Revistas
Revista:
AMERICAN JOURNAL OF CLINICAL DERMATOLOGY
ISSN:
1175-0561
Año:
2023
Vol.:
24
N°:
1
Págs.:
135 - 141
Introduction Problems in the definition and classification of angioedema, leading to difficulties in its diagnosis and treatment, have been identified; therefore, an improvement in the current classification of angioedema is required. Objective The aim of this study was to propose a practical classification of angioedema without wheals that helps to establish a differential diagnosis and take appropriate therapeutic decisions. Methods An initial proposal of classification of angioedema without wheals was agreed by a scientific committee of experts and was subsequently validated by a panel of experts by means of consensus based on the Delphi methodology. Forty-five items on the classification, diagnosis, and treatment of angioedema without wheals were proposed for the survey. Results Most items (93.8%) were agreed after two rounds. All panelists agreed with the proposed classification, as well as with most of the clinical and treatment characteristics. The angioedema without wheals classification established three groups: histamine-mediated, bradykinin-mediated, and unknown mechanism angioedema. The clinical characteristics of the proposed types of angioedema were also agreed, except for the allergic histamine-mediated and unknown mechanism angioedema, which generated debate. Regarding treatments, although there was broad agreement with the proposed items, a lack of knowledge about some treatments in this pathology was observed. Conclusion The proposed classification of angioedema without wheals was accepted with a high degree of agreement; however, knowledge of available treatments needs to be increased and the definition of angioedema of unknown mechanism needs to be improved.
Autores:
Monino-Romero, S.; Kolkhir, P.; Szepfalusi, Z.; et al.
Revista:
CLINICAL AND TRANSLATIONAL ALLERGY
ISSN:
2045-7022
Año:
2023
Vol.:
13
N°:
7
Págs.:
e12272
Revista:
ALLERGY
ISSN:
0105-4538
Año:
2023
Vol.:
78
N°:
2
Págs.:
599 - 602
Revista:
ALLERGY
ISSN:
0105-4538
Año:
2023
Vol.:
78
N°:
1
Págs.:
299 - 301
Autores:
Segú-Vergés, C.; Gómez, J.; Terradas-Montana, P.; et al.
Revista:
THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY
ISSN:
0091-6749
Año:
2023
Vol.:
151
N°:
4
Págs.:
1005 - 1014
Background: Chronic spontaneous urticaria (CSU) is a rare, heterogeneous, severely debilitating, and often poorly controlled skin disease resulting in an itchy eruption that can be persistent. Antihistamines and omalizumab, an anti-IgE mAb, are the only licensed therapies. Although CSU pathogenesis is not yet fully understood, mast cell activation through the IgE:high-affinity IgE receptor (Fc¿RI) axis appears central to the disease process.
Objective: We sought to model CSU pathophysiology and identify in silico the mechanism of action of different CSU therapeutic strategies currently in use or under development.
Methods: Therapeutic performance mapping system technology, based on systems biology and machine learning, was used to create a CSU interactome validated with gene expression data from patients with CSU and a CSU model that was used to evaluate CSU pathophysiology and the mechanism of action of different therapeutic strategies.
Results: Our models reflect the known role of mast cell activation as a central process of CSU pathophysiology, as well as recognized roles for different therapeutic strategies in this and other innate and adaptive immune processes. They also allow determining similarities and differences between them; anti-IgE and Bruton tyrosine kinase inhibitors play a more direct role in mast cell biology through abrogation of Fc¿RI signaling activity, whereas anti-interleukins and anti-Siglec-8 have a role in adaptive immunity modulation.
Conclusion: In silico CSU models reproduced known CSU and therapeutic strategies features. Our results could help advance understanding of therapeutic mechanisms of action and further advance treatment research by patient profile.
Autores:
Giménez-Arnau, A. (Autor de correspondencia); Bartra, J.; Ferrer, Marta; et al.
Revista:
JOURNAL OF INVESTIGATIONAL ALLERGOLOGY AND CLINICAL IMMUNOLOGY
ISSN:
1018-9068
Año:
2022
Vol.:
32
N°:
3
Págs.:
191 - 199
Objective: During its first year, the AWARE study assessed disease activity, patient quality of life (QOL), and treatment patterns in chronic urticaria (CU) refractory to H1-antihistamines (H1-AH) in clinical practice. Methods: We performed an observational, prospective (24 months), international, multicenter study. The inclusion criteria were age _>18 years and H1-AH-refractory CU (>2 months). At each visit, patients completed questionnaires to assess disease burden (Urticaria Control Test [UCT]), disease activity (7 day-Urticaria Activity Score [UAS7]), and QOL (Dermatology Life Quality index [DLQI], Chronic Urticaria Quality of Life Questionnaire [CU-Q2oL], and Angioedema Quality of Life Questionnaire [AE-QoL]). We present data for Spain. Results: The study population comprised 270 evaluable patients (73.3% female, mean [SD] age, 48.9 [14.7] years). At baseline, 89.3% were prescribed a CU treatment. After 1 year, first-and second-line treatments became less frequent and third-line treatments became more frequent. At baseline, 47.0% of patients experienced angioedema; at 1 year, this percentage had fallen to 11.8%. The mean (SD) AE-QoL score decreased from 45.2 (28.7) to 24.0 (25.8). The mean (SD) UCT score decreased from 7.0 (4.5) to 12.1 (4.1). According to UAS7, 38.2% of patients reported absence of wheals and itch in the previous 7 days at 1 year compared with 8.3% at baseline. The mean (SD) DLQI score decreased from 8.0 (7.4) to 2.8 (4.6). At the 1-year visit, the percentage of patients reporting a high or very high impact on QOL fell from 29.9% to 9.6%. Conclusions: H1-AH-refractory CU in Spain is characterized by absence of symptoms and a considerable impact on QOL. Continuous follow-up of CU patients and third-line therapies reduce disease burden and improve patients' QOL.
Revista:
CLINICAL AND EXPERIMENTAL ALLERGY
ISSN:
0954-7894
Año:
2022
Vol.:
52
N°:
11
Págs.:
1343 - 1346
Autores:
Giménez-Arnau, A. M.; Jáuregui, I.; Silvestre-Salvador, J. F.; et al.
Revista:
JOURNAL OF INVESTIGATIONAL ALLERGOLOGY AND CLINICAL IMMUNOLOGY
ISSN:
1018-9068
Año:
2022
Vol.:
32
N°:
4
Págs.:
261 - 269
he terms control and remission and other key terms used in chronic urticaria (CU) such as flare-up, relapse, exacerbation, and recurrence have not been fully defined in the literature. Disease monitoring and treatment goals in clinical practice are not well established. After a qualitative appraisal of available evidence, we aimed to find a consensus definition of control and remission, clarify key terminology, provide guidance on how to monitor the disease, and establish treatment goals in clinical practice. A modified Delphi consensus approach was used. Based on a literature review, a scientific committee provided 137 statements addressing controversial definitions and terms, available patient-reported outcomes (PROs), and recommendations on how to measure therapeutic objectives in CU. The questionnaire was evaluated by 138 expert allergists and dermatologists. A consensus was reached on 105 out of the 137 proposed items (76.6%). The experts agreed that complete control and remission of CU could be defined as the absence of signs or symptoms while on treatment and in the absence of treatment, respectively. Consensus was not reached on the definition of other key terms such as flare-up, exacerbation, and recurrence. The panel agreed that the objective of therapy in CU should be to achieve complete control. PROs that define the degree of control (complete, good, partial, or absence) were established. An algorithm for disease assessment is provided. In conclusion, this work offers consensus definitions and tools that may be useful in the management of patients with CU.
Revista:
ACTAS DERMO-SIFILIOGRAFICAS
ISSN:
0001-7310
Año:
2022
Vol.:
113
N°:
1
Págs.:
4 - 14
BACKGROUND: Chronic Urticaria (CU) is a debilitating disease whose treatment is mainly symptomatic. UCREX study aimed to identify CU patients' profile, disease management and quality-of-life (QoL) in daily clinical practice in Spain.
METHODS: Observational, 12-months prospective, multicenter study, included de novo or established CU patients attending to dermatology/allergy consultations in 39 Spanish hospitals.
MAIN VARIABLES: Urticaria Activity Score (UAS), UAS over 7 days (UAS7). Secondary variables: CU-QoL Questionnaire (CU-Q2oL), EuroQol-5 dimensions (EQ-5D), Medical Outcomes Study Sleep (MOS-Sleep) scale, Hospital Anxiety and Depression Scale (HADS).
RESULTS: 361 patients included. Of them, 176 (48.8%) considered for the main objective analysis. Mean age (SD) of 46.6 (14.2) years and 71.8% women. The year prior to inclusion, most patients (57.1%) were treated with non-sedating H1-antihistamines (NS-H1AH). At baseline, mean (SD) 3.6 (6.8) visits were registered to primary care. Mean (SD) UAS7 at baseline was 14.3 (11.0) and CU-Q2oL 24.1 (17.0) which tended to improve by 8.6 (9.7) and 13.9 (15.0), respectively, at 12-months. MOS-Sleep and EQ-5D remained steady during the study, except pain/discomfort and anxiety/depression which went from 58.7% and 49.6% to 29.6% and 26.9%, respectively. At baseline, HADS showed a mean (SD) anxiety of 8.7 (4.5) and depression 5.1 (4.4), decreasing to 7.0 (4.3) and 4.7 (4.3), respectively, at 12-months.
CONCLUSIONS: Although most CU patients are treated with NS-H1AH, disease activity is still important, negatively affecting patients' QoL, work activity and healthcare resources use. An appropriate disease management could be the basis for symptoms control, QoL improvement and resources optimization.
Autores:
Sánchez-Ruano, L.; Fernández-Lozano, C.; Ferrer, Marta; et al.
Revista:
FRONTIERS IN ALLERGY
ISSN:
2673-6101
Año:
2022
Vol.:
3
Págs.:
896617
Background: Peanut-allergic patients from the Mediterranean region are predominantly sensitized to the lipid transfer protein (LTP) Ara h 9, and the peach LTP Pru p 3 seems to be the primary sensitizer. However, LTP sensitization in peanut allergy is not a predictive marker for clinically relevant symptoms.
Objective: We aimed to identify sequential epitopes of IgE and IgG4 from Pru p 3 and Ara h 9 in peach-allergic patients sensitized to peanuts. We also sought to determine the differences in IgE and IgG4 binding between patients who had developed peanut allergy and those tolerating peanuts.
Methods: A total of 46 peach-allergic patients sensitized to peanuts were selected. A total of 35 patients were allergic to peanuts (peanut-allergic group) and 11 were tolerant to peanuts (peanut-tolerant group). We measured sIgE and sIgG4 in peanut, peach, and their recombinant allergen (Ara h 1, Ara h 2, Ara h 3, Ara h 8, and Ara h 9) with fluorescence enzyme immunoassay. We examined the IgE and IgG4 binding to sequential epitopes using a peptide microarray corresponding to linear sequences of the LTPs Ara h 9 and Pru p 3 with a library of overlapping peptides with a length of 20 amino acids (aa) and an offset of 3 aa.
Results: The frequency and the intensity of IgE recognition of Ara h 9 and Pru p 3 peptides were higher in the peanut-tolerant group than in the peanut-allergic group. We found four Ara h 9 peptides (p4, p14, p21, and p25) and four Pru p 3 peptides (p1, p3, p21, and p24) with a significantly elevated IgE recognition in peanut-tolerant patients. Only one peptide of Ara h 9 (p4) recognized by IgG4 was significantly elevated in the peanut-tolerant group. The IgG4/IgE ratio of Ara h 9 peptide 4 was significantly higher in peanut-tolerant patients than in peanut-allergic patients, while no significant differences were observed in the IgG4/IgE ratio of this peptide in Pru p 3.
Conclusion: Although we found significant differences in IgE and IgG4 recognition of Ara h 9 and Pru p 3 between peanut-tolerant and peanut-allergic patients (all of whom were allergic to peach), polyclonal IgE peptide recognition of both LTPs was observed in peach-allergic patients tolerating peanuts. However, the IgG4 blocking antibodies against Ara h 9 peptide 4 could provide an explanation for the absence of clinical reactivity in peanut-tolerant peach-allergic patients. Further studies are needed to validate the usefulness of IgG4 antibodies against Ara h 9 peptide 4 for peanut allergy diagnosis.
Revista:
JOURNAL OF INVESTIGATIONAL ALLERGOLOGY AND CLINICAL IMMUNOLOGY
ISSN:
1018-9068
Año:
2022
Vol.:
32
N°:
3
Págs.:
206 - 212
Objectives: To determine the usefulness of the in vitro and in vivo methods used in the diagnosis of kiwifruit allergy and to specifically assess the impact of seed proteins on sensitivity. Methods: We performed skin prick tests (SPTs) using various commercial extracts, homemade pulp, and seed extracts and prick-prick tests with kiwifruit on 36 allergic patients. The presence of specific IgE (sIgE) was assessed using the ImmunoCAP (kiwifruit extract), ELISA (Act d 1, Act d 2), ISAC, and FABER assays. Immunoblotting of seed extract was carried out, and a single-blind oral food challenge was performed with whole seeds in seed-sensitized individuals. Results: The prick prick test with kiwifruit demonstrated the highest diagnostic capacity (81.8% sensitivity and 94.1% specificity) among the in vivo tests. The sIgE levels measured using ImmunoCAP (kiwifruit extract) showed a similar sensitivity to that of global ISAC and FABER (63.9%, 59.5%, and 58.3%, respectively). Act d 1 was the major allergen. Sensitization to Act d 1 was associated with positive sIgE results to whole kiwifruit extract detected by ImmunoCAP (P<.000). A positive SPT result to kiwifruit seeds was associated with severe symptoms induced by kiwifruit (P=.019) as a marker of advanced disease, but not with clinically relevant sensitization. Challenge testing with kiwifruit seeds performed on 8 seed-sensitized patients yielded negative results. Conclusions: Sensitization to Act d 1 is associated with a positive result in conventional diagnostic techniques, whereas kiwifruit seed sensitization does not increase the sensitivity of the diagnostic techniques evaluated.
Revista:
ANNALS OF ALLERGY ASTHMA AND IMMUNOLOGY
ISSN:
1081-1206
Año:
2022
Vol.:
128
N°:
3
Págs.:
283 - 290
Background: As the use of multiplex-specific immunoglobulin E (sIgE) detection methods becomes increasingly widespread, proper comparative validation assessments of emerging new platforms are vital.
Objective: To evaluate the clinical and technical performance of a newly introduced microarray platform, Allergy Explorer (ALEX) (MacroArray Diagnostics), in the diagnosis of pollen (cypress, grass, olive), dust mite (Dermatophagoides pteronyssinus), mold (Alternaria alternata), fruit (apple, peach), and nut (walnut, hazelnut and peanut) allergies and to compare it with those of the ImmunoCAP Immuno Solid-phase Allergen Chip (ISAC) 112 microarray and the ImmunoCAP singleplex method (ThermoFisher Scientific).
Methods: We enrolled 153 patients with allergy and 16 controls without atopy. The sIgE assays were conducted using ISAC112, ALEX version 2 (ALEX2), and ImmunoCAP for whole extracts and major components. Technical validation of ALEX2 was performed by measuring repeatability and interassay, interbatch, and interlaboratory reproducibility.
Results: When measured globally (detection by 1 or more allergen components), ALEX2 had adequate sensitivity and specificity for most of the allergens studied, comparable in general with that of ISAC112 (except for olive pollen and walnut) and similar to that of ImmunoCAP whole extract measurements. Component-by-component analysis revealed comparable results for all techniques, except for Ole e 1 and Jug r 3, in both ISAC112 and ImmunoCAP comparisons, and Alt a 1, when compared with ISAC112. Continuous sIgE levels correlate with sIgE by ImmunoCAP. Good reproducibility and repeatability were observed for ALEX2.
Conclusion: ALEX2 has sound technical performance and adequate diagnostic capacity, comparable in general with that of ISAC112 and ImmunoCAP.
Revista:
JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE
ISSN:
2213-2198
Año:
2021
Vol.:
9
N°:
6
Págs.:
2284 - 2292
BJECTIVE: In the present work, we sought to verify whether chronic histaminergic angioedema (CHA) is an entity distinct from CSU or represents a CSU subtype that lacks hives.
METHODS: We performed a prospective study comparing 68 CHA patients, angioedema without hives, with 63 CSU patients, with hives and angioedema, from whom we collected demographic and clinical data, as well as blood and serum markers.
RESULTS: We found key pathogenic features that differentiate CHA from CSU: gender distribution, basophil number, and antibodies against the IgE receptor. The male/female ratio in CHA was 0.78, whereas in CSU it was 0.36 (P = .0466). Basopenia was more often seen in CSU (n = 13 [20%]) than in CHA (n = 5 [7%]). Finally, 31.15% of CSU sera induced basophil activation, whereas no CHA sera were able to activate normal basophils. By contrast, nonspecific inflammation or immune markers, for example, erythrocyte sedimentation rate, C-reactive protein, or IgG antithyroid antibodies, were very similar between both groups. IgE antieIL-24 could not be assessed because a control population did not differ from CSU.
CONCLUSIONS: Inclusion of CHA as part of the spectrum of CSU is an assumption not evidence-based, and when studied separately, important differences were observed. Until there is further evidence, CHA and CSU should not necessarily be considered the same disorder, and it is our opinion that review articles and guidelines should reflect that possibility. (C) 2021
Revista:
JOURNAL OF INVESTIGATIONAL ALLERGOLOGY AND CLINICAL IMMUNOLOGY
ISSN:
1018-9068
Año:
2021
Vol.:
31
N°:
1
Págs.:
73 - 75
Autores:
Kolkhir, P.; Altrichter, S.; Asero, R.; et al.
Revista:
ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH
ISSN:
2092-7355
Año:
2021
Vol.:
13
N°:
4
Págs.:
545 - 559
Purpose: Patients with chronic spontaneous urticaria (CSU) have an increased risk for comorbid autoimmune diseases. In this retrospective multicenter study of CSU patients, we evaluated clinical and laboratory features of CSU associated with a higher risk of comorbid autoimmune diseases. Methods: We analyzed records of CSU patients (n = 1,199) for a history or presence of autoimmune diseases. Patients were diagnosed with type IIb autoimmune CSU (aiCSU) if all 3 tests were positive: autologous serum skin test (ASST), basophil histamine release assay (BHRA) and/or basophil activation test (BAT), and IgG autoantibodies against Fc epsilon RI alpha/IgE detected by immunoassay. Results: Twenty-eight percent of CSU patients had at least 1 autoimmune disease. The most prevalent autoimmune diseases were Hashimoto's thyroiditis (HT) (>= 21%) and vitiligo (2%). Two percent of CSU patients had >= 2 autoimmune diseases, most frequently HT plus vitiligo. Comorbid autoimmune diseases, in patients with CSU, were associated with female sex, a family history of autoimmune diseases, and higher rates of hypothyroidism and hyperthyroidism (P < 0.001). Presence of autoimmune diseases was linked to aiCSU (P = 0.02). The risks of having autoimmune diseases were 1.7, 2.9 and 3.3 times higher for CSU patients with a positive ASST, BHRA and BAT, respectively. In CSU patients, markers for autoimmune diseases, antinuclear antibodies and/or IgG anti-thyroid antibodies were associated with non-response to omalizumab treatment (P = 0.013). Conclusions: In CSU, autoimmune diseases are common and linked to type IIb autoimmune CSU. Our results suggest that physicians assess and monitor all adult patients with CSU for signs and symptoms of common autoimmune diseases, especially HT and vitiligo.
Autores:
Ansotegui, I. J. (Autor de correspondencia); Melioli, G.; Canonica, G. W.; et al.
Revista:
THE WORLD ALLERGY ORGANIZATION JOURNAL
ISSN:
1939-4551
Año:
2021
Vol.:
14
N°:
7
Págs.:
100557
Autores:
Zuberbier, T. (Autor de correspondencia); Doerr, T.; Aberer, W.; et al.
Revista:
ALLERGY
ISSN:
0105-4538
Background Food anaphylaxis is commonly elicited by unintentional ingestion of foods containing the allergen above the tolerance threshold level of the individual. While labeling the 14 main allergens used as ingredients in food products is mandatory in the EU, there is no legal definition of declaring potential contaminants. Precautionary allergen labeling such as may contain traces of is often used. However, this is unsatisfactory for consumers as they get no information if the contamination is below their personal threshold. In discussions with the food industry and technologists, it was suggested to use a voluntary declaration indicating that all declared contaminants are below a threshold of 0.5 mg protein per 100 g of food. This concentration is known to be below the threshold of most patients, and it can be technically guaranteed in most food production. However, it was also important to assess that in case of accidental ingestion of contaminants below this threshold by highly allergic patients, no fatal anaphylactic reaction could occur. Therefore, we performed a systematic review to assess whether a fatal reaction to 5mg of protein or less has been reported, assuming that a maximum portion size of 1kg of a processed food exceeds any meal and thus gives a sufficient safety margin. Methods MEDLINE and EMBASE were searched until 24 January 2021 for provocation studies and case reports in which one of the 14 major food allergens was reported to elicit fatal or life-threatening anaphylactic reactions and assessed if these occurred below the ingestion of 5mg of protein. A Delphi process was performed to obtain an expert consensus on the results. Results In the 210 studies included, in our search, no reports of fatal anaphylactic reactions reported below 5 mg protein ingested were identified. However, in provocation studies and case reports, severe reactions below 5 mg were reported for the following allergens: eggs, fish, lupin, milk, nuts, peanuts, soy, and sesame seeds. Conclusion Based on the literature studied for this review, it can be stated that cross-contamination of the 14 major food allergens below 0.5 mg/100 g is likely not to endanger most food allergic patients when a standard portion of food is consumed. We propose to use the statement this product contains the named allergens in the list of ingredients, it may contain traces of other contaminations (to be named, e.g. nut) at concentrations less than 0.5 mg per 100 g of this product for a voluntary declaration on processed food packages. This level of avoidance of cross-contaminations can be achieved technically for most processed foods, and the statement would be a clear and helpful message to the consumers. However, it is clearly acknowledged that a voluntary declaration is only a first step to a legally binding solution. For this, further research on threshold levels is encouraged.
Autores:
Lafón, I.; Lampérez, M.; Navarro, M.; et al.
Revista:
ANNALS OF ALLERGY ASTHMA AND IMMUNOLOGY
ISSN:
1081-1206
Año:
2021
Vol.:
127
N°:
5
Págs.:
575 - 578
Background: Double-blind, placebo-controlled oral food challenges are the gold standard in food allergy diagnosis. Nevertheless, proper masking of peanuts is particularly complex owing to their intense flavor and odor. Thus, it is important to use validated recipes to ensure their adequate masking during oral food challenges. Objective: To design and validate recipes containing masked peanuts for double-blind, placebo-controlled oral food challenges. Methods: Two types of products (cookies and a custard-type dessert) containing the masked peanuts and other ingredients with low allergenic potential were designed and validated. For this purpose, of the 24 initial cookie recipes and 12 initial custard recipes developed, those that did not exhibit significant differences in their texture were selected for sensory validation. Results: Similarity triangle tests were performed using a panel of 36 selected tasters, enabling the validation of 1 pair of cookie recipes and 1 pair of custard-type dessert recipe, both with low allergenic potential and suitable for those with celiac disease and for vegans. Conclusion: The validated recipes are of clinical and research interest because they allow to confirm a peanut allergy and detect a wide range of tolerated threshold doses, which makes it possible to provide specific indications for each patient.
Autores:
Wangorsch, A. (Autor de correspondencia); Kulkarni, A.; Jamin, A.; et al.
Revista:
MOLECULAR NUTRITION AND FOOD RESEARCH
ISSN:
1613-4125
Año:
2020
Vol.:
64
N°:
19
Scope Chickpea (Cicer arietinum) allergy has frequently been reported particularly in Spain and India. Nevertheless, chickpea allergens are poorly characterized. The authors aim to identify and characterize potential allergens from chickpea. Methods and Results Candidate proteins are selected by an in silico approach or immunoglobuline E (IgE)-testing. Potential allergens are prepared as recombinant or natural proteins and characterized for structural integrity by sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE), circular dichroism (CD)-spectroscopy, and mass spectrometry (MS) analysis. IgE-sensitization pattern of Spanish chickpea allergic and German peanut and birch pollen sensitized patients are investigated using chickpea extracts and purified proteins. Chickpea allergic patients show individual and heterogeneous IgE-sensitization profiles with extracts from raw and boiled chickpeas. Chickpea proteins pathogenesis related protein family 10 (PR-10), a late embryogenesis abundant protein (LEA/DC-8), and a vicilin-containing fraction, but not 2S albumin, shows IgE reactivity with sera from chickpea, birch pollen, and peanut sensitized patients. Remarkably, allergenic vicilin, DC-8, and PR-10 are detected in the extract of boiled chickpeas. Conclusion Several IgE-reactive chickpea allergens are identified. For the first time a yet not classified DC-8 protein is characterized as minor allergen (Cic a 1). Finally, the data suggest a potential risk for peanut allergic patients by IgE cross-reactivity with homologous chickpea proteins.
Autores:
Schoepke, N. ; Asero, R.; Ellrich, A. ; et al.
Revista:
ALLERGY
ISSN:
0105-4538
Año:
2019
Vol.:
74
N°:
12
Págs.:
2427 - 2436
Background Autoimmune chronic spontaneous urticaria (aiCSU) is an important subtype of chronic spontaneous urticaria (CSU) in which functional IgG autoantibodies to IgE or its high-affinity receptor (Fc epsilon RI) induces mast cell degranulation and subsequent symptom development. However, it has not been tightly characterized. This study aimed to better define the clinical and immunological features and to explore potential biomarkers of aiCSU. Methods This was a multinational, multicenter study of 182 CSU patients. The clinical features studied included: urticaria activity and impact (UAS7 and quality of life); autologous serum skin test (ASST); IgG anti-Fc epsilon RI and IgG anti-IgE; IgG-anti-thyroperoxidase (IgG anti-TPO); total serum IgE; and basophil reactivity (BASO) using the basophil activation test (BAT) and basophil histamine release assay (BHRA). Results Of the 182 patients, 107 (59%) were ASST+, 46 (25%) were BASO+, and 105 (58%) were IgG anti-Fc epsilon RI+/IgE+. Fifteen patients (8%) fulfilled all three criteria of aiCSU. aiCSU patients appeared more severe (UAS7 21 vs 9 P < 0.016) but showed no other clinical or demographic differences from non-aiCSU patients. aiCSU patients also had markedly lower total IgE levels (P 0.0001) and higher IgG anti-TPO levels (P 0.001). Of biomarkers, positive BAT and BHRA tests were 69% and 88% predictive of aiCSU, respectively. Conclusions aiCSU is a relatively small but immunologically distinct subtype of CSU that cannot be identified by routine clinical parameters. Inclusion of BHRA or BAT in the diagnostic workup of CSU patients may aid identification of aiCSU patients, who may have a different prognosis and benefit from specific management.
Revista:
JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE
ISSN:
2213-2198
Año:
2019
Vol.:
7
N°:
5
Págs.:
1599-1609
BACKGROUND: Cholinergic urticaria (UCOL) is a highly disabling inducible urticaria triggered by an increase in core body temperature.
OBJECTIVE: To explore the safety and efficacy of omalizumab in controlling UCOL.
METHODS: We conducted a multicenter randomized mixed double-blind and open-label (first 4 months blinded followed by 8 months open-label) placebo-controlled clinical trial in 22 patients suffering from UCOL who were unresponsive to a double dose of antihistamines. We performed an exercise challenge test during each visit as our main outcome variable.
RESULTS: The overall rate of exercise challenge test negative at week 48 was 31.3%, with an average increase in exercise challenge test negative rate of 2.9% points (95% CI, 1.5-4.2) per visit. Statistically significant differences in the negative exercise challenge test rate between the placebo and active intervention groups were not observed during the blinded period (first 4 months of the study). However, from the fourth dose, a progressive improvement was observed. When comparing before and after treatment, statistically significant improvements in all secondary outcome measures were noted after 4 doses (UCOL score: P = .0015; visual analog scale score: P = .0108; days with symptoms: P [.0125) and after 8 doses (UCOL score: P = .0005; chronic urticaria quality of life questionnaire: P = .0105; visual analog scale score: P = .0008; and days with symptoms: P = .0144). In the followup visit after the cessation ...
Autores:
Jauregui, I.; Gimenez-Arnau, A.; Bartra, J.; et al.
Revista:
HEALTH AND QUALITY OF LIFE OUTCOMES
ISSN:
1477-7525
Año:
2019
Vol.:
17
N°:
1
Págs.:
23 - 32
BACKGROUND:
The daily diary Urticaria Activity Score (UAS) and its weekly score (UAS7) are widely used to assess signs and symptoms in patients with chronic spontaneous urticaria (CSU). The objective of this study was to assess the psychometric properties of a Spanish version of the once-daily UAS.
METHODS:
Observational study in patients ¿18¿years old receiving usual care for CSU (daily or almost daily occurrence of generalized hives or angioedema for ¿6¿weeks). Patients were included consecutively and completed the UAS, EQ-5D, and the Chronic Urticaria Quality of Life scale (CU-Q2oL) at two study visits 6¿weeks apart. On each occasion, the UAS was completed once-daily for 7 consecutive days to be able to calculate the UAS7 score. Psychometric properties of reliability, construct validity, and responsiveness were assessed. The Minimal Important Difference (MID) was estimated for the UAS7 using anchor- and distribution-based approaches.
RESULTS:
Data from 166 patients was available for analysis (mean age 49¿years, 65.7% female). Floor (5.4% of patients with the lowest possible score) and ceiling (1.2%) effects were low; 15% of patients had missing values. Internal consistency and test-retest reliability were good (Cronbach's alpha of 0.83 and an ICC of 0.84, respectively). Convergent validity was demonstrated through the pattern of correlations with the EQ-5D and CU-Q2oL and known groups' validity was demonstrated by the instrument's ability to discriminate between patients with different overall levels of urticaria severity, with between-group effect-sizes (ES) ranging from 0.36 to 1.19. The UAS7 proved responsive to change with effect sizes ranging from 0.3 to 1.52 in patients reporting improvement or deterioration in overall urticaria status. The MID for the UAS7 score was estimated at 7-8 points, on a scale of 0-42.
CONCLUSIONS:
The Spanish version of the UAS score has demonstrated a robust psychometric performance in patients with CSU managed in conditions of usual care. It can therefore be considered a suitable instrument to assess disease activity in clinical practice in Spanish-speaking patients. The Spanish version's reliability and validity are similar to those reported for other language versions of the once- and twice-daily variants of the UAS.
Revista:
ANESTHESIA AND ANALGESIA
ISSN:
0003-2999
Año:
2018
Vol.:
127
N°:
2
Págs.:
414 - 419
BACKGROUND: Differentiating between immunoglobulin E (IgE)-dependent and IgE-independent hypersensitivity reactions may improve the etiologic orientation and clinical management of patients with allergic reactions in the anesthesia setting. Serum tryptase levels may be useful to discriminate the immune mechanism of allergic reactions, but the diagnostic accuracy and optimal cutpoint remain unclear. We aimed to compare the diagnostic accuracy of tryptase during reaction (TDR) alone and the TDR/basal tryptase (TDR/BT) ratio for discriminating IgE- from non-IgE-mediated allergic reactions, and to estimate the best cut point for these indicators. METHODS: We included 111 patients (45% men; aged 3-99 years) who had experienced an allergic reaction, even though the allergic reaction could be nonanaphylactic. Allergy tests were performed to classify the reaction as an IgE- or non-IgE-mediated one. The area under the curve (AUC) of the receiver operating characteristic analysis was performed to estimate the discriminative ability of TDR and TDR/BT ratio. RESULTS: An IgE-mediated reaction was diagnosed in 49.5% of patients, of whom 56% met anaphylaxis criteria. The median (quartiles) TDR for the IgE-mediated reactions was 8.0 (4.9-19.6) and 5.1 (3.5-8.1) for the non-IgE-mediated (P = .022). The median (quartiles) TDR/BT ratio was 2.7 (1.7-4.5) in IgE-mediated and 1.1 (1.0-1.6) in non-IgE-mediated reactions (P < .001). The TDR/BT ratio showed the greatest ability to discriminate IgE- from non-IgE-mediated reactions compared to TDR (AUC TDR/BT = 0.79 [95% confidence interval (CI), 1.1-2.2] and AUC TDR = 0.66 [95% CI, 1.1-2.2]; P = .003). The optimal cut point for TDR/BT (maximization of the sum of the sensitivity and specificity) was 1.66 (95% CI, 1.1-2.2). CONCLUSIONS: The TDR/BT ratio showed a significantly better discriminative ability than TDR to discriminate IgE- from non-IgE-mediated allergic reactions. An optimal TDR/BT ratio threshold of approximately 1.66 may be useful in clinical practice to classify allergic reactions as IgE- or non-IgE-mediated.
Revista:
JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE
ISSN:
2213-2198
Año:
2018
Vol.:
6
N°:
4
Págs.:
1191 - 97
BACKGROUND: Omalizumab is highly effective in controlling chronic spontaneous urticaria (CSU) symptoms; however, patients can experience symptom return on treatment discontinuation. Pivotal clinical trials have identified 2 categories of patients who experience symptom return: rapid and slow. OBJECTIVE: The objective of this study was to identify potential predictors of the speed of symptom return after stopping omalizumab treatment. METHODS: Phase III randomized controlled trial (RCT) data from ASTERIA I (n = 319; 6 3 4 weekly injections of omalizumab 75, 150, 300 mg or placebo; NCT01287117) and ASTERIA II (n = 323; 3 3 4 weekly injections of omalizumab 75, 150, 300 mg, or placebo; NCT01292473) were pooled to identify predictors of symptom return after stopping omalizumab treatment (16-week follow-up). The least absolute shrinkage and selection operator regularization regression model was used to select predictive variables, and relapse probability was represented using heatmap visualizations. Model accuracy was tested using data from the GLACIAL phase III RCT (n = 336; 6 3 4 weekly injections of omalizumab 300 mg or placebo; NCT0126493). RESULTS: Of 746 variables assessed, 2 were selected by the model as predictors of symptom return: baseline urticaria activity score over 7 days (UAS7) and early area above the curve (AAC; determined by plotting the UAS7 scores across time points). Results suggest that high baseline UAS7 and low UAS7 AAC (slow decrease of symptoms) indicate a higher probability of rapid symptom return than low baseline UAS7 and high UAS7 AAC. CONCLUSIONS: These results suggest that the probability of rapid symptom return in patients with CSU who discontinue treatment with omalizumab can be estimated based on baseline UAS7 and early treatment response. (C) 2018 The Authors. Published by Elsevier Inc. on behalf of the American Academy of Allergy, Asthma & Immunology. This is an open access article under the CC BY-NC-ND license.
Autores:
Del Cuvillo, A.; Santos, V.; Montoro, J. ; et al.
Revista:
RHINOLOGY
ISSN:
0300-0729
Año:
2017
Vol.:
55
N°:
1
Págs.:
34 - 38
Background: Allergic rhinitis is a global healthcare problem due to its high prevalence, impact on individuals and socioeconomic burden for the nations. Allergic rhinitis severity evaluation is the key to a correct treatment, prevention of comorbidities and improving the quality of life of patients. This evaluation should be made with a simple, easy, fast but accurate and reliable methodology, both in a primary care and specialist setting. The visual analogue scale (VAS) meets all requirements to be the ideal tool to assess allergic rhinitis severity and has already been validated by using a single cut-off point, but this classification in two degrees of severity suffer from not allocating the patients uniformly and from giving a blind interval to classify the patients when the score is between 5 to 6 cm. Methodology:The main objective of our study is to describe the optimal cut-off points by using a VAS to discriminate between three degrees of allergic rhinitis severity (mild, moderate, and severe) following the ARIA modified severity criteria that has been previously validated. Sensitivity, specificity, positive and negative predictive values just like receiver operating characteristic curves were used to select the best cut-off values. Results: In a cross-sectional multicentre study with 3,572 patients included we have found that VAS has a significant correlation with nasal symptom score and quality of life and that the best cut-off points to differentiate between mild, moderate an severe allergic rhinitis are a VAS score of 4 and 7, respectively. Conclusions: Allergic rhinitis severity could be assessed in three degrees by using VAS in a simple, easy, and accurate method.
Autores:
Izquierdo-Dominguez, A.; Jauregui, I.; del Cuvillo, A.; et al.
Revista:
RHINOLOGY
ISSN:
0300-0729
Año:
2017
Vol.:
55
N°:
4
Págs.:
326 - 331
Background: Allergic rhinitis (AR) is a highly prevalent disease worldwide. Although a number of studies have described AR, no studies compared children and adult AR populations. The objective was to compare the AR characteristics between two AR cohorts of children and adults. Methods: Two AR cohorts (children and adults) from Spain were studied through observational cross-sectional multicentre studies. AR was classified based on classical (allergen exposure), original (o-ARIA), and modified (m-ARIA) ARIA criteria. AR was evaluated by Total 4-Symptoms Score (T4SS), and disease severity by Visual Analogue Scale (VAS, 0-100 mm). AR comorbidities were also evaluated. Results: A total of 5,405 patients (1,275 children, 4,130 adults) were studied. According to symptom's duration, intermittent AR was more frequent in children than in adults. Using o-ARIA severity, more children than adults had moderate/severe AR while, using m-ARIA, more children than adults had severe AR. T4SS was higher in adults than in children. Moreover, VAS was also higher in adults than in children. In addition, asthma atopic dermatitis and conjunctivitis were more associated to children than adults with AR, the frequency of this comorbidities increasing according to higher severity. Conclusions: AR in children was more intermittent, severe, with less symptoms but with more comorbidities than in adults. These results suggest AR has similarities but also significant differences between children and adults.
Autores:
Jauregui, I. (Autor de correspondencia); Azofra, J.; Diaz, C.; et al.
Revista:
CLINICAL AND EXPERIMENTAL DERMATOLOGY
ISSN:
0307-6938
Año:
2017
Vol.:
42
N°:
4
Págs.:
431 - 432
Autores:
Jáuregui, I.; Azofra, J; Díaz, C; et al.
Revista:
CLINICAL AND EXPERIMENTAL DERMATOLOGY
ISSN:
0307-6938
Año:
2017
Vol.:
42
N°:
4
Págs.:
431 - 432
Revista:
ALLERGOLOGIA ET IMMUNOPATHOLOGIA
ISSN:
0301-0546
Año:
2017
Vol.:
45
N°:
2
Págs.:
134 - 144
Background: Chronic spontaneous urticaria (CSU) is a frequent clinical entity that often presents a diagnostic and therapeutic challenge. Objective: To explore the degree of agreement that exists among the experts caring for patients with CSU diagnosis, evaluation, and management. Methods: An online survey was conducted to explore the opinions of experts in CSU, address controversial issues, and provide recommendations regarding its definition, natural history, diagnosis, and treatment. A modified Delphi method was used for the consensus. Results: The questionnaire was answered by 68 experts (dermatologists, allergologists, and primary care physicians). A consensus was reached on 54 of the 65 items posed (96.4%). The experts concluded that CSU is a difficult-to-control disease of unpredictable evolution. Diagnostic testsshould be limited and based on clinical history and should not be indiscriminate. Autoinflammatory syndromes and urticarial vasculitis must be ruled out in the differential diagnosis. A cutaneous biopsy is only recommended when wheals last more than 24h, to rule out urticarial vasculitis. The use of specific scales to assess the severity of the disease and the quality of life is recommended. In patients with severe and resistant CSU, second -generation H1 -antihistamines could be used at doses up to four times the standard dose before giving second-line treatments. Omalizumab is a safe and effective treatment for CSU that is refractory to H1 -antihistamines treatment. In general, diagnosis and treatment recommendations given for adults could be extrapolated to children. Conclusions: This work offers consensus recommendations that may be useful in the management of CSU. (C) 2016 SEICAP. Published by Elsevier Espana, S.L.U. All rights reserved.
Revista:
SCIENTIFIC REPORTS
ISSN:
2045-2322
Año:
2017
Vol.:
7
N°:
1
Págs.:
8985
Omalizumab (OmAb) is a humanized anti-IgE antibody approved for the treatment of chronic spontaneous urticaria (CSU). OmAb's mechanism of action is known to include actions on free IgE and on pre-bound IgE. However, OmAb is equally and rapidly effective against autoimmune and non-autoimmune urticaria where IgE involvement is not clear, suggesting the involvement of additional mechanisms of action. In this study, we sought to investigate the ability of OmAb to inhibit mast cell and basophil degranulation induced by sera from CSU patients. For this purpose, we performed a comparison between the in vitro incubation of sera from CSU patients treated with OmAb and the in vivo administration of OmAb in a clinical trial. We found that OmAb added in vitro to sera from CSU patients did not modify the ability of the sera to induce cell degranulation. Similarly, the sera from patients treated with OmAb in the context of the clinical trial who had a good clinical outcome maintained the capacity to activate mast cells and basophils. Thus, we conclude that the beneficial activity of OmAb does not correlate with the ability of patient sera to induce cell degranulation
Revista:
IMMUNOTHERAPY
ISSN:
1750-743X
Año:
2017
Vol.:
9
N°:
15
Págs.:
1205 - 1218
Background: Peanut allergy is the most common cause of anaphylaxis and food-related death. However, there is currently no approved immunotherapy treatment. Hence, this warrants the need for relevant and convenient animal models to test for adequate immunotherapies. Materials & methods: In this study, we compared three mouse strains: CD1, BALB/c and C57, to select a model of peanut allergy. After that, we conducted then a therapeutic study using an immunogenic peanut extract encapsulated in nanoparticles made with polymer Gantrez((R)) following the solvent displacement method. Results & conclusion: After implementing a dosing schedule with oral commercial peanut butter, the antibody responses, cytokine profiles and, above all, the anaphylaxis induced after a challenge with peanut proteins, showed that the outbred CD1 strain was the most susceptible to peanut sensitization. CD1 sensitized mice were orally immunized with three doses of the nanoparticle formulation capable of protecting them against the severe anaphylactic symptoms induced by the peanut challenge.
Autores:
Langdon, C; Guilemany, JM; Valls, M; et al.
Revista:
PEDIATRIC ALLERGY AND IMMUNOLOGY
ISSN:
0905-6157
Año:
2016
Vol.:
27
N°:
8
Págs.:
867-870
Children with allergic rhinitis present a mild-moderate loss of smell frequency and intensity which is clearly related to the disease duration and severity. The loss of smell can be considered, as in adults, a clinical marker of disease severity.
Revista:
PEDIATRIC ALLERGY AND IMMUNOLOGY
ISSN:
0905-6157
Año:
2016
Vol.:
28
N°:
1
Págs.:
96-99
Revista:
BMC MEDICAL EDUCATION
ISSN:
1472-6920
Año:
2016
Vol.:
16
N°:
1
Págs.:
47
The formal quality of the MIR exam items has improved over the last five years with regard to testwiseness. A more detailed revision of the items submitted, checking systematically for the presence of technical flaws, could improve the validity and discriminatory power of the exam, without increasing its difficulty.
Autores:
Guillén-Aguinaga, S.; Jáuregui Presa, I.; Aguinaga-Ontoso, E.; et al.
Revista:
BRITISH JOURNAL OF DERMATOLOGY
ISSN:
0007-0963
Año:
2016
Vol.:
175
N°:
6
Págs.:
1153-1165
There is a lack of large, randomized, double-blind studies that address antihistamine updosing for chronic spontaneous urticaria (CSU). The objective of this systematic review is to explore and analyse available data to provide clinical evidence for the efficacy of antihistamine updosing. We searched the literature in Medline, Scopus, Google Scholar, Embase, Web of Science and Cochrane databases using the keywords 'chronic, urticaria, antihistamines' to identify studies published between January 1990 and November 2014. We assessed quality using the Jadad score that evaluates quality of randomization, double-blinding and losses to follow-up. We identified 1042 articles and 15 articles were included in the final evaluation. We performed two meta-analyses, one that included studies that analysed treatment response among groups receiving different antihistamine dosages vs. placebo, and another that analysed antihistamine updosing in those patients who did not respond to standard dosages. Only five articles obtained a high quality level score. We did not find significant differences in response rates or number of weals in those patients who received a standard dosage vs. a high dosage. We found a significant improvement only in the pruritus variable of the Urticaria Activity Score scale. The estimated relative risk for improvement by increasing the antihistamine dosage was 2·27 [95% confidence interval (CI) 1·68-3·06]; however, there was significant heterogeneity. The proportion o
Autores:
Echechipía, S.; Villarreal, O.; Iriarte, P.; et al.
Revista:
CONTACT DERMATITIS
ISSN:
0105-1873
Año:
2015
Vol.:
73
N°:
3
Págs.:
186-187
Autores:
Serrano-Candelas, E.; Martínez-Aranguren, R.; Valero, A.; et al.
Revista:
CLINICAL AND EXPERIMENTAL ALLERGY
ISSN:
0954-7894
Año:
2015
Vol.:
46
N°:
1
Págs.:
92 - 102
Our data prove the existence of common mechanisms of action of OmAb in mast cells and basophils that would explain its effectiveness and rapid effect in chronic urticaria and provide a basis for its use in other diseases mediated by these cells.
Revista:
JOURNAL OF INVESTIGATIONAL ALLERGOLOGY AND CLINICAL IMMUNOLOGY
ISSN:
1018-9068
Año:
2015
Vol.:
25
N°:
4
Págs.:
283 - 287
Fifteen of 201 patients with negative results for LTP in the SPT were sensitized to this allergen in the in vitro tests, and 18 of 41 patients with positive results for LTP in the SPT were not sensitized according to the in vitro tests. Seventeen of 186 patients with negative results for profilin in the SPT were sensitized to Phl p 12 by serum sIgE, and 30 out of 56 patients with positive results for profilin in SPT were not sensitized to Phl p 12 according to the other tests. Moderate agreement was observed between the 3 techniques studied.
CONCLUSIONS:
SPT is a sensitive technique for detecting sensitization to LTP and profilin. Its results are similar to those of in vitro techniques, especially in patients with negative SPT results for peach LTP and palm tree profilin.
Revista:
ATENCION PRIMARIA
ISSN:
0212-6567
Año:
2015
Vol.:
48
N°:
3
Págs.:
210 - 212
Autores:
Azofra, J.; Díaz, C.; Antépara, I.; et al.
Revista:
ANNALS OF ALLERGY ASTHMA AND IMMUNOLOGY
ISSN:
1081-1206
Año:
2015
Vol.:
114
N°:
5
Págs.:
418-9
Revista:
REVISTA DE LA FUNDACION EDUCACION MEDICA
ISSN:
2014-9832
Año:
2015
Vol.:
18
N°:
1
Págs.:
35 - 38
Objetivo.
Conocer la valoración de los estudiantes respecto a la simulación como herramienta de formación y la opinión
sobre la figura del alumno instructor.
Sujetos y métodos.
El taller se realizó en el Centro de Simulación y tuvo una duración aproximada de 90 minutos. En cada
sesión estaba el alumno instructor con diez compañeros. Los alumnos instructores fueron formados previamente por un
profesor de cardiología. Al finalizar la sesión, los estudiantes cumplimentaron un cuestionario de satisfacción anónimo
que contenía preguntas relacionadas con el aprendizaje basado en la simulación y sobre la capacidad de sus compañeros
para actuar como formadores.
Resultados.
Se obtuvieron encuestas de 291 estudiantes: 150 de quinto y 141 de sexto curso (82,4% y 71,2% de los matri
-
culados, respectivamente). Los datos obtenidos del cuestionario de satisfacción respecto a la metodología de aprendizaje
obtuvieron puntuaciones entre 3,64 y 4,75 sobre 5. Las preguntas que valoraban la opinión acerca de los alumnos forma
-
dores obtuvieron valores entre 4,88 y 4,93 sobre 5.
Conclusiones.
La simulación es una herramienta docente complementaria muy valiosa. La participación de alumnos ins
-
tructores podría ser una ayuda adicional en los talleres de simulación de exploración cardiológica.
Autores:
Hoffmann, H.J.; Santos, A.F.; Mayorga, C.; et al.
Revista:
ALLERGY
ISSN:
0105-4538
Año:
2015
Vol.:
70
N°:
11
Págs.:
1393-1405
The basophil activation test (BAT) has become a pervasive test for allergic response through the development of flow cytometry, discovery of activation markers such as CD63 and unique markers identifying basophil granulocytes. Basophil activation test measures basophil response to allergen cross-linking IgE on between 150 and 2000 basophil granulocytes in <0.1 ml fresh blood. Dichotomous activation is assessed as the fraction of reacting basophils. In addition to clinical history, skin prick test, and specific IgE determination, BAT can be a part of the diagnostic evaluation of patients with food-, insect venom-, and drug allergy and chronic urticaria. It may be helpful in determining the clinically relevant allergen. Basophil sensitivity may be used to monitor patients on allergen immunotherapy, anti-IgE treatment or in the natural resolution of allergy. Basophil activation test may use fewer resources and be more reproducible than challenge testing. As it is less stressful for the patient and avoids severe allergic reactions, BAT ought to precede challenge testing. An important next step is to standardize BAT and make it available in diagnostic laboratories. The nature of basophil activation as an ex vivo challenge makes it a multifaceted and promising tool for the allergist. In this EAACI task force position paper, we provide an overview of the practical and technical details as well as the clinical utility of BAT in diagnosis and management of allergic diseases
Revista:
ANESTHESIA AND ANALGESIA
ISSN:
0003-2999
Año:
2015
Vol.:
121
N°:
1
Págs.:
117 - 123
Perioperative reactions are more common than previously reported. Mild hypersensitivity perioperative reactions-involving only skin-should be considered in evaluating patients because a substantial number of these reactions are IgE mediated.
Revista:
JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY
ISSN:
0091-6749
Año:
2015
Vol.:
137
N°:
2
Págs.:
474-81
Benefits of omalizumab treatment were evident early (before week 4) in some patients and persisted to week 24. Use of 300 mg of omalizumab demonstrated best results in controlling CIU/CSU symptoms.
Revista:
JOURNAL OF INVESTIGATIONAL ALLERGOLOGY AND CLINICAL IMMUNOLOGY
ISSN:
1018-9068
Año:
2014
Vol.:
24
N°:
2
Págs.:
80-86
Chronic urticaria (CU) is very prevalent in the general population and, despite its low mortality, can have devastating effects on the quality of life (QoL) of those who experience it.Therefore, consensus documents on its classification, diagnosis, and treatment have become a necessity. The intensity of urticaria is currently evaluated using indices such as the Urticaria Activity Score and visual analog scales to assess itch or the degree of itch associated with the use of antihistamines. QoL is evaluated using various generic questionnaires and specific tools for skin disease and for CU. In recent years, attempts have been made to combine these evaluations to create a specific tool that would enable us to simultaneously evaluate the severity of the condition and the impact of symptoms on QoL. One such tool is the Urticaria Severity Score, which also allows us to compare global changes brought about by different treatments
Revista:
CLINICAL AND VACCINE IMMUNOLOGY
ISSN:
1556-6811
Año:
2014
Vol.:
21
N°:
8
Págs.:
1106 - 1112
In the last decade, peanut allergy has increased substantially. Significant differences in the prevalence among different countries are attributed to the type of thermal processing. In spite of the high prevalence and the severe reaction induced by peanuts, there is no immunotherapy available. The aim of this work was to evaluate the potential application of poly(anhydride) nanoparticles (NPs) as immunoadjuvants for peanut oral immunotherapy. NPs loaded with raw or roasted peanut proteins were prepared by a solvent displacement method and dried by either lyophilization or spray-drying. After physicochemical characterization, their adjuvant capacity was evaluated after oral immunization of C57BL/6 mice. All nanoparticle formulations induced a balanced T(H)1 and T(H)2 antibody response, accompanied by low specific IgE induction. In addition, oral immunization with spray-dried NPs loaded with peanut proteins was associated with a significant decrease in splenic T(H)2 cytokines (interleukin 4 [IL-4], IL-5, and IL-6) and enhancement of both T(H)1 (gamma interferon [IFN-¿]) and regulatory (IL-10) cytokines. In conclusion, oral immunization with poly(anhydride) NPs, particularly spray-dried formulations, led to a pro-T(H)1 immune response.
Revista:
CLINICAL AND EXPERIMENTAL ALLERGY
ISSN:
0954-7894
Año:
2014
Vol.:
45
N°:
4
Págs.:
731-43
In spite of being an old disease and apparently easy to diagnose, chronic spontaneous urticaria (CSU) is still perceived as an uncontrollable and difficult to manage disease. The perception of the patient is that his/her condition is not well understood and that is suffering from a disorder with hidden causes that doctors are not able to tackle. Sometimes patients go through a number of clinicians until they found some CSU expert who is familiar with the disease. It is surprising that myths and believes with no scientific support still persist. Guidelines are not widely implemented, and recent tools to assess severity are infrequently used. European and American recent guidelines do not agree in several key points related to diagnosis and treatment, which further contributes to confusion. With the aim to clarify some aspects of the CSU picture, a group of allergists and dermatologists from the Spanish Dermatology and Allergy societies developed a Frequent Asked Questions leaflet that could facilitate physicians work in daily practice and contribute to a better knowledge of common clinical scenarios related to patients with CSU.
Autores:
Bolla, M; Zenoni, S; Scheurer, S; et al.
Revista:
INTERNATIONAL ARCHIVES OF ALLERGY AND IMMUNOLOGY
ISSN:
1018-2438
Año:
2014
Vol.:
164
N°:
1
Págs.:
112-21
By 2-D electrophoresis, we could separate different nsLTP isoforms possessing different IgE-binding properties, which might reflect peculiar allergenic potencies. The contribution of Pru p 3 to prime sensitization is not central as in other plant nsLTPs.
Revista:
SIMULATION IN HEALTHCARE
ISSN:
1559-2332
Año:
2013
Vol.:
8
N°:
4
Págs.:
234 - 241
Introduction: Current European Resuscitation Guidelines 2010 recommend the use of prompt/feedback devices when training for cardiopulmonary resuscitation (CPR). We aimed to assess the quality of CPR training among second-year medical students with a voice advisory mannequin (VAM) compared to guidance provided by an instructor.
Methods: Forty-three students received a theoretical reminder about CPR followed by a 2-minute pretest on CPR (compressions/ventilations cycle) with Resusci Anne SkillReporter (Laerdal Medical). They were then randomized into a control group (n = 22), trained by an instructor for 4 minutes per student, and an intervention group (n = 21) trained individually with VAM CPR mannequin for 4 minutes. After training, the students performed a 2-minute posttest, with the same method as the pretest.
Results: Participants in the intervention group (VAM) performed more correct hand position (73% vs. 37%; P = 0.014) and tended to display better compression rate (124 min-1 vs. 135 min-1; P = 0.089). In a stratified analyses by sex we found that only among women trained with VAM was there a significant improvement in compression depth before and after training (36 mm vs. 46 mm, P = 0.018) and in the percentage of insufficient compressions before and after training (56% vs. 15%; P = 0.021).
Conclusions: In comparison to the traditional training method involving an instructor, training medical students in CPR with VAM improves the quality of chest compressions in hand position and in compression rate applied to mannequins. Only among women was VAM shown to be superior in compression depth training. This technology reduces costs in 14% in our setup and might potentially release instructors' time for other activities.
Autores:
María Dolores Ibáñez; Antonio Luis Valero; Javier Montoro; et al.
Revista:
PEDIATRIC ALLERGY AND IMMUNOLOGY
ISSN:
0905-6157
Año:
2013
Vol.:
24
N°:
7
Págs.:
678-84
Comorbidities are frequent in children with AR, supporting the notion of allergy as a systemic disease. Severity and duration of AR were significantly associated with presence of most of comorbidities. The most common drugs used for AR treatment were oral antihistamines, followed by nasal corticosteroids and a combination of both used on demand.
Revista:
ALLERGY
ISSN:
0105-4538
Año:
2013
Vol.:
68
N°:
1
Págs.:
27-36
An autoimmune subset of chronic spontaneous urticaria is increasingly being recognized internationally, based on laboratory and clinical evidence that has accrued over the last 20 years. This evidence has been reviewed by a taskforce of the Dermatology section of the European Academy of Allergy and Clinical Immunology. Functional autoantibodies in chronic urticaria (CU) patient sera have been demonstrated against IgE and Fc¿RI¿ by basophil and mast cell histamine release assays and by basophil activation assays. Antibody specificity has been confirmed by immunoassay, but there is a poor correlation between functionality and immunoreactivity. Approximately 25% of CU patients have a positive basophil histamine release assay and show autoreactivity (a positive autologous serum skin test), whereas 50% are negative regarding both. Functionality of CU sera appears to be complement dependent on mast cells but not exclusively on basophils. Basophil activation by CU sera is predominantly restricted to IgG1 and IgG3 subclasses. Circumstantial evidence for CU being an autoimmune disease comes from an observed association with other autoimmune diseases, a strong association between serum functionality and HLA-DR4 haplotype and the good response of CU patients to immunotherapies. It was proposed that a study should be undertaken to prospectively validate potentially relevant clinical criteria (from the history, examination and routinely available clinical investigations) against a new 'go
Autores:
Valero, A; Izquierdo, I; Sastre, J; et al.
Revista:
Journal of investigational allergology & clinical immunology
ISSN:
1018-9068
Año:
2013
Vol.:
23
N°:
1
Págs.:
14 - 19
Autores:
Labrador-Hornillo M; Valero A; Velasco M; et al.
Revista:
EXPERT OPINION ON BIOLOGICAL THERAPY
ISSN:
1471-2598
Año:
2013
Vol.:
13
N°:
9
Págs.:
1225-8
Omalizumab shows excellent efficacy and safety profile in a large series of CSU patients in real-life practice. This drug will contribute to settle the debt with CSU patients contributing to restore their quality of life.
Revista:
JOURNAL OF INVESTIGATIONAL ALLERGOLOGY AND CLINICAL IMMUNOLOGY
ISSN:
1018-9068
Año:
2013
Vol.:
23
N°:
6
Págs.:
392 - 397
Background: 2D7 and BB1 are thought to be basophil-specific markers. In this study, we tested both antibodies in different skin and mast cell disorders with the aim of determining whether it was possible to differentiate between benign and aggressive presentations of mastocytosis.
Methods: Using the antibodies 2D7, BB 1, and c-Kit, we performed an immunohistochemical study of skin biopsy specimens from patients with cutaneous mastocytosis (15 urticaria pigmentosa and telangiectatic macularis eruptive perstans) and liver or bone marrow biopsy specimens from patients with systemic mastocytosis. A basophil leukemia cell line was used as a reference. Peripheral blood basophils from healthy donors were used as controls.
Results: We observed intense expression of 2D7 and BB1 in all skin biopsy specimens from patients with cutaneous mastocytosis. Immunostaining of liver and bone marrow specimens from patients with systemic mastocytosis with 2D7 and BB1 antibodies was negative. Specimens from patients with either type of mastocytosis showed similarly strong expression of c-Kit. The basophil cell line showed a 2D7 and a BB1 profile, with intense expression of c-Kit. Peripheral blood basophils exhibited notable immunostaining for 2D7, BB1, and c-Kit.
Conclusions: 2D7 and BB1 are expressed in cutaneous mastocytosis, although this expression is lost when mast cell proliferation is systemic, thus reflecting either a different cellular differentiation stage or the presence of basophils in these skin diseases.
Revista:
CLINICAL AND EXPERIMENTAL ALLERGY
ISSN:
0954-7894
Año:
2013
Vol.:
44
N°:
2
Págs.:
270 - 277
Anaesthetic hypersensitivity reactions can be IgE- or not IgE-mediated and are a challenge to find the causal agent. Histamine and tryptase determination are classically considered useful in the diagnosis of these reactions. The aim of our study was to assess the diagnostic usefulness of plasma histamine and different cut-off points of serum tryptase.
MethodsPatients suffering a reaction suggestive of hypersensitivity during general anaesthesia in Clinica Universidad de Navarra (2008-2012) were included. Serum tryptase and plasma histamine were measured at the time of the reaction and 2h later. Baseline tryptase was also determined. Four to eight weeks after the reaction an allergological study was performed to all the drugs or products involved in the reaction.
ResultsSixty-five patients suffered an immediate hypersensitivity reaction during the period of the study. Thirty-seven patients (20 male) with median age 48years (12-79) were included because they completed allergological study, and histamine and tryptase were correctly obtained. Elevated plasma histamine was observed in 34 cases (92%). Tryptase exceeded twice the basal values in 10 patients (31%). Using different cut-off points of tryptase, the number of patients with elevated tryptase would be 15 patients (41%) for a cut-off point of 5g/L; 12 patients (32%) for a cut-off point of 8.23g/L; nine patients (24%) for 10.5g/L; and eight patients (22%) for 11.4g/L. The median tryptase level for the IgE-mediated reactions was 9.0g/L (2-70g/L) and 4.0g/L (3-13g/L) in non-IgE-mediated reactions (P<0.01). Median tryptase levels were higher in more severe reactions (grade 2 or 3) in comparison with grade 1. The best ratio for serum-tryptase-during-reaction/basal-serum-tryptase to discriminate between IgE and non-IgE reactions was 2.0.
ConclusionThe best criterion for discriminating IgE- and non IgE-mediated hypersensitivity reactions in anaesthesia was a tryptase value exceeding twice the basal one.
Revista:
Journal of investigational allergology & clinical immunology
ISSN:
1018-9068
Año:
2012
Vol.:
22
N°:
Suppl 1
Págs.:
7 - 15
Revista:
EUROPEAN JOURNAL OF PHARMACEUTICS AND BIOPHARMACEUTICS
ISSN:
0939-6411
Año:
2012
Vol.:
82
N°:
2
Págs.:
241-249
Allergen-specific immunotherapy is based on the administration of allergens with the main disadvantage of inducing an allergic reaction. Within this context, we report the generation of an adjuvant and allergen-delivery system for peanut allergen immunotherapy with reduced IgE induction. Therefore, we prepared and characterized poly(anhydride) nanoparticles loaded with peanut proteins using the solvent displacement method, with some modifications in the manufacturing process. The precipitation of polymer was performed with either a mixture of ethanol and water or water. The resultant nanoparticles were dried by either freeze-drying or spray-drying, respectively. Poly(anhydride) nanoparticles loaded with peanut proteins were successfully developed, achieving both high encapsulation efficiency (70-80%) and manufacturing yield (60-80%). After intradermal immunization of mice (C57Bl/6) with peanut proteins incorporated into poly(anhydride) nanoparticles, a strong mixed T(H)1/T(H)2-type immune response was observed. Furthermore, we also provide, to our knowledge for the first time, clear evidence of the influence of formulation design on the immunostimulatory properties of nanoparticles. Taken together, our findings indicate that poly(anhydride) nanoparticles are efficient stimulators of immune responses and promising adjuvants and allergen-delivery systems applied for immunotherapy. (C) 2012 Elsevier B.V. All rights reserved.
Revista:
JOURNAL OF BIOMEDICINE AND BIOTECHNOLOGY
ISSN:
1110-7243
Revista:
ANALES DEL SISTEMA SANITARIO DE NAVARRA
ISSN:
1137-6627
Año:
2012
Vol.:
35
N°:
1
Págs.:
41 - 51
La inmunoterapia para el tratamiento de enfermedades alérgicas implica ciertas desventajas, que pueden ser reducidas si se emplean adyuvantes adecuados, que sean capaces de amplificar la respuesta inmune con un efecto alergénico mínimo. En ese contexto, las formas farmacéuticas más prometedoras para aumentar la eficacia y seguridad de la inmunoterapia, parecen ser las micro y nanopartículas, de polímeros biodegradables y liposomas. En esta revisión describimos estudios previos de nuestro grupo en los que empleamos como adyuvante nanopartículas Gantrez® AN y demostramos su capacidad de estimular el sistema inmune. Empleamos dos tipos de nanopartículas, con y sin lipopolisacárido de Brucella ovis como inmunomodulador en un modelo de ratón alérgico a L. perenne. Encontramos que los ratones sensiblizados a Phleum cuando recibían inmunoterapia con nanopartículas Lolium-Gantrez® estaban protegidos de la anafilaxia inducida por el alérgeno tanto en las tasas de mortalidad como en los niveles de MCP-1. Probamos asimismo estas formulaciones por vía oral en un modelo animal sensibilizado a ovoalbúmina y comprobamos que les protegía también del shock anafiláctico.
Revista:
JOURNAL OF INVESTIGATIONAL ALLERGOLOGY AND CLINICAL IMMUNOLOGY
ISSN:
1018-9068
Año:
2012
Vol.:
22
N°:
7
Págs.:
508-13
The determination of sIgE to Ara h 9 using FEIA and BAT offers high sensitivity and specificity in the diagnosis of peanut allergy in the Spanish population. The CRD103 version of ISAC is not of value in our region as it does not include the most common allergen, Ara h 9.
Revista:
JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY
ISSN:
0091-6749
Año:
2012
Vol.:
130
N°:
6
Págs.:
1432 - 1434
Autores:
Montoro, J; del Cuvillo, A; Mullol, J; et al.
Revista:
ALLERGY
ISSN:
0105-4538
Año:
2012
Vol.:
67
N°:
11
Págs.:
1437 - 1442
Revista:
Journal of investigational allergology & clinical immunology
ISSN:
1018-9068
Año:
2011
Vol.:
21
N°:
2
Págs.:
108 - 112
Desensitization is a useful procedure in patients who are allergic to their chemotherapy agents..
Revista:
Clinical & Experimental Allergy (print)
ISSN:
0954-7894
Año:
2011
Vol.:
41
N°:
10
Págs.:
1440 - 1446
Component-based microarray ISAC CRD103 and whole-allergen CAP showed high Se and Sp diagnosing equally grass and cypress pollen allergy. The cut-off point for each allergen should be properly applied for both techniques.
Revista:
Journal of Allergy and Clinical Immunology
ISSN:
0091-6749
Año:
2011
Vol.:
127
N°:
5
Págs.:
1300 - 1302
Revista:
EXPERT OPINION ON DRUG METABOLISM AND TOXICOLOGY
ISSN:
1742-5255
Año:
2011
Vol.:
7
N°:
8
Págs.:
1035 - 1047
Revista:
Journal of investigational allergology & clinical immunology
ISSN:
1018-9068
Año:
2011
Vol.:
21
N°:
2
Págs.:
158 - 159
Autores:
Jáuregui, Ignacio; Dávila, Ignacio; Sastre, Joaquín; et al.
Revista:
PEDIATRIC ALLERGY AND IMMUNOLOGY
ISSN:
0905-6157
Año:
2011
N°:
22
Págs.:
388 - 392
Autores:
Betlloch, I; Izu, R; Lleonart, M; et al.
Revista:
ACTAS DERMO-SIFILIOGRAFICAS
ISSN:
0001-7310
Año:
2010
Vol.:
101
N°:
2
Págs.:
143-50
Treatments used by patients for an outbreak of AD are similar to those prescribed by dermatologists in recent outbreaks.
Revista:
Clinical drug investigation
ISSN:
1173-2563
Año:
2010
Vol.:
30
N°:
1
Págs.:
15 - 34
Revista:
Clinical & Experimental Allergy (print)
ISSN:
0954-7894
Año:
2010
Vol.:
40
N°:
12
Págs.:
1760 - 1766
Autores:
del Cuvillo, Alfonso; Montoro, Javier; Bartra, Joan; et al.
Revista:
RHINOLOGY
ISSN:
0300-0729
Año:
2010
Vol.:
48
N°:
2
Págs.:
201 - 205
