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Fasshauer M, Borte M, Bitzenhofer M, Pausch C, Pittrow D, Park M, Gladiator A, Jandus P. Real-World Use, Safety, and Patient Experience of 20% Subcutaneous Immunoglobulin for Primary Immunodeficiency Diseases. Adv Ther 2023; 40:5168-5187. [PMID: 37751025 PMCID: PMC10611600 DOI: 10.1007/s12325-023-02649-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 08/15/2023] [Indexed: 09/27/2023]
Abstract
INTRODUCTION The CORE study aimed to provide a detailed understanding of real-world immune globulin subcutaneous (human) 20% solution (Ig20Gly) utilization in patients with primary immunodeficiency diseases (PIDs) in Germany and Switzerland. METHODS Patients with PIDs receiving a stable dose of any subcutaneous immunoglobulin for ≥ 3 months before enrollment were eligible for this multicenter (n = 5), phase 4, non-interventional, prospective, longitudinal cohort study. Besides baseline demographics and clinical characteristics, Ig20Gly utilization and safety data, and patient-reported outcomes (Life Quality Index/Treatment Satisfaction Questionnaire for Medication) were collected at baseline, 6 and 12 months. Statistical analysis was descriptive. RESULTS Overall, 36 patients provided data at baseline [69.4% female; mean age: 41.6 years (7-78 years)]. Totals of 23 and 26 patients attended 6- and 12-month visits, respectively; 16 attended all three visits. One patient withdrew consent before 6-month follow-up. Median maximum infusion rates of Ig20Gly at baseline, 6 months, and 12 months were 26.7, 24.5, and 40.0 mL/h, respectively (10-60 mL/h). Infusion and dosing parameters remained consistent across time points: patients used a median of two infusion sites, primarily the abdomen, and all patients used an infusion pump; all but one infused at home and most self-administered Ig20Gly (80.8-83.3%) at once-weekly intervals (69.2-73.9%). During follow-up, 10 adverse events were reported: none were rated serious, while 2 were considered probably related to Ig20Gly. Total patient-reported outcome scores remained high throughout the study. CONCLUSION The CORE study provides real-world evidence of the flexibility, feasibility, safety, and tolerability of Ig20Gly infusions, at mostly weekly intervals, over 1 year in patients with PIDs. TRIAL REGISTRATION German Clinical Trials Register, DRKS00014562. Registered April 9, 2018, https://drks.de/search/en/trial/DRKS00014562.
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Affiliation(s)
- Maria Fasshauer
- Hospital for Children and Adolescents, Hospital St. Georg, Academic Teaching Hospital of the University of Leipzig, Leipzig, Germany.
- ImmunoDeficiencyCenter Leipzig (IDCL), Hospital St. Georg, Academic Teaching Hospital of the University of Leipzig, Leipzig, Germany.
| | - Michael Borte
- Hospital for Children and Adolescents, Hospital St. Georg, Academic Teaching Hospital of the University of Leipzig, Leipzig, Germany
- ImmunoDeficiencyCenter Leipzig (IDCL), Hospital St. Georg, Academic Teaching Hospital of the University of Leipzig, Leipzig, Germany
| | - Michaela Bitzenhofer
- Division of Allergology and Clinical Immunology, Department of Pneumology, University Hospital Berne (Inselspital Bern), Berne, Switzerland
| | - Christine Pausch
- GWT-TUD GmbH, Innovation Centre Real World Evidence, Dresden, Germany
| | - David Pittrow
- GWT-TUD GmbH, Innovation Centre Real World Evidence, Dresden, Germany
- Institute for Clinical Pharmacology, Technical University, Dresden, Germany
| | - Michelle Park
- Takeda Development Center Americas, Inc., Cambridge, MA, USA
| | - André Gladiator
- Takeda Pharmaceuticals International AG, Zurich, Switzerland
| | - Peter Jandus
- Division of Clinical Immunology and Allergy, Department of Medicine, University Hospital and Medical Faculty, Geneva, Switzerland
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2
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Länzlinger Y, Leroquais C, Meynard A, Jandus P, Harr T, Chevallier-Lugon C. [Management of allergic rhinitis in general practitioner's office]. Rev Med Suisse 2023; 19:1739-1742. [PMID: 37753911 DOI: 10.53738/revmed.2023.19.843.1739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
In Switzerland, almost 20 % of the population suffers from allergic rhinitis, which has a major impact on patients' quality of life. Allergen avoidance remains the most effective measure but is not always possible. Intranasal corticosteroids, oral antihistamines, or combination of intranasal corticosteroids and antihistamines remain first-line pharmacological treatments. In case of refractory symptoms, despite well-managed symptomatic treatment, when the patient wishes a more long-term effect or for prevention of asthma, the patient can be referred to the allergologist for specific immunotherapy. The specific immunotherapy is the only treatment option that targets the underlying pathophysiology of allergy and therefore shows disease-modifying effects.
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Affiliation(s)
- Yoann Länzlinger
- Service de médecine de premier recours, Département de médecine de premier recours, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Camille Leroquais
- Service de médecine de premier recours, Département de médecine de premier recours, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Anne Meynard
- Consultante externe, Département de médecine de premier recours, Hôpitaux universitaires de Genève, 1211 Genève 14
- Cabinet médical, Route de Petit-Chancy 59C, 1213 Petit-Lancy
| | - Peter Jandus
- Service d'immunologie et allergologie, Département de médecine, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Thomas Harr
- Service d'immunologie et allergologie, Département de médecine, Hôpitaux universitaires de Genève, 1211 Genève 14
- Faculté de médecine, Université de Genève, 1211 Genève 4
| | - Chloé Chevallier-Lugon
- Service de médecine de premier recours, Département de médecine de premier recours, Hôpitaux universitaires de Genève, 1211 Genève 14
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3
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Sultan J, Goethals M, Jandus P, Harr T, Perone N, Braillard O. [Urticaria : updates of a chronic condition]. Rev Med Suisse 2023; 19:1730-1733. [PMID: 37753909 DOI: 10.53738/revmed.2023.19.843.1730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
Urticaria is a frequent disease and exist in an acute or chronic form. The pathophysiology, focused on mast cells and histamine among other mediators, is an active research field but still poorly understood. The medical care focus on the avoidance of triggers and aggravating factors. The recommended drug therapy has not changed. The acknowledgment of chronic urticaria as a chronic disease is essential according to the last international recommendations. Acknowledging the disease morbidity and consequences, in a private, social or professional environment, allows better medical care for patients. The latter should get support on the long term, thanks to multiple diagnostic and therapeutic guidance tools.
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Affiliation(s)
- Judith Sultan
- Service de médecine de premier recours, Département de médecine de premier recours, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Maureen Goethals
- Service de médecine de premier recours, Département de médecine de premier recours, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Peter Jandus
- Service d'immunologie et allergologie, Département de médecine, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Thomas Harr
- Service d'immunologie et allergologie, Département de médecine, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Nicolas Perone
- Service de médecine de premier recours, Département de médecine de premier recours, Hôpitaux universitaires de Genève, 1211 Genève 14
- Institut de médecine de famille et de l'enfance, Faculté de médecine, Centre médical universitaire, 1211 Genève 4
- Centre médical de Lancy, Route de Chancy 59C, 1213 Petit-Lancy
| | - Olivia Braillard
- Service de médecine de premier recours, Département de médecine de premier recours, Hôpitaux universitaires de Genève, 1211 Genève 14
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4
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Matthes T, Jandus P. [Hypogammaglobulinemia and immunodeficiency in multiple myeloma and chronic lymphoid leukemia]. Rev Med Suisse 2023; 19:668-673. [PMID: 37017348 DOI: 10.53738/revmed.2023.19.821.668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Abstract
Infections are among the leading causes of morbidity and mortality in lymphoproliferative malignancies such as multiple myeloma (MM) and chronic lymphocytic leukemia (CLL). The causes of infections are often multifactorial and may be due to disease- or treatment-related factors. New therapies have improved survival in lymphoproliferative malignancies, resulting in an increased incidence of secondary immune deficiencies (SID) in these diseases.
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Affiliation(s)
- Thomas Matthes
- Service d'hématologie, Département d'oncologie, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Peter Jandus
- Service d'immunologie et allergologie, Département de médecine, Hôpitaux universitaires de Genève, 1211 Genève 14
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5
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Nieke JP, Jandus P. Reply to "Jacobsen Syndrome in a Patient with Combined Immunodeficiency, Thrombocytopenia, and Lymphoma". J Investig Allergol Clin Immunol 2023; 33:156-157. [PMID: 37071443 DOI: 10.18176/jiaci.0893] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023] Open
Affiliation(s)
- J P Nieke
- Division of Immunology and Allergology, University Hospitals and Medical Faculty of Geneva, Geneva, Switzerland
| | - P Jandus
- Division of Immunology and Allergology, University Hospitals and Medical Faculty of Geneva, Geneva, Switzerland
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6
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Jandus P. Arachidonic acid metabolism and its use in the diagnosis of mastocytosis. ALLERGY 2023. [DOI: 10.3934/allergy.2023006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
<abstract>
<p>Mast cells and basophils degranulate upon activation, releasing preformed mediators from intracellular granules into the extracellular environment, of which tryptase and histamine are the two most common and best characterized mediators. Despite the large number of mediators synthesized by mast cells, the non-tryptase biomarkers used to evaluate systemic mastocytosis and mast cell activation syndrome do not include the metabolites of the prestored amine histamine and the <italic>de novo</italic> synthesized phospholipids prostaglandin D2 and leukotriene C4. Currently, these markers are not used as criteria for the diagnosis of mastocytosis and mast cell activation syndrome. However, consensus groups foster the use of increases in measured baseline levels of these metabolites as potential diagnostic criteria. Metabolites of arachidonic acid such as prostaglandin D2 or leukotriene C4 play a role in the development of symptoms in systemic mastocytosis and mast cell activation syndrome. In this review, the metabolites of arachidonic acid and the detection of the metabolites of leukotrienes and prostaglandins in mastocytosis are highlighted. Measurement of these metabolites remains a major challenge because they are not widely available in daily clinical practice. However, new insights have been gained in recent years, and their application in the clinic has progressed.</p>
</abstract>
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Rohner GB, Jandus P. Impfungen und Impfantwort bei Immundefekten. Therapeutische Umschau 2022; 79:307-311. [DOI: 10.1024/0040-5930/a001366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Zusammenfassung. Die Impfung von Patenten mit Immundefekten stellt eine Herausforderung dar. Ein fehlender Anstieg von Impfantikörpertitern oder impfinduzierte Infektionen können auf einen primären Immundefekt hinweisen. Alle in der Schweiz zugelassenen Impfstoffe gegen SARS-CoV-2 können auch bei immungeschwächten Patienten verabreicht werden.
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Affiliation(s)
- Géraldine Blanchard Rohner
- Département de la femme, de l’enfant et de l’adolescent, Unité d’immunologie-vaccinologie pédiatrique, Hôpitaux Universitaires de Genève, Suisse
| | - Peter Jandus
- Département de médecine, Service d’Immunologie et Allergologie, Hôpitaux Universitaires de Genève, Suisse
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8
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Jandus P, Bitzenhofer-Grüber M. Antikörpermangelsyndrome. Therapeutische Umschau 2022; 79:279-283. [DOI: 10.1024/0040-5930/a001361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Zusammenfassung. Die Primären Immundefekte (PID) werden durch eine genetisch bedingte Fehlentwicklung/Funktionsstörung des Immunsystems verursacht. Leitsymptome sind neben Infektanfälligkeit, Autoimmunerkrankungen, lymphoproliferative, allergische als auch malige Erkrankungen. Sie können in zehn Hauptgruppen unterteilt werden, worunter die primären Antikörpermangelsyndrome (PAD) bei den Erwachsenen dominieren. Zu den bekanntesten PAD gehören das variable Immundefektsyndrom (CVID), die Brutonsche Agammaglobulinämie, die IgG-Subklassendefekte, der Immunglobulin-A-Mangel, der spezifische Antikörpermangel und die transiente Hypogammaglobulinämie im Kindesalter. Sekundäre bedingte Hypogammaglobulinämien durch Medikamente, hämatologische Erkrankungen, Malignome und Infektionen sollten ausgeschlossen werden. Bei Diagnoseverzögerungen der CVID konnte eine signifikante Erhöhung der Morbidität und Zunahme der Mortalität nachgewiesen werden. Therapeutisch erfolgt neben Impfungen auch eine Immunglobulin-Ersatztherapie.
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Affiliation(s)
- Peter Jandus
- Service d’Immunologie et d’Allergologiwe, Hôpitaux Universitaires de Genève, Suisse
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9
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Jandus P. Wachsende Erkenntnisse im Bereich der Hypogammaglobulinämie. Therapeutische Umschau 2022; 79:277. [DOI: 10.1024/0040-5930/a001360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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10
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Ercolano G, Trabanelli S, Jandus C, Jandus P. IL-9R loss in innate lymphoid cell type 2 (ILC2) reflects Treg impairment in mastocytosis patients. J Investig Allergol Clin Immunol 2022; 33:129-131. [PMID: 35416152 DOI: 10.18176/jiaci.0815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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)
- G Ercolano
- Department of Pharmacy, University of Naples Federico II, Naples, Italy
| | - S Trabanelli
- Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Ludwig Institute for Cancer Research, Lausanne Branch, Lausanne, Switzerland
| | - C Jandus
- Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Ludwig Institute for Cancer Research, Lausanne Branch, Lausanne, Switzerland
| | - P Jandus
- Division of Immunology and Allergology, University Hospitals and Medical Faculty of Geneva, Geneva, Switzerland
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11
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Nieke JP, Vargas MI, Meyer P, Seebach JD, Jandus P. Non-Invasive Versus Invasive Treatment Options for Challenging and Progressive Infundibulitis. Am J Med 2022; 135:453-455. [PMID: 34813736 DOI: 10.1016/j.amjmed.2021.10.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 10/11/2021] [Accepted: 10/12/2021] [Indexed: 11/01/2022]
Affiliation(s)
- Jan P Nieke
- Division of Immunology and Allergology, University Hospitals and Medical Faculty of Geneva, Geneva, Switzerland
| | - Maria I Vargas
- Division of Neuroradiology, University Hospitals and University of Geneva, Geneva, Switzerland
| | - Patrick Meyer
- Division of Endocrinology, Diabetes, Hypertension and Nutrition, University Hospitals of Geneva, Geneva, Switzerland
| | - Jörg D Seebach
- Division of Immunology and Allergology, University Hospitals and Medical Faculty of Geneva, Geneva, Switzerland
| | - Peter Jandus
- Division of Immunology and Allergology, University Hospitals and Medical Faculty of Geneva, Geneva, Switzerland.
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12
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Zgheib O, Trombert V, Jandus P, Serratrice C. Drug-induced hypersensitivity syndrome with lupus manifestations due to mesalazine in a patient with ulcerative colitis. BMJ Case Rep 2022; 15:e248229. [PMID: 35217557 PMCID: PMC8883224 DOI: 10.1136/bcr-2021-248229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2022] [Indexed: 11/04/2022] Open
Abstract
Mesalazine is often used as first-line therapy for ulcerative colitis. Several reports have pointed to systemic adverse reactions associated with this drug. Most have evoked a drug-induced hypersensitivity syndrome, while some have described lupus syndromes but with limited clinical and varied biological features. A 75-year-old man presented with fever, dyspnoea, chest pain, polyarthralgia, and myalgia, following mesalazine introduction. Clinical symptoms and low-titre positive antihistone antibodies disappeared after mesalazine withdrawal without recourse to steroids. Pericardial effusion and 8F-fluorodeoxyglucose uptake on positron emission tomography/CT scan, and glomerular haematuria and proteinuria also disappeared. Cytokine-lymphocyte transformation tests showed a strong sensitisation pattern with interleukin-5 production. This case advances our knowledge of the mechanism of mesalazine-induced adverse effects, namely via drug-induced hypersensitivity with lupus manifestations, which we are the first to report.
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Affiliation(s)
- Omar Zgheib
- Internal Medicine of the Elderly, Geneva University Hospitals, Geneva, Switzerland
| | - Véronique Trombert
- Internal Medicine of the Elderly, Geneva University Hospitals, Geneva, Switzerland
| | - Peter Jandus
- Immunology and Allergology, Geneva University Hospitals, Geneva, Switzerland
| | - Christine Serratrice
- Internal Medicine of the Elderly, Geneva University Hospitals, Geneva, Switzerland
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Blanchard-Rohner G, Peirolo A, Coulon L, Korff C, Horvath J, Burkhard PR, Gumy-Pause F, Ranza E, Jandus P, Dibra H, Taylor AMR, Fluss J. Childhood-Onset Movement Disorders Can Mask a Primary Immunodeficiency: 6 Cases of Classical Ataxia-Telangiectasia and Variant Forms. Front Immunol 2022; 13:791522. [PMID: 35154108 PMCID: PMC8831727 DOI: 10.3389/fimmu.2022.791522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 01/07/2022] [Indexed: 02/02/2023] Open
Abstract
Ataxia-telangiectasia (A-T) is a neurodegenerative and primary immunodeficiency disorder (PID) characterized by cerebellar ataxia, oculocutaneous telangiectasia, immunodeficiency, progressive respiratory failure, and an increased risk of malignancies. It demands specialized care tailored to the individual patient’s needs. Besides the classical ataxia-telangiectasia (classical A-T) phenotype, a variant phenotype (variant A-T) exists with partly overlapping but some distinctive disease characteristics. Here we present a case series of 6 patients with classical A-T and variant A-T, which illustrates the phenotypic variability of A-T that can present in childhood with prominent extrapyramidal features, with or without cerebellar ataxia. We report the clinical data, together with a detailed genotype description, immunological analyses, and related expression of the ATM protein. We show that the presence of some residual ATM kinase activity leads to the clinical phenotype variant A-T that differs from the classical A-T. Our data illustrate that the diagnosis of the variant form of A-T can be delayed and difficult, while early recognition of the variant form as well as the classical A-T is a prerequisite for providing a correct prognosis and appropriate rehabilitation and support, including the avoidance of diagnostic X-ray procedures, given the increased risk of malignancies and the higher risk for side effects of subsequent cancer treatment.
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Affiliation(s)
- Geraldine Blanchard-Rohner
- Paediatric Immunology and Vaccinology Unit, Division of General Pediatrics, Department of Pediatrics, Gynecology and Obstetrics, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
- *Correspondence: Geraldine Blanchard-Rohner,
| | - Anna Peirolo
- Department of Clinical and Experimental Sciences, University of Brescia, ASST Spedali Civili, Brescia, Italy
| | - Ludivine Coulon
- Division of General Pediatrics, Department of Pediatrics, Gynecology and Obstetrics, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - Christian Korff
- Pediatric Neurology Unit, Department of Pediatrics, Gynecology and Obstetrics, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - Judit Horvath
- Department of Neurology, University Hospitals of Geneva, Geneva, Switzerland
| | - Pierre R. Burkhard
- Department of Neurology, University Hospitals of Geneva, Geneva, Switzerland
| | - Fabienne Gumy-Pause
- Division of Pediatric Oncology and Hematology, Department of Women, Child and Adolescent Medicine, Geneva University Hospitals, Geneva, Switzerland
- CANSEARCH Research Platform for Pediatric Oncology and Hematology, Department of Pediatrics, Gynaecology and Obstetrics, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Emmanuelle Ranza
- Medigenome, Swiss Institute of Genomic Medicine, Geneva, Switzerland
| | - Peter Jandus
- Division of Immunology and Allergology, University Hospitals and Medical Faculty of Geneva, Geneva, Switzerland
| | - Harpreet Dibra
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom
| | | | - Joel Fluss
- Pediatric Neurology Unit, Department of Pediatrics, Gynecology and Obstetrics, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
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Nigolian H, Nieke JP, Chevallier M, Stathaki E, Sloan-Béna F, Carminho-Rodrigues MT, Jandus P. Immunodeficiency and lymphoma in Jacobsen syndrome. J Investig Allergol Clin Immunol 2022; 32:408-409. [PMID: 35029149 DOI: 10.18176/jiaci.0777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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)
- H Nigolian
- Division of Immunology and Allergology, University Hospitals and Medical Faculty of Geneva, Geneva, Switzerland
| | - J P Nieke
- Division of Immunology and Allergology, University Hospitals and Medical Faculty of Geneva, Geneva, Switzerland
| | - M Chevallier
- Division of Oncology, University Hospitals and Medical Faculty of Geneva, Geneva, Switzerland
| | - E Stathaki
- Division of Genetic Medicine, University Hospitals and Medical Faculty of Geneva, Geneva, Switzerland
| | - F Sloan-Béna
- Division of Genetic Medicine, University Hospitals and Medical Faculty of Geneva, Geneva, Switzerland
| | - M T Carminho-Rodrigues
- Division of Genetic Medicine, University Hospitals and Medical Faculty of Geneva, Geneva, Switzerland
| | - P Jandus
- Division of Immunology and Allergology, University Hospitals and Medical Faculty of Geneva, Geneva, Switzerland
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15
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Luterbacher F, Bernard F, Baleydier F, Ranza E, Jandus P, Blanchard-Rohner G. Case Report: Persistent Hypogammaglobulinemia More Than 10 Years After Rituximab Given Post-HSCT. Front Immunol 2021; 12:773853. [PMID: 35003091 PMCID: PMC8727997 DOI: 10.3389/fimmu.2021.773853] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 11/26/2021] [Indexed: 12/14/2022] Open
Abstract
Rituximab (RTX) is an anti-CD20 monoclonal antibody that targets B cells-from the immature pre-B-cell stage in the bone marrow to mature circulating B cells-while preserving stem cells and plasma cells. It is used to treat autoimmune diseases, hematological malignancies, or complications after hematopoietic stem cell transplantation (HSCT). Its safety profile is acceptable; however, a subset of patients can develop persistent hypogammaglobulinemia and associated severe complications, especially in pediatric populations. We report the unrelated cases of two young men aged 17 and 22, presenting with persistent hypogammaglobulinemia more than 7 and 10 years after treatment with RTX, respectively, and administered after HSCT for hemolytic anemia and Epstein-Barr virus reactivation, respectively. Both patients' immunological workups showed low levels of total immunoglobulin, vaccine antibodies, and class switched-memory B cells but an increase in naive B cells, which can also be observed in primary immunodeficiencies such as those making up common variable immunodeficiency. Whole exome sequencing for one of the patients failed to detect a pathogenic variant causing a Mendelian immunological disorder. Annual assessments involving interruption of immunoglobulin replacement therapy each summer failed to demonstrate the recovery of endogenous immunoglobulin production or normal numbers of class switched-memory B cells 7 and 10 years after the patients' respective treatments with RTX. Although the factors that may lead to prolonged hypogammaglobulinemia after rituximab treatment (if necessary) remain unclear, a comprehensive immunological workup before treatment and long-term follow-up are mandatory to assess long-term complications, especially in children.
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Affiliation(s)
- Fanny Luterbacher
- The Children’s Hospital, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Fanette Bernard
- Pediatric Hematology/Oncology Unit, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Frédéric Baleydier
- Pediatric Hematology/Oncology Unit, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Emmanuelle Ranza
- Genetic Medicine Division, Geneva University Hospitals, Geneva, Switzerland
- Medigenome, Swiss Institute of Genomic Medicine, Geneva, Switzerland
| | - Peter Jandus
- Immunology and Allergology Division, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Geraldine Blanchard-Rohner
- Pediatric Immunology and Vaccinology Unit, General Pediatrics Division, Department for Women, Children, and Teenagers, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
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Falquet M, Ercolano G, Jandus P, Jandus C, Trabanelli S. Healthy and Patient Type 2 Innate Lymphoid Cells are Differently Affected by in vitro Culture Conditions. J Asthma Allergy 2021; 14:773-783. [PMID: 34239308 PMCID: PMC8259735 DOI: 10.2147/jaa.s304126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 04/29/2021] [Indexed: 12/20/2022] Open
Abstract
Background Type 2 innate lymphoid cells (ILC2s) have emerged as key players in the development of type 2 driven diseases such as allergy and asthma. Due to their low number in the circulation, in vitro expansion is needed to unravel their mechanisms of action. Purpose The aim of this study is to assess the impact of different culture conditions and address whether the method of expansion may distinctly affect healthy donor or patient-derived ILC2s. Methods Here, we described the impact of six different culture conditions on the proliferation, phenotype and function of human ILC2s freshly obtained from healthy donors (healthy ILC2s) and allergic patients (patient ILC2s). Results We showed that the cytokine cocktail or the PHA induced the highest proliferation of healthy ILC2s and patient ILC2s, respectively. We observed that the stromal cells OP9, used as ILC2 feeders, did not boost their proliferation, but impaired the activation marker expression and the function of patient ILC2s. Furthermore, we demonstrated that the culture conditions differently impacted the activation state of c-Kithigh and c-Kitlow ILC2s, in both healthy donors and allergic patients. Last, we also observed that ILC2s expanded only with IL-2 and IL-7 were the most prone to secrete IL-5 and IL-13 upon IL-33 stimulation. In contrast, in patients, the addition of OP9 cells during the expansion restrained their type 2 cytokine secretory functions. Conclusion This report highlights that culture conditions distinctly impacted on the healthy or patient ILC2 behavior, with important consequences for their study in disease settings.
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Affiliation(s)
- Maryline Falquet
- Ludwig Institute for Cancer Research, Lausanne Branch, Lausanne, Switzerland.,Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Giuseppe Ercolano
- Ludwig Institute for Cancer Research, Lausanne Branch, Lausanne, Switzerland.,Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Peter Jandus
- Division of Immunology and Allergology, University Hospital and Medical Faculty, Geneva, Switzerland
| | - Camilla Jandus
- Ludwig Institute for Cancer Research, Lausanne Branch, Lausanne, Switzerland.,Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Sara Trabanelli
- Ludwig Institute for Cancer Research, Lausanne Branch, Lausanne, Switzerland.,Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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17
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Jandus P, Duc M, Fay BC. Diagnosis and Management of Severe Asthma in Switzerland: Analysis of Survey Results Conducted with Specialists and General Practitioners. Respiration 2021; 100:476-487. [PMID: 33784703 DOI: 10.1159/000514628] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 01/19/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Severe asthma commonly affects 5-10% of the asthmatic population and accounts for approximately 50% of the overall asthma costs. OBJECTIVE This analysis investigated how severe asthma is diagnosed, treated, and managed by specialists and general practitioners (GPs) in Switzerland. METHODS Two surveys, one each among specialists (N = 44) and GPs (N = 153), were conducted to understand their self-perception on diagnosis, treatment, and management of severe asthma. RESULTS Fifty-five percent of the specialists felt very confident and 43% confident in recognizing the symptoms of severe asthma and diagnosing severe asthma. In contrast, 9% of the GPs were very confident and 59% confident in diagnosing severe asthma. More specific diagnostic tests for severe asthma, like total and specific immunoglobulin E levels and measurement of the fraction of exhaled nitric oxide, were run by specialists (χ2 = 171.4; df = 15, p < 0.001). GPs and specialists were using different measurements to assess severe asthma (χ2 = 385.2; df = 13, p < 0.001) and their prescribing patterns differed significantly (χ2 = 189.8; df = 10, p < 0.001). GPs referred patients with severe asthma if the diagnosis was unclear (24%), if treatment failure occurred (26%), and if the patients were at high risk (41%). CONCLUSIONS Oral corticosteroids (OCSs) are considered as background therapy for severe asthma by GPs and specialists. In order to reduce the OCS burden, there is a need to improve the awareness for other add-on therapies. A joint collaboration between GPs and specialists is the key to leverage therapeutic strategies together.
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Affiliation(s)
- Peter Jandus
- Service d'Immunologie et d'Allergologie, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Mélanie Duc
- Novartis Pharma Schweiz AG, Rotkreuz, Switzerland
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18
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Coen M, Jandus P, Rollason V, Seebach J, Serratrice J. Cinderella side effect: Intravenous corticosteroid-induced bradycardia. Therapie 2020; 76:480-481. [PMID: 32646687 DOI: 10.1016/j.therap.2020.06.007] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 04/01/2020] [Accepted: 06/19/2020] [Indexed: 01/03/2023]
Affiliation(s)
- Matteo Coen
- Division of General Internal Medicine, Department of Medicine, Geneva University Hospitals, 1211 Geneva, Switzerland; Unit of Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, 1211 Geneva, Switzerland.
| | - Peter Jandus
- Division of immunology and allergology, Department of Medicine, University Hospitals of Geneva , 1211 Geneva, Switzerland
| | - Victoria Rollason
- Department of anesthesiology, pharmacology, intensive care, and emergency medicine, division of clinical pharmacology and toxicology, Geneva University Hospitals,, 1211 Geneva, Switzerland
| | - Jörg Seebach
- Division of immunology and allergology, Department of Medicine, University Hospitals of Geneva , 1211 Geneva, Switzerland
| | - Jacques Serratrice
- Division of General Internal Medicine, Department of Medicine, Geneva University Hospitals, 1211 Geneva, Switzerland
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19
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Abstract
The diagnosis of anaphylaxis relies on a suggestive clinical history after exposure to a potential triggering factor. Serum tryptase concentrations increase on degranulation of mast cells and therefore serum tryptase levels are measured to diagnose anaphylaxis. There is no standardized method for assessing total serum mast cell tryptase (MCT) in anaphylaxis. The Working Conference in 2010 proposed a consensus equation (peak MCT should be > 1.2x baseline tryptase + 2 ng/L) to diagnose acute mast cell activation (aMCA). Our objective was to narratively review the literature since the Working Conference in 2010, examining the use of the consensus equation and other equations comparing baseline and peak serum tryptase during anaphylaxis. Computerized bibliographic searches of PUBMED and EMBASE were supplemented with a manual search of reference lists. English-language studies were included. Eleven studies met our inclusion criteria with a total of 4551 participants. However, only four studies with 653 participants used the consensus equation. The other seven studies used other methods to compare peak and baseline serum tryptase concentrations. Measuring serum tryptase levels is valuable in the diagnosis of anaphylaxis but is unable to detect all anaphylactic reactions. Based on our current literature review, the consensus equation is underused in the diagnosis of anaphylaxis. There is also a need for exploration of other biomarkers which could be used in parallel to peak and baseline serum tryptase measurements for further diagnostic certainty. Serum tryptase is the most studied biomarker in anaphylaxis but is still far from being the ideal biomarker for this. There is a need to identify new potential useful biomarkers. Serum tryptase levels are valuable in the diagnosis of anaphylaxis, but are unable to detect all anaphylactic reactions. Additionally serial tryptase measurements are laborious in daily clinical practice.
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Affiliation(s)
| | - Peter Jandus
- Department of Medicine, Division of Immunology and Allergy, University Hospital and Medical Faculty, Geneva, Switzerland.
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20
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Papaserafeim M, Jandus P, Iancu Ferfoglia R, Nieke JP, Vonarburg C, Spirig R, Puga Yung GL, Seebach JD. Effect of intravenous IgG therapy on natural killer cell function related to Fc gamma receptor gene expression. J Allergy Clin Immunol 2020; 146:667-670. [PMID: 32311389 DOI: 10.1016/j.jaci.2020.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 03/26/2020] [Accepted: 04/03/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Maria Papaserafeim
- Division of Immunology and Allergology, University Hospitals and Medical Faculty, Geneva, Switzerland
| | - Peter Jandus
- Division of Immunology and Allergology, University Hospitals and Medical Faculty, Geneva, Switzerland
| | | | - Jan P Nieke
- Division of Immunology and Allergology, University Hospitals and Medical Faculty, Geneva, Switzerland
| | - Cédric Vonarburg
- CSL Behring AG, CSL Biologics Research Center, Bern, Switzerland
| | - Rolf Spirig
- CSL Behring AG, CSL Biologics Research Center, Bern, Switzerland
| | - Gisella L Puga Yung
- Division of Immunology and Allergology, University Hospitals and Medical Faculty, Geneva, Switzerland
| | - Jörg D Seebach
- Division of Immunology and Allergology, University Hospitals and Medical Faculty, Geneva, Switzerland.
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21
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Vandenberghe-Dürr S, Landis BN, Jandus P. [Widal's triad : clinical manifestations, pathophysiology and therapeutic advances]. Rev Med Suisse 2020; 16:694-697. [PMID: 32270937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
NSAID-Exacerbated respiratory disease (also known as Samter's or Widal's triad, aspirin-exacerbated respiratory disease) is characte- rized by asthma, nasal polyposis and hypersensitivity to NSAIDs. The pathogenesis of this chronic inflammation arises from an imbalance in arachidonic acid metabolism, leading to an increase in pro- inflammatory cysteinyl-leukotrienes. The treatment is based on drug management of asthma and polyps and, in advanced situations, surgical management of polyposis. Monoclonal antibodies have shown promising results in the further medical treatment of this entity.
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Affiliation(s)
| | | | - Peter Jandus
- Service d'immunologie et allergologie, HUG, 1211 Genève 14
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22
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Coattrenec Y, Ibrahim Yasmine L, Harr T, Spoerl D, Jandus P. Long-term Remission of Wells Syndrome With Omalizumab. J Investig Allergol Clin Immunol 2020; 30:58-59. [DOI: 10.18176/jiaci.0436] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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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23
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Vandenberghe-Dürr S, Jandus P, Serratrice J, Harr T. [A first-line guide to the evaluation of « Penicillin Allergy » in general medical practice]. Rev Med Suisse 2020; 16:138-142. [PMID: 31967757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
« Penicillin allergy » is a common finding in patient's medical files (up to 10 %). Although it is important not to neglect such records (due to the serious and life-threatening reactions an allergic patient may suffer from), most of the time these reported notions of allergy are wrong and lead to the unfortunate avoidance of all betalactamins. This in turn leads to increased risks of antibiotic resistance and increased health costs. This review aims to summarize the current knowledge on penicillin allergy epidemiologic data and proposes a first-line guide for general practitioners to the evaluation of the patient with a history of « penicillin allergy ».
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Affiliation(s)
- Sophie Vandenberghe-Dürr
- Service de médecine interne générale (SMIG), HUG, 1211 Genève 14
- Service d'immunologie et allergologie (SIA), HUG, 1211 Genève 14
| | - Peter Jandus
- Service d'immunologie et allergologie (SIA), HUG, 1211 Genève 14
| | | | - Thomas Harr
- Service d'immunologie et allergologie (SIA), HUG, 1211 Genève 14
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24
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Distler M, Maul JT, Steiner UC, Jandus P, Kolios AGA, Murer C, Graf N, Seebach JD, Pichler WJ, Navarini AA, French LE, Helbling A, Schmid-Grendelmeier P. Efficacy of Omalizumab in Mastocytosis: Allusive Indication Obtained from a Prospective, Double-Blind, Multicenter Study (XOLMA Study). Dermatology 2020; 236:529-539. [PMID: 31958790 DOI: 10.1159/000504842] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 11/16/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Patients with mastocytosis often suffer from a variety of symptoms caused by mast cell mediators where treatments remain difficult, showing various success rates. Omalizumab, a monoclonal anti-IgE antibody, has been postulated to have a positive impact on mastocytosis-associated symptoms such as flush, vertigo, gastrointestinal problems, or anaphylaxis. OBJECTIVE To investigate the efficacy and safety of omalizumab in systemic mastocytosis. METHODS Patients with histologically proven mastocytosis were investigated in a multicenter prospective double-blind placebo-controlled trial to receive either omalizumab or placebo, dosed according to IgE and body weight. The primary endpoint was change in the AFIRMM activity score after 6 months of treatment. Different laboratory parameters were analyzed. RESULTS Sixteen patients were analyzed: 7 to omalizumab and 9 to placebo (mean age 47.7 ± 13.8 vs. 45.4 ± 8.8 years; 66.6 vs. 85.7% were female; mean disease duration 10.0 ± 5.1 vs. 4.5 ± 2.9 years, respectively). After 6 months the median AFIRMM score decreased 50% from 52.0 to 26.0 in the omalizumab group versus 104.0-102.0 in the placebo group (p = 0.286); however, the difference was not significant (p = 0.941). Secondary endpoints, including the number of allergic reactions, changes in major complaints, wheal-and-flare reaction due to mechanical irritation (Darier's sign), and frequency of the use of mastocytosis-specific drugs improved in the omalizumab group, but not significantly. Adverse events like urticaria, bronchospasm, and anaphylactic shock showed no significant difference between the groups. No severe adverse events occurred. FcεRI (Fc-epsilon receptor) expression on basophils decreased after receiving omalizumab versus placebo. CONCLUSION Omalizumab was safe and showed a tendency to improve mastocytosis-related symptoms, in particular diarrhea, dizziness, flush, and anaphylactic reactions, including the AFIRMM score and secondary endpoints; however, the difference was not significant. Due to the small study size and difference at baseline between the study groups, further studies are required to confirm our findings.
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Affiliation(s)
- Meike Distler
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland,
| | - Julia-Tatjana Maul
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Urs C Steiner
- Department of Immunology, University Hospital Zurich, Zurich, Switzerland.,Department of Rheumatology, Immunology and Allergology, University Hospital Berne, Berne, Switzerland
| | - Peter Jandus
- Division of Immunology and Allergology, Department of Medical Specialties, Geneva University Hospital, Geneva, Switzerland
| | - Antonios G A Kolios
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.,Department of Immunology, University Hospital Zurich, Zurich, Switzerland
| | - Carla Murer
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | | | - Jörg D Seebach
- Division of Immunology and Allergology, Department of Medical Specialties, Geneva University Hospital, Geneva, Switzerland
| | - Werner J Pichler
- Department of Rheumatology, Immunology and Allergology, University Hospital Berne, Berne, Switzerland.,ADR-AC GmbH Berne, Zurich, Switzerland
| | - Alexander A Navarini
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.,Department of Dermatology, University Hospital Basel, Basel, Switzerland
| | - Lars E French
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.,Department of Dermatology, Klinikum der Universität München, LMU Munich, Munich, Germany
| | - Arthur Helbling
- Department of Rheumatology, Immunology and Allergology, University Hospital Berne, Berne, Switzerland
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25
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Jandus P, Harr T, Soyka MB, Landis BN. [The efficacy of omalizumab in the treatment of chronic rhinosinusitis with nasal polyps: a discussion of 2 refractory cases]. Rev Med Suisse 2019; 15:1748-1751. [PMID: 31580018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Nasal polyposis is a specific phenotype of chronic rhinosinusitis (CRS). Some cases can be managed with topical and infrequent use of systemic steroids, while many patients require surgery. Despite postoperative, regular steroid administration, recurrences may be found especially in patients suffering from Aspirin exacerbated respiratory disease (AERD), a particularly severe form of CRS with polyps, asthma and non-steroid-anti-inflammatory-drug (NSAID) intolerance. We report two cases of difficult-to-treat AERD patients following revision surgery, treated with monoclonal anti-IgE antibody (omalizumab) and successful control of the disease and symptoms. Omalizumab may be a promising alternative in selected cases of CRS with nasal polyps to avoid overuse of systemic steroids and frustrating repetition of paranasal sinus surgeries.
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Affiliation(s)
- Peter Jandus
- Service d'allergologie et immunologie clinique, HUG, 1211 Genève 14
| | - Thomas Harr
- Service d'allergologie et immunologie clinique, HUG, 1211 Genève 14
| | - Michael B Soyka
- Service d'otorhinolaryngologie et chirurgie cervico-faciale, Hôpital universitaire de Zurich, 8091 Zurich
| | - Basile Nicolas Landis
- Unité de rhinologie-olfactologie, Service d'otorhinolaryngologie et chirurgie cervico-faciale, HUG, 1211 Genève 14
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26
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Jandus P. [The diagnostic challenge of primary immunodeficiencies in adults]. Rev Med Suisse 2019; 15:719-722. [PMID: 30942969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Primary immunodeficiencies (PID) constitute a heterogeneous group of genetic disorders caused by defects in the development and/or function of the immune system resulting in an increased susceptibility to recurrent infections. In addition to a predisposition to infections, PID patients present an increased vulnerability to autoimmunity, lymphoproliferation, allergies and malignancies. Studies performed in the past decade revealed that the prevalence of PID in adults was largely underestimated. These have also demonstrated that the disease burden of PID is not less than in children. PID is more common than generally thought.
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Affiliation(s)
- Peter Jandus
- Service d'immunologie et d'allergologie, Département de médecine interne, HUG, 1211 Genève 14
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27
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Distler M, Maul T, Steiner U, Jandus P, Murer C, Graf N, Petkvic T, Sebach J, Navarini A, French L, Helbling A, Schmid-Grendelmeier P. The Effect of omalizumab in Mastocytosis Patients. Prospective double-blind, placebo-controlled multicentre study. J Allergy Clin Immunol 2019. [DOI: 10.1016/j.jaci.2018.12.407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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28
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Harr T, Jandus P. Late Diagnosis of Anaphylactic Reaction to Gadolinium-Based Contrast Media by Skin Tests 10 Years After Onset. J Investig Allergol Clin Immunol 2018; 28:203-205. [DOI: 10.18176/jiaci.0240] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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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29
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Passia E, Jandus P. [Mastcell activation syndrome]. Rev Med Suisse 2018; 14:742-745. [PMID: 29620297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Mast cell activation syndrome (MCAS) encompasses a heterogeneous group of pathologies, which are characterized by the existence of clinical symptoms secondary to the systemic effects of mediators released by activated mast cells. MCAS-related symptoms may be mild, moderate, severe, or even life-threatening. Detailed knowledge of the pathogenesis and complexity of MCAS can help in the management and treatment of these patients.
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Affiliation(s)
- Evangelia Passia
- Service d'immunologie et d'allergologie, Département des spécialités de médecine, HUG, 1211 Genève 14
| | - Peter Jandus
- Service d'immunologie et d'allergologie, Département des spécialités de médecine, HUG, 1211 Genève 14
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30
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Trabanelli S, Gomez-Cadena A, Salomé B, Michaud K, Mavilio D, Landis BN, Jandus P, Jandus C. Human innate lymphoid cells (ILCs): Toward a uniform immune-phenotyping. Cytometry B Clin Cytom 2018; 94:392-399. [PMID: 29244250 DOI: 10.1002/cyto.b.21614] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Revised: 12/08/2017] [Accepted: 12/12/2017] [Indexed: 12/11/2022]
Abstract
Helper innate lymphoid cells (ILCs), the most recently identified population of the ILC family, play a fundamental role in the restoration of tissue integrity, in the protection against infiltrating pathogens as well as in tumor immune-surveillance. ILCs have been divided into three main subsets, ILC1, ILC2, and ILC3, that can be specifically activated by different signals coming either indirectly from pathogens or from other cell populations, including cancer cells. Following activation, ILCs are in turn able to promptly secrete a wide range of soluble mediators that modulate effector cell functions. The discovery and the study of these immune cells is now offering important opportunities for innovative therapies of allergic airway diseases, inflammatory disorders and might be crucial for the discovery of new targets for the therapy of cancer. It is therefore fundamental that the scientific community establishes harmonized guidelines to obtain a consensus in the identification and phenotypical and functional characterization of ILCs. © 2018 International Clinical Cytometry Society.
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Affiliation(s)
- Sara Trabanelli
- Department of Fundamental Oncology, University of Lausanne, Lausanne, Switzerland
| | | | - Bérengère Salomé
- Department of Fundamental Oncology, University of Lausanne, Lausanne, Switzerland
| | - Katarzyna Michaud
- University Center of Legal Medicine, University Hospital of Lausanne, Lausanne, Switzerland
| | - Domenico Mavilio
- Unit of Clinical and Experimental Immunology, Humanitas Clinical and Research Center, Rozzano-Milan, Italy.,Department of Medical Biotechnologies and Translational Medicine, University of Milan, Milan, Italy
| | - Basile Nicolas Landis
- Rhinology-Olfactology Unit, Otolaryngology Head & Neck Surgery Department, University Hospital and Medical Faculty, Geneva, Switzerland
| | - Peter Jandus
- Division of Immunology and Allergology, Department of Medical Specialities, University Hospital and Medical Faculty, Geneva, Switzerland
| | - Camilla Jandus
- Department of Fundamental Oncology, University of Lausanne, Lausanne, Switzerland
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31
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Coattrenec Y, Harr T, Chizzolini C, Jandus P. [Allergology and clinical immunology]. Rev Med Suisse 2018; 14:15-18. [PMID: 29337441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Hereditary angioedema (HA) is a disabling and potentially fatal condition. The management of HA includes treatment of acute attacks, short-term prophylaxis to prevent an attack, and long-term prophylaxis to minimize the frequency and severity of recurrent attacks. In this article, we will present new therapeutic alternatives for long term prophylaxis. Glucocorticoids (GC) usage leads to a number of severe side-effects. In giant cell arteritis, the use of tocilizumab in conjunction with low doses of GC reduces the number of relapses. In ANCA-associated vasculitis the use of an anti-C5R (avacopan) alone or in conjunction with low doses of GC results in similar remission rates to those induced by high dose GC.
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Affiliation(s)
- Yann Coattrenec
- Service d'immunologie et d'allergologie, Département des spécialités de médecine, HUG, 1211 Genève 14
| | - Thomas Harr
- Service d'immunologie et d'allergologie, Département des spécialités de médecine, HUG, 1211 Genève 14
| | - Carlo Chizzolini
- Service d'immunologie et d'allergologie, Département des spécialités de médecine, HUG, 1211 Genève 14
| | - Peter Jandus
- Service d'immunologie et d'allergologie, Département des spécialités de médecine, HUG, 1211 Genève 14
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32
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Coattrenec Y, Spoerl D, Jandus P, Harr T. Anaphylactic shock to H1 antihistamine drug bilastine: A case report. J Allergy Clin Immunol Pract 2018; 6:256-257. [PMID: 28939141 DOI: 10.1016/j.jaip.2017.07.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 07/16/2017] [Accepted: 07/26/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Yann Coattrenec
- Division of Immunology and Allergology, Department of Medical Specialties, University Hospital and Medical Faculty, Geneva, Switzerland
| | - David Spoerl
- Division of Immunology and Allergology, Department of Medical Specialties, University Hospital and Medical Faculty, Geneva, Switzerland
| | - Peter Jandus
- Division of Immunology and Allergology, Department of Medical Specialties, University Hospital and Medical Faculty, Geneva, Switzerland.
| | - Thomas Harr
- Division of Immunology and Allergology, Department of Medical Specialties, University Hospital and Medical Faculty, Geneva, Switzerland
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33
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Vigano S, Trabanelli S, Indulsi F, Salomé B, Harari A, Romero P, Helbling A, Jandus C, Jandus P. Dysregulated Innate Lymphocytes in Patients With Primary Antibody Deficiency Treated With Intravenous Immunoglobulin. J Investig Allergol Clin Immunol 2017; 27:394-396. [DOI: 10.18176/jiaci.0200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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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34
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Coattrenec Y, Jaques D, Jandus P, Harr T, Spoerl D. Anaphylactic shock following castor bean contact: a case report. Allergy Asthma Clin Immunol 2017; 13:50. [PMID: 29201066 PMCID: PMC5701385 DOI: 10.1186/s13223-017-0221-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 11/02/2017] [Indexed: 11/10/2022] Open
Abstract
Background The castor bean plant, Ricinus communis, is known to have allergenic and toxic properties. Castor bean allergy has been described mainly as an occupational inhalation allergy in laboratory workers, in persons working in oil processing mills or in agricultural industry. So far, only one case of anaphylactic reaction due to castor bean sensitization confirmed by specific IgE has been described in literature. Case presentation A 30-year-old woman presented to the emergency room with severe angioedema followed by urticaria, hypotension and tachycardia. She recovered after treatment with antihistamines, corticosteroids, nebulized adrenaline and intravenous fluids. Food induced anaphylaxis was excluded by allergological investigations. After repeated thorough history, the patient mentioned having bitten into a castor bean just before the reaction. Cutaneous test (prick-to-prick) and specific IgE for castor bean were highly positive. Conclusions We report the second case of a severe anaphylactic reaction to castor beans, confirmed by IgE testing, reported in the literature. It underlines the importance of a meticulous history in allergology and highlights the fact, that castor beans may cause potentially fatal anaphylaxis.
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Affiliation(s)
- Y Coattrenec
- Division of Immunology and Allergology, Department of Medical Specialties, University Hospital and Medical Faculty, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva, Switzerland
| | - D Jaques
- Dr. med. Dominique Jaques, Rue Emile-Yung 11, 1205 Geneva, Switzerland
| | - P Jandus
- Division of Immunology and Allergology, Department of Medical Specialties, University Hospital and Medical Faculty, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva, Switzerland
| | - T Harr
- Division of Immunology and Allergology, Department of Medical Specialties, University Hospital and Medical Faculty, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva, Switzerland
| | - D Spoerl
- Division of Immunology and Allergology, Department of Medical Specialties, University Hospital and Medical Faculty, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva, Switzerland
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Homsy A, Rüegg EM, Jandus P, Pittet-Cuénod B, Modarressi A. Immunological reaction after facial hyaluronic acid injection. Case Reports Plast Surg Hand Surg 2017; 4:68-72. [PMID: 28804742 PMCID: PMC5532757 DOI: 10.1080/23320885.2017.1356202] [Citation(s) in RCA: 7] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Accepted: 07/12/2017] [Indexed: 11/01/2022]
Abstract
We report two rare cases of inflammatory reactions with multiple subcutaneous facial painful collections after Hyaluronic acid injections, expose their management and discuss aetiologic hypothesis. Due to unfavourable evolution despite antibiotic treatment, surgical drainage was performed. Immune-mediated delayed hypersensitivity reactions were the most probable cause.
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Affiliation(s)
- Antoine Homsy
- Department of Plastic, Reconstructive and Aesthetic Surgery, Faculty of Medicine, Geneva University Hospitals, University of GenevaGenevaSwitzerland
| | - Eva Meia Rüegg
- Department of Plastic, Reconstructive and Aesthetic Surgery, Faculty of Medicine, Geneva University Hospitals, University of GenevaGenevaSwitzerland
| | - Peter Jandus
- Immunology and Allergology Unit, Faculty of Medicine, Geneva University Hospitals, University of GenevaGenevaSwitzerland
| | - Brigitte Pittet-Cuénod
- Department of Plastic, Reconstructive and Aesthetic Surgery, Faculty of Medicine, Geneva University Hospitals, University of GenevaGenevaSwitzerland
| | - Ali Modarressi
- Department of Plastic, Reconstructive and Aesthetic Surgery, Faculty of Medicine, Geneva University Hospitals, University of GenevaGenevaSwitzerland
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Rey F, Roffi M, Bouvet C, Bréguet R, Jandus P, Rigamonti F. Recurrent Vasospastic Myocardial Infarctions and Hand Necrosis. JACC Cardiovasc Interv 2017; 10:198-199. [PMID: 28040441 DOI: 10.1016/j.jcin.2016.10.007] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Accepted: 10/06/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Florian Rey
- Division of Cardiology, Geneva University Hospitals, Geneva, Switzerland.
| | - Marco Roffi
- Division of Cardiology, Geneva University Hospitals, Geneva, Switzerland
| | - Cindy Bouvet
- Division of Hand Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Romain Bréguet
- Division of Radiology, Geneva University Hospitals, Geneva, Switzerland
| | - Peter Jandus
- Division of Immunology and Allergy, Geneva University Hospitals, Geneva, Switzerland
| | - Fabio Rigamonti
- Division of Cardiology, Geneva University Hospitals, Geneva, Switzerland
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Spoerl D, Jandus P, Harr T. Pitfalls and peculiarities in chlorhexidine allergy. J Allergy Clin Immunol Pract 2016; 4:991-2. [PMID: 27130710 DOI: 10.1016/j.jaip.2016.03.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 03/22/2016] [Accepted: 03/28/2016] [Indexed: 11/30/2022]
Affiliation(s)
- David Spoerl
- Division of Clinical Immunology and Allergy, Department of Medical Specialties, University Hospital and Faculty of Medicine, Genève, Switzerland.
| | - Peter Jandus
- Division of Clinical Immunology and Allergy, Department of Medical Specialties, University Hospital and Faculty of Medicine, Genève, Switzerland
| | - Thomas Harr
- Division of Clinical Immunology and Allergy, Department of Medical Specialties, University Hospital and Faculty of Medicine, Genève, Switzerland
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Jandus P, Grange E, Seebach JD. [Understanding primary immunodeficiencies: usefulness of a register]. Rev Med Suisse 2016; 12:708-712. [PMID: 27197327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Primary Immunodeficiency Diseases (PID) comprise inborn defects of the immune system which are and therefore difficult to study For this reason, the European Society for ImmunoDeficiencies (ESID) has set up an internet-based international patient and research database which integrates research data with more detailed clinical information. These disorders are not only found in children, but also in adults resulting in a wide range of clinical manifestations. Primary immunodeficiency adults are much less known and may remain undiagnosed.
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Schwitzguébel AJP, Jandus P, Lacroix JS, Seebach JD, Harr T. Immunoglobulin deficiency in patients with chronic rhinosinusitis: Systematic review of the literature and meta-analysis. J Allergy Clin Immunol 2015; 136:1523-1531. [DOI: 10.1016/j.jaci.2015.07.016] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Revised: 07/15/2015] [Accepted: 07/21/2015] [Indexed: 12/18/2022]
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Marschall K, Hoernes M, Bitzenhofer-Grüber M, Jandus P, Duppenthaler A, Wuillemin WA, Rischewski J, Boyman O, Heininger U, Hauser T, Steiner U, Posfay-Barbe K, Seebach J, Recher M, Hess C, Helbling A, Reichenbach J. The Swiss National Registry for Primary Immunodeficiencies: report on the first 6 years' activity from 2008 to 2014. Clin Exp Immunol 2015; 182:45-50. [PMID: 26031847 DOI: 10.1111/cei.12661] [Citation(s) in RCA: 36] [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] [Received: 02/20/2015] [Revised: 05/22/2015] [Accepted: 05/27/2015] [Indexed: 11/30/2022] Open
Abstract
The Swiss National Registry for Primary Immunodeficiency Disorders (PID) was established in 2008, constituting a nationwide network of paediatric and adult departments involved in the care of patients with PID at university medical centres, affiliated teaching hospitals and medical institutions. The registry collects anonymized clinical and genetic information on PID patients and is set up within the framework of the European database for PID, run by the European Society of Immunodeficiency Diseases. To date, a total of 348 patients are registered in Switzerland, indicating an estimated minimal prevalence of 4·2 patients per 100 000 inhabitants. Distribution of different PID categories, age and gender are similar to the European cohort of currently 19 091 registered patients: 'predominantly antibody disorders' are the most common diseases observed (n = 217/348, 62%), followed by 'phagocytic disorders' (n = 31/348, 9%). As expected, 'predominantly antibody disorders' are more prevalent in adults than in children (78 versus 31%). Within this category, 'common variable immunodeficiency disorder' (CVID) is the most prevalent PID (n = 98/217, 45%), followed by 'other hypogammaglobulinaemias' (i.e. a group of non-classified hypogammaglobulinaemias) (n = 54/217, 25%). Among 'phagocytic disorders', 'chronic granulomatous disease' is the most prevalent PID (n = 27/31, 87%). The diagnostic delay between onset of symptoms and diagnosis is high, with a median of 6 years for CVID and more than 3 years for 'other hypogammaglobulinaemias'.
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Affiliation(s)
- K Marschall
- Division of Immunology, University Children's Hospital Zurich and Children's Research Centre, University Zurich, Zurich
| | - M Hoernes
- Division of Immunology, University Children's Hospital Zurich and Children's Research Centre, University Zurich, Zurich
| | | | - P Jandus
- Division of Immunology and Allergology, University Hospital Geneva, Geneva
| | - A Duppenthaler
- Division of Infectious Diseases, University Children's Hospital Berne, Berne
| | - W A Wuillemin
- Division of Haematology and Central Haematology Laboratory, Luzerner Kantonsspital and University of Berne, Berne
| | - J Rischewski
- Division of Oncology/Haematology, Children's Hospital Lucerne, Lucerne
| | - O Boyman
- Division of Immunology, University Hospital Zurich, Zurich
| | - U Heininger
- Division of Infectious Diseases, University Children's Hospital Basel
| | - T Hauser
- IZZ Immunology-Zentrum Zürich, Zurich
| | - U Steiner
- Division of Immunology and Allergology, Spital Tiefenau Berne, Berne
| | - K Posfay-Barbe
- Division of Immunology, University Children's Hospital Geneva, Geneva
| | - J Seebach
- Division of Immunology and Allergology, University Hospital Geneva, Geneva
| | - M Recher
- Immunodeficiency Clinic, Medical Outpatient Unit and Immunodeficiency Laboratory, Department of Biomedicine, University Hospital Basel, Basel, Switzerland
| | - C Hess
- Immunodeficiency Clinic, Medical Outpatient Unit and Immunodeficiency Laboratory, Department of Biomedicine, University Hospital Basel, Basel, Switzerland
| | - A Helbling
- Division of Allergology, University Hospital Berne, Berne
| | - J Reichenbach
- Division of Immunology, University Children's Hospital Zurich and Children's Research Centre, University Zurich, Zurich
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Jandus P, Flatz A, von Elm E. [What is the value of measles passive vaccination after exposure?]. Praxis (Bern 1994) 2015; 104:587-588. [PMID: 26098156 DOI: 10.1024/1661-8157/a002031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Peter Jandus
- 1 Service d'Allergologie et d'Immunologie, Hôpitaux Universitaires de Genève
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Jandus P, Harr T. [Sulfonamide allergy and cross-reactivity]. Rev Med Suisse 2013; 9:798-802. [PMID: 23667968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Beside beta-lactams, sulfonamide antibiotics are among the most common causes of drug allergy. Hypersensitivity to sulfonamides including IgE-mediated immediate, delayed cell-mediated mechanisms, and severe life-threatening reactions are still incompletely understood. Unfounded concerns of cross-reactivity between sulfonamide antibiotics and a variety of non-antibiotic-containing sulfonamide drugs render pharmacotherapy unnecessarily difficult. Here, the history, clinical manifestations, diagnosis and treatment of sulfonamide allergy are briefly reviewed.
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Affiliation(s)
- Peter Jandus
- Service d'Immunologie, et d'allergologie, HUG, 1211 Genève 14.
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Jandus P, Hausmann O, Pichler WJ, Helbling A. Intravenous immunoglobulin in urticaria. J Investig Allergol Clin Immunol 2013; 23:71-73. [PMID: 23653985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Affiliation(s)
- P Jandus
- Division of Allergology, Department of Rheumatology, Clinical Immunology and Allergology, University Hospital, Bern, Switzerland.
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Borer-Reinhold M, Haeberli G, Bitzenhofer M, Jandus P, Hausmann O, Fricker M, Helbling A, Müller U. An increase in serum tryptase even below 11.4 ng/mL may indicate a mast cell-mediated hypersensitivity reaction: a prospective study in Hymenoptera venom allergic patients. Clin Exp Allergy 2011; 41:1777-83. [PMID: 22092437 DOI: 10.1111/j.1365-2222.2011.03848.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2011] [Revised: 07/11/2011] [Accepted: 07/15/2011] [Indexed: 12/28/2022]
Abstract
BACKGROUND During a systemic hypersensitivity reaction (SR), an increase in serum tryptase compared to the baseline value is an indicator of mast cell activation, most often due to an IgE-mediated mechanism. OBJECTIVE To study the relevance of an increase in serum tryptase below the upper normal value of 11.4 ng/mL. METHODS Serum tryptase levels were measured in 35 patients with Hymenoptera venom hypersensitivity before and during venom exposure. Of these, 20 developed SR to stings or following venom injections during immunotherapy (reactors), while 15 tolerated reexposure to stings or venom injections during immunotherapy without SR (non-reactors). Serum tryptase was estimated at 2, 5 and 24 h after exposure and was compared to a baseline value obtained before or at least 72 h after exposure. RESULTS Considering circadian variation of serum tryptase, a relative increase to ≥135% of the baseline value (relative delta bound) was defined to indicate mast cell activation. Such an increase was observed in 17 of 20 reactors (85%), but none of 15 non-reactors. A serum tryptase of ≥11.4 ng/mL following venom exposure was observed in eight of the 20 reactors (40%) and 2 (13.3%) of the 15 non-reactors. Both these non-reactors also had an elevated baseline serum tryptase. CONCLUSIONS AND CLINICAL RELEVANCE Serum tryptase values obtained during a suspected hypersensitivity reaction must always be compared to a baseline value. A relative tryptase increase to ≥135% of the baseline value during a suspected hypersensitivity reaction indicates mast cell activation even below 11.4 ng/mL.
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Affiliation(s)
- M Borer-Reinhold
- Allergiestation, Medizinische Klinik, Spital Netz Bern Ziegler, Bern, Switzerland
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Jandus P, Hausmann O, Haeberli G, Gentinetta T, Mueller U, Helbling A. Unpredicted adverse reaction to omalizumab. J Investig Allergol Clin Immunol 2011; 21:563-566. [PMID: 22312942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
Despite promising reports of the use of omalizumab as add-on therapy in patients with systemic mastocytosis and recurrent anaphylaxis during specific venom immunotherapy (VIT), unpredicted adverse effects may lead to therapy failure. We present the case of a patient with systemic mastocytosis and Hymenoptera venom allergy who was administered omalizumab as add-on therapy to improve VIT tolerability after repeated severe adverse reactions despite H1/H2-antihistamine prophylaxis. We describe an unexpected discontinuation of omalizumab following successful initiation of VIT in a patient with systemic mastocytosis, with subsequent lack of tolerability of VIT. An interesting aspect of this case is the correlation of basophil activation test results with both clinical tolerability and VIT intolerance.
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Affiliation(s)
- P Jandus
- Allergy Unit, Department of Internal Medicine, Spital Netz Bern Zieglerspital, Switzerland
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Abstract
The case history of a 75-year-old woman, who was hospitalized with the diagnosis of an acute erosive colitis, is presented. The patient was treated with hysterectomy for an endometrial cancer in 2000 and had suffered from multiple sclerosis for 15 years. A persistent non-productive cough with fever requested a pneumological consultation. Multiple small alveolar opacities and cavitating lesions were found at chest imaging, but no precise diagnosis was possible. Only 3 weeks after hospitalization, we noticed that a urine analysis had been forgotten. This additional test clearly demonstrated a nephritic sediment and further analysis confirmed the diagnosis of a ANCA-positive microscopic polyangiitis, which promptly responded to immunosuppressive therapy. The necessity of a routine urine analysis in the majority of internal medicine patients and the possible link between small vessel vasculitis and multiple sclerosis are discussed.
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Affiliation(s)
- Sándor Györik
- Departement of Internal Medicine, Ospedale Regionale di Bellinzona e Valli, 6500 Bellinzona (TI)
| | - Peter Jandus
- Departement of Internal Medicine, Ospedale Regionale di Bellinzona e Valli, 6500 Bellinzona (TI)
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Jandus P, Savioz D, Purek L, Frey JG, Schnyder JM, Tschopp JM. [Bochdalek hernia: a rare cause of dyspnea and abdominal pain in adults]. Rev Med Suisse 2009; 5:1061-1064. [PMID: 19526975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
We present here a case of a sixty year old man with a symptomatic hernia of Bochdalek. Its diagnostic was long to be established because this type of congenital diaphragmatic hernia is rare and mainly occurs in neonates. However when looking at a patient with dyspnea and lasting atypical abdominal pain, such a diagnosis has to be looked for, even if such a clinical entity is extremely rare in adults.
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Affiliation(s)
- P Jandus
- Centre valaisan de pneumologie, Département de médecine interne CHCVs, 3963 Crans-Montana
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Giovanella L, Pedrazzi P, Jandus P, Marone C. Steroid responsive encephalopathy associated with autoimmune thyroiditis (SREAT) with negative thyroperoxidase antibodies. Eur J Clin Invest 2008; 38:693-4. [PMID: 18837747 DOI: 10.1111/j.1365-2362.2008.01997.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Englberger L, Savolainen H, Jandus P, Widmer M, Do DD, Haeberli A, Baumgartner I, Carrel TP, Schmidli J. Activated coagulation during open and endovascular abdominal aortic aneurysm repair. J Vasc Surg 2006; 43:1124-9. [PMID: 16765226 DOI: 10.1016/j.jvs.2006.02.029] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2004] [Accepted: 02/09/2006] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The study was conducted to determine activation of coagulation in patients undergoing open and endovascular infrarenal abdominal aortic aneurysm repair (EVAR). METHODS In a prospective, comparative study, 30 consecutive patients undergoing open repair (n = 15) or EVAR (n = 15) were investigated. Blood samples to determine fibrinopeptide A, fibrin monomer, thrombin-antithrombin complex, and D-dimer were taken up to 5 days postoperatively. Routine hematologic and hematochemical parameters as well as clinical data were collected. RESULTS Both groups showed comparable demographic variables. Operating time was longer in open repair (249 +/- 77 minutes vs 186 +/- 69 minutes, P < .05). Perioperatively elevated markers of coagulation were measured in both groups. Fibrinopeptide A levels did not differ significantly between the groups (P = .55). The levels of fibrin monomer and thrombin-antithrombin complex were significantly higher in patients undergoing EVAR (P < .0001), reflecting increased thrombin activity and thrombin formation compared with open surgery. The D-dimer level did not differ significantly between the groups. These results were also valid after correction for hemodilution. CONCLUSION These data suggest increased procoagulant activity in EVAR compared with open surgery. A procoagulant state may favor possible morbidity derived from micro- and macrovascular thrombosis, such as in myocardial infarction, multiple organ dysfunction, venous thrombosis and thromboembolism, or disseminated intravascular coagulation.
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Affiliation(s)
- Lars Englberger
- Department of Cardiovascular Surgery, Inselspital, University Hospital Berne, Freiburgstrasse, 3010 Berne, Switzerland.
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