The cutoff time of 8 days between fast and slow responders was chosen because it corresponds with the peak plasma level of omalizumab after its initial injection.3 We hypothesized that a slow ...response to omalizumab occurs in patients with CSU in whom IgG antibodies to unoccupied IgE receptors (FcepsilonRI) activate mast cell mediator release to cause wheal and angioedema formation.4 This hypothesis is based on the knowledge that omalizumab first complexes soluble IgE then sequesters IgE released from mast cells, thus uncovering membrane FcepsilonRI, which subsequently decays slowly over several weeks.5 To test this, the basophil histamine release assay (BHRA) was used. Quantification of free serum IgE, IgE neutralization, and omalizumab concentrations A commercially available recoveryELISA kit was used for the quantification of free IgE, IgE neutralization rates, and omalizumab levels in patient serum (BioTeZ Berlin Buch GmbH, Berlin, Germany) as described previously.E4 Characteristic All complete responders (n = 56) Complete response within 8 d Complete response after 8 d P value Age (y) 48 (33-60) 49 (37-58) 42 (31-63) .544 Sex Female 40 (71.4%) 28 (71.8%) 12 (70.6%) .583 Male 16 (28.6%) 11 (28.2%) 5 (29.4%) BMI 27.3 ± 4.8 27.9 ± 4.9 26.1 ± 4.6 .192 UAS7low * 24.0 ± 9.7 23.0 ± 9.3 26.5 ± 4.6 .215 Disease durationlow * 36 (16-102) 40 (18-103) 24 (14-85) .240 ASST+low * 23 of 46 (50.0%) 12 of 33 (36.4%) 11 of 13 (84.6%) <.01 BHRA+low * 9 of 55 (16.4%) 1 of 38 (2.6%) 8 of 17 (47.1%) <.001 Anti-FcepsilonRI+low * 5 of 44 (11.4%) 4 of 30 (13.3%) 1 of 14 (7.1%) .485 Anti-IgE+low * 1 of 44 (2.3%) 1 of 30 (3.3%) 0 of 14 (0.0%) .682 Total IgElow * 205.4 ± 229.6 239.2 ± 250.6 130.0 ± 155.0 .104 Free IgE after omalizumabdagger 31.8 ± 47.7 31.2 ± 39.6 33.2 ± 64.7 .893 % IgE neutralizationdagger 94.7 ± 13.4 96.7 ± 2.2 90.0 ± 24.5 .106 Omalizumab (μg/mL)dagger 16.2 ± 7.8 16.6 ± 7.2 15.2 ± 9.2 .557 Table I CSU responders to omalizumab:
Background A subgroup of patients with chronic spontaneous urticaria (CU) exhibits IgE antibodies directed against autoantigens, such as thyroperoxidase (TPO). We conducted this study to investigate ...whether such patients with CU with IgE against TPO benefit from treatment with omalizumab, a humanized anti-IgE mAb licensed for the treatment of severe persistent allergic (IgE-mediated) asthma. Objectives We sought to assess the efficacy of omalizumab treatment in patients with CU with IgE autoantibodies against TPO. Methods In this multicenter, randomized, double-blind, placebo-controlled study patients with CU (male/female, 18-70 years of age) with IgE autoantibodies against TPO who had persistent symptoms (wheals and pruritus) despite standard antihistamine therapy were randomized to receive either omalizumab (75-375 mg, dose determined by using the approved asthma dosing table) or placebo subcutaneously once every 2 or 4 weeks for 24 weeks. The primary end point was the change from baseline in mean weekly urticaria activity score after 24 weeks of treatment, as calculated from patients’ diaries. The safety and tolerability of omalizumab were also assessed. Results Of the 49 randomized patients (omalizumab, n = 27; placebo, n = 22), 42 completed the study. At week 24, patients demonstrated a mean reduction in the weekly urticaria activity score from baseline of 17.8 with omalizumab and 7.9 with placebo ( P = .0089). Complete protection from wheal development was observed in 19 (70.4%) patients in the omalizumab group compared with only 1 (4.5%) patient in the placebo group. The rate of adverse events was similar in both groups. Conclusions The results of this study indicate that omalizumab is an effective treatment option for patients with CU with IgE autoantibodies against TPO who are refractory to conventional treatment.
Physical urticarias and cholinergic urticaria Abajian, Marina; Schoepke, Nicole; Altrichter, Sabine ...
Immunology and allergy clinics of North America,
02/2014, Letnik:
34, Številka:
1
Journal Article
Recenzirano
Physical urticarias are a unique subgroup of chronic urticaria in which urticarial responses can be reproducibly induced by different specific physical stimuli acting on the skin. These conditions ...include urticaria factitia/symptomatic dermographism, delayed pressure urticaria, cold contact urticaria, heat contact urticaria, solar urticaria, and vibratory urticaria/angioedema. Physical urticarias and cholinergic urticarias are diagnosed based on the patients' history and provocation tests including trigger threshold testing where possible. Treatment is mainly symptomatic. Many patients benefit from avoiding eliciting triggers, and desensitization to these triggers can be helpful in some physical urticarias and in cholinergic urticaria.
Clinical Measures of Chronic Urticaria Weller, Karsten; Siebenhaar, Frank; Hawro, Tomasz ...
Immunology and allergy clinics of North America,
02/2017, Letnik:
37, Številka:
1
Journal Article
Recenzirano
The use of standardized, valid, and reliable clinical measures is an important element in modern patient management, particularly in diseases that are not objectively assessable and are associated ...with a high disease burden. Chronic urticaria is such a disorder for which several new and well-developed clinical measures became available. These measures comprise tools to assess disease activity, disease control, and health-related quality-of-life impairment. This review provides an overview of the currently available clinical measures for chronic urticaria. In addition, it provides information on their strengths and limitations and how to best use them and evaluate their results.
To the Editor: Chronic urticaria is a severe skin disease characterized by itchy wheals and/or angioedema1,2 with an estimated lifetime prevalence of 3% to 5% in the general population.3,4 The ...current European Academy of Allergy and Clinical Immunology (EAACI)/Global Allergy and Asthma European Network (GA2LEN)/European Dermatology Forum (EDF)/World Allergy Organization (WAO) treatment guidelines recommend nonsedating H1-antihistamines as first-line treatment, increasing their dosage as second-line treatment, and switching to another such antihistamine or adding a leukotriene antagonist as the third-line treatment.5 Thereafter, among several other fourth-line options including cyclosporine A,6 the guidelines suggest the possibility of using omalizumab, a humanized mAb that blocks the IgE receptor.7 Since September 2008, our specialized university clinic has used omalizumab (Xolair; Genentech & Novartis, San Francisco & Basel) to treat 8 patients with chronic spontaneous urticaria patients (Table I) who had not benefited from the recommended first-line, second-line, and third-line treatments.
Following the bite in August, 2001, the reaction developed rapidly, and he immediately lost consciousness and went into cardiac arrest before the ambulance arrived. Because of delayed resuscitation, ...he had hypoxic brain damage to the basal ganglia, resulting in spastic tetraplegia. Despite having only slightly raised serum tryptase of 11·5 ?g/L (normal range <11·4 ?g/L), bone marrow examination showed spindle shaped mast cells expressing CD25, and the typical Kit-mutation (D816V) was detected by PCR of peripheral blood leucocytes.1 From the patient's description of the appearance of the mosquitoes that bit him, and knowledge of the geographic region where the incidents occurred, Culex pipiens was identified by an expert from the Bernhard Nocht Institute, Hamburg, Germany, as the most likely of the 100 known mosquito species in central Europe to be responsible for inducing such reactions.
COVID-19 vaccines contain additives such as Polyethylenglycol-2000 (PEG2000; mRNA vaccines) or Polysorbat 80 (vector vaccines), which have been described previously as culprits for anaphylactic ...events.
This retrospective study included 46 individuals, who were referred to Comprehensive Allergy Center at the Department Dermatology and Venereology, Kepler University Hospital, Linz, Austria, with suspected allergic reactions to the first COVID-19 vaccine dose with either mRNA or vector-based vaccines.
Patients underwent detailed anamnesis, clinical examination, and in most cases, skin prick testing using pure additive substances (PEG – different molecular weights, Polysorbate 80).
Out of 46, 7 patients’ reactions were classified as possibly anaphylactic and graded according to Ring & Messmer. Forty patients out of 46 were assessed with skin prick tests for potential allergens in COVID-19 vaccines. Only 1 patient showed an immediate positive prick test to PEG2000. Second-dose vaccination with mRNA or vector-based vaccines were tolerated well in all patients, including the individual with a positive skin prick test against PEG2000.
The currently available COVID-19 vaccines have an overall low allergic potential and may be administered safely in patients with suspected allergic reactions to the first dose.
Patients frequently report reactions after COVID-19 vaccinations, but only about 15% of these qualify as possible allergic reactions. Prick-Tests using pure vaccine additives resulted rarely in positive results and all revaccinated patients tolerated a second dose without anaphylaxis.
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