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Fabian Zellweger, Alexander Eggel
IgE-associated allergic diseases belong to the most common inflammatory conditions. Their clinical manifestation ranges from mild symptoms to life-threatening episodes. Often patients experience a reduction in physical and psychologic well-being and suffer from a decreased quality-of-life due to disease activity. The continuously rising number of people that are affected by an allergic condition indicates an urgent need for better diagnostics and more efficient treatment options. Recent progress in the understanding of pathophysiologic mechanisms underlying IgE-associated allergic disorders have led to the identification of novel therapeutic targets and the development of drug candidates that are currently under evaluation...
October 6, 2016: Allergy
Jasper H Kappen, Stephen R Durham, Hans In 't Veen, Mohamed H Shamji
Clinical and immunologic tolerance are hallmarks of successful allergen immunotherapy (AIT). Clinical benefits such as reduced symptoms, pharmacotherapy intake and improvement of quality of life persist following cessation of treatment. Successful AIT is associated with suppression of allergic inflammatory cells such as mast cells, eosinophils and basophils in target organs. Furthermore, AIT down-regulates type 2 innate lymphoid cells and allergen-specific type 2 T-helper (Th2) cells. The immunologic tolerant state following AIT is associated with the induction of distinct phenotypes of regulatory T-cells (T-regs) including interleukin (IL)-10-, IL-35- and transforming growth factor (TGF)-β- producing T-regs and FoxP3(+) T-regs...
September 27, 2016: Therapeutic Advances in Respiratory Disease
Mignon van den Elzen, M F C L Go, A C Knulst, M A Blankestijn, H van Os-Medendorp, H G Otten
Non-hereditary angioedema (AE) with normal C1 esterase inhibitor (C1INH) can be presumably bradykinin- or mast cell-mediated, or of unknown cause. In this systematic review, we searched PubMed, EMBASE, and Scopus to provide an overview of the efficacy of different treatment options for the abovementioned subtypes of refractory non-hereditary AE with or without wheals and with normal C1INH. After study selection and risk of bias assessment, 61 articles were included for data extraction and analysis. Therapies were described for angiotensin-converting enzyme inhibitor-induced AE (ACEi-AE), for idiopathic AE, and for AE with wheals...
September 27, 2016: Clinical Reviews in Allergy & Immunology
John W Steinke, Larry Borish
OBJECTIVE: To review the current knowledge surrounding different chronic rhinosinusitis (CRS) presentations and the relative roles of nasal polyps, eosinophilia, and allergies in discerning phenotypes. DATA SOURCES: PubMed literature review. STUDY SELECTIONS: Articles discussing the various phenotypes of CRS with emphasis on pathologic and immune mechanistic studies that distinguish disease. RESULTS: Current guidelines primarily separate CRS based on the presence or absence of nasal polyps...
September 2016: Annals of Allergy, Asthma & Immunology
Duy Le Pham, Ji-Ho Lee, Hae-Sim Park
PURPOSE OF THE REVIEW: The pathophysiology of aspirin-exacerbated respiratory disease (AERD) is not fully understood and diagnostic methods and so far, treatments for AERD have not been standardized. We summarize recent research into the pathological mechanisms of AERD, diagnostic methods, and treatments for AERD patients. RECENT FINDINGS: In AERD pathophysiology, not only the reduced expression of E prostanoid 2 but also the dysfunction of its pathway could be involved...
September 20, 2016: Current Opinion in Pulmonary Medicine
Carmen Rondón, Gador Bogas, Esther Barrionuevo, Miguel Blanca, Maria J Torres, Paloma Campo
In the past years several investigators have demonstrated the existence of local nasal responses in some patients with typical allergic rhinitis symptoms but without atopy, and have defined a new phenotype called local allergic rhinitis (LAR) or "entopy". In a percentage of LAR subjects, the upper airway disease is also associated with lower airway symptoms. After the description of this phenotype, the differential diagnosis between LAR and non-allergic rhinitis (NAR) has become a challenge for the clinician...
July 20, 2016: Allergy
Victoria Cardona, Olga Luengo, Moises Labrador
Allergic rhinitis and asthma constitute two clinical expressions of a single condition, respiratory allergy. Allergen immunotherapy (AIT) is a form of treatment specifically aimed at modifying the response to sensitizing allergens. The inherent potential benefit of AIT is the simultaneous treatment of all clinical expressions of respiratory allergy. Current data support the effectiveness of subcutaneous and sublingual immunotherapy in rhinitis. Studies also provide proof for a beneficial effect in allergic asthma...
July 20, 2016: Allergy
Claus Bachert, Cezmi A Akdis
Chronic rhinosinusitis can be differentiated into several phenotypes based on clinical criteria; however, these phenotypes do not teach us much about the underlying inflammatory mechanisms. Thus, the use of nasal endoscopy and CT scanning, and eventually taking a swab or a biopsy, may not be sufficient to fully appreciate the individual patient's pathology. Endotyping of chronic rhinosinusitis on the basis of pathomechanisms, functionally and pathologically different from others by the involvement of specific molecules or cells, may in contrast provide us with information on the risk of disease progression or recurrence and on the best available treatment, and also helps us identifying innovative therapeutic targets for treatment...
July 2016: Journal of Allergy and Clinical Immunology in Practice
Robert M Naclerio, Fuad M Baroody
Chronic rhinosinusitis (CRS) is difficult to define, partly because the disease recognized by clinicians is both heterogeneous and the endpoint of different pathophysiologic, genetic, and environmental interactions. For this article, we define CRS as symptoms lasting more than 3 months combined with an imaging study showing inflammation in the sinuses. This article comments on some factors that are believed to influence the expression of CRS. These factors include anatomic abnormalities, immotile cilia, age, allergic sensitization, immune deficiency, dental infections, gastrointestinal reflux, smoking, biofilm, and the microbiome...
July 2016: Journal of Allergy and Clinical Immunology in Practice
Alice E W Hoyt, Larry Borish, José Gurrola, Spencer Payne
This article reviews the history of allergic fungal rhinosinusitis and the clinical, pathologic, and radiographic criteria necessary to establish its diagnosis and differentiate this disease from other types of chronic rhinosinusitis. Allergic fungal rhinosinusitis is a noninvasive fungal form of sinus inflammation characterized by an often times unilateral, expansile process in which the typical allergic "peanut-butter-like" mucin contributes to the formation of nasal polyps, hyposmia/anosmia, and structural changes of the face...
July 2016: Journal of Allergy and Clinical Immunology in Practice
Dennis K Ledford, Richard F Lockey
Aspirin (ASA)-exacerbated respiratory disease (AERD) is characterized by upper airway congestion due to eosinophilic inflammation of the nasal and sinus membranes and nasal polyposis, associated with increased leukotriene production that is further accentuated by ASA or other nonsteroidal anti-inflammatory drug (NSAID) ingestion. It occurs in 5% to 10% of subjects with chronic rhinosinusitis (CRS) and in 15% to 40% of those with nasal polyposis. Although AERD with CRS is usually associated with asthma, this is not always the case...
July 2016: Journal of Allergy and Clinical Immunology in Practice
Sumit Bose, Leslie C Grammer, Anju T Peters
Chronic rhinosinusitis (CRS) is a persistent inflammatory disease that affects a multitude of people worldwide. The pathogenesis of CRS involves many factors including genetics, status of the sinonasal microbiome, infections, and environmental influences. Comorbidities associated with CRS include asthma, allergic rhinitis, bronchiectasis, and certain kinds of immunodeficiency. CRS can be divided into different subtypes based on endotypes and phenotypes. Infectious CRS is one such category. The etiology of infectious CRS is usually secondary to chronic bacterial infection that commonly begins with a viral upper respiratory tract infection...
July 2016: Journal of Allergy and Clinical Immunology in Practice
Seong Ho Cho, Dae Woo Kim, Philippe Gevaert
Chronic rhinosinusitis without nasal polyps (CRSsNP) is more prevalent than chronic rhinosinusitis with nasal polyps (CRSwNP). Certain diseases predispose to whereas others are associated with CRSsNP. Predisposing diseases include allergic and nonallergic upper and lower airway diseases, epithelial cell disorders, immunodeficiencies, autoimmune diseases, and some infectious diseases. In addition, environmental and host factors, examples of which include smoking, a higher incidence of abnormal biofilms, and innate immune defects, play a role in the pathogenesis of this disease...
July 2016: Journal of Allergy and Clinical Immunology in Practice
Whitney W Stevens, Robert P Schleimer, Robert C Kern
Chronic rhinosinusitis with nasal polyps (CRSwNP) is an important clinical entity diagnosed by the presence of both subjective and objective evidence of chronic sinonasal inflammation. Symptoms include anterior or posterior rhinorrhea, nasal congestion, hyposmia, and/or facial pressure or pain that last for a duration of more than 12 weeks. Nasal polyps are inflammatory lesions that project into the nasal airway, are typically bilateral, and originate from the ethmoid sinus. Males are more likely to be affected than females, but no specific genetic or environmental factors have been strongly linked to the development of this disorder to date...
July 2016: Journal of Allergy and Clinical Immunology in Practice
Hilary Longhurst, Anette Bygum
Hereditary angioedema due to C1 inhibitor deficiency (C1-INH-HAE) is a rare disorder characterized by intermittent and unpredictable episodes of swelling which cause disfigurement, disability, pain, or, in case of laryngeal swelling, risk of death. Historical factors, including the intermittent nature of the disorder, the lack of awareness of this ultra-rare condition amongst medical personnel, lack of specialist centers, and limited treatment options have contributed to under-diagnosis and under-treatment of the condition...
October 2016: Clinical Reviews in Allergy & Immunology
Axel Trautmann, Diana Anders, Johanna Stoevesandt
BACKGROUND: Therapeutic options for pain management are restricted in patients with nonsteroidal anti-inflammatory drug (NSAID)-induced or NSAID-exacerbated urticaria because strong cyclooxygenase (COX)-I inhibiting NSAID cannot be used. Alternative NSAID such as weak COX-I inhibitors or selective COX-II inhibitors are sometimes not sufficiently effective or have potentially troublesome adverse effects. OBJECTIVE: To date, prophylactic premedication with H1-antihistamines is rarely practiced in patients concurrently suffering from recurrent pain and NSAID-associated urticaria...
June 30, 2016: Journal of Allergy and Clinical Immunology in Practice
María J Torres, Maria Salas, Adriana Ariza, Tahia D Fernández
PURPOSE OF REVIEW: The purpose is to understand the underlying mechanisms of accelerated allergic reactions to drugs, defined here as reactions occurring between 1 and 24 h after drug intake. RECENT FINDINGS: Recent publications have shown that accelerated reactions are T cell-mediated, although an IgE mechanism cannot be ruled out in some cases. SUMMARY: Classification of allergic reactions to drugs is complex. Based on the time interval between drug administration and appearance of the clinical reaction, as well as the type of clinical symptoms, they can be classified as: immediate, typically appearing from less than 1 to 6 h after the last drug administration and nonimmediate, occurring at any time from 1 h after drug administration...
August 2016: Current Opinion in Allergy and Clinical Immunology
David González-de-Olano, Carla Lombardo, Eloína González-Mancebo
PURPOSE OF REVIEW: In this article, an overview of the main characteristics of the anaphylaxis in the elderly, a subset of the population with particular clinical and physiological features that might influence the presentation and management of this entity, is performed. RECENT FINDINGS: Life expectancy of the population is increasing and so is the prevalence of allergic diseases in the elderly, including anaphylaxis. Older people present higher risk of fatalities after anaphylaxis, and some comorbidities and pharmacological treatments they may use might also increase that risk...
August 2016: Current Opinion in Allergy and Clinical Immunology
Pedro Giavina-Bianchi, Marcelo Vivolo Aun, Edgardo José Jares, Jorge Kalil
PURPOSE OF REVIEW: The review critically assesses the different phenotypes of angioedemas associated with NSAIDs. Angioedemas exacerbated or induced by NSAIDs have high morbidity and, when they affect the larynx, can lead to death by asphyxiation. RECENT FINDINGS: Angioedema can present as a manifestation of a syndrome such as anaphylaxis or it can be a separate entity, which comprises different forms that can be diagnosed based on specific criteria. NSAIDs are the drugs most used worldwide and they are also one of the leading causes of angioedema...
August 2016: Current Opinion in Allergy and Clinical Immunology
Henriette Farkas, Nóra Veszeli, Erika Kajdácsi, László Cervenak, Lilian Varga
Angioedema, as a distinct disease entity, often becomes a clinical challenge for physicians, because it may cause a life-threatening condition, whereas prompt and accurate laboratory diagnostics may not be available. Although the bedside diagnosis needs to be established based on clinical symptoms and signs, family history, and the therapeutic response, later, laboratory tests are available. Currently, only for five out of the nine different types of angioedema can be diagnosed by laboratory testing, and these occur only in a minority of the patient population...
October 2016: Clinical Reviews in Allergy & Immunology
2016-07-06 21:16:57
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