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Monthly Archives

September 2021

Anxiety and depression risk in patients with allergic rhinitis: a systematic review and meta-analysis

By Artículos seleccionados, Selected articles

J. Rodrigues, F. Franco-Pego, B. Sousa-Pinto, J. Bousquet, K. Raemdonck, R. Va

Rhinology. 2021 Aug 1;59(4):360-373. doi: 10.4193/Rhin21.087.

More than 400 million people suffer from allergic rhinitis worldwide. In Europe, its prevalence is around 25%, higher in urban areas. Although allergic rhinitis is not a life-threatening condition, it affects health and well-being (disruption of sleeping patterns, cognitive and performance impairment, decreased quality of life, and work/school performance). It may also be associated with a higher risk for psychiatric diseases, such as depression and anxiety.

This systematic review and meta-analysis aimed to quantify the relationship between allergic rhinitis and depression and anxiety.

An electronic search for observational studies that evaluated the relationship between allergic rhinitis and depression and anxiety was conducted. The association was quantified by random-effects meta-analysis, with an estimation of the pooled odds ratio.

Twenty-four studies were included (23 evaluated depression and 11 anxiety). Of these, 12 have odds ratio values from multivariable regression models and were included.

Allergic rhinitis was associated with higher odds of depression and anxiety.

In conclusion, allergic rhinitis seems to be related to a high risk of depression and anxiety; however, more studies are needed.

This document is only available for registered healthcare professionals


Autoimmune chronic spontaneous urticaria detection with IgG anti-TPO and total IgE

By Artículos seleccionados, Selected articles

Pavel Kolkhir, Elena Kovalkova, Anton Chernov, Inna Danilycheva, Karoline Krause, Merle Sauer, Andrey Shulzhenko, Daria Fomina, Marcus Maurer

J Allergy Clin Immunol Pract . 2021 Aug 4;S2213-2198(21)00884-9. doi: 10.1016/j.jaip.2021.07.043. Online ahead of print.

Common spontaneous urticaria (CSU) is a common skin condition driven by mast cells and characterized by the development of wheals, angioedema, or both for more than six weeks. Recently, studies have demonstrated the existence of two endotypes on the pathogenesis of CSU: type I (“autoallergic”) and type IIb autoimmune CSU.

Type IIb autoimmune CSU (aiCSU) is related to IgG, IgM, and IgA autoantibodies against the high affinity IgE receptor, FcɛRIα, activating skin mast cells. At least 8% of the CSU cases are aiCSU and represent a high disease burden (high disease activity, high rates of autoimmune comorbidity, and inadequate response to treatment). aiCSU can be challenging to diagnose because the existing tests (autologous serum skin test (ASST), autoantibody immunoassays, and basophil testing) are not usually available and have limitations. Also, aiCSU responds poorly to treatment.

This study aimed to evaluate how high anti-thyroid peroxidase (aTPO) and low IgE relate to aiCSU and treatment response.

A total of 1120 patient records were analyzed for demographic, clinical, laboratory parameters and treatment responses. Total IgE and aTPO were measured, and four markers were analyzed (ASST, basophil activation test (BAT), eosinophil, and basophil counts).

One of ten patients (n=123) had both high aTPO and low IgE, which was linked to higher age at CSU onset, female, angioedema, and shorter CSU duration. It was also related to positivity to aiCSU markers. A positive BAT was present in 44% of the patients with high aTPO and low IgE. These patients had low response rates to antihistamine treatment compared to the remaining patients.

In conclusion, a high aTPO and low IgE may constitute a valuable biomarker for diagnosing aiCSU in daily clinical practice.

This document is only available for registered healthcare professionals


One hundred and ten years of Allergen Immunotherapy: A journey from empiric observation to evidence

By Artículos seleccionados, Selected articles

Oliver Pfaar, Jean Bousquet, Stephen R. Durham, Jörg Kleine-Tebbe, Mark Larche, Graham C Roberts, Mohamed H Shamji, Roy Gerth Van Wijk

Allergy . 2021 Jul 27. doi: 10.1111/all.15023. Online ahead of print.

It was back in 1911 that Noon has first described the favorable effects of subcutaneous injections with grass pollen extract on himself. Since then, allergen immunotherapy (AIT) has evolved as the most important treatment for allergic patients. AIT constitutes the only disease-modifying treatment available, with consistent efficacy and safety. Worldwide regulatory authorities recognize AIT, which products are subject to thorough assessments before a market authorization is granted.

The disease-modifying effects of AIT are associated with immune modulation of the innate and adaptive immune responses. The recent advances in understanding

the mechanisms supporting AIT will enable the identification of immune monitoring biomarkers as well as biomarkers of efficacy and tolerance. Additionally, this knowledge will be helpful for the development of new therapeutic targets that can be used in conjunction with immunotherapy to shorten treatment duration and improve patient compliance and efficacy.

Recent regulations of allergen products by authorities have positively integrated scientific progress in modern allergology and clinical advances. Definitions of homologous allergen groups based on biological and molecular relationships, manufacturing, and quality aspects have been combined with a framework for the clinical development of allergen products.

Also, a list of in vivo diagnostic and AIT-products is still to be market authorized, including pollen, dust mites, pets, and venoms.

The delivery of cost-effective modern health care is exciting for allergic diseases. Novel solutions – based on mobile health devices- are required to support authorities, and they should promote change of health and care towards integrated care with organizational health literacy.

International guidelines describe and acknowledge the use of AIT.

This document is only available for registered healthcare professionals


The Role of Coagulation and Complement Factors for Mast Cell Activation in the Pathogenesis of Chronic Spontaneous Urticaria

By Artículos seleccionados, Selected articles

Yuhki Yanase, Shunsuke Takahagi, Koichiro Ozawa y Michihiro Hide

Cells. 2021 Jul 12;10(7):1759. doi: 10.3390/cells10071759.

Chronic spontaneous urticaria is a skin condition characterized by skin edema and itchy flares for more than six weeks. Inflammatory mediators, such as histamine, are released from skin mast cells and/or peripheral basophils at the cell level. It is known that the extrinsic coagulation cascade triggered by tissue (TF) and complement factors is based on the pathogenesis of chronic spontaneous urticaria (CSU).

This review aimed to give a detailed role of vascular endothelial cells, leukocytes, extrinsic coagulation factors, and complement components on TF-induced activation of skin mast cells and peripheral basophils to form edema.

The extrinsic coagulation system triggered by TF and activated coagulation factors has been suggested in urticaria’s pathogenesis. Some studies have reported its improvement with heparin or warfarin treatment.

The detailed role of vascular endothelial cells in plasma leakage, especially at local areas of the skin in CSU is unclear. In vitro studies revealed that vascular endothelial cells might have a role in the early stage of CSU pathogenesis, as human umbilical vein endothelial cells and human dermal microvascular endothelial cells express a large amount of TF on their surface in response to the combination of several molecules such as histamine. TF-expressing leucocytes can generate the extrinsic coagulation cascade and produce activated coagulation factors, followed by the induction of intercellular gap formation of human umbilical vein endothelial cells. TF expression on monocytes may be utilized as a marker for pathological conditions of CSU and a therapeutic target of severe and refractory CSU. Studies have also shown that complement factors, such as C5a are increased in people with CSU.

Medications that target the activated coagulation factors and/or complement components may constitute a new and effective treatment for severe and refractory urticaria, namely low-molecular-weight antagonists of C5a and targets of the TF-triggered extrinsic coagulation pathway – complement system – mast cell and/or basophil activation axis.

This document is only available for registered healthcare professionals


Severity and duration of allergic conjunctivitis: are they associated with severity and duration of allergic rhinitis and asthma?

By Artículos seleccionados, Selected articles

M C Sánchez-Hernández, M. T. Dordal, A. M. Navarro, I. Dávila, B. Fernández-Parra, C. Colás, C. Rondón, A. del Cuvillo, F. Vega, J. Montoro, M. Lluch-Bernal, V. Matheu, P. Campo, M. L. González, R. González-Pérez, A. Izquierdo-Domínguez, A. Puiggros, M. Velasco, A. Fernández-Palacín, A. Valero, SEAIC Rhinoconjunctivitis Committee 2014-2018

Eur Ann Allergy Clin Immunol. 2021 Jul 27. doi: 10.23822/EurAnnACI.1764-1489.231. Versión digital previa a la impresión.

Allergic conjunctivitis is a reaction of the conjunctiva of the eye due to IgE hypersensitivity. It is commonly associated with other allergic conditions, such as eczema, food allergy, but especially allergic rhinitis and asthma. Still, the relation between allergic conjunctivitis and allergic rhinitis and asthma needs to be understood.

This study aimed to classify allergic conjunctivitis in a patient population and evaluate the relationship between allergic conjunctivitis and asthma, using the Consensus Document for Allergic Conjunctivitis (DECA).

A total of 2914 participants of all ages who participated in the “Alergológica 2015” study were included. They were then divided into two age groups ≤14 and >14 years old. Of these, 965 participants were diagnosed with allergic conjunctivitis, classified by severe (1,8%), moderate (46,4%) or mild (51,8%), and as intermittent (51,6%) or persistent (48,4%). Allergic conjunctivitis was mainly associated with allergic rhinitis (88,4%), asthma (38,2%), food allergy (8,3%), and atopic dermatitis (3,5%). The duration and severity of allergic conjunctivitis were significantly related to allergic rhinitis for both age groups and asthma in adults.

In conclusion, the new DECA classification showed a direct relationship between allergic conjunctivitis, allergic rhinitis, and asthma, which suggests that it should be considered in the hypothesis of the one airway concept.

This document is only available for registered healthcare professionals

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