Monthly Archives

May 2020

Nivel de dímero D en plasma

Efficacy and Safety of Active Vitamin D Supplementation in Chronic Spontaneous Urticaria Patients.

By | Selected articles

Ahmed Mohamed A, Hussein MS, Salah EM, Eldemery A, Darwish MM, Ghaith DM, Attala RA, El Borolossy R.

J Dermatolog Treat. 2020 Apr 29:1-22. doi: 10.1080/09546634.2020.1762838. [Epub ahead of print]

Chronic spontaneous urticaria is one of the most common cutaneous disorders, characterized by the recurrence of transient wheals, angioedema or both for more than 6 weeks. Vitamin D has a main role in bone homeostasis, but also has immunomodulatory action in innate and adaptive immunity. Some studies have shown that vitamin D plays also a role in the improvement of clinical symptoms of chronic urticaria.

The aim of this study was to assess the association between serum levels of vitamin D and chronic spontaneous urticaria and to evaluate its efficacy and safety.

The study included 77 participants with chronic spontaneous urticaria and 67 healthy controls. They were randomized to receive 0,25 ug of alfacalcidol daily or placebo for 12 weeks.

Participants with chronic spontaneous urticaria had a significantly lower serum vitamin D than healthy controls at the beginning of the study. 12 weeks after administration of alfacalcidol, participants with chronic spontaneous urticaria showed a significant higher level of serum vitamin D compared to placebo. Additionally, mean serum level of IL6, CRP and TNFa significantly also decreased in these participants.

Although vitamin D deficiency is more common in people with chronic spontaneous urticaria, supplementation with alfacalcidol may have a beneficial role as add-on therapy of chronic spontaneous urticaria with no relevant side effects.

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International expert consensus on the management of allergic rhinitis (AR) aggravated by air pollutants: Impact of air pollution on patients with AR: Current knowledge and future strategies.

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Naclerio R, Ansotegui IJ, Bousquet J, Canonica GW, D’Amato G, Rosario N, Pawankar R, Peden D, Bergmann KC, Bielory L, Caraballo L, Cecchi L, Cepeda SAM, Chong Neto HJ, Galán C, Gonzalez Diaz SN, Idriss S, Popov T, Ramon GD, Ridolo E, Rottem M, Songnuan W, Rouadi P.

World Allergy Organ J. 2020 Apr 3;13(3):100106. doi: 10.1016/j.waojou.2020.100106. eCollection 2020 Mar.

Exposition to pollution and climate change worsen symptoms in people with allergic rhinitis. The aim of this study was to summarize the conclusions of an International Expert Consensus on the management of allergic rhinitis aggravated by air pollution.

Epidemiological and clinical studies have shown that co-exposure to aeroallergens and pollutants have an immunological effect that induces inflammatory responses with recruitment of inflammatory cells, cytokines and interleukins. In addition, allergic rhinitis symptoms can be mediated by a neurogenic component upon contact with environmental irritants. Other studies that included specific pollutants exposure and allergen challenge propose that pollution can exacerbate allergic airway disease and increase responsiveness.

Although there have been advances in the understanding of the mechanistic ways of airway inflammation, there is lack of evidence about the benefits of management of allergic rhinitis aggravated by pollution. Fexofenadine, a non-sedating oral antihistamine as shown to improve allergic rhinitis symptoms aggravated by pollution, however, more studies with other related antihistamines in mitigating symptoms resulting from co-exposure to pollution and allergens are needed.

Nevertheless, an individual and careful approach with avoidance measures and conventional pharmacotherapy can improve symptoms caused by allergic rhinitis and air pollution.

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vitamina modulador rinitis

Defining biomarkers to predict symptoms in subjects with and without allergy under natural pollen exposure.

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Gökkaya M, Damialis A, Nussbaumer T, Beck I, Bounas-Pyrros N, Bezold S, Amisi MM, Kolek F, Todorova A, Chaker A, Aglas L, Ferreira F, Redegeld FA, Brunner JO, Neumann AU, Traidl-Hoffmann C, Gilles S.

J Allergy Clin Immunol. 2020 Apr 6. pii: S0091-6749(20)30419-X. doi: 10.1016/j.jaci.2020.02.037. [Epub ahead of print]

The exposition to airborne pollen is the main cause of seasonal allergic rhinitis. This exposition induces local and systemic allergic immune responses in sensitized and non-sensitized individuals. The mechanisms of action of the expression of symptoms under natural pollen exposure is not fully understood. The aim of this study was to monitor the humoral immune response under natural pollen exposure to categorise and understand nasal biomarkers for in-season symptom severity and to identify protective factors.

50 participants with seasonal allergic rhinitis and non-allergic rhinitis were included from November 2015 to October 2016. Immune monitoring to compare humoral immune response kinetics and cross-sectional and interseasonal differences in levels of serum and nasal, total and Bet v 1-specific immunoglobulin isotypes, immunoglobulin free light chains, cytokines and chemokines was performed every 4 weeks out of season and bi-weekly within the main pollen season. Nasal immune variables were registered with non-supervised principal component analysis and single immune variables were correlated with in-season severity by Spearman test.

Participants with seasonal allergic rhinitis had symptoms in 0 to 13 days after airborne pollen exposure, depending on the pollen type. 4 out of 7 non-allergic participants also exhibited in-season symptoms. Non-allergic participants had lower cumulative symptoms than participants with seasonal allergic rhinitis but followed the pollen exposure with similar kinetics. Seasonal allergic rhinitis participants had higher levels of nasal eotaxin-2, MDC and MCP-1, non-allergic participants had higher levels of IL-7. Non-supervises principal component analysis and Spearman correlations identified nasal IL-8, IL-33, Bet v 1-specific IgG4 and sIgE antibodies a prognostic for seasonal symptom severity.

Nasal IL-8, IL-33, sIgG3 and sIgE could be predictive biomarkers for pollen-specific symptom expression, irrespective of atopy, while nasal pollen-specific IgA and IgG isotypes seem to be potentially protective within the humoral compartment.

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skin microdyalisis

Chronic urticaria in the real-life clinical practice setting in the UK: results from the non-interventional multicentre AWARE study.

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Savic S, Leeman L, El-Shanawany T, Ellis R, Gach JE, Marinho S, Wahie S, Sargur R, Bewley AP, Nakonechna A, Randall R, Fragkas N, Somenzi O, Marsland A.

Clin Exp Dermatol. 2020 Apr 4. doi: 10.1111/ced.14230. [Epub ahead of print]

Chronic urticaria is a group of skin conditions that include chronic spontaneous urticaria and chronic inducible urticaria. Symptoms include itchy wheals and/or angioedema for a period longer than 6 weeks. The objective of this study was to provide information demonstrating the real-life burden of chronic urticaria in the UK.

The non-interventional AWARE study (A World-wide Antihistamine-Refractory chronic urticaria patient Evaluation) collected data from a representative sample of chronic urticaria patients worldwide. A subset of UK patients aged 18-75 diagnosed with H1-antihistamine-refractory chronic spontaneous urticaria was analysed.

Baseline analysis included 252 UK patients, mostly female (77,8%) with moderate-to-severe disease activity and a spontaneous component to their chronic urticaria. Comorbidities included depression/anxiety (24,6%), asthma (23,8%) and allergic rhinitis (12,7%). 57,9% of the patients had undergone a treatment. Their mean Dermatology Life Quality Index score was 9,5 with report of reduction in work productivity and activity. These patients referred a high need to use healthcare resources. Chronic spontaneous urticaria severity was linked to gender, obesity, anxiety and diagnosis.

Only 28,5% of UK patients completed all nine study visits, which limits analysis of long-term treatment patterns and disease impact. Chronic urticaria patients reported high rates of healthcare resource use and impairment in quality of life, work productivity and activity at baseline, which highlights the need to ensure appropriate management to optimise patient quality of life and reduce the socioeconomic burden of chronic urticaria in the UK.

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Urticaria cronica angioedema

Urticaria and Angioedema Across the Ages

By | Selected articles

Saini S, Shams M, Bernstein JA, Maurer M.

J Allergy Clin Immunol Pract. 2020 Apr 13. pii: S2213-2198(20)30329-9. doi: 10.1016/j.jaip.2020.03.030. [Epub ahead of print]

Chronic urticaria symptoms include itchy wheals, angioedema, or both, caused by the release of histamine, prostaglandin metabolites, leukotrienes, platelet activating factor and other proinflammatory mediators, which in turn lead to vasodilation and extravasation, sensory nerve activation and cellular infiltration.

Chronic urticaria is a common clinical condition that impairs quality of life of people and represent an important health burden. International Consensus guidelines have been published that recommend the use of standard terminology and definitions for different types of chronic urticaria, such as chronic spontaneous urticaria and chronic inducible urticaria. However, there is a lack in the understanding of mechanistic pathways and treatment in some more vulnerable populations, such as children, elderly people and pregnant or lactating women.

40-50% of the patients are effectively treated with monotherapy with a non-sedating H1-antihistamine or 2-4 times the recommended dose of a non-sedating H1-antihistamine. Biologics like omalizumab or immunosuppressants such as cyclosporin are used when patients fail to respond to simpler treatments. There is evidence that omalizumab can be safely used in the vulnerable populations, however cyclosporin has a greater toxicity and is not appropriate in these populations.

Additional therapies for vulnerable chronic urticaria patients are needed.

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Terapia combinada de azelastina intranasal y propionato de fluticasona

Adherence to Prescribed E-Diary Recording by Patients With Seasonal Allergic Rhinitis: Observational Study.

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Di Fraia M, Tripodi S, Arasi S, Dramburg S, Castelli S, Villalta D, Buzzulini F, Sfika I, Villella V, Potapova E, Perna S, Brighetti MA, Travaglini A, Verardo P, Pelosi S, Zicari AM, Matricardi PM.

J Med Internet Res. 2020 Mar 16;22(3):e16642. doi: 10.2196/16642.

Seasonal allergic rhinitis affects patients exposed to pollens to which they are sensitized. The etiological diagnosis and therapy of allergic rhinitis require an evidence that exposure to the sensitizing pollen triggers allergic symptoms. Electronic clinical diaries can demonstrate this association as patients can record disease severity scores and pollen exposure. However, there is a lack of adherence in patients who have spontaneously downloaded an e-diary application.

The aim of the study @IT-2020 project was to evaluate adherence of patients with seasonal allergic rhinitis to symptom recording via e-diary clearly prescribed by a specialist within a blended care approach. Italian children and adults with seasonal allergic rhinitis were included and instructed to record their symptoms, medication intake and general conditions daily through a mobile app (Allergy.Monitor) during pollen season.

A total of 101 children and 93 adults with seasonal allergic rhinitis were included and showed a slow decline in the adherence to device use during monitoring: from 90% at the end of the first week to 70 to 80% from the seventh week onward. At the individual level, the adherence evaluated in the second and third weeks predicted with enough confidence the overall participant adherence to recording.

If prescribed and motivated by an allergist in a blended care setting, the adherence to daily recording in an e-diary is very high, which supports their use in addition to face-to-face visits for diagnosis and treatment of seasonal allergic rhinitis. The proper use of mobile health technology in monitoring seasonal allergic rhinitis strengthens the blended care approach.

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interacciones contaminacion rinitis

Clinical symptoms and biomarkers of Bermuda grass-induced allergic rhinitis using the nasal allergen challenge model.

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Rawls M, Thiele J, Adams DE, Steacy LM, Ellis AK.

Ann Allergy Asthma Immunol. 2020 Mar 12. pii: S1081-1206(20)30147-2. doi: 10.1016/j.anai.2020.03.003. [Epub ahead of print]

Allergic rhinitis is an immunoglobulin E (IgE) mediated inflammatory disorder of the nose. Its prevalence ranges from 10 to 30% in North America. Grass pollens are common allergens that can provoke allergic rhinitis symptoms, such as sneezing, nasal itching, congestion and postnasal drip. Uncontrolled allergic rhinitis symptoms can have a negative impact on sleep quality, work productivity, driving ability and academic performance. Antihistamines and nasal corticoids are the usual treatments to reduce symptoms severity. This study objective was to evaluate whether Bermuda grass allergens can provoke allergic rhinitis symptoms in sensitized participants and to determine if nasal allergen challenge model is adequate to study this type of allergic rhinitis.

The study included 22 participants sensitized to Bermuda grass and 12 nonallergic participants, who completed a titrated nasal allergen challenge with increasing allergen concentrations at a screening visit. Total nasal symptom score (TNSS) and peak nasal inspiratory flow were registered before allergen exposure and 10 minutes after each concentration.

At titrated nasal allergen challenge, 19 of 22 sensitized participants met the criteria for positive allergic response when challenged. During single-dose nasal allergen challenge, sensitized participants had significantly greater TNSS between 15 min and 3 hours after nasal allergen challenge than nonallergic participants. Likewise, allergic participants had a significantly increased number of nasal lavage eosinophils at both 1 and 6 hours after nasal allergen challenge. Also, Bermuda grass specific IgE was significantly increased in Bermuda grass allergic participants at nasal allergen challenge than at screening visit.

In conclusion, Bermuda grass induces allergic rhinitis symptoms in sensitized participants and the model of nasal allergen challenge is adequate to study this type of allergic rhinitis.

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Diagnosis and treatment of urticaria in primary care

Urticaria: Collegium Internationale Allergologicum (CIA) Update 2020.

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Maurer M, Eyerich K, Eyerich S, Ferrer M, Gutermuth J, Hartmann K, Jakob T, Kapp A, Kolkhir P, Larenas-Linnemann D, Park HS, Pejler G, Sánchez-Borges M, Schäkel K, Simon D, Simon HU, Weller K, Zuberbier T, Metz M.

Int Arch Allergy Immunol. 2020 Mar 30:1-13. doi: 10.1159/000507218. [Epub ahead of print] Review.

Chronic urticaria is a heterogeneous persistent, severely debilitating and often poorly controlled disease. Recent studies have shown that the prevalence of CU and its sub forms may be more heterogeneous than previously thought.

This update on chronic urticaria focuses on its prevalence and pathogenesis, the expanding spectrum of patient-reported outcome measures for assessing disease activity, impact and control, as well as future treatment options.

Chronic urticaria is a mast cell-driven disease which presents with transient wheals (hives), angioedema, or both, without any definite triggers and reoccurrence of signs and symptoms for more than six weeks. It is common in both children and adults; its prevalence is increasing with substantial differences across geographical regions.

The objective of treatment in chronic urticaria is complete disease control with absence of signs and symptoms, as well as normalization of quality of life. Specialists can monitor by using sets of patient-reported outcome measures. Antihistamines and omalizumab are the only currently licensed treatments for chronic urticaria. Some inhibit the effects of signals that drive mast cells activation and accumulation, others inhibit intracellular pathways of mast cells activation and degranulation, or silence mast cells by binding to inhibitory receptors.

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enfermedades de la piel

The role of eosinophils in chronic spontaneous urticaria

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Altrichter S, Frischbutter S, Fok JS, Kolkhir P, Jiao Q, Skov PS, Metz M, Church MK, Maurer M.

J Allergy Clin Immunol. 2020 Mar 26. pii: S0091-6749(20)30406-1. doi: 10.1016/j.jaci.2020.03.005. [Epub ahead of print]

Chronic spontaneous urticaria is a mast-cell driven skin disease characterized by the recurrence of transient wheals, angioedema or both for more than 6 weeks. Recent studies have suggested that eosinophils may also have a major role in symptomatology. In urticaria, it is usually observed a peripheral blood eosinopenia, opposed to other allergic and inflammatory conditions. Histological studies have shown the presence of eosinophils and eosinophil granules in urticaria lesions. They may enhance urticaria in three ways: first, eosinophil-derived stem cell factor (SCF) promotes the recruitment and local maturation of mast cells in the tissues. Second, eosinophil proteins, such as major basic protein, eosinophil cationic protein and eosinophil peroxidase can provoke mast cell degranulation. And third, activated eosinophils also express tissue factor, the main initiator of the coagulation cascade leading to thrombin formation. Eosinophil infiltration may contribute to tissue edema of skin in urticaria but can also, together with increased mast cells, prime the skin for further healing.

Treatments aimed at reducing eosinophil accumulation and activation, such as the anti-IL5 humanized antibodies mepolizumab, reslizumab and benralizumab, have shown to reduce chronic spontaneous urticaria.

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enfoque rinitis alergica

Allergen immunotherapy: what is the added value of real-world evidence from retrospective claims database studies?

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Devillier P, Demoly P, Molimard M.

Expert Rev Respir Med. 2020 Mar 4:1-8. doi: 10.1080/17476348.2020.1733417. [Epub ahead of print]

Allergen immunotherapy (AIT) is the only disease-modifying treatment available for allergic rhinitis. It works by inducing allergen-specific immune tolerance and by preventing the development of new allergen sensitization. Studies have shown that AIT has proven long-term efficacy in people with allergic rhinitis, however there is a lack of studies of real-world evidence.

In this review, retrospective studies from France and Germany have confirmed the sustained benefits of grass and pollen AIT. When compared to standard of care, AIT improved allergic rhinitis symptom control after treatment cessation (reduced allergic rhinitis symptomatic medication use), as well as asthma control and decreased the risk of developing asthma.

Real-world evidence studies have advantages over randomizes clinical trials, such as evaluation of a broader patient population that mirrors clinical practice, greater generalizability and enabling the assessment of long-term safety and effectiveness. In particular real-world evidence of AIT in people with allergic rhinitis and asthma confirm and build on the efficacy findings of regular studies, and their results can be used to guide clinical management and assist counselling of patients, so much so that recent guidance supports the inclusion of real-world evidence data in updated guidelines.

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