ALERGOLOGÍA PARA MÉDICOS Y PACIENTES 2021

 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

Secondary prevention measures in anaphylaxis patients: Data from the anaphylaxis registry Authors: Magdalena Kraft et al. Abstract Background Patients with a history of anaphylaxis are at risk of future anaphylactic reactions. Thus, secondary prevention measures are recommended for these patients to prevent or attenuate the next reaction. Methods Data from the Anaphylaxis Registry were analyzed to identify secondary prevention measures offered to patients who experienced anaphylaxis. Our analysis included 7788 cases from 10 European countries and Brazil. Results The secondary prevention measures offered varied across the elicitors. A remarkable discrepancy was observed between prevention measures offered in specialized allergy centers (84% of patients were prescribed adrenaline autoinjectors following EAACI guidelines) and outside the centers: Here, EAACI guideline adherence was only 37%. In the multivariate analysis, the elicitor of the reaction, age of the patient, masto...

Anaphylaxis-a 2020 Practice Parameter Update, Systematic Review, and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) Analysis Authors: Marcus S Shaker 1, Dana V Wallace 2, David B K Golden 3, John Oppenheimer 4, Jonathan A Bernstein 5, Ronna L Campbell 6, Chitra Dinakar 7, Anne Ellis 8, Matthew Greenhawt 9, David A Khan 10, David M Lang 11, Eddy S Lang 12, Jay A Lieberman 13, Jay Portnoy 14, Matthew A Rank 15, David R Stukus 16, Julie Wang 17, Collaborators; Natalie Riblet 18, Aiyana M P Bobrownicki 18, Teresa Bontrager 19, Jarrod Dusin 19, Jennifer Foley 19, Becky Frederick 19, Eyitemi Fregene 18, Sage Hellerstedt 18, Ferdaus Hassan 19, Kori Hess 19, Caroline Horner 20, Kelly Huntington 19, Poojita Kasireddy 18, David Keeler 19, Bertha Kim 18, Phil Lieberman 13, Erin Lindhorst 19, Fiona McEnany 18, Jennifer Milbank 18, Helen Murphy 19, Oriana Pando 18, Ami K Patel 18, Nicole Ratliff 19, Robert Rhodes 19, Kim Robertson 19, Hope Scott 19, Audrey Snell 19, ...

Successful treatment with mepolizumab in a case of allergic bronchopulmonary aspergillosis complicated with nontuberculous mycobacterial infection. Authors: Tsubouchi H1, Tsuchida S1, Yanagi S1, Shigekusa T1, Miura M2, Sakaguchi K2, Matsumoto N1, Nakazato M1. Author information 1 Division of Neurology, Respirology, Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Kiyotake, Japan. 2 Kyoritsu Clinic, Miyakonojo, Japan. Abstract Allergic bronchopulmonary aspergillosis (ABPA) is a complex hypersensitivity reaction that is associated with an allergic immunological response to Aspergillus species via Th2-related inflammation. The long-term use of a systemic corticosteroid is often needed for the treatment of ABPA. However, systemic corticosteroid treatment imposes a risk of the onset of a nontuberculous mycobacterial infection. Here we report the case of a patient with ABPA who required the long-term use of an oral cortic...

Nasal IgE production in allergic rhinitis: Impact of rhinovirus infection. Authors: Hamed A1, Preston DC1, Eschenbacher W1, Khokhar D1, Workman L1, Steinke JW1, Heymann P2, Lawrence M1, Soto-Quiros M3, Platts-Mills TAE1,4, Payne S1,5, Borish L1,4. Author information 1 Department of Medicine, University of Virginia Health System, Charlottesville, Virginia. 2 Department of Pediatrics, University of Virginia Health System, Charlottesville, Virginia. 3 Hospital Naçional de Niños, San José, Costa Rica. 4 Department of Microbiology, University of Virginia Health System, Charlottesville, Virginia. 5 Department of Otolaryngology, University of Virginia Health System, Charlottesville, Virginia. Abstract BACKGROUND: Rhinovirus (RV) infections exacerbate asthma in part by enhancing an allergic state, and these exacerbations can be mitigated via administration of anti-IgE. OBJECTIVE: We investigated the presence of local IgE production in the nose of allergic and non-allergic ...

Next-generation Allergic Rhinitis and Its Impact on Asthma (ARIA) guidelines for allergic rhinitis based on Grading of Recommendations Assessment, Development and Evaluation (GRADE) and real-world evidence. Authors: Bousquet J1, Schünemann HJ2, Togias A3, Bachert C4, Erhola M5, Hellings PW6, Klimek L7, Pfaar O8, Wallace D9, Ansotegui I10, Agache I11, Bedbrook A12, Bergmann KC13, Bewick M14, Bonniaud P15, Bosnic-Anticevich S16, Bossé I17, Bouchard J18, Boulet LP19, Brozek J2, Brusselle G20, Calderon MA21, Canonica WG22, Caraballo L23, Cardona V24, Casale T25, Cecchi L26, Chu DK2, Costa EM27, Cruz AA28, Czarlewski W29, D'Amato G30, Devillier P31, Dykewicz M32, Ebisawa M33, Fauquert JL34, Fokkens WJ35, Fonseca JA36, Fontaine JF37, Gemicioglu B38, van Wijk RG39, Haahtela T40, Halken S41, Ierodiakonou D42, Iinuma T43, Ivancevich JC44, Jutel M45, Kaidashev I46, Khaitov M47, Kalayci O48, Kleine Tebbe J49, Kowalski ML50, Kuna P51, Kvedariene V52, La Grutta S53, Larenas-Linemann D5...

Future perspectives of anticholinergics for the treatment of asthma in adults and children. Authors : Buhl R1, Hamelmann E2,3. 1 Pulmonary Department, Johannes Gutenberg University Hospital Mainz, Mainz, Germany, roland.buhl@unimedizin-mainz.de. 2 Children's Center Bethel, Evangelic Hospital Bethel, Department of Pediatrics, Bielefeld, Germany. 3 University Children's Hospital, Allergy Center Ruhr, Ruhr University Bochum, Bochum, Germany. Abstract Despite major advances in therapeutic interventions and the availability of detailed treatment guidelines, a high proportion of patients with symptomatic asthma remain uncontrolled. Asthma management is largely guided by the Global Initiative for Asthma (GINA) strategy and is based on a backbone of inhaled corticosteroid (ICS) therapy with the use of additional therapies to achieve disease control. Inhaled long-acting bronchodilators alone and in combination are the preferred add-on treatment options. Although long-ac...

The first year of treatment predicts the prognosis of asthma over 25 y-A prospective study. Authors:  Kauppinen R1, Vilkka V1, Sintonen H2, Hedman J1 . 1 Pulmonary Department, South Karelia Central Hospital, Lappeenranta, Finland. 2 Department of Public Health, University of Helsinki, Helsinki, Finland. Abstract: BACKGROUND: An investigator-driven, real-life follow-up study of adult-onset steroid-naïve, newly diagnosed asthma (162 patients) to investigate the treatment results over the 25-year course of the disease and whether the first treatment year's forced expiratory volume in one second (FEV1 ) predicts the long-term prognosis. METHODS: Eighty-three per cent of the 133 living patients participated in the 25-year examinations. At this visit, basic asthma examinations including lung function, as well as questionnaires for health-related quality of life (HRQoL), GINA and the Asthma Control Test, were used for evaluation. The use of medication and remission ...

Does understanding endotypes translate to better asthma management options for all? Authors:  Custovic A1, Henderson J2, Simpson A3. 1 Department of Paediatrics, Imperial College London, London, United Kingdom; National Heart and Lung Institute, Imperial College London, London, United Kingdom. Electronic address: a.custovic@imperial.ac.uk. 2 MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom. 3 Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom. Abstract:  Despite the development of novel treatments, improvement in the design of delivery devices, and new technologies for monitoring and improving adherence, the burden of asthma is not decreasing. Predicting an individual patient's response to asthma drugs ...

Recombinant allergens for immunotherapy: state of the art. Authors:  Zhernov Y1, Curin M2, Khaitov M1, Karaulov A3, Valenta R1,2,3. Author information 1 NRC Institute of Immunology FMBA of Russia, Moscow, Russia. 2 Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria. 3 Laboratory of Immunopathology, Department of Clinical Immunology and Allergy, Sechenov First Moscow State Medical University, Moscow, Russia. Abstract: PURPOSE OF REVIEW: More than 30 years ago, the first molecular structures of allergens were elucidated and defined recombinant allergens became available. We review the state of the art regarding molecular AIT with the goal to understand why progress in this field has been slow, although there is huge potential for treatment and allergen-specific prevention. RECENT FINDINGS: On the basis of allergen structures, ...

Modified Recombinant Allergens for Safer Immunotherapy Authors:  Fátima Ferreira, Peter Briza, Daniela Inführ, Georg Schmidt, Michael Wallner, Nicole Wopfner, Josef Thalhamer and Gernot Achatz Department of Molecular Biology, University of Salzburg, A-5020 Salzburg, Austria Abstract:  Molecular cloning and recombinant production of allergens offered new perspectives for the increasing problem of allergies. A variety of preparations are being developed aiming to increase safety and improve efficacy of specific immunotherapy. Recombinant-based approaches are mostly focused on genetic modification of allergens to produce molecules with reduced allergenic activity and conserved antigenicity, i.e. hypoallergens. Studies dealing with genetic modifications of allergen genes reported the production of site-directed mutants, deletion mutants, allergen fragments and oligomers, and allergen chimeras. An alternative to genetic engineering is the chemical modification of pure ...

Management of Cough Authors :  Gibson PG1. 1 Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, NSW, Australia; Priority Research Centre for Healthy Lungs, The University of Newcastle, Newcastle, NSW, Australia. Electronic address: peter.gibson@newcastle.edu.au. Abstract:  People with chronic cough can experience significant quality-of-life impairment. New concepts based around cough reflex hypersensitivity are leading to improved management strategies and showing promise in relieving the distress from persistent cough. The clinical cough assessment seeks to classify patients on the basis of symptom duration, and to identify and manage exposures and diseases that activate the afferent limb of the cough reflex. Cough hypersensitivity is also addressed by managing laryngeal dysfunction with speech pathology therapy and managing central cough reflex sensitization with neuromodulators. There are prospects for novel therapies based around seve...

Sinus Infections, Inflammation, and Asthma Authors:   Staudacher AG1, Stevens WW2. 1 Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, 211 East Ontario Street Suite 1000, Chicago, IL 60611, USA. 2 Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, 211 East Ontario Street Suite 1000, Chicago, IL 60611, USA. Electronic address: whitney-stevens@northwestern.edu. Abstract: There is an important link between the upper and lower respiratory tracts whereby inflammation in one environment can influence the other. In acute rhinosinusitis, pathogen exposures are the primary driver for inflammation in the nose, which can exacerbate asthma. In chronic rhinosinusitis, a disease clinically associated with asthma, the inflammation observed is likely from a combination of an impaired epithelial barrier, dysregulated immune response, and potentially infection (or ...

Management of ocular allergy. Authors: Leonardi A1, Silva D2, Perez Formigo D3,4, Bozkurt B5, Sharma V6, Allegri P7, Rondon C8, Calder V9, Ryan D10, Kowalski ML11, Delgado L2, Doan S12, Fauquert JL13. 1 Ophthalmology Unit, Department of Neuroscience, University of Padua, Padua, Italy. 2 Basic and Clinical Immunology, Department of Pathology, Faculty of Medicine, Serviço de Imunoalergologia, Centro Hospitalar São João, University of Porto, EPE - Porto, Porto, Portugal. 3 Department of Ophthalmology, Hospital Universitario de Torrejon, Madrid, Spain. 4 Faculty of Medicine, University of Francisco de Vitoria (UFV), Pozuelo de Alarcon, Madrid, Spain. 5 Department of Ophthalmology, Faculty of Medicine, Selcuk University, Konya, Turkey. 6 Department of Paediatric Allergy and Immunology, Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, UK. 7 Allergic Conjunctivitis Unit, Ocular Inflammatory Diseases Referral Center, Rapallo Hospit...

Comparison of Corticosteroids by 3 Approaches to the Treatment of Chronic Rhinosinusitis With Nasal Polyps. Authors: Zhang Y#1,2, Lou H#1,2, Wang Y2, Li Y2, Zhang L1,2,3, Wang C1,4 . 1 Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China. 2 Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China. 3 Department of Allergy, Beijing Tongren Hospital, Capital Medical University, Beijing, China. dr.luozhang@139.com. 4 Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China. wangcs830@126.com. Abstract: PURPOSE: Corticosteroids are regarded as the mainstay of medical treatment of eosinophilic chronic rhinosinusitis with nasal polyps (ECRSwNP). To date, a head-to-head comparison of the efficacy and safety of glucocorticoid preparations administered via different routes for the treatment of chronic rhinosinusitis with nasal polyps has not...

Effect of Subcutaneous Dupilumab on Nasal Polyp Burden in Patients With Chronic Sinusitis and Nasal Polyposis: A Randomized Clinical Trial. Authors: Bachert C1, Mannent L2, Naclerio RM3, Mullol J4, Ferguson BJ5, Gevaert P6, Hellings P7, Jiao L8, Wang L8, Evans RR9, Pirozzi G8, Graham NM9, Swanson B8, Hamilton JD9, Radin A9, Gandhi NA9, Stahl N9, Yancopoulos GD9, Sutherland ER10. 1 Upper Airway Research Laboratory, Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium2Clintec, Karolinska Institute, Stockholm, Sweden. 2 Research and Development, Sanofi, Chilly Mazarin, France. 3 University of Chicago, Chicago, Illinois. 4 Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain. 5 University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. 6 Upper Airway Research Laboratory, Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium. 7 Laboratory of Experimental Immunology, Department of ...

Chronic Rhinosinusitis with Nasal Polyps. Authors:  Hopkins C1. 1 From Guy's and St. Thomas' Hospitals, London. A 50-year-old man presents with a 5-year history of progressive nasal obstruction and reduction in his sense of smell. Symptoms were initially intermittent but have become persistent and very bothersome, with the patient rating them as severe. He reports sleep disturbance and postnasal drip and recently received a diagnosis of asthma. Alcohol consumption exacerbates his nasal congestion. Anterior rhinoscopy reveals pale, fleshy polyps filling both sides of the nasal cavity. How would you further evaluate and manage this case? DOI:   10.1056/NEJMcp1800215

Eosinophilic Granulomatosis with Polyangiitis (Churg–Strauss) Authors:   Nguyen Y1, Guillevin L1. 1 Department of Internal Medicine, Referral Center for Rare Systemic and Autoimmune Diseases, Hôpital Cochin, Université Paris Descartes, Paris, France. Abstract: Eosinophilic granulomatosis with polyangiitis (EGPA), formerly called Churg-Strauss syndrome, is a systemic necrotizing vasculitis of small- and medium-size vessels, characterized by asthma and blood eosinophilia. EGPA typically occurs in patients with preexisting asthma, and involves the skin, lungs, and peripheral nerves. Poor-prognosis factors (i.e., involvement(s) of the gastrointestinal tract, heart, and/or kidney) have been assessed with the Five-Factor Score (FFS). One-third of the patients have anti-myeloperoxidase antineutrophil cytoplasm antibodies, and their presence seems to differentiate between two phenotypes, with different clinical characteristics and prognoses. Overall survival has improved marke...

Twelve-year follow-up study after endoscopic sinus surgery in patients with chronic rhinosinusitis with nasal polyposis Authors:   Lien Calus1, Nicholas Van Bruaene1, Cedric Bosteels1, Sarah Dejonckheere1, Thibaut Van Zele1, Gabrielle Holtappels1, Claus Bachert1,2 and Philippe Gevaert1* 1 Upper Airways Research Laboratory, Department of Otorhinolaryngology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium Abstract: Background: Chronic rhinosinusitis with nasal polyposis (CRSwNP) is a therapeutic challenge because of the high recurrence rate. Surgical intervention should be considered in patients who fail to improve after medical treatment. We monitored recurrence and revision surgery over 12 years after endoscopic sinus surgery in CRSwNP patients. Methods: In this prospective cohort study, 47 patients with CRSwNP, who underwent primary or revision extended endoscopic sinus surgery, were followed. Clinical symptoms and total nasal endoscopic polyp scor...

Reduced need for surgery in severe nasal polyposis with mepolizumab: Randomized trial. Authors: Bachert C1, Sousa AR2, Lund VJ3, Scadding GK3, Gevaert P4, Nasser S5, Durham SR6, Cornet ME7, Kariyawasam HH3, Gilbert J8, Austin D2, Maxwell AC9, Marshall RP2, Fokkens WJ7. 1 Upper Airways Research Laboratory and Department of Oto-Rhino-Laryngology, Ghent University and Ghent University Hospital, Ghent, Belgium; Division of ENT Diseases, CLINTEC, Karolinska Institute, University of Stockholm, Stockholm, Sweden. Electronic address: Claus.Bachert@UGent.be. 2 Respiratory Therapy Unit, GlaxoSmithKline, Stockley Park, Uxbridge, United Kingdom. 3 Royal National Throat, Nose and Ear Hospital, UCLH London, London, United Kingdom. 4 Upper Airways Research Laboratory and Department of Oto-Rhino-Laryngology, Ghent University and Ghent University Hospital, Ghent, Belgium. 5 Department of Allergy, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom. 6 Allergy and ...