Current Opinion in Allergy and Clinical Immunology最新文献_第10页

Drug allergy in primary care: systematic review to support quality improvement initiative of management and optimization of healthcare pathways. 药物过敏在初级保健:系统评价，以支持质量改进倡议的管理和优化保健途径。

IF 2.8 4区医学

Current Opinion in Allergy and Clinical Immunology Pub Date : 2023-08-01 DOI: 10.1097/ACI.0000000000000924

Clara Gaudin, Dermot Ryan, Pascal Demoly, Luciana Kase Tanno

{"title":"Drug allergy in primary care: systematic review to support quality improvement initiative of management and optimization of healthcare pathways.","authors":"Clara Gaudin, Dermot Ryan, Pascal Demoly, Luciana Kase Tanno","doi":"10.1097/ACI.0000000000000924","DOIUrl":"https://doi.org/10.1097/ACI.0000000000000924","url":null,"abstract":"Purpose of review: The aim of this study was to review the practice of general practitioners (GPs) in regard to the diagnosis and management of drug hypersensitivity reactions (DHRs) to identify major challenges and to facilitate the development of decision support tools to GPs confronted with DHRs patients.Recent findings: DHRs are still a challenge in the GPs clinical practice, which implies difficulties in clinical decisions and referral to allergy specialists.Summary: DHRs can range from mild to severe and even life-threatening. Drugs are the main cause of anaphylaxis deaths in most countries. Most DHRs are firstly seen by GPs, paediatricians or emergency doctors. However, our systematic review demonstrated difficulties in differentiating DHRs from other drug side effects. Most DHRs epidemiological data are from hospital and emergency departments, which may not reflect the real-life experience in primary care. GPs should be aware of the alert signs of DHRs: the involvement of other systems beyond the skin and/or atypical skin/ mucosal involvement, which mandated immediate referral to an emergency department. Data still stress difficulties in the recognition of DHRs clinical manifestations and highlight the need for decision aids to support their management by GPs. Structured clinical history and clinical examination are key diagnostic tools. Reasons for referring to allergy specialists based on the literature are to investigate cause, to undergo specific procedure, such as desensitization and to identify well tolerated, alternative drugs.","PeriodicalId":10956,"journal":{"name":"Current Opinion in Allergy and Clinical Immunology","volume":"23 4","pages":"263-270"},"PeriodicalIF":2.8,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10076306","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

New approaches in childhood asthma treatment. 儿童哮喘治疗新途径

IF 2.8 4区医学

Current Opinion in Allergy and Clinical Immunology Pub Date : 2023-08-01 DOI: 10.1097/ACI.0000000000000922

Riccardo Castagnoli, Ilaria Brambilla, Mattia Giovannini, Gian Luigi Marseglia, Amelia Licari

{"title":"New approaches in childhood asthma treatment.","authors":"Riccardo Castagnoli, Ilaria Brambilla, Mattia Giovannini, Gian Luigi Marseglia, Amelia Licari","doi":"10.1097/ACI.0000000000000922","DOIUrl":"https://doi.org/10.1097/ACI.0000000000000922","url":null,"abstract":"Purpose of review: This review aims to summarize the most recent advances in asthma management, focusing on novel approaches to pediatric asthma.Recent findings: In recent years, the therapeutic tools for pediatric asthma have expanded significantly for both the nonsevere and severe forms. The use of anti-inflammatory treatment, even for the mildest cases, and the withdrawal of symptomatic bronchodilation as monotherapy have been included in the most recent guidelines. Also, different biological therapies have revolutionized the therapeutical approach for severe uncontrolled asthma in children and adolescents.Summary: With the expanding landscape of novel therapeutic approaches for pediatric asthma, further evidence is needed to help clinicians choose the best option for patients, particularly those with severe asthma. The identification of novel predictive biomarkers may also help pediatricians in selecting children and adolescents for innovative therapies.","PeriodicalId":10956,"journal":{"name":"Current Opinion in Allergy and Clinical Immunology","volume":"23 4","pages":"319-326"},"PeriodicalIF":2.8,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10317303/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10075781","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

Highlights of the treatment of allergic rhinitis according to Chinese guidelines. 根据中国指南治疗过敏性鼻炎的要点。

IF 2.8 4区医学

Current Opinion in Allergy and Clinical Immunology Pub Date : 2023-08-01 DOI: 10.1097/ACI.0000000000000921

Min Zhang, Tian Ao, Lei Cheng

{"title":"Highlights of the treatment of allergic rhinitis according to Chinese guidelines.","authors":"Min Zhang, Tian Ao, Lei Cheng","doi":"10.1097/ACI.0000000000000921","DOIUrl":"https://doi.org/10.1097/ACI.0000000000000921","url":null,"abstract":"Purpose of review: This review aimed to introduce the pharmacotherapy of allergic rhinitis according to the 2022 updated Chinese guidelines.Recent findings: Despite recent advances in basic and clinical research worldwide, pharmacotherapy remains a mainstream in allergic rhinitis treatment. Usually, the first-line drugs, involving intranasal corticosteroids, second-generation oral and intranasal H1-antihistamines, or leukotriene receptor antagonists, can achieve acceptable outcomes in the treatment of allergic rhinitis. The second-line drugs, such as oral corticosteroids, intranasal decongestants and intranasal anticholinergics, can assist in controlling severe symptoms, like nasal congestion/blockage and watery rhinorrhea. For those with moderate-to-severe allergic rhinitis, evidence-based stepwise strategies are suitable, in which the types and dosages of drugs are de-escalated or upgraded according to their therapeutic efficacy. Meanwhile, omalizumab, a novel biological agent, has burgeoned to satisfy the need of patients.Summary: This review highlights the staples in Chinese guidelines about the pharmacotherapy for allergic rhinitis to better understand the guidelines and promote the clinical practice.","PeriodicalId":10956,"journal":{"name":"Current Opinion in Allergy and Clinical Immunology","volume":"23 4","pages":"334-340"},"PeriodicalIF":2.8,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10076305","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: 1

Giant cell arteritis and innovative treatments. 巨细胞动脉炎和创新治疗。

IF 2.8 4区医学

Current Opinion in Allergy and Clinical Immunology Pub Date : 2023-08-01 DOI: 10.1097/ACI.0000000000000923

Giulia Costanzo, Andrea Giovanni Ledda, Giada Sambugaro

{"title":"Giant cell arteritis and innovative treatments.","authors":"Giulia Costanzo, Andrea Giovanni Ledda, Giada Sambugaro","doi":"10.1097/ACI.0000000000000923","DOIUrl":"https://doi.org/10.1097/ACI.0000000000000923","url":null,"abstract":"Purpose of review: Giant cell arteritis (GCA) is an idiopathic and persistent condition characterized by granulomatous vasculitis of the medium and large vessels with overlapping phenotypes, including conventional cranial arteritis and extra-cranial GCA, also known as large-vessel GCA. Vascular problems linked with large vessel involvement may partly be caused by delayed diagnosis, emphasizing the necessity of early detection and the fast beginning of appropriate therapy. Glucocorticoids are the cornerstone of treatment for GCA, but using them for an extended period has numerous, often severe, side effects.Recent findings: clinical practice and novel discoveries on the pathogenic pathways suggest that steroid-free biologic treatments may be efficient and safe for GCA patients.Summary: since now, only Tocilizumab is approved for GCA treatment, but several drugs are currently used, and ongoing trials could give both researchers and patients novel therapeutic strategies for induction, maintenance, and prevention of relapse of GCA. The aims of this work is to synthesize evidence from current studies present in scientific literature about innovative treatment of Giant cell artheritis.","PeriodicalId":10956,"journal":{"name":"Current Opinion in Allergy and Clinical Immunology","volume":"23 4","pages":"327-333"},"PeriodicalIF":2.8,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10076307","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

New insights into the diagnosis and management of Stevens-Johnson syndrome and toxic epidermal necrolysis. 史蒂文斯-约翰逊综合征和中毒性表皮坏死松解症的诊断和治疗的新见解。

IF 2.8 4区医学

Current Opinion in Allergy and Clinical Immunology Pub Date : 2023-08-01 DOI: 10.1097/ACI.0000000000000914

Yuki Saito, Riichiro Abe

{"title":"New insights into the diagnosis and management of Stevens-Johnson syndrome and toxic epidermal necrolysis.","authors":"Yuki Saito, Riichiro Abe","doi":"10.1097/ACI.0000000000000914","DOIUrl":"https://doi.org/10.1097/ACI.0000000000000914","url":null,"abstract":"Purpose of review: Recent studies have been clarifying the pathogenesis and early diagnostic markers of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). Additionally, the efficacy of tumor necrosis factor alpha inhibitors is attracting attention. This review provides) recent evidence for the diagnosis and management of SJS/TEN.Recent findings: Risk factors for the development of SJS/TEN have been identified, particularly the association between HLA and the onset of SJS/TEN with specific drugs, which has been intensively studied. Research on the pathogenesis of keratinocyte cell death in SJS/TEN has also progressed, revealing the involvement of necroptosis, an inflammatory cell death, in addition to apoptosis. Diagnostic biomarkers associated with these studies have also been identified.Summary: The pathogenesis of SJS/TEN remains unclear and effective therapeutic agents have not yet been established. As the involvement of innate immunity, such as monocytes and neutrophils, in addition to T cells, has become clear, a more complex pathogenesis is predicted. Further elucidation of the pathogenesis of SJS/TEN is expected to lead to the development of new diagnostic and therapeutic agents.","PeriodicalId":10956,"journal":{"name":"Current Opinion in Allergy and Clinical Immunology","volume":"23 4","pages":"271-278"},"PeriodicalIF":2.8,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10130002","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

Clinical outcomes of AIT in the elderly population. AIT 在老年人群中的临床效果。

IF 2.8 4区医学

Current Opinion in Allergy and Clinical Immunology Pub Date : 2023-08-01 Epub Date: 2023-06-19 DOI: 10.1097/ACI.0000000000000925

Andrzej Bożek

{"title":"Clinical outcomes of AIT in the elderly population.","authors":"Andrzej Bożek","doi":"10.1097/ACI.0000000000000925","DOIUrl":"10.1097/ACI.0000000000000925","url":null,"abstract":"Purpose of review: This review aims to present the current knowledge on the effectiveness and safety of allergen immunotherapy (AIT) in patients over 60 years of age with inhalant allergies.Recent findings: Over the last 10 years, the problem of immunoglobulin E allergy in seniors has been noticed by many authors. At the same time, in the 1990s, trials of desensitization to selected inhalant allergens were started, obtaining evidence of the effectiveness of AIT, both with the use of sublingual immunotherapy (SLIT) and injection immunotherapy (SCIT), in patients over 60 years of age with allergic rhinitis. Such data have been confirmed for AITs for grasses, birch, and house dust mites. Currently, these patients are being monitored to assess the long-term effect of AIT. All available observations confirm the high safety of AIT in seniors.Summary: Seniors with allergic rhinitis or asthma may qualify for AIT if they do not have contraindications. These patients can experience a sustained clinical benefit even after completing AIT treatment. Studies indicate that injectable and sublingual routes of administration may be effective in this age group, provided the suspect allergen is accurately diagnosed.","PeriodicalId":10956,"journal":{"name":"Current Opinion in Allergy and Clinical Immunology","volume":"23 4","pages":"341-345"},"PeriodicalIF":2.8,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10749673/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10076302","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

Hypersensitivity to gadolinium-based contrast. 对钆造影剂过敏。

IF 2.8 4区医学

Current Opinion in Allergy and Clinical Immunology Pub Date : 2023-08-01 DOI: 10.1097/ACI.0000000000000911

Rocío Sáenz de Santa María, Marina Labella, Gádor Bogas, Inmaculada Doña, María José Torres

{"title":"Hypersensitivity to gadolinium-based contrast.","authors":"Rocío Sáenz de Santa María, Marina Labella, Gádor Bogas, Inmaculada Doña, María José Torres","doi":"10.1097/ACI.0000000000000911","DOIUrl":"https://doi.org/10.1097/ACI.0000000000000911","url":null,"abstract":"Purpose of review: The use of contrast media is increasing in recent decades. Although gadolinium-based contrast agents (GBCAs) are generally well tolerated, adverse reactions, including hypersensitivity reactions (HSRs), although infrequent, may occur. It is important to perform a thorough allergological evaluation in patients with suspected GBCA-HSRs to avoid potentially serious reactions in subsequent exposures.Recent findings: Data on GBCA-HSRs are scarce. Most published articles dealing with skin tests and drug provocation tests (DPTs) with GBCAs are case series and small cohorts. Controversies exist about the role of premedication for preventing HSRs on subsequent exposures. Selection of well tolerated alternatives is based on potential cross-reactivity among GBCAs; however, the extent of cross-reactivity among them remains unclear.Summary: As premedication is not useful because breakthrough reactions are frequent in patients with GBCA-HSRs in subsequent exposures, an allergological evaluation is required. Available data suggest a high negative predictive value of skin tests, being crucial for guiding the selection of an alternative GBCA. However, DPTs are still necessary to confirm or exclude the diagnosis or find alternative GBCAs. Cross-reactivity is high among GBCAs belonging from the same group, mainly among macrocyclic compounds, so this must be taken into account for selecting alternatives.","PeriodicalId":10956,"journal":{"name":"Current Opinion in Allergy and Clinical Immunology","volume":"23 4","pages":"300-306"},"PeriodicalIF":2.8,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10076304","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

Editorial introductions. 编辑介绍。

IF 2.8 4区医学

Current Opinion in Allergy and Clinical Immunology Pub Date : 2023-08-01 DOI: 10.1097/ACI.0000000000000917

引用次数: 0

Editorial introductions. 编辑介绍。

IF 2.8 4区医学

Current Opinion in Allergy and Clinical Immunology Pub Date : 2023-08-01 DOI: 10.1097/ACI.0000000000000917

引用次数: 0

Transgenic murine models for the study of drug hypersensitivity reactions linked to HLA-I molecules. 用于研究与hla - 1分子相关的药物过敏反应的转基因小鼠模型。

IF 2.8 4区医学

Current Opinion in Allergy and Clinical Immunology Pub Date : 2023-08-01 DOI: 10.1097/ACI.0000000000000913

Montserrat Puig, Michael A Norcross

{"title":"Transgenic murine models for the study of drug hypersensitivity reactions linked to HLA-I molecules.","authors":"Montserrat Puig, Michael A Norcross","doi":"10.1097/ACI.0000000000000913","DOIUrl":"https://doi.org/10.1097/ACI.0000000000000913","url":null,"abstract":"Purpose of review: Immune-mediated drug hypersensitivity reactions (DHRs) can be life-threatening and an impediment to drug development. Mechanism of disease studies are difficult to perform in humans. Here we review human leukocyte antigens class I (HLA-I) transgenic murine models and highlight how these systems have helped to elucidate drug-specific and host immune factors that initiate, propagate and control severe drug toxicities to skin and liver.Recent findings: HLA transgenic mice have been developed and used to study immune-mediated drug reactions in vitro and in vivo . CD8+ T cells from HLA-B∗57:01-expressing mice respond strongly to abacavir (ABC) in vitro but have self-limited responses to drug exposure in vivo . Immune tolerance can be overcome by depleting regulatory T cells (Treg) allowing antigen-presenting dendritic cells to express CD80/86 costimulatory molecules and signal through CD28 on the CD8+ T cell. Depletion of Treg also removes competition for interleukin 2 (IL-2) to allow T cell expansion and differentiation. Fine tuning of responses depends on inhibitory checkpoint molecules such as PD-1. Improved mouse models express only HLA in the absence of PD-1. These models show enhanced liver injury to flucloxacillin (FLX) which depends on drug priming, CD4+ T cell depletion, and lack of PD-1 expression. Drug-specific HLA-restricted cytotoxic CD8+ T cells can infiltrate the liver but are suppressed by Kupffer and liver sinusoidal endothelial cells.Summary: HLA-I transgenic mouse models are now available to study ABC, FLX and carbamazepine-induced adverse reactions. In vivo studies range from characterizing drug-antigen presentation, T cell activation, immune-regulatory molecules and cell-cell interaction pathways that are specifically involved in causing or controlling unwanted DHRs.","PeriodicalId":10956,"journal":{"name":"Current Opinion in Allergy and Clinical Immunology","volume":"23 4","pages":"279-286"},"PeriodicalIF":2.8,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10317295/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10130001","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