RESUMO
BACKGROUND: Clinical trials of the mRNA coronavirus disease 2019 (COVID-19) vaccines excluded individuals with primary antibody deficiencies. OBJECTIVE: To evaluate whether antibody and T-cell responses to mRNA COVID-19 vaccination in patients with common variable immunodeficiency (CVID) and specific antibody deficiency (SAD) were comparable to those in healthy controls. METHODS: We measured antibody responses against the spike glycoprotein and the receptor-binding domain (RBD) in addition to severe acute respiratory syndrome coronavirus 2 specific T-cell responses using peripheral blood mononuclear cells 2 to 8 weeks after the subjects completed the primary 2-dose vaccine series. RESULTS: The study comprised 12 patients with CVID, 7 patients with SAD, and 10 controls. Individuals with CVID had lower immunoglobulin (Ig) G and Ig A levels against spike glycoprotein than did both individuals with SAD (P = .27 and P = .01, respectively) and controls (P = .01 and P = .004, respectively). The CVID group developed lower IgG titers against the RBD epitope than did the control group (P = .01). Participants with CVID had lower neutralizing titers than did the control group (P = .002). All participants with SAD developed neutralizing titers. All 3 groups (SAD, CVID, and control) developed antigen-specific CD4+ and CD8+ T-cell responses after vaccination. CONCLUSION: Our results suggest that patients with CVID may have impaired antibody responses to COVID-19 vaccination but intact T-cell responses, whereas patients with SAD would be expected to have both intact antibody and T-cell responses to vaccination.
Assuntos
COVID-19 , Imunodeficiência de Variável Comum , Doenças da Imunodeficiência Primária , Humanos , COVID-19/prevenção & controle , Vacinas contra COVID-19 , Leucócitos Mononucleares , Vacinação , Imunoglobulina G , GlicoproteínasAssuntos
Alergia e Imunologia , Asma , Hipersensibilidade , Escolaridade , Humanos , Estados Unidos/epidemiologiaAssuntos
Asma/epidemiologia , COVID-19/epidemiologia , Doença da Artéria Coronariana/epidemiologia , Diabetes Mellitus/epidemiologia , Insuficiência Cardíaca/epidemiologia , Hipertensão/epidemiologia , Pandemias , Insuficiência Renal Crônica/epidemiologia , Adulto , Idoso , Asma/mortalidade , Asma/patologia , Asma/virologia , COVID-19/mortalidade , COVID-19/patologia , COVID-19/virologia , Comorbidade , Doença da Artéria Coronariana/mortalidade , Doença da Artéria Coronariana/patologia , Doença da Artéria Coronariana/virologia , Diabetes Mellitus/mortalidade , Diabetes Mellitus/patologia , Diabetes Mellitus/virologia , Registros Eletrônicos de Saúde , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/patologia , Insuficiência Cardíaca/virologia , Humanos , Hipertensão/mortalidade , Hipertensão/patologia , Hipertensão/virologia , Unidades de Terapia Intensiva , Intubação Intratraqueal/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Prevalência , Insuficiência Renal Crônica/mortalidade , Insuficiência Renal Crônica/patologia , Insuficiência Renal Crônica/virologia , Estudos Retrospectivos , SARS-CoV-2/patogenicidade , Espanha/epidemiologia , Análise de SobrevidaAssuntos
Anafilaxia/epidemiologia , Vacinas contra COVID-19/efeitos adversos , Vacinas contra COVID-19/imunologia , Hipersensibilidade a Drogas/imunologia , COVID-19/prevenção & controle , Humanos , Polietilenoglicóis/efeitos adversos , Polissorbatos/efeitos adversos , SARS-CoV-2/imunologia , Estados Unidos/epidemiologiaRESUMO
OBJECTIVE: To review major milestones in the development of subcutaneous allergen immunotherapy in 20-year segments. DATA SOURCES: Review of the literature available in textbooks and journals. STUDY SELECTION: Articles and books addressing major achievements in the development of subcutaneous allergy immunotherapy were selected for inclusion in this review. RESULTS: Immunotherapy administration has improved the lives of possibly millions of patients with hay fever. Asthmatic symptoms have been relieved if not ablated in millions as well. Insect venom hypersensitivity became treatable and highly effective. In the beginning years of immunotherapy, it was clear that immunotherapy worked; in the later years, the mechanisms for this efficacy were discovered. In this case, the therapy preceded its validation. Methods, materials, and safety have vastly improved. Postulated mechanisms explain much but not everything. CONCLUSIONS: There is still research to be accomplished, improvements to be made, and, of course, patients to be made well.
Assuntos
Alérgenos/uso terapêutico , Venenos de Artrópodes/efeitos adversos , Dessensibilização Imunológica , Mordeduras e Picadas de Insetos/tratamento farmacológico , Hipersensibilidade Respiratória/tratamento farmacológico , Alérgenos/imunologia , Animais , Venenos de Artrópodes/administração & dosagem , Venenos de Artrópodes/imunologia , Dessensibilização Imunológica/tendências , Humanos , Injeções Subcutâneas , Mordeduras e Picadas de Insetos/imunologia , Insetos , Guias de Prática Clínica como Assunto , Hipersensibilidade Respiratória/imunologiaRESUMO
Cephalosporins are commonly used antibiotics both in hospitalized patients and in outpatients. Hypersensitivity reactions to cephalosporins are becoming increasingly common with a wide range of immunopathologic mechanisms. Cephalosporins are one of the leading causes for perioperative anaphylaxis and severe cutaneous adverse reactions. Patients allergic to cephalosporins tend to tolerate cephalosporins with disparate R1 side chains but may react to other beta-lactams with common R1 side chains. Skin testing for cephalosporins has not been well validated but appears to have a good negative predictive value for cephalosporins with disparate R1 side chains. In vitro tests including basophil activation tests have lower sensitivity when compared with skin testing. Rapid drug desensitization procedures are safe and effective and have been used successfully for immediate and some nonimmediate cephalosporin reactions. Many gaps in knowledge still exist regarding cephalosporin hypersensitivity.
Assuntos
Anafilaxia/imunologia , Cefalosporinas/efeitos adversos , Reações Cruzadas/imunologia , Toxidermias/imunologia , Hipersensibilidade a Drogas/imunologia , Anafilaxia/induzido quimicamente , Anafilaxia/epidemiologia , Teste de Degranulação de Basófilos , Cefalosporinas/química , Cefalosporinas/imunologia , Dessensibilização Imunológica , Toxidermias/epidemiologia , Toxidermias/etiologia , Hipersensibilidade a Drogas/diagnóstico , Hipersensibilidade a Drogas/epidemiologia , Hipersensibilidade a Drogas/terapia , Humanos , Período Perioperatório , Variantes Farmacogenômicos , Doença do Soro , Testes Cutâneos , beta-Lactamas/efeitos adversos , beta-Lactamas/imunologiaRESUMO
For decades, health care policy experts have wrestled with ways to solve problems of access, cost, and quality in US health care. The current consensus is that the solution to all three lies in changing financial incentives for providers and delivering care through integrated systems. The currently favored vehicle for this, both in the public and private sectors, is through Accountable Care Organizations (ACOs). Medicare has several models and has fostered rapid growth in the number of operative ACOs. At least an equal number of private ACOs are in operation. Whether or not these organizations will fulfill their promise is unknown but there is reason for cautious optimism. Allergists can and should be part of the process of this transformation in our health care system. They can be integral to helping these organizations save money by reducing hospitalizations and improving the quality of allergy and asthma care in the populations served. In order to accomplish this, allergists must become more involved in their medical communities and hospitals.