RESUMO
Atopic dermatitis (AD) is a recurrent and chronic skin disease characterized by dysfunction of the epithelial barrier, skin inflammation, and immune dysregulation, with changes in the skin microbiota and colonization by Staphylococcus aureus being common. For this reason, the therapeutic approach to AD is complex and should be directed at restoring skin barrier function, reducing dehydration, maintaining acidic pH, and avoiding superinfection and exposure to possible allergens. There is no curative treatment for AD. However, a series of measures are recommended to alleviate the disease and enable patients to improve their quality of life. These include adequate skin hydration and restoration of the skin barrier with the use of emollients, antibacterial measures, specific approaches to reduce pruritus and scratching, wet wrap applications, avoidance of typical AD triggers, and topical anti-inflammatory drugs. Anti-inflammatory treatment is generally recommended during acute flares or, more recently, for preventive management. Nevertheless, the selection of the pharmacologic agent, as well as its potency, duration, and frequency of application must be in accordance with the severity of the disease and the distribution and type of the lesion. The objectives of this review are to emphasize the importance of basic skin care and to describe current and novel topical therapies for AD.
Assuntos
Dermatite Atópica/tratamento farmacológico , Pele/efeitos dos fármacos , Animais , Humanos , Qualidade de Vida , Higiene da Pele/métodosRESUMO
Results from a 16-question survey about self-administration of hereditary angioedema (HAE) therapy, administered in Europe, Canada and the USA, were used to guide discussion at an international HAE expert meeting. The aim was to capture information about current practice in self-administered HAE therapy in these countries, including self-administration training, the key benefits of switching to self-administration, the barriers to self-administration and trends in self-administration. Overall, switching to self-administration therapy is looked upon favourably from both patient and clinician perspectives by virtue of the potential improvement in quality of life arising from optimisation of therapy and early intervention. The recent changes to product licences allowing self-administration provide additional options for the management of HAE.
Assuntos
Angioedemas Hereditários/tratamento farmacológico , Proteína Inibidora do Complemento C1/administração & dosagem , Educação de Pacientes como Assunto/métodos , Autoadministração/métodos , Canadá , Europa (Continente) , Humanos , Autoadministração/normas , Inquéritos e Questionários , Estados UnidosRESUMO
BACKGROUND: Allergic rhinitis (AR) is an increasingly prevalent worldwide disease that has a considerable impact on quality of life and health care costs. Asthma and AR may be part of the same disease, with AR leading to an increased risk of asthma. OBJECTIVES: To assess the prevalence of asthma in patients with AR due to house dust mites (HDMs) or Parietaria judaica and analyze the characteristics of asthma and AR in each group. METHODS: Cross-sectional, multicenter study with recording of demographic and clinical characteristics. All patients had AR confirmed by symptoms and a positive skin prick test to HDMs or P judaica. They were classified according to the severity and frequency ofAR following the Allergic Rhinitis and its Impact on Asthma (ARIA) and modified ARIA criteria and according to the severity of asthma following the Global Initiative for Asthma criteria. RESULTS: We studied 395 patients (226 in the HDM group and 169 in the Pjudaica group) with a mean (SD) age of 43 (15.3) years. Using the modified ARIA criteria, we detected more severe and persistent AR in the P judaica group than in the HDM group (44.5% vs 24.8%, P < .001). Nevertheless, there were no statistically significant differences between the groups in terms of the severity or prevalence (50% in HDM vs 47.9% in P judaica, P = .685) of asthma. CONCLUSION: AR due to P judaica pollen, which behaves like a perennial allergen, is associated with the same prevalence of asthma and with more severe rhinitis than AR due to HDMs.
Assuntos
Antígenos de Plantas/imunologia , Asma/epidemiologia , Asma/etiologia , Extratos Vegetais/imunologia , Pyroglyphidae/imunologia , Rinite Alérgica Perene/etiologia , Adolescente , Adulto , Idoso , Animais , Antígenos de Plantas/efeitos adversos , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Extratos Vegetais/efeitos adversos , Prevalência , Rinite Alérgica , Adulto JovemRESUMO
BACKGROUND: Alcohol, exercise or non-steroidal anti-inflamatory drugs (NSAID) are frequently mentioned as amplifiers of food allergic reactions but only individual cases or small series have been previously published. METHODS: Descriptive study including 74 cases of suspected co-factor enhanced food allergy, assessed by skin-prick tests, specific IgE and oral challenges. RESULTS: Anaphylaxis accounted for 85.1% of reactions. In 99% of cases culprit food allergens were plant-derived, mainly vegetables and cereals. NSAID were involved in 58%, exercise in 52.7% and alcohol in 12.2%. Lipid transfer protein was the most frequently involved allergen. CONCLUSIONS: Co-factor enhanced food allergy should be considered when assessing food, alcohol, exercise and NSAID allergic reactions.
Assuntos
Alérgenos/efeitos adversos , Anafilaxia , Anti-Inflamatórios não Esteroides/efeitos adversos , Exercício Físico , Hipersensibilidade Alimentar , Proteínas de Plantas/efeitos adversos , Adulto , Alérgenos/imunologia , Anafilaxia/etiologia , Anafilaxia/imunologia , Anti-Inflamatórios não Esteroides/imunologia , Proteínas de Transporte/efeitos adversos , Proteínas de Transporte/imunologia , Hipersensibilidade Alimentar/etiologia , Hipersensibilidade Alimentar/imunologia , Humanos , Imunoglobulina E/sangue , Proteínas de Plantas/imunologia , Testes CutâneosRESUMO
Purpose of Review: The purpose of this review is to provide a better understanding of anaphylaxis pathophysiology and describe the underlying mechanisms, effector cells, and the potential biomarkers involved depending on the anaphylaxis endotypes. Recent Findings: New insight into the potential relevance of pathways others than IgE-dependent anaphylaxis has been unraveled, as well as other biomarkers than tryptase, such as the role of platelet activation factor, basogranulin, dipeptidyl peptidase I, CCL-2, and other cytokines. Summary: Gaining knowledge of all the mediators and cellular activation/communication pathways involved in each endotype of anaphylaxis will allow the application of precision medicine in patients with anaphylactic reactions, providing insights to the most appropriate approach in each case and helping to stratify severity and risk prediction.
RESUMO
BACKGROUND: There are no Spanish guidelines or consensus statement on bradykinin-induced angioedema. AIM: To review the pathophysiology, genetics, and clinical symptoms of the different types of bradykinin-induced angioedema and to draft a consensus statement in light of currently available scientific evidence and the experience of experts. This statement will serve as a guideline to health professionals. METHODS: The consensus was led by the Spanish Study Group on Bradykinin-Induced Angioedema (SGBA), a working group of the Spanish Society of Allergology and Clinical Immunology. A review was conducted of scientific papers on different types of bradykinin-induced angioedema (hereditary and acquired angioedema due to C1 inhibitor deficiency, hereditary angioedema related to estrogens, angioedema induced by angiotensin-converting enzyme inhibitors). Several discussion meetings of the SGBA were held in Madrid to reach the consensus. RESULTS: The pathophysiology, genetics, and clinical symptoms of the different types of angioedema are reviewed. Diagnostic approaches are discussed and the consensus reached is described. CONCLUSIONS: A review of bradykinin-induced angioedema and a consensus on diagnosis are presented.
Assuntos
Angioedema , Bradicinina/efeitos adversos , Vasoespasmo Coronário/tratamento farmacológico , Hipersensibilidade a Drogas/fisiopatologia , Vasodilatadores/efeitos adversos , Angioedema/classificação , Bradicinina/uso terapêutico , Hipersensibilidade a Drogas/diagnóstico , Hipersensibilidade a Drogas/epidemiologia , Hipersensibilidade a Drogas/genética , Serviços Médicos de Emergência , Medicina Baseada em Evidências , Prova Pericial , Humanos , Guias de Prática Clínica como Assunto , Fatores de Risco , Espanha , Vasodilatadores/uso terapêuticoRESUMO
BACKGROUND: There are no previous Spanish guidelines or consensus statements on bradykinin-induced angioedema. AIM: To draft a consensus statement on the management and treatment of angioedema mediated by bradykinin in light of currently available scientific evidence and the experience of experts. This statement will serve as a guideline to health professionals. METHODS: The consensus was led by the Spanish Study Group on Bradykinin-Induced Angioedema, a working group of the Spanish Society of Allergology and Clinical Immunology. A review was conducted of scientific papers on different types of bradykinin-induced angioedema (hereditary and acquired angioedema due to C1 inhibitor deficiency, hereditary angioedema related to estrogens, angioedema induced by angiotensin-converting enzyme inhibitors). Several discussion meetings were held to reach the consensus. RESULTS: Treatment approaches are discussed, and the consensus reached is described. Specific situations are addressed, namely, pregnancy, contraception, travelling, blood donation, and organ transplantation. CONCLUSIONS: A review of and consensus on treatment of bradykinin-induced angioedema is presented.