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Arzt-Gradwohl L, Annik Herzog S, Aberer W, Alfaya Arias T, Antolín-Amérigo D, Bonadonna P, Boni E, Bożek A, Chełmińska M, Ernst B, Frelih N, Gawlik R, Gelincik A, Hawranek T, Hoetzenecker W, Jiménez Blanco A, Kita K, Kendirlinan R, Košnik M, Laipold K, Lang R, Marchi F, Mauro M, Nittner-Marszalska M, Poziomkowska-Gęsicka I, Pravettoni V, Preziosi D, Quercia O, Reider N, Rosiek-Biegus M, Ruiz-Leon B, Schrautzer C, Serrano P, Sin A, Ayşe Sin B, Stoevesandt J, Trautmann A, Vachová M, Johannes Sturm G. Influencing factors on the safety and effectiveness of venom immunotherapy. J Investig Allergol Clin Immunol 2023; 35:0. [PMID: 37937715 DOI: 10.18176/jiaci.0967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND AND OBJECTIVE The safety profile of venom immunotherapy (VIT) is a relevant issue and considerable differences in safety and efficacy of VIT have been reported. The primary aim of this study was to evaluate the safety of ACE inhibitors and beta-blockers during VIT, which has already been published. For a second analysis, data concerning premedication and venom preparations in relation to systemic adverse events (AE) during the up-dosing phase and the first year of the maintenance phase were evaluated as well as the outcome of field stings and sting challenges. METHODS The study was conducted as an open, prospective, observational, multicenter study. In total, 1,425 patients were enrolled and VIT was performed in 1,342 patients. RESULTS Premedication with oral antihistamines was taken by 52.1% of patients during the up-dosing and 19.7% of patients during the maintenance phase. Taking antihistamines had no effect on the frequency of systemic AE (p=0.11) but large local reactions (LLR) were less frequently seen (OR: 0.74; 95% CI: 0.58-0.96; p=0.02). Aqueous preparations were preferentially used for up-dosing (73.0%) and depot preparations for the maintenance phase (64.5%). The type of venom preparation neither had an influence on the frequency of systemic AE nor on the effectiveness of VIT (p=0.26 and p=0.80, respectively), while LLR were less frequently seen when depot preparations were used (p<0.001). CONCLUSION Pretreatment with oral antihistamines during VIT significantly reduces the frequency of LLR but not systemic AE. All venom preparations used were equally effective and did not differ in the frequency of systemic AE.
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Affiliation(s)
- L Arzt-Gradwohl
- Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria
| | - S Annik Herzog
- Institute for Medical Informatics, Statistics, and Documentation, Medical University of Graz, Graz, Austria
| | - W Aberer
- Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria
| | - T Alfaya Arias
- Allergy Department, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - D Antolín-Amérigo
- Servicio de Enfermedades del Sistema Inmune-Alergia, Hospital Universitario Príncipe de Asturias, Departamento de Medicina y Especialidades Médicas, Universidad de Alcalá, Madrid, Spain
- Servicio de Alergia, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain
| | - P Bonadonna
- Allergy Unit, Verona General Hospital, Verona, Italy
| | - E Boni
- Laboratorio Unico Metropolitano, Maggiore Hospital, Bologna, Italy
| | - A Bożek
- Clinical Department of Internal Diseases, Dermatology, and Allergology, Medical University of Silesia, Zabrze, Poland
| | - M Chełmińska
- Allergology Department, Medical University of Gdańsk, Gdańsk, Poland
| | - B Ernst
- Department of Dermatology, General Hospital Ordensklinikum Linz GmbH Elisabethinen, Linz, Austria
| | - N Frelih
- University Clinic of Respiratory and Allergic Diseases, Golnik, Slovenia
| | - R Gawlik
- Department of Internal Medicine, Allergy, and Clinical Immunology, Silesian University of Medicine, Katowice, Poland
| | - A Gelincik
- Department of Internal Medicine, Division of Immunology and Allergic Diseases, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye
| | - T Hawranek
- Department of Dermatology and Allergology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - W Hoetzenecker
- Department of Dermatology, Kepler University Hospital and Medical Faculty, Johannes Kepler University, Linz, Austria
| | - A Jiménez Blanco
- Allergy Unit, Hospital Central de la Cruz Roja. Faculty of Medicine, Alfonso X El Sabio University, ARADyAL, Madrid, Spain
| | - K Kita
- Allergology Department, Medical University of Gdańsk, Gdańsk, Poland
| | - R Kendirlinan
- Department of Pulmonary Diseases, Division of Immunology and Allergy, Faculty of Medicine, Ankara University, Ankara, Türkiye
| | - M Košnik
- University Clinic of Respiratory and Allergic Diseases, Golnik and Medical Faculty Ljubljana, Slovenia
| | - K Laipold
- Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria
| | - R Lang
- Department of Dermatology and Allergology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - F Marchi
- SD Allergologia Clinica, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - M Mauro
- Allergy Unit, Sant´Anna Hospital, Como, Italy
| | - M Nittner-Marszalska
- Department of Internal Diseases, Pulmonology and Allergology, Medical University of Wroclaw, Wroclaw, Poland
| | | | - V Pravettoni
- Department of Internal Medicine, Fondazione IRCCS Ca´ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - D Preziosi
- Allergy Unit, Sant´Anna Hospital, Como, Italy
| | - O Quercia
- High Specialization Unit of Allergology, Hospital of Faenza, AUSL (Local Health Unit) of Romagna, Romagna, Italy
| | - N Reider
- Department of Dermatology, Venereology, and Allergology, Medical University of Innsbruck, Innsbruck, Austria
| | - M Rosiek-Biegus
- Department of Internal Diseases, Pulmonology and Allergology, Medical University of Wroclaw, Wroclaw, Poland
| | - B Ruiz-Leon
- Allergy Section of University Hospital Reina Sofia, ARADyAL Network, Maimonides Biomedical Research Institute of Córdoba (IMIBIC), Córdoba, Spain
| | - C Schrautzer
- Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria
| | - P Serrano
- Allergy Section of University Hospital Reina Sofia, ARADyAL Network, Maimonides Biomedical Research Institute of Córdoba (IMIBIC), Córdoba, Spain
| | - A Sin
- Department of Internal Medicine, Division of Allergy and Immunology, Medical Faculty, Ege University, Izmir, Türkiye
| | - B Ayşe Sin
- Department of Pulmonary Diseases, Division of Immunology and Allergy, Faculty of Medicine, Ankara University, Ankara, Türkiye
| | - J Stoevesandt
- Department of Dermatology and Allergy, University Hospital Würzburg, Würzburg, Germany
| | - A Trautmann
- Department of Dermatology and Allergy, University Hospital Würzburg, Würzburg, Germany
| | - M Vachová
- Department of Immunology and Allergology, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
- Department of Immunology and Allergology, University Hospital Pilsen, Czech Republic
| | - G Johannes Sturm
- Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria
- Allergy Outpatient Clinic Reumannplatz, Vienna, Austria
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Viñals C, Conget I, Pané A, Boswell L, Perea V, Blanco AJ, Ruiz S, Giménez M, Vinagre I, Esmatjes E, Ortega E, Amor AJ. Steno type 1 risk engine and preclinical atherosclerosis in Mediterranean individuals with type 1 diabetes. Diabetes Metab Res Rev 2020; 36:e3320. [PMID: 32239693 DOI: 10.1002/dmrr.3320] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 01/31/2020] [Accepted: 03/18/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND AIMS Tools to detect type 1 diabetes (T1D) individuals at overt cardiovascular disease (CVD) risk are scarce. We aimed to assess the usefulness of the score 'Steno Type 1 Risk Engine' (Steno-Risk) to identify T1D patients with advanced carotid atherosclerosis. MATERIAL AND METHODS T1D patients without CVD with at least one of the following were included: ≥40 years, diabetic nephropathy, or diabetes duration ≥10 years with ≥1 CVD risk factor. Intima-media thickness (IMT) and plaque presence (IMT ≥1.5 mm) were assessed by standardized B-mode ultrasonography. Steno-Risk was used to estimate 10-year risk (<10% low; 10%-20% moderate; ≥20% high risk). Associations between Steno-Risk and preclinical atherosclerosis were assessed after adjusting for other CVD risk factors. RESULTS We evaluated 302 patients (55% men, age 47.8 ± 9.8 years, T1D duration 26.3 ± 9.3 years). The prevalence of carotid plaque and ≥2 plaques were 36.4% and 19.2%, respectively; without sex differences. Age (57.4 ± 7.4 vs 37.1 ± 6.2 years), T1D duration (31.3 ± 10.4 vs 21.5 ± 7.1 years), hypertension (52.3% vs 6.3%), nephropathy (25.6% vs 5.1%) and retinopathy (53.5% vs 32.9%) were higher in high-risk (n = 86) vs low-risk participants (n = 79; P < .001 for all). Preclinical atherosclerosis (IMT and plaque) increased in parallel with Steno-Risk (P < .001). In logistic regression analysis, both age ≥40 years and Steno-Risk ≥20% were associated with the presence of plaque (OR 4.22 [1.57-11.36] and 3.79 [1.61-6.80]; respectively), but only high Steno-Risk remained independently associated with ≥2 plaques (OR 3.31 [1.61-6.80]). CONCLUSION Steno-Risk is independently associated with preclinical atherosclerosis. Further studies are needed to ascertain its usefulness in this high-risk population.
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Affiliation(s)
- C Viñals
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - I Conget
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, Spain
- Institut d'investigacions biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - A Pané
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - L Boswell
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - V Perea
- Endocrinology and Nutrition Department, Hospital Universitari Mútua de Terrassa, Terrassa, Spain
| | - A J Blanco
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Barcelona, Spain
- Institut d'investigacions biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - S Ruiz
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - M Giménez
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, Spain
- Institut d'investigacions biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - I Vinagre
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Barcelona, Spain
- Institut d'investigacions biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - E Esmatjes
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, Spain
- Institut d'investigacions biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - E Ortega
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Barcelona, Spain
- Institut d'investigacions biomèdiques August Pi i Sunyer, Barcelona, Spain
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - A J Amor
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Barcelona, Spain
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Dixon CE, Markgraf CG, Angileri F, Pike BR, Wolfson B, Newcomb JK, Bismar MM, Blanco AJ, Clifton GL, Hayes RL. Protective effects of moderate hypothermia on behavioral deficits but not necrotic cavitation following cortical impact injury in the rat. J Neurotrauma 1998; 15:95-103. [PMID: 9512085 DOI: 10.1089/neu.1998.15.95] [Citation(s) in RCA: 109] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
A number of experimental studies have reported that moderate hypothermia can produce significant protection against behavioral deficits and/or morphopathological alterations following traumatic brain injury; a Phase 3 clinical trial is currently examining the therapeutic potential for moderate hypothermia (32 degrees C) to improve outcome following severe traumatic brain injury in humans. The current study examined whether hypothermia (32 degrees C) provided behavioral protection following experimental cortical impact injury. The extent of focal cortical contusion was also examined in the same rats. A total of 30 male Sprague-Dawley rats were trained on beam balance and beam walking tasks prior to injury. Under isoflurane anesthesia, cortical impact was produced on the right parietal cortex of 20 rats. Ten rats underwent all surgical procedures but were not impacted (sham-injured rats). Ten of the injured rats were cooled to 32 degrees C (measured in temporalis muscle) beginning 5 min postinjury, maintained for 2 h and rewarmed slowly for 1 h. In the other 10 injured rats, normothermic temperatures (37.5 degrees C) were maintained for the same duration. Beam balance and beam walking performance was assessed daily for 5 days following injury. At 11 days postinjury, rats were assessed for 5 days on acquisition of the Morris water maze task. Following behavioral assessments, rats were perfused and the brain removed. Coronal sections were cut through the site of cortical impact injury and stained with hematoxylin and eosin. Hypothermic treatment resulted in significantly less beam balance and beam walking deficits than observed in normothermic rats. Hypothermia also significantly attenuated spatial memory performance deficits. Quantitative morphometric analyses failed to detect any significant differences in volumes of necrotic tissue cavitation in cortices of hypothermic and normothermic rats. Hypothermic treatment also had no effect on volumes of dorsal hippocampal tissue or numbers of cells in CA1 or CA3 regions of the hippocampus. These data suggest that hypothermia, consistent with the reports of others, can produce significant behavioral protection following cortical impact injury that is not necessarily correlated with changes in focal cortical necrosis within the first 15 days following injury.
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Affiliation(s)
- C E Dixon
- Division of Neurosurgery, University of Pittsburgh, PA 15260, USA
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