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1.
Rev Alerg Mex ; 67(2): 199-201, 2020.
Artigo em Espanhol | MEDLINE | ID: mdl-32892535
2.
J Allergy Clin Immunol Pract ; 8(8): 2461-2473.e3, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32603900

RESUMO

Telemedicine adoption has rapidly accelerated since the onset of the COVID-19 pandemic. Telemedicine provides increased access to medical care and helps to mitigate risk by conserving personal protective equipment and providing for social/physical distancing to continue to treat patients with a variety of allergic and immunologic conditions. During this time, many allergy and immunology clinicians have needed to adopt telemedicine expeditiously in their practices while studying the complex and variable issues surrounding its regulation and reimbursement. Some concerns have been temporarily alleviated since March 2020 to aid with patient care in the setting of COVID-19. Other changes are ongoing at the time of this publication. Members of the Telemedicine Work Group in the American Academy of Allergy, Asthma & Immunology (AAAAI) completed a telemedicine literature review of online and Pub Med resources through May 9, 2020, to detail Pre-COVID-19 telemedicine knowledge and outline up-to-date telemedicine material. This work group report was developed to provide guidance to allergy/immunology clinicians as they navigate the swiftly evolving telemedicine landscape.


Assuntos
Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Telemedicina/organização & administração , Alergia e Imunologia/organização & administração , Betacoronavirus , Codificação Clínica , Segurança Computacional , Acesso aos Serviços de Saúde/organização & administração , Humanos , Hipersensibilidade/terapia , Controle de Infecções/organização & administração , Reembolso de Seguro de Saúde , Pandemias , Sociedades Médicas , Telemedicina/economia
3.
Ann Allergy Asthma Immunol ; 125(2): 126-136, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32289524

RESUMO

OBJECTIVE: To define the concept of value-based care in allergy, and to review challenges and opportunities in value-based health care delivery for allergists and immunologists. DATA SOURCES: Articles describing practice variation, health care financing and reimbursement, shared decision-making, cost-effective health care delivery, patient-reported outcome measures, social determinants of health, and screening. STUDY SELECTIONS: A narrative review detailing concepts and approaches to improve value-based health care in the context of the Quadruple Aim to address the patient and physician experience, cost, and population health. RESULTS: Efforts to improve cost-effective care can be informed by understanding unwarranted geographic practice variation and benchmarking best practices. Although evidence suggests that shared decision-making and addressing social determinants of health have critical roles in high-quality care, some practices such as routine laboratory screening for urticaria, premedication to prevent recurrent low- or iso-osmolar contrast reactions, extended observation of resolved anaphylaxis, food allergy screening, and penicillin allergy overdiagnosis have high costs in relation to overall societal benefit. Food allergy prevention, newborn screening for severe combined immune deficiency, and penicillin delabeling are examples of population-based opportunities in which allergists and immunologists can assist in creating health care value. Although efforts to incentivize value-based care have emerged in recent years, the degree to which process measures improve patient-important outcomes remain uncertain. Clinician wellness must be made a priority for continued effective practice. CONCLUSION: As health care systems continue to evolve, allergists and immunologists will play a key role in optimizing value by translating emerging evidence into practice and communicating novel approaches to prevent and treat allergic diseases.


Assuntos
Benchmarking/métodos , Análise Custo-Benefício , Assistência à Saúde , Hipersensibilidade/epidemiologia , Prática Clínica Baseada em Evidências , Custos de Cuidados de Saúde , Humanos , Hipersensibilidade/terapia , Padrões de Prática Médica , Melhoria de Qualidade , Estados Unidos/epidemiologia
4.
Rev Med Suisse ; 16(689): 688-693, 2020 Apr 08.
Artigo em Francês | MEDLINE | ID: mdl-32270936

RESUMO

Allergy to furry animals is a frequent health issue, and should be suspected when investigating any yearlong rhinoconjonctivitis or asthma. A detailed medical history and skin prick tests are usually sufficient for diagnosis, and if necessary, specific IgE testing may be performed. In case of proven hypersensitivity, avoidance of animal allergens is the main therapeutic measure, primarily by removing the animal from the patient's environment, in association with symptomatic treatment. If animal removing is impossible, other measures exist to decrease allergen load, but not with the same -efficacy as removing the animal, particularly for asthma. Immunotherapy is available for cat and dog allergy, but indication is to be carefully discussed.


Assuntos
Asma , Cabelo/imunologia , Hipersensibilidade , Alérgenos/imunologia , Animais , Asma/diagnóstico , Asma/imunologia , Asma/terapia , Gatos , Cães , Humanos , Hipersensibilidade/diagnóstico , Hipersensibilidade/imunologia , Hipersensibilidade/terapia , Imunoterapia , Testes Cutâneos
6.
Ann Allergy Asthma Immunol ; 125(3): 252-261, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32044453

RESUMO

OBJECTIVE: To review risk communication in the context of shared decision making. DATA SOURCES: Articles describing risk communication, shared decision making, and cost-effective healthcare delivery. STUDY SELECTIONS: A narrative review detailing approaches to improve risk communication and shared decision making to optimize patient-centered cost-effective practice. RESULTS: Risk communication must occur on a foundation of mutual trust and can be improved by keeping risk in perspective of everyday hazards, such as using pictograms when possible, providing numeric likelihoods of risks and benefits, and discussing absolute risks. Variability in patient-perceived quality of life for allergic and nonallergic health states may affect the health and economic outcomes of many allergy therapies. Shared decision making improves patient knowledge and risk perception, engagement, and adherence. Patient decision aids can be time-consuming to develop and validate, but their use is associated with a more accurate understanding of patient-oriented outcomes. CONCLUSION: Communicating risk is complex, and validated patient decision aids using visual aids, presenting essential information, using knowledge checks, and incorporating values clarification can reduce decisional conflict and improve decisional self-efficacy.


Assuntos
Hipersensibilidade/terapia , Assistência ao Paciente/métodos , Participação do Paciente/métodos , Análise Custo-Benefício/métodos , Tomada de Decisões , Técnicas de Apoio para a Decisão , Humanos , Qualidade de Vida , Risco
7.
Ann Otol Rhinol Laryngol ; 129(7): 699-706, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32059621

RESUMO

BACKGROUND: Chronic rhinosinusitis (CRS) is a chronic inflammatory disease of the sinonasal mucosa and with strong associations to other immune-mediated comorbidities. Patients often require referral to both an otolaryngologist and an allergist/immunologist. This study is the first in the literature to describe a multidisciplinary clinic that offers patient care by subspecialists in rhinology and in allergy/immunology. METHODS: One hundred twenty-nine patients were seen in the Comprehensive Sinus and Allergy Clinic (CSAC) between January 2016 and June 2017 and 43 selected patients were seen in both the standalone allergy and rhinology clinics over the same time period. Patient satisfaction was retrospectively assessed using a modified Press-Ganey satisfaction survey. Time to evaluation and time to follow up appointment were compared between the CSAC and both the standalone rhinology and allergy/immunology clinics. RESULTS: Patients seen in the CSAC reported high satisfaction with the amount of time spent with the physicians (98.3%), quality of medical care (9.3 ± 1.0), and most importantly, the convenience of seeing two physicians in one day (9.5 ± 1.2). Time from referral placement to clinic evaluation (P ≤ .02) and time to follow up appointment (P ≤ .002) was significantly shorter for the CSAC than for the standalone Rhinology or Allergy clinics. CONCLUSION: Patients reported high satisfaction with the medical care provided and were also seen much faster in our multidisciplinary clinic as compared to standalone rhinology or allergy/immunology clinics. Overall, a multidisciplinary approach may be beneficial to patients presenting to tertiary referral centers with CRS and atopic conditions.


Assuntos
Alergia e Imunologia/organização & administração , Assistência Ambulatorial/organização & administração , Hipersensibilidade/diagnóstico , Otolaringologia/organização & administração , Otorrinolaringopatias/diagnóstico , Satisfação do Paciente , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Instituições de Assistência Ambulatorial , Asma Induzida por Aspirina/diagnóstico , Asma Induzida por Aspirina/terapia , Doença Crônica , Dessensibilização Imunológica , Eficiência Organizacional , Feminino , Humanos , Hipersensibilidade/terapia , Imunoterapia , Masculino , Pessoa de Meia-Idade , Pólipos Nasais/diagnóstico , Pólipos Nasais/terapia , Procedimentos Cirúrgicos Nasais , Otorrinolaringopatias/terapia , Seios Paranasais/cirurgia , Equipe de Assistência ao Paciente , Qualidade da Assistência à Saúde , Encaminhamento e Consulta , Rinite/diagnóstico , Rinite/terapia , Rinite Alérgica/diagnóstico , Rinite Alérgica/terapia , Sinusite/diagnóstico , Sinusite/terapia , Adulto Jovem
8.
Zhongguo Zhen Jiu ; 40(2): 199-202, 2020 Feb 12.
Artigo em Chinês | MEDLINE | ID: mdl-32100508

RESUMO

The academic thought of professor CHEN Ri-xin on "no allergy without any deficiency" was explored. Theory and the clinical application were elaborated on allergic diseases treated with heat-sensitive moxibustion. It is believed that the critical pathogenesis of allergic diseases is deficiency, particularly the deficiency of the lung, the spleen and the kidney. The invasion of exogenous factors or the disturbance of the retained pathogens in the body may induce allergy. Regarding the therapeutic method, the warming method is applicable for the deficiency and the heat-sensitization counteracts allergy. The sensitized points are detected in accordance with the two-step location method and they are stimulated with the suspended moxibustion. The feeling of heat-sensitive moxibustion is a sign of activation of endogenous regulatory function in the human body. It is a kind of external therapy for the internal disorders, directly acting on the pathogenesis, strengthening the antipathogenic qi and removing the allergic factors. This therapy is a new endogenous anti-allergic approach.


Assuntos
Terapia por Acupuntura , Hipersensibilidade/fisiopatologia , Moxibustão , Pontos de Acupuntura , Humanos , Hipersensibilidade/terapia , Rim/fisiopatologia , Pulmão/fisiopatologia , Medicina Tradicional Chinesa , Baço/fisiopatologia
9.
Expert Opin Ther Pat ; 30(3): 163-177, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31913726

RESUMO

Introduction: Allergic illnesses are one of the most prevalent immunological disorders worldwide and house dust mites are important triggers of these diseases. Allergen-specific immunotherapy (AIT) is an alternative treatment to pharmacotherapy and among its technologies, recombinant hypoallergenic derivatives have shown promising features, turn them into safer and more efficient allergy vaccines.Areas covered: Patents and scientific publications referring to advances in the design of Dermatophagoides spp. hypoallergenic molecules. Data were obtained from the Espacenet® and PubMed websites, using different key terms, advanced tools and Boolean operators for searches. The retrieved data were then descriptively analyzed, taking into consideration clinical targets, geographical, temporal, collaborative, and different classification aspects of the productions.Expert opinion: Joint advances of molecular biology, genetic engineering, and bioinformatics technologies led to progresses in the design of Dermatophagoides spp. hypoallergenic derivatives. Collaborative networks seem to be an interesting way not only to improve technologies in AIT but also to boost the number of patents, publications, and grants for researchers. The observed trend for the use of hypoallergenic hybrid molecules was a fundamental AIT advance and this type of molecule appears to be a more attractive product for companies and more convenient, efficient, and safer allergy immunotherapy for patients.


Assuntos
Dessensibilização Imunológica/métodos , Hipersensibilidade/terapia , Pyroglyphidae/imunologia , Alérgenos/imunologia , Animais , Humanos , Hipersensibilidade/imunologia , Patentes como Assunto
10.
Int Arch Allergy Immunol ; 181(3): 170-182, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31801149

RESUMO

OBJECTIVES: To systematically review the effect and safety of epicutaneous immunotherapy (EPIT) for allergic diseases. METHODS: We searched PubMed, EMBASE, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, CQ VIP Database, Wanfang Data, and international trial register from their inception to July 29, 2019, without language restrictions, for randomized controlled trials (RCTs) that compared EPIT versus no EPIT for allergen-triggered allergic reactions. We assessed certainty of evidence by the GRADE approach. RESULTS: Ten RCTs with 1,085 participants (aged from 10 months to 65 years) comparing EPIT with placebo for peanut, cow milk, or grass-pollen allergy met the eligibility criteria. A substantial benefit in terms of desensitization in EPIT group was more likely for peanut or cow milk protein allergy (risk ratio [RR] 2.34, 95% CI 1.69-3.23; I2 = 0%; high certainty evidence). EPIT increased local-treatment-related adverse events (L-TRAE; RR 1.56, 95% CI 1.03-2.36; I2 = 82%; moderate certainty evidence). But there were no significantly increased risk of any TRAEs (low certainty evidence) or systemic-TRAEs (S-TRAEs; very low certainty evidence) in EPIT group. The incidence rate of serious AEs, the use of rescue medications, and anaphylactic reactions stratified by organ systems including skin and mucosa, eyes and upper respiratory, lower respiratory, and gastrointestinal system in EPIT group were similar to placebo group. In subgroup analysis, desensitization of EPIT was significantly effective in peanut allergy (RR 2.29, 95% CI 1.64-3.21; I2 = 0%) and children <12 years (RR 2.85, 95% CI 1.92-4.24; I2 = 0%) with high certainty evidence. Only epicutaneous grass-pollen immunotherapy significantly increased the risk of S-TRAE (RR 4.65, 95% CI 1.10-19.64; I2 = 0%). CONCLUSION: The systematic review suggests that EPIT might induce desensitization in peanut allergy and an increased risk of local AEs. These findings should be interpreted with caution owing to the limited study and heterogeneity. More data in the older (children ≥12 years and adults) and other allergic diseases are needed.


Assuntos
Dessensibilização Imunológica/métodos , Hipersensibilidade/terapia , Alérgenos/imunologia , Ensaios Clínicos como Assunto , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/etnologia , Humanos , Hipersensibilidade/imunologia , Resultado do Tratamento
11.
Immunol Allergy Clin North Am ; 40(1): 1-14, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31761112

RESUMO

Allergen immunotherapy (AIT) is considered to be the only treatment option with the promise of healing and induction of long-lasting allergen tolerance, persisting even after discontinuation of therapy. Despite a more than 100-year-long history, still only a minority of patients are being treated with AIT. Substantial developments took place in the last decade to overcome problems in standardization, efficacy, safety, high costs, long duration of treatment; and new guidelines have also been implemented. Major advancements in the understanding of AIT mechanisms with the focus on recent findings of subcutaneous and sublingual AIT have been summarized.


Assuntos
Linfócitos B Reguladores/imunologia , Dessensibilização Imunológica/tendências , Hipersensibilidade/terapia , Linfócitos T Reguladores/imunologia , Administração Sublingual , Alérgenos/imunologia , Animais , Custos e Análise de Custo , Dessensibilização Imunológica/economia , Humanos , Hipersensibilidade/imunologia , Tolerância Imunológica , Imunidade Inata , Injeções Subcutâneas , Material Particulado/imunologia , Guias de Prática Clínica como Assunto , Padrões de Referência
12.
Immunol Allergy Clin North Am ; 40(1): 15-24, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31761116

RESUMO

Increasing safety while maintaining or even augmenting efficiency are the main goals of research for novel vaccine development and improvement of treatment schemes in allergen immunotherapy (AIT). To increase the efficacy of AIT, allergens have been coupled to innate immunostimulatory substances and new adjuvants have been introduced. Allergens have been modified to increase their uptake and presentation. Hypoallergenic molecules have been developed to improve the safety profile of the vaccines. Administration of recombinant IgG4 antibodies is a new, quick, passive immunization strategy with remarkable efficiency. Results of some current investigations aiming at further improvement of AIT vaccines have been summarized.


Assuntos
Alérgenos/uso terapêutico , Hipersensibilidade/terapia , Vacinas/imunologia , Adjuvantes Imunológicos , Alérgenos/genética , Animais , Dessensibilização Imunológica/métodos , Humanos , Hipersensibilidade/imunologia , Fragmentos de Peptídeos/genética , Proteínas Recombinantes/genética , Vacinação
13.
Immunol Allergy Clin North Am ; 40(1): 25-39, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31761119

RESUMO

Subcutaneous immunotherapy (SCIT) is effective for allergic rhinitis and conjunctivitis, asthma, and insect venom hypersensitivity. The risk of severe allergic reactions induced by SCIT remains low, and mild systemic reactions have recently shown a tendency to decline. However, near-fatal and fatal anaphylactic reactions may occur. Clinicians administering allergen-specific immunotherapy should receive specialized training and be aware of risk factors and preventive measures to avoid severe allergic reactions induced by SCIT.


Assuntos
Alérgenos/imunologia , Anafilaxia/epidemiologia , Asma/terapia , Dessensibilização Imunológica/efeitos adversos , Hipersensibilidade/terapia , Anafilaxia/etiologia , Asma/epidemiologia , Asma/imunologia , Humanos , Hipersensibilidade/epidemiologia , Hipersensibilidade/imunologia , Incidência , Injeções Subcutâneas , Fatores de Risco , Inquéritos e Questionários
14.
Immunol Allergy Clin North Am ; 40(1): 41-57, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31761120

RESUMO

There is some evidence to support the use of sublingual immunotherapy (SLIT) in food allergy, although its role is unclear. One randomized, double-blind, placebo-controlled trial supports the safe and efficacious use of dust mite SLIT in children with mild to moderate atopic dermatitis, but these data have not been confirmed. Although there are several randomized, double-blind, placebo-controlled trials to support the use of SLIT-LATEX, this product is not available in the United States and extrapolation of these effects to latex extracts is unsubstantiated. There is also insufficient evidence to support the use of SLIT for venom hypersensitivity at this time.


Assuntos
Dermatite Atópica/terapia , Hipersensibilidade/terapia , Imunoterapia Sublingual/métodos , Alérgenos/imunologia , Animais , Antígenos de Dermatophagoides/imunologia , Criança , Dermatite Atópica/imunologia , Alimentos , Humanos , Hipersensibilidade/imunologia , Látex/imunologia , Pyroglyphidae , Ensaios Clínicos Controlados Aleatórios como Assunto , Peçonhas/imunologia
15.
Immunol Allergy Clin North Am ; 40(1): 59-68, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31761121

RESUMO

Questions and controversies regarding venom immunotherapy (VIT) remain. It is important to recognize risk factors for severe sting anaphylaxis that guide the recommendation for testing, epinephrine injectors, and VIT. Premedication, rush VIT, and omalizumab are successful in overcoming recurrent systemic reactions to VIT. A maintenance dose is adequate in children, but higher doses are needed in high-risk patients. The consensus on risk of ß-blockers and angiotensin-converting enzyme inhibitors in patients on VIT has shifted to the belief that risk is small. The decision to stop VIT after 5 years rests on known risk factors rather than any diagnostic tests.


Assuntos
Anafilaxia/prevenção & controle , Mordeduras e Picadas/complicações , Dessensibilização Imunológica/métodos , Epinefrina/uso terapêutico , Hipersensibilidade/terapia , Omalizumab/uso terapêutico , Alérgenos/imunologia , Anafilaxia/etiologia , Animais , Criança , Dessensibilização Imunológica/efeitos adversos , Humanos , Hipersensibilidade/complicações , Hipersensibilidade/imunologia , Insetos , Peçonhas/imunologia
17.
Curr Opin Pediatr ; 31(6): 828-834, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31693594

RESUMO

PURPOSE OF REVIEW: Allergic rhinoconjunctivitis is the most common manifestation of allergic disease. This break in the normal natural function of the immune system to ignore harmless molecules such as pollen and pet dander to now aggressively react has lead to a substantial disease burden that is not always recognized and adequately treated. RECENT FINDINGS: Individual molecular component testing may increase the predictive value of blood sIgE and clinical symptoms. Defining the most symptoms inducing allergenic protein has led to advances in peptide-based allergen immunotherapy. There have been steady consistent reports that allergy immunotherapy for children with symptomatic allergic rhinitis prevents the onset of asthma. SUMMARY: Allergy immunotherapy is an effective disease-modulating treatment that alters the underlying immune dysfunction which is a currently underutilized therapy especially as it is likely effective in preventing the onset of asthma in children, at least in the short term.


Assuntos
Alérgenos/uso terapêutico , Asma/terapia , Hipersensibilidade/terapia , Imunoterapia/métodos , Rinite Alérgica/terapia , Alérgenos/imunologia , Criança , Dessensibilização Imunológica , Medicina Baseada em Evidências , Humanos , Hipersensibilidade/imunologia , Fatores Imunológicos
18.
J Agric Food Chem ; 67(47): 13127-13138, 2019 Nov 27.
Artigo em Inglês | MEDLINE | ID: mdl-31682438

RESUMO

Allergen-specific immunotherapy is the only available curative treatment for IgE-mediated allergen diseases. A safe hypoallergenic allergen derivative with high efficiency is required as a tolerogen to induce immune tolerance to the causitive allergens. In this study, to generate a rice-based oral allergy vaccine for Japanese cedar (JC) pollinosis, the tertiary structures of major JC pollen allergens, Cry j 1 and Cry j 2, were more completely destructed by shuffling than the previous ones without losing immunogenicity and then were specifically expressed in the endosperm of transgenic rice seed. They accumulated at high levels and were deposited in endoplasmic reticulum (ER) and ER-derived protein bodies. The low allergenicity of these deconstructed Cry j 1 and Cry j 2 allergens was evaluated by examining their binding activities to the specific IgE antibody and by the basophil degranulation test.


Assuntos
Antígenos de Plantas/imunologia , Cryptomeria/imunologia , Hipersensibilidade/imunologia , Oryza/genética , Plantas Geneticamente Modificadas/genética , Animais , Antígenos de Plantas/genética , Cryptomeria/genética , Humanos , Hipersensibilidade/terapia , Imunoterapia , Camundongos , Oryza/metabolismo , Plantas Geneticamente Modificadas/metabolismo , Pólen/genética , Pólen/imunologia , Ratos , Sementes/genética , Sementes/imunologia , Vacinas/administração & dosagem , Vacinas/genética , Vacinas/imunologia
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