ALERGOLOGÍA PARA MÉDICOS Y PACIENTES 2021

 Food allergies and food-induced anaphylaxis: Role of cofactors Authors: Meeyong Shin   Abstract Food allergies and food-induced anaphylaxis are important health problems. Several cofactors modulating the onset of anaphylaxis have been identified. In the presence of cofactors, allergic reactions may be induced at lower doses of food allergens and/or become severe. Exercise and concomitant infections are well-documented cofactors of anaphylaxis in children. Other factors such as consumption of nonsteroidal anti-inflammatory drugs, alcohol ingestion, and stress have been reported. Cofactors reportedly play a role in approximately 30% of anaphylactic reactions in adults and 14-18.3% in children. Food-dependent exercise-induced anaphylaxis (FDEIA) is the best-studied model of cofactor-induced anaphylaxis. Wheat-dependent exercise-induced anaphylaxis, the most common FDEIA condition, has been studied the most. The mechanisms of action of cofactors have not yet been fully identified. This re

 Omalizumab Updosing in Chronic Spontaneous Urticaria: an Overview of Real-World Evidence Authors: Martin Metz, Zahava Vadasz, Emek Kocatürk & Ana M. Giménez-Arnau Abstract Chronic spontaneous urticaria (CSU) is defined as the spontaneous development of itchy hives and/or angioedema due to known or unknown causes that last for at least 6 weeks. At any given time, CSU is believed to affect 0.5–1% of the global population. Omalizumab (a recombinant, humanized anti-immunoglobulin-E antibody) is the only approved treatment for antihistamine refractory CSU. However, ~ 30% of patients remain symptomatic at licensed doses of omalizumab 150 mg and 300 mg, even after a treatment period of over 6 months. In the recent years, there have been several studies on updosing of the drug, suggesting that the individualized approach for urticaria treatment with omalizumab is useful. In this article, we provide an overview of these studies and the real-world data on omalizumab updosing as it became ne

 Rhinitis Phenotypes Authors: Joaquim MullolMD, PhDabAlfonsodel CuvilloMD, PhDcRichard F.LockeyMDd Abstract Rhinitis is an umbrella term of a group of upper airway diseases with nasal symptoms and signs with different etiologies and various clinical features or traits. It can be classified into different “phenotypes,” based on these observable traits. A proper differential diagnosis is necessary to adequately manage the disease. The objective of this review is to clarify the concept of rhinitis phenotypes while analyzing the clinical features and/or traits of each in order to determine a proper differential diagnosis and appropriate treatment. 10.1016/j.jaip.2020.02.004

 Progress in understanding hypersensitivity reactions to nonsteroidal anti-inflammatory drugs Authors: Inmaculada Doña  1   2 , Natalia Pérez-Sánchez  1   2   3 , Ibon Eguiluz-Gracia  1   2 , Rosa Muñoz-Cano  4   5 , Joan Bartra  4   5 , María José Torres  1   2   3   6 , José Antonio Cornejo-García  1 Abstract Nonsteroidal anti-inflammatory drugs (NSAIDs), the medications most commonly used for treating pain and inflammation, are the main triggers of drug hypersensitivity reactions. The latest classification of NSAIDs hypersensitivity by the European Academy of Allergy and Clinical Immunology (EAACI) differentiates between cross-hypersensitivity reactions (CRs), associated with COX-1 inhibition, and selective reactions, associated with immunological mechanisms. Three phenotypes fill into the first group: NSAIDs-exacerbated respiratory disease, NSAIDs-exacerbated cutaneous disease and NSAIDs-induced urticaria/angioedema. Two phenotypes fill into the second one: single-NSAID-induced ur

 A butterfly flaps its wings: Extinction of biological experience and the origins of allergy Authors: Susan L.PrescottMD, PhD, FRACP∗† Abstract Objective To explore links between biodiversity on all scales and allergic disease as a measure of immune dysregulation. Data Sources PubMed and Web of Science were searched using the keywords biodiversity, nature relatedness, allergic disease, microbiome, noncommunicable diseases, coronavirus disease 2019, and associated terms. Study Selections Studies were selected based on relevance to human health and biodiversity. Results Contact with natural environments enriches the human microbiome, promotes regulated immune responses, and protects against allergy and both acute and chronic inflammatory disorders. These important links to ecopsychological constructs of the extinction of experience, which indicates that loss of direct, personal contact with biodiversity (wildlife and the more visible elements of the natural world), might lead to emotiona

 Clinical Control of CSU with Antihistamines Allows for Tolerance of NSAID-Exacerbated Cutaneous Disease Authors: Jorge Sánchez  1 , Susana Diez  2 , Ricardo Cardona  2 Abstract Background: Many patients with chronic spontaneous urticaria (CSU) experience exacerbations after the administration of nonsteroidal anti-inflammatory drugs (NSAIDs), with clinical implications for the selection of therapeutic options for pain management. Case reports suggest that antihistamines could prevent these reactions. Objective: To determine whether antihistamines can prevent NSAID-exacerbated reactions in patients with CSU. Methods: Data on 121 patients with CSU and a history of NSAID exacerbations were evaluated. Two types of challenge with NSAIDs were performed using the NSAIDs reported in the medical record (a diagnostic challenge test without the use of antihistamines and a challenge test using antihistamines). The order in which the tests were performed in each patient was dependent on the treatin

 Neuromuscular blocking agents induced anaphylaxis: Results and trends of a French pharmacovigilance survey from 2000 to 2012 Authors: N Petitpain  1 , L Argoullon  1 , K Masmoudi  2 , S Fedrizzi  3 , J Cottin  4 , C Latarche  5 , P M Mertes  6 , P Gillet  7 , French Network of Regional Pharmacovigilance Centres Abstract Background: Perioperative anaphylaxis mainly involves neuromuscular blocking agents (NMBAs) with an IgE-mediated mechanism. In France, this life-threatening condition is reported by anesthetists and allergologists, and two safety alerts concerning suxamethonium were raised in 2011 and 2012. This led to start a national survey over the 2000-2012 period which objectives were to provide a descriptive analysis, to estimate incidence rates, and to analyze the trends over this period. Methods: The French pharmacovigilance database was retrospectively queried for all the available NMBAs. Anaphylaxis cases with elevated tryptase and positive skin tests were qualified as "

 Delayed Pressure Urticaria: A Systematic Review of Treatment Options Authors: Kanokvalai Kulthanan  1 , Patompong Ungprasert  2 , Papapit Tuchinda  1 , Leena Chularojanamontri  1 , Norramon Charoenpipatsin  1 , Marcus Maurer  3 Abstract Background: Delayed pressure urticaria (DPU) is characterized by recurrent erythematous and often painful swelling after the skin is exposed to sustained pressure. Treatment is challenging. Antihistamines, the first-line and only approved treatment, are often not effective. Objective: To systematically review the treatment options for DPU. Method: A literature search of electronic databases for all relevant articles published till April 29, 2019, was conducted using the search terms "delayed pressure urticaria" and "pressure urticaria." This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. Results: Twenty-one studies (8 randomized controlled tr

 Clinical and in vitro cross-reactivity of cereal grains in children with IgE-mediated wheat allergy Authors: Witchaya Srisuwatchari  1 , Surapon Piboonpocanun  2 , Unchalee Wangthan  1 , Orathai Jirapongsananuruk  1 , Nualanong Visitsunthorn  1 , Punchama Pacharn  3 Abstract Introduction and objectives: Wheat and cereal grains have a broad range of cross-reactivity, but the clinical relevance of this cross-reactivity is uncertain. This study aimed to evaluate clinical and in vitro cross-reactivity with barley, oat, and Job's tears among wheat-allergic patients. Materials and methods: Patients aged 5 to 15 years with IgE-mediated wheat allergy were enrolled. Skin prick test (SPT) and specific IgE (sIgE) to wheat, barley, and oat, and SPT to Job's tears were performed. Oral food challenge (OFC) was conducted if the SPT was ≤5 mm in size and there was no history of anaphylaxis to each grain. Profiles of sIgE bound allergens of wheat, barley, and oat, and inhibition ELISA of IgE b