Selected articles archivos - Page 9 of 15

Nov 28

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

By Bilastina 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.

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Nov 28

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

By Bilastina 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.

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Nov 28

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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 Bilastina 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.

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Nov 27

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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 Bilastina 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.

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Nov 08

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

By Bilastina 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.

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Nov 08

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

By Bilastina 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.

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Nov 08

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Current and Emerging Treatments for Chronic Spontaneous Urticaria

By Bilastina 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).

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Nov 07

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Recent developments and highlights in allergic rhinitis

By Bilastina 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.

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Nov 06

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investigacion seguridad cardiaca antihistaminicos

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

By Bilastina 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.

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Sep 26

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The Role of Mobile Health Technologies in Allergy Care: an EAACI Position Paper.

Quality of Life and Work Productivity Impairment of Patients with Allergic Occupational Rhinitis

By Bilastina Selected articles

Maher Maoua, et al.

(2019) Tanaffos

Allergic rhinitis impacts negatively the quality of life and occupational activities of patients.

A 10-year duration cross-sectional study evaluated the quality of life and work productivity of patients diagnosed with allergic occupational rhinitis. Quality of Life was assessed by the Mini-RQLQ (rhinitis quality of life questionnaire) and work impairment was assessed by the Work Productivity and Activity Impairment questionnaire.

This study included 414 participants from both genders and with a mean age of 38 years old. Most of them were workers from the textile and clothing industry. Absenteeism was not relevant, however participants experienced activity limitations and practical problems, reducing productivity and quality of life.

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Sep 26

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Psychiatric comorbidity in chronic urticaria patients: a systematic review and meta‑analysis

By Bilastina Selected articles

Gerasimos N. Konstantinou and George N. Konstantinou

(2019) Clin Transl Allergy

Chronic urticaria may affect the quality of life, namely in respect to an increase of psychiatric disorders.

This study aimed at evaluating the published evidence of psychiatric disorders that may coexist with chronic urticaria and the effect of psychiatric treatments on people with urticaria.

A systematic literature search for studies that investigated the existence of psychiatric comorbidity in patients with chronic urticaria was conducted, and twenty-five studies that met all the criteria were identified. Studies to be included in the study had to possess the following features: distinction between chronic urticaria and allergic conditions, direct collection of diagnostic psychiatric data by using clinical interview and standardized questionnaires, International Classification of Disorders criteria or the Diagnostic and Statistical Manual of Mental Disorders criteria for the diagnosis of mental disorders and manuscripts written or publish in English.

Analysis of the included studies showed that almost one out of three patients with chronic urticaria have at least one underlying psychiatric disorder. However, no studies clarified if the psychiatric disorder pre-existed at chronic urticaria onset and no association between chronic urticaria severity and duration and psychological functioning. Only a case report and two case series referred to the psychiatric disorder treatment as improving of urticaria.

This study shows the importance of a multidisciplinary approach involving recognition and management of any psychiatric disorder in addition to urticaria treatment.

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Sep 26

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New treatments for chronic urticaria

By Bilastina Selected articles

Pavel Kolkhir, Sabine Altrichter, Melba Munoz, Tomasz Hawro, Marcus Maurer,

(2019) Annals of Allergy, Asthma and Immunology

Current international guideline classifies chronic urticaria as inducible or spontaneous, whether there is a defined trigger sign or not. However chronic urticaria is unpredictable in its course and duration and persists for several years in many patients.

Antihistamines and omalizumab are the most common treatments for chronic urticaria.

This study reviewed the off and beyond label use of licensed drugs, novel treatments under development and promising new targets.

A search was performed and some of the key messages include that omalizumab should be explored in chronic inducible urticaria, in children with chronic spontaneous urticaria and at higher doses. Off label treatments, such as dupilumab, reslizumab, mepolizumab and benralizumab are showing effectiveness in chronic urticaria. Ongoing clinical trials include more monoclonal antibodies, ligelizumab and UB-221. Other promising treatments under development for chronic urticaria include a CRTh2 antagonist, a monoclonal antibody to Siglec-8, bruton’s tyrosine kinase inhibitors, a Syk inhibitor and dupilumab.

New pathogenically important targets for chronic urticaria include Mas-related G-protein coupled receptor X2, the H4 receptor, C5a and its receptor, and other inhibitory mast cell receptors.

The ultimate goal remains the development of treatments that can prevent chronic urticaria, alter its course and cure it.

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Sep 26

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Eosinopenia, in chronic spontaneous urticaria, is associated with high disease activity, autoimmunity and poor response to treatment

By Bilastina Selected articles

Pavel Kolkhir, Martin K. Church, Sabine Altrichter, Per Stahl Skov, Tomasz Hawro, Stefan Frischbutter, Martin Metz, Marcus Maurer.

(2019) The Journal of Allergy and Clinical Immunology: In Practice

Chronic spontaneous urticaria is characterized by the degranulation of skin mast cells and the influx of basophils and eosinophils to affected skin sites. Blood basopenia has been linked to severe antihistamine-resistant urticaria and type IIb autoimmunity, whereas the role of eosinophils in chronic spontaneous urticaria is largely unknown.

This study analysed the prevalence, role and relevance of eosinopenia of 1613 patients with chronic spontaneous urticaria from two centres. Peripheral blood eosinophil and basophil counts were analysed, and patient files were screened for clinical characteristics, results of laboratory tests, the autologous serum skin test, the serum-induced basophil-histamine release assay, and response to second generation H1-antihistamines and omalizumab.

Ten percent of the patients analysed had eosinopenia. This was also associated with being female, high disease activity, autologous serum skin test and basophil-histamine release assay positivity, low total IgE and high levels of C-reative protein and IgG-anti-TPO. Non-responders to treatment had even lower eosinophils compared to responders. Blood eosinophil counts correlated with basophil counts and 81% of patients with undetectable eosinophils had basopenia.

Investigators concluded that the combination of eosinopenia and basopenia is a better predictor of non-response to sgAHs than eosinopenia alone and that eosinopenia in patients with chronic spontaneous urticaria is associated with type IIb autoimmunity, high disease activity and poor response to treatment. This makes eosinophils as excellent biomarkers for the management of people with chronic urticaria.

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Sep 26

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Mobile technology in allergic rhinitis: evolution in management or revolution in health and care?

By Bilastina Selected articles

Jean Bousquet, Ignacio J. Ansotegui, Josep M. Anto, Sylvie Arnavielhe, Claus Bachert, et al.

(2019) The Journal of Allergy and Clinical Immunology: In Practice

Mobile technology has spread rapidly around the globe. Over 5 billion people have mobile devices, with over half of which are smartphones. Mobile health (mHealth) is the use of information and communication technology for health services and information transfer. Internet-based applications and smart devices are already used in allergic rhinitis and may help to undress some unmet needs, including improving quality of life especially in those with asthma.

This study reviewed existing mHealth applications for allergic rhinitis with published studies, discussed applications that included risk factors of allergic rhinitis, examined its impact in phenotype discovery, provided real-word evidence and discussed mHealth tools that enable digital transformation.

WHO recognizes the significant role that digital technologies can play in strengthening the health systems in countries to achieve universal health coverage, the health-related Sustainable Development Goals and other health objectives. mHealth has the potential to profoundly impact healthcare as existing apps represent an important evolution of health and care for rhinitis. Real world evidence has identified patients’ behaviours and practices, and this will have a profound impact on current guidelines and care pathways. Allergic rhinitis is not a severe disease but it does have a major impact on social life, school and work productivity.

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Aug 26

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Clinical characteristics and epidemiology of chronic urticaria: a nationwide, multicentre study on 1091 patients

By Bilastina Selected articles

Jankowska-Konsur A, Reich A, Szepietowski J; Polish Chronic Urticaria Working Group.

Urticaria is one of the most common skin diseases. Depending on the length of symptoms, acute (< 6 weeks) and chronic urticaria (> 6 weeks) are distinguished. Chronic urticaria is divided into inducible urticaria and chronic spontaneous urticaria.

This was a nationwide, multicentre, cross-sectional, questionnaire-based study which objective was to assess the epidemiology and clinical characteristics of chronic urticaria in Poland. A total of 1091 patients with chronic urticaria were included. Among these patients, 383 (35,1%) had inducible urticaria and 667 (61,1%) chronic spontaneous urticaria. The remaining 41 patients (3.8%) suffered from both. Participants with chronic spontaneous urticaria were twice more likely to report family history of urticaria than those with inducible urticaria (12.1% vs. 6.0%, p = 0.001).

In conclusion, chronic spontaneous urticaria is about twice as frequent cause of chronic urticaria as compared to inducible urticaria and constitutes a significant economic burden on society in terms of the absence from work and production lost. It is the cause of absenteeism in almost every fifth patient with this condition. The treatment of chronic urticaria is a major challenge for physicians of various specialties and the treatment choice is closely associated with the specialist knowledge of current treatment guidelines.

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Selected articles

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

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

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

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

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

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

Current and Emerging Treatments for Chronic Spontaneous Urticaria

Recent developments and highlights in allergic rhinitis

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

Quality of Life and Work Productivity Impairment of Patients with Allergic Occupational Rhinitis

Psychiatric comorbidity in chronic urticaria patients: a systematic review and meta‑analysis

New treatments for chronic urticaria

Eosinopenia, in chronic spontaneous urticaria, is associated with high disease activity, autoimmunity and poor response to treatment

Mobile technology in allergic rhinitis: evolution in management or revolution in health and care?

Clinical characteristics and epidemiology of chronic urticaria: a nationwide, multicentre study on 1091 patients

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