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Exacerbating Factors in Chronic Spontaneous Urticaria
AbstractPurpose of reviewChronic spontaneous urticaria (CSU) is frequently associated with autoimmunity and is often exacerbated by several factors. These include stress, infections, colourings and preservatives in pre-packaged foods, as well as deficiency of vitamin D3 and iron. While chronic underlying infection and mental and emotional stress have been known to precede the onset of CSU, it is now clear that they can also aggravate the severity of the symptoms and perpetuate the condition. It is unclear how gastrointestinal dysbiosis affects CSU. Vitamin D3, however, can increase T regulatory function which can control a...
Source: Current Treatment Options in Allergy - March 29, 2020 Category: Allergy & Immunology Source Type: research

Chronic Rhinosinusitis in Pediatric Immunodeficiency
AbstractPurpose of ReviewChronic rhinosinusitis and other sinopulmonary infections can be a hallmark of impaired immunity in children. Rhinosinusitis in the setting of immunodeficiency can often be chronic and refractory, and involve opportunistic pathogens. We review the evaluation and management of pediatric chronic rhinosinusitis in the context of primary immunodeficiency diseases.Recent FindingsImmunodeficiencies found to be associated with chronic rhinosinusitis include common variable immune deficiency, X-linked agammaglobulinemia, antibody deficiencies, hyper-IgM syndrome, hyper-IgE syndrome, Wiskott –Aldrich synd...
Source: Current Treatment Options in Allergy - March 23, 2020 Category: Allergy & Immunology Source Type: research

Anaphylaxis Attended in Emergency Departments: a Reliable Picture of Real-world Anaphylaxis
AbstractPurpose of reviewThe aim of this document is to review the epidemiology of anaphylaxis in the emergency departments (EDs) (burden and temporal trends), the generally deficient management of anaphylaxis in the ED, and the measures and interventions tested in different settings to improve management of anaphylaxis in the ED.Recent findingsThe population attended for anaphylaxis episodes is low (0.009 to 0.4%). Recent studies report an increase in anaphylaxis episodes attended in the ED. Discordance has been observed between the diagnosis of anaphylaxis in the ED and the diagnosis confirmed in allergy units; this can ...
Source: Current Treatment Options in Allergy - March 22, 2020 Category: Allergy & Immunology Source Type: research

In Vitro Diagnosis of Anaphylaxis: an Update
AbstractPurpose of reviewThe management of anaphylaxis, after a rapid clinical-based hypothesis and prompt treatment introduction, includes diagnosis confirmation. We reviewed main laboratory methods available for diagnosing anaphylaxis and its etiology. Then, we searched for new methods that can gain utility in the next few years.Recent findingsSerum tryptase is still the most accurate and available method for diagnosis during the acute phase, although it is necessary to measure baseline levels after a period of time. However, measurement of other mediators, such as histamine and lipid metabolites, is available in many si...
Source: Current Treatment Options in Allergy - March 20, 2020 Category: Allergy & Immunology Source Type: research

Delabelling Antibiotic Hypersensitivity in Children Is Critical for Future Treatments
AbstractPurpose of ReviewAntibiotics are most commonly prescribed drugs in children; among them, beta-lactams are the most frequently used antibiotics. Antibiotic allergy mislabelling is a considerable public health problem which is associated with adverse health and economic outcomes. In this review, the actual antibiotic allergy prevalence, the reasons for overdiagnosis, and the consequences of mislabelling are summarized.Recent FindingsThe physicians should consider the use of drug provocation tests without prior skin testing in the cases of non-immediate mild cutaneous reactions due to antibiotics as proposed by Pediat...
Source: Current Treatment Options in Allergy - March 15, 2020 Category: Allergy & Immunology Source Type: research

Unresponsiveness to Omalizumab in Chronic Spontaneous Urticaria
AbstractPurpose of the ReviewOmalizumab has become the mainstay of the treatment of severe CSU, but a subset of patients seems completely unresponsive to the drug. This review tried to understand the reasons for this different behavior.Recent FindingsGrowing evidence shows that IgE-mediated autoimmunity to an array of autoallergens is common in CSU, while IgG-mediated autoimmunity to IgE or to the high-affinity IgE receptor, which has been known for many years, seems to be involved in a minority of patients. This may explain the different responsiveness to anti-IgE therapy.SummaryCSU is probably an autoimmune disease in mo...
Source: Current Treatment Options in Allergy - March 2, 2020 Category: Allergy & Immunology Source Type: research

A Precision Medicine Approach to Rhinitis Evaluation and Management
AbstractPurpose of ReviewPrecision medicine (PM) represents a new paradigm in disease diagnosis, prevention, and treatment. The PM approach focuses on the characterization of different phenotypes and pathogenic pathways in order to allow the selection of specific biomarkers that will be useful in disease management. Rhinitis is a highly prevalent and heterogeneous disease, both in terms of underlying endotypes and clinical presentations. Therefore, to apply the PM principles to the various rhinitis subtypes rise as a meaningful strategy to improve evaluation and treatment.Recent FindingsThe technology of recombinant allerg...
Source: Current Treatment Options in Allergy - February 20, 2020 Category: Allergy & Immunology Source Type: research

Irritant Contact Dermatitis: Why It Happens, Who Suffers It and How to Manage
AbstractPurpose of ReviewIrritant contact dermatitis (ICD) is defined as a localized skin reaction to irritants which does not require prior sensitization of the immune adaptative system. ICD is a consequence of direct toxic effect of physical or chemical agents resulting in keratinocyte damage. The purpose of this review was to highlight the various aspects of ICD to improve its management.Recent FindingsIt is now known that ICD is a complex reaction that involved both endogenous and exogenous factors, and does not represent a homogenous entity but can cover various clinical subtypes. The management of ICD is based on its...
Source: Current Treatment Options in Allergy - February 18, 2020 Category: Allergy & Immunology Source Type: research

How Mechanism Knowledge Can Help to Management of Drug Hypersensitivity
AbstractPurpose of reviewTo describe the mechanisms involved in the heterogeneous drug hypersensitivity reactions and how a better understanding of them can help in the correct diagnosis, the improvement of the in vitro diagnostic methods, and the management of the reaction.Recent findingsWe know that drug hypersensitivity reactions are mediated by different mechanisms and until now some drugs have been reported to be able to activate the immune system by a single mechanism while other drugs can be involved in different mechanisms. Moreover, studies show that important clinical aspects such as risk factors, predictability,...
Source: Current Treatment Options in Allergy - February 3, 2020 Category: Allergy & Immunology Source Type: research

Perioperative Reactions to Sugammadex
AbstractPurpose of the reviewThe γ-cyclodextrin sugammadex, chemically modified to encapsulate the steroidal muscle relaxant rocuronium, was introduced into anesthesia as the first selective relaxant binding agent to reverse neuromuscular blockade. In the face of sugammadex’s alleged propensity to cause anaphylaxis, the agent wa s finally approved by the FDA in 2015. With its steadily increasing usage, it has become apparent that there is a small but concerning incidence of perioperative anaphylaxis to sugammadex and some reactions that are anaphylactic like but where diagnosis has not been definitive. The purpose here ...
Source: Current Treatment Options in Allergy - February 2, 2020 Category: Allergy & Immunology Source Type: research

Anaphylaxis Induced by Magnetic Resonance Imaging (MRI) Contrast Media
Opinion statementPurpose of reviewThe aim of this document is to review the epidemiology, diagnosis, and treatment of immediate and anaphylactic reactions to gadolinium-based contrast agents (GBCA) most commonly used in magnetic resonance imaging (MRI).Recent findingsThe frequency of adverse reactions to GBCA ranges from 0.04 to 2.2%. Most reactions are mild (47% –95%) and the frequency of anaphylactic shock is 0.004%–0.01%. Mortality due to anaphylaxis induced by GBCAs has been 0.0019%.Allergic reactions are more frequent in patients with a previous reaction, in females, using macrocycle estructure GBCA and with hepat...
Source: Current Treatment Options in Allergy - January 29, 2020 Category: Allergy & Immunology Source Type: research

Childhood Anaphylaxis: State of the Art
AbstractPurpose of the ReviewAnaphylaxis is a systemic immunologic reaction of immediate hypersensitivity that occurs as consequence of an interaction between antigen and immunoglobulin E (IgE) and may be potentially fatal. Anaphylaxis symptoms usually occur minutes or seconds after the exposure to the causing allergen. The sooner the reaction is established, the more severe it is. The main causes in children are food (cow ’s milk, peanut, egg) and insect bite. Its clinical manifestations usually vary. They can be mild, presenting with hives, angioedema, abdominal pain; or severe, presenting with hypotension or shock, an...
Source: Current Treatment Options in Allergy - January 26, 2020 Category: Allergy & Immunology Source Type: research

Hypersensitivity Reactions to Biologicals: from Bench to Bedside
AbstractPurpose of ReviewBiologic agents are new treatment options for chronic inflammatory diseases and cancers. As a result of their unique mechanism of action, they are more effective and less toxic treatment option and their clinical usage is increasing. While they are more commonly used, various adverse effects have been observed including life-threatening ones, including anaphylaxis. The aim of this review is to distinguish the anaphylaxis from other hypersensitivity reactions (HSR) and provide a management algorithm for the anaphylactic reactions induced by biological agents.Recent FindingsMany case reports and seri...
Source: Current Treatment Options in Allergy - January 17, 2020 Category: Allergy & Immunology Source Type: research

The Roadmap From Allergic Rhinitis to Asthma
AbstractPurpose of reviewUpper and lower airways display some common characteristic described as a holistic model. Because rhinitis may proceed asthma, it is imperative to understand the mechanisms and risk factors responsible for the progression from rhinitis to asthma.Recent findingsSubclinical lower airway abnormalities have been observed in patients with rhinitis without asthma. Recent evidence indicates that these patients may have an increased risk of developing asthma. Environmental and genetic factors can contribute to enhance this possibility. The treatments of rhinitis have also been shown to be beneficial to the...
Source: Current Treatment Options in Allergy - January 14, 2020 Category: Allergy & Immunology Source Type: research

Vitamin-Induced Anaphylaxis
AbstractPurpose of reviewThis paper aimed to summarize and review the known data on anaphylaxis and hypersensitivity reactions to vitamins.Recent FindingsVitamins A, C, D, and E seem to be extremely safe compounds, with few or no related case of anaphylaxis to them. Vitamin B1 is considered the most allergenic vitamin. Immediate reactions are unusual, but urticaria and anaphylaxis to thiamine intravenous administration have been described. Vitamin B12 hypersensitivity is also infrequent. Reactions occur mostly in patients receiving long-term supplementation. Desensitization is mandatory for patients with hypersensitivity t...
Source: Current Treatment Options in Allergy - January 13, 2020 Category: Allergy & Immunology Source Type: research