Current Opinion in Allergy and Clinical Immunology最新文献

Tailoring the treatment of type-2 related chronic rhinosinusitis with or without nasal polyps: a comparative analysis of medical and surgical approaches.

IF 3 4区医学

Current Opinion in Allergy and Clinical Immunology Pub Date : 2024-12-24 DOI: 10.1097/ACI.0000000000001057

Francesco Giombi, Giuseppe Mercante, Emanuele Nappi, Valentina Marzio, Luca Malvezzi

{"title":"Tailoring the treatment of type-2 related chronic rhinosinusitis with or without nasal polyps: a comparative analysis of medical and surgical approaches.","authors":"Francesco Giombi, Giuseppe Mercante, Emanuele Nappi, Valentina Marzio, Luca Malvezzi","doi":"10.1097/ACI.0000000000001057","DOIUrl":"10.1097/ACI.0000000000001057","url":null,"abstract":"Purpose of review: Advances in understanding the molecular pathways underlying nasal epithelial inflammation have ushered in the era of personalized medicine for chronic rhinosinusitis with nasal polyps (CRSwNP). Research progress has led to the approval of several monoclonal antibodies (mAbs) for severe CRSwNP, demonstrating promising outcomes in both clinical trials and real-world settings. Similarly, evolution in surgical techniques has enhanced progression-free survival due to the development of novel approaches. This narrative review summarizes current evidence comparing medical and surgical options for CRSwNP.Recent findings: There is general consensus that surgery is most effective in reducing nasal polyp size (NPS), while mAbs appears to provide greater benefits in terms of quality-of-life measures and olfactory function. Overall, surgery has shown higher long-term cost-effectiveness, although this could change with the upcoming patent expirations of mAbs. Additionally, head-to-head trials will allow for a direct comparison of the effectiveness of different mAbs in disease-specific outcomes.Summary: The high heterogeneity among studies has limited the ability to draw definitive conclusions through meta-analyses. To date, endoscopic sinus surgery remains the preferred option for surgery-naive patients, while individuals with recalcitrant CRSwNP and confirmed type-2 inflammation should be considered for mAb treatment.","PeriodicalId":10956,"journal":{"name":"Current Opinion in Allergy and Clinical Immunology","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142869409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

What rationale for treatment of occupational interstitial lung diseases with the drugs approved for idiopathic pulmonary fibrosis? 用批准用于特发性肺纤维化的药物治疗职业性间质性肺病的理由是什么？

IF 3 4区医学

Current Opinion in Allergy and Clinical Immunology Pub Date : 2024-12-17 DOI: 10.1097/ACI.0000000000001055

Serena Bellani, Paolo Spagnolo

{"title":"What rationale for treatment of occupational interstitial lung diseases with the drugs approved for idiopathic pulmonary fibrosis?","authors":"Serena Bellani, Paolo Spagnolo","doi":"10.1097/ACI.0000000000001055","DOIUrl":"10.1097/ACI.0000000000001055","url":null,"abstract":"Purpose of review: To critically discuss the rationale for the use of drugs approved for idiopathic pulmonary fibrosis (IPF) to treat occupational interstitial lung diseases (OILDs).Recent findings: Although IPF and OILDs share several clinical, radiological and probably pathogenetic features, currently, OILDs do not have a standard of care. In recent years, our knowledge and understanding of ILDs has improved substantially. Recently, the progressive pulmonary fibrosis (PPF) phenotype, which refers to non-IPF fibrotic ILDs that progress despite appropriate treatment, has been defined. OILDs may also be progressive. Nintedanib, initially approved for treatment of IPF, is also approved in patients with PPF. On the other hand, pirfenidone is approved in IPF but not in PPF, due to the lack of robust evidence of efficacy in this patient subset.Summary: OILDs are a large and highly heterogeneous group of conditions without a proper standard of care. Nintedanib may slow functional decline and disease progression in progressive OILDs, and new clinical trials are ongoing.","PeriodicalId":10956,"journal":{"name":"Current Opinion in Allergy and Clinical Immunology","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142827749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Update on aspirin exacerbated respiratory disease with chronic rhinosinusitis.

IF 3 4区医学

Current Opinion in Allergy and Clinical Immunology Pub Date : 2024-12-06 DOI: 10.1097/ACI.0000000000001054

Jason R Gandre, Dennis K Ledford

{"title":"Update on aspirin exacerbated respiratory disease with chronic rhinosinusitis.","authors":"Jason R Gandre, Dennis K Ledford","doi":"10.1097/ACI.0000000000001054","DOIUrl":"https://doi.org/10.1097/ACI.0000000000001054","url":null,"abstract":"Purpose of review: This review provides the current understanding on the mechanism, diagnosis, and treatment of aspirin exacerbated respiratory disease (AERD) with chronic rhinosinusitis (CRS).Recent findings: Updates focus on the current understanding of type 2 inflammation as a disease driver, alterations in gene expression in nasal polyps, and use of biologics in treating aspirin exacerbated respiratory disease. Recent findings include altered expression of GATA binding protein 3 (GATA3), interleukin (IL)-4, IL-5, and IL-17 in nasal polyps supports the current understanding that type 2 inflammation predominantly drives the pathophysiology of AERD with CRS. From a clinical standpoint, biologics offer an effective treatment option to address type 2 inflammation. Biologics should not be favored over endoscopic sinus surgery and aspirin desensitization with daily aspirin therapy (unless contraindication are present) due to high associated cost and failure to achieve remission.Summary: This review outlines the current approach for diagnosis and treatment of aspirin exacerbated respiratory disease with a focus on desensitization protocols, the importance of endoscopic sinus surgery, the role of biologics, and the use of leukotriene modulators.","PeriodicalId":10956,"journal":{"name":"Current Opinion in Allergy and Clinical Immunology","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142784435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Precision medicine and choosing a biologic in asthma: understanding the current state of knowledge for predictors of response and clinical remission.

IF 3 4区医学

Current Opinion in Allergy and Clinical Immunology Pub Date : 2024-12-02 DOI: 10.1097/ACI.0000000000001044

Sadhana Balasubramanyam, Elizabeth K George, Eileen Wang

{"title":"Precision medicine and choosing a biologic in asthma: understanding the current state of knowledge for predictors of response and clinical remission.","authors":"Sadhana Balasubramanyam, Elizabeth K George, Eileen Wang","doi":"10.1097/ACI.0000000000001044","DOIUrl":"https://doi.org/10.1097/ACI.0000000000001044","url":null,"abstract":"Purpose of review: We review updated key literature on comparative meta-analyses and real-world effectiveness of asthma biologics, with a focus on predictors of response and clinical remission while highlighting ongoing knowledge gaps. We aim to provide insight into the many factors to consider when choosing a biologic to treat uncontrolled moderate to severe asthma.Recent findings: Predictors of response included higher type 2 (T2) biomarkers, shorter duration of asthma, and presence of key T2-related comorbidities. There were outcome-related variations in predictors. Predictors of clinical remission included better controlled asthma, better lung function, and higher T2 biomarkers. Few real-world studies included those treated with tezepelumab, a clear knowledge gap.Summary: Asthma biologics demonstrate clear real-world effectiveness. There have been significant strides in better understanding predictors of response or clinical remission to guide management, yet ongoing knowledge gaps and the heterogeneity of asthma preclude a simple algorithmic approach. Our tools for precision medicine include consideration of clinical phenotypes and shared decision making while striving to achieve clinical remission in all our patients with asthma.","PeriodicalId":10956,"journal":{"name":"Current Opinion in Allergy and Clinical Immunology","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142767322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Where AIRE we now? Where AIRE we going? 我们现在在哪里？我们要去哪里？

IF 3 4区医学

Current Opinion in Allergy and Clinical Immunology Pub Date : 2024-12-01 Epub Date: 2024-10-23 DOI: 10.1097/ACI.0000000000001041

Patrick Bez, Martina Ceraudo, Fabrizio Vianello, Marcello Rattazzi, Riccardo Scarpa

{"title":"Where AIRE we now? Where AIRE we going?","authors":"Patrick Bez, Martina Ceraudo, Fabrizio Vianello, Marcello Rattazzi, Riccardo Scarpa","doi":"10.1097/ACI.0000000000001041","DOIUrl":"10.1097/ACI.0000000000001041","url":null,"abstract":"Purpose of review: The purpose of the review is to describe the most recent advancement in understanding of the pivotal role of autoimmune regulator ( AIRE ) gene expression in central and peripheral tolerance, and the implications of its impairment in the genetic and pathogenesis of autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED) manifestations with insight into possible treatment options.Recent findings: AIRE gene expression has an important role of central and peripheral tolerance. Different AIRE gene mutations cause APECED, whereas polymorphisms and some variants may be implicated in development of other more frequently autoimmune diseases. Impaired negative T cell selection, reduction of T regulatory function, altered germinal center response, activated B cells and production of autoantibodies explain the development of autoimmunity in APECED. Recent data suggest that an excessive interferon-γ response may be the primer driver of the associated organ damage. Therefore, Janus kinase (JAK)-inhibitors may be promising therapies for treatment of broad spectrum of manifestations.Summary: AIRE has a pivotal role in immune tolerance. Disruption of this delicate equilibrium results in complex immune perturbation, ranging from severe autoimmunity, like APECED, to more common organ-specific disorders. Therefore, a deeper understanding of the correlation between AIRE function and clinical phenotype is warranted given the potential translational implication in clinical practice.","PeriodicalId":10956,"journal":{"name":"Current Opinion in Allergy and Clinical Immunology","volume":" ","pages":"448-456"},"PeriodicalIF":3.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11537476/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142496681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Liver disease in primary antibody deficiencies. 原发性抗体缺乏症的肝病。

IF 3 4区医学

Current Opinion in Allergy and Clinical Immunology Pub Date : 2024-12-01 Epub Date: 2024-09-25 DOI: 10.1097/ACI.0000000000001035

Patrick Bez, Klaus Warnatz

{"title":"Liver disease in primary antibody deficiencies.","authors":"Patrick Bez, Klaus Warnatz","doi":"10.1097/ACI.0000000000001035","DOIUrl":"10.1097/ACI.0000000000001035","url":null,"abstract":"Purpose of review: Liver disease has emerged as a major risk factor for increased mortality in patients with common variable immunodeficiency (CVID). This is mostly due to presinusoidal portal hypertension (PHTN) frequently secondary to nodular regenerative hyperplasia (NRH). Its pathogenesis is still poorly understood and treatment strategies for its various stages are often guided by trial and error. This review summarizes the most recent findings in the light of previous literature.Recent findings: In the last 2 years, different groups have addressed pathology, diagnostics, treatment, and liver transplantation. Histological examinations seem to support the pathogenetic sequence of T-cell mediated infiltration and damage of the sinusoidal space with secondary development of NRH, pericellular fibrosis, and the manifestation of PHTN. While markers of the early phase - beyond slight elevation of cholestatic enzymes - are still missing, elevated liver stiffness and splenomegaly above 16 cm longitudinal diameter have been suggested as warning signs for PHTN in CVID patients. Data on immunosuppressive treatment of this manifestation is still very heterogeneous, but a recent report on liver transplantation was encouraging for end stage liver disease.Summary: Liver disease deserves higher attention in the management of CVID. More studies are needed to understand its pathogenesis and optimal treatment.","PeriodicalId":10956,"journal":{"name":"Current Opinion in Allergy and Clinical Immunology","volume":" ","pages":"434-439"},"PeriodicalIF":3.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142343325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

STAT1 and STAT3 gain of function: clinically heterogenous immune regulatory disorders. STAT1 和 STAT3 功能增益：临床上的异源性免疫调节紊乱。

IF 3 4区医学

Current Opinion in Allergy and Clinical Immunology Pub Date : 2024-12-01 Epub Date: 2024-10-17 DOI: 10.1097/ACI.0000000000001039

Peter Olbrich, Alexandra F Freeman

{"title":"STAT1 and STAT3 gain of function: clinically heterogenous immune regulatory disorders.","authors":"Peter Olbrich, Alexandra F Freeman","doi":"10.1097/ACI.0000000000001039","DOIUrl":"10.1097/ACI.0000000000001039","url":null,"abstract":"Purpose of review: The identification of STAT1 gain-of-function (GOF) in 2011 and STAT3 GOF in 2014 has advanced our understanding of the host immunity along the JAK/STAT pathway and allowed targeted treatment approaches. We review the clinical features and pathogenesis of STAT1 and STAT3 GOF and how this has shaped new approaches to therapy.Recent findings: STAT1 GOF, initially described in patients with chronic mucocutaneous candidiasis (CMC) and autoimmune thyroid disease, is now recognized to cause early-onset multisystem autoimmunity and a range of infections. STAT3 GOF comprises mostly lymphoproliferation and autoimmunity but also with varying severity, including some with life threatening organ dysfunction. Treatment has evolved along with the understanding of the pathogenesis, with patients now receiving JAK inhibition to block upstream of the STAT defect with good response in autoimmunity and CMC in STAT1 GOF. Blockade of IL-6 signaling has also been used in STAT3 GOF. Hematopoietic cell transplantation had initial poor outcomes, but outcomes are now improving with focus on the control of inflammation pretransplant.Summary: Understanding the pathogenesis of STAT1 and STAT3 GOF has allowed great recent advancements in therapy, but many questions remain as to the best approach to therapy for each patient's clinical presentation as well as the durability of these therapies.","PeriodicalId":10956,"journal":{"name":"Current Opinion in Allergy and Clinical Immunology","volume":"24 6","pages":"440-447"},"PeriodicalIF":3.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11573110/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142544286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Hereditary angioedema due to C1-inhibitor deficiency: current therapeutic approaches. C1 抑制剂缺乏症导致的遗传性血管性水肿：当前的治疗方法。

IF 3 4区医学

Current Opinion in Allergy and Clinical Immunology Pub Date : 2024-12-01 Epub Date: 2024-10-15 DOI: 10.1097/ACI.0000000000001042

Giulia Costanzo, Giada Sambugaro, Davide Firinu

引用次数: 0

Editorial introductions. 编辑介绍。

IF 3 4区医学

Current Opinion in Allergy and Clinical Immunology Pub Date : 2024-12-01 Epub Date: 2024-10-31 DOI: 10.1097/ACI.0000000000001038

引用次数: 0

Real-world evidence of allergen immunotherapy. 过敏原免疫疗法的现实证据。

IF 3 4区医学

Current Opinion in Allergy and Clinical Immunology Pub Date : 2024-12-01 Epub Date: 2024-08-29 DOI: 10.1097/ACI.0000000000001026

Federica Buta, Giovanni Paoletti, Maria Chiara Bragato, Mattia Giovannini, Giorgio Walter Canonica, Enrico Heffler

{"title":"Real-world evidence of allergen immunotherapy.","authors":"Federica Buta, Giovanni Paoletti, Maria Chiara Bragato, Mattia Giovannini, Giorgio Walter Canonica, Enrico Heffler","doi":"10.1097/ACI.0000000000001026","DOIUrl":"10.1097/ACI.0000000000001026","url":null,"abstract":"Purpose of review: The full understanding of the long-term effectiveness and safety of allergen immunotherapy (AIT) for allergic respiratory diseases cannot be achieved through randomized controlled trials (RCTs) alone. However, real-world studies designed as registries can complement RCTs.Recent findings: The significance of registries is highlighted by their potential to reassess contraindications and collect data on adult and pediatric patients with multiple comorbidities who are often excluded from RCTs.Summary: AIT is the sole disease-modifying therapeutic approach capable of inducing tolerance and offering a long-term response to allergens. AIT has been shown to play a role in arresting the 'allergic march' in young people, which reduces the risk of developing asthmatic clinical manifestations. Although RCTs are considered the gold standard for evaluating the efficacy and safety of AIT, their duration is usually too short (seldom lasting more than 1 year) to assess the long-term effects of AIT. Several long-term studies show that AIT's effect depends strongly on its use duration.","PeriodicalId":10956,"journal":{"name":"Current Opinion in Allergy and Clinical Immunology","volume":" ","pages":"529-535"},"PeriodicalIF":3.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142105220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0