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4.
Curr Allergy Asthma Rep ; 19(4): 20, 2019 03 11.
Artigo em Inglês | MEDLINE | ID: mdl-30859323

RESUMO

PURPOSE OF REVIEW: The aim of this study is to critically review the relevant literature published on basophil activation test, presenting the current knowledge and future perspectives. RECENT FINDINGS: Basophil activation test (BAT) results varied accordingly to the class of the drug studied, and have promising results in immediate hypersensitivity reactions to pyrazolone (selective reactors), neuromuscular blockers, beta-lactams, and platinum compounds, all examples of classical IgE-mediated hypersensitivity drug reactions. Currently, BAT is applied in research settings, but based in the results of our review, the test can be considered as a diagnostic tool for daily practice for selected patients and selected drugs, when the test is available, particularly for patients who experienced severe reactions and when diagnosis cannot be stablished by serum-specific IgE and skin testing, in order to avoid unnecessary drug provocations tests.


Assuntos
Teste de Degranulação Basófila , Basófilos/imunologia , Hipersensibilidade a Drogas/diagnóstico , Hipersensibilidade Imediata/induzido quimicamente , Anti-Inflamatórios não Esteroides/efeitos adversos , Humanos , Hipersensibilidade Imediata/diagnóstico , Fármacos Neuromusculares/efeitos adversos , Pirazolonas/efeitos adversos , beta-Lactamas/efeitos adversos
6.
Clin Exp Allergy ; 49(3): 350-356, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30408255

RESUMO

BACKGROUND: The gold standard for the diagnosis of cow's milk allergy is the Double-Blind Placebo-Controlled Food Challenge (DBPCFC) test. However, disadvantages of the DBPCFC are the potential risk of anaphylactic reactions, the time-consuming procedure and high costs. OBJECTIVE: The aim of this study was to determine the reliability of the Basophil Activation Test (BAT) both for the initial diagnosis of cow's milk allergy in children and for the determination of tolerance in children with cow's milk allergy. METHODS: Ninety-seven BATs and cow's milk-specific IgE (sIgE) tests were performed in 86 infants/young children, suspected of (persistent) cow's milk allergy, who were qualified for an in-hospital DBPCFC. The BAT was performed with cow's milk extract and the purified major allergens casein, α-lactalbumin, ß-lactoglubulin. Basophil activation was determined by CD63 upregulation measured by flow cytometry. The BAT results were compared to the DBPCFC outcomes. RESULTS: Based on unequivocal DBPCFC and BAT result combinations (80%), the BAT had a sensitivity and specificity of 100% (CI: 86%-100% and 68%-100%, respectively) in IgE-sensitized children (41% of the tested children). All non-IgE-sensitized children (59%) had a negative DBPCFC and BAT, except for five patients. These latter showed delayed and relatively mild symptoms in the DBPCFC with a negative BAT, supporting a non-IgE-mediated allergy in these children. CONCLUSIONS AND CLINICAL RELEVANCE: The BAT seems reliable and cost-effective to diagnose patients with an IgE-mediated cow's milk allergy. In IgE-sensitized patients, a BAT might replace a DBPCFC. For non-IgE-sensitized patients presenting with mild symptoms, we propose to consider a (double-blind) extended (time) challenge test at home.


Assuntos
Alérgenos/química , Teste de Degranulação Basófila , Basófilos , Tolerância Imunológica , Imunoglobulina E/imunologia , Hipersensibilidade a Leite , Basófilos/imunologia , Basófilos/patologia , Pré-Escolar , Método Duplo-Cego , Feminino , Seguimentos , Humanos , Lactente , Masculino , Hipersensibilidade a Leite/imunologia , Hipersensibilidade a Leite/patologia , Estudos Prospectivos , Sensibilidade e Especificidade
7.
Immunobiology ; 224(1): 30-33, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30466958

RESUMO

INTRODUCTION: Chronic spontaneous urticaria (CSU) is characterized by recurrent itchy wheals, angioedema or both, that persist for longer than six weeks. In children, up to 40% of chronic spontaneous urticaria is due to mast cells and basophils-activating autoantibodies, mostly directed against the IgE high-affinity receptor subunit (FcεRI). Indirect basophil activation test (BAT) has been proposed in the diagnosis of autoimmune urticaria. MATERIALS AND METHODS: Sera from sixteen patients, aged from 2 to 15 yrs, with CSU were evaluated through indirect BAT by flow cytometry using a commercial kit (Flow CAST®, BUHLMANN Laboratories, Schonenbuch, Switzerland) according to the manufacturer's instructions. RESULTS: Indirect BAT test gave a much better diagnosis in our cohort than the gold standard ASST. Six children (37.5%) showed a positive indirect BAT while we could perform ASST in only 3 patients with just one patients showing a positive ASST. The specificity of BAT positive results was confirmed by the absence of significant difference between the BAT results obtained from negative controls vs negative sera of the patient (p = 0.65) on the basophil donors, indicating that the serum is not activating basophil per se. CONCLUSIONS: This pilot study suggests the utility of BAT to identify the subtype of autoimmune CSU in children in clinical practice.


Assuntos
Doenças Autoimunes/diagnóstico , Teste de Degranulação Basófila/métodos , Urticária/diagnóstico , Adolescente , Autoanticorpos/sangue , Células Cultivadas , Criança , Pré-Escolar , Doença Crônica , Estudos de Coortes , Feminino , Humanos , Masculino , Projetos Piloto , Receptores de IgG/imunologia
8.
Occup Environ Med ; 76(2): 78-82, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30554157

RESUMO

OBJECTIVES: Cannabis allergy has mainly been described following recreational use but some cases also point to cannabis sensitisation as a result of occupational exposure. As a consequence, little is known on the prevalence and clinical phenotype of occupational cannabis allergy. Therefore, this study aims to explore the allergy-associated health risks of occupational cannabis exposure in Belgian police force personnel. METHODS: 81 participants, active in the police force, reporting regular occupational cannabis exposure during the past 12 months, were included. History was combined with a standardised questionnaire on allergies and cannabis exposure.Basophil activation tests (BATs) with a crude cannabis extract and rCan s 3 were performed. In addition, specific (s)IgE rCan s 3 as well as sIgE to house dust mite, six pollen and three mould allergens were quantified. RESULTS: Although 42% of the participants reported respiratory and/or cutaneous symptoms on occupational cannabis exposure, all cannabis diagnostics were entirely negative, except one symptomatic case demonstrating a borderline result. Furthermore, there is no significant difference between the groups with and without symptoms on cannabis exposure in terms of allergenic sensitisations. CONCLUSIONS: The origins of the reported respiratory and cutaneous symptoms during cannabis exposure remain elusive but are probably due to non-immune reactions. It should be noted that the study was volunteer-based possibly reflecting an excessive number of symptomatic individuals. Nevertheless, as only one participant reported using fully protective gear, much improvement is needed for reducing the number of symptoms reported on duty, independent of their origin.


Assuntos
Cannabis/imunologia , Hipersensibilidade/diagnóstico , Hipersensibilidade/imunologia , Exposição Ocupacional/efeitos adversos , Polícia , Adulto , Alérgenos/análise , Teste de Degranulação Basófila , Bélgica , Feminino , Humanos , Hipersensibilidade/prevenção & controle , Imunoglobulina E/sangue , Masculino , Pessoa de Meia-Idade , Testes Cutâneos
10.
J Allergy Clin Immunol Pract ; 7(1): 61-65, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30573421

RESUMO

The risk for developing immediate or delayed hypersensitivity reactions to radiocontrast media (RCM) interferes with the diagnosis and treatment of a number of patients requiring imaging diagnostic methods for many common diseases. A group of experts met in Orlando, Florida, in March 2018 to analyze the similarities and differences in the management of RCM reactions in different areas of the world. This paper presents a summary of the recommendations provided by this consensus group, highlighting controversial issues and unmet needs that require further research.


Assuntos
Anafilaxia/prevenção & controle , Meios de Contraste/efeitos adversos , Diagnóstico por Imagem/efeitos adversos , Hipersensibilidade a Drogas/diagnóstico , Anafilaxia/etiologia , Teste de Degranulação Basófila , Conferências de Consenso como Assunto , Hipersensibilidade a Drogas/complicações , Prova Pericial , Humanos , Hipersensibilidade Tardia , Hipersensibilidade Imediata , Testes Cutâneos , Estados Unidos
11.
Curr Opin Allergy Clin Immunol ; 19(2): 92-97, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30585790

RESUMO

PURPOSE OF REVIEW: There is an unmet need for better immunological tests in cases of suspected occupational asthma to many workplace chemicals; here we consider the basophil activation test (BAT), a potential alternative to the detection of specific IgE antibodies. RECENT FINDINGS: BAT is fairly widely used in general allergy services; and there is increasing experience of its use in the diagnosis of occupational allergy to low molecular weight agents and chemicals including wood dusts, persulphates, antibiotics and latex. SUMMARY: There is potential for BAT to become a useful tool in the clinical consideration of occupational asthma and of its mechanisms, and even to take a place in a Bayesian-based diagnostic algorithm. Further development will only occur if specialist centres with appropriate facilities, and preferably in collaboration, contemplate its use.


Assuntos
Asma Ocupacional/diagnóstico , Teste de Degranulação Basófila/métodos , Basófilos/imunologia , Exposição Ocupacional/efeitos adversos , Alérgenos/imunologia , Animais , Degranulação Celular , Humanos , Imunoglobulina E/metabolismo , Material Particulado/imunologia , Hipersensibilidade Respiratória , Local de Trabalho
14.
J. investig. allergol. clin. immunol ; 29(2): 84-93, 2019. ilus, tab
Artigo em Inglês | IBECS | ID: ibc-184050

RESUMO

Eosinophilic asthma is the most common phenotype of severe asthma. It is characterized by abnormal production and release of type 2 cytokines from T helper type 2 (TH2) lymphocytes and type 2 innate lymphoid cells, such as IL-5. This leads to a persistent increase and activation of eosinophils in blood and the airways despite treatment with high-dose inhaled corticosteroids. Eosinophil differentiation, survival, and activation are preferentially regulated by IL-5, a cytokine that binds to the IL-5 receptor (IL-5R), which is located on the surface of eosinophils or basophils and plays a critical role in the pathogenesis and severity of asthma. Benralizumab is a monoclonal antibody that binds to IL-5R via its Fab domain, blocking the binding of IL-5 to its receptor and resulting in inhibition of eosinophil differentiation and maturation in bone marrow. In addition, this antibody is able to bind through its afucosylated Fc domain to the RIIIa region of the Fcgamma receptor on NK cells, macrophages, and neutrophils, thus strongly inducing antibody-dependent, cell-mediated cytotoxicity in both circulating and tissue-resident eosinophils. This double function of benralizumab induces almost complete fast and maintained depletion of eosinophils that is much greater than that induced by other monoclonal antibodies targeting the IL-5 pathway, such as mepolizumab and reslizumab. This review focuses on benralizumab as an alternative to other agents targeting the IL-5 pathway in the treatment of eosinophilic asthma


El asma eosinofílica es el fenotipo más común del asma grave. Se caracteriza por una producción y liberación anómala de citocinas de tipo 2, como la IL-5, por los linfocitos T colaboradores de tipo 2 (Th2) y las células linfoides innatas de tipo 2 (ILC-2). Con ello se activan los eosinófilos y se incrementa su número en sangre y vías respiratorias, a pesar del tratamiento con dosis altas de corticosteroides inhalados. La diferenciación, supervivencia y activación de los eosinófilos está regulada principalmente por la IL-5, una citocina que se une a su receptor (IL-5R), situado en la superficie de eosinófilos y basófilos, y que desempeña un papel fundamental en la patogénesis y gravedad del asma. El benralizumab es un anticuerpo monoclonal que se une al IL-5R a través de su dominio Fab, bloqueando la unión de la IL-5 a su receptor, lo que provoca una inhibición de la diferenciación y maduración de los eosinófilos en la médula ósea. Además, este anticuerpo es capaz de unirse a través de su dominio Fc afucosilado a la región RIIIa del receptor Fcgamma situado en células NK, macrófagos y neutrófilos, induciendo así una intensa citotoxicidad mediada por células dependiente de anticuerpos (ADCC), tanto de los eosinófilos circulantes como de los residentes en tejidos. Esta doble función del benralizumab induce una disminución casi completa de los eosinófilos de una forma rápida y mantenida, mucho mayor a la inducida por otros anticuerpos monoclonales dirigidos contra la IL-5, como el mepolizumab o el reslizumab. Esta revisión se centra en describir el uso del benralizumab en el tratamiento del asma eosinofílica como una alternativa a otros agentes que actúan directamente sobre la IL-5


Assuntos
Humanos , Asma/tratamento farmacológico , Eosinofilia/tratamento farmacológico , Interleucina-5/imunologia , Linfócitos/imunologia , Citocinas/imunologia , Teste de Degranulação Basófila/métodos , Exacerbação dos Sintomas , Asma/imunologia , Eosinofilia/imunologia , Variação Biológica da População/imunologia
18.
Expert Rev Clin Immunol ; 14(11): 957-964, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30261765

RESUMO

INTRODUCTION: Allergic rhinitis (AR) is a disorder with high prevalence worldwide. Identification of clinically relevant allergens is the key step for the diagnosis, allergen avoidance and allergen specific immunotherapy for AR. Areas covered: With the new findings of mechanisms of AR and the development of technology, much progress has been achieved in the diagnosis of AR recently. We review the recent advances about local IgE, in vivo and in vitro tests, cytological diagnosis and nitric oxide (NO) in the diagnosis of AR. Expert commentary: AR is traditionally diagnosed with the combined evaluation of history and allergen sensitization by in vivo skin prick tests and in vitro allergen specific IgE in serum, to confirm the correlation between clinical history and potential allergens. Nasal provocation test and local IgE measurement can be used to diagnose local AR. Allergen microarray has the ability to detect more potential allergens. Basophil activation and mast cell activation tests can be used in allergen diagnosis and to modify the response to immunotherapy, while cytological diagnosis is useful in the differential diagnosis of AR and non-AR. Nasal NO has been confirmed to be an optimal biomarker to discriminate between AR and non-AR.


Assuntos
Dessensibilização Imunológica/métodos , Rinite Alérgica/diagnóstico , Alérgenos/imunologia , Teste de Degranulação Basófila , Humanos , Imunoglobulina E/sangue , Anamnese , Testes de Provocação Nasal , Óxido Nítrico/metabolismo , Rinite Alérgica/terapia , Testes Cutâneos
19.
Adv Clin Exp Med ; 27(12): 1737-1744, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30066498

RESUMO

BACKGROUND: The basophil activation test (BAT) is an effective diagnostic tool in mold allergy, which is still not sufficiently known. OBJECTIVES: The aim of our study was to assess the degree of annexin V binding to the surface of the basophil cell membrane after stimulation with anti-immunoglobulin E (anti-IgE) and Alternaria alternata allergenic extract. MATERIAL AND METHODS: Alternaria alternata allergic patients (n = 32) and healthy volunteers (n = 33) were evaluated using skin prick tests (SPT), quantification of specific IgE (sIgE) and the BAT. Basophil activation was detected as a percentage degree of annexin V binding to the surface of the basophil cell membrane. RESULTS: Receiver operating characteristic (ROC) curve analysis yielded a threshold value of 4.95% of activated basophils when the tested group and control group were studied, with a sensitivity and specificity of 100% (area under curve [AUC] = 1; p = 0.00000) for 100 SBU/mL Alternaria alternata allergen extract. The threshold value was 10.28% with a sensitivity of 93.8% and specificity of 100% (AUC = 0.98958; p = 0.00000) for 10 SBU/mL mold extract, and 9.37% with a sensitivity of 90.3% and specificity of 100% (AUC = 0.96307; p = 0.00000) for 1 SBU/mL Alternaria alternata allergen extract. The method was least efficacious in antiIgE stimulation, where the threshold value was 5.48% with a sensitivity of 90.6% and specificity of 30.3% (AUC = 0.46780; p = 0.67039). CONCLUSIONS: The BAT with annexin V and sIgE measurement against Alternaria alternata increase the capability of a diagnostic laboratory for detecting mold sensitization. Both methods may certainly replace SPT, which are currently routinely used in allergy diagnosis. Annexin V may be considered a new basophil activation marker with an efficacy comparable to that of CD63 or CD203c.


Assuntos
Alternaria/imunologia , Teste de Degranulação Basófila/métodos , Basófilos/imunologia , Hipersensibilidade/diagnóstico , Imunoglobulina E/imunologia , Anexina A5 , Anticorpos Anti-Idiotípicos , Citometria de Fluxo , Humanos , Hipersensibilidade/sangue , Imunoglobulina E/sangue , Sensibilidade e Especificidade , Testes Cutâneos
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