with good response. CONCLUSIONS OFG is a rare and neglected disease showing multiple clinical phenotypes. While early diagnosis is crucial, management is difficult and highly dependent on the expertise of clinicians due to the lack of international guidelines. There is a need to establish registry databases and address challenges of long-term management.
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Affiliation(s)
- Maria R. Galdiero
- Department of Translational Medical Sciences, Allergy and Clinical Immunology Center for Basic and Clinical Immunology Research (CISI) WAO Center of ExcellenceUniversity of Naples Federico II Naples Italy
| | - Filomena Maio
- Department of Translational Medical Sciences, Allergy and Clinical Immunology Center for Basic and Clinical Immunology Research (CISI) WAO Center of ExcellenceUniversity of Naples Federico II Naples Italy
| | - Francesco Arcoleo
- Ospedali Riuniti Villa Sofia‐CervelloUnità Operativa Complessa di Patologia Clinica Palermo Italy
| | - Elisa Boni
- Laboratorio Unico Metropolitano Maggiore Hospital AUSL Bologna Italy
| | - Laura Bonzano
- Dermatology and Allergy Unit Surgical, Medical and Dental Department of Morphological Sciences related to Transplant, Oncology and Regenerative Medicine University of Modena and Reggio Emilia Modena Italy
| | - Luisa Brussino
- Department of Medical Sciences, Allergy and Clinical Immunology University of Turin & AO Mauriziano “UmbertoI” Turin Italy
| | - Mauro Cancian
- Department of Medicine University of Padova Padova Italy
| | - Luigi Cremonte
- Allergy Unit San Giacomo HospitalNovi Ligure Alessandria Italy
| | - Stefano R. Del Giacco
- Department of Medical Sciences and Public Health University of Cagliari Monserrato Italy
| | - Amato De Paulis
- Department of Translational Medical Sciences, Allergy and Clinical Immunology Center for Basic and Clinical Immunology Research (CISI) WAO Center of ExcellenceUniversity of Naples Federico II Naples Italy
| | - Aikaterini Detoraki
- Department of Translational Medical Sciences, Allergy and Clinical Immunology Center for Basic and Clinical Immunology Research (CISI) WAO Center of ExcellenceUniversity of Naples Federico II Naples Italy
| | - Davide Firinu
- Department of Medical Sciences and Public Health University of Cagliari Monserrato Italy
| | | | - Stefania Loffredo
- Department of Translational Medical Sciences, Allergy and Clinical Immunology Center for Basic and Clinical Immunology Research (CISI) WAO Center of ExcellenceUniversity of Naples Federico II Naples Italy
| | - Eustachio Nettis
- Department of Emergency and Organ Transplantation School of Allergology and Clinical Immunology University of Bari Aldo Moro Bari Italy
| | - Roberta Parente
- Division of Allergy and Clinical Immunology University of Salerno Salerno Italy
| | - Paola Parronchi
- Experimental and Clinical Medicine Department University of Florence Florence Italy
| | - Giovanni Pellacani
- Dermatology and Allergy Unit Surgical, Medical and Dental Department of Morphological Sciences related to Transplant, Oncology and Regenerative Medicine University of Modena and Reggio Emilia Modena Italy
| | - Angelica Petraroli
- Department of Translational Medical Sciences, Allergy and Clinical Immunology Center for Basic and Clinical Immunology Research (CISI) WAO Center of ExcellenceUniversity of Naples Federico II Naples Italy
| | - Giovanni Rolla
- Department of Medical Sciences, Allergy and Clinical Immunology University of Turin & AO Mauriziano “UmbertoI” Turin Italy
| | | | - Massimo Triggiani
- Department of Translational Medical Sciences, Allergy and Clinical Immunology Center for Basic and Clinical Immunology Research (CISI) WAO Center of ExcellenceUniversity of Naples Federico II Naples Italy
| | - Gianfranco Vitiello
- Experimental and Clinical Medicine Department University of Florence Florence Italy
| | - Giuseppe Spadaro
- Department of Translational Medical Sciences, Allergy and Clinical Immunology Center for Basic and Clinical Immunology Research (CISI) WAO Center of ExcellenceUniversity of Naples Federico II Naples Italy
| | - Maria Bova
- Department of Translational Medical Sciences, Allergy and Clinical Immunology Center for Basic and Clinical Immunology Research (CISI) WAO Center of ExcellenceUniversity of Naples Federico II Naples Italy
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15
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Galdiero MR, Maio F, Arcoleo F, Boni E, Bonzano L, Brussino L, Cancian M, Cremonte L, Del Giacco SR, De Paulis A, Detoraki A, Firinu D, Lamacchia D, Loffredo S, Nettis E, Parente R, Parronchi P, Pellacani G, Petraroli A, Rolla G, Senter R, Triggiani M, Vitiello G, Spadaro G, Bova M. Orofacial granulomatosis: Clinical and therapeutic features in an Italian cohort and review of the literature. Allergy 2021. [PMID: 33641182 DOI: 10.1111/all.14799.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Orofacial granulomatosis (OFG) is characterized by granulomatous inflammation of the soft tissues of maxillofacial region. We explored OFG patients from 10 different Italian centers and summarized the most recent literature data. METHODS A review of patients with OFG was carried out. An extensive online literature search was performed to identify studies reporting diagnosis and management of OFG. RESULTS Thirty-nine patients were recruited between January 2018 and February 2020. Most of them (97.4%) displayed involvement of the lips, and 28.2% suffered from Melkersson-Rosenthal syndrome. Two patients received diagnosis of CD and one patient of sarcoidosis, suggesting secondary OFG. Oral aphthosis and cervical lymphadenopathy were also described. The mean diagnostic delay was 3.4 years. Histological evaluation was performed in 34/39 patients (87.2%); non-caseating granulomas were found in 73.5% of them. Neurological symptoms (28.2%), gastrointestinal symptoms in absence of overt inflammatory bowel disease (IBD) (20.5%), and atopy (35.9%) were also identified. Therapeutic approaches varied among the centers. Steroids (51.3%) were used with good or partial results. Anti-TNF-α and anti-IgE monoclonal antibodies were used in 6 (15.4%) and 1 (2.6%) patients, respectively, with variable results. Surgery was the choice for 2 patients with good response. CONCLUSIONS OFG is a rare and neglected disease showing multiple clinical phenotypes. While early diagnosis is crucial, management is difficult and highly dependent on the expertise of clinicians due to the lack of international guidelines. There is a need to establish registry databases and address challenges of long-term management.
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Affiliation(s)
- Maria R Galdiero
- Department of Translational Medical Sciences, Allergy and Clinical Immunology, Center for Basic and Clinical Immunology Research (CISI), WAO Center of Excellence, University of Naples Federico II, Naples, Italy
| | - Filomena Maio
- Department of Translational Medical Sciences, Allergy and Clinical Immunology, Center for Basic and Clinical Immunology Research (CISI), WAO Center of Excellence, University of Naples Federico II, Naples, Italy
| | - Francesco Arcoleo
- Ospedali Riuniti Villa Sofia-Cervello, Unità Operativa Complessa di Patologia Clinica, Palermo, Italy
| | - Elisa Boni
- Laboratorio Unico Metropolitano, Maggiore Hospital AUSL, Bologna, Italy
| | - Laura Bonzano
- Dermatology and Allergy Unit, Surgical, Medical and Dental Department of Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Luisa Brussino
- Department of Medical Sciences, Allergy and Clinical Immunology, University of Turin & AO Mauriziano "UmbertoI", Turin, Italy
| | - Mauro Cancian
- Department of Medicine, University of Padova, Padova, Italy
| | - Luigi Cremonte
- Allergy Unit, San Giacomo Hospital, Novi Ligure, Alessandria, Italy
| | - Stefano R Del Giacco
- Department of Medical Sciences and Public Health, University of Cagliari, Monserrato, Italy
| | - Amato De Paulis
- Department of Translational Medical Sciences, Allergy and Clinical Immunology, Center for Basic and Clinical Immunology Research (CISI), WAO Center of Excellence, University of Naples Federico II, Naples, Italy
| | - Aikaterini Detoraki
- Department of Translational Medical Sciences, Allergy and Clinical Immunology, Center for Basic and Clinical Immunology Research (CISI), WAO Center of Excellence, University of Naples Federico II, Naples, Italy
| | - Davide Firinu
- Department of Medical Sciences and Public Health, University of Cagliari, Monserrato, Italy
| | | | - Stefania Loffredo
- Department of Translational Medical Sciences, Allergy and Clinical Immunology, Center for Basic and Clinical Immunology Research (CISI), WAO Center of Excellence, University of Naples Federico II, Naples, Italy
| | - Eustachio Nettis
- Department of Emergency and Organ Transplantation, School of Allergology and Clinical Immunology, University of Bari Aldo Moro, Bari, Italy
| | - Roberta Parente
- Division of Allergy and Clinical Immunology, University of Salerno, Salerno, Italy
| | - Paola Parronchi
- Experimental and Clinical Medicine Department, University of Florence, Florence, Italy
| | - Giovanni Pellacani
- Dermatology and Allergy Unit, Surgical, Medical and Dental Department of Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Angelica Petraroli
- Department of Translational Medical Sciences, Allergy and Clinical Immunology, Center for Basic and Clinical Immunology Research (CISI), WAO Center of Excellence, University of Naples Federico II, Naples, Italy
| | - Giovanni Rolla
- Department of Medical Sciences, Allergy and Clinical Immunology, University of Turin & AO Mauriziano "UmbertoI", Turin, Italy
| | | | - Massimo Triggiani
- Department of Translational Medical Sciences, Allergy and Clinical Immunology, Center for Basic and Clinical Immunology Research (CISI), WAO Center of Excellence, University of Naples Federico II, Naples, Italy
| | - Gianfranco Vitiello
- Experimental and Clinical Medicine Department, University of Florence, Florence, Italy
| | - Giuseppe Spadaro
- Department of Translational Medical Sciences, Allergy and Clinical Immunology, Center for Basic and Clinical Immunology Research (CISI), WAO Center of Excellence, University of Naples Federico II, Naples, Italy
| | - Maria Bova
- Department of Translational Medical Sciences, Allergy and Clinical Immunology, Center for Basic and Clinical Immunology Research (CISI), WAO Center of Excellence, University of Naples Federico II, Naples, Italy
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16
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Savarese L, Bova M, Maiello A, Petraroli A, Mormile I, Cancian M, Senter R, Zanichelli A, Spadaro G, Freda MF. Psychological processes in the experience of hereditary angioedema in adult patients: an observational study. Orphanet J Rare Dis 2021; 16:23. [PMID: 33422102 PMCID: PMC7796642 DOI: 10.1186/s13023-020-01643-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 12/09/2020] [Indexed: 12/04/2022] Open
Abstract
Background Hereditary angioedema associated to C1 inhibitor deficiency (C1-INH-HAE) is a pathological condition characterized by episodes of subcutaneous swelling and it is frequently associated with discomfort and social impairment of the patients, due to the anxiety experienced for an unpreventable manifestation of an attack during daily life. In children increased level of stress and alexithymia have been associated to C1-INH-HAE, and the latter correlated also with the severity of the disease. We hypothesized that the involvement of psychological issues may impact on the severity of C1-INH-HAE in adult patients as well, interfering with their ability to engage with the management of the disease. Methods 28 adult patients with C1-INH-HAE were evaluated for clinical (C1-INH-HAE Severity Score) and psychological factors (alexithymia, emotion regulation, stress, patient health engagement, general severity index) by means of validated questionnaires. Results Mean age (standard deviation [SD]) was 45 (11) years and time from diagnosis was 20 (12) years. The mean C1-INH-HAE severity score was 6.4. Alexithymia was absent in 22 (78%) patients. Moderate and high stress levels were present in 17 (61%) and 4 (14%) patients, respectively. Moderate-high discomfort was experienced by 9 (36%) patients and a discomfort beyond the clinical attention threshold was shown by 3 (12%) patients. Stress correlated with patient health engagement and with psychological discomfort. Conclusions In C1-INH-HAE, patients health engagement and moderate-high psychological discomfort are linked with stress but not with the severity of the disease or alexithymia. A better patient health engagement may be a target for psychological intervention in clinics to ameliorate the stress perceived by C1-INH-HAE patients.
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Affiliation(s)
- Livia Savarese
- Department of Humanities, University "Federico II", Naples, Italy.
| | - Maria Bova
- Department of Translational Medical Sciences and Center for Basic and Clinical Immunology Research (CISI), University of Naples Federico II, Naples, Italy
| | - Assunta Maiello
- Department of Humanities, University "Federico II", Naples, Italy
| | - Angelica Petraroli
- Department of Translational Medical Sciences and Center for Basic and Clinical Immunology Research (CISI), University of Naples Federico II, Naples, Italy
| | - Ilaria Mormile
- Department of Translational Medical Sciences and Center for Basic and Clinical Immunology Research (CISI), University of Naples Federico II, Naples, Italy
| | - Mauro Cancian
- Department of Medicine, University of Padua, Padua, Italy
| | | | - Andrea Zanichelli
- ASST Fatebenefratelli Sacco, Department of Biomedical and Clinical Sciences, "Luigi Sacco" Hospital, University of Milan, Milan, Italy
| | - Giuseppe Spadaro
- Department of Translational Medical Sciences and Center for Basic and Clinical Immunology Research (CISI), University of Naples Federico II, Naples, Italy
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17
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Savarese L, Freda MF, De Luca Picione R, Dolce P, De Falco R, Alessio M, Cancian M, Franzese A, Guarino MD, Perricone R, Petraroli A, Senter R, Traverso C, Zanichelli A, Zito E, Bova M. The experience of living with a chronic disease in pediatrics from the mothers' narratives: The Clinical Interview on Parental Sense of Grip on the Disease. Health Psychol Open 2020; 7:2055102920971496. [PMID: 33343914 PMCID: PMC7727074 DOI: 10.1177/2055102920971496] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The Clinical Interview on the Sense of Grip on Chronic Disease has been administered to 68 mothers of children affected by Hereditary Angioedema (C1-Inh HAE), Type 1 Diabetes (T1D), Juvenile Rheumatoid Arthritis (JRA). The objectives are to detect general features of the experience of parenting children with chronic illness as well as the specificities of this experience related to the different conditions. Four Profiles of Sense of Grip were identified: Adempitive, Controlling, Reactive, Dynamic. The Sense of Grip Interview is an effective clinical tool for understanding the characteristics of the disease in daily life, which can help clinicians to encourage family adjustment to disease.
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Affiliation(s)
- Livia Savarese
- Department of Humanities, University of Naples Federico II, Italy
| | | | | | - Pasqaule Dolce
- Department of Public Health, University of Naples Federico II, Italy
| | - Raffaella De Falco
- Department of Neuroscience and Reproductive and Odontostomatological Sciences, University of Naples Federico II, Italy
| | - Maria Alessio
- Department of Translational and Medical Science, Pediatric Unit, University Federico II, Naples, Italy
| | | | - Adriana Franzese
- Department of Translational and Medical Science, Pediatric Unit, University Federico II, Naples, Italy
| | | | | | - Angelica Petraroli
- Department of Translational Medical Sciences and Center for Basic and Clinical Immunology Research (CISI), WAO Center of Excellence., University Federico II, Naples, Italy
| | - Riccardo Senter
- Department of Humanities, University of Naples Federico II, Italy
| | - Claudia Traverso
- Department of Translational and Medical Science, Pediatric Unit, University Federico II, Naples, Italy
| | - Andrea Zanichelli
- Department of Biomedical and Clinical Science Luigi Sacco, University of Milan, Milan, Italy
| | - Eugenio Zito
- Department of Social Sciences, University of Naples Federico II
| | - Maria Bova
- Department of Translational and Medical Science, Pediatric Unit, University Federico II, Naples, Italy
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18
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Denas G, Battaggia A, Fusello M, Novelletto B, Cancian M, Pengo V. Incidence of atrial fibrillation in an opportunistic screening campaign in a general practitioner setting: a prospective population study. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
The detection of atrial fibrillation (AF) largely depends on the method used, thus the reported true rate of incident AF is controversial. The detection of symptomatic AF is straight forward in most cases, while it is unclear which strategies provide the best results for the detection of silent AF. Traditional methods like pulse palpation have a low accuracy and pulse guided ECG confirmation is not deemed cost-effective.
Purpose
The aim of the study was to detect the incidence symptomatic AF, using ECG, and opportunistic screening of silent AF, using an AF-detection capable automatic sphygmomanometer, in patients ≥65 years old in the general practitioner (GP) setting.
Methods
This was a population-based prospective cohort study of unselected general population referred for routine visits in 93 randomly selected GPs. Patients of both sexes of ≥65 years without previous diagnosis of AF were considered for the study. Each patient if symptomatic was directly referred to perform an ECG, otherwise if asymptomatic, underwent blood pressure monitoring with an AF-detection capable automatic sphygmomanometer followed by an ECG in case the device signaled AF.
Results
The final population comprised of 14987 individuals of ≥65 years old. The follow up extended to 16838 patient-years. The overall incidence of AF was 2.25% patient-years (95% CI 2.03–2.48). AF incidence was significantly higher in male (male/female ratio 1.29), overweight (BMI: 28.2 kg/m2 vs 27.0 kg/m2), older (79.1 vs 75.4 years old) individuals, with 44.9% belonging to the ≥80-year-old group. Other risk factors for incident AF were higher systolic BP measurements, history of stroke/TIA, congestive heart failure and chronic kidney disease. On multivariate analysis, age (annual increment), mitral valve disease, previous stroke and the number of annual visits (>10), were independent predictors of incidental AF.
About 25% of cases were silent AF (0.56% patient-years, 95% CI 0.46–0.69) and were identified using the AF-detection capable automatic sphygmomanometer. Independent predictors of silent AF were age (per year increment), overweight (BMI >28 kg/m2) and the number of visits (>10) in the GPs' office.
Conclusions
We found a higher than previously reported incidence of AF possibly due to capturing silent AF. This simple protocol, using an AF-capable automatic sphygmomanometer, might be feasible and easily implemented on the routine GP care where high rates of coverage can be achieved.
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Veneto Region Italy
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Affiliation(s)
- G Denas
- University of Padova, Padua, Italy
| | - A Battaggia
- Italian Society of General Medicine and Primary Care (SIMG), Padua, Italy
| | - M Fusello
- Italian Society of General Medicine and Primary Care (SIMG), Padua, Italy
| | - B.F Novelletto
- Italian Society of General Medicine and Primary Care (SIMG), Padua, Italy
| | - M Cancian
- Italian Society of General Medicine and Primary Care (SIMG), Padua, Italy
| | - V Pengo
- University of Padova, Padua, Italy
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19
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Maurer M, Aberer W, Agondi R, Al‐Ahmad M, Al‐Nesf MA, Ansotegui I, Arnaout R, Arruda LK, Asero R, Aygören‐Pürsün E, Banerji A, Bauer A, Ben‐Shoshan M, Berardi A, Bernstein JA, Betschel S, Bindslev‐Jensen C, Bizjak M, Boccon‐Gibod I, Bork K, Bouillet L, Boysen HB, Brodszki N, Broesby‐Olsen S, Busse P, Buttgereit T, Bygum A, Caballero T, Campos RA, Cancian M, Cherrez‐Ojeda I, Cohn DM, Costa C, Craig T, Criado PR, Criado RF, Csuka D, Dissemond J, Du‐Thanh A, Ensina LF, Ertaş R, Fabiani JE, Fantini C, Farkas H, Ferrucci SM, Figueras‐Nart I, Fili NL, Fomina D, Fukunaga A, Gelincik A, Giménez‐Arnau A, Godse K, Gompels M, Gonçalo M, Gotua M, Gower R, Grumach AS, Guidos‐Fogelbach G, Hide M, Ilina N, Inomata N, Jakob T, Josviack DO, Kang H, Kaplan A, Kasperska‐Zając A, Katelaris C, Kessel A, Kleinheinz A, Kocatürk E, Košnik M, Krasowska D, Kulthanan K, Kumaran MS, Larco Sousa JI, Longhurst HJ, Lumry W, MacGinnitie A, Magerl M, Makris MP, Malbrán A, Marsland A, Martinez‐Saguer I, Medina IV, Meshkova R, Metz M, Nasr I, Nicolay J, Nishigori C, Ohsawa I, Özyurt K, Papadopoulos NG, Parisi CAS, Peter JG, Pfützner W, Popov T, Prior N, Ramon GD, Reich A, Reshef A, Riedl MA, Ritchie B, Röckmann‐Helmbach H, Rudenko M, Salman A, Sanchez‐Borges M, Schmid‐Grendelmeier P, Serpa FS, Serra‐Baldrich E, Sheikh FR, Smith W, Soria A, Staubach P, Steiner UC, Stobiecki M, Sussman G, Tagka A, Thomsen SF, Treudler R, Valle S, Doorn M, Varga L, Vázquez DO, Wagner N, Wang L, Weber‐Chrysochoou C, Ye Y, Zalewska‐Janowska A, Zanichelli A, Zhao Z, Zhi Y, Zuberbier T, Zwiener RD, Castaldo A. Definition, aims, and implementation of GA 2 LEN/HAEi Angioedema Centers of Reference and Excellence. Allergy 2020; 75:2115-2123. [PMID: 32248571 DOI: 10.1111/all.14293] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 03/16/2020] [Accepted: 03/18/2020] [Indexed: 01/12/2023]
Affiliation(s)
- Marcus Maurer
- Department of Dermatology and Allergy Dermatological Allergology Allergie‐Centrum‐Charité Charité—Universitätsmedizin Berlin Berlin Germany
| | - Werner Aberer
- Department of Dermatology Medical University of Graz Graz Austria
| | | | - Mona Al‐Ahmad
- Microbiology Department Faculty of Medicine Kuwait University Safat Kuwait
| | - Maryam Ali Al‐Nesf
- Allergy and Immunology Section Department of Medicine Hamad General Hospital Doha Qatar
| | - Ignacio Ansotegui
- Department of Allergy and Immunology Hospital Quiron Bizkaia Bizkaia Spain
| | - Rand Arnaout
- King Faisal Specialist Hospital & Research Center Al Faisal University Riyadh Saudi Arabia
| | | | - Riccardo Asero
- Ambulatorio di Allergologia Clinica San Carlo Paderno Dugnano (MI) Italy
| | - Emel Aygören‐Pürsün
- Center for Children and Adolescents University Hospital Frankfurt Frankfurt Germany
| | - Aleena Banerji
- Division of Rheumatology, Allergy and Immunology Massachusetts General Hospital Boston MA USA
| | - Andrea Bauer
- Department of Dermatology University Allergy Center University Hospital Carl Gustav Carus Technical University Dresden Germany
| | - Moshe Ben‐Shoshan
- Division of Allergy, Immunology and Dermatology Department of Pediatrics McGill University Health Center Montreal QC Canada
| | - Alejandro Berardi
- Instituto de Asma Alergia y Enfermedades Respiratorias Corrientes Argentina
| | - Jonathan A. Bernstein
- Allergy Section Division of Immunology Department of Internal Medicine Partner Bernstein Allergy Group Partner Bernstein Clinical Research Center University of Cincinnati Cincinnati OH USA
| | - Stephen Betschel
- Division of Clinical Immunology and Allergy St. Michael’s Hospital University of Toronto Toronto ON Canada
| | | | - Mojca Bizjak
- Division of Allergy University Clinic of Respiratory and Allergic Diseases Golnik Golnik Slovenia
| | - Isabelle Boccon‐Gibod
- Clinical Immunology/Internal Medicine Department National Reference Center for Angioedema Grenoble University Hospital Grenoble France
| | - Konrad Bork
- Department of Dermatology Johannes Gutenberg University Mainz Mainz Germany
| | - Laurence Bouillet
- Clinical Immunology/Internal Medicine Department National Reference Center for Angioedema Grenoble University Hospital Grenoble France
| | | | | | - Sigurd Broesby‐Olsen
- Department of Dermatology and Allergy Center Odense University Hospital Odense Denmark
| | - Paula Busse
- Division of Clinical Immunology Icahn School at Mount Sinai New York NY USA
| | - Thomas Buttgereit
- Department of Dermatology and Allergy Dermatological Allergology Allergie‐Centrum‐Charité Charité—Universitätsmedizin Berlin Berlin Germany
| | - Anette Bygum
- HAE Centre Odense University Hospital Odense Denmark
| | - Teresa Caballero
- Allergy Department Hospital Universitario La Paz IdiPaz, CIBERER U754 Madrid Spain
| | - Régis A. Campos
- Universidade Federal da Bahia Salvador Brazil
- Serviço de Imunologia Hospital das Clínicas Professor Edgard Santos Salvador Brazil
| | - Mauro Cancian
- Department of Systems Medicine University Hospital of Padua Padua Italy
| | - Ivan Cherrez‐Ojeda
- School of Medicine Universidad de Especialidades Espíritu Santo Samborondón Ecuador
- RespiraLab, Research Guayaquil Ecuador
| | - Danny M. Cohn
- Department of Vascular Medicine Amsterdam UMC University of Amsterdam Amsterdam The Netherlands
| | - Célia Costa
- Immunoallergology Department Hospital de Santa Maria Centro Hospitalar Universitário de Lisboa Norte (CHLN) EPE Lisbon Portugal
| | - Timothy Craig
- Department of Medicine and Pediatrics Penn State University Hershey PA USA
| | - Paulo Ricardo Criado
- Faculdade de Medicina do ABC Santo André Brazil
- Alergoskin Alergia e Dermatologia SS ltda Santo André Brazil
- UCARE Center São Paulo Brazil
| | | | - Dorottya Csuka
- 3rd Department of Internal Medicine Hungarian Angioedema Reference Center Semmelweis University Budapest Hungary
| | - Joachim Dissemond
- Department of Dermatology, Venereology and Allergology University of Essen Essen Germany
| | - Aurélie Du‐Thanh
- Service de Dermatologie‐allergologie CHU Montpellier Montpellier Cedex 5 France
| | - Luis Felipe Ensina
- Division of Allergy, Clinical Immunology and Rheumatology Department of Pediatrics Federal University of São Paulo São Paulo Brazil
| | - Ragıp Ertaş
- Department of Dermatology Kayseri City Education and Research Hospital Kayseri Turkey
| | | | - Claudio Fantini
- Servicio de Alergia e Inmunología—Hospital Alende y Clínica Colón Mar del Plata Argentina
| | - Henriette Farkas
- 3rd Department of Internal Medicine Hungarian Angioedema Reference Center Semmelweis University Budapest Hungary
| | - Silvia Mariel Ferrucci
- Ambulatorio di Dermatologia Allergologica e Professionale Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico Milano (MI) Italy
| | - Ignasi Figueras‐Nart
- The Dermatology Department of the Hospital de Bellvitge Universitat de Barcelona Barcelona Spain
| | - Natalia L. Fili
- Unidad Alergia e Inmunología Clínica Hospital Público Materno Infantil Salta Argentina
| | - Daria Fomina
- Center of Allergy and Immunology City Clinical Hospital No. 52 Moscow Ministry of Healthcare Moscow Russian Federation
- Department of Allergology and Clinical Immunology I.M. Sechenov First Moscow State Medical University Moscow Russian Federation
| | - Atsushi Fukunaga
- Division of Dermatology Graduate School of Medicine Kobe University Kobe Japan
| | - Asli Gelincik
- Division of Immunology and Allergic Diseases Department of Internal Medicine Istanbul Faculty of Medicine Istanbul University Istanbul Turkey
| | - Ana Giménez‐Arnau
- Department of Dermatology Hospital del Mar IMIM Universitat Autònoma Barcelona Spain
| | - Kiran Godse
- Department of Dermatology D Y. Patil University School of Medicine Mumbai India
| | - Mark Gompels
- Department of Immunology North Bristol NHS Trust Southmead Hospital Bristol UK
| | - Margarida Gonçalo
- Clinica de Dermatologia Centro Hospitalar Universitário Coimbra Coimbra Portugal
| | - Maia Gotua
- Center of Allergy and Immunology Tbilsi Georgia
| | | | - Anete S. Grumach
- Clinical Immunology Medical School University Center Health ABC Santo Andre Brazil
| | | | - Michihiro Hide
- Department of Dermatology Graduate School of Biomedical and Health Sciences Hiroshima University Hiroshima Japan
| | | | - Naoko Inomata
- Department of Environmental Immuno‐Dermatology Yokohama City University Graduate School of Medicine Yokohama Japan
| | - Thilo Jakob
- Department of Dermatology and Allergy University Medical Center Giessen (UKGM) Justus‐Liebig‐University Giessen Giessen Germany
| | | | - Hye‐Ryun Kang
- Institute of Allergy and Clinical Immunology Seoul National University Medical Research Center Seoul Korea
| | - Allen Kaplan
- Medical University of South Carolina Charleston SC USA
| | | | - Constance Katelaris
- Immunology & Allergy Unit Department of Medicine Campbelltown Hospital Campbelltown NSW Australia
| | - Aharon Kessel
- Division of Allergy & Clinical Immunology Rappaport Faculty of Medicine Bnai Zion Medical Center Technion Haifa Israel
| | | | - Emek Kocatürk
- Department of Dermatology School of Medicine Koç University Koc Turkey
| | - Mitja Košnik
- Division of Allergy University Clinic of Respiratory and Allergic Diseases Golnik Golnik Slovenia
| | - Dorota Krasowska
- Department of Dermatology, Venerology and Pediatric Dermatology Medical University of Lublin Lublin Poland
| | - Kanokvalai Kulthanan
- Department of Dermatology Faculty of Medicine Siriraj Hospital Mahidol University Bangkok Thailand
| | - M. Sendhil Kumaran
- Department of Dermatology Postgraduate Institute of Medical Education and Research Chandigarh India
| | | | - Hilary J. Longhurst
- Department of Immunology Addenbrookes Hospital Cambridge University NHS Foundation Trust Cambridge UK
- UCLH London UK
- Addenbrooke's Hospital Cambridge and University College Hospital London UK
| | - William Lumry
- Allergy/Immunology Division Department of Internal Medicine University of Texas Southwestern Medical School Dallas TX USA
| | - Andrew MacGinnitie
- Division of Immunology Department of Pediatrics Boston Children’s Hospital Harvard Medical School Boston MA USA
| | - Markus Magerl
- Department of Dermatology and Allergy Dermatological Allergology Allergie‐Centrum‐Charité Charité—Universitätsmedizin Berlin Berlin Germany
| | - Michael P. Makris
- Allergy Unit “D. Kalogeromitros” 2nd Department of Dermatology and Venereology University Hospital “Attikon”, National and Kapodistrian University of Athens Athens Greece
| | | | - Alexander Marsland
- Department of Dermatology The Urticaria Clinic Salford Royal Foundation Trust University of Manchester Manchester UK
| | | | - Iris V. Medina
- Allergy and Clinical Immunology Department Centro Médico Vitae de Julio Argentina
| | - Raisa Meshkova
- Department of Clinical Immunology and Allergology Smolensk State Medical University Smolensk Russian Federation
| | - Martin Metz
- Department of Dermatology and Allergy Dermatological Allergology Allergie‐Centrum‐Charité Charité—Universitätsmedizin Berlin Berlin Germany
| | - Iman Nasr
- Adult Immunology and Allergy Unit Department of Medicine Royal Hospital Muscat Oman
| | - Jan Nicolay
- Klinik für Dermatologie Universitätsklinikum Mannheim Mannheim Germany
| | - Chikako Nishigori
- Division of Dermatology Kobe University Graduate School of Medicine Kobe Japan
| | - Isao Ohsawa
- Department of Internal Medicine Saiyu Soka Hospital Soka Japan
| | - Kemal Özyurt
- Department of Dermatology Faculty of Medicine Kırşehir Ahi Evran University Kırşehir Turkey
| | | | - Claudio A. S. Parisi
- Adults and Pediatrics Allergy Unit Hospital Italiano de Buenos Aires Buenos Aires Argentina
| | | | - Wolfgang Pfützner
- Department of Dermatology and Allergology Allergy Center Hessen University Clinic Marburg Marburg Germany
| | - Todor Popov
- University Hospital Sv. Ivan Rilski Sofia Bulgaria
| | - Nieves Prior
- Allergy Department Hospital Universitario Severo Ochoa Madrid Spain
| | - German D. Ramon
- Instituto de Alergia e Inmunologia del Sur Buenos Aires Argentina
| | - Adam Reich
- Department of Dermatology University of Rzeszow Rzeszów Poland
| | - Avner Reshef
- Angioedema Center Barzilai Medical Center Ashkelon Israel
| | - Marc A. Riedl
- Department of Medicine University of California—San Diego La Jolla CA USA
| | - Bruce Ritchie
- Departments of Medicine and Medical Oncology University of Alberta Edmonton AB Canada
| | - Heike Röckmann‐Helmbach
- Department of Dermatology and Allergology University Medical Center Utrecht Utrecht The Netherlands
| | | | - Andaç Salman
- Dermatology Department Marmara University School of Medicine Pendik Research and Training Hospital Istanbul Turkey
| | - Mario Sanchez‐Borges
- Allergy and Clinical Immunology Department Centro Medico Docente La Trinidad Caracas Venezuela
| | | | - Faradiba S. Serpa
- Hospital Santa Casa de Misericórdia de Vitória Espírito Santo Brazil
| | | | - Farrukh R. Sheikh
- Department of Medicine King Faisal Specialist Hospital & Research Center Riyadh Saudi Arabia
| | - William Smith
- Clinical Immunology and Allergy Royal Adelaide Hospital Adelaide SA Australia
| | - Angèle Soria
- Service de Dermatologie et Allergologie Hopital Tenon APHP Sorbonne Université Paris France
| | - Petra Staubach
- Department of Dermatology University Medical Center Mainz Germany
| | - Urs C. Steiner
- Department of Clinical Immunology University Hospital Zurich Zurich Switzerland
| | - Marcin Stobiecki
- Department of Environmental Allergology Jagiellonian University Medical College Kraków HAE Center University Hospital Kraków Poland
| | - Gordon Sussman
- Division of Allergy and Immunology University of Toronto Toronto ON Canada
| | - Anna Tagka
- First Department of Dermatology and Venereology National and Kapodistrian University of Athens, "A. Syggros" Hospital Referral Center of Occupational Dermatological Diseases Athens Greece
| | | | - Regina Treudler
- Department of Dermatology, Venerology and Allergology and Leipzig Interdisciplinary Center of Allergology—Comprehensive Allergy Center UMC Leipzig Leipzig Germany
| | - Solange Valle
- Federal University of Rio de Janeiro Rio de Janeiro Brazil
| | - Martijn Doorn
- Department of Dermatology Erasmus MC Rotterdam The Netherlands
| | - Lilian Varga
- 3rd Department of Internal Medicine Hungarian Angioedema Reference Center Semmelweis University Budapest Hungary
| | | | - Nicola Wagner
- Department of Dermatology University of Erlangen Erlangen Germany
| | - Liangchun Wang
- Dermatology Department of Sun Yat‐sen Memorial Hospital Guangzhou China
| | | | - Young‐Min Ye
- Department of Allergy and Clinical Immunology Ajou University School of Medicine Suwon Korea
| | - Anna Zalewska‐Janowska
- Chair of Clinical Immunology and Rheumatology Department of Psychodermatology Medical University of Lodz Lodz Poland
| | - Andrea Zanichelli
- Department of Biomedical and Clinical Sciences Luigi Sacco Hospital University of Milan Milan Italy
| | - Zuotao Zhao
- Department of Dermatology and Venereology First Hospital Peking University Beijing China
- Beijing Key Laboratory of Molecular Diagnosis on Dermatoses Beijing China
| | - Yuxiang Zhi
- Department of Allergy Peking Union Medical College Hospital & Chinese Academy of Medical Sciences Beijing China
| | - Torsten Zuberbier
- Department of Dermatology and Allergy Allergie‐Centrum‐Charité Charité—Universitätsmedizin Berlin Berlin Germany
| | - Ricardo D. Zwiener
- Servicio de Alergia e Inmunología Hospital Universitario Austral Buenos Aires Argentina
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Cancian M, Borella E, D'Onofrio A, Gerosa G, Simioni P, Campello E. Heparin challenge test in patients undergoing cardiac surgery: dealing with heparin allergy. Blood Coagul Fibrinolysis 2020; 31:165-169. [PMID: 32004200 DOI: 10.1097/mbc.0000000000000883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
: A history of heparin hypersensitivity in patients undergoing cardiopulmonary bypass surgery poses the dilemma of which anticoagulant to use. Here, we report the successful use of a heparin challenge test in a 66-year-old female candidate for coronary artery bypass graft surgery with a past medical history of enoxaparin type I hypersensitivity after pulmonary embolism. Challenge and desensitization protocols are effectively used for essential antibiotics in patients with severe infections and/or allergies, or patients with aspirin intolerance requiring revascularization for coronary disease. A successful use of desensitization protocols to unfractionated heparin has been previously described in four patients undergoing cardiac surgery with various schemes. However, our case report indicates that a challenge test may also offer a quick, safe and effective approach in patients with a history of hypersensitivity reactions to heparin with inconclusive diagnostic tests and/or whenever the use of alternative heparins is tricky.
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Affiliation(s)
| | | | - Augusto D'Onofrio
- Department of Cardiac, Thoracic and Vascular Sciences, Padova University Hospital, Padova, Italy
| | - Gino Gerosa
- Department of Cardiac, Thoracic and Vascular Sciences, Padova University Hospital, Padova, Italy
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21
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Cancian M, Perego F, Senter R, Arcoleo F, De Pasquale T, Zoli A, Cicardi M, Zanichelli A. Pediatric angioedema: Essential features and preliminary results from the Hereditary Angioedema Global Registry in Italy. Pediatr Allergy Immunol 2020; 31 Suppl 24:22-24. [PMID: 32017221 DOI: 10.1111/pai.13170] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/24/2019] [Indexed: 11/27/2022]
Abstract
Isolated angioedema, which is a localized, non-pitting, and transient swelling of the subcutaneous or submucosal tissue not associated with pruritus, urticaria, or anaphylaxis, may be classified, based on genetic pattern and mediators, respectively, as acquired or hereditary and histamine- or non-histamine-induced. The pediatric population with C1-INH-HAE (Hereditary angioedema due to C1-inhibitor deficiency) is mostly symptomatic. The frequency of symptoms in such a population compared to adults seems to be lower, but we need more prospective data to conclude on this point. The HGR (Hereditary angioedema global registry), which collects symptoms in real time, will probably provide such information. In terms of treatments, pediatric patients are significantly disadvantaged due to the few studies aimed at registering treatment for this population.
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Affiliation(s)
- Mauro Cancian
- Department of Medicine, University of Padova, Padova, Italy
| | | | | | - Francesco Arcoleo
- Ospedali Riuniti Villa Sofia-Cervello, Unità Operativa Complessa di Patologia Clinica, Palermo, Italy
| | | | - Alessandra Zoli
- Servizio di Immunologia Clinica e Tipizzazione Tessutale-Ospedali Riuniti di Ancona, Ancona, Italy
| | - Marco Cicardi
- IRCCS Istituti Clinici Scientifici Maugeri, Milano, Italy.,Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Milano, Italy
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22
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Cancian M, Giovannini S, Angelini A, Fedrigo M, Bendo R, Senter R, Sivolella S. Melkersson-Rosenthal syndrome: a case report of a rare disease with overlapping features. Allergy Asthma Clin Immunol 2019; 15:1. [PMID: 30622569 PMCID: PMC6320604 DOI: 10.1186/s13223-018-0316-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 12/24/2018] [Indexed: 01/27/2023]
Abstract
BACKGROUND Melkersson-Rosenthal syndrome (MRS) is a rare, neuro-mucocutaneous disease which presents as orofacial swelling, facial palsy and fissured tongue. These symptoms may occur simultaneously or, more frequently, with a oligosymptomatic or monosymptomatic pattern. Swelling, that is the most common initial finding, may mimic hereditary or acquired angioedema, a disorder caused by histamine or bradykinin-mediated plasma-leakage affecting subcutaneous and/or submucosal tissue. The differential diagnosis of MRS includes also chronic inflammatory and infective diseases characterized by granulomatous infiltration, as well as rosacea, contact dermatitis, allergic reactions and Bell's palsy. CASE PRESENTATION A 71-year old, non-allergic female patient with no familial and personal history of angioedema presented, a few days after a possible herpes simplex or varicella-zoster virus infection, with monolateral facial paraesthesia and lower lip edema. After temporary remission of symptoms on oral steroids and antihistamines, she showed swelling recurrence refractory to valaciclovir therapy and a subsequent course of antihistamines. The clinical picture and a previous history of non-Hodgkin lymphoma prompted us to rule out an acquired form of paraneoplastic, C1-inhibitor (C1-INH) deficiency: C1q and both antigen and functional C1-INH tested normal, whilst we found low plasma levels of C3 and C4 possibly related to the parallel detection of antiphospholipid antibodies. Thus, we hypothesized a non-histaminergic, idiopathic form of angioedema and planned further therapy with tranexamic acid and the leukotriene receptor antagonist montelukast. Treatment failure with both drugs finally suggested a Melkersson-Rosenthal syndrome, which was confirmed by histologic findings of non caseating granulomas on lip biopsy. CONCLUSION Melkersson-Rosenthal syndrome may occur with rather non-specific symptoms and overlap with alternative conditions, including recurrent angioedema. No specific biomarkers for MRS exist and clinical diagnosis is often of exclusion. The finding of complement or immune alterations, as in our patient, may be further confounding and justify the need for skin or mucosal biopsy to establish a correct diagnosis and prescribe targeted therapy.
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Affiliation(s)
- Mauro Cancian
- Department of Medicine, University of Padua, Padua, Italy
| | - Stefano Giovannini
- Department of Neuroscience, Division of Dentistry, University of Padua, Via Giustiniani 2, 35128 Padua, Italy
| | - Annalisa Angelini
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Marny Fedrigo
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Raffaele Bendo
- Department of Medicine, University of Padua, Padua, Italy
| | | | - Stefano Sivolella
- Department of Neuroscience, Division of Dentistry, University of Padua, Via Giustiniani 2, 35128 Padua, Italy
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23
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Riedl MA, Aygören-Pürsün E, Baker J, Farkas H, Anderson J, Bernstein J, Bouillet L, Busse P, Manning M, Magerl M, Gompels M, Huissoon AP, Longhurst H, Lumry W, Ritchie B, Shapiro R, Soteres D, Banerji A, Cancian M, Johnston DT, Craig T, Launay D, Li HH, Liebhaber M, Nickel T, Offenberger J, Rae W, Schrijvers R, Triggiani M, Wedner HJ, Dobo S, Cornpropst M, Clemons D, Fang L, Collis P, Sheridan W, Maurer M. Evaluation of avoralstat, an oral kallikrein inhibitor, in a Phase 3 hereditary angioedema prophylaxis trial: The OPuS-2 study. Allergy 2018; 73:1871-1880. [PMID: 29688579 PMCID: PMC6175137 DOI: 10.1111/all.13466] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2018] [Indexed: 12/02/2022]
Abstract
Background Effective inhibition of plasma kallikrein may have significant benefits for patients with hereditary angioedema due to deficiency of C1 inhibitor (C1‐INH‐HAE) by reducing the frequency of angioedema attacks. Avoralstat is a small molecule inhibitor of plasma kallikrein. This study (OPuS‐2) evaluated the efficacy and safety of prophylactic avoralstat 300 or 500 mg compared with placebo. Methods OPuS‐2 was a Phase 3, multicenter, randomized, double‐blind, placebo‐controlled, parallel‐group study. Subjects were administered avoralstat 300 mg, avoralstat 500 mg, or placebo orally 3 times per day for 12 weeks. The primary efficacy endpoint was the angioedema attack rate based on adjudicator‐confirmed attacks. Results A total of 110 subjects were randomized and dosed. The least squares (LS) mean attack rates per week were 0.589, 0.675, and 0.593 for subjects receiving avoralstat 500 mg, avoralstat 300 mg, and placebo, respectively. Overall, 1 subject in each of the avoralstat groups and no subjects in the placebo group were attack‐free during the 84‐day treatment period. The LS mean duration of all confirmed attacks was 25.4, 29.4, and 31.4 hours for the avoralstat 500 mg, avoralstat 300 mg, and placebo groups, respectively. Using the Angioedema Quality of Life Questionnaire (AE‐QoL), improved QoL was observed for the avoralstat 500 mg group compared with placebo. Avoralstat was generally safe and well tolerated. Conclusions Although this study did not demonstrate efficacy of avoralstat in preventing angioedema attacks in C1‐INH‐HAE, it provided evidence of shortened angioedema episodes and improved QoL in the avoralstat 500 mg treatment group compared with placebo.
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Affiliation(s)
- M. A. Riedl
- Division of Rheumatology; Allergy & Immunology; University of California San Diego; San Diego CA USA
| | - E. Aygören-Pürsün
- Department for Children and Adolescents; University Hospital Frankfurt; Frankfurt Germany
| | - J. Baker
- Baker Allergy Asthma Dermatology Research Center; Portland OR USA
| | - H. Farkas
- 3rd Department of Internal Medicine; Semmelweis University; Budapest Hungary
| | - J. Anderson
- Clinical Research Center of Alabama; Birmingham AL USA
| | - J. A. Bernstein
- Department of Internal Medicine; University of Cincinnati; Cincinnati OH USA
| | - L. Bouillet
- Internal Medicine; National Reference Centre of Angioedema; Grenoble University Hospital; Grenoble France
| | - P. Busse
- Division of Clinical Immunology and Allergy; Department of Medicine; Icahn School of Medicine at Mount Sinai; New York NY USA
| | - M. Manning
- Medical Research of Arizona; Allergy; Asthma & Immunology Associates; Scottsdale AZ USA
| | - M. Magerl
- Dermatology, Venerology and Allergology; Charite - Universitätsmedizin Berlin; Berlin Germany
| | - M. Gompels
- Immunology; North Bristol NHS Trust; Bristol UK
| | - A. P. Huissoon
- Department of Allergy and Immunology; Heartlands Hospital; Birmingham UK
| | - H. Longhurst
- Immunology; Addenbrookes Hospital; Cambridge University Hospitals; Cambridge UK
| | - W. Lumry
- Allergy and Asthma Research Associates Research Center; Dallas TX USA
| | - B. Ritchie
- Division of Hematology; Department of Medicine; University of Alberta; Edmonton AB Canada
| | - R. Shapiro
- Immunology; Midwest Immunology Clinic; Plymouth MN USA
| | - D. Soteres
- Asthma and Allergy Associates PC; Colorado Springs CO USA
| | - A. Banerji
- Division of Rheumatology; Allergy& Immunology; Department of Medicine; Massachusetts General Hospital; Harvard Medical School; Boston MA USA
| | - M. Cancian
- Department of Medicine; University of Padova; Padova Italy
| | | | - T. J. Craig
- Department of Medicine and Pediatrics; Penn State Hershey Allergy Asthma, and Immunology; Hershey PA USA
| | - D. Launay
- Internal Medicine; CHRU Lille; France France
| | - H. H. Li
- Institute for Asthma and Allergy; Chevy Chase MD USA
| | - M. Liebhaber
- Allergy and Immunology; Sansum Clinic; Santa Barbara CA USA
| | - T. Nickel
- Allergy & Immunology; Allergy Clinic of Tulsa; Tulsa OK USA
| | | | - W. Rae
- Allergy & Clinical Immunology; University Hospital Southampton NHS Foundation Trust; Southampton UK
| | - R. Schrijvers
- Laboratory of Clinical Immunology; KU Leuven; Leuven Belgium
| | - M. Triggiani
- Division of Allergy and Clinical Immunology; University of Salerno; Salerno Italy
| | - H. J. Wedner
- Division of Allergy and Immunology; Washington University School of Medicine; St. Louis MO USA
| | - S. Dobo
- Biocryst Pharmaceuticals; Durham NC USA
| | | | | | - L. Fang
- Statistics; PharStat, Inc.; Raleigh NC USA
| | - P. Collis
- Biocryst Pharmaceuticals; Durham NC USA
| | | | - M. Maurer
- Department of Dermatology and Allergy; Charité - Universitätsmedizin Berlin; Berlin Germany
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24
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Aygören-Pürsün E, Bygum A, Grivcheva-Panovska V, Magerl M, Graff J, Steiner UC, Fain O, Huissoon A, Kinaciyan T, Farkas H, Lleonart R, Longhurst HJ, Rae W, Triggiani M, Aberer W, Cancian M, Zanichelli A, Smith WB, Baeza ML, Du-Thanh A, Gompels M, Gonzalez-Quevedo T, Greve J, Guilarte M, Katelaris C, Dobo S, Cornpropst M, Clemons D, Fang L, Collis P, Sheridan W, Maurer M, Cicardi M. Oral Plasma Kallikrein Inhibitor for Prophylaxis in Hereditary Angioedema. N Engl J Med 2018; 379:352-362. [PMID: 30044938 DOI: 10.1056/nejmoa1716995] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Hereditary angioedema is a life-threatening illness caused by mutations in the gene encoding C1 inhibitor (also called C1 esterase inhibitor) that lead to overactivation of the kallikrein-bradykinin cascade. BCX7353 is a potent oral small-molecule inhibitor of plasma kallikrein with a pharmacokinetic and pharmacodynamic profile that may help prevent angioedema attacks. METHODS In this international, three-part, dose-ranging, placebo-controlled trial, we evaluated four doses of BCX7353 (62.5 mg, 125 mg, 250 mg, and 350 mg once daily) for the prevention of angioedema attacks over a 28-day period. Patients with type I or II hereditary angioedema with a history of at least two angioedema attacks per month were randomly assigned to BCX7353 or placebo. The primary efficacy end point was the number of confirmed angioedema attacks. Key secondary end points included angioedema attacks according to anatomical location and quality of life. RESULTS A total of 77 patients underwent randomization, 75 received BCX7353 or placebo, and 72 completed the trial. The rate of confirmed angioedema attacks was significantly lower among patients who received BCX7353 at daily doses of 125 mg or more than among those who received placebo, with a 73.8% difference at 125 mg (P<0.001). Significant benefits with respect to quality-of-life scores were observed in the 125-mg and 250-mg dose groups (P<0.05). Gastrointestinal adverse events, predominantly of grade 1, were the most commonly reported adverse events, particularly in the two highest BCX7353 dose groups. CONCLUSIONS Once-daily oral administration of BCX7353 at a dose of 125 mg or more resulted in a significantly lower rate of attacks of hereditary angioedema than placebo. Mild gastrointestinal symptoms were the principal side effect. (Funded by BioCryst Pharmaceuticals; APeX-1 ClinicalTrials.gov number, NCT02870972 .).
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Affiliation(s)
- Emel Aygören-Pürsün
- From the Division of Hematology, Oncology, and Hemostaseology, Department of Children and Adolescents, Angioedema Center, University Hospital Frankfurt (E.A.-P.), and the Fraunhofer Institute for Molecular Biology and Applied Ecology, Translational Medicine and Pharmacology (J. Graff), Frankfurt, the Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin (M. Magerl, M. Maurer), and the Department of Otorhinolaryngology and Head and Neck Surgery, Ulm University Medical Center, Ulm (J. Greve) - all in Germany; the Department of Dermatology and Allergy Center, Odense University Hospital, Odense, Denmark (A.B.); Public Health Institution University Clinic of Dermatology, School of Medicine, University Sts. Cyril and Methodius, Skopje, Macedonia (V.G.-P.); the Department of Clinical Immunology, University Hospital Zurich, Zurich, Switzerland (U.C.S.); Assistance Publique-Hôpitaux de Paris Hôpital Saint Antoine, Sorbonne Université, Paris (O.F.), and the Department of Dermatology, Université de Montpellier, Montpellier (A.D.-T.) - both in France; the Allergy and Immunology West Midlands, Birmingham Heartlands Hospital, Birmingham (A.H.), Barts Health NHS Trust-Royal London Hospital, London (H.J.L.), the National Institute for Health Research Southampton Clinical Research Facility, Southampton (W.R.), and the North Bristol NHS Trust, Southmead Hospital, Bristol (M. Gompels) - all in the United Kingdom; the Department of Dermatology, Medical University of Vienna, Vienna (T.K.), and the Department of Dermatology and Venereology, Medical University of Graz, Graz (W.A.) - both in Austria; the Hungarian Angioedema Reference Center, 3rd Department of Internal Medicine, Semmelweis University, Budapest, Hungary (H.F.); the Allergology Unit, Department of Internal Medicine, Hospital Universitario Bellvitge de L'Hospitalet de Llobregat (R.L.) and Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute (M. Guilarte), Barcelona, Hospital General Universitario Gregorio Marañón, Biomedical Research Network on Rare Diseases (Centro de Investigación Biomédica en Red de Enfermedades Raras)-Unit 761, Institute for Health Research, Gregorio Marañon, Madrid (M.L.B.), and Hospital Universitario Virgen del Rocío, Seville (T.G.-Q.) - all in Spain; the Division of Allergy and Clinical Immunology, University of Salerno, Salerno (M.T.), the Department of Medicine, University of Padua, Padua (M. Cancian), and Azienda Socio Sanitaria Territoriale Fatebenefratelli Sacco-Università degli Studi di Milano, Milan (A.Z., M. Cicardi) - all in Italy; the Department of Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide, SA (W.B.S.), and Campbelltown Hospital, Immunology and Allergy, Western Sydney University, Sydney (C.K.) - both in Australia; and BioCryst Pharmaceuticals (S.D., M. Cornpropst, D.C., P.C., W.S.) and PharStat (L.F.) - both in Durham, NC
| | - Anette Bygum
- From the Division of Hematology, Oncology, and Hemostaseology, Department of Children and Adolescents, Angioedema Center, University Hospital Frankfurt (E.A.-P.), and the Fraunhofer Institute for Molecular Biology and Applied Ecology, Translational Medicine and Pharmacology (J. Graff), Frankfurt, the Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin (M. Magerl, M. Maurer), and the Department of Otorhinolaryngology and Head and Neck Surgery, Ulm University Medical Center, Ulm (J. Greve) - all in Germany; the Department of Dermatology and Allergy Center, Odense University Hospital, Odense, Denmark (A.B.); Public Health Institution University Clinic of Dermatology, School of Medicine, University Sts. Cyril and Methodius, Skopje, Macedonia (V.G.-P.); the Department of Clinical Immunology, University Hospital Zurich, Zurich, Switzerland (U.C.S.); Assistance Publique-Hôpitaux de Paris Hôpital Saint Antoine, Sorbonne Université, Paris (O.F.), and the Department of Dermatology, Université de Montpellier, Montpellier (A.D.-T.) - both in France; the Allergy and Immunology West Midlands, Birmingham Heartlands Hospital, Birmingham (A.H.), Barts Health NHS Trust-Royal London Hospital, London (H.J.L.), the National Institute for Health Research Southampton Clinical Research Facility, Southampton (W.R.), and the North Bristol NHS Trust, Southmead Hospital, Bristol (M. Gompels) - all in the United Kingdom; the Department of Dermatology, Medical University of Vienna, Vienna (T.K.), and the Department of Dermatology and Venereology, Medical University of Graz, Graz (W.A.) - both in Austria; the Hungarian Angioedema Reference Center, 3rd Department of Internal Medicine, Semmelweis University, Budapest, Hungary (H.F.); the Allergology Unit, Department of Internal Medicine, Hospital Universitario Bellvitge de L'Hospitalet de Llobregat (R.L.) and Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute (M. Guilarte), Barcelona, Hospital General Universitario Gregorio Marañón, Biomedical Research Network on Rare Diseases (Centro de Investigación Biomédica en Red de Enfermedades Raras)-Unit 761, Institute for Health Research, Gregorio Marañon, Madrid (M.L.B.), and Hospital Universitario Virgen del Rocío, Seville (T.G.-Q.) - all in Spain; the Division of Allergy and Clinical Immunology, University of Salerno, Salerno (M.T.), the Department of Medicine, University of Padua, Padua (M. Cancian), and Azienda Socio Sanitaria Territoriale Fatebenefratelli Sacco-Università degli Studi di Milano, Milan (A.Z., M. Cicardi) - all in Italy; the Department of Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide, SA (W.B.S.), and Campbelltown Hospital, Immunology and Allergy, Western Sydney University, Sydney (C.K.) - both in Australia; and BioCryst Pharmaceuticals (S.D., M. Cornpropst, D.C., P.C., W.S.) and PharStat (L.F.) - both in Durham, NC
| | - Vesna Grivcheva-Panovska
- From the Division of Hematology, Oncology, and Hemostaseology, Department of Children and Adolescents, Angioedema Center, University Hospital Frankfurt (E.A.-P.), and the Fraunhofer Institute for Molecular Biology and Applied Ecology, Translational Medicine and Pharmacology (J. Graff), Frankfurt, the Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin (M. Magerl, M. Maurer), and the Department of Otorhinolaryngology and Head and Neck Surgery, Ulm University Medical Center, Ulm (J. Greve) - all in Germany; the Department of Dermatology and Allergy Center, Odense University Hospital, Odense, Denmark (A.B.); Public Health Institution University Clinic of Dermatology, School of Medicine, University Sts. Cyril and Methodius, Skopje, Macedonia (V.G.-P.); the Department of Clinical Immunology, University Hospital Zurich, Zurich, Switzerland (U.C.S.); Assistance Publique-Hôpitaux de Paris Hôpital Saint Antoine, Sorbonne Université, Paris (O.F.), and the Department of Dermatology, Université de Montpellier, Montpellier (A.D.-T.) - both in France; the Allergy and Immunology West Midlands, Birmingham Heartlands Hospital, Birmingham (A.H.), Barts Health NHS Trust-Royal London Hospital, London (H.J.L.), the National Institute for Health Research Southampton Clinical Research Facility, Southampton (W.R.), and the North Bristol NHS Trust, Southmead Hospital, Bristol (M. Gompels) - all in the United Kingdom; the Department of Dermatology, Medical University of Vienna, Vienna (T.K.), and the Department of Dermatology and Venereology, Medical University of Graz, Graz (W.A.) - both in Austria; the Hungarian Angioedema Reference Center, 3rd Department of Internal Medicine, Semmelweis University, Budapest, Hungary (H.F.); the Allergology Unit, Department of Internal Medicine, Hospital Universitario Bellvitge de L'Hospitalet de Llobregat (R.L.) and Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute (M. Guilarte), Barcelona, Hospital General Universitario Gregorio Marañón, Biomedical Research Network on Rare Diseases (Centro de Investigación Biomédica en Red de Enfermedades Raras)-Unit 761, Institute for Health Research, Gregorio Marañon, Madrid (M.L.B.), and Hospital Universitario Virgen del Rocío, Seville (T.G.-Q.) - all in Spain; the Division of Allergy and Clinical Immunology, University of Salerno, Salerno (M.T.), the Department of Medicine, University of Padua, Padua (M. Cancian), and Azienda Socio Sanitaria Territoriale Fatebenefratelli Sacco-Università degli Studi di Milano, Milan (A.Z., M. Cicardi) - all in Italy; the Department of Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide, SA (W.B.S.), and Campbelltown Hospital, Immunology and Allergy, Western Sydney University, Sydney (C.K.) - both in Australia; and BioCryst Pharmaceuticals (S.D., M. Cornpropst, D.C., P.C., W.S.) and PharStat (L.F.) - both in Durham, NC
| | - Markus Magerl
- From the Division of Hematology, Oncology, and Hemostaseology, Department of Children and Adolescents, Angioedema Center, University Hospital Frankfurt (E.A.-P.), and the Fraunhofer Institute for Molecular Biology and Applied Ecology, Translational Medicine and Pharmacology (J. Graff), Frankfurt, the Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin (M. Magerl, M. Maurer), and the Department of Otorhinolaryngology and Head and Neck Surgery, Ulm University Medical Center, Ulm (J. Greve) - all in Germany; the Department of Dermatology and Allergy Center, Odense University Hospital, Odense, Denmark (A.B.); Public Health Institution University Clinic of Dermatology, School of Medicine, University Sts. Cyril and Methodius, Skopje, Macedonia (V.G.-P.); the Department of Clinical Immunology, University Hospital Zurich, Zurich, Switzerland (U.C.S.); Assistance Publique-Hôpitaux de Paris Hôpital Saint Antoine, Sorbonne Université, Paris (O.F.), and the Department of Dermatology, Université de Montpellier, Montpellier (A.D.-T.) - both in France; the Allergy and Immunology West Midlands, Birmingham Heartlands Hospital, Birmingham (A.H.), Barts Health NHS Trust-Royal London Hospital, London (H.J.L.), the National Institute for Health Research Southampton Clinical Research Facility, Southampton (W.R.), and the North Bristol NHS Trust, Southmead Hospital, Bristol (M. Gompels) - all in the United Kingdom; the Department of Dermatology, Medical University of Vienna, Vienna (T.K.), and the Department of Dermatology and Venereology, Medical University of Graz, Graz (W.A.) - both in Austria; the Hungarian Angioedema Reference Center, 3rd Department of Internal Medicine, Semmelweis University, Budapest, Hungary (H.F.); the Allergology Unit, Department of Internal Medicine, Hospital Universitario Bellvitge de L'Hospitalet de Llobregat (R.L.) and Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute (M. Guilarte), Barcelona, Hospital General Universitario Gregorio Marañón, Biomedical Research Network on Rare Diseases (Centro de Investigación Biomédica en Red de Enfermedades Raras)-Unit 761, Institute for Health Research, Gregorio Marañon, Madrid (M.L.B.), and Hospital Universitario Virgen del Rocío, Seville (T.G.-Q.) - all in Spain; the Division of Allergy and Clinical Immunology, University of Salerno, Salerno (M.T.), the Department of Medicine, University of Padua, Padua (M. Cancian), and Azienda Socio Sanitaria Territoriale Fatebenefratelli Sacco-Università degli Studi di Milano, Milan (A.Z., M. Cicardi) - all in Italy; the Department of Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide, SA (W.B.S.), and Campbelltown Hospital, Immunology and Allergy, Western Sydney University, Sydney (C.K.) - both in Australia; and BioCryst Pharmaceuticals (S.D., M. Cornpropst, D.C., P.C., W.S.) and PharStat (L.F.) - both in Durham, NC
| | - Jochen Graff
- From the Division of Hematology, Oncology, and Hemostaseology, Department of Children and Adolescents, Angioedema Center, University Hospital Frankfurt (E.A.-P.), and the Fraunhofer Institute for Molecular Biology and Applied Ecology, Translational Medicine and Pharmacology (J. Graff), Frankfurt, the Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin (M. Magerl, M. Maurer), and the Department of Otorhinolaryngology and Head and Neck Surgery, Ulm University Medical Center, Ulm (J. Greve) - all in Germany; the Department of Dermatology and Allergy Center, Odense University Hospital, Odense, Denmark (A.B.); Public Health Institution University Clinic of Dermatology, School of Medicine, University Sts. Cyril and Methodius, Skopje, Macedonia (V.G.-P.); the Department of Clinical Immunology, University Hospital Zurich, Zurich, Switzerland (U.C.S.); Assistance Publique-Hôpitaux de Paris Hôpital Saint Antoine, Sorbonne Université, Paris (O.F.), and the Department of Dermatology, Université de Montpellier, Montpellier (A.D.-T.) - both in France; the Allergy and Immunology West Midlands, Birmingham Heartlands Hospital, Birmingham (A.H.), Barts Health NHS Trust-Royal London Hospital, London (H.J.L.), the National Institute for Health Research Southampton Clinical Research Facility, Southampton (W.R.), and the North Bristol NHS Trust, Southmead Hospital, Bristol (M. Gompels) - all in the United Kingdom; the Department of Dermatology, Medical University of Vienna, Vienna (T.K.), and the Department of Dermatology and Venereology, Medical University of Graz, Graz (W.A.) - both in Austria; the Hungarian Angioedema Reference Center, 3rd Department of Internal Medicine, Semmelweis University, Budapest, Hungary (H.F.); the Allergology Unit, Department of Internal Medicine, Hospital Universitario Bellvitge de L'Hospitalet de Llobregat (R.L.) and Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute (M. Guilarte), Barcelona, Hospital General Universitario Gregorio Marañón, Biomedical Research Network on Rare Diseases (Centro de Investigación Biomédica en Red de Enfermedades Raras)-Unit 761, Institute for Health Research, Gregorio Marañon, Madrid (M.L.B.), and Hospital Universitario Virgen del Rocío, Seville (T.G.-Q.) - all in Spain; the Division of Allergy and Clinical Immunology, University of Salerno, Salerno (M.T.), the Department of Medicine, University of Padua, Padua (M. Cancian), and Azienda Socio Sanitaria Territoriale Fatebenefratelli Sacco-Università degli Studi di Milano, Milan (A.Z., M. Cicardi) - all in Italy; the Department of Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide, SA (W.B.S.), and Campbelltown Hospital, Immunology and Allergy, Western Sydney University, Sydney (C.K.) - both in Australia; and BioCryst Pharmaceuticals (S.D., M. Cornpropst, D.C., P.C., W.S.) and PharStat (L.F.) - both in Durham, NC
| | - Urs C Steiner
- From the Division of Hematology, Oncology, and Hemostaseology, Department of Children and Adolescents, Angioedema Center, University Hospital Frankfurt (E.A.-P.), and the Fraunhofer Institute for Molecular Biology and Applied Ecology, Translational Medicine and Pharmacology (J. Graff), Frankfurt, the Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin (M. Magerl, M. Maurer), and the Department of Otorhinolaryngology and Head and Neck Surgery, Ulm University Medical Center, Ulm (J. Greve) - all in Germany; the Department of Dermatology and Allergy Center, Odense University Hospital, Odense, Denmark (A.B.); Public Health Institution University Clinic of Dermatology, School of Medicine, University Sts. Cyril and Methodius, Skopje, Macedonia (V.G.-P.); the Department of Clinical Immunology, University Hospital Zurich, Zurich, Switzerland (U.C.S.); Assistance Publique-Hôpitaux de Paris Hôpital Saint Antoine, Sorbonne Université, Paris (O.F.), and the Department of Dermatology, Université de Montpellier, Montpellier (A.D.-T.) - both in France; the Allergy and Immunology West Midlands, Birmingham Heartlands Hospital, Birmingham (A.H.), Barts Health NHS Trust-Royal London Hospital, London (H.J.L.), the National Institute for Health Research Southampton Clinical Research Facility, Southampton (W.R.), and the North Bristol NHS Trust, Southmead Hospital, Bristol (M. Gompels) - all in the United Kingdom; the Department of Dermatology, Medical University of Vienna, Vienna (T.K.), and the Department of Dermatology and Venereology, Medical University of Graz, Graz (W.A.) - both in Austria; the Hungarian Angioedema Reference Center, 3rd Department of Internal Medicine, Semmelweis University, Budapest, Hungary (H.F.); the Allergology Unit, Department of Internal Medicine, Hospital Universitario Bellvitge de L'Hospitalet de Llobregat (R.L.) and Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute (M. Guilarte), Barcelona, Hospital General Universitario Gregorio Marañón, Biomedical Research Network on Rare Diseases (Centro de Investigación Biomédica en Red de Enfermedades Raras)-Unit 761, Institute for Health Research, Gregorio Marañon, Madrid (M.L.B.), and Hospital Universitario Virgen del Rocío, Seville (T.G.-Q.) - all in Spain; the Division of Allergy and Clinical Immunology, University of Salerno, Salerno (M.T.), the Department of Medicine, University of Padua, Padua (M. Cancian), and Azienda Socio Sanitaria Territoriale Fatebenefratelli Sacco-Università degli Studi di Milano, Milan (A.Z., M. Cicardi) - all in Italy; the Department of Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide, SA (W.B.S.), and Campbelltown Hospital, Immunology and Allergy, Western Sydney University, Sydney (C.K.) - both in Australia; and BioCryst Pharmaceuticals (S.D., M. Cornpropst, D.C., P.C., W.S.) and PharStat (L.F.) - both in Durham, NC
| | - Olivier Fain
- From the Division of Hematology, Oncology, and Hemostaseology, Department of Children and Adolescents, Angioedema Center, University Hospital Frankfurt (E.A.-P.), and the Fraunhofer Institute for Molecular Biology and Applied Ecology, Translational Medicine and Pharmacology (J. Graff), Frankfurt, the Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin (M. Magerl, M. Maurer), and the Department of Otorhinolaryngology and Head and Neck Surgery, Ulm University Medical Center, Ulm (J. Greve) - all in Germany; the Department of Dermatology and Allergy Center, Odense University Hospital, Odense, Denmark (A.B.); Public Health Institution University Clinic of Dermatology, School of Medicine, University Sts. Cyril and Methodius, Skopje, Macedonia (V.G.-P.); the Department of Clinical Immunology, University Hospital Zurich, Zurich, Switzerland (U.C.S.); Assistance Publique-Hôpitaux de Paris Hôpital Saint Antoine, Sorbonne Université, Paris (O.F.), and the Department of Dermatology, Université de Montpellier, Montpellier (A.D.-T.) - both in France; the Allergy and Immunology West Midlands, Birmingham Heartlands Hospital, Birmingham (A.H.), Barts Health NHS Trust-Royal London Hospital, London (H.J.L.), the National Institute for Health Research Southampton Clinical Research Facility, Southampton (W.R.), and the North Bristol NHS Trust, Southmead Hospital, Bristol (M. Gompels) - all in the United Kingdom; the Department of Dermatology, Medical University of Vienna, Vienna (T.K.), and the Department of Dermatology and Venereology, Medical University of Graz, Graz (W.A.) - both in Austria; the Hungarian Angioedema Reference Center, 3rd Department of Internal Medicine, Semmelweis University, Budapest, Hungary (H.F.); the Allergology Unit, Department of Internal Medicine, Hospital Universitario Bellvitge de L'Hospitalet de Llobregat (R.L.) and Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute (M. Guilarte), Barcelona, Hospital General Universitario Gregorio Marañón, Biomedical Research Network on Rare Diseases (Centro de Investigación Biomédica en Red de Enfermedades Raras)-Unit 761, Institute for Health Research, Gregorio Marañon, Madrid (M.L.B.), and Hospital Universitario Virgen del Rocío, Seville (T.G.-Q.) - all in Spain; the Division of Allergy and Clinical Immunology, University of Salerno, Salerno (M.T.), the Department of Medicine, University of Padua, Padua (M. Cancian), and Azienda Socio Sanitaria Territoriale Fatebenefratelli Sacco-Università degli Studi di Milano, Milan (A.Z., M. Cicardi) - all in Italy; the Department of Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide, SA (W.B.S.), and Campbelltown Hospital, Immunology and Allergy, Western Sydney University, Sydney (C.K.) - both in Australia; and BioCryst Pharmaceuticals (S.D., M. Cornpropst, D.C., P.C., W.S.) and PharStat (L.F.) - both in Durham, NC
| | - Aarnoud Huissoon
- From the Division of Hematology, Oncology, and Hemostaseology, Department of Children and Adolescents, Angioedema Center, University Hospital Frankfurt (E.A.-P.), and the Fraunhofer Institute for Molecular Biology and Applied Ecology, Translational Medicine and Pharmacology (J. Graff), Frankfurt, the Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin (M. Magerl, M. Maurer), and the Department of Otorhinolaryngology and Head and Neck Surgery, Ulm University Medical Center, Ulm (J. Greve) - all in Germany; the Department of Dermatology and Allergy Center, Odense University Hospital, Odense, Denmark (A.B.); Public Health Institution University Clinic of Dermatology, School of Medicine, University Sts. Cyril and Methodius, Skopje, Macedonia (V.G.-P.); the Department of Clinical Immunology, University Hospital Zurich, Zurich, Switzerland (U.C.S.); Assistance Publique-Hôpitaux de Paris Hôpital Saint Antoine, Sorbonne Université, Paris (O.F.), and the Department of Dermatology, Université de Montpellier, Montpellier (A.D.-T.) - both in France; the Allergy and Immunology West Midlands, Birmingham Heartlands Hospital, Birmingham (A.H.), Barts Health NHS Trust-Royal London Hospital, London (H.J.L.), the National Institute for Health Research Southampton Clinical Research Facility, Southampton (W.R.), and the North Bristol NHS Trust, Southmead Hospital, Bristol (M. Gompels) - all in the United Kingdom; the Department of Dermatology, Medical University of Vienna, Vienna (T.K.), and the Department of Dermatology and Venereology, Medical University of Graz, Graz (W.A.) - both in Austria; the Hungarian Angioedema Reference Center, 3rd Department of Internal Medicine, Semmelweis University, Budapest, Hungary (H.F.); the Allergology Unit, Department of Internal Medicine, Hospital Universitario Bellvitge de L'Hospitalet de Llobregat (R.L.) and Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute (M. Guilarte), Barcelona, Hospital General Universitario Gregorio Marañón, Biomedical Research Network on Rare Diseases (Centro de Investigación Biomédica en Red de Enfermedades Raras)-Unit 761, Institute for Health Research, Gregorio Marañon, Madrid (M.L.B.), and Hospital Universitario Virgen del Rocío, Seville (T.G.-Q.) - all in Spain; the Division of Allergy and Clinical Immunology, University of Salerno, Salerno (M.T.), the Department of Medicine, University of Padua, Padua (M. Cancian), and Azienda Socio Sanitaria Territoriale Fatebenefratelli Sacco-Università degli Studi di Milano, Milan (A.Z., M. Cicardi) - all in Italy; the Department of Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide, SA (W.B.S.), and Campbelltown Hospital, Immunology and Allergy, Western Sydney University, Sydney (C.K.) - both in Australia; and BioCryst Pharmaceuticals (S.D., M. Cornpropst, D.C., P.C., W.S.) and PharStat (L.F.) - both in Durham, NC
| | - Tamar Kinaciyan
- From the Division of Hematology, Oncology, and Hemostaseology, Department of Children and Adolescents, Angioedema Center, University Hospital Frankfurt (E.A.-P.), and the Fraunhofer Institute for Molecular Biology and Applied Ecology, Translational Medicine and Pharmacology (J. Graff), Frankfurt, the Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin (M. Magerl, M. Maurer), and the Department of Otorhinolaryngology and Head and Neck Surgery, Ulm University Medical Center, Ulm (J. Greve) - all in Germany; the Department of Dermatology and Allergy Center, Odense University Hospital, Odense, Denmark (A.B.); Public Health Institution University Clinic of Dermatology, School of Medicine, University Sts. Cyril and Methodius, Skopje, Macedonia (V.G.-P.); the Department of Clinical Immunology, University Hospital Zurich, Zurich, Switzerland (U.C.S.); Assistance Publique-Hôpitaux de Paris Hôpital Saint Antoine, Sorbonne Université, Paris (O.F.), and the Department of Dermatology, Université de Montpellier, Montpellier (A.D.-T.) - both in France; the Allergy and Immunology West Midlands, Birmingham Heartlands Hospital, Birmingham (A.H.), Barts Health NHS Trust-Royal London Hospital, London (H.J.L.), the National Institute for Health Research Southampton Clinical Research Facility, Southampton (W.R.), and the North Bristol NHS Trust, Southmead Hospital, Bristol (M. Gompels) - all in the United Kingdom; the Department of Dermatology, Medical University of Vienna, Vienna (T.K.), and the Department of Dermatology and Venereology, Medical University of Graz, Graz (W.A.) - both in Austria; the Hungarian Angioedema Reference Center, 3rd Department of Internal Medicine, Semmelweis University, Budapest, Hungary (H.F.); the Allergology Unit, Department of Internal Medicine, Hospital Universitario Bellvitge de L'Hospitalet de Llobregat (R.L.) and Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute (M. Guilarte), Barcelona, Hospital General Universitario Gregorio Marañón, Biomedical Research Network on Rare Diseases (Centro de Investigación Biomédica en Red de Enfermedades Raras)-Unit 761, Institute for Health Research, Gregorio Marañon, Madrid (M.L.B.), and Hospital Universitario Virgen del Rocío, Seville (T.G.-Q.) - all in Spain; the Division of Allergy and Clinical Immunology, University of Salerno, Salerno (M.T.), the Department of Medicine, University of Padua, Padua (M. Cancian), and Azienda Socio Sanitaria Territoriale Fatebenefratelli Sacco-Università degli Studi di Milano, Milan (A.Z., M. Cicardi) - all in Italy; the Department of Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide, SA (W.B.S.), and Campbelltown Hospital, Immunology and Allergy, Western Sydney University, Sydney (C.K.) - both in Australia; and BioCryst Pharmaceuticals (S.D., M. Cornpropst, D.C., P.C., W.S.) and PharStat (L.F.) - both in Durham, NC
| | - Henriette Farkas
- From the Division of Hematology, Oncology, and Hemostaseology, Department of Children and Adolescents, Angioedema Center, University Hospital Frankfurt (E.A.-P.), and the Fraunhofer Institute for Molecular Biology and Applied Ecology, Translational Medicine and Pharmacology (J. Graff), Frankfurt, the Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin (M. Magerl, M. Maurer), and the Department of Otorhinolaryngology and Head and Neck Surgery, Ulm University Medical Center, Ulm (J. Greve) - all in Germany; the Department of Dermatology and Allergy Center, Odense University Hospital, Odense, Denmark (A.B.); Public Health Institution University Clinic of Dermatology, School of Medicine, University Sts. Cyril and Methodius, Skopje, Macedonia (V.G.-P.); the Department of Clinical Immunology, University Hospital Zurich, Zurich, Switzerland (U.C.S.); Assistance Publique-Hôpitaux de Paris Hôpital Saint Antoine, Sorbonne Université, Paris (O.F.), and the Department of Dermatology, Université de Montpellier, Montpellier (A.D.-T.) - both in France; the Allergy and Immunology West Midlands, Birmingham Heartlands Hospital, Birmingham (A.H.), Barts Health NHS Trust-Royal London Hospital, London (H.J.L.), the National Institute for Health Research Southampton Clinical Research Facility, Southampton (W.R.), and the North Bristol NHS Trust, Southmead Hospital, Bristol (M. Gompels) - all in the United Kingdom; the Department of Dermatology, Medical University of Vienna, Vienna (T.K.), and the Department of Dermatology and Venereology, Medical University of Graz, Graz (W.A.) - both in Austria; the Hungarian Angioedema Reference Center, 3rd Department of Internal Medicine, Semmelweis University, Budapest, Hungary (H.F.); the Allergology Unit, Department of Internal Medicine, Hospital Universitario Bellvitge de L'Hospitalet de Llobregat (R.L.) and Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute (M. Guilarte), Barcelona, Hospital General Universitario Gregorio Marañón, Biomedical Research Network on Rare Diseases (Centro de Investigación Biomédica en Red de Enfermedades Raras)-Unit 761, Institute for Health Research, Gregorio Marañon, Madrid (M.L.B.), and Hospital Universitario Virgen del Rocío, Seville (T.G.-Q.) - all in Spain; the Division of Allergy and Clinical Immunology, University of Salerno, Salerno (M.T.), the Department of Medicine, University of Padua, Padua (M. Cancian), and Azienda Socio Sanitaria Territoriale Fatebenefratelli Sacco-Università degli Studi di Milano, Milan (A.Z., M. Cicardi) - all in Italy; the Department of Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide, SA (W.B.S.), and Campbelltown Hospital, Immunology and Allergy, Western Sydney University, Sydney (C.K.) - both in Australia; and BioCryst Pharmaceuticals (S.D., M. Cornpropst, D.C., P.C., W.S.) and PharStat (L.F.) - both in Durham, NC
| | - Ramon Lleonart
- From the Division of Hematology, Oncology, and Hemostaseology, Department of Children and Adolescents, Angioedema Center, University Hospital Frankfurt (E.A.-P.), and the Fraunhofer Institute for Molecular Biology and Applied Ecology, Translational Medicine and Pharmacology (J. Graff), Frankfurt, the Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin (M. Magerl, M. Maurer), and the Department of Otorhinolaryngology and Head and Neck Surgery, Ulm University Medical Center, Ulm (J. Greve) - all in Germany; the Department of Dermatology and Allergy Center, Odense University Hospital, Odense, Denmark (A.B.); Public Health Institution University Clinic of Dermatology, School of Medicine, University Sts. Cyril and Methodius, Skopje, Macedonia (V.G.-P.); the Department of Clinical Immunology, University Hospital Zurich, Zurich, Switzerland (U.C.S.); Assistance Publique-Hôpitaux de Paris Hôpital Saint Antoine, Sorbonne Université, Paris (O.F.), and the Department of Dermatology, Université de Montpellier, Montpellier (A.D.-T.) - both in France; the Allergy and Immunology West Midlands, Birmingham Heartlands Hospital, Birmingham (A.H.), Barts Health NHS Trust-Royal London Hospital, London (H.J.L.), the National Institute for Health Research Southampton Clinical Research Facility, Southampton (W.R.), and the North Bristol NHS Trust, Southmead Hospital, Bristol (M. Gompels) - all in the United Kingdom; the Department of Dermatology, Medical University of Vienna, Vienna (T.K.), and the Department of Dermatology and Venereology, Medical University of Graz, Graz (W.A.) - both in Austria; the Hungarian Angioedema Reference Center, 3rd Department of Internal Medicine, Semmelweis University, Budapest, Hungary (H.F.); the Allergology Unit, Department of Internal Medicine, Hospital Universitario Bellvitge de L'Hospitalet de Llobregat (R.L.) and Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute (M. Guilarte), Barcelona, Hospital General Universitario Gregorio Marañón, Biomedical Research Network on Rare Diseases (Centro de Investigación Biomédica en Red de Enfermedades Raras)-Unit 761, Institute for Health Research, Gregorio Marañon, Madrid (M.L.B.), and Hospital Universitario Virgen del Rocío, Seville (T.G.-Q.) - all in Spain; the Division of Allergy and Clinical Immunology, University of Salerno, Salerno (M.T.), the Department of Medicine, University of Padua, Padua (M. Cancian), and Azienda Socio Sanitaria Territoriale Fatebenefratelli Sacco-Università degli Studi di Milano, Milan (A.Z., M. Cicardi) - all in Italy; the Department of Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide, SA (W.B.S.), and Campbelltown Hospital, Immunology and Allergy, Western Sydney University, Sydney (C.K.) - both in Australia; and BioCryst Pharmaceuticals (S.D., M. Cornpropst, D.C., P.C., W.S.) and PharStat (L.F.) - both in Durham, NC
| | - Hilary J Longhurst
- From the Division of Hematology, Oncology, and Hemostaseology, Department of Children and Adolescents, Angioedema Center, University Hospital Frankfurt (E.A.-P.), and the Fraunhofer Institute for Molecular Biology and Applied Ecology, Translational Medicine and Pharmacology (J. Graff), Frankfurt, the Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin (M. Magerl, M. Maurer), and the Department of Otorhinolaryngology and Head and Neck Surgery, Ulm University Medical Center, Ulm (J. Greve) - all in Germany; the Department of Dermatology and Allergy Center, Odense University Hospital, Odense, Denmark (A.B.); Public Health Institution University Clinic of Dermatology, School of Medicine, University Sts. Cyril and Methodius, Skopje, Macedonia (V.G.-P.); the Department of Clinical Immunology, University Hospital Zurich, Zurich, Switzerland (U.C.S.); Assistance Publique-Hôpitaux de Paris Hôpital Saint Antoine, Sorbonne Université, Paris (O.F.), and the Department of Dermatology, Université de Montpellier, Montpellier (A.D.-T.) - both in France; the Allergy and Immunology West Midlands, Birmingham Heartlands Hospital, Birmingham (A.H.), Barts Health NHS Trust-Royal London Hospital, London (H.J.L.), the National Institute for Health Research Southampton Clinical Research Facility, Southampton (W.R.), and the North Bristol NHS Trust, Southmead Hospital, Bristol (M. Gompels) - all in the United Kingdom; the Department of Dermatology, Medical University of Vienna, Vienna (T.K.), and the Department of Dermatology and Venereology, Medical University of Graz, Graz (W.A.) - both in Austria; the Hungarian Angioedema Reference Center, 3rd Department of Internal Medicine, Semmelweis University, Budapest, Hungary (H.F.); the Allergology Unit, Department of Internal Medicine, Hospital Universitario Bellvitge de L'Hospitalet de Llobregat (R.L.) and Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute (M. Guilarte), Barcelona, Hospital General Universitario Gregorio Marañón, Biomedical Research Network on Rare Diseases (Centro de Investigación Biomédica en Red de Enfermedades Raras)-Unit 761, Institute for Health Research, Gregorio Marañon, Madrid (M.L.B.), and Hospital Universitario Virgen del Rocío, Seville (T.G.-Q.) - all in Spain; the Division of Allergy and Clinical Immunology, University of Salerno, Salerno (M.T.), the Department of Medicine, University of Padua, Padua (M. Cancian), and Azienda Socio Sanitaria Territoriale Fatebenefratelli Sacco-Università degli Studi di Milano, Milan (A.Z., M. Cicardi) - all in Italy; the Department of Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide, SA (W.B.S.), and Campbelltown Hospital, Immunology and Allergy, Western Sydney University, Sydney (C.K.) - both in Australia; and BioCryst Pharmaceuticals (S.D., M. Cornpropst, D.C., P.C., W.S.) and PharStat (L.F.) - both in Durham, NC
| | - William Rae
- From the Division of Hematology, Oncology, and Hemostaseology, Department of Children and Adolescents, Angioedema Center, University Hospital Frankfurt (E.A.-P.), and the Fraunhofer Institute for Molecular Biology and Applied Ecology, Translational Medicine and Pharmacology (J. Graff), Frankfurt, the Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin (M. Magerl, M. Maurer), and the Department of Otorhinolaryngology and Head and Neck Surgery, Ulm University Medical Center, Ulm (J. Greve) - all in Germany; the Department of Dermatology and Allergy Center, Odense University Hospital, Odense, Denmark (A.B.); Public Health Institution University Clinic of Dermatology, School of Medicine, University Sts. Cyril and Methodius, Skopje, Macedonia (V.G.-P.); the Department of Clinical Immunology, University Hospital Zurich, Zurich, Switzerland (U.C.S.); Assistance Publique-Hôpitaux de Paris Hôpital Saint Antoine, Sorbonne Université, Paris (O.F.), and the Department of Dermatology, Université de Montpellier, Montpellier (A.D.-T.) - both in France; the Allergy and Immunology West Midlands, Birmingham Heartlands Hospital, Birmingham (A.H.), Barts Health NHS Trust-Royal London Hospital, London (H.J.L.), the National Institute for Health Research Southampton Clinical Research Facility, Southampton (W.R.), and the North Bristol NHS Trust, Southmead Hospital, Bristol (M. Gompels) - all in the United Kingdom; the Department of Dermatology, Medical University of Vienna, Vienna (T.K.), and the Department of Dermatology and Venereology, Medical University of Graz, Graz (W.A.) - both in Austria; the Hungarian Angioedema Reference Center, 3rd Department of Internal Medicine, Semmelweis University, Budapest, Hungary (H.F.); the Allergology Unit, Department of Internal Medicine, Hospital Universitario Bellvitge de L'Hospitalet de Llobregat (R.L.) and Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute (M. Guilarte), Barcelona, Hospital General Universitario Gregorio Marañón, Biomedical Research Network on Rare Diseases (Centro de Investigación Biomédica en Red de Enfermedades Raras)-Unit 761, Institute for Health Research, Gregorio Marañon, Madrid (M.L.B.), and Hospital Universitario Virgen del Rocío, Seville (T.G.-Q.) - all in Spain; the Division of Allergy and Clinical Immunology, University of Salerno, Salerno (M.T.), the Department of Medicine, University of Padua, Padua (M. Cancian), and Azienda Socio Sanitaria Territoriale Fatebenefratelli Sacco-Università degli Studi di Milano, Milan (A.Z., M. Cicardi) - all in Italy; the Department of Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide, SA (W.B.S.), and Campbelltown Hospital, Immunology and Allergy, Western Sydney University, Sydney (C.K.) - both in Australia; and BioCryst Pharmaceuticals (S.D., M. Cornpropst, D.C., P.C., W.S.) and PharStat (L.F.) - both in Durham, NC
| | - Massimo Triggiani
- From the Division of Hematology, Oncology, and Hemostaseology, Department of Children and Adolescents, Angioedema Center, University Hospital Frankfurt (E.A.-P.), and the Fraunhofer Institute for Molecular Biology and Applied Ecology, Translational Medicine and Pharmacology (J. Graff), Frankfurt, the Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin (M. Magerl, M. Maurer), and the Department of Otorhinolaryngology and Head and Neck Surgery, Ulm University Medical Center, Ulm (J. Greve) - all in Germany; the Department of Dermatology and Allergy Center, Odense University Hospital, Odense, Denmark (A.B.); Public Health Institution University Clinic of Dermatology, School of Medicine, University Sts. Cyril and Methodius, Skopje, Macedonia (V.G.-P.); the Department of Clinical Immunology, University Hospital Zurich, Zurich, Switzerland (U.C.S.); Assistance Publique-Hôpitaux de Paris Hôpital Saint Antoine, Sorbonne Université, Paris (O.F.), and the Department of Dermatology, Université de Montpellier, Montpellier (A.D.-T.) - both in France; the Allergy and Immunology West Midlands, Birmingham Heartlands Hospital, Birmingham (A.H.), Barts Health NHS Trust-Royal London Hospital, London (H.J.L.), the National Institute for Health Research Southampton Clinical Research Facility, Southampton (W.R.), and the North Bristol NHS Trust, Southmead Hospital, Bristol (M. Gompels) - all in the United Kingdom; the Department of Dermatology, Medical University of Vienna, Vienna (T.K.), and the Department of Dermatology and Venereology, Medical University of Graz, Graz (W.A.) - both in Austria; the Hungarian Angioedema Reference Center, 3rd Department of Internal Medicine, Semmelweis University, Budapest, Hungary (H.F.); the Allergology Unit, Department of Internal Medicine, Hospital Universitario Bellvitge de L'Hospitalet de Llobregat (R.L.) and Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute (M. Guilarte), Barcelona, Hospital General Universitario Gregorio Marañón, Biomedical Research Network on Rare Diseases (Centro de Investigación Biomédica en Red de Enfermedades Raras)-Unit 761, Institute for Health Research, Gregorio Marañon, Madrid (M.L.B.), and Hospital Universitario Virgen del Rocío, Seville (T.G.-Q.) - all in Spain; the Division of Allergy and Clinical Immunology, University of Salerno, Salerno (M.T.), the Department of Medicine, University of Padua, Padua (M. Cancian), and Azienda Socio Sanitaria Territoriale Fatebenefratelli Sacco-Università degli Studi di Milano, Milan (A.Z., M. Cicardi) - all in Italy; the Department of Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide, SA (W.B.S.), and Campbelltown Hospital, Immunology and Allergy, Western Sydney University, Sydney (C.K.) - both in Australia; and BioCryst Pharmaceuticals (S.D., M. Cornpropst, D.C., P.C., W.S.) and PharStat (L.F.) - both in Durham, NC
| | - Werner Aberer
- From the Division of Hematology, Oncology, and Hemostaseology, Department of Children and Adolescents, Angioedema Center, University Hospital Frankfurt (E.A.-P.), and the Fraunhofer Institute for Molecular Biology and Applied Ecology, Translational Medicine and Pharmacology (J. Graff), Frankfurt, the Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin (M. Magerl, M. Maurer), and the Department of Otorhinolaryngology and Head and Neck Surgery, Ulm University Medical Center, Ulm (J. Greve) - all in Germany; the Department of Dermatology and Allergy Center, Odense University Hospital, Odense, Denmark (A.B.); Public Health Institution University Clinic of Dermatology, School of Medicine, University Sts. Cyril and Methodius, Skopje, Macedonia (V.G.-P.); the Department of Clinical Immunology, University Hospital Zurich, Zurich, Switzerland (U.C.S.); Assistance Publique-Hôpitaux de Paris Hôpital Saint Antoine, Sorbonne Université, Paris (O.F.), and the Department of Dermatology, Université de Montpellier, Montpellier (A.D.-T.) - both in France; the Allergy and Immunology West Midlands, Birmingham Heartlands Hospital, Birmingham (A.H.), Barts Health NHS Trust-Royal London Hospital, London (H.J.L.), the National Institute for Health Research Southampton Clinical Research Facility, Southampton (W.R.), and the North Bristol NHS Trust, Southmead Hospital, Bristol (M. Gompels) - all in the United Kingdom; the Department of Dermatology, Medical University of Vienna, Vienna (T.K.), and the Department of Dermatology and Venereology, Medical University of Graz, Graz (W.A.) - both in Austria; the Hungarian Angioedema Reference Center, 3rd Department of Internal Medicine, Semmelweis University, Budapest, Hungary (H.F.); the Allergology Unit, Department of Internal Medicine, Hospital Universitario Bellvitge de L'Hospitalet de Llobregat (R.L.) and Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute (M. Guilarte), Barcelona, Hospital General Universitario Gregorio Marañón, Biomedical Research Network on Rare Diseases (Centro de Investigación Biomédica en Red de Enfermedades Raras)-Unit 761, Institute for Health Research, Gregorio Marañon, Madrid (M.L.B.), and Hospital Universitario Virgen del Rocío, Seville (T.G.-Q.) - all in Spain; the Division of Allergy and Clinical Immunology, University of Salerno, Salerno (M.T.), the Department of Medicine, University of Padua, Padua (M. Cancian), and Azienda Socio Sanitaria Territoriale Fatebenefratelli Sacco-Università degli Studi di Milano, Milan (A.Z., M. Cicardi) - all in Italy; the Department of Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide, SA (W.B.S.), and Campbelltown Hospital, Immunology and Allergy, Western Sydney University, Sydney (C.K.) - both in Australia; and BioCryst Pharmaceuticals (S.D., M. Cornpropst, D.C., P.C., W.S.) and PharStat (L.F.) - both in Durham, NC
| | - Mauro Cancian
- From the Division of Hematology, Oncology, and Hemostaseology, Department of Children and Adolescents, Angioedema Center, University Hospital Frankfurt (E.A.-P.), and the Fraunhofer Institute for Molecular Biology and Applied Ecology, Translational Medicine and Pharmacology (J. Graff), Frankfurt, the Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin (M. Magerl, M. Maurer), and the Department of Otorhinolaryngology and Head and Neck Surgery, Ulm University Medical Center, Ulm (J. Greve) - all in Germany; the Department of Dermatology and Allergy Center, Odense University Hospital, Odense, Denmark (A.B.); Public Health Institution University Clinic of Dermatology, School of Medicine, University Sts. Cyril and Methodius, Skopje, Macedonia (V.G.-P.); the Department of Clinical Immunology, University Hospital Zurich, Zurich, Switzerland (U.C.S.); Assistance Publique-Hôpitaux de Paris Hôpital Saint Antoine, Sorbonne Université, Paris (O.F.), and the Department of Dermatology, Université de Montpellier, Montpellier (A.D.-T.) - both in France; the Allergy and Immunology West Midlands, Birmingham Heartlands Hospital, Birmingham (A.H.), Barts Health NHS Trust-Royal London Hospital, London (H.J.L.), the National Institute for Health Research Southampton Clinical Research Facility, Southampton (W.R.), and the North Bristol NHS Trust, Southmead Hospital, Bristol (M. Gompels) - all in the United Kingdom; the Department of Dermatology, Medical University of Vienna, Vienna (T.K.), and the Department of Dermatology and Venereology, Medical University of Graz, Graz (W.A.) - both in Austria; the Hungarian Angioedema Reference Center, 3rd Department of Internal Medicine, Semmelweis University, Budapest, Hungary (H.F.); the Allergology Unit, Department of Internal Medicine, Hospital Universitario Bellvitge de L'Hospitalet de Llobregat (R.L.) and Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute (M. Guilarte), Barcelona, Hospital General Universitario Gregorio Marañón, Biomedical Research Network on Rare Diseases (Centro de Investigación Biomédica en Red de Enfermedades Raras)-Unit 761, Institute for Health Research, Gregorio Marañon, Madrid (M.L.B.), and Hospital Universitario Virgen del Rocío, Seville (T.G.-Q.) - all in Spain; the Division of Allergy and Clinical Immunology, University of Salerno, Salerno (M.T.), the Department of Medicine, University of Padua, Padua (M. Cancian), and Azienda Socio Sanitaria Territoriale Fatebenefratelli Sacco-Università degli Studi di Milano, Milan (A.Z., M. Cicardi) - all in Italy; the Department of Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide, SA (W.B.S.), and Campbelltown Hospital, Immunology and Allergy, Western Sydney University, Sydney (C.K.) - both in Australia; and BioCryst Pharmaceuticals (S.D., M. Cornpropst, D.C., P.C., W.S.) and PharStat (L.F.) - both in Durham, NC
| | - Andrea Zanichelli
- From the Division of Hematology, Oncology, and Hemostaseology, Department of Children and Adolescents, Angioedema Center, University Hospital Frankfurt (E.A.-P.), and the Fraunhofer Institute for Molecular Biology and Applied Ecology, Translational Medicine and Pharmacology (J. Graff), Frankfurt, the Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin (M. Magerl, M. Maurer), and the Department of Otorhinolaryngology and Head and Neck Surgery, Ulm University Medical Center, Ulm (J. Greve) - all in Germany; the Department of Dermatology and Allergy Center, Odense University Hospital, Odense, Denmark (A.B.); Public Health Institution University Clinic of Dermatology, School of Medicine, University Sts. Cyril and Methodius, Skopje, Macedonia (V.G.-P.); the Department of Clinical Immunology, University Hospital Zurich, Zurich, Switzerland (U.C.S.); Assistance Publique-Hôpitaux de Paris Hôpital Saint Antoine, Sorbonne Université, Paris (O.F.), and the Department of Dermatology, Université de Montpellier, Montpellier (A.D.-T.) - both in France; the Allergy and Immunology West Midlands, Birmingham Heartlands Hospital, Birmingham (A.H.), Barts Health NHS Trust-Royal London Hospital, London (H.J.L.), the National Institute for Health Research Southampton Clinical Research Facility, Southampton (W.R.), and the North Bristol NHS Trust, Southmead Hospital, Bristol (M. Gompels) - all in the United Kingdom; the Department of Dermatology, Medical University of Vienna, Vienna (T.K.), and the Department of Dermatology and Venereology, Medical University of Graz, Graz (W.A.) - both in Austria; the Hungarian Angioedema Reference Center, 3rd Department of Internal Medicine, Semmelweis University, Budapest, Hungary (H.F.); the Allergology Unit, Department of Internal Medicine, Hospital Universitario Bellvitge de L'Hospitalet de Llobregat (R.L.) and Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute (M. Guilarte), Barcelona, Hospital General Universitario Gregorio Marañón, Biomedical Research Network on Rare Diseases (Centro de Investigación Biomédica en Red de Enfermedades Raras)-Unit 761, Institute for Health Research, Gregorio Marañon, Madrid (M.L.B.), and Hospital Universitario Virgen del Rocío, Seville (T.G.-Q.) - all in Spain; the Division of Allergy and Clinical Immunology, University of Salerno, Salerno (M.T.), the Department of Medicine, University of Padua, Padua (M. Cancian), and Azienda Socio Sanitaria Territoriale Fatebenefratelli Sacco-Università degli Studi di Milano, Milan (A.Z., M. Cicardi) - all in Italy; the Department of Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide, SA (W.B.S.), and Campbelltown Hospital, Immunology and Allergy, Western Sydney University, Sydney (C.K.) - both in Australia; and BioCryst Pharmaceuticals (S.D., M. Cornpropst, D.C., P.C., W.S.) and PharStat (L.F.) - both in Durham, NC
| | - William B Smith
- From the Division of Hematology, Oncology, and Hemostaseology, Department of Children and Adolescents, Angioedema Center, University Hospital Frankfurt (E.A.-P.), and the Fraunhofer Institute for Molecular Biology and Applied Ecology, Translational Medicine and Pharmacology (J. Graff), Frankfurt, the Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin (M. Magerl, M. Maurer), and the Department of Otorhinolaryngology and Head and Neck Surgery, Ulm University Medical Center, Ulm (J. Greve) - all in Germany; the Department of Dermatology and Allergy Center, Odense University Hospital, Odense, Denmark (A.B.); Public Health Institution University Clinic of Dermatology, School of Medicine, University Sts. Cyril and Methodius, Skopje, Macedonia (V.G.-P.); the Department of Clinical Immunology, University Hospital Zurich, Zurich, Switzerland (U.C.S.); Assistance Publique-Hôpitaux de Paris Hôpital Saint Antoine, Sorbonne Université, Paris (O.F.), and the Department of Dermatology, Université de Montpellier, Montpellier (A.D.-T.) - both in France; the Allergy and Immunology West Midlands, Birmingham Heartlands Hospital, Birmingham (A.H.), Barts Health NHS Trust-Royal London Hospital, London (H.J.L.), the National Institute for Health Research Southampton Clinical Research Facility, Southampton (W.R.), and the North Bristol NHS Trust, Southmead Hospital, Bristol (M. Gompels) - all in the United Kingdom; the Department of Dermatology, Medical University of Vienna, Vienna (T.K.), and the Department of Dermatology and Venereology, Medical University of Graz, Graz (W.A.) - both in Austria; the Hungarian Angioedema Reference Center, 3rd Department of Internal Medicine, Semmelweis University, Budapest, Hungary (H.F.); the Allergology Unit, Department of Internal Medicine, Hospital Universitario Bellvitge de L'Hospitalet de Llobregat (R.L.) and Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute (M. Guilarte), Barcelona, Hospital General Universitario Gregorio Marañón, Biomedical Research Network on Rare Diseases (Centro de Investigación Biomédica en Red de Enfermedades Raras)-Unit 761, Institute for Health Research, Gregorio Marañon, Madrid (M.L.B.), and Hospital Universitario Virgen del Rocío, Seville (T.G.-Q.) - all in Spain; the Division of Allergy and Clinical Immunology, University of Salerno, Salerno (M.T.), the Department of Medicine, University of Padua, Padua (M. Cancian), and Azienda Socio Sanitaria Territoriale Fatebenefratelli Sacco-Università degli Studi di Milano, Milan (A.Z., M. Cicardi) - all in Italy; the Department of Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide, SA (W.B.S.), and Campbelltown Hospital, Immunology and Allergy, Western Sydney University, Sydney (C.K.) - both in Australia; and BioCryst Pharmaceuticals (S.D., M. Cornpropst, D.C., P.C., W.S.) and PharStat (L.F.) - both in Durham, NC
| | - Maria L Baeza
- From the Division of Hematology, Oncology, and Hemostaseology, Department of Children and Adolescents, Angioedema Center, University Hospital Frankfurt (E.A.-P.), and the Fraunhofer Institute for Molecular Biology and Applied Ecology, Translational Medicine and Pharmacology (J. Graff), Frankfurt, the Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin (M. Magerl, M. Maurer), and the Department of Otorhinolaryngology and Head and Neck Surgery, Ulm University Medical Center, Ulm (J. Greve) - all in Germany; the Department of Dermatology and Allergy Center, Odense University Hospital, Odense, Denmark (A.B.); Public Health Institution University Clinic of Dermatology, School of Medicine, University Sts. Cyril and Methodius, Skopje, Macedonia (V.G.-P.); the Department of Clinical Immunology, University Hospital Zurich, Zurich, Switzerland (U.C.S.); Assistance Publique-Hôpitaux de Paris Hôpital Saint Antoine, Sorbonne Université, Paris (O.F.), and the Department of Dermatology, Université de Montpellier, Montpellier (A.D.-T.) - both in France; the Allergy and Immunology West Midlands, Birmingham Heartlands Hospital, Birmingham (A.H.), Barts Health NHS Trust-Royal London Hospital, London (H.J.L.), the National Institute for Health Research Southampton Clinical Research Facility, Southampton (W.R.), and the North Bristol NHS Trust, Southmead Hospital, Bristol (M. Gompels) - all in the United Kingdom; the Department of Dermatology, Medical University of Vienna, Vienna (T.K.), and the Department of Dermatology and Venereology, Medical University of Graz, Graz (W.A.) - both in Austria; the Hungarian Angioedema Reference Center, 3rd Department of Internal Medicine, Semmelweis University, Budapest, Hungary (H.F.); the Allergology Unit, Department of Internal Medicine, Hospital Universitario Bellvitge de L'Hospitalet de Llobregat (R.L.) and Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute (M. Guilarte), Barcelona, Hospital General Universitario Gregorio Marañón, Biomedical Research Network on Rare Diseases (Centro de Investigación Biomédica en Red de Enfermedades Raras)-Unit 761, Institute for Health Research, Gregorio Marañon, Madrid (M.L.B.), and Hospital Universitario Virgen del Rocío, Seville (T.G.-Q.) - all in Spain; the Division of Allergy and Clinical Immunology, University of Salerno, Salerno (M.T.), the Department of Medicine, University of Padua, Padua (M. Cancian), and Azienda Socio Sanitaria Territoriale Fatebenefratelli Sacco-Università degli Studi di Milano, Milan (A.Z., M. Cicardi) - all in Italy; the Department of Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide, SA (W.B.S.), and Campbelltown Hospital, Immunology and Allergy, Western Sydney University, Sydney (C.K.) - both in Australia; and BioCryst Pharmaceuticals (S.D., M. Cornpropst, D.C., P.C., W.S.) and PharStat (L.F.) - both in Durham, NC
| | - Aurelie Du-Thanh
- From the Division of Hematology, Oncology, and Hemostaseology, Department of Children and Adolescents, Angioedema Center, University Hospital Frankfurt (E.A.-P.), and the Fraunhofer Institute for Molecular Biology and Applied Ecology, Translational Medicine and Pharmacology (J. Graff), Frankfurt, the Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin (M. Magerl, M. Maurer), and the Department of Otorhinolaryngology and Head and Neck Surgery, Ulm University Medical Center, Ulm (J. Greve) - all in Germany; the Department of Dermatology and Allergy Center, Odense University Hospital, Odense, Denmark (A.B.); Public Health Institution University Clinic of Dermatology, School of Medicine, University Sts. Cyril and Methodius, Skopje, Macedonia (V.G.-P.); the Department of Clinical Immunology, University Hospital Zurich, Zurich, Switzerland (U.C.S.); Assistance Publique-Hôpitaux de Paris Hôpital Saint Antoine, Sorbonne Université, Paris (O.F.), and the Department of Dermatology, Université de Montpellier, Montpellier (A.D.-T.) - both in France; the Allergy and Immunology West Midlands, Birmingham Heartlands Hospital, Birmingham (A.H.), Barts Health NHS Trust-Royal London Hospital, London (H.J.L.), the National Institute for Health Research Southampton Clinical Research Facility, Southampton (W.R.), and the North Bristol NHS Trust, Southmead Hospital, Bristol (M. Gompels) - all in the United Kingdom; the Department of Dermatology, Medical University of Vienna, Vienna (T.K.), and the Department of Dermatology and Venereology, Medical University of Graz, Graz (W.A.) - both in Austria; the Hungarian Angioedema Reference Center, 3rd Department of Internal Medicine, Semmelweis University, Budapest, Hungary (H.F.); the Allergology Unit, Department of Internal Medicine, Hospital Universitario Bellvitge de L'Hospitalet de Llobregat (R.L.) and Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute (M. Guilarte), Barcelona, Hospital General Universitario Gregorio Marañón, Biomedical Research Network on Rare Diseases (Centro de Investigación Biomédica en Red de Enfermedades Raras)-Unit 761, Institute for Health Research, Gregorio Marañon, Madrid (M.L.B.), and Hospital Universitario Virgen del Rocío, Seville (T.G.-Q.) - all in Spain; the Division of Allergy and Clinical Immunology, University of Salerno, Salerno (M.T.), the Department of Medicine, University of Padua, Padua (M. Cancian), and Azienda Socio Sanitaria Territoriale Fatebenefratelli Sacco-Università degli Studi di Milano, Milan (A.Z., M. Cicardi) - all in Italy; the Department of Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide, SA (W.B.S.), and Campbelltown Hospital, Immunology and Allergy, Western Sydney University, Sydney (C.K.) - both in Australia; and BioCryst Pharmaceuticals (S.D., M. Cornpropst, D.C., P.C., W.S.) and PharStat (L.F.) - both in Durham, NC
| | - Mark Gompels
- From the Division of Hematology, Oncology, and Hemostaseology, Department of Children and Adolescents, Angioedema Center, University Hospital Frankfurt (E.A.-P.), and the Fraunhofer Institute for Molecular Biology and Applied Ecology, Translational Medicine and Pharmacology (J. Graff), Frankfurt, the Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin (M. Magerl, M. Maurer), and the Department of Otorhinolaryngology and Head and Neck Surgery, Ulm University Medical Center, Ulm (J. Greve) - all in Germany; the Department of Dermatology and Allergy Center, Odense University Hospital, Odense, Denmark (A.B.); Public Health Institution University Clinic of Dermatology, School of Medicine, University Sts. Cyril and Methodius, Skopje, Macedonia (V.G.-P.); the Department of Clinical Immunology, University Hospital Zurich, Zurich, Switzerland (U.C.S.); Assistance Publique-Hôpitaux de Paris Hôpital Saint Antoine, Sorbonne Université, Paris (O.F.), and the Department of Dermatology, Université de Montpellier, Montpellier (A.D.-T.) - both in France; the Allergy and Immunology West Midlands, Birmingham Heartlands Hospital, Birmingham (A.H.), Barts Health NHS Trust-Royal London Hospital, London (H.J.L.), the National Institute for Health Research Southampton Clinical Research Facility, Southampton (W.R.), and the North Bristol NHS Trust, Southmead Hospital, Bristol (M. Gompels) - all in the United Kingdom; the Department of Dermatology, Medical University of Vienna, Vienna (T.K.), and the Department of Dermatology and Venereology, Medical University of Graz, Graz (W.A.) - both in Austria; the Hungarian Angioedema Reference Center, 3rd Department of Internal Medicine, Semmelweis University, Budapest, Hungary (H.F.); the Allergology Unit, Department of Internal Medicine, Hospital Universitario Bellvitge de L'Hospitalet de Llobregat (R.L.) and Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute (M. Guilarte), Barcelona, Hospital General Universitario Gregorio Marañón, Biomedical Research Network on Rare Diseases (Centro de Investigación Biomédica en Red de Enfermedades Raras)-Unit 761, Institute for Health Research, Gregorio Marañon, Madrid (M.L.B.), and Hospital Universitario Virgen del Rocío, Seville (T.G.-Q.) - all in Spain; the Division of Allergy and Clinical Immunology, University of Salerno, Salerno (M.T.), the Department of Medicine, University of Padua, Padua (M. Cancian), and Azienda Socio Sanitaria Territoriale Fatebenefratelli Sacco-Università degli Studi di Milano, Milan (A.Z., M. Cicardi) - all in Italy; the Department of Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide, SA (W.B.S.), and Campbelltown Hospital, Immunology and Allergy, Western Sydney University, Sydney (C.K.) - both in Australia; and BioCryst Pharmaceuticals (S.D., M. Cornpropst, D.C., P.C., W.S.) and PharStat (L.F.) - both in Durham, NC
| | - Teresa Gonzalez-Quevedo
- From the Division of Hematology, Oncology, and Hemostaseology, Department of Children and Adolescents, Angioedema Center, University Hospital Frankfurt (E.A.-P.), and the Fraunhofer Institute for Molecular Biology and Applied Ecology, Translational Medicine and Pharmacology (J. Graff), Frankfurt, the Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin (M. Magerl, M. Maurer), and the Department of Otorhinolaryngology and Head and Neck Surgery, Ulm University Medical Center, Ulm (J. Greve) - all in Germany; the Department of Dermatology and Allergy Center, Odense University Hospital, Odense, Denmark (A.B.); Public Health Institution University Clinic of Dermatology, School of Medicine, University Sts. Cyril and Methodius, Skopje, Macedonia (V.G.-P.); the Department of Clinical Immunology, University Hospital Zurich, Zurich, Switzerland (U.C.S.); Assistance Publique-Hôpitaux de Paris Hôpital Saint Antoine, Sorbonne Université, Paris (O.F.), and the Department of Dermatology, Université de Montpellier, Montpellier (A.D.-T.) - both in France; the Allergy and Immunology West Midlands, Birmingham Heartlands Hospital, Birmingham (A.H.), Barts Health NHS Trust-Royal London Hospital, London (H.J.L.), the National Institute for Health Research Southampton Clinical Research Facility, Southampton (W.R.), and the North Bristol NHS Trust, Southmead Hospital, Bristol (M. Gompels) - all in the United Kingdom; the Department of Dermatology, Medical University of Vienna, Vienna (T.K.), and the Department of Dermatology and Venereology, Medical University of Graz, Graz (W.A.) - both in Austria; the Hungarian Angioedema Reference Center, 3rd Department of Internal Medicine, Semmelweis University, Budapest, Hungary (H.F.); the Allergology Unit, Department of Internal Medicine, Hospital Universitario Bellvitge de L'Hospitalet de Llobregat (R.L.) and Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute (M. Guilarte), Barcelona, Hospital General Universitario Gregorio Marañón, Biomedical Research Network on Rare Diseases (Centro de Investigación Biomédica en Red de Enfermedades Raras)-Unit 761, Institute for Health Research, Gregorio Marañon, Madrid (M.L.B.), and Hospital Universitario Virgen del Rocío, Seville (T.G.-Q.) - all in Spain; the Division of Allergy and Clinical Immunology, University of Salerno, Salerno (M.T.), the Department of Medicine, University of Padua, Padua (M. Cancian), and Azienda Socio Sanitaria Territoriale Fatebenefratelli Sacco-Università degli Studi di Milano, Milan (A.Z., M. Cicardi) - all in Italy; the Department of Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide, SA (W.B.S.), and Campbelltown Hospital, Immunology and Allergy, Western Sydney University, Sydney (C.K.) - both in Australia; and BioCryst Pharmaceuticals (S.D., M. Cornpropst, D.C., P.C., W.S.) and PharStat (L.F.) - both in Durham, NC
| | - Jens Greve
- From the Division of Hematology, Oncology, and Hemostaseology, Department of Children and Adolescents, Angioedema Center, University Hospital Frankfurt (E.A.-P.), and the Fraunhofer Institute for Molecular Biology and Applied Ecology, Translational Medicine and Pharmacology (J. Graff), Frankfurt, the Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin (M. Magerl, M. Maurer), and the Department of Otorhinolaryngology and Head and Neck Surgery, Ulm University Medical Center, Ulm (J. Greve) - all in Germany; the Department of Dermatology and Allergy Center, Odense University Hospital, Odense, Denmark (A.B.); Public Health Institution University Clinic of Dermatology, School of Medicine, University Sts. Cyril and Methodius, Skopje, Macedonia (V.G.-P.); the Department of Clinical Immunology, University Hospital Zurich, Zurich, Switzerland (U.C.S.); Assistance Publique-Hôpitaux de Paris Hôpital Saint Antoine, Sorbonne Université, Paris (O.F.), and the Department of Dermatology, Université de Montpellier, Montpellier (A.D.-T.) - both in France; the Allergy and Immunology West Midlands, Birmingham Heartlands Hospital, Birmingham (A.H.), Barts Health NHS Trust-Royal London Hospital, London (H.J.L.), the National Institute for Health Research Southampton Clinical Research Facility, Southampton (W.R.), and the North Bristol NHS Trust, Southmead Hospital, Bristol (M. Gompels) - all in the United Kingdom; the Department of Dermatology, Medical University of Vienna, Vienna (T.K.), and the Department of Dermatology and Venereology, Medical University of Graz, Graz (W.A.) - both in Austria; the Hungarian Angioedema Reference Center, 3rd Department of Internal Medicine, Semmelweis University, Budapest, Hungary (H.F.); the Allergology Unit, Department of Internal Medicine, Hospital Universitario Bellvitge de L'Hospitalet de Llobregat (R.L.) and Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute (M. Guilarte), Barcelona, Hospital General Universitario Gregorio Marañón, Biomedical Research Network on Rare Diseases (Centro de Investigación Biomédica en Red de Enfermedades Raras)-Unit 761, Institute for Health Research, Gregorio Marañon, Madrid (M.L.B.), and Hospital Universitario Virgen del Rocío, Seville (T.G.-Q.) - all in Spain; the Division of Allergy and Clinical Immunology, University of Salerno, Salerno (M.T.), the Department of Medicine, University of Padua, Padua (M. Cancian), and Azienda Socio Sanitaria Territoriale Fatebenefratelli Sacco-Università degli Studi di Milano, Milan (A.Z., M. Cicardi) - all in Italy; the Department of Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide, SA (W.B.S.), and Campbelltown Hospital, Immunology and Allergy, Western Sydney University, Sydney (C.K.) - both in Australia; and BioCryst Pharmaceuticals (S.D., M. Cornpropst, D.C., P.C., W.S.) and PharStat (L.F.) - both in Durham, NC
| | - Mar Guilarte
- From the Division of Hematology, Oncology, and Hemostaseology, Department of Children and Adolescents, Angioedema Center, University Hospital Frankfurt (E.A.-P.), and the Fraunhofer Institute for Molecular Biology and Applied Ecology, Translational Medicine and Pharmacology (J. Graff), Frankfurt, the Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin (M. Magerl, M. Maurer), and the Department of Otorhinolaryngology and Head and Neck Surgery, Ulm University Medical Center, Ulm (J. Greve) - all in Germany; the Department of Dermatology and Allergy Center, Odense University Hospital, Odense, Denmark (A.B.); Public Health Institution University Clinic of Dermatology, School of Medicine, University Sts. Cyril and Methodius, Skopje, Macedonia (V.G.-P.); the Department of Clinical Immunology, University Hospital Zurich, Zurich, Switzerland (U.C.S.); Assistance Publique-Hôpitaux de Paris Hôpital Saint Antoine, Sorbonne Université, Paris (O.F.), and the Department of Dermatology, Université de Montpellier, Montpellier (A.D.-T.) - both in France; the Allergy and Immunology West Midlands, Birmingham Heartlands Hospital, Birmingham (A.H.), Barts Health NHS Trust-Royal London Hospital, London (H.J.L.), the National Institute for Health Research Southampton Clinical Research Facility, Southampton (W.R.), and the North Bristol NHS Trust, Southmead Hospital, Bristol (M. Gompels) - all in the United Kingdom; the Department of Dermatology, Medical University of Vienna, Vienna (T.K.), and the Department of Dermatology and Venereology, Medical University of Graz, Graz (W.A.) - both in Austria; the Hungarian Angioedema Reference Center, 3rd Department of Internal Medicine, Semmelweis University, Budapest, Hungary (H.F.); the Allergology Unit, Department of Internal Medicine, Hospital Universitario Bellvitge de L'Hospitalet de Llobregat (R.L.) and Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute (M. Guilarte), Barcelona, Hospital General Universitario Gregorio Marañón, Biomedical Research Network on Rare Diseases (Centro de Investigación Biomédica en Red de Enfermedades Raras)-Unit 761, Institute for Health Research, Gregorio Marañon, Madrid (M.L.B.), and Hospital Universitario Virgen del Rocío, Seville (T.G.-Q.) - all in Spain; the Division of Allergy and Clinical Immunology, University of Salerno, Salerno (M.T.), the Department of Medicine, University of Padua, Padua (M. Cancian), and Azienda Socio Sanitaria Territoriale Fatebenefratelli Sacco-Università degli Studi di Milano, Milan (A.Z., M. Cicardi) - all in Italy; the Department of Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide, SA (W.B.S.), and Campbelltown Hospital, Immunology and Allergy, Western Sydney University, Sydney (C.K.) - both in Australia; and BioCryst Pharmaceuticals (S.D., M. Cornpropst, D.C., P.C., W.S.) and PharStat (L.F.) - both in Durham, NC
| | - Constance Katelaris
- From the Division of Hematology, Oncology, and Hemostaseology, Department of Children and Adolescents, Angioedema Center, University Hospital Frankfurt (E.A.-P.), and the Fraunhofer Institute for Molecular Biology and Applied Ecology, Translational Medicine and Pharmacology (J. Graff), Frankfurt, the Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin (M. Magerl, M. Maurer), and the Department of Otorhinolaryngology and Head and Neck Surgery, Ulm University Medical Center, Ulm (J. Greve) - all in Germany; the Department of Dermatology and Allergy Center, Odense University Hospital, Odense, Denmark (A.B.); Public Health Institution University Clinic of Dermatology, School of Medicine, University Sts. Cyril and Methodius, Skopje, Macedonia (V.G.-P.); the Department of Clinical Immunology, University Hospital Zurich, Zurich, Switzerland (U.C.S.); Assistance Publique-Hôpitaux de Paris Hôpital Saint Antoine, Sorbonne Université, Paris (O.F.), and the Department of Dermatology, Université de Montpellier, Montpellier (A.D.-T.) - both in France; the Allergy and Immunology West Midlands, Birmingham Heartlands Hospital, Birmingham (A.H.), Barts Health NHS Trust-Royal London Hospital, London (H.J.L.), the National Institute for Health Research Southampton Clinical Research Facility, Southampton (W.R.), and the North Bristol NHS Trust, Southmead Hospital, Bristol (M. Gompels) - all in the United Kingdom; the Department of Dermatology, Medical University of Vienna, Vienna (T.K.), and the Department of Dermatology and Venereology, Medical University of Graz, Graz (W.A.) - both in Austria; the Hungarian Angioedema Reference Center, 3rd Department of Internal Medicine, Semmelweis University, Budapest, Hungary (H.F.); the Allergology Unit, Department of Internal Medicine, Hospital Universitario Bellvitge de L'Hospitalet de Llobregat (R.L.) and Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute (M. Guilarte), Barcelona, Hospital General Universitario Gregorio Marañón, Biomedical Research Network on Rare Diseases (Centro de Investigación Biomédica en Red de Enfermedades Raras)-Unit 761, Institute for Health Research, Gregorio Marañon, Madrid (M.L.B.), and Hospital Universitario Virgen del Rocío, Seville (T.G.-Q.) - all in Spain; the Division of Allergy and Clinical Immunology, University of Salerno, Salerno (M.T.), the Department of Medicine, University of Padua, Padua (M. Cancian), and Azienda Socio Sanitaria Territoriale Fatebenefratelli Sacco-Università degli Studi di Milano, Milan (A.Z., M. Cicardi) - all in Italy; the Department of Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide, SA (W.B.S.), and Campbelltown Hospital, Immunology and Allergy, Western Sydney University, Sydney (C.K.) - both in Australia; and BioCryst Pharmaceuticals (S.D., M. Cornpropst, D.C., P.C., W.S.) and PharStat (L.F.) - both in Durham, NC
| | - Sylvia Dobo
- From the Division of Hematology, Oncology, and Hemostaseology, Department of Children and Adolescents, Angioedema Center, University Hospital Frankfurt (E.A.-P.), and the Fraunhofer Institute for Molecular Biology and Applied Ecology, Translational Medicine and Pharmacology (J. Graff), Frankfurt, the Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin (M. Magerl, M. Maurer), and the Department of Otorhinolaryngology and Head and Neck Surgery, Ulm University Medical Center, Ulm (J. Greve) - all in Germany; the Department of Dermatology and Allergy Center, Odense University Hospital, Odense, Denmark (A.B.); Public Health Institution University Clinic of Dermatology, School of Medicine, University Sts. Cyril and Methodius, Skopje, Macedonia (V.G.-P.); the Department of Clinical Immunology, University Hospital Zurich, Zurich, Switzerland (U.C.S.); Assistance Publique-Hôpitaux de Paris Hôpital Saint Antoine, Sorbonne Université, Paris (O.F.), and the Department of Dermatology, Université de Montpellier, Montpellier (A.D.-T.) - both in France; the Allergy and Immunology West Midlands, Birmingham Heartlands Hospital, Birmingham (A.H.), Barts Health NHS Trust-Royal London Hospital, London (H.J.L.), the National Institute for Health Research Southampton Clinical Research Facility, Southampton (W.R.), and the North Bristol NHS Trust, Southmead Hospital, Bristol (M. Gompels) - all in the United Kingdom; the Department of Dermatology, Medical University of Vienna, Vienna (T.K.), and the Department of Dermatology and Venereology, Medical University of Graz, Graz (W.A.) - both in Austria; the Hungarian Angioedema Reference Center, 3rd Department of Internal Medicine, Semmelweis University, Budapest, Hungary (H.F.); the Allergology Unit, Department of Internal Medicine, Hospital Universitario Bellvitge de L'Hospitalet de Llobregat (R.L.) and Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute (M. Guilarte), Barcelona, Hospital General Universitario Gregorio Marañón, Biomedical Research Network on Rare Diseases (Centro de Investigación Biomédica en Red de Enfermedades Raras)-Unit 761, Institute for Health Research, Gregorio Marañon, Madrid (M.L.B.), and Hospital Universitario Virgen del Rocío, Seville (T.G.-Q.) - all in Spain; the Division of Allergy and Clinical Immunology, University of Salerno, Salerno (M.T.), the Department of Medicine, University of Padua, Padua (M. Cancian), and Azienda Socio Sanitaria Territoriale Fatebenefratelli Sacco-Università degli Studi di Milano, Milan (A.Z., M. Cicardi) - all in Italy; the Department of Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide, SA (W.B.S.), and Campbelltown Hospital, Immunology and Allergy, Western Sydney University, Sydney (C.K.) - both in Australia; and BioCryst Pharmaceuticals (S.D., M. Cornpropst, D.C., P.C., W.S.) and PharStat (L.F.) - both in Durham, NC
| | - Melanie Cornpropst
- From the Division of Hematology, Oncology, and Hemostaseology, Department of Children and Adolescents, Angioedema Center, University Hospital Frankfurt (E.A.-P.), and the Fraunhofer Institute for Molecular Biology and Applied Ecology, Translational Medicine and Pharmacology (J. Graff), Frankfurt, the Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin (M. Magerl, M. Maurer), and the Department of Otorhinolaryngology and Head and Neck Surgery, Ulm University Medical Center, Ulm (J. Greve) - all in Germany; the Department of Dermatology and Allergy Center, Odense University Hospital, Odense, Denmark (A.B.); Public Health Institution University Clinic of Dermatology, School of Medicine, University Sts. Cyril and Methodius, Skopje, Macedonia (V.G.-P.); the Department of Clinical Immunology, University Hospital Zurich, Zurich, Switzerland (U.C.S.); Assistance Publique-Hôpitaux de Paris Hôpital Saint Antoine, Sorbonne Université, Paris (O.F.), and the Department of Dermatology, Université de Montpellier, Montpellier (A.D.-T.) - both in France; the Allergy and Immunology West Midlands, Birmingham Heartlands Hospital, Birmingham (A.H.), Barts Health NHS Trust-Royal London Hospital, London (H.J.L.), the National Institute for Health Research Southampton Clinical Research Facility, Southampton (W.R.), and the North Bristol NHS Trust, Southmead Hospital, Bristol (M. Gompels) - all in the United Kingdom; the Department of Dermatology, Medical University of Vienna, Vienna (T.K.), and the Department of Dermatology and Venereology, Medical University of Graz, Graz (W.A.) - both in Austria; the Hungarian Angioedema Reference Center, 3rd Department of Internal Medicine, Semmelweis University, Budapest, Hungary (H.F.); the Allergology Unit, Department of Internal Medicine, Hospital Universitario Bellvitge de L'Hospitalet de Llobregat (R.L.) and Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute (M. Guilarte), Barcelona, Hospital General Universitario Gregorio Marañón, Biomedical Research Network on Rare Diseases (Centro de Investigación Biomédica en Red de Enfermedades Raras)-Unit 761, Institute for Health Research, Gregorio Marañon, Madrid (M.L.B.), and Hospital Universitario Virgen del Rocío, Seville (T.G.-Q.) - all in Spain; the Division of Allergy and Clinical Immunology, University of Salerno, Salerno (M.T.), the Department of Medicine, University of Padua, Padua (M. Cancian), and Azienda Socio Sanitaria Territoriale Fatebenefratelli Sacco-Università degli Studi di Milano, Milan (A.Z., M. Cicardi) - all in Italy; the Department of Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide, SA (W.B.S.), and Campbelltown Hospital, Immunology and Allergy, Western Sydney University, Sydney (C.K.) - both in Australia; and BioCryst Pharmaceuticals (S.D., M. Cornpropst, D.C., P.C., W.S.) and PharStat (L.F.) - both in Durham, NC
| | - Desiree Clemons
- From the Division of Hematology, Oncology, and Hemostaseology, Department of Children and Adolescents, Angioedema Center, University Hospital Frankfurt (E.A.-P.), and the Fraunhofer Institute for Molecular Biology and Applied Ecology, Translational Medicine and Pharmacology (J. Graff), Frankfurt, the Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin (M. Magerl, M. Maurer), and the Department of Otorhinolaryngology and Head and Neck Surgery, Ulm University Medical Center, Ulm (J. Greve) - all in Germany; the Department of Dermatology and Allergy Center, Odense University Hospital, Odense, Denmark (A.B.); Public Health Institution University Clinic of Dermatology, School of Medicine, University Sts. Cyril and Methodius, Skopje, Macedonia (V.G.-P.); the Department of Clinical Immunology, University Hospital Zurich, Zurich, Switzerland (U.C.S.); Assistance Publique-Hôpitaux de Paris Hôpital Saint Antoine, Sorbonne Université, Paris (O.F.), and the Department of Dermatology, Université de Montpellier, Montpellier (A.D.-T.) - both in France; the Allergy and Immunology West Midlands, Birmingham Heartlands Hospital, Birmingham (A.H.), Barts Health NHS Trust-Royal London Hospital, London (H.J.L.), the National Institute for Health Research Southampton Clinical Research Facility, Southampton (W.R.), and the North Bristol NHS Trust, Southmead Hospital, Bristol (M. Gompels) - all in the United Kingdom; the Department of Dermatology, Medical University of Vienna, Vienna (T.K.), and the Department of Dermatology and Venereology, Medical University of Graz, Graz (W.A.) - both in Austria; the Hungarian Angioedema Reference Center, 3rd Department of Internal Medicine, Semmelweis University, Budapest, Hungary (H.F.); the Allergology Unit, Department of Internal Medicine, Hospital Universitario Bellvitge de L'Hospitalet de Llobregat (R.L.) and Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute (M. Guilarte), Barcelona, Hospital General Universitario Gregorio Marañón, Biomedical Research Network on Rare Diseases (Centro de Investigación Biomédica en Red de Enfermedades Raras)-Unit 761, Institute for Health Research, Gregorio Marañon, Madrid (M.L.B.), and Hospital Universitario Virgen del Rocío, Seville (T.G.-Q.) - all in Spain; the Division of Allergy and Clinical Immunology, University of Salerno, Salerno (M.T.), the Department of Medicine, University of Padua, Padua (M. Cancian), and Azienda Socio Sanitaria Territoriale Fatebenefratelli Sacco-Università degli Studi di Milano, Milan (A.Z., M. Cicardi) - all in Italy; the Department of Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide, SA (W.B.S.), and Campbelltown Hospital, Immunology and Allergy, Western Sydney University, Sydney (C.K.) - both in Australia; and BioCryst Pharmaceuticals (S.D., M. Cornpropst, D.C., P.C., W.S.) and PharStat (L.F.) - both in Durham, NC
| | - Lei Fang
- From the Division of Hematology, Oncology, and Hemostaseology, Department of Children and Adolescents, Angioedema Center, University Hospital Frankfurt (E.A.-P.), and the Fraunhofer Institute for Molecular Biology and Applied Ecology, Translational Medicine and Pharmacology (J. Graff), Frankfurt, the Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin (M. Magerl, M. Maurer), and the Department of Otorhinolaryngology and Head and Neck Surgery, Ulm University Medical Center, Ulm (J. Greve) - all in Germany; the Department of Dermatology and Allergy Center, Odense University Hospital, Odense, Denmark (A.B.); Public Health Institution University Clinic of Dermatology, School of Medicine, University Sts. Cyril and Methodius, Skopje, Macedonia (V.G.-P.); the Department of Clinical Immunology, University Hospital Zurich, Zurich, Switzerland (U.C.S.); Assistance Publique-Hôpitaux de Paris Hôpital Saint Antoine, Sorbonne Université, Paris (O.F.), and the Department of Dermatology, Université de Montpellier, Montpellier (A.D.-T.) - both in France; the Allergy and Immunology West Midlands, Birmingham Heartlands Hospital, Birmingham (A.H.), Barts Health NHS Trust-Royal London Hospital, London (H.J.L.), the National Institute for Health Research Southampton Clinical Research Facility, Southampton (W.R.), and the North Bristol NHS Trust, Southmead Hospital, Bristol (M. Gompels) - all in the United Kingdom; the Department of Dermatology, Medical University of Vienna, Vienna (T.K.), and the Department of Dermatology and Venereology, Medical University of Graz, Graz (W.A.) - both in Austria; the Hungarian Angioedema Reference Center, 3rd Department of Internal Medicine, Semmelweis University, Budapest, Hungary (H.F.); the Allergology Unit, Department of Internal Medicine, Hospital Universitario Bellvitge de L'Hospitalet de Llobregat (R.L.) and Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute (M. Guilarte), Barcelona, Hospital General Universitario Gregorio Marañón, Biomedical Research Network on Rare Diseases (Centro de Investigación Biomédica en Red de Enfermedades Raras)-Unit 761, Institute for Health Research, Gregorio Marañon, Madrid (M.L.B.), and Hospital Universitario Virgen del Rocío, Seville (T.G.-Q.) - all in Spain; the Division of Allergy and Clinical Immunology, University of Salerno, Salerno (M.T.), the Department of Medicine, University of Padua, Padua (M. Cancian), and Azienda Socio Sanitaria Territoriale Fatebenefratelli Sacco-Università degli Studi di Milano, Milan (A.Z., M. Cicardi) - all in Italy; the Department of Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide, SA (W.B.S.), and Campbelltown Hospital, Immunology and Allergy, Western Sydney University, Sydney (C.K.) - both in Australia; and BioCryst Pharmaceuticals (S.D., M. Cornpropst, D.C., P.C., W.S.) and PharStat (L.F.) - both in Durham, NC
| | - Phil Collis
- From the Division of Hematology, Oncology, and Hemostaseology, Department of Children and Adolescents, Angioedema Center, University Hospital Frankfurt (E.A.-P.), and the Fraunhofer Institute for Molecular Biology and Applied Ecology, Translational Medicine and Pharmacology (J. Graff), Frankfurt, the Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin (M. Magerl, M. Maurer), and the Department of Otorhinolaryngology and Head and Neck Surgery, Ulm University Medical Center, Ulm (J. Greve) - all in Germany; the Department of Dermatology and Allergy Center, Odense University Hospital, Odense, Denmark (A.B.); Public Health Institution University Clinic of Dermatology, School of Medicine, University Sts. Cyril and Methodius, Skopje, Macedonia (V.G.-P.); the Department of Clinical Immunology, University Hospital Zurich, Zurich, Switzerland (U.C.S.); Assistance Publique-Hôpitaux de Paris Hôpital Saint Antoine, Sorbonne Université, Paris (O.F.), and the Department of Dermatology, Université de Montpellier, Montpellier (A.D.-T.) - both in France; the Allergy and Immunology West Midlands, Birmingham Heartlands Hospital, Birmingham (A.H.), Barts Health NHS Trust-Royal London Hospital, London (H.J.L.), the National Institute for Health Research Southampton Clinical Research Facility, Southampton (W.R.), and the North Bristol NHS Trust, Southmead Hospital, Bristol (M. Gompels) - all in the United Kingdom; the Department of Dermatology, Medical University of Vienna, Vienna (T.K.), and the Department of Dermatology and Venereology, Medical University of Graz, Graz (W.A.) - both in Austria; the Hungarian Angioedema Reference Center, 3rd Department of Internal Medicine, Semmelweis University, Budapest, Hungary (H.F.); the Allergology Unit, Department of Internal Medicine, Hospital Universitario Bellvitge de L'Hospitalet de Llobregat (R.L.) and Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute (M. Guilarte), Barcelona, Hospital General Universitario Gregorio Marañón, Biomedical Research Network on Rare Diseases (Centro de Investigación Biomédica en Red de Enfermedades Raras)-Unit 761, Institute for Health Research, Gregorio Marañon, Madrid (M.L.B.), and Hospital Universitario Virgen del Rocío, Seville (T.G.-Q.) - all in Spain; the Division of Allergy and Clinical Immunology, University of Salerno, Salerno (M.T.), the Department of Medicine, University of Padua, Padua (M. Cancian), and Azienda Socio Sanitaria Territoriale Fatebenefratelli Sacco-Università degli Studi di Milano, Milan (A.Z., M. Cicardi) - all in Italy; the Department of Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide, SA (W.B.S.), and Campbelltown Hospital, Immunology and Allergy, Western Sydney University, Sydney (C.K.) - both in Australia; and BioCryst Pharmaceuticals (S.D., M. Cornpropst, D.C., P.C., W.S.) and PharStat (L.F.) - both in Durham, NC
| | - William Sheridan
- From the Division of Hematology, Oncology, and Hemostaseology, Department of Children and Adolescents, Angioedema Center, University Hospital Frankfurt (E.A.-P.), and the Fraunhofer Institute for Molecular Biology and Applied Ecology, Translational Medicine and Pharmacology (J. Graff), Frankfurt, the Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin (M. Magerl, M. Maurer), and the Department of Otorhinolaryngology and Head and Neck Surgery, Ulm University Medical Center, Ulm (J. Greve) - all in Germany; the Department of Dermatology and Allergy Center, Odense University Hospital, Odense, Denmark (A.B.); Public Health Institution University Clinic of Dermatology, School of Medicine, University Sts. Cyril and Methodius, Skopje, Macedonia (V.G.-P.); the Department of Clinical Immunology, University Hospital Zurich, Zurich, Switzerland (U.C.S.); Assistance Publique-Hôpitaux de Paris Hôpital Saint Antoine, Sorbonne Université, Paris (O.F.), and the Department of Dermatology, Université de Montpellier, Montpellier (A.D.-T.) - both in France; the Allergy and Immunology West Midlands, Birmingham Heartlands Hospital, Birmingham (A.H.), Barts Health NHS Trust-Royal London Hospital, London (H.J.L.), the National Institute for Health Research Southampton Clinical Research Facility, Southampton (W.R.), and the North Bristol NHS Trust, Southmead Hospital, Bristol (M. Gompels) - all in the United Kingdom; the Department of Dermatology, Medical University of Vienna, Vienna (T.K.), and the Department of Dermatology and Venereology, Medical University of Graz, Graz (W.A.) - both in Austria; the Hungarian Angioedema Reference Center, 3rd Department of Internal Medicine, Semmelweis University, Budapest, Hungary (H.F.); the Allergology Unit, Department of Internal Medicine, Hospital Universitario Bellvitge de L'Hospitalet de Llobregat (R.L.) and Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute (M. Guilarte), Barcelona, Hospital General Universitario Gregorio Marañón, Biomedical Research Network on Rare Diseases (Centro de Investigación Biomédica en Red de Enfermedades Raras)-Unit 761, Institute for Health Research, Gregorio Marañon, Madrid (M.L.B.), and Hospital Universitario Virgen del Rocío, Seville (T.G.-Q.) - all in Spain; the Division of Allergy and Clinical Immunology, University of Salerno, Salerno (M.T.), the Department of Medicine, University of Padua, Padua (M. Cancian), and Azienda Socio Sanitaria Territoriale Fatebenefratelli Sacco-Università degli Studi di Milano, Milan (A.Z., M. Cicardi) - all in Italy; the Department of Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide, SA (W.B.S.), and Campbelltown Hospital, Immunology and Allergy, Western Sydney University, Sydney (C.K.) - both in Australia; and BioCryst Pharmaceuticals (S.D., M. Cornpropst, D.C., P.C., W.S.) and PharStat (L.F.) - both in Durham, NC
| | - Marcus Maurer
- From the Division of Hematology, Oncology, and Hemostaseology, Department of Children and Adolescents, Angioedema Center, University Hospital Frankfurt (E.A.-P.), and the Fraunhofer Institute for Molecular Biology and Applied Ecology, Translational Medicine and Pharmacology (J. Graff), Frankfurt, the Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin (M. Magerl, M. Maurer), and the Department of Otorhinolaryngology and Head and Neck Surgery, Ulm University Medical Center, Ulm (J. Greve) - all in Germany; the Department of Dermatology and Allergy Center, Odense University Hospital, Odense, Denmark (A.B.); Public Health Institution University Clinic of Dermatology, School of Medicine, University Sts. Cyril and Methodius, Skopje, Macedonia (V.G.-P.); the Department of Clinical Immunology, University Hospital Zurich, Zurich, Switzerland (U.C.S.); Assistance Publique-Hôpitaux de Paris Hôpital Saint Antoine, Sorbonne Université, Paris (O.F.), and the Department of Dermatology, Université de Montpellier, Montpellier (A.D.-T.) - both in France; the Allergy and Immunology West Midlands, Birmingham Heartlands Hospital, Birmingham (A.H.), Barts Health NHS Trust-Royal London Hospital, London (H.J.L.), the National Institute for Health Research Southampton Clinical Research Facility, Southampton (W.R.), and the North Bristol NHS Trust, Southmead Hospital, Bristol (M. Gompels) - all in the United Kingdom; the Department of Dermatology, Medical University of Vienna, Vienna (T.K.), and the Department of Dermatology and Venereology, Medical University of Graz, Graz (W.A.) - both in Austria; the Hungarian Angioedema Reference Center, 3rd Department of Internal Medicine, Semmelweis University, Budapest, Hungary (H.F.); the Allergology Unit, Department of Internal Medicine, Hospital Universitario Bellvitge de L'Hospitalet de Llobregat (R.L.) and Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute (M. Guilarte), Barcelona, Hospital General Universitario Gregorio Marañón, Biomedical Research Network on Rare Diseases (Centro de Investigación Biomédica en Red de Enfermedades Raras)-Unit 761, Institute for Health Research, Gregorio Marañon, Madrid (M.L.B.), and Hospital Universitario Virgen del Rocío, Seville (T.G.-Q.) - all in Spain; the Division of Allergy and Clinical Immunology, University of Salerno, Salerno (M.T.), the Department of Medicine, University of Padua, Padua (M. Cancian), and Azienda Socio Sanitaria Territoriale Fatebenefratelli Sacco-Università degli Studi di Milano, Milan (A.Z., M. Cicardi) - all in Italy; the Department of Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide, SA (W.B.S.), and Campbelltown Hospital, Immunology and Allergy, Western Sydney University, Sydney (C.K.) - both in Australia; and BioCryst Pharmaceuticals (S.D., M. Cornpropst, D.C., P.C., W.S.) and PharStat (L.F.) - both in Durham, NC
| | - Marco Cicardi
- From the Division of Hematology, Oncology, and Hemostaseology, Department of Children and Adolescents, Angioedema Center, University Hospital Frankfurt (E.A.-P.), and the Fraunhofer Institute for Molecular Biology and Applied Ecology, Translational Medicine and Pharmacology (J. Graff), Frankfurt, the Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin (M. Magerl, M. Maurer), and the Department of Otorhinolaryngology and Head and Neck Surgery, Ulm University Medical Center, Ulm (J. Greve) - all in Germany; the Department of Dermatology and Allergy Center, Odense University Hospital, Odense, Denmark (A.B.); Public Health Institution University Clinic of Dermatology, School of Medicine, University Sts. Cyril and Methodius, Skopje, Macedonia (V.G.-P.); the Department of Clinical Immunology, University Hospital Zurich, Zurich, Switzerland (U.C.S.); Assistance Publique-Hôpitaux de Paris Hôpital Saint Antoine, Sorbonne Université, Paris (O.F.), and the Department of Dermatology, Université de Montpellier, Montpellier (A.D.-T.) - both in France; the Allergy and Immunology West Midlands, Birmingham Heartlands Hospital, Birmingham (A.H.), Barts Health NHS Trust-Royal London Hospital, London (H.J.L.), the National Institute for Health Research Southampton Clinical Research Facility, Southampton (W.R.), and the North Bristol NHS Trust, Southmead Hospital, Bristol (M. Gompels) - all in the United Kingdom; the Department of Dermatology, Medical University of Vienna, Vienna (T.K.), and the Department of Dermatology and Venereology, Medical University of Graz, Graz (W.A.) - both in Austria; the Hungarian Angioedema Reference Center, 3rd Department of Internal Medicine, Semmelweis University, Budapest, Hungary (H.F.); the Allergology Unit, Department of Internal Medicine, Hospital Universitario Bellvitge de L'Hospitalet de Llobregat (R.L.) and Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute (M. Guilarte), Barcelona, Hospital General Universitario Gregorio Marañón, Biomedical Research Network on Rare Diseases (Centro de Investigación Biomédica en Red de Enfermedades Raras)-Unit 761, Institute for Health Research, Gregorio Marañon, Madrid (M.L.B.), and Hospital Universitario Virgen del Rocío, Seville (T.G.-Q.) - all in Spain; the Division of Allergy and Clinical Immunology, University of Salerno, Salerno (M.T.), the Department of Medicine, University of Padua, Padua (M. Cancian), and Azienda Socio Sanitaria Territoriale Fatebenefratelli Sacco-Università degli Studi di Milano, Milan (A.Z., M. Cicardi) - all in Italy; the Department of Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide, SA (W.B.S.), and Campbelltown Hospital, Immunology and Allergy, Western Sydney University, Sydney (C.K.) - both in Australia; and BioCryst Pharmaceuticals (S.D., M. Cornpropst, D.C., P.C., W.S.) and PharStat (L.F.) - both in Durham, NC
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Savarese L, Bova M, De Falco R, Guarino MD, De Luca Picione R, Petraroli A, Senter R, Traverso C, Zabotto M, Zanichelli A, Zito E, Alessio M, Cancian M, Cicardi M, Franzese A, Perricone R, Marone G, Valerio P, Freda MF. Emotional processes and stress in children affected by hereditary angioedema with C1-inhibitor deficiency: a multicenter, prospective study. Orphanet J Rare Dis 2018; 13:115. [PMID: 30005674 PMCID: PMC6043996 DOI: 10.1186/s13023-018-0871-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 07/06/2018] [Indexed: 12/16/2022] Open
Abstract
Background Hereditary angioedema with C1-inhibitor deficiency (C1-INH-HAE) is characterized by recurrent edema of unpredictable frequency and severity. Stress, anxiety, and low mood are among the triggering factors most frequently reported. Impaired regulation and processing of emotions, also known as alexithymia, may influence outcomes. The aim of this study was to confirm the presence of alexithymia and stress in children with C1-INH-HAE, to determine whether they are also present in children affected by other chronic diseases, and to investigate their relationship with C1-INH-HAE severity. Data from children with C1-INH-HAE (n = 28) from four reference centers in Italy were compared with data from children with type 1 diabetes (T1D; n = 23) and rheumatoid arthritis (RA; n = 25). Alexithymia was assessed using the Alexithymia Questionnaire for Children scale; perceived stress was assessed using the Coddington Life Event Scale for Children (CLES-C). Results Mean age (standard deviation [SD]) in the C1-INH-HAE, T1D, and RA groups was 11.8 (3.3), 11.7 (2.9), and 11.1 (2.6) years, respectively. Mean C1-INH-HAE severity score was 5.9 (2.1), indicating moderate disease. Alexithymia scores were similar among disease groups and suggestive of difficulties in identifying and describing emotions; CLES-C scores tended to be worse in C1-INH-HAE children. C1-INH-HAE severity was found to correlate significantly and positively with alexithymia (p = 0.046), but not with perceived stress. Alexithymia correlated positively with perceived stress. Conclusions Alexithymia is common in children with chronic diseases. In C1-INH-HAE, it may result in increased perceived stress and act as a trigger of edema attacks. Comprehensive management of C1-INH-HAE children should consider psychological factors. Electronic supplementary material The online version of this article (10.1186/s13023-018-0871-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Livia Savarese
- Department of Humanities, University Federico II, via Porta di Massa 1, 80133, Naples, Italy.
| | - Maria Bova
- Department of Translational Medical Sciences and Center for Basic and Clinical Immunology Research (CISI), University of Naples Federico II, Naples, Italy
| | - Raffaella De Falco
- Department of Clinical Neuroscience, Anesthesiology and Drug Administration, University Federico II, Naples, Italy
| | - Maria Domenica Guarino
- Rheumatology, Allergology and Clinical Immunology, Department of "Medicina dei Sistemi", University of Rome Tor Vergata, Rome, Italy
| | | | - Angelica Petraroli
- Department of Translational Medical Sciences and Center for Basic and Clinical Immunology Research (CISI), University of Naples Federico II, Naples, Italy
| | | | - Claudia Traverso
- Department of Pediatrics, Rheumatology Unit, University Federico II, Naples, Italy
| | - Matteo Zabotto
- Department of Psychiatry, "Luigi Sacco" Hospital, University of Milan, Milan, Italy
| | - Andrea Zanichelli
- ASST Fatebenefratelli Sacco, Department of Biomedical and Clinical Sciences, "Luigi Sacco" Hospital, University of Milan, Milan, Italy
| | - Eugenio Zito
- Department of Social Sciences, University Federico II, Naples, Italy
| | - Maria Alessio
- Department of Pediatrics, Rheumatology Unit, University Federico II, Naples, Italy
| | - Mauro Cancian
- Department of Medicine, University of Padua, Padua, Italy
| | - Marco Cicardi
- ASST Fatebenefratelli Sacco, Department of Biomedical and Clinical Sciences, "Luigi Sacco" Hospital, University of Milan, Milan, Italy
| | - Adriana Franzese
- Department of Social Sciences, University Federico II, Naples, Italy
| | - Roberto Perricone
- Rheumatology, Allergology and Clinical Immunology, Department of "Medicina dei Sistemi", University of Rome Tor Vergata, Rome, Italy
| | - Gianni Marone
- Department of Translational Medical Sciences and Center for Basic and Clinical Immunology Research (CISI), University of Naples Federico II, Naples, Italy
| | - Paolo Valerio
- Department of Clinical Neuroscience, Anesthesiology and Drug Administration, University Federico II, Naples, Italy
| | - Maria Francesca Freda
- Department of Humanities, University Federico II, via Porta di Massa 1, 80133, Naples, Italy
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Giorgi D, Giordano L, Senore C, Merlino G, Negri R, Cancian M, Lerda M, Segnan N, Del Turco MR. General Practitioners and Mammographic Screening Uptake: Influence of Different Modalities of General Practitioner Participation. Tumori 2018; 86:124-9. [PMID: 10855848 DOI: 10.1177/030089160008600203] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aims and background To compare the impact of different modalities of general practitioner (GP) involvement, including the introduction of target payments, on the attendance rate of organized population-based screening programs for breast cancer in Italy. Study design The study was conducted between 1994 and 1996 in four Italian cities where mammographic screening programs are active: Caltanissetta (CL), Firenze (Fl), Modena (MO) and Torino (TO). The impact on attendance rate of different invitation strategies based on active GP involvement was tested in each center. The additional effect of economic incentives was also assessed. The incentives were proportional to the level of compliance attained by each GP and weighted by the size of his eligible patients’ list. Results In the Firenze project, an invitation signed by the GP and the project co-ordinator attained a statistically significant higher participation (difference: 4.2%, χ2 = 7.42, P = 0.006). In Caltanissetta and Torino there was a significant increase of about 7% in the response rate to the postal reminder in the groups contacted by the GPs. No difference was observed in the Modena project between the two groups. Conclusions The main contributions of GP involvement can be: “cleaning up'’ the invitation lists, especially when computerized archives with the mammographic history of the target population are not available; increasing the women's participation by signing the invitation letter, by counseling and active participation in the invitation phase; co-operating in the reminder phase by recalling women non responders at first invitation. The offer of target payment had a certain impact on the screening uptake, but not easily distinguishable from GP signature of the invitation letter; further studies of appropriate design should be planned. Organizational factors, such as availability of a list of non-responders, might be crucial in order to enhance the effect of the GPs’ action.
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Affiliation(s)
- D Giorgi
- Azienda Ospedaliera Careggi, Centre for Study and Prevention of Cancer (CSPO), Firenze, Italy.
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Cancian M. Omalizumab in complex conditions: when urticaria is associated with other diseases and safety may be a challenge. J DERMATOL TREAT 2018; 29:1. [PMID: 31282779 DOI: 10.1080/09546634.2018.1561391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Mauro Cancian
- a Department of Medicine , University of Padua , Padua , Italy
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Schmaier AH, Cicardi M, Reshef A, Moldovan D, Mócsai A, López-Trascasa M, Lera AL, Brown NJ, Germenis AE, Filippelli-Silva R, Duarte DA, Martin RP, Veronez CL, Bouvier M, Bader M, Costa-Neto CM, Pesquero JB, Charest-Morin X, Marceau F, Rivard GÉ, Bonnefoy A, Wagner É, Debreczeni ML, Németh Z, Kajdácsi E, Schwaner E, Cervenak L, Oroszlán G, Szilágyi A, Dani R, Závodszky P, Gál P, Dobó J, Hébert J, Vincent M, Boursiquot JN, Chapdeleine H, Desjardins M, Laramée B, Gagnon R, Payette N, Lepeshkina O, Charignon D, Ghannam A, Ponard D, Drouet C, Joseph K, Tholanikunnel BG, Sexton DJ, Kaplan AP, Loffredo S, Bova M, Ferrara AL, Petraroli A, Suffritti C, Veszeli N, Zanichelli A, Farkas H, Marone G, Luyasu S, Favier B, Martin L, Kőhalmi KV, Temesszentandrási G, Várnai K, Varga L, Zuraw BL, Feussner A, Tortorici MA, Pawaskar D, Li HH, Anderson J, Bernstein JA, Zhang Y, Pragst I, Aygören-Pürsün E, Jacobson K, Christensen J, Van Leerberghe A, Wang Y, Schranz J, Martinez-Saguer I, Soteres D, Steiner U, Panovska VG, Rae W, Aberer W, Huissoon A, Bygum A, Magerl M, Graff J, Longhurst H, Lleonart R, Fang L, Cornpropst M, Clemons D, Mathis A, Collis P, Dobo S, Sheridan WP, Maurer M, Riedl MA, Craig T, Banerji A, Shennak M, Yang W, Baptista J, Busse P, Kalfus I, McDonald A, Qian S, Roberts A, Panousis C, Green T, Gille A, Zamanakou M, Loules G, Csuka D, Psarros F, Parsopoulou F, Speletas M, Firinu D, De Pasquale TMA, Zoli A, Radice A, Pizzimenti S, Manoussakis E, Konstantinou GN, Bafunno V, Montinaro V, Cancian M, Margaglione M, Bork K, Wulff K, Witzke G, Hardt J, Bouillet L, Caballero T, Grumach AS, Pommie C, Andresen I, Ettingshausen CE, Gutowski Z, Andritschke K, Linde R, Andrási N, Szilágyi T, Leibovich-Nassi I, Symons C, Dempster J, Boccon-Gibod I, Pagnier A, Lehmann A, Kreiberg KB, Nieto SA, Martins R, Martins R, Menendez A, Valle SOR, Olivares M, Hernandez-Landeros ME, Nievas E, Fili N, Barrera OM, Bailleau R, Gallardo-Olivos AM, Grau M, Rodriguez-Galindo J, Carabantes MJO, Zapata-Venegas E, Alfonso MM, Rosario-Grauert M, Ratti M, Vaszquez D, Josviack D, Landivar-Salinas LF, Calderón-Llosa OME, Campilay-Sarmiento R, Raby P, Fabiani J, Lumry WR, Feuersenger H, Watson DJ, Machnig T, Lamacchia D, Hernanz A, Alvez A, Lluncor M, Pedrosa M, Cabañas R, Prior N, Nordenfelt P, Nilsson M, Lindfors A, Wahlgren CF, Björkander J, Hakl R, Kuklínek P, Krčmová I, Hanzlíková J, Vachová M, Zachová R, Sobotková M, Strenková J, Litzman J, Palasopoulou M, Tsinti G, Gianni P, Kompoti M, Garrido S, Dyga W, Bogdali A, Obtułowicz A, Tomasz M, Czarnobilska E, Obtulowicz K, Książek T, Koncz A, Gulyás D, Staevska M, Jesenak M, Hrubiskova K, Bellizzi L, Relan A, Wu MA, Castelli A, Colombo R, Podda G, Del Medico M, Catena E, Casella F, Perego F, Afifi NA, Tobaldini E, Montano N, Sánchez-Jareño M, Stobiecki M, Obtułowicz K, Guryanova I, Polyakova E, Lebedz V, Salivonchik A, Aleshkevich S, Belevtsev M, Nordmann-Kleiner M, Trainotti S, Hahn J, Greve J, Zabrodska L, Alonso MLO, Tórtora RP, França AT, Ribeiro MG, Fu L, Kanani A, Lacuesta G, Waserman S, Betschel S, Espinosa MI, Contreras FA, Hrubisko M, Vavrova L, Banovcin P, Ayazi M, Fazlollahi MR, Saghafi S, Mohammadian S, Deshiry SN, Bidad K, Shoormasti RS, Mohammadzadeh I, Bemanian MH, Mahdaviani SA, Pourpak Z, Valerieva A, Vasileva M, Velikova T, Petkova E, Dimitrov V, Di Maulo R, Somech R, Golander H, Sifuentes EJ, Mansard C, Gompel A, Floccard B, Blanchard-Delaunay C, Launay D, Fain O, Sobel A, Gayet S, Amarger S, Armengol G, Ollivier Y, Zélinsky-Gurung A, Jeandel PY, Kanny G, Coppéré B, Dubrel M, Pelletier F, Du Thanh A, Trouiller S, Laurent J, De Moreuil C, Pajot CA, Belot A, Rodríguez A, Roa D, Prieto A, Baeza ML, Krusheva B, Almeida SKA, Constantino-Silva RN, Melo N, Simoes JA, Palma SMU, da Silva J, de Azevedo BF, Mansour E, González-Quevedo T, Marcos C, Lobera T, de San Pedro BS, Avilla E, Badiou J, Binkley K, Borici-Mazi R, Howlett L, Keith PK, Rowe A, Waite P, Billebeau A, Boccon-Gibbod I, Lis K, Laitman Y, Friedman E, Gokmen NM, Gulbahar O, Onay H, Koc ZP, Sin AZ. Abstracts from the 10th C1-inhibitor deficiency workshop. Allergy Asthma Clin Immunol 2017. [PMCID: PMC5496025 DOI: 10.1186/s13223-017-0198-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Bova M, Bafunno V, Zanichelli A, Cancian M, Barca MP, Angela De Pasquale TM, Firinu D, Marone G, Montinaro V, Pizzimenti S, Rossi O, Suffritti C, Triggiani M, Zoli A, Cicardi M. Hereditary Angioedema with Normal C1 Inhibitor: An Italian Case Series. J Allergy Clin Immunol 2017. [DOI: 10.1016/j.jaci.2016.12.745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Cancian M, Zanichelli A, Arcoleo F, Bova M, Senter R, Cicardi M. Acquired angioedema due to C1-inhibitor deficiency: a survey of 101 Italian patients. J Allergy Clin Immunol 2017. [DOI: 10.1016/j.jaci.2016.12.747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Gidaro A, Perego F, Colombo E, Cancian M, Zanichelli A, Wu MA, Cicardi M. Effect of long term prophylaxis with attenuated androgen (AA-LTP) on the risk for cardiovascular and neoplastic diseases in a cohort of 289 patients with Hereditary Angioedema (HAE) due to C1 inhibitor deficiency. J Allergy Clin Immunol 2017. [DOI: 10.1016/j.jaci.2016.12.761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Senter R, Fabris F, Bendo R, Cancian M. Activation of the Contact System in Idiopathic Angiodema. J Allergy Clin Immunol 2017. [DOI: 10.1016/j.jaci.2016.12.764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Cappuccio A, Limonta T, Parodi A, Cristaudo A, Bugliaro F, Cannavò SP, Rossi O, Gurioli C, Vignoli A, Parente R, Iemoli E, Caldarola G, De Pità O, Di Nuzzo S, Cancian M, Potenza C, Caminati M, Stingeni L, Saraceno R, Trevisini S, Piccirillo A, Sciarrone C, Panebianco R, Gola M, Costanzo A, Grieco T, Massaroni K, Reale L, Marini MG. Living with Chronic Spontaneous Urticaria in Italy: A Narrative Medicine Project to Improve the Pathway of Patient Care. Acta Derm Venereol 2017; 97:81-85. [PMID: 27275626 DOI: 10.2340/00015555-2478] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Chronic spontaneous urticaria (CSU) is perceived as a difficult to manage disease with negative impact on quality of life. The aim of this study was to highlight how to improve the care of people with CSU, using the methodology of narrative medicine. From June 2014 to March 2015, CSU-diagnosed patients and their physicians were asked to record their experiences of the condition in writing. Fourteen healthcare teams participated: 41% considered CSU as a challenge to overcome, while 22% experienced CSU as a big commitment. The number of professional involved was evaluated as insufficient in 11 hospitals. Seventy-five percent of the 190 Italian patients had visited 3 or more physicians before receiving a final diagnosis, with a perceived waste of time and resources. The therapeutic pathways were described as unsatisfactory in 83% of cases. As a result, anger and frustration were life-dominant emotions in 92% of patients. The critical points of the care pathway are related to organizational issues and lack of awareness.
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Pellizzari M, Hui D, Pinato E, Lisiero M, Serpentini S, Gubian L, Figoli F, Cancian M, De Chirico C, Ferroni E, Avossa F, Saugo M. Impact of intensity and timing of integrated home palliative cancer care on end-of-life hospitalization in Northern Italy. Support Care Cancer 2016; 25:1201-1207. [PMID: 27913873 DOI: 10.1007/s00520-016-3510-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 11/21/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE The Veneto Region implemented a novel integrated home-based palliative cancer care (HPCC) program embedded in primary care. We examined the impact of timing and intensity of this program on the quality of end-of-life (EOL) care. METHODS We selected adult cancer patients died in the Veneto Region between March and December 2013, excluding those died from haematological malignancies as well as the very elderly (85+ years). We retrieved the claim-based data on hospitalization and homecare visits, and defined two observation windows: 90 to 16 days before death to examine intensity of HPCC exposure, and the last 15 days of life to examine EOL outcomes, including hospital death, any hospital stay for medical reasons and hospital stay ≥7 days for medical reasons. Multivariate analysis was conducted using a Poisson model. RESULTS Among the 2211 adults who died of solid tumours and received 1+ homecare visits during the exposure period, 1077 (48.7%), 552 (25.0%) and 582 (26.3%) had 0.1-1.9, 2-3.9 and 4+ homecare visits/week, respectively. The median duration between an HPCC home visit and death was 92 days (IQR 42-257 days). Hospital death occurred in 856 (38.7%) patients, while 1087 (49.2%) and 556 (25.1%) had a hospital stay and a hospital stay ≥7 days during the exposure period, respectively. In the multivariate analysis, a greater intensity of integrated HPCC (4+ visits/week) was significantly associated with a lower risk of hospital death (relative risk [RR] = 0.67, 0.59-0.76), any hospital stay (RR = 0.69, 0.62-0.77) and hospital stay ≥7 days for medical reasons (RR = 0.59, 0.49-0.71). A late activation (≤30 days before death) of HPCC was also associated with increased both hospital stay (RR = 1.26, 0.11-1.42) and hospital stay ≥7 days (RR = 1.25, 1.01-1.54). CONCLUSIONS A greater HPCC program intensity reduces the risk of hospital death and hospital stay in the end-of-life. An early activation of this program can contribute to improve these EOL outcomes.
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Affiliation(s)
- M Pellizzari
- Epidemiological Service of the Veneto Region, Passaggio Gaudenzio, 1, 35131, Padua, Padova, Italy
| | - D Hui
- Department of Palliative Care and Rehabilitation Medicine, MD Anderson Cancer Center, Houston, TX, USA
| | - E Pinato
- Epidemiological Service of the Veneto Region, Passaggio Gaudenzio, 1, 35131, Padua, Padova, Italy
| | - M Lisiero
- Hospital Direction, Local Health Unit n° 8, Asolo, Italy
| | - S Serpentini
- Palliative Care Unit Local Health Unit n° 3, Bassano del Grappa and Veneto Oncology Institute, Padua, Italy
| | - L Gubian
- Information Technology Service of the Veneto Region, Venezia, Italy
| | - F Figoli
- Palliative Care Unit, Local Health Unit n° 4, Thiene, Italy
| | - M Cancian
- GP, Local Health Unit n° 7, Conegliano, Italy
| | - C De Chirico
- Palliative Care Unit, Local Health Unit n° 7, Pieve di Soligo, Italy
| | - E Ferroni
- Epidemiological Service of the Veneto Region, Passaggio Gaudenzio, 1, 35131, Padua, Padova, Italy.
| | - F Avossa
- Epidemiological Service of the Veneto Region, Passaggio Gaudenzio, 1, 35131, Padua, Padova, Italy
| | - M Saugo
- Epidemiological Service of the Veneto Region, Passaggio Gaudenzio, 1, 35131, Padua, Padova, Italy
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Lapi F, Levi M, Simonetti M, Cancian M, Parretti D, Cricelli I, Sobrero A, Cricelli C. Risk of prostate cancer in low-dose aspirin users: A retrospective cohort study. Int J Cancer 2016; 139:205-11. [PMID: 26915905 DOI: 10.1002/ijc.30061] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 02/16/2016] [Accepted: 02/19/2016] [Indexed: 11/06/2022]
Abstract
A growing body of evidence indicates that use of low-dose aspirin (LDA) reduces the risk of certain adenocarcinomas. While there are several and consistent findings on the protective effect of LDA on colorectal and other cancers, few and conflicting evidence is available on prostate cancer (PCa). The aim of this study was to assess whether LDA reduces the incidence rate of PCa. We conducted a nationwide, population-based, retrospective cohort study by using Health Search IMS Health Longitudinal Patient Database (HSD). Patients with ischemic cardio- or cerebrovascular disease (index date) were identified. Time-dependent multivariable Cox proportional hazard models were adopted to estimate Hazard Ratios (HRs) and related 95% confidence intervals (95% CI) of PCa associated with use of LDA. The exposure was lagged by one year to consider the latency of drug effect on the outcome onset. Within a cohort 13,453 patients, the overall incidence rate of PCa was 2.5 per 1,000 person-years. Use of LDA was associated with a decreased incidence rate of PCa (HR = 0.64; 95% CI: 0.48-0.86), which was primarily driven by a frequency of LDA use equal to or higher than twice per week (HR = 0.60; 95% CI: 0.43-0.83). Such an association was more pronounced (HR = 0.43; 95% CI: 0.21-0.91) when LDA was used for five or more years. Our findings indicate that LDA use might be associated with a reduction of risk of PCa in patients with cardio- or cerebrovascular diseases.
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Affiliation(s)
- F Lapi
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - M Levi
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy.,Department of Health Sciences, University of Florence, Florence, Italy
| | - M Simonetti
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - M Cancian
- Italian College of General Practitioners and Primary Care, Florence, Italy
| | - D Parretti
- Italian College of General Practitioners and Primary Care, Florence, Italy
| | - I Cricelli
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - A Sobrero
- Medical Oncology, IRCCS Ospedale San Martino IST, Genova, Italy
| | - C Cricelli
- Italian College of General Practitioners and Primary Care, Florence, Italy
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Zanichelli A, Arcoleo F, Barca MP, Borrelli P, Bova M, Cancian M, Cicardi M, Cillari E, De Carolis C, De Pasquale T, Del Corso I, Massardo I, Minale P, Montinaro V, Neri S, Perricone R, Pucci S, Quattrocchi P, Rossi O, Triggiani M. A nationwide survey of hereditary angioedema due to C1 inhibitor deficiency in Italy. World Allergy Organ J 2015. [PMCID: PMC4406698 DOI: 10.1186/1939-4551-8-s1-a184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Cancian M. Hereditary Angioedema due to C1 Inhibitor Deficiency: C1-INH Replacement Therapy. RHC 2014. [DOI: 10.7175/rhc.v5i2.913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Hereditary angioedema (HAE) is a rare condition affecting about 1 in 50.000 individuals and caused by a mutation in the gene encoding the C1-esterase inhibitor (C1-INH), which is involved in the control of complement, clotting, fibrinolytic and kinin pathways. HAE is characterized by plasma outflow from blood vessels, leading to fluid collecting (edema) in the deep tissue layers of the face, larynx, abdomen, and extremities. Three different types of HAE have been identified: in type I the mutation leads to the lack of production of C1-INH, in type II the mutation leads to the production of dysfunctional C1-INH, while type III is extremely rare and still not fully understood. Therapeutic approaches for HAE include on-demand treatments to stop angioedema attacks and prophylactic treatment to prevent attacks both by pre-procedural (short-term) and routine (long-term) prophylaxis. Aim of the present review is to present an overview of C1-INH replacement therapy with the plasma-derived concentrate of C1-INH Berinert® (CSL Behring GmbH) in the treatment of type I and II HAE.
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Cicardi M, Bellis P, Bertazzoni G, Cancian M, Chiesa M, Cremonesi P, Marino P, Montano N, Morselli C, Ottaviani F, Perricone R, Triggiani M, Zanichelli A. Guidance for diagnosis and treatment of acute angioedema in the emergency department: consensus statement by a panel of Italian experts. Intern Emerg Med 2014; 9:85-92. [PMID: 24002787 DOI: 10.1007/s11739-013-0993-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Accepted: 08/21/2013] [Indexed: 11/25/2022]
Abstract
Angioedema attacks, characterized by the transient swelling of the skin and mucosae, are a frequent cause of visits to the emergency department. Swellings of the oral cavity, tongue, or larynx can result in life-threatening airway obstruction, while abdominal attacks can cause severe pain and often lead to unnecessary surgery. The underlying pathophysiologic process resulting in increased vascular permeability and plasma extravasation is mediated by vasoactive molecules, most commonly histamine and bradykinin. Based on the mediator involved, distinct angioedema forms can be recognized, calling for distinct therapeutic approaches. Prompt recognition is challenging for the emergency physician. The low awareness among physicians of the existence of rare forms of angioedema with different aetiologies and pathogenesis, considerably adds to the problem. Also poorly appreciated by emergency personnel may be the recently introduced bradykinin-targeted treatments. The main objective of this consensus statement is to provide guidance for the management of acute angioedema in the emergency department, from presentation to discharge or hospital admission, with a focus on identifying patients in whom new treatments may prevent invasive intervention.
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Affiliation(s)
- Marco Cicardi
- Medicina Interna, Ospedale Luigi Sacco, Università degli Studi di Milano, Milan, Italy,
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Caballero T, Sala-Cunill A, Cancian M, Craig TJ, Neri S, Keith PK, Boccon-Gibod I, Bethune C, Bork K. Current status of implementation of self-administration training in various regions of Europe, Canada and the USA in the management of hereditary angioedema. Int Arch Allergy Immunol 2013; 161 Suppl 1:10-6. [PMID: 23689239 DOI: 10.1159/000351233] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Results from a 16-question survey about self-administration of hereditary angioedema (HAE) therapy, administered in Europe, Canada and the USA, were used to guide discussion at an international HAE expert meeting. The aim was to capture information about current practice in self-administered HAE therapy in these countries, including self-administration training, the key benefits of switching to self-administration, the barriers to self-administration and trends in self-administration. Overall, switching to self-administration therapy is looked upon favourably from both patient and clinician perspectives by virtue of the potential improvement in quality of life arising from optimisation of therapy and early intervention. The recent changes to product licences allowing self-administration provide additional options for the management of HAE.
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Affiliation(s)
- T Caballero
- Hospital La Paz Institute for Health Research (IdiPaz), Madrid, Spain. mteresa.caballero @ idipaz.es
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Moldovan D, Reshef A, Fabiani J, Kivity S, Toubi E, Shlesinger M, Triggiani M, Montinaro V, Cillari E, Realdi G, Cancian M, Visscher S, Zanichelli A, Relan A, Cicardi M. Efficacy and safety of recombinant human C1-inhibitor for the treatment of attacks of hereditary angioedema: European open-label extension study. Clin Exp Allergy 2012; 42:929-35. [DOI: 10.1111/j.1365-2222.2012.03984.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- D. Moldovan
- Department of Allergology - Immunology; Mures County Hospital; University of Medicine and Pharmacy; Tîrgu-Mureş Romania
| | - A. Reshef
- The Allergy and Clinical Immunology Unit; The Chaim Sheba Medical Center; Tel Hashomer Israel
| | - J. Fabiani
- Argentine Institute of Allergy and Immunology; Lezica Capital Federal Argentina
| | - S. Kivity
- Allergy and Immunology Institute; Souraski MC; Tel-Aviv Israel
| | - E. Toubi
- Immunology and Allergy Institute; Bnei Zion Hospital; Haifa Israel
| | - M. Shlesinger
- Department of Immunology; The Barzilai M.C; Ashkelon Israel
| | - M. Triggiani
- Division of Allergy and Clinical Immunology; University of Naples Federico II; Naples Italy
| | - V. Montinaro
- Division of Nephrology; Azienda Ospedaliero-Universitaria “Consorziale Policlinico” Bari; Bari Italy
| | - E. Cillari
- Department of Clinical Pathology; Azienda Ospedaliera “V.Cervello”; Palermo Italy
| | - G. Realdi
- Department of Medical and Surgical Sciences; University of Padova; Italy
| | - M. Cancian
- Department of Medical and Surgical Sciences; University of Padova; Italy
| | - S. Visscher
- Pharming Technologies B.V; Leiden The Netherlands
| | - A. Zanichelli
- Dipartimento di Scienze Cliniche “Luigi Sacco”; Università di Milano; Milan Italy
| | - A. Relan
- Pharming Technologies B.V; Leiden The Netherlands
| | - M. Cicardi
- Dipartimento di Scienze Cliniche “Luigi Sacco”; Università di Milano; Milan Italy
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Cancian M, Vettore G, Realdi G. An uncommon cause of acute pancreatitis. Hereditary angioedema-induced acute pancreatitis. Gastroenterology 2011; 140:33, 370. [PMID: 21110969 DOI: 10.1053/j.gastro.2010.02.064] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2010] [Revised: 02/04/2010] [Accepted: 02/18/2010] [Indexed: 12/02/2022]
Affiliation(s)
- Mauro Cancian
- Department of Medical and Surgical Sciences, University of Padova, Padova, Italy
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Manani G, Facco E, Casiglia E, Cancian M, Zanette G. Isolated atrial fibrillation (IAF) after local anaesthesia with epinephrine in an anxious dental patient. Br Dent J 2008; 205:539-41. [PMID: 19023307 DOI: 10.1038/sj.bdj.2008.979] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2008] [Indexed: 11/09/2022]
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Cancian M, Andres AL, Bendo R, Maggioni L, Ossi E, Vettore G, Realdi G. Hereditary angioedema-induced acute pancreatitis: Clinical picture and effects of C1-esterase inhibitor replacement. Mol Immunol 2008. [DOI: 10.1016/j.molimm.2008.08.187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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D'Ambrosio G, Samani F, Cancian M, De Mola C. Practice of opportunistic prostate-specific antigen screening in Italy: data from the Health Search database. Eur J Cancer Prev 2004; 13:383-6. [PMID: 15452450 DOI: 10.1097/00008469-200410000-00005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The effectiveness of prostate-specific antigen (PSA) testing for opportunistic screening of prostate cancer is not yet well established, although this practice seems to be widely accepted. To estimate the opportunistic use of PSA by general practitioners (GPs) in Italy, we conducted a survey by querying the Health Search (HS) database, which collects clinical records from a representative sample of the Italian population. Clinical computerized data from 320 GPs and 221,557 male patients were analysed. Among total requests for PSA, 3% were linked to prostate cancer, 18% to a urological disease or symptom and 79% were not linked to any urological condition (opportunistic screening). Opportunistic screening was used for 31.4% of subjects over 50 with a significant (P<0.0001) difference between geographical areas (36.4% north, 33.5% central regions, 22.9% south and isles). This distribution was very similar to prostate cancer prevalence as it resulted from the HS data. PSA testing practice showed an increase over the years (12.7% of men over 50 in 2000, 14.3% in 2001 and 15.9% in 2002). In conclusion, the practice of opportunistic screening of prostate cancer seems to be extensively adopted by Italian GPs and is becoming more and more popular, although to date it is not supported by strong scientific evidence.
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Affiliation(s)
- G D'Ambrosio
- SIMG Società Italiana di Medicina Generale, Italian College of General Practitioners, Italy.
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Cancian M, Bortolati M, Fagiolo U. [Urticaria and angioedema]. Ann Ital Med Int 2003; 18:16-23. [PMID: 12739424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
Urticaria is a common complaint characterized by the eruption of cutaneous wheals, accompanied by redness and itching and in which mast cells are thought to play a central role. Wheals range from a few millimeters to several centimeters in diameter and are usually short lasting, except in case of urticarial vasculitis in which they last longer than 24 hours. Urticaria may occur alone or be associated with angioedema, that can be defined as a deep dermal and subcutaneous edema typically affecting the lips, face, hands, feet, penis or scrotum. Angioedema may also involve the submucosal tissue, and when the swellings occur in the oropharynx they can be alarming and occasionally life-threatening. In many cases the cause of acute urticaria or angioedema may be determined, whilst the pathogenetic and diagnostic aspects of the chronic forms are more complex and variable. The clinical features of, as well as the diagnostic and therapeutic approaches to the different forms of urticaria and angioedema are here reviewed, focusing on chronic idiopathic urticaria.
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Affiliation(s)
- Mauro Cancian
- Clinica Medica I, Dipartimento di Scienze Mediche e Chirurgiche, Università degli Studi di Padova.
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Abstract
The argument presented in this article is that although work is one path toward improved well-being for poor families, a successful and humane social welfare policy must recognize and respond to its limitations. The prowork rhetoric surrounding current efforts to move women from welfare to work rests on at least three propositions: Work is the norm, work is good for families, and work leads to self-sufficiency. The article reviews empirical evidence on each of these propositions and concludes that many former welfare participants will earn low wages in unstable employment and will require a broad range of supports to move from welfare to self-sufficiency and improved family well-being.
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Affiliation(s)
- M Cancian
- University of Wisconsin, Madison, 1225 Observatory Drive, Madison, WI 53706, USA.
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Fagiolo U, Kricek F, Ruf C, Peserico A, Amadori A, Cancian M. Effects of complement inactivation and IgG depletion on skin reactivity to autologous serum in chronic idiopathic urticaria. J Allergy Clin Immunol 2000; 106:567-72. [PMID: 10984379 DOI: 10.1067/mai.2000.108913] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Intradermal injection of autologous serum elicits a wheal-and-flare response in about 60% of patients with chronic idiopathic urticaria (CIU). This reactivity has been attributed to the presence of IgG autoantibodies directed against IgE or the alpha-chain of the high-affinity IgE receptor (FcepsilonRIalpha) expressed on basophils and mast cells, leading to the hypothesis that at least some forms of CIU could be sustained by an autoimmune process. OBJECTIVES The aim of this study was to investigate the relationship between the presence of anti-IgE or anti-FcepsilonRI antibodies and the ability to induce wheal-and-flare responses in CIU sera selected for the capacity to give a positive skin test response. METHODS Fifteen patients with CIU and a positive skin test response to autologous serum were injected intradermally with native serum and with serum heated at 56 degrees C for 30 minutes and then adsorbed on Sepharose-protein G to obtain IgG depletion. Serum levels of anti-IgE and anti-FcepsilonRIalpha antibodies were measured by ELISA by using purified IgE and recombinant RIalpha-soluble double-fusion protein RIalpha-human serum albumin-RIalpha, respectively. The histamine-releasing activity of sera was tested by using ELISA with whole human blood from a healthy donor. RESULTS All patients had positive cutaneous responses to native serum injection. Anti-FcepsilonRIalpha antibodies were present in 14 of 15 native sera, only two of which were able to induce in vitro basophil degranulation. On the contrary, detectable amounts of anti-IgE antibodies were not found in any serum. IgG depletion by protein G resulted in complete (10/14 samples) or considerable (4/14 samples) removal of anti-FcepsilonRIalpha antibodies. The two sera endowed with functional activity lost their capacity to trigger histamine release from basophils after heating and protein G adsorption. Nonetheless, heat-decomplemented/IgG-depleted sera elicited wheal-and-flare reactions comparable with those observed with untreated sera. CONCLUSIONS These results strongly suggest that skin reactivity to autologous serum could be due to as yet unidentified non-Ig reactants present in the sera of patients with CIU.
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Affiliation(s)
- U Fagiolo
- Department of Medical and Surgical Sciences, Padova, Austria
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Cancian M, Fortina AB, Peserico A. Contact urticaria syndrome from constituents of balsam of Peru and fragrance mix in a patient with chronic urticaria. Contact Dermatitis 1999; 41:300. [PMID: 10554075 DOI: 10.1111/j.1600-0536.1999.tb06173.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- M Cancian
- Department of Medical and Surgical Sciences, University of Padua, Italy
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Fagiolo U, Cancian M, Bertollo L, Peserico A, Amadori A. Inhibitory effect of heparin on skin reactivity to autologous serum in chronic idiopathic urticaria. J Allergy Clin Immunol 1999; 103:1143-7. [PMID: 10359897 DOI: 10.1016/s0091-6749(99)70190-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Most patients with chronic idiopathic urticaria (CIU) show cutaneous reactivity to intradermal injection of autologous serum. In some cases this reactivity is associated with the presence of autoantibodies directed against IgE or IgE receptors expressed on mast cells, whereas in others no autoimmune mechanisms can be documented. OBJECTIVES The aims of this study were to compare the cutaneous reactivity to serum and plasma samples in a series of patients with active CIU and to address the mechanisms of the inhibitory effect exerted by heparin on the cutaneous responsiveness to the histamine-releasing factors (HRFs) present in CIU serum. METHODS Fourteen patients with CIU were injected intradermally with autologous serum, plasma (anticoagulated by either heparin or EDTA), or serum samples to which heparin had been added. The effects of heparin injection on cutaneous responsiveness to allergens was tested in 5 atopic patients. Moreover, in a set of experiments sera were also adsorbed with Sepharose-conjugated heparin. RESULTS All the patients had positive cutaneous reactions to autologous serum injection. When heparinized plasma was injected, negative reactions were observed in 12 of 14 patients, and a sizable reduction in the wheal-and-flare reactions was recorded in the remaining 2. Compared with results obtained with serum, no substantial change was observed in 6 of 8 patients injected with EDTA-anticoagulated plasma. When heparin was added to serum, abrogation of skin reactivity was seen; nonetheless, no change in the cutaneous response to allergens was associated with locally administered heparin in 5 atopic patients with no history of CIU. Finally, adsorption of CIU sera with solid-phase heparin abrogated the ability to induce cutaneous reactions in 5 of 7 patients, whereas in the remaining 2 a sizable reduction was observed. CONCLUSIONS These data indicate that heparin is able to profoundly inhibit the cutaneous response to HRFs present in the sera of patients with CIU. Although the precise level of action of this heparin-mediated effect is unclear from present data, preliminary evidence seems to indicate that heparin could directly interfere with HRFs present in CIU sera.
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Affiliation(s)
- U Fagiolo
- Institute of Internal Medicine, Department of Clinical Dermatology, University of Padova, Italy
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Cancian M, Reed D. The impact of wives' earnings on income inequality: issues and estimates. Demography 1999; 36:173-84. [PMID: 10332609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
We estimate the extent to which rising family income inequality can be explained by changes in the earnings of married women. We develop a decomposition equation that separates single persons from married couples (decomposition by population group) and, for married couples, distinguishes the impact of wives' earnings from other sources of income (decomposition by income source). Despite the rising correlation between husbands' and wives' earnings, changes in wives' earnings do not explain a substantial portion of the increase in family income inequality. Our results contradict those of some previous analyses. The inconsistency of recent estimates can be traced to the use of a variety of conceptually different approaches in the previous literature. We clarify these approaches by explicitly distinguishing the conceptual issues, analyzing the empirical components, and providing comprehensive estimates.
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Affiliation(s)
- M Cancian
- La Follette Institute of Public Affairs, School of Social Work, University of Wisconsin, Madison 53706, USA.
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