The Diagnosis and Management of Allergic Reactions Caused by Chinese Materia Medica
AbstractTraditional Chinese medicines (TCM) have been used in China for thousands of years. Although TCM has been generally perceived to be safe, adverse reactions to Chinese materia medica (CMM) have been reported. Most of the adverse reactions are allergic in nature, but other mechanisms may play a role. This review focuses on the mechanism and clinical presentation of these allergic reactions. Allergic reactions can occur as a result of the active and inactive ingredients of CMM. Impurities and chemicals generated during the production process can also lead to allergic or adverse reactions. Environmental factors such as...
Source: Clinical Reviews in Allergy and Immunology - February 19, 2021 Category: Allergy & Immunology Source Type: research

Correction to: Pathophysiology of Hereditary Angioedema (HAE) Beyond the SERPING1 Gene
The original version of this article unfortunately contained a mistake. The image of Fig.  1 should be corrected. In the previous figure, we had shown that the plasma kallikrein cleaves both high molecular weight kininogen (HMWK) and low molecular weight kininogen (LMWK) to produce bradykinin. However, the plasma kallikrein activates only high molecular weight kininogen (HMWK) while low molecular weight kininogen (LMWK) is activated by tissue kallikrein. Hence we have removed low molecular weight kininogen (LMWK) in the revised figure. We wish to acknowledge Dr. Allen P. Kaplan, Medical University of South Carolina, Charl...
Source: Clinical Reviews in Allergy and Immunology - February 17, 2021 Category: Allergy & Immunology Source Type: research

Biomarkers in Hereditary Angioedema
AbstractA biomarker is a defined characteristic measured as an indicator of normal, biologic, pathogenic processes, or biological responses to an exposure or intervention. Diagnostic biomarkers are used to detect a disease or a subtype of a disease; monitoring biomarkers are measured serially to assess a medical condition; response biomarkers are used to check biologic response following a medical intervention; predictive biomarkers are used to identify patients who are more likely to respond to a medical intervention; and prognostic biomarkers are used to assess the future likelihood of a clinical event. Although biomarke...
Source: Clinical Reviews in Allergy and Immunology - February 9, 2021 Category: Allergy & Immunology Source Type: research

New Instrument for the Evaluation of Prodromes and Attacks of Hereditary Angioedema (HAE-EPA)
In conclusion, t he new Prodrome-Attack Evaluation questionnaire (HAE-EPA) is capable of distinguishing attacks and prodromes of HAE, as well as determining associations between the two interrelated phenomena. The new instrument achieves the required discriminative ability, acceptability, and content validity/reliab ility and therefore can be used as a reliable tool for the investigation of prodromes, attacks, and their relationships. (Source: Clinical Reviews in Allergy and Immunology)
Source: Clinical Reviews in Allergy and Immunology - February 4, 2021 Category: Allergy & Immunology Source Type: research

B Cell Aberrance in Lupus: the Ringleader and the Solution
AbstractSystemic lupus erythematosus (SLE) is a prototypical autoimmune disease with high heterogeneity but the common characterization of numerous autoantibodies and systemic inflammation which lead to the damage of multiple organs. Aberrance of B cells plays a pivotal role in the immunopathogenesis of SLE via both antibody-dependent and antibody-independent manners. Escape of autoreactive B cells from the central and peripheral tolerance checkpoints, over-activation of B cells and their excessive cytokines release which  drive T cells and dendritic cells stimulation, and dysregulated surface molecules, as well as intrac...
Source: Clinical Reviews in Allergy and Immunology - February 3, 2021 Category: Allergy & Immunology Source Type: research

Differences and Similarities in the Mechanisms and Clinical Expression of Bradykinin-Mediated vs. Mast Cell –Mediated Angioedema
AbstractAngioedema (AE), transient localized swelling due to extravasated fluid, is commonly classified as mast cell mediator-induced, bradykinin-mediated or of unknown cause. AE often occurs more than once, and it is these recurrent forms of AE that are challenging for patients and physicians, and they are the ones we focus on and refer to as AE in this review. Since effective treatment depends on the causative mediator, reliable and early diagnosis is essential. Although their clinical presentations bear similarities, many forms of angioedema exhibit specific patterns of clinical appearance or disease history that may ai...
Source: Clinical Reviews in Allergy and Immunology - February 3, 2021 Category: Allergy & Immunology Source Type: research

The Enigma of Prodromes in Hereditary Angioedema (HAE)
AbstractA prodrome is a premonitory set of signs and symptoms indicating the onset of a disease. Prodromes are frequently reported by hereditary angioedema (HAE) patients, antedating attacks by a few hours or even longer. In some studies, high incidence of prodromes was reported by patients, with considerable number being able to predict oncoming attacks. Regrettably, prodromes have never received a consensual definition and have not been properly investigated in a systematic fashion. Therefore, their nature remains elusive and their contribution to the diagnosis and treatment of disorders is uncertain. The term “prodrom...
Source: Clinical Reviews in Allergy and Immunology - February 3, 2021 Category: Allergy & Immunology Source Type: research

Serum Immunoglobulin G Levels Predict Biochemical and Histological Remission of Autoimmune Hepatitis Type 1: A Single-Center Experience and Literature Review
In conclusion, lower serum IgG levels, less fibrosis in liver histology at diagnosis, and rapid response to immunosuppressive therapy are reliable predictors of biochemical and histological remission. Our study underscores the importance of early diagnosis and appropriate treatment. (Source: Clinical Reviews in Allergy and Immunology)
Source: Clinical Reviews in Allergy and Immunology - January 29, 2021 Category: Allergy & Immunology Source Type: research

Leveraging Genetics for Hereditary Angioedema: A Road Map to Precision Medicine
AbstractBiochemical studies performed during the last decades resulted in the development of various innovative medicinal products for hereditary angioedema (HAE). These therapeutic agents target the production or the function of bradykinin —the main mediator of HAE due to C1-inhibitor (C1-INH) deficiency. However, despite these remarkable achievements, current knowledge cannot provide convincing explanations for the clinical variability of the disease. As a consequence, treatment indications apply for drugs available for C1-INH defi ciency. The advent of high-throughput next-generation sequencing technologies may assist...
Source: Clinical Reviews in Allergy and Immunology - January 28, 2021 Category: Allergy & Immunology Source Type: research

Eosinophils in the Field of Nasal Polyposis: Towards a Better Understanding of Biologic Therapies
AbstractEosinophils are often considered as the pathologic landmark of chronic rhinosinusitis with nasal polyps (CRSwNP). Many studies emphasize their pivotal role in mucosal remodeling by their innate action via cytotoxic proteins degranulation. Eosinophil nasal recruitment from the bloodstream through endothelium diapedeses requires the intricate action between the nasal epithelium, epithelial cell-activated type 2 innate lymphoid cells, and adaptive immune cells secreting alarmins, cytokines, and specific chemokines. This immune pathway refers to a T-helper 2 (T2)-driven lymphocyte response, often considered as the main...
Source: Clinical Reviews in Allergy and Immunology - January 26, 2021 Category: Allergy & Immunology Source Type: research

In Search of an Association Between Genotype and Phenotype in Hereditary Angioedema due to C1-INH Deficiency
AbstractHereditary angioedema due to C1 inhibitor deficiency (C1-INH-HAE) is caused by mutations affecting the SERPING1 gene. Adult patients ( ≥ 18 years old) diagnosed with C1-INH-HAE were clustered according to a modified SERPING1 gene mutation classification [5]. Demographic, clinical, and laboratory data were studied. Published manuscripts on the genotype/phenotype relationship were reviewed. Eighty-eight patients participated in the study, with 78 having a classifiable mutation. We compared the data in the 3 largest groups: class 0 only (n = 32), class II only (n = 18), class III only (n = 22). Antigen...
Source: Clinical Reviews in Allergy and Immunology - January 19, 2021 Category: Allergy & Immunology Source Type: research

Clinical Treatment Options in Scleroderma: Recommendations and Comprehensive Review
AbstractThere are two major clinical subsets of scleroderma: (i) systemic sclerosis (SSc) is a complex systemic autoimmune disorder characterized by inflammation, vasculopathy, and excessive fibrosis of the skin and multiple internal organs and (ii) localized scleroderma (LoS), also known as morphea, is confined to the skin and/or subcutaneous tissues resulting in collagen deposition and subsequent fibrosis. SSc is rare but is associated with significant morbidity and mortality compared with other rheumatic diseases. Fatal outcomes in SSc often originate from organ complications of the disease, such as lung fibrosis, pulmo...
Source: Clinical Reviews in Allergy and Immunology - January 15, 2021 Category: Allergy & Immunology Source Type: research

Pathophysiology of Hereditary Angioedema (HAE) Beyond the SERPING1 Gene
AbstractHereditary Angioedema (HAE) is an autosomal dominant disorder characterized clinically by recurrent episodes of swelling involving subcutaneous tissues, gastrointestinal tract, and oro-pharyngeal area. Gene mutations are the most common genetic cause of HAE and observed in more than 90% of patients. More than 700 mutation variants have been described so far. Patients with angioedema who have no mutations in the gene for C1-INH and normal levels and activity of this inhibitor are labelled: normal C1 inhibitor HAE. These include genetic mutations in factor 12 gene, plasminogen gene, angiopoietin gene, kininogen 1, an...
Source: Clinical Reviews in Allergy and Immunology - January 14, 2021 Category: Allergy & Immunology Source Type: research

External Environmental Pollution as a Risk Factor for Asthma
AbstractAir pollution is a worrisome risk factor for global morbidity and mortality and plays a special role in many respiratory conditions. It contributes to around 8 million deaths/year, with outdoor exposure being responsible for more than 4.2 million deaths throughout the world, while more than 3.8 million die from situations related to indoor pollution. Pollutant agents induce several respiratory symptoms. In addition, there is a clear interference in numerous asthma outcomes, such as incidence, prevalence, hospital admission, visits to emergency departments, mortality, and asthma attacks, among others. The particulat...
Source: Clinical Reviews in Allergy and Immunology - January 12, 2021 Category: Allergy & Immunology Source Type: research

Current and Prospective Targets of Pharmacologic Treatment of Hereditary Angioedema Types 1 and 2
In conclusion, an increasing shift towards the use of highly effective long-term prophylaxis is anticipated, which should drastically abate the burden on patients with hereditary angioedema. (Source: Clinical Reviews in Allergy and Immunology)
Source: Clinical Reviews in Allergy and Immunology - January 9, 2021 Category: Allergy & Immunology Source Type: research