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1.
Handb Exp Pharmacol ; 268: 487-500, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34219201

RESUMO

Allergic diseases are characterized by a complex complex chronic pathophysiology. Therapeutic patient education (TPE) programs are an important part of health care for allergic patients. These programs aim to increase the patient's adherence to evidence-based treatment and improve their ability to cope with the disease. TPE led by a multiprofessional team covers the complex pathogenesis of the disease, trigger factors, nursing and dietary issues, and the broad variety of treatment options available including psychological and behavioral aspects.Regarding atopic dermatitis (AD), randomized, controlled studies have demonstrated the beneficial effects of delivering structured group training to children, their caregivers, and adult patients with AD. Such intervention achieved substantial improvements in quality of life and objective clinical disease parameters. Besides AD, training programs have also been developed and evaluated for patients with anaphylaxis and asthma. This article provides an overview of the multitude of TPE concepts and their impact on subjective and objective outcomes. It focuses on AD but also sheds light on other allergic diseases such as anaphylaxis and asthma.


Assuntos
Asma , Dermatite Atópica , Adulto , Criança , Dermatite Atópica/terapia , Humanos , Educação de Pacientes como Assunto , Qualidade de Vida , Projetos de Pesquisa
2.
Handb Exp Pharmacol ; 268: 101-115, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34236520

RESUMO

Atopic eczema (AE) is a chronic inflammatory disease hallmarked by intense pruritus and eczematous lesions. It depicts one of the most common skin diseases affecting a major part of children and several percentages of adults.Both pathogenesis and pathophysiology are based on complex orchestrated interactions of skin barrier defects, immunological changes, the environment, and an abundance of other contributing factors. Frequently, AE displays the starting point for other allergic diseases such as allergic asthma and rhinoconjunctivitis. Additionally, the risk of developing food allergy is increased. Furthermore, the disease is accompanied by a susceptibility to bacterial, fungal, and viral infections. The development of new therapies received great impetus by an ample research of the pathophysiological mechanisms, leading to a new era in the treatment of severe atopic eczema due to targeted treatments, e.g. the IL-4R alpha specific monoclonal antibody dupilumab.This article provides an overview of the causative and pathophysiological characteristics, the clinical and diagnostic aspects as well as current and future therapeutical possibilities focusing allergic aspects contributing to the course of the disease.


Assuntos
Asma , Dermatite Atópica , Eczema , Hipersensibilidade , Adulto , Criança , Dermatite Atópica/tratamento farmacológico , Humanos
3.
Hautarzt ; 72(12): 1102, 2021 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-34817627
4.
Hautarzt ; 72(12): 1103-1112, 2021 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-34792615

RESUMO

Since the first report of allergen-specific immunotherapy (AIT) by Noon et al. 110 years ago, a multitude of clinical and in vitro studies have been performed to identify the effects of the only curative treatment for allergies. However, in atopic dermatitis (AD), one of the most prevalent skin diseases, it is rarely used, despite evidence showing that aeroallergens can contribute to disease exacerbation. This review gives an overview about the studies, meta-analyses, and current guideline recommendations regarding AIT in AD patients. There is a distinct heterogeneity in the study designs, different allergens and application forms, endpoints and patient cohorts, which hinders the comparability of studies. Several trials depict a beneficial effect of AIT in AD patients suggesting that at least a subgroup of patients can benefit from treatment. Further developments in the field of AIT may advocate broader use in AD patients.


Assuntos
Dermatite Atópica , Eczema , Hipersensibilidade , Alérgenos , Dermatite Atópica/diagnóstico , Dermatite Atópica/terapia , Dessensibilização Imunológica , Humanos
6.
Allergol Select ; 5: 293-304, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34532638

RESUMO

The JAK-STAT pathway is involved in the signaling of multiple cytokines driving cutaneous inflammation in atopic dermatitis (AD). Janus kinase (JAK) inhibitors target individual receptor-associated kinases, thereby preventing the mediation of inflammatory signals. Several JAK inhibitors with varying mechanism of action, potency, and safety represent potential therapeutic options for AD in both topical and systemic application. The JAK1/2 selective JAK inhibitor baricitinib was the first substance from this class of drugs approved by the EMA for the systemic oral treatment of AD. The clinical development program of the JAK1 selective inhibitors upadacitinib and abrocitinib is finalized with positive results for AD. The PAN-JAK inhibitor delgocitinib was the first substance being approved for the treatment of AD (in Japan). This review article covers the rising data on investigational and approved JAK inhibitors in the context of the treatment of AD.

8.
Acta Derm Venereol ; 101(9): adv00560, 2021 Sep 28.
Artigo em Inglês | MEDLINE | ID: mdl-34427313

RESUMO

The globally increasing prevalence of chronic inflammatory skin diseases has substantial costs. Biologicals have become available as therapeutic options, but are encumbered with barriers to prescription. The aim of this study was to evaluate the barriers to prescription of biologicals in the treatment of chronic dermatological diseases. Dermatologists working in private practices in the German federal states of Bavaria and Lower Saxony participated in a cross-sectional study. Economic and legal aspects, including "high therapy costs", "low reimbursements", and "fear of regress claims", were identified as the most prevalent barriers. Significant differences between dermatologists from Bavaria and Lower Saxony were found only regarding the treatment of atopic dermatitis. This study demonstrates the prevalence of barriers to the prescription of biologicals in the treatment of chronic dermatological diseases. Overcoming these barriers could improve the usage of modern therapies and thereby expand patient-centred care for chronic skin diseases.


Assuntos
Produtos Biológicos , Dermatite Atópica , Dermatopatias , Produtos Biológicos/efeitos adversos , Estudos Transversais , Dermatite Atópica/diagnóstico , Dermatite Atópica/tratamento farmacológico , Dermatite Atópica/epidemiologia , Humanos , Prescrições , Dermatopatias/diagnóstico , Dermatopatias/tratamento farmacológico , Dermatopatias/epidemiologia
9.
JAAD Case Rep ; 12: 67-69, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34041335
10.
Allergy ; 76(10): 3017-3027, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-33844308

RESUMO

Atopic dermatitis (AD) is one of the most common chronic inflammatory skin diseases leading to pruritic skin lesions. A subset of AD patients exhibits a disseminated severe HSV infection called eczema herpeticum (EH) that can cause life-threatening complications. This review gives an overview of the clinical picture, and characteristics of the patients as well as the diagnosis and therapy of EH. A special focus lies on the pathophysiological hallmarks identified so far that predispose for EH. This aspect covers genetic aberrations, immunological changes, and environmental influences displaying a complex multifactorial situation, which is not completely understood. Type 2 skewing of virus-specific T cells in ADEH+ patients has been implicated in immune profile abnormalities, along with impaired functions of dendritic cells and natural killer cells. Furthermore, aberrations in interferon pathway-related genes such as IFNG and IFNGR1 have been identified to increase the risk of EH. IL-4, IL-25, and thymic stromal lymphopoietin (TSLP) are overexpressed in EH, whereas antimicrobial peptides like human ß-defensins and LL-37 are reduced. Concerning the epidermal barrier, single nucleotide polymorphisms (SNPs) in skin barrier proteins such as filaggrin were identified in ADEH+ patients. A dysbalance of the skin microbiome also contributes to EH due to an increase of Staphylococcus aureus, which provides a supporting role to the viral infection via secreted toxins such as α-toxin. The risk of EH is reduced in AD patients treated with dupilumab. Further research is needed to identify and specifically target risk factors for EH in AD patients.


Assuntos
Dermatite Atópica , Eczema , Erupção Variceliforme de Kaposi , Microbiota , Dermatite Atópica/epidemiologia , Humanos , Pele
11.
Contact Dermatitis ; 85(3): 297-306, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33882155

RESUMO

BACKGROUND: Allergic contact dermatitis caused by shoes is common and new relevant allergens have been identified. OBJECTIVES: To investigate the pattern of type IV sensitization in patients with suspected allergic contact dermatitis of the feet related to shoes as a presumed culprit trigger. METHODS: Retrospective analysis of data of the Information Network of Departments of Dermatology (IVDK), 2009-2018. RESULTS: Six hundred twenty-five patients with presumed shoe dermatitis were identified in a cohort of 119 417 patients. Compared to patients with suspected contact sensitization from other allergen sources (n = 118 792), study group patients were more frequently sensitized to potassium dichromate (10.8% vs 3.5%), colophony (7.2% vs 3.7%), mercaptobenzothiazole (MBT; 4.0% vs 0.6%), mercapto mix (4.6% vs 0.6%), and p-tert-butylphenol formaldehyde resin (1.6% vs 0.5%). Sensitizations to urea formaldehyde resin, melamine formaldehyde resin, glutaraldehyde, tricresyl phosphate, and phenyl glycidylether were rare. Moreover, reactions to compounds in the leather or textile dyes test series were scarce. CONCLUSION: A distinct sensitization pattern was observed in patients with suspected allergy to shoe materials. Although substances with low sensitization rates should be removed from the leather and shoe patch test series, novel potential allergens should be added.

12.
Immunotargets Ther ; 10: 27-45, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33628747

RESUMO

Urticaria and angioedema are very common. Management of chronic urticaria subtypes, which usually persist for many years, is challenging. Recent years have demonstrated that targeting IgE with antibodies provides a safe and efficient treatment approach. Whilst several anti-IgE antibodies have been developed, omalizumab is currently the only one approved for use. International and national guidelines recommend its use after failure of antihistamines at standard and increased dose. Whilst not yet approved, many new anti-IgE approaches are currently being investigated in pre-clinical studies or clinical trials. This non-systematic focused review summarizes current knowledge of omalizumab and other anti-IgE biologics in chronic urticaria using data extracted from PubMed, Google Scholar and clinical trial databases, clinicaltrials.gov and clinicaltrials.eu. For adults, there is good evidence from randomized clinical trials and real-world data that symptomatic treatment with omalizumab is efficacious and safe in chronic spontaneous urticaria (CSU), whereas evidence in chronic inducible urticaria (CINDU) and special populations is limited. Easy-to-use tools to identify non-responders and predict the required duration of treatment have not been established yet. Phase 2 b results of ligelizumab have not only demonstrated efficacy and safety but also superiority to omalizumab. Indeed, there is preliminary evidence that omalizumab non- or partial responders benefit from ligelizumab. Whereas further development of quilizumab was discontinued, other approaches, eg UB-221 or DARPins are under investigation. Anti-IgE treatment with omalizumab represents a landmark in the treatment of chronic urticaria, with and without angioedema, and there is light on the horizon suggesting success may come with various next-generation anti-IgE approaches.

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