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Haroun-Díaz E, Blanca-López N, Martín-Pedraza L, Ruano FJ, Somoza ML, Vázquez de la Torre M, Pérez-Alzate D, López-González P, Prieto-Moreno A, Bartolomé B, Blanca M, Canto G. Sensitization profile to related animal proteins (crocodile, frog, and chicken) among fish-allergic patients. J Investig Allergol Clin Immunol 2021; 32:50-52. [PMID: 34515030 DOI: 10.18176/jiaci.0705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- E Haroun-Díaz
- Allergy Service, Infanta Leonor University Hospital, Madrid, Spain
| | - N Blanca-López
- Allergy Service, Infanta Leonor University Hospital, Madrid, Spain
| | - L Martín-Pedraza
- Allergy Service, Infanta Leonor University Hospital, Madrid, Spain
| | - F J Ruano
- Allergy Service, Infanta Leonor University Hospital, Madrid, Spain
| | - M L Somoza
- Allergy Service, Infanta Leonor University Hospital, Madrid, Spain
| | | | - D Pérez-Alzate
- Allergy Service, Infanta Leonor University Hospital, Madrid, Spain
| | - P López-González
- Allergy Service, Infanta Leonor University Hospital, Madrid, Spain
| | - A Prieto-Moreno
- Allergy Service, Infanta Leonor University Hospital, Madrid, Spain
| | | | - M Blanca
- Allergy Service, Infanta Leonor University Hospital, Madrid, Spain
| | - G Canto
- Allergy Service, Infanta Leonor University Hospital, Madrid, Spain
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2
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Haroun-Díaz E, Torres I, Blanca-López N, Somoza ML, Martín-Pedraza L, Ruano FJ, Vázquez de la Torre M, Cuesta-Herranz J, Bartolomé Zavala B, Blanca M, Canto Díez G. Anaphylaxis Due to Silene Vulgaris Ingestion. J Investig Allergol Clin Immunol 2021; 32:150-152. [PMID: 34085937 DOI: 10.18176/jiaci.0715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- E Haroun-Díaz
- Allergy Service, Infanta Leonor University Hospital. Madrid, Spain
| | - I Torres
- Allergy Service, Infanta Leonor University Hospital. Madrid, Spain
| | - N Blanca-López
- Allergy Service, Infanta Leonor University Hospital. Madrid, Spain
| | - M L Somoza
- Allergy Service, Infanta Leonor University Hospital. Madrid, Spain
| | - L Martín-Pedraza
- Allergy Service, Infanta Leonor University Hospital. Madrid, Spain
| | - F J Ruano
- Allergy Service, Infanta Leonor University Hospital. Madrid, Spain
| | | | | | | | - M Blanca
- Allergy Service, Infanta Leonor University Hospital. Madrid, Spain
| | - G Canto Díez
- Allergy Service, Infanta Leonor University Hospital. Madrid, Spain
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3
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Torres M, Mayorga C, Fernández T, Cornejo-García J, Antúnez C, Valenzuela M, Prado MD, Rodriguez-Pena R, Blanca M. T Cell Assessment in Allergic Drug Reactions during the Acute Phase According to the Time of Occurrence. Int J Immunopathol Pharmacol 2018. [DOI: 10.1177/205873920601900112] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Allergic drug reactions can be classified as immediate, accelerated or delayed. This classification usually correlates with the mechanism involved: immediate reactions are IgE mediated and delayed reactions are T cell dependent. We analyzed lymphocyte involvement in patients with these reactions by determining cell subpopulations, activation state and skin homing receptor expression (CLA) in blood and skin. Patients with immediate, accelerated and delayed reactions were evaluated during the acute phase and after resolution. Controls taking drugs were included. Phenotypic immunofluorescence analysis was done by flow cytometry in peripheral blood, and by immunohistochemistry in skin for delayed reactions. Forty-six patients were included, 17 with immediate reactions, 10 accelerated and 19 delayed. At the acute phase CLA was significantly increased in delayed reactions and HLA-DR in all three types of reaction. In the severest delayed reactions, Steven-Johnson/Lyell syndromes, the CD4 subsets were increased in peripheral blood and skin compared to maculopapular exanthemas and urticaria and HLA-DR when compared with urticaria. In maculopapular exanthemas CLA was significantly increased in peripheral blood and skin compared to urticaria and the severe reactions. We found that T-cells are implicated, besides delayed reactions, in immediate and accelerated reactions. In delayed reactions there is a parallelism between results found in skin and peripheral blood with a higher participation of CD4+ cells the more severe the reaction.
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Affiliation(s)
- M.J. Torres
- Allergy Service, Carlos Haya Hospital, Malaga, Spain
| | - C. Mayorga
- Research Laboratory for Allergic Diseases, Carlos Haya Hospital, Malaga, Spain
| | - T.D. Fernández
- Research Laboratory for Allergic Diseases, Carlos Haya Hospital, Malaga, Spain
| | - J.A. Cornejo-García
- Research Laboratory for Allergic Diseases, Carlos Haya Hospital, Malaga, Spain
| | - C. Antúnez
- Research Laboratory for Allergic Diseases, Carlos Haya Hospital, Malaga, Spain
| | - M. Valenzuela
- Research Laboratory for Allergic Diseases, Carlos Haya Hospital, Malaga, Spain
| | | | - R. Rodriguez-Pena
- Research Laboratory for Allergic Diseases, Carlos Haya Hospital, Malaga, Spain
| | - M. Blanca
- Allergy Service, Carlos Haya Hospital, Malaga, Spain
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4
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Rondón C, Blanca-López N, Campo P, Mayorga C, Jurado-Escobar R, Torres MJ, Canto G, Blanca M. Specific immunotherapy in local allergic rhinitis: A randomized, double-blind placebo-controlled trial with Phleum pratense subcutaneous allergen immunotherapy. Allergy 2018; 73:905-915. [PMID: 29168570 DOI: 10.1111/all.13350] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND Allergen immunotherapy has been shown to be an effective treatment for local allergic rhinitis (LAR) to house dust mites. Studies with pollen allergen immunotherapy are limited to observational studies. The aim of this study was to evaluate the clinical efficacy and safety of Phleum pratense subcutaneous immunotherapy (Phl-SCIT) in LAR. METHODS In a randomized double-blind placebo-controlled study, 56 patients with moderate-severe LAR to grass pollen received Phl-SCIT with a depigmented polymerized pollen vaccine or placebo for the first year, and Phl-SCIT the second one. The blind was maintained throughout the study. Primary outcome was combined symptom medication score (CSMS) during grass pollen season (GPS). Secondary clinical outcomes included organ-specific symptoms, medication-free days, rhinitis severity and asthma control. Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ), nasal allergen provocation test (NAPT), skin testing, serum levels of specific IgG4 and specific IgE and safety were also evaluated. RESULTS Subcutaneous immunotherapy (SCIT) had a short-term and sustained effect with significant improvements of all primary and secondary clinical outcomes and RQLQ score. SCIT significantly increased serum sIgG4 levels and allergen tolerance, from the 6th to 24th months of treatment. At the end of the study, 83% of patients treated with ≥6 months of SCIT tolerated a concentration of P. pratense over 50 times higher than baseline, and 56% gave a negative NAPT. SCIT was well tolerated; six mild local reactions occurred, and there were no serious adverse events related to the study medication. CONCLUSIONS Subcutaneous immunotherapy with depigmented polymerized allergen extracts is a safe and clinically effective treatment for LAR to P. pratense.
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Affiliation(s)
- C. Rondón
- Allergy Unit; IBIMA-Regional University Hospital of Málaga; UMA; Malaga Spain
| | - N. Blanca-López
- Allergy Unit; Infanta Leonor University Hospital; Madrid Spain
| | - P. Campo
- Allergy Unit; IBIMA-Regional University Hospital of Málaga; UMA; Malaga Spain
| | - C. Mayorga
- Research Laboratory-Allergy Unit; IBIMA-Regional University Hospital of Malaga; UMA; Malaga Spain
| | - R. Jurado-Escobar
- Research Laboratory-Allergy Unit; IBIMA-Regional University Hospital of Malaga; UMA; Malaga Spain
| | - M. J. Torres
- Allergy Unit; IBIMA-Regional University Hospital of Málaga; UMA; Malaga Spain
| | - G. Canto
- Allergy Unit; Infanta Leonor University Hospital; Madrid Spain
| | - M. Blanca
- Allergy Unit; IBIMA-Regional University Hospital of Málaga; UMA; Malaga Spain
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5
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Gomez F, Bogas G, Gonzalez M, Campo P, Salas M, Diaz-Perales A, Rodriguez MJ, Prieto A, Barber D, Blanca M, Torres MJ, Mayorga C. The clinical and immunological effects of Pru p 3 sublingual immunotherapy on peach and peanut allergy in patients with systemic reactions. Clin Exp Allergy 2017; 47:339-350. [PMID: 28160513 DOI: 10.1111/cea.12901] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 12/30/2016] [Accepted: 01/03/2017] [Indexed: 01/07/2023]
Abstract
BACKGROUND The peach non-specific lipid transfer protein, Pru p 3, is the primary sensitizer in fruits and responsible for severe reactions in the Mediterranean area. Peach allergy is frequently associated with other allergies such as peanut. Therefore, it is important to assess how specific immunotherapy to Pru p 3 could affect both peach and peanut tolerance. OBJECTIVES To evaluate peach and peanut desensitization and immunological changes after 1 year of Pru p 3 sublingual immunotherapy (SLIT) in patients with systemic allergic reactions to peach and/or peanut. METHODS Forty-eight peach allergic patients, 36 treated with SLIT and 12 non-treated, were monitored for 12 months. Treated patients were subclassified as peanut allergic (Group A), sensitized (Group B) or tolerant (Group C). SLIT effect was evaluated by skin prick test (SPT) reactivity and food challenge. Immunological changes were evaluated by monitoring sIgE and sIgG4 levels and basophil reactivity. RESULTS After 1 year of SLIT, the weal area in SPT significantly decreased and a significant increase in peach threshold in treated patients was observed (P < 0.001). Patients in Group A showed a significant decrease in peanut SPT weal area and an increase in peanut threshold (P < 0.001). Immunological changes were observed in treated patients only, with a significant decrease in sIgE and a parallel increase in sIgG4, sIgG4/sIgE and basophil reactivity for both Pru p 3 and Ara h 9. CONCLUSIONS AND CLINICAL RELEVANCE After 1 year, Pru p 3 SLIT induces both desensitization and immunological changes not only for peach but also for other food allergens relevant in the induction of severe reactions such as peanut.
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Affiliation(s)
- F Gomez
- Allergy Unit, IBIMA-Regional University Hospital of Malaga, UMA, Spain
| | - G Bogas
- Allergy Unit, IBIMA-Regional University Hospital of Malaga, UMA, Spain
| | - M Gonzalez
- Research Laboratory, IBIMA-Regional University Hospital of Malaga, UMA, Malaga, Spain
| | - P Campo
- Allergy Unit, IBIMA-Regional University Hospital of Malaga, UMA, Spain
| | - M Salas
- Allergy Unit, IBIMA-Regional University Hospital of Malaga, UMA, Spain
| | - A Diaz-Perales
- Centre for Plant Biotechnology and Genomics (UPM-INIA), Pozuelo de Alarcón, Madrid, Spain
| | - M J Rodriguez
- Research Laboratory, IBIMA-Regional University Hospital of Malaga, UMA, Malaga, Spain
| | - A Prieto
- Pediatric Unit,-Regional University Hospital of Malaga, UMA, Malaga, Spain
| | - D Barber
- Institute for Applied Molecular Medicine (IMMA), School of Medicine, Universidad CEU San Pablo, Madrid, Spain
| | - M Blanca
- Allergy Unit, IBIMA-Regional University Hospital of Malaga, UMA, Spain
| | - M J Torres
- Allergy Unit, IBIMA-Regional University Hospital of Malaga, UMA, Spain
| | - C Mayorga
- Allergy Unit, IBIMA-Regional University Hospital of Malaga, UMA, Spain.,Research Laboratory, IBIMA-Regional University Hospital of Malaga, UMA, Malaga, Spain
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6
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Pérez-Alzate D, Cornejo-García JA, Pérez-Sánchez N, Andreu I, García-Moral A, Agúndez JA, Bartra J, Doña I, Torres MJ, Blanca M, Blanca-López N, Canto G. Immediate Reactions to More Than 1 NSAID Must Not Be Considered Cross-Hypersensitivity Unless Tolerance to ASA Is Verified. J Investig Allergol Clin Immunol 2017; 27:32-39. [PMID: 28211343 DOI: 10.18176/jiaci.0080] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [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: 11/20/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Individuals who develop drug hypersensitivity reactions (DHRs) to chemically unrelated nonsteroidal anti-inflammatory drugs (NSAIDs) are considered cross-hypersensitive. The hallmark for this classification is that the patient presents a reaction after intake of or challenge with acetylsalicylic acid (ASA). Whether patients react to 2 or more NSAIDs while tolerating ASA remains to be studied (selective reactions, SRs). Objective: To identify patients with SRs to 2 or more NSAIDs including strong COX-1 inhibitors. METHODS Patients who attended the Allergy Service of Hospital Infanta Leonor, Madrid, Spain with DHRs to NSAIDs between January 2011 and December 2014 were evaluated. Those with 2 or more immediate reactions occurring in less than 1 hour after intake were included. After confirming tolerance to ASA, the selectivity of the response to 2 or more NSAIDs was demonstrated by in vivo and/or in vitro testing or by controlled administration. RESULTS From a total of 203 patients with immediate DHRs to NSAIDs, 16 (7.9%) met the inclusion criteria. The patients presented a total of 68 anaphylactic or cutaneous reactions (mean [SD], 4.2 [2.1]). Most reactions were to ibuprofen and other arylpropionic acid derivatives and to metamizole. Two different NSAIDs were involved in 11 patients and 3 in 5 patients. CONCLUSIONS Patients with NSAID-induced anaphylaxis or urticaria/angioedema should not be considered cross-hypersensitive unless tolerance to ASA is verified.
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Affiliation(s)
- D Pérez-Alzate
- Allergy Service, Infanta Leonor University Hospital, Madrid, Spain
| | - J A Cornejo-García
- Allergy Unit, Malaga Regional University Hospital-IBIMA, UMA, Malaga, Spain.,Research Laboratory, Malaga Regional University Hospital-IBIMA, UMA, Malaga, Spain
| | - N Pérez-Sánchez
- Allergy Unit, Malaga Regional University Hospital-IBIMA, UMA, Malaga, Spain
| | - I Andreu
- Chemical Technology Institute, UPV-CSIC, Polytechnic University of Valencia, Valencia, Spain
| | - A García-Moral
- Allergy Unit, Pneumology and Allergy Service, Clinic Hospital, Barcelona, Spain
| | - J A Agúndez
- Department of Pharmacology, University of Extremadura, Caceres, Spain
| | - J Bartra
- Allergy Unit, Pneumology and Allergy Service, Clinic Hospital, Barcelona, Spain
| | - I Doña
- Allergy Unit, Malaga Regional University Hospital-IBIMA, UMA, Malaga, Spain
| | - M J Torres
- Allergy Unit, Malaga Regional University Hospital-IBIMA, UMA, Malaga, Spain
| | - M Blanca
- Allergy Unit, Malaga Regional University Hospital-IBIMA, UMA, Malaga, Spain
| | - N Blanca-López
- Allergy Service, Infanta Leonor University Hospital, Madrid, Spain
| | - G Canto
- Allergy Service, Infanta Leonor University Hospital, Madrid, Spain
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7
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Cortellini G, Romano A, Santucci A, Barbaud A, Bavbek S, Bignardi D, Blanca M, Bonadonna P, Costantino MT, Laguna JJ, Lombardo C, Losappio L, Makowska J, Nakonechna A, Quercia O, Pastorello EA, Patella V, Terreehorst I, Testi S, Cernadas JR, Dionicio Elera J, Lippolis D, Voltolini S, Grosseto D. Clinical approach on challenge and desensitization procedures with aspirin in patients with ischemic heart disease and nonsteroidal anti-inflammatory drug hypersensitivity. Allergy 2017; 72:498-506. [PMID: 27732743 DOI: 10.1111/all.13068] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Hypersensitivity to acetylsalicylic acid (ASA) constitutes a serious problem for subjects with coronary artery disease. In such subjects, physicians have to choose the more appropriate procedure between challenge and desensitization. As the literature on this issue is sparse, this study aimed to establish in these subjects clinical criteria for eligibility for an ASA challenge and/or desensitization. METHODS Collection and analysis of data on ASA challenges and desensitizations from 10 allergy centers, as well as consensus among the related physicians and an expert panel. RESULTS Altogether, 310 subjects were assessed; 217 had histories of urticaria/angioedema, 50 of anaphylaxis, 26 of nonimmediate cutaneous eruptions, and 17 of bronchospasm related to ASA/nonsteroidal anti-inflammatory drugs (NSAID) intake. Specifically, 119 subjects had index reactions to ASA doses lower than 300 mg. Of the 310 subjects, 138 had an acute coronary syndrome (ACS), 101 of whom underwent desensitizations, whereas 172 suffered from a chronic ischemic heart disease (CIHD), 126 of whom underwent challenges. Overall, 163 subjects underwent challenges and 147 subjects underwent desensitizations; 86 of the latter had index reactions to ASA doses of 300 mg or less. Ten subjects reacted to challenges, seven at doses up to 500 mg, three at a cumulative dose of 110 mg. The desensitization failure rate was 1.4%. CONCLUSIONS In patients with stable CIHD and histories of nonsevere hypersensitivity reactions to ASA/NSAIDs, an ASA challenge is advisable. Patients with an ACS and histories of hypersensitivity reactions to ASA, especially following doses lower than 100 mg, should directly undergo desensitization.
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Affiliation(s)
- G. Cortellini
- Internal Medicine and Rheumatology Department; Azienda Sanitaria Romagna; Rimini Hospital; Rimini Italy
| | - A. Romano
- Allergy Unit; Complesso Integrato Columbus; Rome Italy
- IRCCS Oasi Maria S.S.; Troina Italy
| | - A. Santucci
- Internal Medicine and Rheumatology Department; Azienda Sanitaria Romagna; Rimini Hospital; Rimini Italy
| | - A. Barbaud
- Department of Dermatology and Allergology; University Hospital of Nancy; Vandoeuvre-lès-Nancy France
| | - S. Bavbek
- Department of Clinical Immunology and Allergy; School of Medicine; Ankara University; Ankara Turkey
| | - D. Bignardi
- Allergy Unit; San Martino Hospital; Genoa Italy
| | - M. Blanca
- Allergy Service; Carlos Haya Hospital; Malaga Spain
| | - P. Bonadonna
- Allergy Unit; University Hospital of Verona; Verona Italy
| | | | - J. J. Laguna
- Allergy Unit; Hospital de la Cruz Roja; Madrid Spain
| | - C. Lombardo
- Allergy Unit; University Hospital of Verona; Verona Italy
| | - L.M. Losappio
- Allergology and Immunology Unit; Niguarda Ca' Granda Hospital; Milan Italy
| | - J. Makowska
- Department of Rheumatology; Medical University of Lodz; Lodz Poland
| | - A. Nakonechna
- Allergy and Immunology; Clinic Royal Liverpool and Broadgreen University Hospital; Liverpool UK
| | - O. Quercia
- Allergy Unit; Internal Medicine Department; Azienda Sanitaria Romagna; Faenza Italy
| | - E. A. Pastorello
- Allergology and Immunology Unit; Niguarda Ca' Granda Hospital; Milan Italy
| | - V. Patella
- Allergy Unit; Santa Maria della Speranza Hospital; Battipaglia Italy
- Azienda Sanitaria Locale Salerno; Salerno Italy
| | - I. Terreehorst
- Academisch Medisch Centrum; University of Amsterdam; Amsterdam The Netherlands
| | - S. Testi
- Allergy and Clinical Immunology Unit; Azienda Sanitaria di Firenze; San Giovanni di Dio Hospital; Florence Italy
| | - J. R. Cernadas
- Immunoallergy Department; Centro Hospitalar Sao Joao; Porto Portugal
| | | | - D. Lippolis
- Internal Medicine and Rheumatology Department; Azienda Sanitaria Romagna; Rimini Hospital; Rimini Italy
| | | | - D. Grosseto
- Cardiology Unit; Azienda Sanitaria Romagna; Rimini Hospital; Rimini Italy
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8
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Sánchez-Gómez FJ, González-Morena JM, Vida Y, Pérez-Inestrosa E, Blanca M, Torres MJ, Pérez-Sala D. Amoxicillin haptenates intracellular proteins that can be transported in exosomes to target cells. Allergy 2017; 72:385-396. [PMID: 27319758 DOI: 10.1111/all.12958] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Allergic reactions to β-lactams are among the most frequent causes of drug allergy and constitute an important clinical problem. Drug covalent binding to endogenous proteins (haptenation) is thought to be required for activation of the immune system. Nevertheless, neither the nature nor the role of the drug protein targets involved in this process is fully understood. Here, we aim to identify novel intracellular targets for haptenation by amoxicillin (AX) and their cellular fate. METHODS We have treated B lymphocytes with either AX or a biotinylated analog (AX-B). The identification of protein targets for haptenation by AX has been approached by mass spectrometry and immunoaffinity techniques. In addition, intercellular communication mediated by the delivery of vesicles loaded with AX-B-protein adducts has been explored by microscopy techniques. RESULTS We have observed a complex pattern of AX-haptenated proteins. Several novel targets for haptenation by AX in B lymphocytes have been identified. AX-haptenated proteins were detected in cell lysates and extracellularly, either as soluble proteins or in lymphocyte-derived extracellular vesicles. Interestingly, exosomes from AX-B-treated cells showed a positive biotin signal in electron microscopy. Moreover, they were internalized by endothelial cells, thus supporting their involvement in intercellular transfer of haptenated proteins. CONCLUSIONS These results represent the first identification of AX-mediated haptenation of intracellular proteins. Moreover, they show that exosomes can constitute a novel vehicle for haptenated proteins, and raise the hypothesis that they could provide antigens for activation of the immune system during the allergic response.
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Affiliation(s)
- F. J. Sánchez-Gómez
- Department of Chemical and Physical Biology; Centro de Investigaciones Biológicas; CSIC; Madrid Spain
| | - J. M. González-Morena
- Department of Chemical and Physical Biology; Centro de Investigaciones Biológicas; CSIC; Madrid Spain
| | - Y. Vida
- Department of Organic Chemistry; University of Málaga; IBIMA; Málaga Spain
- Andalusian Center for Nanomedicine and Biotechnology-BIONAND; Parque Tecnológico de Andalucía; Málaga Spain
| | - E. Pérez-Inestrosa
- Department of Organic Chemistry; University of Málaga; IBIMA; Málaga Spain
- Andalusian Center for Nanomedicine and Biotechnology-BIONAND; Parque Tecnológico de Andalucía; Málaga Spain
| | - M. Blanca
- Allergy Unit; IBIMA-Regional University Hospital of Málaga; UMA; Málaga Spain
| | - M. J. Torres
- Allergy Unit; IBIMA-Regional University Hospital of Málaga; UMA; Málaga Spain
| | - D. Pérez-Sala
- Department of Chemical and Physical Biology; Centro de Investigaciones Biológicas; CSIC; Madrid Spain
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9
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Abstract
In the past years, several investigators have demonstrated the existence of local nasal responses in some patients with typical allergic rhinitis symptoms but without atopy and have defined a new phenotype called local allergic rhinitis (LAR) or 'entopy'. In a percentage of LAR subjects, the upper airway disease is also associated with lower airway symptoms. After the description of this phenotype, the differential diagnosis between LAR and nonallergic rhinitis (NAR) has become a challenge for the clinician. To correctly identify LAR patients is of high importance for treatment and management of these patients, and for an appropriate inclusion of patients in clinical trials and genetics studies. The treatment of LAR patients, in contrast with NAR, is oriented to allergen avoidance and specific treatment. Allergen immunotherapy, the aetiological treatment for allergic respiratory diseases, has demonstrated to be an effective and safe treatment in LAR, increasing immunological tolerance, and reducing the clinical symptoms and the use of medication. In this article, the important and novel aspects of LAR in terms of mechanisms, diagnosis and treatment will be discussed. Also, the involvement of the lower airway and the potential role of IgE in the bronchial disease will be also reviewed.
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Affiliation(s)
- C. Rondón
- Allergy Unit; IBIMA-Regional University Hospital of Málaga; UMA; Malaga Spain
| | - G. Bogas
- Allergy Unit; IBIMA-Regional University Hospital of Málaga; UMA; Malaga Spain
| | - E. Barrionuevo
- Allergy Unit; IBIMA-Regional University Hospital of Málaga; UMA; Malaga Spain
| | - M. Blanca
- Allergy Unit; IBIMA-Regional University Hospital of Málaga; UMA; Malaga Spain
| | - M. J. Torres
- Allergy Unit; IBIMA-Regional University Hospital of Málaga; UMA; Malaga Spain
| | - P. Campo
- Allergy Unit; IBIMA-Regional University Hospital of Málaga; UMA; Malaga Spain
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10
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Brockow K, Aberer W, Atanaskovic-Markovic M, Bavbek S, Bircher A, Bilo B, Blanca M, Bonadonna P, Burbach G, Calogiuri G, Caruso C, Celik G, Cernadas J, Chiriac A, Demoly P, Oude Elberink JNG, Fernandez J, Gomes E, Garvey LH, Gooi J, Gotua M, Grosber M, Kauppi P, Kvedariene V, Laguna JJ, Makowska J, Mosbech H, Nakonechna A, Papadopolous NG, Ring J, Romano A, Rockmann H, Sargur R, Sedlackova L, Sigurdardottir S, Schnyder B, Storaas T, Torres M, Zidarn M, Terreehorst I. Drug allergy passport and other documentation for patients with drug hypersensitivity - An ENDA/EAACI Drug Allergy Interest Group Position Paper. Allergy 2016; 71:1533-1539. [PMID: 27145347 DOI: 10.1111/all.12929] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2016] [Indexed: 12/27/2022]
Abstract
The strongest and best-documented risk factor for drug hypersensitivity (DH) is the history of a previous reaction. Accidental exposures to drugs may lead to severe or even fatal reactions in sensitized patients. Preventable prescription errors are common. They are often due to inadequate medical history or poor risk assessment of recurrence of drug reaction. Proper documentation is essential information for the doctor to make sound therapeutic decision. The European Network on Drug Allergy and Drug Allergy Interest Group of the European Academy of Allergy and Clinical Immunology have formed a task force and developed a drug allergy passport as well as general guidelines of drug allergy documentation. A drug allergy passport, a drug allergy alert card, a certificate, and a discharge letter after medical evaluation are adequate means to document DH in a patient. They are to be handed to the patient who is advised to carry the documentation at all times especially when away from home. A drug allergy passport should at least contain information on the culprit drug(s) including international nonproprietary name, clinical manifestations including severity, diagnostic measures, potential cross-reactivity, alternative drugs to prescribe, and where more detailed information can be obtained from the issuer. It should be given to patients only after full allergy workup. In the future, electronic prescription systems with alert functions will become more common and should include the same information as in paper-based documentation.
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11
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Campo P, Villalba M, Barrionuevo E, Rondón C, Salas M, Galindo L, Rodríguez MJ, López-Rodríguez JC, Prieto-Del Prado MA, Torres MJ, Blanca M, Mayorga C. Immunologic responses to the major allergen of Olea europaea in local and systemic allergic rhinitis subjects. Clin Exp Allergy 2016. [PMID: 26221871 DOI: 10.1111/cea.12600] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To evaluate the in vivo and in vitro responses to nOle e 1 in allergic rhinitis (AR) and local allergic rhinitis (LAR) patients sensitized to olive tree pollen (OL) confirmed by nasal allergen provocation test (NAPT). METHODS Twelve subjects with AR, 12 with LAR and 12 subjects as control group (CG) were selected. Skin testing and NAPT with nOle e 1 were performed. Eosinophilic cationic protein (ECP) and tryptase were measured in nasal lavages before and after NAPT. Serum IgE to OL allergens was measured by ELISA. Basophil activation tests (BAT) with OL and nOle e 1 and dendritic cell maturation/proliferation studies were carried out. RESULTS All AR (12/12) and 10/12 (83%) of LAR had a +NAPT to nOle e 1. ECP levels in nasal lavages were significantly increased after NAPT in both AR and LAR compared with CG at 15 min (P < 0.05). Serum IgE was positive only in AR. All AR had +BAT responses to OL and 10/12 to nOle e 1 (83%); 8/12 LAR (66.6%) had a +BAT to OL and 4/12 (33%) to nOle e 1, with only one subject of the CG with a +BAT to both OL and nOle e 1 (8%). Dendritic cell proliferation to nOle e 1 was increased in AR compared to LAR and CG (P = 0.019 and P = 0.001, respectively). CONCLUSION Both AR and LAR had a similar in vivo response to nOle e 1 with release of inflammatory mediators. Specific basophil activation with OL and nOle e 1 was observed in LAR confirming previous data obtained with dust mites.
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Affiliation(s)
- P Campo
- U.G.C. Allergy, IBIMA, Regional University Hospital of Málaga, UMA, Málaga, Spain
| | - M Villalba
- Department of Biochemistry and Molecular Biology, Faculty of Chemistry, Complutense University of Madrid, Madrid, Spain
| | - E Barrionuevo
- U.G.C. Allergy, IBIMA, Regional University Hospital of Málaga, UMA, Málaga, Spain
| | - C Rondón
- U.G.C. Allergy, IBIMA, Regional University Hospital of Málaga, UMA, Málaga, Spain
| | - M Salas
- U.G.C. Allergy, IBIMA, Regional University Hospital of Málaga, UMA, Málaga, Spain
| | - L Galindo
- U.G.C. Allergy, IBIMA, Regional University Hospital of Málaga, UMA, Málaga, Spain
| | - M J Rodríguez
- Allergy Research Laboratory, IBIMA, Regional University Hospital of Málaga, UMA, Málaga, Spain
| | - J C López-Rodríguez
- Department of Biochemistry and Molecular Biology, Faculty of Chemistry, Complutense University of Madrid, Madrid, Spain
| | - M A Prieto-Del Prado
- U.G.C. Allergy, IBIMA, Regional University Hospital of Málaga, UMA, Málaga, Spain
| | - M J Torres
- U.G.C. Allergy, IBIMA, Regional University Hospital of Málaga, UMA, Málaga, Spain
| | - M Blanca
- U.G.C. Allergy, IBIMA, Regional University Hospital of Málaga, UMA, Málaga, Spain
| | - C Mayorga
- U.G.C. Allergy, IBIMA, Regional University Hospital of Málaga, UMA, Málaga, Spain.,Allergy Research Laboratory, IBIMA, Regional University Hospital of Málaga, UMA, Málaga, Spain
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12
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Bogas G, Pérez-Sánchez N, Andreu I, Doña I, Perkins JR, Blanca M, Canto G, Cornejo-García JA, Blanca-López N. Anaphylaxis to 2 NSAIDs in a Patient Who Tolerated ASA. J Investig Allergol Clin Immunol 2016; 26:266-8. [DOI: 10.18176/jiaci.0066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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13
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Cornejo-García JA, Jurado-Escobar R, Doña I, Doña JR, Agúndez JA, García-Martín E, Viguera E, Blanca-López N, Canto G, Blanca M. The Genetics of Drug Hypersensitivity Reactions. J Investig Allergol Clin Immunol 2016; 26:222-32, quiz next two pages. [DOI: 10.18176/jiaci.0078] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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14
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Blanca-López N, Pérez-Alzate D, Andreu I, Doña I, Agúndez JA, García-Martín E, Salas M, Miranda MÁ, Torres MJ, Cornejo-García JA, Blanca M, Canto G. Immediate hypersensitivity reactions to ibuprofen and other arylpropionic acid derivatives. Allergy 2016; 71:1048-56. [PMID: 26841325 DOI: 10.1111/all.12855] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND Although ibuprofen and other arylpropionic acid derivatives (APs) are the most common medicines involved in hypersensitivity drug reactions (HDRs) to NSAIDs, no patient series studies have been performed regarding immediate selective reactions (SRs) to these drugs. OBJECTIVE To characterize patients with immediate selective HDRs to ibuprofen and other APs through clinical history and challenge. METHODS Subjects who developed an HDR to APs less than 1 h after drug intake were included. Tolerance to aspirin was assessed and challenge was performed with ibuprofen in all cases, and additionally with the culprit drug (if different) in those patients that tolerated ibuprofen. Serum tryptase levels and tryptase immunohistochemical staining in skin biopsies were also assessed in some patients with a positive DPT to ibuprofen. RESULTS From a total of 245 patients with a confirmed history of HDRs to APs, 17% were classified as selective immediate hypersensitivity reactors by both clinical history and challenge. A selective response to naproxen and dexketoprofen with tolerance to ibuprofen was found in 16 of 20 cases. Significant differences in serum tryptase levels were observed between 2 and 24 h in the 11 cases that were studied further. CONCLUSIONS Within the group of patients with HDRs to NSAIDs, APs can induce immediate SRs. Within this group, selective responses to a single drug or responders to several APs may exist, suggesting potential immunological cross-reactivity.
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Affiliation(s)
- N. Blanca-López
- Allergy Service; Infanta Leonor University Hospital; Madrid Spain
| | - D. Pérez-Alzate
- Allergy Service; Infanta Leonor University Hospital; Madrid Spain
| | - I. Andreu
- Chemical Technology Institute; UPV-CSIC; Polytechnic University of Valencia; Valencia Spain
| | - I. Doña
- Allergy Unit; Malaga Regional University Hospital-IBIMA, UMA; Malaga Spain
| | - J. A. Agúndez
- Department of Pharmacology; University of Extremadura; Caceres Spain
| | - E. García-Martín
- Department of Pharmacology; University of Extremadura; Caceres Spain
| | - M. Salas
- Allergy Unit; Malaga Regional University Hospital-IBIMA, UMA; Malaga Spain
| | - M. Á. Miranda
- Chemical Technology Institute; UPV-CSIC; Polytechnic University of Valencia; Valencia Spain
| | - M. J. Torres
- Allergy Unit; Malaga Regional University Hospital-IBIMA, UMA; Malaga Spain
| | - J. A. Cornejo-García
- Allergy Unit; Malaga Regional University Hospital-IBIMA, UMA; Malaga Spain
- Research Laboratory; IBIMA; Malaga Regional University Hospital, UMA; Malaga Spain
| | - M. Blanca
- Allergy Unit; Malaga Regional University Hospital-IBIMA, UMA; Malaga Spain
| | - G. Canto
- Allergy Service; Infanta Leonor University Hospital; Madrid Spain
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15
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Rondón C, Campo P, Salas M, Aranda A, Molina A, González M, Galindo L, Mayorga C, Torres MJ, Blanca M. Efficacy and safety of D. pteronyssinus immunotherapy in local allergic rhinitis: a double-blind placebo-controlled clinical trial. Allergy 2016; 71:1057-61. [PMID: 27008542 DOI: 10.1111/all.12889] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2016] [Indexed: 12/14/2022]
Abstract
The effects of allergen immunotherapy (AIT) on local allergic rhinitis (LAR) are largely unknown. We conducted the first randomized, double-blind, placebo-controlled (DBPC), phase II trial of D. pteronyssinus (DP) subcutaneous AIT (DP-AIT) on LAR (clinicaltrials.gov identifier: NCT02123316). Thirty-six LAR patients received Pangramin PLUS DP or placebo for 24 months. The primary endpoints were symptoms, medication scores, and medication-free days. The secondary included skin test, serum specific IgE and IgG4, nasal allergen provocation test (NAPT), and adverse events. AIT-DP produced significant improvements in both primary and secondary endpoints vs placebo. After 12 months of AIT-DP, we detected a significant and marked increase in allergen tolerance with negative NAPT in 50% of patients, and significant increases of serum sIgG4. Immunotherapy was well tolerated; no systemic reactions were reported. This study demonstrated that AIT-DP is a safe and clinically effective treatment for LAR, confirming that LAR is a new indication for AIT.
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Affiliation(s)
- C. Rondón
- Allergy Unit; IBIMA-Regional University Hospital of Málaga; UMA; Malaga Spain
| | - P. Campo
- Allergy Unit; IBIMA-Regional University Hospital of Málaga; UMA; Malaga Spain
| | - M. Salas
- Allergy Unit; IBIMA-Regional University Hospital of Málaga; UMA; Malaga Spain
| | - A. Aranda
- Research Laboratory-Allergy Unit; IBIMA-Regional University Hospital of Málaga; UMA; Malaga Spain
| | - A. Molina
- Research Laboratory-Allergy Unit; IBIMA-Regional University Hospital of Málaga; UMA; Malaga Spain
| | - M. González
- Research Laboratory-Allergy Unit; IBIMA-Regional University Hospital of Málaga; UMA; Malaga Spain
| | - L. Galindo
- Research Laboratory-Allergy Unit; IBIMA-Regional University Hospital of Málaga; UMA; Malaga Spain
| | - C. Mayorga
- Research Laboratory-Allergy Unit; IBIMA-Regional University Hospital of Málaga; UMA; Malaga Spain
| | - M. J. Torres
- Allergy Unit; IBIMA-Regional University Hospital of Málaga; UMA; Malaga Spain
| | - M. Blanca
- Allergy Unit; IBIMA-Regional University Hospital of Málaga; UMA; Malaga Spain
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16
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Gómez E, Fernández TD, Doña I, Rondon C, Campo P, Gomez F, Salas M, Gonzalez M, Perkins JR, Palomares F, Blanca M, Torres MJ, Mayorga C. Initial immunological changes as predictors for house dust mite immunotherapy response. Clin Exp Allergy 2016; 45:1542-53. [PMID: 26032922 DOI: 10.1111/cea.12578] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 05/14/2015] [Accepted: 05/15/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although specific immunotherapy is the only aetiological treatment for allergic disorders, the underlying mechanisms are not fully understood. Specific immunotherapy induces changes in lymphocyte Th subsets from Th2 to Th1/Treg. Whether differences in immunological patterns underlie patient response to immunotherapy has not yet been established. OBJECTIVES We studied the immunological changes occurring during a 1-year period of Dermatophagoides pteronyssinus (DP) immunotherapy and their relation with clinical outcome. METHODS We included 34 patients with DP allergy who received subcutaneous specific immunotherapy (SCIT) for 1 year. Following treatment, patients were classified as responders or non-responders. Fourteen allergic subjects who did not receive SCIT were included as controls. Peripheral blood was obtained at 0, 1, 3, 6 and 12 months and cultured with nDer p 1. Phenotypic changes, cytokine production and basophil response were analysed by flow cytometry; transcription factors were measured by mRNA quantification. Serum immunoglobulin levels were also measured. RESULTS After 1 year of SCIT, 82% of cases showed improved symptoms (responders). Although increases in sIgG4 were observed, BAT reactivity was not modified in these patients. Increases in T-BET/FOXP3 as well as nDer p 1-specific Th1/Treg frequencies were also observed, along with a decrease in Th2, Th9 and Th17. These changes corresponded to changes in cytokine levels. CONCLUSION Patients who respond well to DP-SCIT show immunological differences compared to non-responders. In responders, basal differences include a lower frequency of Th1 and higher frequencies of Th2, Th9 and Th17 cells. After 1 year of treatment, an increased production of sIgG4 was observed in responders, along with a change in Th2 response towards Th1/Treg.
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Affiliation(s)
- E Gómez
- Research Laboratory-Allergy Unit, IBIMA-Regional University Hospital of Málaga, UMA, Malaga, Spain
| | - T D Fernández
- Research Laboratory-Allergy Unit, IBIMA-Regional University Hospital of Málaga, UMA, Malaga, Spain
| | - I Doña
- Allergy Service, IBIMA-Regional University Hospital of Málaga, UMA, Malaga, Spain
| | - C Rondon
- Allergy Service, IBIMA-Regional University Hospital of Málaga, UMA, Malaga, Spain
| | - P Campo
- Allergy Service, IBIMA-Regional University Hospital of Málaga, UMA, Malaga, Spain
| | - F Gomez
- Allergy Service, IBIMA-Regional University Hospital of Málaga, UMA, Malaga, Spain
| | - M Salas
- Allergy Service, IBIMA-Regional University Hospital of Málaga, UMA, Malaga, Spain
| | - M Gonzalez
- Research Laboratory-Allergy Unit, IBIMA-Regional University Hospital of Málaga, UMA, Malaga, Spain
| | - J R Perkins
- Research Laboratory-Allergy Unit, IBIMA-Regional University Hospital of Málaga, UMA, Malaga, Spain
| | - F Palomares
- Research Laboratory-Allergy Unit, IBIMA-Regional University Hospital of Málaga, UMA, Malaga, Spain
| | - M Blanca
- Allergy Service, IBIMA-Regional University Hospital of Málaga, UMA, Malaga, Spain
| | - M J Torres
- Allergy Service, IBIMA-Regional University Hospital of Málaga, UMA, Malaga, Spain
| | - C Mayorga
- Research Laboratory-Allergy Unit, IBIMA-Regional University Hospital of Málaga, UMA, Malaga, Spain
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Blanca-López N, Bogas G, Doña I, Torres MJ, Blanca M, Cornejo-García JA, Canto G, Demir S, Olgac M, Unal D, Gelincik A, Colakoglu B, Buyukozturk S. ASA must be given to classify multiple NSAID-hypersensitivity patients as selective or cross-intolerant. Allergy 2016; 71:576-8. [PMID: 27003105 DOI: 10.1111/all.12823] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- N. Blanca-López
- Allergy Service; Infanta Leonor University Hospital; Madrid Spain
| | - G. Bogas
- Allergy Unit; Regional University Hospital of Malaga-IBIMA; UMA; Malaga Spain
| | - I. Doña
- Allergy Unit; Regional University Hospital of Malaga-IBIMA; UMA; Malaga Spain
| | - M. J. Torres
- Allergy Unit; Regional University Hospital of Malaga-IBIMA; UMA; Malaga Spain
| | - M. Blanca
- Allergy Unit; Regional University Hospital of Malaga-IBIMA; UMA; Malaga Spain
| | - J. A. Cornejo-García
- Allergy Unit; Regional University Hospital of Malaga-IBIMA; UMA; Malaga Spain
- Research Laboratory; Regional University Hospital of Malaga-IBIMA; UMA; Malaga Spain
| | - G. Canto
- Allergy Service; Infanta Leonor University Hospital; Madrid Spain
| | - S. Demir
- Department of Allergy and Immunology; Division of Internal Medicine; Istanbul University; Istanbul Medical Faculty; Istanbul Turkey
| | - M. Olgac
- Department of Allergy and Immunology; Division of Internal Medicine; Istanbul University; Istanbul Medical Faculty; Istanbul Turkey
| | - D. Unal
- Department of Allergy and Immunology; Division of Internal Medicine; Istanbul University; Istanbul Medical Faculty; Istanbul Turkey
| | - A. Gelincik
- Department of Allergy and Immunology; Division of Internal Medicine; Istanbul University; Istanbul Medical Faculty; Istanbul Turkey
| | - B. Colakoglu
- Department of Allergy and Immunology; Division of Internal Medicine; Istanbul University; Istanbul Medical Faculty; Istanbul Turkey
| | - S. Buyukozturk
- Department of Allergy and Immunology; Division of Internal Medicine; Istanbul University; Istanbul Medical Faculty; Istanbul Turkey
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18
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Blanca-Lopez N, Campo P, Salas M, García Rodríguez C, Palomares F, Blanca M, Canto G, Feo Brito F, Rondon C. Seasonal Local Allergic Rhinitis in Areas With High Concentrations of Grass Pollen. J Investig Allergol Clin Immunol 2016; 26:83-91. [DOI: 10.18176/jiaci.0018] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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19
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Oussalah A, Mayorga C, Blanca M, Barbaud A, Nakonechna A, Cernadas J, Gotua M, Brockow K, Caubet JC, Bircher A, Atanaskovic M, Demoly P, K. Tanno L, Terreehorst I, Laguna JJ, Romano A, Guéant JL. Genetic variants associated with drugs-induced immediate hypersensitivity reactions: a PRISMA-compliant systematic review. Allergy 2016; 71:443-62. [PMID: 26678823 DOI: 10.1111/all.12821] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2015] [Indexed: 12/31/2022]
Abstract
Drug hypersensitivity includes allergic (AR) and nonallergic reactions (NARs) influenced by genetic predisposition. We performed a systematic review of genetic predictors of IgE-mediated AR and NAR with MEDLINE and PubMed search engine between January 1966 and December 2014. Among 3110 citations, the search selected 53 studies, 42 of which remained eligible. These eligible studies have evaluated genetic determinants of immediate reactions (IR) to beta-lactams (n = 19), NAR against aspirin (n = 12) and other nonsteroidal anti-inflammatory drugs (NSAIDs) (n = 8), and IR to biologics (n = 3). We reported two genomewide association studies and four case-control studies on candidate genes validated by replication. Genes involved in IR to beta-lactams belonged to HLA type 2 antigen processing, IgE production, atopy, and inflammation, including 4 genes validated by replications, HLA-DRA, ILR4, NOD2, and LGALS3. Genes involved in NAR to aspirin belonged to arachidonic acid pathway, membrane-spanning 4A gene family, histamine production pathway, and pro-inflammatory cytokines, while those involved in NAR to all NSAIDs belonged to arachidonic acid pathway and HLA antigen processing pathway. ALOX5 was a common predictor of studies on NAR to both aspirin and NSAIDs. Although these first conclusions could be drawn, this review highlights also the lack of reliable data and the need for replicating studies in contrasted populations, taking into account worldwide allele frequencies, gene-gene interactions, and contrasted situations of environmental exposure.
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Affiliation(s)
- A. Oussalah
- Faculty of Medicine of Nancy; NGERE - Nutrition, Genetics and Environmental Risk Exposure; INSERM U954; University of Lorraine; Vandoeuvre-lès-Nancy France
- Department of Molecular Medicine and Personalized Therapeutics; Department of Biochemistry, Molecular Biology, Nutrition and Metabolism; University Hospital of Nancy; Vandoeuvre-lès-Nancy France
| | - C. Mayorga
- Research Laboratory; IBIMA; Regional University Hospital of Malaga; UMA; Malaga Spain
- Allergy Unit; IBIMA; Regional University Hospital of Malaga; UMA; Malaga Spain
| | - M. Blanca
- Allergy Unit; IBIMA; Regional University Hospital of Malaga; UMA; Malaga Spain
| | - A. Barbaud
- Department of Dermatology and Allergology; University Hospital of Nancy; Vandoeuvre-lès-Nancy France
| | - A. Nakonechna
- Allergy and Immunology; Clinic Royal Liverpool and Broadgreen University Hospital; Thomas Drive Liverpool UK
| | - J. Cernadas
- Immunoallergy Department; Centro Hospitalar Sao Joao; Porto Portugal
| | - M. Gotua
- Center for Allergy and Immunology Research; Tbilisi Georgia
| | - K. Brockow
- Klinik für Dermatologie und Allergologie am Biederstein; Technische Universität München; München Germany
| | - J.-C. Caubet
- Division of Paediatrics; University Hospital of Geneva; Geneva Switzerland
| | - A. Bircher
- Dermatologie/Allergologie; Universitätsspital Basel; Basel Switzerland
| | - M. Atanaskovic
- Department of Allergology and Pulmonology; University Children's Hospital; Belgrade Serbia
| | - P. Demoly
- Department of Pulmonology; Division of Allergy; Hôpital Arnaud de Villeneuve; University Hospital of Montpellier; Montpellier France
| | | | - I. Terreehorst
- Academisch Medisch Centrum; University of Amsterdam; Amsterdam Netherlands
| | - J. J. Laguna
- Allergy Unit; Hospital de la Cruz Roja and Department of Immunology Alfonso X el Sabio University; Madrid Spain
| | - A. Romano
- Allergy Unit; Complesso Integrato Columbus, Rome and IRCCS Oasi Maria S.S.; Troina Italy
| | - J.-L. Guéant
- Faculty of Medicine of Nancy; NGERE - Nutrition, Genetics and Environmental Risk Exposure; INSERM U954; University of Lorraine; Vandoeuvre-lès-Nancy France
- Department of Molecular Medicine and Personalized Therapeutics; Department of Biochemistry, Molecular Biology, Nutrition and Metabolism; University Hospital of Nancy; Vandoeuvre-lès-Nancy France
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Torres MJ, Montañez MI, Ariza A, Salas M, Fernandez TD, Barbero N, Mayorga C, Blanca M. The role of IgE recognition in allergic reactions to amoxicillin and clavulanic acid. Clin Exp Allergy 2016; 46:264-74. [DOI: 10.1111/cea.12689] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- M. J. Torres
- Allergy Unit; IBIMA-Regional University Hospital of Malaga; Malaga Spain
| | - M. I. Montañez
- Research Laboratory; IBIMA-Regional University Hospital of Malaga; Malaga Spain
- BIONAND-Andalusian Centre for Nanomedicine and Biotechnology; Malaga Spain
| | - A. Ariza
- Research Laboratory; IBIMA-Regional University Hospital of Malaga; Malaga Spain
| | - M. Salas
- Allergy Unit; IBIMA-Regional University Hospital of Malaga; Malaga Spain
| | - T. D. Fernandez
- Research Laboratory; IBIMA-Regional University Hospital of Malaga; Malaga Spain
| | - N. Barbero
- BIONAND-Andalusian Centre for Nanomedicine and Biotechnology; Malaga Spain
- Department of Organic Chemistry; IBIMA; University of Malaga; Malaga Spain
| | - C. Mayorga
- Allergy Unit; IBIMA-Regional University Hospital of Malaga; Malaga Spain
- Research Laboratory; IBIMA-Regional University Hospital of Malaga; Malaga Spain
| | - M. Blanca
- Allergy Unit; IBIMA-Regional University Hospital of Malaga; Malaga Spain
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Abstract
Local allergic rhinitis (LAR) is characterized by the presence of a nasal Th2 inflammatory response with local production of specific IgE antibodies and a positive response to a nasal allergen provocation test (NAPT) without evidence of systemic atopy. The prevalence has been shown to be up to 25% in subjects affected with rhinitis with persistence, comorbidity and evolution similar to allergic rhinitis. LAR is a consistent entity that does not evolve to allergic rhinitis with systemic atopy over time although patients have significant impairment in quality of life and increase in the severity of nasal symptoms over time. Lower airways can be also involved. The diagnosis of LAR is based mostly on demonstration of positive response to NAPT and/or local synthesis of specific IgE. Allergens involved include seasonal or perennial such as house dusts mites, pollens, animal epithelia, moulds (alternaria) and others. Basophils from peripheral blood may be activated by the involved allergens suggesting the spill over of locally synthesized specific IgE to the circulation. LAR patients will benefit from the same treatment as allergic patients using antihistamines, inhaled corticosteroids and IgE antagonists. Studies on immunotherapy are ongoing and will determine its efficacy in LAR in terms of symptoms improvement and evolution of the natural course of the disease.
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Affiliation(s)
- P Campo
- Allergy Unit, Regional University Hospital of Malaga, IBIMA, UMA, Malaga, Spain
| | - C Rondón
- Allergy Unit, Regional University Hospital of Malaga, IBIMA, UMA, Malaga, Spain
| | - H J Gould
- Randall Division of Cell and Molecular Biophysics, Division of Asthma, Allergy and Lung Biology, King's College London, MRC-Asthma UK Centre in Allergic Mechanisms of Asthma, London, UK
| | - E Barrionuevo
- Allergy Unit, Regional University Hospital of Malaga, IBIMA, UMA, Malaga, Spain
| | - P Gevaert
- Upper Airways Research Laboratory, Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
| | - M Blanca
- Allergy Unit, Regional University Hospital of Malaga, IBIMA, UMA, Malaga, Spain
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Lacombe-Barrios J, Salas M, Gómez F, Doña I, Ariza A, Mayorga C, Blanca M, Montañez MI, Torres MJ. The Addition of Benzylpenicillin Does Not Increase the Skin Test Sensitivity Obtained With Classic β-Lactam Determinants. J Investig Allergol Clin Immunol 2016; 26:52-54. [PMID: 27012018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
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23
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Garcia-Blanca A, Aranda A, Blanca-Lopez N, Perez D, Gomez F, Mayorga C, Torres MJ, Diaz-Perales A, Perkins JR, Villalba M, Blanca M, Canto G. Influence of age on IgE response in peanut-allergic children and adolescents from the Mediterranean area. Pediatr Allergy Immunol 2015; 26:497-502. [PMID: 26046378 DOI: 10.1111/pai.12418] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/28/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Peanut allergens are common triggers of food allergy. Analyses of sensitization patterns, relationships with other allergens, clinical symptoms, and variation with age are needed. We studied sensitization to Ara h 2, Ara h 9, and Pru p 3 in a peanut allergic children/adolescents and the relationship with peach and pollen. METHODS Peanut allergic patients aged between 1 and 20 years old were classified into two groups: A) allergic to peanut only and B) allergic to peach and peanut. The IgE response was measured to Ara h 2, Ara h 9, and Pru p 3. RESULTS Of 964 subjects evaluated, 28% were allergic to peanut. From this group, 68% were also sensitized to pollen. Urticaria was the most frequent entity followed by anaphylaxis and OAS. Fifty-eight percent had Ara h 2- and/or Ara h 9-specific IgE. More than half reported symptoms with peanut alone (Group A) and 35% to peanut and peach (Group B). We observed significant differences in sex, age, onset of symptoms, and sensitization to Artemisia between groups. IgE response to Ara h 2 was more frequent in Group A, and Ara h 9 and Pru p 3 in Group B. We observed a decrease in sensitization to Ara h 2 and an increase to Ara h 9 and Pru p 3 with increasing age. CONCLUSION Peanut allergy is frequent in subjects with allergy to plant foods, with Ara h 2 and Ara h 9 being two important allergens. In younger patients, Ara h 2 predominates over Ara h 9. The reverse was observed in older patients.
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Affiliation(s)
| | - A Aranda
- Research Laboratory, IBIMA, Regional University Hospital of Malaga, UMA, Malaga, Spain
| | | | - D Perez
- Allergy Service, Infanta Leonor Hospital, Madrid, Spain
| | - F Gomez
- Allergy UGC, IBIMA, Regional University Hospital of Malaga, UMA, Malaga, Spain
| | - C Mayorga
- Research Laboratory, IBIMA, Regional University Hospital of Malaga, UMA, Malaga, Spain
| | - M J Torres
- Allergy UGC, IBIMA, Regional University Hospital of Malaga, UMA, Malaga, Spain
| | | | - J R Perkins
- Research Laboratory, IBIMA, Regional University Hospital of Malaga, UMA, Malaga, Spain
| | - M Villalba
- Biochemistry and Molecular Biology Department, University Complutense Madrid, Madrid, Spain
| | - M Blanca
- Allergy UGC, IBIMA, Regional University Hospital of Malaga, UMA, Malaga, Spain
| | - G Canto
- Allergy Service, Infanta Leonor Hospital, Madrid, Spain
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Blanca-Lopez N, Perez-Alzate D, Ruano F, Garcimartin M, de la Torre V, Mayorga C, Somoza ML, Perkins J, Blanca M, Canto MG, Torres MJ. Selective immediate responders to amoxicillin and clavulanic acid tolerate penicillin derivative administration after confirming the diagnosis. Allergy 2015; 70:1013-9. [PMID: 25913298 DOI: 10.1111/all.12636] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND An increasing number of patients show immediate selective hypersensitivity reactions to clavulanic acid (CLV) and amoxicillin (AX), probably due to their increased prescription. The maintenance of this response should be established. OBJECTIVE To assess that the immediate hypersensitivity selective response to AX or to CLV is maintained after repeated administration of penicillin G (PG)/penicillin V (PV) and AX. METHODS Patients with proven immediate hypersensitivity to AX (Group A) or CLV (Group B) were included. Diagnosis was performed using skin tests with major and minor determinants of PG (PPL/MDM), AX and CLV and by drug provocation test (DPT) if required. Selectivity was established by confirming tolerance to PG/PV (Group A) and to PG/PV and AX (Group B). The maintenance of the selective response was verified by repeating DPT, 15 days after the initial investigation, with the same procedure. RESULTS Of 51 patients, 78% belonged to Group A and 22% to Group B. Most had anaphylaxis. In Group A, 72% were skin test positive; 28% required DPT. In Group B, 63% were skin test positive; 37% required DPT. Only two AX-selective cases developed positive responses after re-provocation with PG/PV. No cases selective for CLV developed a positive response to PG, PV or AX. DISCUSSION The selective response to AX appears consistent, and a response to penicillin determinants only develops in a minority of cases. For the case of CLV, the selective response appears not to be modified by exposure to penicillin determinants, meaning that patients with CLV allergy can take penicillin derivatives safely.
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Affiliation(s)
| | | | - F. Ruano
- Allergy Service; Hospital Infanta Leonor; Madrid Spain
| | | | | | - C. Mayorga
- Allergy Service; Hospital Infanta Leonor; Madrid Spain
| | - M. L. Somoza
- Allergy Service; Hospital Infanta Leonor; Madrid Spain
| | - J. Perkins
- Allergy Service; Hospital Infanta Leonor; Madrid Spain
| | - M. Blanca
- Allergy Unit; IBIMA; Regional University Hospital of Malaga; Málaga Spain
| | - M. G. Canto
- Allergy Service; Hospital Infanta Leonor; Madrid Spain
| | - M. J. Torres
- Allergy Unit; IBIMA; Regional University Hospital of Malaga; Málaga Spain
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Perkins JR, Barrionuevo E, Ranea JA, Blanca M, Cornejo-Garcia JA. Systems biology approaches to enhance our understanding of drug hypersensitivity reactions. Clin Exp Allergy 2015; 44:1461-72. [PMID: 25040150 DOI: 10.1111/cea.12371] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Hypersensitivity drug reactions (HDRs) encompass a wide spectrum of unpredictable clinical entities. They represent an important health problem, affecting people of all ages, and lead to a large strain on the public health system. Here, we summarize experiments that use high-throughput genomics technologies to investigate HDRs. We also introduce the field of systems biology as a relatively recent discipline concerned with the integration and analysis of high-throughput data sets such as DNA microarrays and next-generation sequencing data. We describe previous studies that have applied systems biology techniques to related fields such as allergy and asthma. Finally, we present a number of potential applications of systems biology to the study of HDRs, in order to make the reader aware of the types of analyses that can be performed and the insights that can be gained through their application.
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Affiliation(s)
- J R Perkins
- Research Laboratory, IBIMA-Regional University Hospital of Malaga-UMA, Spain
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26
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Cornejo-García JA, Romano A, Guéant-Rodríguez RM, Oussalah A, Blanca-López N, Gaeta F, Tramoy D, Josse T, Doña I, Torres MJ, Canto G, Blanca M, Guéant JL. A non-synonymous polymorphism in galectin-3 lectin domain is associated with allergic reactions to beta-lactam antibiotics. Pharmacogenomics J 2015; 16:79-82. [PMID: 25869013 DOI: 10.1038/tpj.2015.24] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 01/02/2015] [Accepted: 01/28/2015] [Indexed: 11/09/2022]
Abstract
Genetic predictors of beta-lactam (BL) allergy are mostly related to Immunoglobulin E (IgE) synthesis and atopy. Despite this context, little attention has been devoted to genes of IgE/FcɛRI pathway, such as galectin-3, a β-galactoside-binding lectin, which binds to IgE. We evaluated the association of LGALS3 polymorphisms with BL allergy in 395 Spanish and 198 Italian cases, compared with 310- and 339-matched controls, respectively. The rs11125 predicted BL allergy with an odds ratio of 4.0 in Spanish population (P<0.0001). This association was replicated with an odds ratio of 5.1 in Italian population (P<0.0001); rs11125 predicted also increased serum level of total IgE in Spanish controls. These data are consistent with the predicted deleterious influence of Gln>His substitution produced by rs11125 on galactose-binding activity of galectin-3. In conclusion, LGALS3 is the strongest genetic predictor of BL allergy reported so far. This association reflects the influence of genes of IgE/FcɛRI pathway in this pathology.
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Affiliation(s)
- J A Cornejo-García
- INSERM U-954, University of Lorraine and University Hospital Center (CHU) of Nancy, Nancy, France.,Research Laboratory, IBIMA, Regional University Hospital of Malaga, UMA, Malaga, Spain.,Allergy Unit, IBIMA, Regional University Hospital of Malaga, UMA, Malaga, Spain
| | - A Romano
- Department of Internal Medicine and Geriatrics, UCSC-Allergy Unit, Complesso Integrato Columbus, Rome and IRCCS Oasi Maria S.S., Troina, Italy
| | - R M Guéant-Rodríguez
- INSERM U-954, University of Lorraine and University Hospital Center (CHU) of Nancy, Nancy, France
| | - A Oussalah
- INSERM U-954, University of Lorraine and University Hospital Center (CHU) of Nancy, Nancy, France
| | | | - F Gaeta
- Department of Internal Medicine and Geriatrics, UCSC-Allergy Unit, Complesso Integrato Columbus, Rome and IRCCS Oasi Maria S.S., Troina, Italy
| | - D Tramoy
- INSERM U-954, University of Lorraine and University Hospital Center (CHU) of Nancy, Nancy, France
| | - T Josse
- INSERM U-954, University of Lorraine and University Hospital Center (CHU) of Nancy, Nancy, France
| | - I Doña
- Allergy Unit, IBIMA, Regional University Hospital of Malaga, UMA, Malaga, Spain
| | - M J Torres
- Allergy Unit, IBIMA, Regional University Hospital of Malaga, UMA, Malaga, Spain
| | - G Canto
- Allergy Service, Infanta Leonor Hospital, Madrid, Spain
| | - M Blanca
- Allergy Unit, IBIMA, Regional University Hospital of Malaga, UMA, Malaga, Spain
| | - J-L Guéant
- INSERM U-954, University of Lorraine and University Hospital Center (CHU) of Nancy, Nancy, France
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Blanca-López N, Cornejo-García JA, Pérez-Alzate D, Pérez-Sánchez N, Plaza-Serón MC, Doña I, Torres MJ, Canto G, Kidon M, Perkins JR, Blanca M. Hypersensitivity Reactions to Nonsteroidal Anti-inflammatory Drugs in Children and Adolescents: Selective Reactions. J Investig Allergol Clin Immunol 2015; 25:385-395. [PMID: 26817135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
Nonsteroidal anti-inflammatory drugs (NSAIDs) are used throughout the world to treat pain and inflammation; however, they can trigger several types of drug hypersensitivity reactions (DHRs) in all age groups. Although most such reactions occur through activation of the leukotriene pathway without specific immunological recognition (cross-intolerance), a significant number of DHRs to NSAIDs are due to immunological mechanisms (selective reactions [SRs]). SRs are thought to be induced by specific IgE antibodies or by T cells. In this manuscript, we focus on SRs, which are of great concern in children and adolescents and comprise a heterogeneous set of clinical pictures ranging from mild entities such as urticaria/angioedema to potentially life-threatening conditions such as Stevens-Johnson syndrome/toxic epidermal necrolysis. Paracetamol and ibuprofen are the most frequent elicitors of IgE-mediated SRs, although pyrazolones have also been implicated. T cell-mediated reactions are infrequent in children but have been associated with ibuprofen, naproxen, and dipyrone. In this review, we analyze the available literature on SRs in children and adolescents, with emphasis on epidemiological data, mechanisms, and drugs involved, as well as on diagnostic procedures.
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Blanca-López N, Cornejo-García JA, Plaza-Serón MC, Doña I, Torres-Jaén MJ, Canto G, Padilla-España L, Kidon M, Perkins JR, Blanca M. Hypersensitivity to Nonsteroidal Anti-inflammatory Drugs in Children and Adolescents: Cross-Intolerance Reactions. J Investig Allergol Clin Immunol 2015; 25:259-269. [PMID: 26310040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
Nonsteroidal anti-inflammatory drugs (NSAIDs) are used worldwide and are responsible for several types of drug hypersensitivity reactions (DHRs) in all age groups. The 2 major groups of DHRs to NSAIDs are those induced by immunological mechanisms (selective reactions) and those where inflammatory mediators are released through activation of the prostaglandin-leukotriene pathway without specific immunological recognition (cross-intolerance). In the present review, we focus on cross-intolerance reactions, which are the most frequent DHRs and are becoming a topic of major interest in children and adolescents. Paracetamol and ibuprofen are the drugs that most frequently cause DHRs in children; other NSAIDs are responsible for reactions in adolescents. In vivo and in vitro tests are of limited diagnostic value, with some exceptions for the less common selective reactions. In cross-intolerance, the clinical history and controlled administration are in many instances the only way to establish a diagnosis and look for alternatives. The clinical history is diagnostic when consistent symptoms occur repeatedly after exposure to NSAIDs with different chemical structures. Cutaneous and respiratory symptoms often co-occur in young children. The natural history of these reactions in children is unknown, and some patients can develop tolerance over time. Atopy remains a major risk factor for cross-intolerant reactions. The increasing interest in hypersensitivity to NSAIDs with improvements in patient phenotyping and the information provided by pharmacogenetics will improve our understanding and management of these reactions in the near future.
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Ariza A, Mayorga C, Fernandez TD, Barbero N, Martín-Serrano A, Pérez-Sala D, Sánchez-Gómez FJ, Blanca M, Torres MJ, Montanez MI. Hypersensitivity reactions to β-lactams: relevance of hapten-protein conjugates. J Investig Allergol Clin Immunol 2015; 25:12-25. [PMID: 25898690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
β-Lactams (BL) are the drugs most frequently involved in allergic reactions. They are classified according to their chemical structure as penicillins, cephalosporins, monobactams, carbapenems, and clavams. All BL antibiotics have a BL ring that is fused to a 5-member or 6-member ring (except in monobactams) and has 1, 2 or 3 side chains (except in clavams). Differences in chemical structure mean that a wide range of BLs are recognized by the immune system, and patients may experience clinical reactions to one BL while tolerating others. Diagnosis is based on skin and in vitro testing, although both display low sensitivity, possibly because they are based on drugs or drug conjugates that are not optimally recognized by the immune system. BLs are haptens that need to bind to proteins covalently to elicit an immune response. These drugs have a high capacity to form covalent adducts with proteins through nucleophilic attack of amino groups in proteins on the BL ring. Allergenic determinants have been described for all BLs, although benzylpenicillin is the most widely studied. Moreover, formation of BL-protein adducts is selective, as we recently demonstrated for amoxicillin, which mainly modifies albumin, transferrin, and immunoglobulin heavy and light chains in human serum. Given the complexity of BL allergy, understanding the immunological mechanisms involved and optimization of diagnostic methods require multidisciplinary approaches that take into account the chemical structures of the drugs and the carrier molecules, as well as the patient immune response.
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Corzo JL, Zambonino MA, Muñoz C, Mayorga C, Requena G, Urda A, Gallego C, Blanca M, Torres MJ. Tolerance to COX-2 inhibitors in children with hypersensitivity to nonsteroidal anti-inflammatory drugs. Br J Dermatol 2014; 170:725-9. [PMID: 24116718 DOI: 10.1111/bjd.12674] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Hypersensitivity to nonsteroidal anti-inflammatory drugs (NSAIDs) can affect children, with the mechanism proposed being inhibition of the cyclooxygenase enzyme-1 (COX-1). In these patients nonchemically related NSAIDs, including COX-2 inhibitors, can induce the reaction, hampering treatment of fever and inflammatory processes. OBJECTIVES To analyse retrospectively tolerance to etoricoxib, a selective COX-2 inhibitor, and to meloxicam, a preferential COX-2 inhibitor, in children with hypersensitivity to NSAIDs. METHODS Clinical records of children (aged 1-14 years) diagnosed with hypersensitivity reactions to NSAIDs from January 2006 to January 2013 were included. The diagnosis was confirmed by oral drug provocation test (DPT) with the culprit NSAIDs and acetylsalicylic acid (ASA). Tolerance to paracetamol, etoricoxib and meloxicam was also evaluated. RESULTS The study included 41 children with a positive DPT with ASA and the culprit NSAID. DPT with paracetamol and etoricoxib was negative in all children, although two (4.9%) children developed a reaction after the administration of meloxicam. CONCLUSIONS These data indicate that both etoricoxib and meloxicam are good alternatives for treatment in older children with hypersensitivity to NSAIDs.
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Affiliation(s)
- J L Corzo
- Pediatric Service, Carlos Haya Hospital/IBIMA, Plaza del Hospital Civil s/n, pabellón 5, sótano, 29009, Malaga, Spain
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Sirvent S, Cantó B, Gómez F, Blanca N, Cuesta-Herranz J, Canto G, Blanca M, Rodríguez R, Villalba M, Palomares O. Detailed characterization of Act d 12 and Act d 13 from kiwi seeds: implication in IgE cross-reactivity with peanut and tree nuts. Allergy 2014; 69:1481-8. [PMID: 25041438 DOI: 10.1111/all.12486] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2014] [Indexed: 01/09/2023]
Abstract
BACKGROUND Act d 12 (11S globulin) and Act d 13 (2S albumin) are two novel relevant allergens from kiwi seeds that might be useful to improve the diagnostic sensitivity and the management of kiwifruit-allergic patients. OBJECTIVE To perform a comprehensive structural and immunological characterization of purified Act d 12 and Act d 13 from kiwi seeds. METHODS Sera from 55 well-defined kiwifruit-allergic patients were used. Act d 12 and Act d 13 were purified by chromatographic procedures. Circular dichroism, mass spectrometry, concanavalin A detection, immunoblotting, enzyme-linked immunosorbent assays, basophil activation tests, and IgE-inhibition experiments were used. RESULTS Act d 12 and Act d 13 were purified from kiwi seeds to homogeneity by combining size-exclusion, ion-exchange, and RP-HPLC chromatographies. Both purified allergens preserve the structural integrity and display typical features of their homologous counterparts from the 11S globulin and 2S albumin protein families, respectively. These allergens are released from kiwi seeds after oral and gastric digestion of whole kiwifruit, demonstrating their bioavailability after ingestion. The allergens retain the capacity to bind serum IgE from kiwifruit-allergic patients, induce IgE cross-linking in effector-circulating basophils, and display in vitro IgE cross-reactivity with homologous counterparts from peanut and tree nuts. CONCLUSION Purified Act d 12 and Act d 13 from kiwi seeds are well-defined molecules involved in in vitro IgE cross-reactivity with peanut and tree nuts. Their inclusion in component-resolved diagnosis of kiwifruit allergy might well contribute to improve the diagnostic sensitivity and the management of kiwifruit-allergic patients.
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Affiliation(s)
- S. Sirvent
- Department of Biochemistry and Molecular Biology; School of Chemistry; Complutense University of Madrid; Madrid Spain
| | - B. Cantó
- Department of Biochemistry and Molecular Biology; School of Chemistry; Complutense University of Madrid; Madrid Spain
| | - F. Gómez
- Allergy Service; Hospital Carlos Haya; Málaga Spain
| | - N. Blanca
- Allergy Service; Hospital Infanta Leonor; Madrid Spain
| | | | - G. Canto
- Allergy Service; Hospital Infanta Leonor; Madrid Spain
| | - M. Blanca
- Allergy Service; Hospital Carlos Haya; Málaga Spain
| | - R. Rodríguez
- Department of Biochemistry and Molecular Biology; School of Chemistry; Complutense University of Madrid; Madrid Spain
| | - M. Villalba
- Department of Biochemistry and Molecular Biology; School of Chemistry; Complutense University of Madrid; Madrid Spain
| | - O. Palomares
- Department of Biochemistry and Molecular Biology; School of Chemistry; Complutense University of Madrid; Madrid Spain
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Ventura I, Vega A, Chacón P, Chamorro C, Aroca R, Gómez E, Bellido V, Puente Y, Blanca M, Monteseirín J. Neutrophils from allergic asthmatic patients produce and release metalloproteinase-9 upon direct exposure to allergens. Allergy 2014; 69:898-905. [PMID: 24773508 DOI: 10.1111/all.12414] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2014] [Indexed: 01/30/2023]
Abstract
BACKGROUND Asthma is characterized by airway inflammation and remodelling in which matrix metalloproteinases (MMPs) play an important role. MMP-9 is the major MMP found in the bronchoalveolar lavage fluids and bronchial biopsies from patients with allergic asthma after allergen challenge, where it correlates with the count of neutrophils and macrophages. However, the cellular sources of MMP-9 in this inflammatory condition have not yet been clearly identified. This work was undertaken to analyse whether neutrophils may be a source of MMP-9 in the allergic asthma condition upon allergen challenge. METHODS Neutrophils from allergic asthmatic patients were in vitro stimulated, and the levels of MMP-9 release were measured in the cell culture supernatants using enzyme-linked immunosorbent assay (ELISA) and zymography. RESULTS We show that MMP-9 is released by neutrophils, but not by eosinophils from allergic asthmatic patients in response to allergens to which the patients were sensitized. Neutrophils also released MMP-9 in response to anti-IgE Abs, and agonist Abs against FcεRI, FcεRII/CD23 and galectin-3. Inhibitors of transcription and translation, actinomycin D and cycloheximide, partially cancelled this process, suggesting that MMP-9 is also de novo synthesized in response to stimuli. We also show evidence that the MAPKs, p38 and extracellular signal-regulated kinase, as well as the transcription factor NF-κB, are involved, as specific chemical inhibitors of these cell-signalling pathways abolished the anti-IgE/allergen-dependent MMP-9 release. CONCLUSIONS These data demonstrate that the exposure of neutrophils to allergens leads to generation of MMP-9, which may then lead to remodelling in asthma.
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Affiliation(s)
- I. Ventura
- Servicio Regional de Inmunología y Alergia; Hospital Universitario Virgen Macarena; Sevilla Spain
| | - A. Vega
- Servicio Regional de Inmunología y Alergia; Hospital Universitario Virgen Macarena; Sevilla Spain
| | - P. Chacón
- Servicio Regional de Inmunología y Alergia; Hospital Universitario Virgen Macarena; Sevilla Spain
| | - C. Chamorro
- Servicio Regional de Inmunología y Alergia; Hospital Universitario Virgen Macarena; Sevilla Spain
| | - R. Aroca
- Servicio Regional de Inmunología y Alergia; Hospital Universitario Virgen Macarena; Sevilla Spain
| | - E. Gómez
- Servicio Regional de Inmunología y Alergia; Hospital Universitario Virgen Macarena; Sevilla Spain
| | - V. Bellido
- Servicio Regional de Inmunología y Alergia; Hospital Universitario Virgen Macarena; Sevilla Spain
| | - Y. Puente
- Servicio Regional de Inmunología y Alergia; Hospital Universitario Virgen Macarena; Sevilla Spain
| | - M. Blanca
- Research Laboratory; Carlos Haya Hospital-Fundacion IMABIS; Málaga Spain
| | - J. Monteseirín
- Servicio Regional de Inmunología y Alergia; Hospital Universitario Virgen Macarena; Sevilla Spain
- Departamento de Medicina; Facultad de Medicina; Universidad de Sevilla; Sevilla Spain
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Mayorga C, Gomez F, Aranda A, Koppelman SJ, Diaz-Perales A, Blanca-López N, Blazquez AB, Blanca M, Torres MJ. Basophil response to peanut allergens in Mediterranean peanut-allergic patients. Allergy 2014; 69:964-8. [PMID: 24816395 DOI: 10.1111/all.12421] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2014] [Indexed: 11/30/2022]
Abstract
Ara h 1, Ara h 2, and Ara h 3 are important sensitizers in peanut allergy. Ara h 9 has also been shown to be relevant in the Mediterranean area. We evaluated the basophil response to peanut allergens and Pru p 3 in Mediterranean patients: Group 1, peanut and peach allergy; Group 2, peanut allergy and tolerance to peach; Group 3, peach allergy and tolerance to peanut; Group 4, nonallergic subjects that tolerate both peanut and peach. Compared to controls (Group 4), there was an increased basophil activation with Ara h 2 (P = 0.031) and Pru p 3 (P = 0.009) in Group 1 and with Ara h 1 (P = 0.016), Ara h 2 (P = 0.001), and Ara h 9 (P = 0.016) in Group 2. Importantly, only Ara h 2 showed an increased activation (P = 0.009) in Group 2 compared to Group 3. Ara h 2 is the best discriminating allergen for peanut allergy diagnosis in a Mediterranean population showing two patterns: patients also allergic to peach, responding to Ara h 2 and Pru p 3, and patients allergic only to peanut, responding to Ara h 1, Ara h 2, and Ara h 9.
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Affiliation(s)
- C. Mayorga
- Research Laboratory; IBIMA; Regional University Hospital of Malaga; UMA; Malaga Spain
- UGC Allergy; IBIMA; Regional University Hospital of Malaga; UMA; Malaga Spain
| | - F. Gomez
- UGC Allergy; IBIMA; Regional University Hospital of Malaga; UMA; Malaga Spain
| | - A. Aranda
- Research Laboratory; IBIMA; Regional University Hospital of Malaga; UMA; Malaga Spain
| | - S. J. Koppelman
- University of Nebraska; Lincoln NE USA
- HAL Allergy; Leiden the Netherlands
| | - A. Diaz-Perales
- Centre for Plant Biotechnology and Genomics UPM-INIA; Pozuelo de Alarcón; Madrid Spain
| | | | - A. B. Blazquez
- Research Laboratory; IBIMA; Regional University Hospital of Malaga; UMA; Malaga Spain
| | - M. Blanca
- UGC Allergy; IBIMA; Regional University Hospital of Malaga; UMA; Malaga Spain
| | - M. J. Torres
- UGC Allergy; IBIMA; Regional University Hospital of Malaga; UMA; Malaga Spain
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Ayuso P, Blanca-López N, Doña I, Torres MJ, Guéant-Rodríguez RM, Canto G, Sanak M, Mayorga C, Guéant JL, Blanca M, Cornejo-García JA. Advanced phenotyping in hypersensitivity drug reactions to NSAIDs. Clin Exp Allergy 2014; 43:1097-109. [PMID: 24074328 DOI: 10.1111/cea.12140] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Non-steroidal anti-inflammatory drugs (NSAIDs) are the medications most frequently involved in hypersensitivity drug reactions. Because NSAIDs are prescribed for many conditions, this is a world-wide problem affecting patients of all ages. Various hypersensitivity reactions have been reported, mainly affecting the skin and/or the respiratory airways. The most frequent of these is acute urticaria, which can be induced by several different NSAIDs. Both specific and non-specific immunological pathways have been proposed as underlying mechanisms. This review presents the clinical phenotypes and the drugs involved in NSAID hypersensitivity. Five major clinical syndromes can be distinguished: aspirin-exacerbated respiratory disease (AERD), aspirin-exacerbated cutaneous disease (AECD), multiple NSAID-induced urticaria/angioedema (MNSAID-UA), single NSAID-IgE reactions and single NSAID T cell responses. However, further classification is possible within these five major entities, by detailed descriptions of the clinical characteristics enabling more phenotypes to be defined. This detailed differentiation now seems required in order to undertake appropriate pharmacogenetic studies.
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Affiliation(s)
- P Ayuso
- Allergy Research Laboratory, Carlos Haya Hospital, Málaga, Spain
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Ariza A, Barrionuevo E, Mayorga C, Montañez M, Perez-Inestrosa E, Ruiz-Sánchez A, Rodríguez-Guéant R, Fernández T, Guéant J, Torres M, Blanca M. IgE to penicillins with different specificities can be identified by a multiepitope macromolecule. J Immunol Methods 2014; 406:43-50. [DOI: 10.1016/j.jim.2014.03.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 01/16/2014] [Accepted: 03/05/2014] [Indexed: 11/24/2022]
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Doña I, Blanca-López N, Torres MJ, Gómez F, Fernández J, Zambonino MA, Monteseirín FJ, Canto G, Blanca M, Cornejo-García JA. NSAID-induced urticaria/angioedema does not evolve into chronic urticaria: a 12-year follow-up study. Allergy 2014; 69:438-44. [PMID: 24372026 DOI: 10.1111/all.12335] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most frequent medicaments involved in drug hypersensitivity reactions, with NSAID-induced urticaria/angioedema (NIUA) being the most frequent clinical entity. The natural evolution of NIUA has been suggested to lead to chronic urticaria (CU) in an important proportion of patients, such that NIUA may therefore precede CU. Our aim was to verify whether these entities are related by following up a large cohort of patients with NIUA as well as a control group over a long period of time. METHODS The study comprised three groups: (i) patients with a confirmed history of NIUA (more than two episodes with at least two different NSAIDs or positive drug provocation tests), (ii) patients with more than two episodes of urticaria/angioedema to a single NSAID with good tolerance to a strong COX-1 inhibitor and/or evidence by in vivo tests supporting specific IgE antibodies to the drug (single NSAID-induced urticaria/angioedema, SNIUA), and (iii) controls who tolerated NSAIDs. All cases in the three groups were followed up over a period of 12 years. RESULTS There were 190 patients with NIUA (64.6% female; mean age 43.71 ± 15.82 years, 110 with SNIUA, and 152 controls. At the 12-year evaluation, 12 patients with NIUA (6.15%) had developed CU over a 1- to 8-year period. Similar proportions were seen in SNIUA and controls. CONCLUSIONS Nonsteroidal anti-inflammatory drugs-induced urticaria/angioedema does not seem to precede the onset of CU over the medium term. Further research including a longer follow-up is necessary to verify this observation.
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Affiliation(s)
- I. Doña
- Allergy Service; Carlos Haya Hospital; Malaga Spain
| | | | - M. J. Torres
- Allergy Service; Carlos Haya Hospital; Malaga Spain
| | - F. Gómez
- Allergy Service; Carlos Haya Hospital; Malaga Spain
| | - J. Fernández
- Allergy Service; Elche General Hospital; Alicante Spain
| | | | | | - G. Canto
- Allergy Service; Infanta Leonor Hospital; Madrid Spain
| | - M. Blanca
- Allergy Service; Carlos Haya Hospital; Malaga Spain
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Affiliation(s)
- J.-L. Guéant
- Faculty of Medicine; Nutrition-Genetics and Risks to Environmental Exposure; Inserm-U954; University of Lorraine; Nancy France
| | - S. Dong
- Faculty of Medicine; Nutrition-Genetics and Risks to Environmental Exposure; Inserm-U954; University of Lorraine; Nancy France
- Inserm U 1116; Nancy France
| | - R.-M. Guéant-Rodriguez
- Faculty of Medicine; Nutrition-Genetics and Risks to Environmental Exposure; Inserm-U954; University of Lorraine; Nancy France
| | - M. Blanca
- Faculty of Medicine; Nutrition-Genetics and Risks to Environmental Exposure; Inserm-U954; University of Lorraine; Nancy France
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Fernandez TD, Mayorga C, Guéant JL, Blanca M, Cornejo-García JA. Contributions of pharmacogenetics and transcriptomics to the understanding of the hypersensitivity drug reactions. Allergy 2014; 69:150-8. [PMID: 24467839 DOI: 10.1111/all.12304] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2013] [Indexed: 01/11/2023]
Abstract
Hypersensitivity drug reactions (HDRs) represent a large and important health problem, affecting many patients and leading to a variety of clinical entities, some of which can be life-threatening. The culprit drugs include commonly used medications including antibiotics and NSAIDs. Nontherapeutical agents, such as contrast media, are also involved. Because the pathophysiological mechanisms are not well known and the current diagnostic procedures are somewhat insufficient, new approaches are needed for understanding the complexity of HDRs. Histochemical and molecular biology studies have enabled us to classify these reactions more precisely. Pharmacogenetics has led to the identification of several genes, involved mainly in T-cell-dependent responses, with a number of markers being replicated in different studies. These markers are now being considered as potential targets for reducing the number of HDRs. Transcriptomic approaches have also been used to investigate HDRs by identifying genes that show different patterns of expression in a number of clinical entities. This information can be of value for further elucidation of the mechanisms involved. Although first studies were performed using RT-PCR analysis to monitor the acute phase of the reaction, nowadays high-density expression platforms represent a more integrative way for providing a complete view of gene expression. By combining a detailed and precise clinical description with information obtained by these approaches, we will obtain a better understanding and management of patients with HDRs.
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Affiliation(s)
- T. D. Fernandez
- Research Laboratory; Malaga General Hospital-IBIMA; Malaga Spain
| | - C. Mayorga
- Research Laboratory; Malaga General Hospital-IBIMA; Malaga Spain
| | - J. L. Guéant
- Faculty of Medicine; INSERM U-954; Nutrition-Génétique et exposition aux risques environmentaux; University of Nancy; Vandoeuvre-les-Nancy France
- University Hospital Center of Nancy; Vandoeuvre-les-Nancy France
| | - M. Blanca
- Allergy Service; Malaga General Hospital; Malaga Spain
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Doña I, Barrionuevo E, Blanca-Lopez N, Torres MJ, Fernandez TD, Mayorga C, Canto G, Blanca M. Trends in hypersensitivity drug reactions: more drugs, more response patterns, more heterogeneity. J Investig Allergol Clin Immunol 2014; 24:143-153. [PMID: 25011351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
Hypersensitivity drug reactions (HDRs) vary over time in frequency, drugs involved, and clinical entities. Specific reactions are mediated by IgE, other antibody isotypes (IgG or IgM), and T cells. Nonspecific HDRs include those caused by nonsteroidal anti-inflammatory drugs (NSAIDs). beta-Lactams--the most important of which are amoxicillin and clavulanic acid--are involved in specific immunological mechanisms. Fluoroquinolones (mainly moxifloxacin, followed by ciprofloxacin and levofloxacin) can also induce HDRs mediated by IgE and T cells. In the case of radio contrast media, immediate reactions have decreased, while nonimmediate reactions, mediated by T cells, have increased. There has been a substantial rise in hypersensitivity reactions to antibiotics and latex in perioperative allergic reactions to anesthetics. NSAIDs are the most frequent drugs involved in HDRs. Five well-defined clinical entities, the most common of which is NSAID-induced urticaria/angioedema, have been proposed in a new consensus classification. Biological agents are proteins including antibodies that have been humanized in order to avoid adverse reactions. Reactions can be mediated by IgE or T cells or they may be due to an immunological imbalance. Chimeric antibodies are still in use and may have epitopes that are recognized by the immune system, resulting in allergic reactions.
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Dong S, Acouetey DS, Guéant-Rodriguez RM, Zmirou-Navier D, Rémen T, Blanca M, Mertes PM, Guéant JL. Prevalence of IgE against neuromuscular blocking agents in hairdressers and bakers. Clin Exp Allergy 2013; 43:1256-62. [DOI: 10.1111/cea.12189] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Revised: 08/12/2013] [Accepted: 08/20/2013] [Indexed: 11/28/2022]
Affiliation(s)
- S. Dong
- Faculty of Medicine; Nutrition-Genetics and Risks to Environmental Exposure; Inserm-U954; University of Lorraine; Nancy France
- Inserm U 961 - Groupe Choc; Nancy France
| | - D. S. Acouetey
- Faculty of Medicine; Nutrition-Genetics and Risks to Environmental Exposure; Inserm-U954; University of Lorraine; Nancy France
| | - R.-M. Guéant-Rodriguez
- Faculty of Medicine; Nutrition-Genetics and Risks to Environmental Exposure; Inserm-U954; University of Lorraine; Nancy France
| | - D. Zmirou-Navier
- Faculty of Medicine; Nutrition-Genetics and Risks to Environmental Exposure; Inserm-U954; University of Lorraine; Nancy France
- Ecole des Hautes Etudes en Santé Publique; Rennes France
| | - T. Rémen
- Faculty of Medicine; Nutrition-Genetics and Risks to Environmental Exposure; Inserm-U954; University of Lorraine; Nancy France
| | - M. Blanca
- Faculty of Medicine; Nutrition-Genetics and Risks to Environmental Exposure; Inserm-U954; University of Lorraine; Nancy France
| | | | - J.-L. Guéant
- Faculty of Medicine; Nutrition-Genetics and Risks to Environmental Exposure; Inserm-U954; University of Lorraine; Nancy France
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Kowalski ML, Asero R, Bavbek S, Blanca M, Blanca-Lopez N, Bochenek G, Brockow K, Campo P, Celik G, Cernadas J, Cortellini G, Gomes E, Niżankowska-Mogilnicka E, Romano A, Szczeklik A, Testi S, Torres MJ, Wöhrl S, Makowska J. Classification and practical approach to the diagnosis and management of hypersensitivity to nonsteroidal anti-inflammatory drugs. Allergy 2013; 68:1219-32. [PMID: 24117484 DOI: 10.1111/all.12260] [Citation(s) in RCA: 284] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2013] [Indexed: 01/27/2023]
Abstract
Hypersensitivity reactions to aspirin (acetylsalicylic acid) and other nonsteroidal anti-inflammatory drugs (NSAIDs) constitute only a subset of all adverse reactions to these drugs, but due to their severity pose a significant burden to patients and are a challenge to the allergist. In susceptible individuals, NSAIDs induce a wide spectrum of hypersensitivity reactions with various timing, organ manifestations, and severity, involving either immunological (allergic) or nonimmunological mechanisms. Proper classification of reactions based on clinical manifestations and suspected mechanism is a prerequisite for the implementation of rational diagnostic procedures and adequate patient management. This document, prepared by a panel of experts from the European Academy of Allergy and Clinical Immunology Task Force on NSAIDs Hypersensitivity, aims at reviewing the current knowledge in the field and proposes uniform definitions and clinically useful classification of hypersensitivity reactions to NSAIDs. The document proposes also practical algorithms for the diagnosis of specific types of NSAIDs hypersensitivity (which include drug provocations, skin testing and in vitro testing) and provides, when data are available, evidence-based recommendations for the management of hypersensitive patients, including drug avoidance and drug desensitization.
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Affiliation(s)
- M. L. Kowalski
- Department of Immunology Rheumatology and Allergy; Medical University of Lodz; Lodz; Poland
| | - R. Asero
- Ambulatorio di Allergologia; Clinica San Carlo; Paderno Dugnano; Italy
| | - S. Bavbek
- Department of Immunology and Allergy; Ankara University School of Medicine; Ankara; Turkey
| | - M. Blanca
- Allergy Service; Carlos Haya Hospital; Malaga; Spain
| | | | - G. Bochenek
- Department of Respiratory Diseases; Jagiellonian University; Krakow; Poland
| | - K. Brockow
- Department of Dermatology und Allergology Biederstein and Division Environmental Dermatology and Allergology; Helmholtz Zentrum Munchen/TUM; Technical University Munich; Munich; Germany
| | - P. Campo
- Allergy Service; Carlos Haya Hospital; Malaga; Spain
| | - G. Celik
- Department of Immunology and Allergy; Ankara University School of Medicine; Ankara; Turkey
| | - J. Cernadas
- Department of Allergy; University Hospital of SanJoão; Porto; Portugal
| | - G. Cortellini
- Internal Medicine and Rheumatology; Rimini Hospital; Rimini; Italy
| | - E. Gomes
- Department of Allergy; Hospital Pediatrico Maria Pia; Porto; Portugal
| | | | | | - A. Szczeklik
- Department of Medicine; Jagiellonian University; Krakow; Poland
| | - S. Testi
- Allergy and Clinical Immunology Unit; Azienda Sanitaria di Firenze; San Giovanni di Dio Hospital; Florence; Italy
| | - M. J. Torres
- Allergy Service; Carlos Haya Hospital; Malaga; Spain
| | - S. Wöhrl
- Floridsdorf Allergy Centre (FAZ); Vienna; Austria
| | - J. Makowska
- Department of Immunology Rheumatology and Allergy; Medical University of Lodz; Lodz; Poland
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Salas M, Gomez F, Fernandez TD, Doña I, Aranda A, Ariza A, Blanca-López N, Mayorga C, Blanca M, Torres MJ. Diagnosis of immediate hypersensitivity reactions to radiocontrast media. Allergy 2013; 68:1203-6. [PMID: 23991759 DOI: 10.1111/all.12214] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND No consensus exists on the diagnostic approach for immediate hypersensitivity reactions (IHR) to radiocontrast media (RCM). We analyzed the diagnostic value of a skin test (ST), drug provocation test (DPT) and basophil activation test (BAT) in patients with symptoms compatible with IHR to RCM. METHODS Ninety patients with symptoms suggestive of IHR to RCM were evaluated. ST with a panel of RCM was performed, and if negative, DPT was carried out with the culprit RCM. If ST or DPT were positive, tolerance was assessed with an alternative RCM and BAT was carried out with the same panel used for ST. RESULTS Eight (8.9%) cases were confirmed as having IHR, 5 (62.5%) by ST and 3 (37.5%) by DPT. Five from those confirmed as IHR (62.5%) had a positive BAT. CONCLUSIONS Hypersensitivity to RCM was confirmed in 9%, by ST or DPT. BAT proved a valuable method for diagnosis.
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Affiliation(s)
- M. Salas
- Allergy Service; Carlos Haya Hospital; Malaga; Spain
| | - F. Gomez
- Allergy Service; Carlos Haya Hospital; Malaga; Spain
| | - T. D. Fernandez
- Research Laboratory for Allergic Diseases; Carlos Haya Hospital; Malaga; Spain
| | - I. Doña
- Allergy Service; Carlos Haya Hospital; Malaga; Spain
| | - A. Aranda
- Research Laboratory for Allergic Diseases; Carlos Haya Hospital; Malaga; Spain
| | - A. Ariza
- Research Laboratory for Allergic Diseases; Carlos Haya Hospital; Malaga; Spain
| | | | - C. Mayorga
- Research Laboratory for Allergic Diseases; Carlos Haya Hospital; Malaga; Spain
| | - M. Blanca
- Allergy Service; Carlos Haya Hospital; Malaga; Spain
| | - M. J. Torres
- Allergy Service; Carlos Haya Hospital; Malaga; Spain
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Bursztejn AC, Romano A, Guéant-Rodriguez RM, Cornejo JA, Oussalah A, Chery C, Gastin I, Gaeta F, Barbaud A, Blanca M, Guéant JL. Allergy to betalactams and nucleotide-binding oligomerization domain (NOD) gene polymorphisms. Allergy 2013; 68:1076-80. [PMID: 23888881 DOI: 10.1111/all.12196] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Polymorphisms of interleukin genes related to IgE production and inflammation are predictors of hypersensitivity to betalactam, but nothing is known on the influence of NOD genes, despite their association with inflammation and atopy. OBJECTIVE To evaluate the association of NOD2 and NOD1 polymorphisms with betalactam allergy. METHOD We genotyped 3 polymorphisms of NOD2 and 1 of NOD1 in 368 Italian and 387 Spanish patients, compared with 368 and 326 controls, respectively. RESULTS CT/TT genotypes of rs2066845 of NOD2 predicted a lower risk in Italy (P = 0.003), while WT/insC genotype of rs5743293 (also in leucine-rich repeat domain) predicted a higher risk in Spain (P = 0.007). G allele of rs2066845 was associated with a higher level of IgE in the Italian population. CONCLUSION The mirrored influence of these NOD2 polymorphisms on betalactam allergy in two populations suggests a link with pathways of inflammation and/or atopy through mechanisms, which need to be clarified.
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Affiliation(s)
| | | | - R. M. Guéant-Rodriguez
- Inserm U954 N-GERE (Nutrition-Génétique-Exposition aux risques environnementaux); Faculté de Médecine et Centre Hospitalier Universitaire; Université de Lorraine; Nancy
| | - J. A. Cornejo
- Research Laboratory for Allergic Diseases and Allergy Service; Carlos Haya Hospital; Malaga; Spain
| | - A. Oussalah
- Inserm U954 N-GERE (Nutrition-Génétique-Exposition aux risques environnementaux); Faculté de Médecine et Centre Hospitalier Universitaire; Université de Lorraine; Nancy
| | - C. Chery
- Inserm U954 N-GERE (Nutrition-Génétique-Exposition aux risques environnementaux); Faculté de Médecine et Centre Hospitalier Universitaire; Université de Lorraine; Nancy
| | - I. Gastin
- Inserm U954 N-GERE (Nutrition-Génétique-Exposition aux risques environnementaux); Faculté de Médecine et Centre Hospitalier Universitaire; Université de Lorraine; Nancy
| | - F. Gaeta
- Allergy Unit; Complesso Integrato Columbus; Rome
| | | | - M. Blanca
- Research Laboratory for Allergic Diseases and Allergy Service; Carlos Haya Hospital; Malaga; Spain
| | - J. L. Guéant
- Inserm U954 N-GERE (Nutrition-Génétique-Exposition aux risques environnementaux); Faculté de Médecine et Centre Hospitalier Universitaire; Université de Lorraine; Nancy
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Campo P, Ayuso P, Salas M, Plaza MC, Cornejo-García JA, Doña I, Torres MJ, Blanca-López N, Canto G, Guéant JL, Sanak M, Blanca M. Mediator release after nasal aspirin provocation supports different phenotypes in subjects with hypersensitivity reactions to NSAIDs. Allergy 2013; 68:1001-7. [PMID: 23889565 DOI: 10.1111/all.12187] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2013] [Indexed: 12/21/2022]
Abstract
BACKGROUND Multiple NSAID-induced urticaria/angioedema (MNSAID-UA) is an entity well differentiated from aspirin-exacerbated respiratory disease (AERD), although no detailed phenotype analysis has yet been performed. The objective was to evaluate the functional characteristics of MNSAID-UA subjects by analyzing the response to nasal lysine-aspirin challenge and measurement of nasal inflammatory mediator release compared with AERD subjects and controls. METHODS The study included 85 subjects with confirmed hypersensitivity to NSAIDs (≥3 episodes with >2 different NSAIDs or positive drug provocation) with either cutaneous (MNSAID-UA, n = 25) or respiratory manifestations (AERD, n = 60) and 30 tolerant controls (15 aspirin-tolerant asthmatic patients and 15 healthy controls). Nasal lavages at 0, 15, 60, and 120 min after lysine-aspirin challenge were analyzed for ECP, tryptase, PGE2 , PGD2 , LTD4 , and LTE4 . RESULTS Lysine nasal challenge was positive in 80% of the AERD cases but positive only in 12% of the MNSAID-UA group. MNSAID-UA subjects showed no changes in nasal ECP, whereas subjects with AERD had increased levels of ECP, with the highest peak at 15 min after challenge (P < 0.05). Tryptase levels were higher in AERD compared with MNSAID-UA and controls with the highest release of tryptase at 60 min (P < 0.05). Significant increases in PGD2 , LTD4 , and LTE4 were observed in AERD (at 60 min for PGD2 , LTD4 , and LTE4 ) but not in MNSAID-UA or control subjects (P < 0.05). CONCLUSIONS Data support the observation that MNSAID-UA, although sharing a common response with AERD to COX inhibitors, seems to have a distinctive phenotype, based on the response to nasal challenge and the release of inflammatory mediators.
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Affiliation(s)
- P. Campo
- Allergy Service; Carlos Haya Hospital, Málaga; Málaga; Spain
| | - P. Ayuso
- Allergy Research Laboratory; Carlos Haya Hospital, Málaga; Málaga; Spain
| | - M. Salas
- Allergy Service; Carlos Haya Hospital, Málaga; Málaga; Spain
| | - M. C. Plaza
- Allergy Research Laboratory; Carlos Haya Hospital, Málaga; Málaga; Spain
| | | | - I. Doña
- Allergy Service; Carlos Haya Hospital, Málaga; Málaga; Spain
| | - M. J. Torres
- Allergy Service; Carlos Haya Hospital, Málaga; Málaga; Spain
| | | | - G. Canto
- Allergy Service; Infanta Leonor Hospital; Madrid; Spain
| | - J.-L. Guéant
- Nutrition, Genetics and Environment; Faculty of Medicine; INSERM-U954; Vandoeuvre lès Nancy; France
| | - M. Sanak
- Division of Molecular Biology and Clinical Genetics; Department of Medicine; Jagiellonian University Medical College; Krakow; Poland
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Blanca-Lopez N, J Torres M, Doña I, Campo P, Rondón C, Seoane Reula ME, Salas M, Canto G, Blanca M. Value of the clinical history in the diagnosis of urticaria/angioedema induced by NSAIDs with cross-intolerance. Clin Exp Allergy 2013; 43:85-91. [PMID: 23278883 DOI: 10.1111/cea.12013] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Revised: 07/15/2012] [Accepted: 08/13/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND Multiple Non-steroidal anti-inflammatory drugs (NSAID)-induced urticaria/angioedema is the most common manifestation of hypersensitivity reactions to NSAIDs. Diagnostic evaluation is based on the clinical history and a drug provocation test. OBJECTIVE To evaluate the role of the clinical history in the diagnosis of multiple NSAID-induced urticaria/angioedema. METHODS We studied a group of patients with an unequivocal history of urticaria and/or angioedema after NSAID intake. Subjects had to have had at least two episodes of cutaneous symptoms with two different COX-1 inhibitors. The diagnosis was confirmed in all cases by a drug provocation test with acetyl salicylic acid (ASA). Multivariate analysis was done by analysing different variables, including number of drugs involved, episodes and time elapsed between drug intake and symptom onset. RESULTS Of the total group of 75 cases with multiple NSAID-induced urticaria/angioedema diagnosed according to the clinical history, 76% developed a positive drug provocation test with ASA. The risk for having hypersensitivity was 17 times higher in patients who developed symptoms within the first 60 min after drug intake, 13 times higher in those who experienced reactions with more than two non-chemically related NSAIDs, and 10 times higher in women. CONCLUSIONS Drug provocation testing with ASA confirms the diagnosis of multiple NSAID-induced urticaria/angioedema in up to 92% of cases with an unequivocal clinical history, when reactions occur within 1 h and more than two different NSAIDs are involved.
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Affiliation(s)
- N Blanca-Lopez
- Allergy Service, Infanta Leonor Hospital, Madrid, Spain.
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Blazquez AB, Aranda A, Mascaraque A, Torres MJ, Mayorga C, Rojo J, Blanca M. Design of dendrimeric structures to treat allergic disorders. Clin Transl Allergy 2013. [PMCID: PMC3723477 DOI: 10.1186/2045-7022-3-s3-p81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Mayorga C, Torres MJ, Blazquez AB, Gomez F, Aranda A, Koppelman S, Diaz Perales A, Vieths S, Blanca M. Basophil response to peanut allergens in the mediterranean area. Clin Transl Allergy 2013. [PMCID: PMC3723514 DOI: 10.1186/2045-7022-3-s3-p167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Brockow K, Garvey LH, Aberer W, Atanaskovic-Markovic M, Barbaud A, Bilo MB, Bircher A, Blanca M, Bonadonna B, Campi P, Castro E, Cernadas JR, Chiriac AM, Demoly P, Grosber M, Gooi J, Lombardo C, Mertes PM, Mosbech H, Nasser S, Pagani M, Ring J, Romano A, Scherer K, Schnyder B, Testi S, Torres M, Trautmann A, Terreehorst I. Skin test concentrations for systemically administered drugs -- an ENDA/EAACI Drug Allergy Interest Group position paper. Allergy 2013; 68:702-12. [PMID: 23617635 DOI: 10.1111/all.12142] [Citation(s) in RCA: 541] [Impact Index Per Article: 49.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2013] [Indexed: 12/15/2022]
Abstract
Skin tests are of paramount importance for the evaluation of drug hypersensitivity reactions. Drug skin tests are often not carried out because of lack of concise information on specific test concentrations. The diagnosis of drug allergy is often based on history alone, which is an unreliable indicator of true hypersensitivity.To promote and standardize reproducible skin testing with safe and nonirritant drug concentrations in the clinical practice, the European Network and European Academy of Allergy and Clinical Immunology (EAACI) Interest Group on Drug Allergy has performed a literature search on skin test drug concentration in MEDLINE and EMBASE, reviewed and evaluated the literature in five languages using the GRADE system for quality of evidence and strength of recommendation. Where the literature is poor, we have taken into consideration the collective experience of the group.We recommend drug concentration for skin testing aiming to achieve a specificity of at least 95%. It has been possible to recommend specific drug concentration for betalactam antibiotics, perioperative drugs, heparins, platinum salts and radiocontrast media. For many other drugs, there is insufficient evidence to recommend appropriate drug concentration. There is urgent need for multicentre studies designed to establish and validate drug skin test concentration using standard protocols. For most drugs, sensitivity of skin testing is higher in immediate hypersensitivity compared to nonimmediate hypersensitivity.
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Affiliation(s)
- K. Brockow
- Department of Dermatology und Allergology Biederstein; Division Environmental Dermatology and Allergology Helmholtz Zentrum München/TUM; Technical University Munich; Munich; Germany
| | - L. H. Garvey
- Allergy Clinic; Copenhagen University Hospital; Gentofte; Denmark
| | - W. Aberer
- Department of Dermatology; Medical University of Graz; Graz; Austria
| | | | - A. Barbaud
- Dermatology Department and EA 72-98 INGRES; Brabois Hospital; University Hospital of Nancy; Lorraine University; Vandoeuvre les Nancy; France
| | - M. B. Bilo
- Department of Immunology, Allergy and Respiratory Diseases; Allergy Unit; University Hospital Ospedali Riuniti; Ancona; Italy
| | - A. Bircher
- Dermatologische Universitätsklinik Kantonsspital; Basel; Switzerland
| | - M. Blanca
- Allergy Service; Carlos Haya Hospital; Malaga; Spain
| | - B. Bonadonna
- Allergy Unit; Verona University Hospital; Verona; Italy
| | - P. Campi
- Allergy and Clinical Immunology Unit; San Giovanni di Dio Hospital; Florence; Italy
| | - E. Castro
- Department of Allergy and Clinical Immunology; Medical University; H. S. Joao; Porto; Portugal
| | - J. R. Cernadas
- Department of Allergy and Clinical Immunology; Medical University; H. S. Joao; Porto; Portugal
| | - A. M. Chiriac
- Allergy Department; University Hospital of Montpellier and INSERM U657; Montpellier; France
| | - P. Demoly
- Allergy Department; University Hospital of Montpellier and INSERM U657; Montpellier; France
| | - M. Grosber
- Department of Dermatology und Allergology Biederstein; Division Environmental Dermatology and Allergology Helmholtz Zentrum München/TUM; Technical University Munich; Munich; Germany
| | - J. Gooi
- Department of Immunology; Beaumont Hospital; Dublin; Ireland
| | - C. Lombardo
- Allergy Unit; Verona University Hospital; Verona; Italy
| | - P. M. Mertes
- Service d'anesthésie-réanimation chirurgicale; Hôpitaux Universitaires de Strasbourg; Strasbourg; France
| | - H. Mosbech
- Allergy Clinic; Copenhagen University Hospital; Gentofte; Denmark
| | - S. Nasser
- Department of Allergy; Addenbrooke's Hospital; Cambridge; UK
| | - M. Pagani
- Allergology and Oncology Service; Civil Hospital of Asola; Mantova; Italy
| | - J. Ring
- Department of Dermatology und Allergology Biederstein; Division Environmental Dermatology and Allergology Helmholtz Zentrum München/TUM; Technical University Munich; Munich; Germany
| | - A. Romano
- Allergy Unit; C. I. Columbus; Rome and IRCCS Oasi Maria S. S.; Troina; Italy
| | - K. Scherer
- Dermatologische Universitätsklinik Kantonsspital; Basel; Switzerland
| | - B. Schnyder
- Department of Rheumatology; Clinical Immunology and Allergology; Bern; Switzerland
| | - S. Testi
- Allergy and Clinical Immunology Unit; San Giovanni di Dio Hospital; Florence; Italy
| | - M. Torres
- Allergy Service; Carlos Haya Hospital; Malaga; Spain
| | - A. Trautmann
- Department of Dermatology and Allergology; University of Würzburg; Würzburg; Germany
| | - I. Terreehorst
- Department of ENT and Pediatrics; AMC; Amsterdam; The Netherlands
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49
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Cornejo-García JA, Jagemann LR, Blanca-López N, Doña I, Flores C, Guéant-Rodríguez RM, Torres MJ, Fernández J, Laguna JJ, Rosado A, Agúndez JAG, García-Martín E, Canto G, Guéant JL, Blanca M. Genetic variants of the arachidonic acid pathway in non-steroidal anti-inflammatory drug-induced acute urticaria. Clin Exp Allergy 2013. [PMID: 23181793 DOI: 10.1111/j.1365-2222.2012.04078.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND To date, genetic studies of hypersensitivity reactions to non-steroidal anti-inflammatory drugs (NSAIDs) have been carried out mainly in aspirin-induced asthma and to a lesser extent in chronic urticaria, with no studies in patients with acute urticaria (AU), the most common entity induced by these drugs. OBJECTIVE In this work, we analysed the association of common variants of 15 relevant genes encoding both enzymes and receptors from the arachidonic acid (AA) pathway with NSAID-induced AU. METHODS Patients were recruited in several Allergy Services that are integrated into the Spanish network RIRAAF, and diagnosed of AU induced by cross-intolerance (CRI) to NSAIDs. Genotyping was carried out by TaqMan allelic discrimination assays. RESULTS A total of 486 patients with AU induced by CRI to NSAIDs and 536 unrelated controls were included in this large Spanish case-control study. Seven variants from 31 tested in six genes were associated in a discovery study population from Malaga (0.0003 ≤ p-value ≤ 0.041). A follow-up analysis in an independent sample from Madrid replicated three of the SNPs from the ALOX15 (rs7220870), PTGDR (rs8004654) and CYSLTR1 (rs320095) genes (1.055x10(-6) ≤meta-analysis p-value ≤ 0.003). CONCLUSIONS AND CLINICAL RELEVANCE Genetic variants of the AA pathway may play an important role in NSAID-induced AU. These data may help understand the mechanism underlying this disease.
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Affiliation(s)
- J A Cornejo-García
- INSERM U-954, Nutrition-Génétique et exposition aux risques environmentaux, Faculty of Medicine, University of Nancy, Vandoeuvre-les-Nancy, France.
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50
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Blanca-López N, Ariza A, Doña I, Mayorga C, Montañez MI, Garcia-Campos J, Gomez F, Rondón C, Blanca M, Torres MJ. Hypersensitivity reactions to fluoroquinolones: analysis of the factors involved. Clin Exp Allergy 2013; 43:560-7. [DOI: 10.1111/cea.12099] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Revised: 01/27/2013] [Accepted: 01/28/2013] [Indexed: 12/16/2022]
Affiliation(s)
| | - A. Ariza
- Research Laboratory for Allergic Diseases; Carlos Haya Hospital; Malaga; Spain
| | - I. Doña
- Allergy Service; Carlos Haya Hospital; Malaga; Spain
| | - C. Mayorga
- Research Laboratory for Allergic Diseases; Carlos Haya Hospital; Malaga; Spain
| | - M. I. Montañez
- Research Laboratory for Allergic Diseases; Carlos Haya Hospital; Malaga; Spain
| | | | - F. Gomez
- Allergy Service; Carlos Haya Hospital; Malaga; Spain
| | - C. Rondón
- Allergy Service; Carlos Haya Hospital; Malaga; Spain
| | - M. Blanca
- Allergy Service; Carlos Haya Hospital; Malaga; Spain
| | - M. J. Torres
- Allergy Service; Carlos Haya Hospital; Malaga; Spain
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