Advancements in Anaphylaxis Management Alvarez-Perea, Alberto; Cabrera-Freitag, Paula; Fuentes-Aparicio, Victoria ...
Current pharmaceutical design,
2023, Letnik:
29, Številka:
3
Journal Article
Recenzirano
Anaphylaxis is defined as a severe life-threatening, generalized or systemic hypersensitivity reaction. Yet, anaphylaxis is often difficult to diagnose, leading to a delay in applying appropriate ...management. Epinephrine is the medication of choice for the immediate treatment of anaphylaxis. The rest of the actions to be taken during the acute anaphylaxis episode, including administering other medications, will depend on the response to epinephrine. Epinephrine auto-injectors (EAI) are the preferred method for administering the treatment of anaphylaxis in the community setting. However, there are multiple potential barriers to using epinephrine during an anaphylactic reaction related to the physicians and the patients themselves. Strategies to overcome gaps in the acute management of anaphylaxis include novel injection devices and research of new routes for epinephrine delivery. Electronic health solutions may also have a role at this level. Long-term management of anaphylaxis is focused on the prevention of new episodes. Etiologic diagnosis and patient education are key to this end. The application of health information technologies, such as telemedicine, social media, and mobile health, can be helpful for the long-term management of anaphylaxis. Additionally, some patients may benefit from long-term immunomodulatory and etiologic treatments when allergen avoidance implies negative consequences. This review article addresses the most recent advances regarding the integral management of anaphylaxis, including pharmacological and non-pharmacological measures.
Eosinophilic esophagitis (EoE) was first described in the 1990s, showing an increasing incidence and prevalence since then, being the leading cause of food impaction and the major cause of dysphagia. ...Probably, in a few years, EoE may no longer be considered a rare disease.
This article discusses new aspects of the pathogenesis, symptoms, diagnosis, and treatment of EoE according to the last published guidelines.
The epidemiological studies indicate a multifactorial origin for EoE, where environmental and genetic factors take part. EoE affects both children and adults and it is frequently associated with atopic disease and IgE-mediated food allergies. In patients undergoing oral immunotherapy for desensitization from IgE-mediated food allergy the risk of developing EoE is 2.72%. Barrier dysfunction and T-helper 2 inflammation is considered to be pathogenetically important factors. There are different patterns of clinical presentation varying with age and can be masked by adaptation habits. Besides, symptoms do not usually correlate with histologic disease activity. The diagnostic criteria for EoE has evolved but mainly requires symptoms of esophageal dysfunction with histologic evidence of a peak value of at least 15 eosinophils per high-power field. Endoscopies have to be repeated in order to diagnose, monitor, and treat EoE. Treatment of EoE can be started either by drugs (PPIs and topical corticosteroids) or elimination diets. The multistage step-up elimination diet management approach of EoE is promising. Endoscopic dilation is used for patients with severe dysphagia/food impaction with inadequate response to anti-inflammatory treatment.
Research in recent years has contributed to a better understanding of EoE's pathogenesis, genetic background, natural history, allergy workup, standardization in assessment of disease activity, evaluation of minimally invasive diagnostic tools, and new therapeutic approaches. However, several unmet needs are to be solved urgently, as finding a non-invasive disease-monitoring methods and biomarkers for routine practice, the development or new therapies, novel food allergy testing to detect triggering foods, drug, and doses required for initial therapy and safety issues with long-term maintenance therapy, amongst others. Besides, multidisciplinary management units of EoE, involving gastroenterologists, pediatricians, allergists, pathologists, dietitians, and ENT specialists are needed.
Non-IgE-mediated gastrointestinal food allergy (non-IgE-GI-FA) is the name given to a series of pathologies whose main entities are food protein-induced allergic proctocolitis (FPIAP), food ...protein-induced enteropathy (FPE), and food protein-induced enterocolitis syndrome (FPIES). These are more uncommon than IgE-mediated food allergies, their mechanisms remain largely unknown, and their diagnosis is mainly done by clinical history, due to the lack of specific biomarkers. In this review, we present the latest advances found in the literature about clinical aspects, the current diagnosis, and treatment options of non-IgE-GI-FAs. We discuss the use of animal models, the analysis of gut microbiota, omics techniques, and fecal proteins with a focus on understanding the pathophysiological mechanisms of these pathologies and obtaining possible diagnostic and/or prognostic biomarkers. Finally, we discuss the unmet needs that researchers should tackle to advance in the knowledge of these barely explored pathologies.
Diagnostic criteria for acute FPIES: What are we missing? Vazquez-Ortiz, Marta; Argiz, Laura; Machinena, Adrianna ...
The journal of allergy and clinical immunology in practice (Cambridge, MA),
05/2020, Letnik:
8, Številka:
5
Journal Article
Results Thirty-two patients (21 paclitaxel; 11 docetaxel) with immediate reactions (IR) (15% mild, 42% moderate and 43% severe) and one with a mild delayed reaction, were selected.
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