Monthly Archives

November 2019

urticaria angioedema hipersensibilidad

Urticaria, angioedema, and type I hypersensitivity reactions associated with fibrinolytic agents

By | Selected articles

Duangmee K, Boonmuang P, Santimaleeworagun W, Prasitdumrong H.

Several clinical trials of fibrinolytic agents have reported the occurrence of allergic reactions, in addition to hemorrhage. These reactions might worsen patient outcomes, especially by causing life-threatening type I hypersensitivity reactions, including anaphylaxis; however, there is a scarcity of data in this regard. This study described and characterized patients with urticaria, angioedema and type I hypersensitivity reactions caused by fibrinolytic agents.

This document is only available for registered healthcare professionals

Login
prevalencia apnea obstructiva

The prevalence of high risk of obstructive sleep apnea in patients with allergic rhinitis

By | Selected articles

Wongvilairat S, Assanasen P, Banhiran W, Tantilipikorn P, Bunnag C.

Although allergic rhinitis (AR) has not been acknowledged as a strong risk factor for obstructive sleep apnea (OSA), several pathophysiological linkages between these two conditions have frequently been reported. However, epidemiological data relating to the prevalence of OSA in patients with AR remain scarce.The objective of this study is to investigate the prevalence of patients at high risk for OSA among patients with AR, and to determine the relationship between OSA and severity of AR.

This document is only available for registered healthcare professionals

Login
historia rinitis alergica

History of allergic rhinitis and risk of asthma; a systematic review and meta-analysis

By | Selected articles

Tohidinik HR, Mallah N, Takkouche B.

Allergic rhinitis has been suspected to be a risk factor for asthma in several studies but this association is not firmly established. The objective of this study was to synthesize the evidence of the association between allergic rhinitis and the risk of asthma through a systematic review and meta-analysis.

We performed a search in Medline, Scopus, ISI Proceedings databases and other databases from inception until February 2019, followed by manual search to identify potentially relevant case-control and cohort studies that reported relative risk estimates and confidence intervals of the association between allergic rhinitis and asthma. Cross-sectional studies were excluded. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using fixed and random effects models and quality of studies was assessed through a modified version of the Newcastle-Ottawa scale.

This document is only available for registered healthcare professionals

Login
urticaria cronica grave

Severe CSU and activation of the coagulation/fibrinolysis system: clinical aspects

By | Selected articles

Asero R.

Eur Ann Allergy Clin Immunol. 2019 Oct 8. doi: 10.23822/EurAnnACI.1764-1489.109. [Epub ahead of print]

This study aimed at comparing patients with severe urticaria and not showing elevated D-dimer plasma levels. It was a real life, cross-sectional study that included 132 adult urticaria patients and results showed identical numbers of patients with elevated and normal D-dimer plasma levels.

This document is only available for registered healthcare professionals

Login
pautas rinitis alergica

Next-generation Allergic Rhinitis and Its Impact on Asthma (ARIA) guidelines for allergic rhinitis based on Grading of Recommendations Assessment, Development and Evaluation (GRADE) and real-world evidence

By | Selected articles

Bousquet J, (…)

J Allergy Clin Immunol. 2019 Oct 15. pii: S0091-6749(19)31187-X. doi: 10.1016/j.jaci.2019.06.049. [Epub ahead of print] Review.

The selection of pharmacotherapy for patients with allergic rhinitis aims to control the disease and depends on patient empowerment, preferences, and age, prominent symptoms, symptom severity, and multimorbidity, efficacy and safety of treatment, speed of onset of action of treatment, current treatment, historic response to treatment, effect on sleep and work productivity, self-management strategies, and resource use.

This team has prepared an algorithm to step up or step down allergic rhinitis treatment based on control, which use varies depends on the availability of medications and resources. To evaluate estimates of effects, the GRADE methodology considered all types of studies and evidence on prognosis, diagnosis, values and preferences, acceptability, and feasibility or directness of findings and real-world evidence.

Different documents were considered for development of ARIA care pathways and the approach proposed confirms most GRADE recommendations for allergic rhinitis and the classification of allergic rhinitis treatments proposed by ARIA. Some conditional evidence was supported by real-world evidence:

  • The combination of oral H1-antihistamines with intranasal corticosteroids was not found to be more effective than intranasal corticosteroids alone.
  • The combination of intranasal H1-antihistamines with intranasal corticosteroid was found to be more effective than intranasal corticosteroids alone.
  • Intranasal H1-antihistamine–containing medications are effective within minutes.

This document is only available for registered healthcare professionals

Login
posición declaración c

CSACI position statement: Newer generation H1-antihistamines are safer than first-generation H1-antihistamines and should be the first-line antihistamines for the treatment of allergic rhinitis and urticaria

By | Selected articles

Fein MN, Fischer DA, O’Keefe AW, Sussman GL.

Allergy Asthma Clin Immunol. 2019 Oct 1;15:61. doi: 10.1186/s13223-019-0375-9. eCollection 2019. Review.

H1-antihistamines are the most used class of medications for the treatment of allergic rhinitis and urticaria. The first generation of antihistamines has been available since 1946, however its common side effects, such as sedation, impairment with decreased cognitive function, poor sleep quality, dry mouth, dizziness and orthostatic hypotension led to the development of newer, less-sedating second and third generation antihistamines, which became available in the 1980s. These newer generations of H1-antihistamines have a better safety profile and improved potency and efficacy. They are the recommended first-line treatment for mild allergic rhinitis and acute and chronic urticaria.

The Canadian Society of Allergy Clinical Immunology (CSACI) recommends that second and third generations of H1-antihistamines are preferred over first generation antihistamines for the treatment of allergic rhinitis and urticaria. CSACI also recommends that first generation antihistamines should only be sold behind the counter in pharmacies and as a last resort due to the risks of their use.

To help change practice and improve patient health and safety, the CSACI recommends that efforts are needed to disseminate this information to healthcare providers and patients.

This document is only available for registered healthcare professionals

Login
seguridad tolerabilidad bilastina

The safety and tolerability profile of bilastine for chronic urticaria in children

By | Articles about Bilastine

Papadopoulos NG, Zuberbier T.

Clin Transl Allergy. 2019 Oct 23;9:55. doi: 10.1186/s13601-019-0294-3. eCollection 2019. Review.

Urticaria is characterized by the development of pruritic wheals, angioedema or both. Guidelines from early 2018 recommend that urticaria is classified based on its duration as acute (< 6 weeks) or chronic (> 6 weeks). In addition, they also classify chronic urticaria as spontaneous or inducible. Chronic urticaria is less frequent than acute in children, but is a condition that requires treatment, as it affects children’s daily activities, disturbs sleep, causes emotional distress and influences negatively learning and cognition.

Bilastine is a H1-antihistamine that has been studied in children at the dose of 10mg/daily and is licensed for the symptomatic relief of urticaria symptoms in children > 6 to 11 years.

Investigation in paediatric population included bilastine and rupatadine among the second-generation antihistamines. A phase III, doubleblind, randomized, placebo-controlled, parallel-group clinical trial was carried out to assess the safety and tolerability of bilastine 10 mg once daily for 12 weeks in 509 children aged 2–11 years with allergic rhinitis or chronic urticaria. The primary endpoint was the proportion of children in each treatment group without treatment-emergent adverse events (TEAEs). Secondary endpoints included the assessment of somnolence/sedation with the Pediatric Sleep Questionnaire (PSQ). No statistically significant differences were found between treatment groups for incidences of TEAEs or related TEAEs in the population overall or by age subgroup. The majority of related TEAEs were mild to moderate in intensity. PSQ scores for somnolence/sedation decreased slightly from baseline to week 12 in both the bilastine 10 mg and placebo groups.

In conclusion, bilastine is a suitable for treatment of urticaria in children, due to its efficacy and good tolerability profile that were proven in well-controlled studies. Specifically, lack of potential to induce sedation allows prolonged administration without impairment of performance and learning abilities.

This document is only available for registered healthcare professionals

Login
bilastina

Bilastine: a lifetime companion for the treatment of allergies

By | Articles about Bilastine

Martin K. Church, Marysia Tiongco-Rectob, Erminia Ridoloc and Zoltan Novàk.

Bilastine is a potent and highly selective H1-antihistamine approved for the treatment of allergic rhinoconjunctivitis and urticaria. This article summarizes available data on the use of bilastine in the treatment of allergic disorders in different age groups, including younger and older adults, and school-age children and adolescents.

This document is only available for registered healthcare professionals

Login

Prevalence of chronic urticaria in children and adults across the globe: systematic review with meta-analysis

By | Selected articles

Fricke J, Ávila G, Keller T, Weller K, Lau S, Maurer M, Zuberbier T, Keil T.

(2019) Allergy. 2019 Sep 8. doi: 10.1111/all.14037. [Epub ahead of print]

Urticaria is a relatively common skin condition, characterized by the development of hives, angioedema, or both. Although it is a common condition, there are few studies that assess urticaria prevalence and do not distinguish between acute and chronic forms.

This review aimed at examining the prevalence of chronic urticaria by assessing the evidence from population-based studies worldwide.

After a systematic search in PUBMED and EMBASE for population-based studies of cross-sectional or cohort design and studies based on health insurance/system databases, 18 studies were included in the systematic evaluation and 11 in the meta-analysis, including data from over 86,000,000 participants.

Globally, the prevalence of chronic urticaria showed considerable regional differences. Asian studies showed a higher point prevalence of chronic urticaria than those from Europe and Northern America. Women seemed to be more affected than men, whereas in children < 15 years there was no sex-specific difference in the prevalence of chronic urticaria. Four of the studies that examined time trends, indicated an increasing prevalence of chronic urticaria over time.

This document is only available for registered healthcare professionals.

Login

Next-generation ARIA care pathways for rhinitis and asthma: a model for multimorbid chronic diseases

By | Selected articles

Bousquet JJ.

(2019) Clin Transl Allergy. 2019 Sep 9;9:44. doi: 10.1186/s13601-019-0279-2. eCollection 2019. Review.Gerasimos N.

ARIA (Allergic rhinitis and its impact on asthma) proposes an innovative patient-centered approach for rhinitis and asthma multimorbidity to be scaled up to chronic diseases. The European Union and global political agendas are of great importance in supporting supporting the digital transformation of health and care with integrated care.

The burden and cost of allergic and chronic respiratory diseases are increasing rapidly, with economies struggling to deliver modern health care effectively. Budgets will continue to be challenged with the move towards universal health coverage as demand increases and newer, more expensive technologies become available. Allergic rhinitis and asthma multimorbidity can be considered a model for chronic diseases because there is a broad agreement on the gold standard of care. In allergic rhinitis and asthma, adherence to treatment is a major unresolved problem. Patients self-treat based on their personal experiences, showing a major disconnect between physicians and patients.

Integrated care pathways (ICPs) are structured multidisciplinary care plans detailing the key steps of patient care, supporting self-care through mobile devices. Three aspects of care pathways are being developed and proposed by ARIA: (i) patient participation, health literacy and self-care through technology-assisted patient activation; (ii) implementation of care pathways by pharmacists and (iii) next-generation guidelines assessing the recommendations of guidelines in allergic rhinitis and asthma using real-world evidence obtained through mobile technology.

This document is only available for registered healthcare professionals.

Login

Current and Emerging Treatments for Chronic Spontaneous Urticaria

By | Selected articles

Johal KJ, Saini SS.

(2019) Ann Allergy Asthma Immunol. 2019 Sep 5. pii: S1081-1206(19)31054-3. doi: 10.1016/j.anai.2019.08.465. [Epub ahead of print] Review.

This is a review of published literature on current and new treatments for chronic spontaneous urticaria.

Chronic spontaneous urticaria is defined as the spontaneous appearance of wheals, angioedema or both for at least 6 weeks due to unknown causes. The management of chronic urticaria frequently overlap with chronic spontaneous urticaria, with the primary aim of the treatment being to eliminate symptoms. Current guidelines recommend H1-antihistamines (up to 4 times the upper limit of normal dosing) with the possible use of an LTRA, H2-antihistamines or alternative ones prior to omalizumab.

A PubMed search was performed to include relevant articles, including studies if they provided information related to the current understanding of the pathophysiology and management of chronic spontaneous urticaria, as well as potential novel therapeutics.

Current treatments include antihistamines, leukotriene receptor antagonists, omalizumab and immunosuppressants. New therapeutics under investigation include new IgG1 and anti-IgE monoclonal antibody with higher affinity for IgE than omalizumab (ligelizumab), targets of receptors regulating inflammatory cell chemotaxis, such as CRTH2/DP2 antagonists (AZD1981), Btk inhibitors (fenebrutinib), anti-siglec-8 monoclonal antibody (AK002) are thought to lead to apoptosis of eosinophils and anti-mediator effects on mast cells, topical syk inhibitors (GSK2646264) and designed ankyrin repeat proteins (DARPins).

This document is only available for registered healthcare professionals.

Login

Recent developments and highlights in allergic rhinitis

By | Selected articles

Meng Y, Wang C, Zhang L.

(2019) Allergy. 2019 Sep 30. doi: 10.1111/all.14067. [Epub ahead of print] Review.

Allergic rhinitis is characterized by symptoms of sneezing, rhinorrhea, nasal obstruction, and pruritus caused by inhaled allergens and involving mucosal inflammation. Allergic rhinitis is a disease with high prevalence all over the world.

This review aimed at highlighting recent developments in the etiology and management of allergic rhinitis.

Exposure of atopic individuals to external environmental factors such as ambient air pollutants, aeroallergens and climate play a crucial role in the pathogenesis of allergic rhinitis. When the nasal mucosa is exposed to inciting allergens such as pollen and dust mites, innate and adaptive immune cells are involved in the pathophysiologic mechanism of allergic rhinitis, which induce specific immunoglobulin E (IgE) production, activation of eosinophils, and degranulation of mast cells and basophils, with the consequent clinical symptoms.

At a cellular and molecular mechanism, several studies reported the role of IL-17 in allergic rhinitis. Serum IL-17 levels are significantly associated with allergy severity during the pollen season and are considered a marker of allergy severity in allergic rhinitis patients.

Current treatment options include patient education, irritant and allergen avoidance measures, pharmacotherapy, allergen immunotherapy, nasal irrigation and other less common measures such as acupuncture and surgery. Recent studies have strengthened the evidence base for the treatment of all aspect of allergic rhinitis.

This document is only available for registered healthcare professionals.

Login
investigacion seguridad cardiaca antihistaminicos

Cardiac safety of second-generation H1-antihistamines when updosed in chronic spontaneous urticaria

By | Selected articles

Mauro Cataldi, Marcus Maurer, Maurizio Taglialatela, Martin K. Church2.

(2019) Clin Exp Allergy. 2019 Sep 13. doi: 10.1111/cea.13500. [Epub ahead of print]

This is a review where the mechanisms and assessment of potential cardiotoxicity of H1-antihistamines are discussed when updosed to four-times their licensed dose. Second generation H1-antihistamines are the primary treatment of chronic urticaria, however there are patients who don’t respond to licensed doses of H1-antihistamines. Current EAACI/GA2LEN/EDF/WAO guideline for urticaria suggest updosing of H1-antihistamines up to 4-fold.

Due to the off label use of this updosing, it is important to ensure its safety. An important aspect of safety is potential cardiotoxicity. This review considered in detail H1-antihistamines such as bilastine, cetirizine, levocetirizine, ebastine, fexofenadine, loratadine, desloratadine, mizolastine and rupatadine. Provided that prescribers carefully considered and ruled out potential risk factors for cardiotoxicity, such as the presence of inherited long QT syndrome, older age, cardiovascular disorders, hypokalemia and hypomagnesemia, or the use of drugs that either haver direct QT prolonging effect or inhibit H1-antihistamines metabolism, reviewers were able to conclude that at up to four-fold the standard dose, H1-antihistamines have excellent cardiac safety profiles.

This is a review where the mechanisms and assessment of potential cardiotoxicity of H1-antihistamines are discussed when updosed to four-times their licensed dose. Second generation H1-antihistamines are the primary treatment of chronic urticaria, however there are patients who don’t respond to licensed doses of H1-antihistamines. Current EAACI/GA2LEN/EDF/WAO guideline for urticaria suggest updosing of H1-antihistamines up to 4-fold.

Due to the off label use of this updosing, it is important to ensure its safety. An important aspect of safety is potential cardiotoxicity. This review considered in detail H1-antihistamines such as bilastine, cetirizine, levocetirizine, ebastine, fexofenadine, loratadine, desloratadine, mizolastine and rupatadine. Provided that prescribers carefully considered and ruled out potential risk factors for cardiotoxicity, such as the presence of inherited long QT syndrome, older age, cardiovascular disorders, hypokalemia and hypomagnesemia, or the use of drugs that either haver direct QT prolonging effect or inhibit H1-antihistamines metabolism, reviewers were able to conclude that at up to four-fold the standard dose, H1-antihistamines have excellent cardiac safety profiles.

This document is only available for registered healthcare professionals.

Login

La información que está a punto de visualizar está dirigida únicamente a los profesionales sanitarios aptos para prescribir o dispensar medicamentos. La correcta utilización de su contenido requiere de formación como profesional sanitario.

Debe hacer clic en Aceptar para confirmar que es usted profesional de la salud y continuar con la navegación.

ACEPTAR