RESUMEN
PURPOSE: To describe a series of non-immediate drug hypersensitivity reactions after intravitreal anti-vascular endothelial growth factors (anti-VEGFs). PATIENTS AND METHODS: Retrospective report of 6 patients with cutaneous non-immediate drug hypersensitivity reactions following intravitreal anti-VEGF injections, 4 after ranibizumab, 1 after bevacizumab and 1 after aflibercept. RESULTS: Clinical manifestations ranged from mild maculopapular rash, purpura to severe generalized erythroderma, with or without systemic involvement such as microscopic hematuria and proteinuria or fever. In two out of the six patients, reintroduction of either the same or an alternative anti-VEGF drug did induce a recurrence of the drug hypersensitivity reaction, while 4 patients showed no recurrence. CONCLUSION: Cutaneous non-immediate drug hypersensitivity reactions secondary to intravitreal anti-VEGF may occur. Continuation of the same drug or switch to another anti-VEGF may either induce recurrence or be well supported by the patient. The decision of drug discontinuation should be guided by the severity of the disease.
Asunto(s)
Hipersensibilidad a las Drogas , Factor A de Crecimiento Endotelial Vascular , Inhibidores de la Angiogénesis/efectos adversos , Bevacizumab/efectos adversos , Hipersensibilidad a las Drogas/diagnóstico , Hipersensibilidad a las Drogas/tratamiento farmacológico , Hipersensibilidad a las Drogas/etiología , Humanos , Inyecciones Intravítreas , Ranibizumab/efectos adversos , Receptores de Factores de Crecimiento Endotelial Vascular , Proteínas Recombinantes de Fusión , Estudios RetrospectivosRESUMEN
Biologic agents (also termed biologicals or biologics) are therapeutics that are synthesized by living organisms and directed against a specific determinant, for example, a cytokine or receptor. In inflammatory and autoimmune diseases, biologicals have revolutionized the treatment of several immune-mediated disorders. Biologicals have also been tested in allergic disorders. These include agents targeting IgE; T helper 2 (Th2)-type and Th2-promoting cytokines, including interleukin-4 (IL-4), IL-5, IL-9, IL-13, IL-31, and thymic stromal lymphopoietin (TSLP); pro-inflammatory cytokines, such as IL-1ß, IL-12, IL-17A, IL-17F, IL-23, and tumor necrosis factor (TNF); chemokine receptor CCR4; and lymphocyte surface and adhesion molecules, including CD2, CD11a, CD20, CD25, CD52, and OX40 ligand. In this task force paper of the Interest Group on Biologicals of the European Academy of Allergy and Clinical Immunology, we review biologicals that are currently available or tested for the use in various allergic and urticarial pathologies, by providing an overview on their state of development, area of use, adverse events, and future research directions.
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Antialérgicos/uso terapéutico , Factores Biológicos/uso terapéutico , Hipersensibilidad/tratamiento farmacológico , Hipersensibilidad/inmunología , Antialérgicos/farmacología , Anticuerpos Monoclonales/farmacología , Anticuerpos Monoclonales/uso terapéutico , Antígenos/inmunología , Antígenos/metabolismo , Factores Biológicos/farmacología , Ensayos Clínicos como Asunto , Humanos , Hipersensibilidad/diagnóstico , Resultado del TratamientoAsunto(s)
Betacoronavirus , Infecciones por Coronavirus , Pandemias , Neumonía Viral , COVID-19 , Desensibilización Inmunológica , Humanos , SARS-CoV-2RESUMEN
Allergic rhinitis is still in need of efficient therapies, in particular for its most severe manifestations, including polyposis, and despite rather satisfying treatments for the benign to moderate presentations. A better understanding of its mechanisms, although still incomplete, of its phenotypes and endotypes, a better evaluation of its severity with adequate scoring systems, and of its risk factors pave the way to innovative but eagerly awaited therapies.
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Rinitis Alérgica/tratamiento farmacológico , Algoritmos , Humanos , Insuficiencia del TratamientoRESUMEN
Two different routes of administration exist for the immunoglobulin therapy: intravenous (Ig IV - monthly administration in medical setting) and subcutaneous (Ig SC - weekly self-administration at home). According to the literature, efficacy and safety are similar,. but Ig SC could improve quality of life and treatment satisfaction. The Policlinique Médicale Universitaire of Lausanne has developed an interdisciplinary program for the long-term support of Ig SC patients. Moreover, it conducted an exploratory survey interviewing Ig IV patients about their interest for Ig SC: patients interested judged less favourably efficacy and/or tolerance of Ig IV and considered that Ig SC would improve their motivation for treatment and its impact on their private and professional life.
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Inmunoglobulinas Intravenosas/administración & dosificación , Inmunoglobulinas/administración & dosificación , Calidad de Vida , Humanos , Inmunoglobulinas/efectos adversos , Inmunoglobulinas Intravenosas/efectos adversos , Inyecciones Subcutáneas , Satisfacción del Paciente , AutoadministraciónRESUMEN
Zostavax, a live attenuated vaccine against shingles (herpes zoster) has been available in Switzerland since 2008. In a population aged 60 and over, evidence suggests the vaccine effectively reduces the incidence of shingles and some of its corresponding complications. More importantly, in terms of public health, vaccination appears to reduce the burden of illness and be pharmaco-economically viable. Despite being part of the vaccination programmes in the United States and several European countries, the vaccine is not yet part of the Swiss vaccination programme. Should Switzerland follow suit by incorporating Zostavax into their vaccination policy?
Asunto(s)
Vacuna contra el Herpes Zóster/administración & dosificación , Herpes Zóster/prevención & control , Vacunación/métodos , Costo de Enfermedad , Economía Farmacéutica , Política de Salud , Herpes Zóster/economía , Herpes Zóster/epidemiología , Vacuna contra el Herpes Zóster/economía , Humanos , Programas de Inmunización , Incidencia , Persona de Mediana Edad , Salud Pública , Suiza , Vacunación/economía , Vacunas Atenuadas/administración & dosificación , Vacunas Atenuadas/economíaRESUMEN
Adverse food reactions can be classified into two main categories depending on wether an immune mechanism is involved or not. The first category includes immune mediated reactions like IgE mediated food allergy, eosinophilic oesophagitis, food protein-induced enterocolitis syndrome and celiac disease. The second category implies non-immune mediated adverse food reactions, also called food intolerances. Intoxications, pharmacologic reactions, metabolic reactions, physiologic, psychologic or reactions with an unknown mechanism belong to this category. We present a classification of adverse food reactions based on the pathophysiologic mechanism that can be useful for both diagnostic approach and management.
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Hipersensibilidad a los Alimentos/diagnóstico , Alimentos/efectos adversos , Enfermedad Celíaca/inmunología , Esofagitis Eosinofílica/inmunología , Hipersensibilidad a los Alimentos/inmunología , Humanos , Inmunoglobulina E/inmunologíaRESUMEN
The initial Phase-I single centre, single dose, randomized, double-blind, cross-over study was planned to assess the pharmacokinetic and pharmacodynamic bioequivalence of the trastuzumab biosimilar (MYL-1401O) compared to the reference Herceptin®. Their respective immunomodulation profile presented in this paper involved healthy males receiving a single infusion of both monoclonals, separated by a washout period. Sixty parameters were assessed in total, including serum cytokines, peripheral mononuclear cell (PBMC) subsets, cell activation and response to recall antigens and mitogen, pre- and post- infusion, as well as a cytokine release assay (CRA) at baseline. Trastuzumab infusion induced a transient and weak peak of serum IL-6 at 6 h, and a modulation of mononuclear cell subset profile and activation level, notably CD16 + cells. Except for CD8 + T cells, there were no significant differences between Herceptin® and MYL-1401O. In CRA, PBMC stimulated with MYL-1401O or Herceptin® similarly secreted IL-6, TNF-α, IL-1ß, GM-CSF, IFN-γ, and IL-10, but no or low level of IL-2. Interestingly, some observed adverse events correlated with IL-2 and IFN-γ in CRA. MYL-1401O exhibited a very similar immunomodulation profile to Herceptin®, strongly supporting its bioequivalence. This approach may thus be included in a proof-of-concept study. CRA may be used as a predictive assay for the evaluation of clinical monoclonals.
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Biosimilares Farmacéuticos , Estudios Cruzados , Citocinas , Equivalencia Terapéutica , Trastuzumab , Humanos , Trastuzumab/farmacocinética , Biosimilares Farmacéuticos/farmacocinética , Biosimilares Farmacéuticos/administración & dosificación , Masculino , Adulto , Citocinas/metabolismo , Citocinas/sangre , Método Doble Ciego , Leucocitos Mononucleares/metabolismo , Leucocitos Mononucleares/efectos de los fármacos , Leucocitos Mononucleares/inmunología , Inmunomodulación/efectos de los fármacos , Adulto JovenRESUMEN
TNFalpha blocking agents are effective and essential tools in the management of many inflammatory conditions including rheumatoid arthritis, spondylarthropathies and chronic inflammatory bowel disease. With time, some known side-effects have gained in importance and others have appeared. This article focuses on the potential risks of infection and autoimmunity induced by TNFalpha blocking agents and on the strategy to prevent and treat such adverse events.
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Antirreumáticos/efectos adversos , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/terapia , Factor de Necrosis Tumoral alfa/antagonistas & inhibidores , Antirreumáticos/uso terapéutico , Enfermedades Autoinmunes/inducido químicamente , Enfermedades Autoinmunes/terapia , Humanos , Infecciones/inducido químicamente , Infecciones/epidemiología , Infecciones/etiología , Neoplasias/inducido químicamente , Neoplasias/terapia , Factores de RiesgoRESUMEN
Compared to total allergenic extracts, recombinant allergens available for specific IgE measurement represent an important advance in the diagnosis and treatment of IgE-mediated allergies. Recombinant allergens lead to define the sensitization profile of allergic patients, to identify markers of sensitization and to understand better polysensitivities related to cross-reactions and markers of severity of allergic reactions. They also contribute to the decision to establish tolerance induction (allergen specific immunotherapy) and the optimal selection of the allergenic composition of the vaccine.
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Alérgenos , Alergia e Inmunología , Hipersensibilidad/terapia , Práctica Profesional , Proteínas Recombinantes , Alérgenos/inmunología , Alérgenos/uso terapéutico , Animales , Desensibilización Inmunológica/métodos , Humanos , Hipersensibilidad/diagnóstico , Pruebas Inmunológicas/métodos , Proteínas de Plantas/inmunología , Proteínas de Plantas/uso terapéutico , Valor Predictivo de las Pruebas , Práctica Profesional/normas , Proteínas Recombinantes/inmunología , Proteínas Recombinantes/uso terapéuticoRESUMEN
Systemic mastocytosis is characterized by an excessive proliferation of mast cells and their accumulation in different organs. Avoidance of trigger factors leading to anaphylaxis is a general measure valid for all forms of mastocytosis. A premedication is necessary in case of surgery, anesthesia or administration of radiocontrast agents. Symptomatic treatment comprises antihistamines, anti-leukotrienes, proton pump inhibitors and topical corticosteroids. Indolent mastocytosis with refractory symptoms, the rare cases of aggressive mastocytosis with organ dysfunction and the even rarer mast cell leukemia require cytoreductive therapy. First-line agents are interferon alpha 2b and imatinib, a tyrosine kinase inhibitor. To date there is no curative treatment.
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Alergia e Inmunología/tendencias , Mastocitosis Sistémica/terapia , Terapias en Investigación/métodos , Antiinflamatorios/uso terapéutico , Cladribina/uso terapéutico , Humanos , Interferón alfa-2 , Interferón-alfa/uso terapéutico , Mastocitosis Sistémica/diagnóstico , Mastocitosis Sistémica/prevención & control , Oncología Médica/métodos , Oncología Médica/tendencias , Inhibidores de Proteínas Quinasas/uso terapéutico , Proteínas Recombinantes/uso terapéutico , Terapias en Investigación/tendenciasRESUMEN
Involvement of the central or peripheral nervous system, frequently present in systemic inflammatory immune disorders, has to be considered a severe threat and requires aggressive immunosuppressive treatment to achieve rapid remission. This is usually obtained with high-dose systemic corticosteroids combined with cyclophosphamide. Once remission is obtained, immunosuppressive agents with a more favorable safety profile are needed to exert a corticosteroid-sparing effect and minimize adverse events. New therapeutic approaches are currently developed to treat autoimmune diseases, mostly linked to the definition of new indications for biological agents such as TNF-alpha antagonists and rituximab.
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Inmunosupresores/uso terapéutico , Enfermedades del Sistema Nervioso/tratamiento farmacológico , Anticuerpos Monoclonales/uso terapéutico , Linfocitos B/inmunología , Humanos , Factor de Necrosis Tumoral alfa/antagonistas & inhibidoresRESUMEN
Common variable immunodeficiency (CVID) is the most frequent primary immune deficiency. Recurrent infections are classical consequences of CVID, but their impact has been largely reduced by immunoglobulin replacement. CVID is also associated with various inflammatory and autoimmune manifestations resulting from abnormal cellular immunity. The lungs are especially affected by a recently described entity called granulomatous lymphocytic interstitial lung disease (GLILD). GLILD currently constitutes an important cause of morbidity and mortality in these patients. It is distinct from bronchiectasis secondary to recurrent infections, and presents similarities but also striking differences with sarcoidosis.
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Inmunodeficiencia Variable Común/fisiopatología , Granuloma/patología , Enfermedades Pulmonares Intersticiales/fisiopatología , Bronquiectasia/diagnóstico , Bronquiectasia/fisiopatología , Inmunodeficiencia Variable Común/diagnóstico , Inmunodeficiencia Variable Común/terapia , Granuloma/diagnóstico , Humanos , Inmunoglobulinas/administración & dosificación , Enfermedades Pulmonares Intersticiales/diagnóstico , Enfermedades Pulmonares Intersticiales/terapia , Pronóstico , Recurrencia , Sarcoidosis/diagnóstico , Sarcoidosis/fisiopatologíaRESUMEN
Beta-lactam antibiotics allergies are common. Up to 10% of the population describe a former allergy to penicillins. However only 10 to 15% of these individuals are actually allergic. In most cases, beta-lactam antibiotics will be avoided and replaced by other antibiotics such as quinolones. This fear of a serious allergic reaction has an economic impact and may lead to the emergence of antibiotic resistance. A thorough allergic work-up can accurately determine true allergic patients. Most of the patients with a proven allergy will be able to tolerate other antibiotics belonging to the beta-lactam family. This article focuses on the management of beta-lactam allergic patients.
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Antibacterianos/efectos adversos , Hipersensibilidad a las Drogas/diagnóstico , Hipersensibilidad a las Drogas/etiología , Reacciones Cruzadas , Humanos , beta-LactamasasRESUMEN
Södgren's syndrome treatment has essentially been based on symptomatic approach and has been of limited efficacy. Novel biological therapies targeting B cells, a key player in the pathophysiology of the syndrome, have recently been tested in controlled clinical trials and raise the hope of improving glandular and extraglandular manifestations of Söigren's syndrome.
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Síndrome de Sjögren/tratamiento farmacológico , Anticuerpos Monoclonales de Origen Murino/uso terapéutico , Antirreumáticos/uso terapéutico , Ensayos Clínicos como Asunto , Humanos , Agonistas Muscarínicos/uso terapéutico , Rituximab , Síndrome de Sjögren/complicacionesRESUMEN
Common variable immune deficiency is the most frequent primary immune deficiency, characterized mainly by a disorder of B lymphocytes differentiation and a deficit in immunoglobulins. The clinical manifestations include recurrent infections, non-infectious lung and digestive involvements, autoimmune diseases, and an increased susceptibility to cancers. Recent breakthroughs have been made in the understanding of some genetic mechanisms of the disease. Replacement therapy with intravenous immunoglobulins remains the treatment of choice, which allows significant improvement in the survival and quality of life. However progress should be made in the understanding of the pathophysiology and in the early detection of this disease, since a delay in the diagnosis may have harmful consequences in terms of morbidity and mortality.
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Inmunodeficiencia Variable Común/diagnóstico , Inmunodeficiencia Variable Común/tratamiento farmacológico , Inmunodeficiencia Variable Común/epidemiología , Inmunodeficiencia Variable Común/genética , Susceptibilidad a Enfermedades , Humanos , Isotipos de Inmunoglobulinas/sangre , Inmunoglobulinas Intravenosas/uso terapéuticoRESUMEN
BACKGROUND: Probiotics have been associated with prevention and improvement of symptoms in atopic diseases such as atopic dermatitis. However, few studies exist that document their efficacy for upper airways allergies such as allergic rhinitis. OBJECTIVE: To investigate the effect of short-term oral administration of Lactobacillus paracasei ST11 on a nasal provocation test (NPT) with grass pollen. METHODS: Thirty-one adult volunteers with allergic rhinitis were enrolled in a randomized, double-blind, placebo-controlled study, based on two 4-week cross-over periods of product consumption (ST11-fermented milk vs. placebo), separated by a wash-out period of 6-8 weeks. Objective and subjective clinical parameters of NPT as well as systemic and nasal immunological parameters were compared between the two treatment periods (registration number: NCT 011 50 253). RESULTS: Subjects that received ST11-fermented milk had lower nasal congestion than subjects under placebo (visual analogical scale; P<0.05). Nasal pruritus followed the same trend. However, no significant change in combined nasal reaction threshold was observed between the two periods. IL-5 secretion by peripheral blood mononuclear cells and serum allergen-specific IgG4 were significantly lower in ST11-fermented milk group compared to placebo group. IL-8 and IL-10 secretion followed the same trend. CONCLUSION AND CLINICAL RELEVANCE: Short-term treatment with ST11-fermented milk before NPT significantly improved a clinical marker of NPT (subjective nasal congestion) and down-regulated systemic immune markers (IL-5 from peripheral blood mononuclear cells and serum IgG4). These data strongly suggest that probiotics may down modulate key parameters of allergic rhinitis and warrant future evaluation in seasonal trials.
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Productos Lácteos Cultivados/microbiología , Lactobacillus/inmunología , Pruebas de Provocación Nasal , Probióticos/uso terapéutico , Rinitis Alérgica Estacional/prevención & control , Adolescente , Adulto , Estudios Cruzados , Método Doble Ciego , Femenino , Humanos , Inmunoglobulina G/sangre , Interleucina-5/biosíntesis , Leucocitos Mononucleares/efectos de los fármacos , Leucocitos Mononucleares/inmunología , Masculino , Poaceae/efectos adversos , Poaceae/inmunología , Polen/efectos adversos , Polen/inmunología , Adulto JovenRESUMEN
Diagnosis in allergology is facing novel challenges because of the availability not only of purified or recombinant allergens, but also of multitests such as allergen micro-arrays. These new diagnostic opportunities contribute to a better understanding of crossreactivities between respiratory and food allergens. In comparison to current diagnosis based on whole allergen extracts, this novel generation of specific IgE tests is expected to provide better information on the risk of reaction to allergens as well as on its severity. However these new technologies are expensive, and will have to be carefully analyzed in terms of medical usefulness and public health costs.
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Alérgenos , Pruebas Cutáneas , Humanos , Inmunoglobulina E/sangre , Análisis por Matrices de Proteínas/métodos , Proteínas Recombinantes/inmunologíaRESUMEN
Anaphylactic reactions to hymenoptera venoms are common and, in our latitudes, mainly concern wasps and bees. Recently, molecular biology techniques have contributed to identifying and to sequencing the major allergens of insect venoms and led to the production of recombinant allergens. Assays for specific IgE directed against these recombinant allergens have recently been made available in clinical practice. They provide considerable assistance in identifying the insect responsible for an anaphylactic reaction, in particular when standard tests are positive for both wasp and bee. This article focuses on these new laboratory tests and also reviews the management of patients experiencing an anaphylactic reaction after hymenoptera sting.