Monthly Archives

March 2019

Efficacy and safety of bilastine in reducing pruritus in patients with chronic spontaneous urticaria and other skin diseases: an exploratory study

By | Articles about Bilastine

Esther Serra, Cristina Campo, Zoltan Novák, Bernardetta Majorek-Olechowska, G Pulka, Aintzane García-Bea & Luis Labeaga (2019)

Journal of Dermatological Treatment

An exploratory, international and multicenter study to evaluate the efficacy of bilastine in the relief of pruritus associated with urticaria and other skin diseases was performed in patients diagnosed of Chronic Spontaneous Urticaria (CSU), eczema/dermatitis, prurigo or cutaneous pruritus.

The first 2 weeks, they were treated with bilastine 20 mg daily. The daily pruritus severity score was assessed. Responders patients stayed on this treatment for the remaining 6 weeks while non-responders were updosed to 40 mg.

The mean change in weekly pruritus severity score from baseline to week 8 was -1.63 ± 0.77 for all patients (p<0.001). The mean change per group was: CSU (-2.1 ± 0.44), cutaneous pruritus (-1.66 ± 0.63), eczema/dermatitis (-1.36 ± 0.79) and prurigo (-1.30 ± 0.92) (all p-values <0.001).

Bilastine at 20 mg and 40 mg showed an excellent profile for both efficacy and safety in reducing pruritus in patients with CSU and other skin disorders.

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Nasal IgE production in Allergic Rhinitis: Impact of Rhinovirus Infection

By | Selected articles

Ahmed Hamed, DeVon C Preston, Will Eschenbacher, Dilawar Khokhar, Lisa Workman, John W Steinke, Peter Heymann, Monica Lawrence, Manuel Soto-Quiros, Thomas AE Platts-Mills, Spencer Payne, Larry Borish (2019)

Practitioners from various specialties investigated the presence of local IgE production in the nose of allergic and non-allergic people and assessed whether it was enhanced by rhinovirus.

Initial studies were performed in patients presenting to the emergency department for allergic and non-allergic respiratory complaints. Local production of specific IgE was determined by comparing ratios of specific to total IgE concentrations between nasal and serum samples.

The analysis revealed evidence of local sIgE production to Dermatophagoides pteronyssinus and Blomia tropicalis in 30.3 and 14.6% of allergic patients, respectively. Patients with active rhinovirus infection were more than twice as likely to have local sIgE, and those with sIgE being produced were three times more likely to have an asthma exacerbation.

In conclusion, local IgE production happens in allergic rhinitis and allergic asthmatics with local IgE are more likely to develop an asthma exacerbation when infected with rhinovirus.

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On the Lipophilic Nature of Autoreactive IgE in Chronic Spontaneous Urticaria

By | Selected articles

Elisa Lakin, Martin K. Church, Marcus Maurer, Oliver Schmetzer (2019)

Theranostics

Investigators at the Department of Dermatology and Allergy of Berlin Charity University Hospital studied autoreactive IgE in chronic spontaneous urticaria patients.

The investigation had three main objectives: quantify and investigate chronic spontaneous urticaria autoreactive IgE physiochemical nature and recognize its patterns compared with healthy control IgE.

IgE autoreactivity, autoantigen recognition patterns and lipophilicity were assessed in sera from 7 chronic spontaneous urticaria and 7 healthy subjects. Although total IgE levels did not differ significantly, the autoreactive proportion of IgE in chronic spontaneous urticaria subjects was 1000-fold higher than that of healthy ones. Chronic spontaneous urticaria IgE differed from healthy control IgE by recognizing 7-fold more and different autoantigens. The median serum level of lipophilic IgE was 1,4-fold higher in chronic spontaneous urticaria subjects.

The analysis revealed that lipophilicity correlated with autoreactivity. Chronic spontaneous urticaria autoreactive IgE is more lipophilic than that of IgE from healthy individuals, which will lead to the development of new diagnostic tests and therapies.

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The Efficacy of a Two-Fold Increase of H1-Antihistamine in the Treatment of Chronic Urticaria – the Vietnamese Experience

By | Selected articles

Thi HT, Thi LP, Van TN, et al..

Vietnamese investigators evaluated the efficacy of increased H1-antihistamine doses in people with chronic urticaria.

Chronic urticaria is a common, debilitating and hard to treat condition. H1-antihistamines are the first line treatment but frequently patients do not get satisfactory relief with the recommended dose. Antihistamine doses may be increased up to four-fold as recommended by European guidelines.

This experience included 102 participants with chronic urticaria who were divided in two groups and treated with 5 mg of levocetirizine or 180 mg of fexofenadine for two weeks, and then increased to 10 mg of levocetirizine or 360 mg of fexofenadine for two more weeks. Wheal, pruritus, size of the wheal, total symptom scores and associated side-effects were measured at beginning, week 2 and week 4.

With the conventional dose, total symptom scores decreased significantly at week 2 and 4 in both groups. However, 26 participants who did not improve at week 2, experienced a two-fold increase in dose, with 11,5% and 38,5% becoming symptom-free at week 4 in levocetirizine and fexofenadine group, respectively. None of the treatments had negative side effects between the conventional dose and the double one.

In conclusion, this study showed that increasing H1-antihistamines dosage by two-fold does not increase the rate of side effects while improving chronic urticaria symptoms.

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Alergias y mastocitos

Current Strategies to Inhibit High Affinity FcεRI-Mediated Signaling for the Treatment of Allergic Disease

By | Selected articles

Gregorio Gomez (2019)

Frontiers in immunology

Gregorio Gomez, from the Department of Pathology, Microbiology and Immunology from the South Carolina School of Medicine made a review of published research that support omalizumab, Designed Ankyrin Repeat Proteins (DARPins) and fusion proteins as the three most currently viable strategies for inhibiting the expression and activation of the high affinity FceRI on mast cells and basofiles.

Activation of mast cells and basofiles that leads to allergic diseases, such as allergic rhinitis, atopic dermatitis, urticaria, anaphylaxis and asthma can happen in different ways. Allergic reactions are normally associated with the crosslinking of the high affinity Fc receptor for IgE, FceRI, with multivalent antigen. Inflammatory mediators released from cytoplasmic granules following FceRI crosslinking induce immediate hypersensitivity reactions, including life-threatening anaphylaxis, and contribute to prolonged inflammation leading to chronic diseases like asthma. Inappropriate or unregulated activation of mast cells and basophils through antigenic crosslinking of FceRI can have adverse consequences.

Researchers based their work on developing biologics that act to inhibit or attenuate the activation of mast cells and basofiles using FceRI as a viable target.

The three most currently viable strategies include omalizumab, an anti-IgE monoclonal antibody, which has the secondary effect of reducing FceRI surface expression, DARPins, which take advantage of the most common structural motifs in nature involved in protein-protein interactions, to inhibit FceRI-IgE interactions and fusion proteins to co-aggregate FceRI with the inhibitory FcgRIIb.

 

In order to maximize the use of omalizumab, additional clinical studies are needed to identify allergic diseases against which omalizumab could be effective beyond asthma and spontaneous urticaria.

The development of DARPins hold the promise of targeting FceRI or IgE with greater specificity and better efficacy than monoclonal antibodies without the difficulties associated with their development.

Harnessing the inhibitory properties of FcgRIIb towards FceRI with fusion proteins also shows promise as shown in pre-clinical studies.

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Fotodermatosis

Real-life experience in the treatment of solar urticaria: retrospective cohort study

By | Selected articles

Snast I, Lapidoth M, Uvaidov V, Enk CD, Mazor S, Hodak E, Levi A.

Solar urticaria (SU) is a rare photodermatosis causing a significant impact on patients’ quality of life. Treatment is often challenging. This study presents our clinical experience with a tailored stepwise therapeutic approach.

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Urticaria Espontánea Crónica (UCE)

Diagnosis, pathogenosis, and treatment of chronic spontaneous urticaria (e-Print)

By | Eprint, Selected articles
Allen P, Kaplan M.D.

Diagnosis, pathogenosis, and treatment of chronic spontaneous urticaria (CSU)

High doses of antihistaminic, omalizumab and ciclosporina (in this order) are effective and advisable for Chronic Spontaneous Urticaria (CSU) therapy, an inflammatory skin disease associated to autoimmunity in 45% of patients.

e-Print. Free download until end of purchased units.
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Rinitis alérgenos y asma en Bélgica

Stepwise approach towards adoption of allergen immunotherapy for allergic rhinitis and asthma patients in daily practice in Belgium: a BelSACI-Abeforcal-EUFOREA statement

By | Selected articles

Hellings PW, Pugin B, Mariën G, Bachert C, Breynaert C, et al.

Physicians dealing with Allergic rhinitis (AR) patients should inform patients on tolerance-inducing effects of Allergen immunotherapy (AIT) and are in the need of a harmonized and practical guide that supports them in selecting eligible patients for AIT, in choosing evidence-based AIT products and in following treatment protocols with proven efficacy. Therefore, a stepwise and holistic approach is needed for better adoption of AIT in the real-life setting in Belgium.

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