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Angioedema Due to ACE Inhibitors
Opinion statementAngiotensin-converting enzyme inhibitors (ACEIs) are widely used for treatment of hypertension, congestive heart failure, and cardiovascular and renal protection in patients with heart failure, among others. Angioedema is a rare but potentially fatal adverse event (ACEI-AAE), whose prevalence is under 0.5  % among patients taking ACEIs and is higher among African Americans and female patients. There is no biomarker that allows diagnosis of ACEI-AAE, and the diagnosis is based on clinical history and the intake of ACEIs. Differential diagnosis with other causes of edema/angioedema must be considered. Recen...
Source: Current Treatment Options in Allergy - October 13, 2016 Category: Allergy & Immunology Source Type: research

Prosthetic and Device Surgery Considerations
Opinion StatementBiomedical implants have a broad array of therapeutic uses, most commonly in orthopedic procedures, such as dynamic hip and knee replacements. There are also wide-ranging applications in cardiology, gynecology, and other specialties. Use of metal components will likely expand with further medical innovations. Hypersensitivity reactions to these devices are well documented but uncommon. Patch testing is currently the best evaluation for metal hypersensitivity reactions (MHR). Preimplant testing for asymptomatic individuals is not necessary. Patients with a history of skin rashes dermatitis after metal conta...
Source: Current Treatment Options in Allergy - October 10, 2016 Category: Allergy & Immunology Source Type: research

Mast Cell Activation Syndromes
We describe associated conditions, such as Hymenoptera Reactions, Familial Tryptasemia, Postural Orthostatic Tachycardia Syndrome and Ehlers-Danlos Syndrome. (Source: Current Treatment Options in Allergy)
Source: Current Treatment Options in Allergy - October 9, 2016 Category: Allergy & Immunology Source Type: research

New Pharmacologic Strategies for Allergic Rhinitis
Opinion statementCurrent treatment guidelines for allergic rhinitis (AR) recommend a stepwise therapeutic approach that combines patient education with specific allergen avoidance, symptomatic pharmacotherapy, and allergen immunotherapy (AIT). The available pharmacological strategies provide suboptimal symptom relief in patients with moderate-to-severe disease who continue to experience symptoms while treated, even on multiple therapies. The development of new symptomatic drugs with improved pharmacokinetics and safety has recently opened new perspective in the field of AR treatment, overcoming current limitations and incr...
Source: Current Treatment Options in Allergy - October 9, 2016 Category: Allergy & Immunology Source Type: research

Preservative Sensitization —Safety With and Safety Without
This article will outline these preservatives, their role in cosmetics, scientific evidence for allergy and toxic effects, and potential alternatives. (Source: Current Treatment Options in Allergy)
Source: Current Treatment Options in Allergy - October 7, 2016 Category: Allergy & Immunology Source Type: research

The Use of Epicutaenous Patch Testing in the Evaluation of Gastrointestinal Disease
Opinion statementTraditionally, gastrointestinal (GI) diseases such as gastroesophageal reflux, gastritis, esophagitis, and irritable bowel syndrome (IBS) have not been thought of as hypersensitivity (allergy)-mediated illnesses; however, there has been growing research suggesting that food and environmental allergens may play a role in the development of GI illnesses, particularly those with refractory symptoms not responding to traditional therapies. The GI system and skin share similar components of the immune system and in some cases respond to foreign antigens in the same manner. With respect to confirmatory diagnosti...
Source: Current Treatment Options in Allergy - October 4, 2016 Category: Allergy & Immunology Source Type: research

Chronic Urticaria in Special Populations: Children, Pregnancy, Lactation and Elderly People
Opinion statementChronic urticaria can occur at any age and in both sexes. Regardless of the different populations affected, a stepwise treatment approach is recommended, beginning with non-sedating antihistamines, from licensed doses to a “controlled overdose” up to fourfold, followed by a change to a different antihistamine and/or addition of a leukotriene antagonist if symptoms persist; systemic corticosteroids in short courses (3 to 7 days) can be used for exacerbations. As a third-line therapy in adults, omalizumab is now co nsidered of choice and only in nonresponsive cases to omalizumab cyclosporin or other opt...
Source: Current Treatment Options in Allergy - September 22, 2016 Category: Allergy & Immunology Source Type: research

Does Antihistamine Up-dosing Solve Chronic Spontaneous Urticaria?
Opinion StatementUrticaria is primarily a disease driven by the actions of mast cell-derived histamine on the dermal vasculature and sensory nerves. Initial treatment with second generation minimally sedating H1-antihistamines is recommended. Start with the standard dose of one tablet daily. Because of the high local levels of histamine in the skin, standard doses of H1-antihistamines are often not able to control the symptoms. Thus, if symptoms persist after 2  weeks, then double the dosage of H1-antihistamines, usually giving one in the morning and one in the evening. If this is still not effective after 2  weeks, doub...
Source: Current Treatment Options in Allergy - September 9, 2016 Category: Allergy & Immunology Source Type: research

Desensitization for Peanut Allergies in Children
This article will describe the immunotherapy approaches that are being investigated to induce peanut desensitization, and highlight the benefits and risks of these therapies that need to be considered before they are ready for routine clinical practice. (Source: Current Treatment Options in Allergy)
Source: Current Treatment Options in Allergy - July 20, 2016 Category: Allergy & Immunology Source Type: research

Pediatric Allergic Rhinitis: the Stepwise Treatment Approach
Opinion Statement Treatment of allergic rhinitis in children requires a thoughtful, stepwise approach. Before considering medication for rhinitis, possibly chronic medication, you must (1) confirm disease based on symptoms or testing for offending allergens, (2) implement environmental controls when possible, (3) understand how allergy medication will affect children, and (4) recognize the need to use the minimum amount of medicine necessary to treat symptoms. Special attention to the impact of medication on school performance and social interactions is important when treating children. For intermittent s...
Source: Current Treatment Options in Allergy - July 18, 2016 Category: Allergy & Immunology Source Type: research

Advances in Food-Induced Anaphylaxis
Opinion statement Anaphylaxis is a potentially life-threatening severe systemic reaction and food allergy is one of its most frequent causes. Diagnosis of food-induced anaphylaxis requires diagnostic criteria for anaphylaxis based on clinical features and a comprehensive history. Adrenaline is a first-line treatment along with support measures. Epinephrine (adrenaline) is the first choice drug in anaphylaxis because it is the only medication that has been proved to reduce hospitalization and death. Long-term treatment based on an accurate identification of the anaphylaxis trigger, a clear education and tr...
Source: Current Treatment Options in Allergy - July 14, 2016 Category: Allergy & Immunology Source Type: research

Prevention of Anaphylaxis Based on Risk Factors and Cofactors
Opinion statement Anaphylaxis is most commonly caused by drugs, food, and hymenoptera stings, or in certain instances may be idiopathic. A variety of risk factors, cofactors, and augmenting factors may act together to trigger anaphylaxis. Patients with certain underlying medical conditions may be at increased risk of anaphylaxis of certain etiologies, e.g., monoclonal mast cell activation syndromes and insect venom anaphylaxis, asthma, and fatal food-induced anaphylaxis especially in adolescents. Identification of risk factors, cofactors, and augmenting factors during clinical assessment is key to determi...
Source: Current Treatment Options in Allergy - July 12, 2016 Category: Allergy & Immunology Source Type: research

Patch Testing in the Diagnosis of Medication Allergy
Opinion statement In evaluation of medication allergy, the utility of drug patch testing is dependent on both the type of drug reaction and the suspected causal drug. Epicutaneous patch tests reproduce T cell-mediated delayed hypersensitivity; thus, eruptions at least partially mediated by T cells can be confirmed by positive drug patch test (DPT) responses in some patients. These include acute generalized exanthematous pustulosis (AGEP), drug reaction with eosinophilia and systemic symptoms (DRESS), fixed drug eruptions (FDE), macular drug reactions (“morbilliform” or “exanthematous” reactions), ...
Source: Current Treatment Options in Allergy - July 11, 2016 Category: Allergy & Immunology Source Type: research

Pediatric Rhinosinusitis
Opinion statement Rhinosinusitis is defined as an inflammation of the paranasal and nasal sinus mucosae. Chronic rhinosinusitis (CRS) is a common problem in the pediatric age group, and the diagnosis and treatment are challenging due to the chronicity and similarity of symptoms with allergic rhinitis and adenoid hypertrophy. Although it is less common than acute rhinosinusitis, CRS is becoming more frequent and significantly affects the quality of life in children and can substantially impair daily function. CRS is characterized by sinus symptoms lasting more than 3 months despite medic...
Source: Current Treatment Options in Allergy - July 10, 2016 Category: Allergy & Immunology Source Type: research

Microbiota-Mediated Immunomodulation and Asthma: Current and Future Perspectives
Opinion statement Estimated to burden over 300 million people and their families around the world, asthma is now considered one of the most common forms of non-communicable disease worldwide (Masoli et al. Allergy Eur J Allergy Clin Immunol 59:469–78, 2004 1). The epidemic rise in prevalence this disease has seen over recent decades (Platts-Mills J Allergy Clin Immunol 136:3–13, 2015 2) suggests that environmental factors are the primary drivers of this phenomenon. In particular, the importance of early life microbial exposure and the composition of the early life gut and lung microbiota are emerging ...
Source: Current Treatment Options in Allergy - July 10, 2016 Category: Allergy & Immunology Source Type: research