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Entrala A, Loli-Ausejo D, Losantos I, Pérez T, Cabañas R, Caballero T. Real-life experience of subcutaneous (SC) plasma derived C1-inhibitor (pdC1INH) as long-term prophylaxis (LTP) in HAE-C1INH. J Investig Allergol Clin Immunol 2023; 34:0. [PMID: 38131209 DOI: 10.18176/jiaci.0977] [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: 12/23/2023] Open
Affiliation(s)
- A Entrala
- Department of Allergy, Hospital Universitario La Paz, Madrid, Spain
- Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
- CSUR de Angioedema Hereditario, Hospital Universitario La Paz, Madrid, Spain
| | - D Loli-Ausejo
- Department of Allergy, Hospital Clinic de Barcelona, Universitat de Barcelona, Clinical and Experimental Respiratory Immunoallergy (IRCE), August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - I Losantos
- Department of Biostatistics, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid Spain
| | - T Pérez
- Department of Pharmacy, Hospital Universitario La Paz. Madrid (Spain)
| | - R Cabañas
- Department of Allergy, Hospital Universitario La Paz, Madrid, Spain
- Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
- CSUR de Angioedema Hereditario, Hospital Universitario La Paz, Madrid, Spain
- Biomedical Research Network on Rare Diseases (CIBERER, U754). Madrid (Spain)
- PIELenRed Consortium
| | - T Caballero
- Department of Allergy, Hospital Universitario La Paz, Madrid, Spain
- Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
- CSUR de Angioedema Hereditario, Hospital Universitario La Paz, Madrid, Spain
- Biomedical Research Network on Rare Diseases (CIBERER, U754). Madrid (Spain)
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Branco Ferreira M, Baeza ML, Spínola Santos A, Prieto-García A, Leal R, Alvarez J, Caballero T. Evolution of Guidelines for the Management of Hereditary Angioedema due to C1 Inhibitor Deficiency. J Investig Allergol Clin Immunol 2023; 33:332-362. [PMID: 37171188 DOI: 10.18176/jiaci.0909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Abstract
Hereditary angioedema (HAE) is a severe and disabling condition characterized by recurrent episodes of subcutaneous or mucosal swelling in the skin and respiratory and gastrointestinal tracts. HAE due to C1-esterase inhibitor deficiency (C1-INH-HAE) is the most prevalent subtype. The present Iberian study compared C1-INH-HAE treatment guidelines published between 2010 and 2022 to identify the main differences in therapeutic approaches for on-demand treatment and short- and long-term prophylaxis (LTP). HAE guidelines evolved with the availability of new treatments and with a change in the management paradigm towards an individualized, patient-centered approach, where quality of life (QOL) is central. A parallel trend was observed towards increasingly frequent home-based treatment, which potentially facilitates timely interventions, provides greater flexibility and convenience, and is associated with increased QOL, enabling patients to lead more normal lives. Most innovations over the years were made for LTP, together with the advent of new therapies and awareness of patients' needs. Several prophylactic therapies with a high level of evidence became available, although formal head-to-head comparisons are lacking. The treatment goals became more ambitious, ranging from a reduction in the frequency, severity, and duration of attacks to achieving total disease control and normalization of patients' lives. The document also addresses relevant items such as changes in terminology (eg, the introduction of designations as "first-line") and the introduction of patient-reported outcome measures to assess patients' perceptions of their self-experienced QOL and well-being. Unmet needs in the management of C1-INH-HAE are identified.
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Affiliation(s)
- M Branco Ferreira
- Serviço de Imunoalergologia, Centro Hospitalar Universitário de Lisboa Norte, Lisbon, Portugal
- Clínica Universitária de Imunoalergologia da Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - M L Baeza
- Department of Allergy, Gregorio Marañón University General Hospital, Madrid, Spain
- Institute for Health Research Gregorio Marañón, IiSGM, Madrid, Spain
- Biomedical Research Network on Rare Diseases (CIBERER, U761), Madrid, Spain
| | - A Spínola Santos
- Serviço de Imunoalergologia, Centro Hospitalar Universitário de Lisboa Norte, Lisbon, Portugal
- Clínica Universitária de Imunoalergologia da Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - A Prieto-García
- Department of Allergy, Gregorio Marañón University General Hospital, Madrid, Spain
- Institute for Health Research Gregorio Marañón, IiSGM, Madrid, Spain
| | - R Leal
- Medical Department Iberia, CSL Behring LDA, Lisbon, Portugal
| | - J Alvarez
- Medical Department Iberia, CSL Behring SA, Barcelona, Spain
| | - T Caballero
- Department of Allergy, La Paz University Hospital, Madrid, Spain
- Hospital La Paz Institute for Health Research IdiPAZ - Group 44, Madrid, Spain
- Biomedical Research Network on Rare Diseases - CIBERER U754, Madrid, Spain
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Caballero T, Lleonart-Bellfill R, Pedrosa M, Ferrer L, Guilarte M. Expert review and consensus on the t2t management of hereditary angioedema: from the scientific evidence to clinical practice. J Investig Allergol Clin Immunol 2023:0. [PMID: 36811842 DOI: 10.18176/jiaci.0875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Hereditary angioedema with C1 inhibitor deficiency (HAE-C1INH) is a rare disease characterized by swelling episodes. It affects quality of life (QoL) and can be lethal, when involving upper airways. Treatment is individualized, with therapeutic options including on-demand treatment (ODT), and short- and long-term prophylaxis (STP, LTP). However, available guidelines are not always clear about treatment selection, its goals or assessment of goal achievement. OBJECTIVE To review the available evidence for the management of HAE-C1INH and build a Spanish expert consensus to steer HAE-C1INH management towards a treat-to-target (T2T) approach, while addressing some of the unclear aspects of the Spanish guidelines. METHODS We reviewed the literature on the management of HAE-C1INH with a T2T approach, focusing on: 1) treatment selection and goals; and 2) available tools to assess goal achievement. We discussed the literature based on clinical experience and drew up 45 statements on undefined management aspects. A panel of 53 HAE experts validated the statements through a two-round Delphi process. RESULTS The goals for ODT and STP are minimizing the morbidity and mortality of attacks, and preventing attacks caused by known triggers, respectively, while the main goal of LTP is to decrease the rate, severity and duration of attacks. Furthermore, when prescribing, clinicians should consider the reduction in adverse events, while increasing patient QoL and satisfaction. Appropriate instruments for assessing goal achievement have also been indicated. CONCLUSIONS We provide recommendations on previously unclear aspects of HAE-C1INH management with ODT, STP and LTP, focusing particularly on clinical and patient-oriented goals.
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Affiliation(s)
- T Caballero
- Allergy Department, Hospital Universitario La Paz, IdiPAZ Group 44, CIBERER U754, Madrid, Spain
| | - R Lleonart-Bellfill
- Allergology Service, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Spain.,Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Spain
| | - M Pedrosa
- Allergy Department, Hospital Universitario La Paz, IdiPAZ Group 44, CIBERER U754, Madrid, Spain
| | - L Ferrer
- Hospital Clínico Universitario "Lozano Blesa", Zaragoza, Spain
| | - M Guilarte
- Allergy Section, Internal Medicine Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Institut de Recerca Vall d'Hebron (VHIR), Barcelona, Spain.,RETIC de Asma, Reacciones Adversas y Alérgicas (ARADYAL)
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Maurer M, Magerl M, Betschel S, Aberer W, Ansotegui IJ, Aygören-Pürsün E, Banerji A, Bara NA, Boccon-Gibod I, Bork K, Bouillet L, Boysen HB, Brodszki N, Busse PJ, Bygum A, Caballero T, Cancian M, Castaldo A, Cohn DM, Csuka D, Farkas H, Gompels M, Gower R, Grumach AS, Guidos-Fogelbach G, Hide M, Kang HR, Kaplan AP, Katelaris C, Kiani-Alikhan S, Lei WT, Lockey R, Longhurst H, Lumry WR, MacGinnitie A, Malbran A, Saguer IM, Matta JJ, Nast A, Nguyen D, Nieto-Martinez SA, Pawankar R, Peter J, Porebski G, Prior N, Reshef A, Riedl M, Ritchie B, Sheikh FR, Smith WB, Spaeth PJ, Stobiecki M, Toubi E, Varga LA, Weller K, Zanichelli A, Zhi Y, Zuraw B, Craig T. [Not Available]. ARERUGI = [ALLERGY] 2023; 72:237-272. [PMID: 37225467 DOI: 10.15036/arerugi.72.237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Affiliation(s)
- M Maurer
- Institute of Allergology, Charité-Universitätsmedizin, Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology
| | - M Magerl
- Institute of Allergology, Charité-Universitätsmedizin, Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology
| | | | - W Aberer
- Department of Dermatology, Medical University of Graz
| | - I J Ansotegui
- Department of Allergy & Immunology, Hospital Quironsalud Bizkaia
| | - E Aygören-Pürsün
- Center for Children and Adolescents, University Hospital Frankfurt
| | - A Banerji
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital
| | - N A Bara
- Romanian Hereditary Angioedema Expertise Centre, Mediquest Clinical Research Center
| | - I Boccon-Gibod
- National Reference Center for Angioedema (CREAK), Angioedema Center of Reference and Excellence (ACARE), Grenoble Alpes University Hospital
| | - K Bork
- Department of Dermatology, University Medical Center, Johannes Gutenberg University
| | - L Bouillet
- National Reference Center for Angioedema (CREAK), Angioedema Center of Reference and Excellence (ACARE), Grenoble Alpes University Hospital
| | | | - N Brodszki
- Department of Pediatric Immunology, Childrens Hospital, Skåne University Hospital
| | - P J Busse
- Icahn School of Medicine at Mount Sinai
| | - A Bygum
- Clinical Institute, University of Southern Denmark
- Department of Clinical Genetics, Odense University Hospital
| | - T Caballero
- Allergy Department, Hospital Universitario La Paz
| | - M Cancian
- Department of Systems Medicine, University Hospital of Padua
| | | | - D M Cohn
- Department of Vascular Medicine, Amsterdam UMC/University of Amsterdam
| | - D Csuka
- Department of Internal Medicine and Haematology, Hungarian Angioedema Center of Reference and Excellence, Semmelweis University
| | - H Farkas
- Department of Internal Medicine and Haematology, Hungarian Angioedema Center of Reference and Excellence, Semmelweis University
| | - M Gompels
- Clinical Immunology, North Bristol NHS Trust
| | - R Gower
- Marycliff Clinical Research, Principle Research Solutions
| | - A S Grumach
- Clinical Immunology, Centro Universitario FMABC
| | | | - M Hide
- Department of Dermatology, Hiroshima Citizens Hospital
- Department of Dermatology, Hiroshima University
| | - H R Kang
- Department of Internal Medicine, Seoul National University College of Medicine
| | - A P Kaplan
- Division of Pulmonary, Critical Care, Allergy and Immunology, Medical University of South Carolina
| | - C Katelaris
- Department of Medicine, Campbelltown Hospital and Western Sydney University
| | | | - W T Lei
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, Mackay Memorial Hospital
| | - R Lockey
- Division of Allergy and Immunology, Department of Internal Medicine, Morsani College of Medicine, University of South Florida
| | - H Longhurst
- Department of Immunology, Auckland District Health Board and Department of Medicine, University of Auckland
| | - W R Lumry
- Internal Medicine, Allergy Division, University of Texas Health Science Center
| | - A MacGinnitie
- Division of Immunology, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School
| | - A Malbran
- Unidad de Alergia, Asma e Inmunología Clínica
| | - I M Saguer
- Pediatrics, Haemophilia Centre Rhine Main (HZRM)
| | - J J Matta
- H. Especialidades C.M.N.SXXI, I.M.S.S
| | - A Nast
- Department of Dermatology, Venereology and Allergology, Division of Evidence-Based Medicine Charité-Universitätsmedizin Berlin, corporate member of Free University of Berlin, Humboldt University of Berlin, and Berlin Institute of Health
| | - D Nguyen
- Respiratory, Allergy and Clinical Immunology Unit, Internal Medicine Department, Vinmec Healthcare System, College of Health Sciences, VinUniversity
| | | | - R Pawankar
- Department of Pediatrics, Nippon Medical School
| | - J Peter
- Division of Allergy and Clinical Immunology, University of Cape Town
- Allergy and Immunology Unit, University of Cape Town Lung Institute
| | - G Porebski
- Department of Clinical and Environmental Allergology, Jagiellonian University Medical College
| | - N Prior
- Allergy, Hospital Universitario Severo Ochoa
| | - A Reshef
- Angioderma Center, Barzilai University Medical Center
| | - M Riedl
- Division of Rheumatology, Allergy and Immunology, University of California San Diego
| | - B Ritchie
- Departments of Medicine and Medical Oncology, University of Alberta
| | - F R Sheikh
- Section of Adult Allergy & Immunology, Department of Medicine, King Faisal Specialist Hospital & Research Centre
| | - W B Smith
- Clinical Immunology and Allergy, Royal Adelaide Hospital
| | - P J Spaeth
- Institute of Pharmacology, University of Bern
| | - M Stobiecki
- Department of Clinical and Environmental Allergology, Jagiellonian University Medical College
| | - E Toubi
- Division of Allergy and Clinical Immunology, Bnai Zion Medical Center, Affiliated with Rappaport Faculty of Medicine, Technion-Israel Institute of Technology
| | - L A Varga
- Department of Internal Medicine and Haematology, Hungarian Angioedema Center of Reference and Excellence, Semmelweis University
| | - K Weller
- Institute of Allergology, Charité-Universitätsmedizin, Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology
| | - A Zanichelli
- Department of Internal Medicine, ASST Fatebenefratelli Sacco, Ospedale Luigi Sacco-University of Milan
| | - Y Zhi
- Department of Allergy and Clinical Immunology, Bejing Union Medical College Hospital & Chinese Academy of Medical Sciences
| | - B Zuraw
- University of California, San Diego
| | - T Craig
- Departments of Medicine and Pediatrics, Penn State University
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Maurer M, Aberer W, Caballero T, Bouillet L, Grumach AS, Botha J, Andresen I, Longhurst HJ. The Icatibant Outcome Survey: 10 years of experience with icatibant for patients with hereditary angioedema. Clin Exp Allergy 2022; 52:1048-1058. [PMID: 35861129 DOI: 10.1111/cea.14206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 06/24/2022] [Accepted: 06/26/2022] [Indexed: 11/28/2022]
Abstract
In patients with hereditary angioedema (HAE), bradykinin causes swelling episodes by activating bradykinin B2 receptors. Icatibant, a selective bradykinin B2 receptor antagonist, is approved for on-demand treatment of HAE attacks. The Icatibant Outcome Survey (IOS; NCT01034969) is an ongoing observational registry initiated in 2009 to monitor effectiveness/safety of icatibant in routine clinical practice. As of March 2019, 549 patients with HAE type 1 or 2 from the IOS registry had been treated, for 5995 total attacks. This article reviews data published from IOS over time which have demonstrated that effectiveness of icatibant in a real-world setting is comparable to efficacy in clinical trials; one dose is effective for the majority of attacks; early treatment (facilitated by self-administration) leads to faster resolution and shorter attack duration; effectiveness/safety of icatibant has been shown across a broad range of patient subgroups, including children/adolescents and patients with HAE with normal C1 inhibitor levels; and tolerability has been demonstrated in patients aged ≥65 years. Additionally, this review highlights how IOS data have provided valuable insights into patients' diagnostic journeys and treatment behaviors across individual countries. Such findings have helped to inform clinical strategies and guidelines to optimize HAE management and limit disease burden. This research was sponsored by Takeda Development Center Americas, Inc. Takeda Development Center Americas, Inc., provided funding to Excel Medical Affairs for support in writing and editing this manuscript.
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Affiliation(s)
- M Maurer
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - W Aberer
- Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria
| | - T Caballero
- Department of Allergy, Hospital Universitario La Paz, Hospital La Paz Institute for Health Research (IdiPaz), Biomedical Research Network on Rare Diseases (CIBERER, U754), Madrid, Spain
| | - L Bouillet
- National Reference Centre for Angioedema, Internal Medicine Department, Grenoble University Hospital, Grenoble, France
| | - A S Grumach
- Clinical Immunology, Faculdade de Medicina, Centro Universitario Saude ABC, Santo Andre, Brazil
| | - J Botha
- Takeda Pharmaceuticals International AG, Zurich, Switzerland
| | - I Andresen
- Takeda Pharmaceuticals International AG, Zurich, Switzerland
| | - H J Longhurst
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, and University College London Hospitals, London, UK
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Nin-Valencia A, Fiandor A, Lluch M, Quirce S, Caballero T, Heredia Revuelto R, González-Muñoz M, Caballero ML, Cabañas R. Safe administration of SARS-CoV-2 vaccine after desensitization to a biologic containing polysorbate 80 in a patient with polyethylene glycol-induced severe anaphylaxis and sensitization to polysorbate 80. J Investig Allergol Clin Immunol 2022; 33:151-153. [PMID: 35638393 DOI: 10.18176/jiaci.0830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- A Nin-Valencia
- Department of Allergy, Hospital Universitario La Paz, Madrid, Spain
| | - A Fiandor
- Department of Allergy, Hospital Universitario La Paz, Madrid, Spain
- Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
- PIELenRed Consortium
| | - M Lluch
- Department of Allergy, Hospital Universitario La Paz, Madrid, Spain
- Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
- PIELenRed Consortium
| | - S Quirce
- Department of Allergy, Hospital Universitario La Paz, Madrid, Spain
- Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
- Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES)
| | - T Caballero
- Department of Allergy, Hospital Universitario La Paz, Madrid, Spain
- Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
- Centro de Investigación en Red de Enfermedades Raras (CIBERER, U754)
| | | | - M González-Muñoz
- Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
- Department of Immunology, Hospital Universitario La Paz, Madrid, Spain
| | - M L Caballero
- Department of Allergy, Hospital Universitario La Paz, Madrid, Spain
- Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | - R Cabañas
- Department of Allergy, Hospital Universitario La Paz, Madrid, Spain
- Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
- PIELenRed Consortium
- Centro de Investigación en Red de Enfermedades Raras (CIBERER, U754)
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Maurer M, Caballero T, Aberer W, Zanichelli A, Bouillet L, Bygum A, Grumach AS, Botha J, Andresen I, Longhurst HJ. Variability of disease activity in patients with hereditary angioedema type 1/2: longitudinal data from the Icatibant Outcome Survey. J Eur Acad Dermatol Venereol 2021; 35:2421-2430. [PMID: 34506666 DOI: 10.1111/jdv.17654] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 08/13/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Hereditary angioedema due to C1 inhibitor deficiency (HAE-1/2) is a chronic and debilitating disease. The unpredictable clinical course represents a significant patient burden. OBJECTIVE To analyse longitudinal registry data from the Icatibant Outcome Survey (IOS) in order to characterize temporal changes in disease activity in patients with HAE-1/2. METHODS Icatibant Outcome Survey (NCT01034969) is an international observational registry monitoring the clinical outcomes of patients eligible for icatibant treatment. The current analyses are based on data collected between July 2009 and July 2019. Retrospective data for attacks recorded in the 12 months prior to IOS enrolment and for each 12-month period up to 7 years were analysed. RESULTS Included patients reported angioedema attacks without long-term prophylaxis (LTP; n = 315) and with LTP (n = 292) use at the time of attack onset. Androgens were the most frequently used LTP option (80.8%). At the population level, regardless of LTP use, most patients (52-80%) reporting <5 attacks in Year 1 continued experiencing this rate; similarly, many patients (25-76%) who reported high attack frequency continued reporting ≥10 attacks/year. However, year on year, 31-51% of patients experienced notable changes (increase/decrease of ≥5 attacks) in annual attack frequency. Of patients who reported an absolute change of ≥10 attacks from Year 1 to 2, 17-50% continued to experience a change of this magnitude in subsequent years. CONCLUSION At the population level, attack frequency was generally consistent over 7 years. At the small group level, 28.8-34.5% of patients reported a change in attack frequency of ≥5 attacks from Year 1 to Year 2; up to half of these patients continued to experience this magnitude of variation in disease activity in later years, reflecting high intra-patient variability.
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Affiliation(s)
- M Maurer
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - T Caballero
- Department of Allergy, Hospital Universitario La Paz, Hospital La Paz Institute for Health Research (IdiPaz), Biomedical Research Network on Rare Diseases (CIBERER, U754), Madrid, Spain
| | - W Aberer
- Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria
| | - A Zanichelli
- Department of Internal Medicine, Ospedale Luigi Sacco, ASST Fatebenefratelli Sacco, University of Milan, Milan, Italy
| | - L Bouillet
- National Reference Centre for Angioedema, Internal Medicine Department, Grenoble University Hospital, Grenoble, France
| | - A Bygum
- Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Clinical Institute, University of Southern Denmark, Odense, Denmark
| | - A S Grumach
- Clinical Immunology, Medical School, University Center Health ABC, Santo Andre, Brazil
| | - J Botha
- Takeda Pharmaceuticals International AG, Zurich, Switzerland
| | - I Andresen
- Takeda Pharmaceuticals International AG, Zurich, Switzerland
| | - H J Longhurst
- Formerly Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.,Formerly University College London Hospitals, London, UK.,Auckland District Health Board, Auckland, New Zealand
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8
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Forjaz MJ, Ayala A, Caminoa M, Prior N, Pérez-Fernández E, Caballero T. HAE-AS: A Specific Disease Activity Scale for Hereditary Angioedema With C1-Inhibitor Deficiency. J Investig Allergol Clin Immunol 2021; 31:246-252. [PMID: 31932270 DOI: 10.18176/jiaci.0479] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND AND OBJECTIVE The activity of hereditary angioedema due to C1-inhibitor deficiency (C1-INH-HAE) varies between patients and within individual patients. Objective: This study aims to develop a disease activity scale for C1-INH-HAE (HAE-AS) with sound measurement properties. METHODS Eleven countries participated in a prospective multicenter cohort study. A clinical questionnaire was self-completed by 290 adult patients with C1-INH-HAE. Patients also completed 2 quality of life scales, the SF-36v2 and the HAE-QoL. Rasch analysis and classic psychometric methods were used to preselect a series of clinical items: number of attacks by location and number of treated attacks, emergency room visits, psychological/psychiatric treatment, missed school/workdays in the previous 6 months; general health; and impairment in everyday work/activities due to pain. RESULTS The mean (SD) age was 41.5 (14.7; range, 18-84) years, and 69% were females. The final 12-item Rasch model showed that the HAE-AS had satisfactory reliability (person separation index, 0.748), local item independence, unidimensionality, and no item bias by age or sex. The HAE-AS provided scores in a linear measure, with a mean of 10.66 (3.92; range, 0-30). Further analysis with classic psychometric methods indicated that the HAE-AS linear measure presented moderate-to-high convergent validity with quality of life scales (SF-36v2: physical component, r=-0.33; mental component, 0.555; HAE-QoL, -0.61), and good discriminative validity by age, sex, and disease severity (P<.05). CONCLUSIONS The HAE-AS is a short, valid, reliable, and psychometrically sound measure of the activity of C1-INH-HAE that could prove useful for research studies.
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Affiliation(s)
- M J Forjaz
- National School of Public Health, Institute of Health Carlos III and REDISSEC, Madrid, Spain
| | - A Ayala
- National School of Public Health, Institute of Health Carlos III and REDISSEC, Madrid, Spain
| | - M Caminoa
- Clinica Marazuela, Talavera de la Reina, Toledo, Spain
| | - N Prior
- Hospital Universitario Severo Ochoa, Leganés, Madrid, Spain
| | - E Pérez-Fernández
- Research Unit, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - T Caballero
- Allergy Department, Hospital Universitario La Paz, Madrid, Spain.,Hospital La Paz Institute for Health Research (IdiPaz), Madrid, Spain.,Biomedical Research Network on Rare Diseases (CIBERER, U754), Madrid, Spain
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9
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López-Gálvez R, de la Morena-Barrio ME, Miñano A, Pathak M, Marcos C, Emsley J, Caballero T, López-Trascasa M, Vicente V, Corral J, López-Lera A. Thrombin in the Activation of the Fluid Contact Phase in Patients with Hereditary Angioedema Carrying the F12 P.Thr309Lys Variant. Clin Rev Allergy Immunol 2021; 60:357-368. [PMID: 33725261 DOI: 10.1007/s12016-021-08840-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 01/13/2021] [Indexed: 11/29/2022]
Abstract
Hereditary angioedema due to pathogenic FXII variants (HAE-FXII) is a rare dominant disease caused by increased activation of the plasma contact system. The most prevalent HAE-FXII variant, c.1032C > A p.Thr309Lys (FXII309Lys), results in a smaller FXII protein with increased sensitivity to fluid-phase activation by poorly understood mechanisms. We aimed to investigate the functionality of the FXII309Lys variant in 33 HAE-FXII patients, 25 healthy controls and 46 patients with congenital disorders of glycosylation (CDG). Activation of the plasma contact system was assessed by western blot and amidolytic assay in basal conditions or after treatment with either artificial or physiological activators. Recombinant wild-type and FXII309Lys variants were expressed in S2 insect (Drosophila) cells. Amidolytic and fibrin generation assays were performed in fresh plasma samples. FXII309Lys samples exhibited an increased electrophoretic mobility comparable with N-glycan-deficient FXII from CDG patients and asialo-FXII generated by neuraminidase treatment. They presented increased sensitivity to activation by dextran sulphate and silica which resulted in the generation of an aberrant 37-kDa heavy chain. We did not observe increased susceptibility of FXII309Lys to proteolysis by exogenous or tPA-generated plasmin. However, both exogenous and endogenous thrombin cleaved the FXII309Lys variant, releasing a 37-kDa fragment and resulting in enhanced proteolytic activation on the fluid phase. This model supports a sequential proteolytic activation process involving thrombin priming of FXII309Lys, followed by kallikrein cleavage and generation of active βFXIIa. The present results and the observation that angioedema episodes in HAE-FXII patients occur predominantly during hypercoagulable situations suggest a key role for thrombin.
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Affiliation(s)
- R López-Gálvez
- Servicio de Hematología Y Oncología Médica, Hospital Universitario Morales Meseguer, Centro Regional de Hemodonación, Universidad de Murcia, IMIB-Arrixaca, CIBERER, Murcia, Spain
| | - M E de la Morena-Barrio
- Servicio de Hematología Y Oncología Médica, Hospital Universitario Morales Meseguer, Centro Regional de Hemodonación, Universidad de Murcia, IMIB-Arrixaca, CIBERER, Murcia, Spain.
| | - A Miñano
- Servicio de Hematología Y Oncología Médica, Hospital Universitario Morales Meseguer, Centro Regional de Hemodonación, Universidad de Murcia, IMIB-Arrixaca, CIBERER, Murcia, Spain
| | - M Pathak
- Centre for Biomolecular Sciences, School of Pharmacy, University of Nottingham, Nottingham, NG7 2RD, England
| | - C Marcos
- Sección Alergología, Complexo Hospitalario Universitario de Vigo. Hospital Meixoeiro, Vigo, Spain
| | - J Emsley
- Centre for Biomolecular Sciences, School of Pharmacy, University of Nottingham, Nottingham, NG7 2RD, England
| | - T Caballero
- Servicio de Alergia, Hospital Universitario La Paz, Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital La Paz (IdiPaz), Madrid, Spain.,Centre for Biomedical Network Research On Rare Diseases (CIBERER) U-754, Hospital Universitario La Paz, Madrid, Spain
| | - M López-Trascasa
- Centre for Biomedical Network Research On Rare Diseases (CIBERER) U-754, Hospital Universitario La Paz, Madrid, Spain.,Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain
| | - V Vicente
- Servicio de Hematología Y Oncología Médica, Hospital Universitario Morales Meseguer, Centro Regional de Hemodonación, Universidad de Murcia, IMIB-Arrixaca, CIBERER, Murcia, Spain
| | - J Corral
- Servicio de Hematología Y Oncología Médica, Hospital Universitario Morales Meseguer, Centro Regional de Hemodonación, Universidad de Murcia, IMIB-Arrixaca, CIBERER, Murcia, Spain
| | - A López-Lera
- Instituto de Investigación Sanitaria del Hospital La Paz (IdiPaz), Madrid, Spain. .,Centre for Biomedical Network Research On Rare Diseases (CIBERER) U-754, Hospital Universitario La Paz, Madrid, Spain.
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10
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Abstract
Hereditary angioedema due to C1-esterase inhibitor deficiency (C1-INH-HAE) is a rare autosomal dominant disease. In the last decade, new drugs and new indications for old drugs have played a role in the management of C1-INH-HAE. This review examines current therapy for C1-INH-HAE and provides a brief summary of drugs that are under development. Increased knowledge of the pathophysiology of C1-INH-HAE has been crucial for advances in the field, with inhibition of the kallikrein-kinin system (plasma kallikrein, activated factor XII) as a key area in the discovery of new drugs, some of which are already marketed for treatment of C1-INH-HAE. Pharmacological treatment is based on 3 pillars: treatment of acute angioedema attacks (on-demand treatment), short-term (preprocedure) prophylaxis, and long-term prophylaxis. The 4 drugs that are currently available for the treatment of acute angioedema attacks (purified plasma-derived human C1 esterase inhibitor concentrate, icatibant acetate, ecallantide, recombinant human C1 esterase inhibitor) are all authorized for self-administration, except ecallantide. Purified plasma-derived human C1 esterase inhibitor concentrate is the treatment of choice for short-term prophylaxis. Tranexamic acid, danazol, intravenous and subcutaneous nanofiltered purified plasma-derived human C1 esterase inhibitor concentrate, and lanadelumab can be used for long-term prophylaxis. New drugs are being investigated, mainly as long-term prophylaxis, and are aimed at blocking the kallikrein-kinin system by means of antiprekallikrein, antikallikrein, and anti-activated FXII action.
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Affiliation(s)
- T Caballero
- Allergy Department, Hospital Universitario La Paz, Madrid, Spain.,Hospital La Paz Institute for Health Research (IdiPaz), Madrid, Spain.,Center for Biomedical Research Network on Rare Diseases (CIBERER U754), Madrid, Spain
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11
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Loli-Ausejo D, Hernández-Martín I, Cabañas R, Entrala A, Gutiérrez-Alvariño M, Martínez-Sánchez N, Caballero T. Tranexamic Acid Plus Bemiparin Sodium as Long- Term Prophylaxis in a Patient With FXII-HAE During Pregnancy: A Case Report. J Investig Allergol Clin Immunol 2020; 30:464-465. [PMID: 32490821 DOI: 10.18176/jiaci.0585] [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)
- D Loli-Ausejo
- Allergy Department, La Paz University Hospital, Madrid, Spain
| | | | - R Cabañas
- Allergy Department, La Paz University Hospital, Madrid, Spain.,Hospital La Paz Institute for Health Research (IdiPaz), Madrid, Spain.,Biomedical Research Network on Rare Diseases - U754 (CIBERER), Madrid, Spain
| | - A Entrala
- Allergy Department, La Paz University Hospital, Madrid, Spain.,Hospital La Paz Institute for Health Research (IdiPaz), Madrid, Spain
| | | | - N Martínez-Sánchez
- Obstetrics and Gynecology Department, High Risk Pregnancy Unit, Autoimmune Diseases and Pregnancy clinic, La Paz University Hospital, Madrid, Spain
| | - T Caballero
- Allergy Department, La Paz University Hospital, Madrid, Spain.,Hospital La Paz Institute for Health Research (IdiPaz), Madrid, Spain.,Biomedical Research Network on Rare Diseases - U754 (CIBERER), Madrid, Spain
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12
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López-Lera A, Garrido S, Nozal P, Skatum L, Bygum A, Caballero T, López Trascasa M. Serum complexes between C1INH and C1INH autoantibodies for the diagnosis of acquired angioedema. Clin Exp Immunol 2019; 198:341-350. [PMID: 31397881 DOI: 10.1111/cei.13361] [Citation(s) in RCA: 5] [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: 08/07/2019] [Indexed: 11/26/2022] Open
Abstract
Acquired angioedema due to C1-inhibitor (C1INH) deficiency (AAE) is caused by secondary C1INH deficiency leading to bradykinin-mediated angioedema episodes. AAE typically presents in adulthood and is associated with B cell lymphoproliferation. Anti-C1INH autoantibodies (antiC1INHAbs) are detectable in a subset of AAE cases and considered a hallmark of the disease. When free antiC1INHAbs and malignant tumors are not detectable, diagnosis relies on the finding of low C1INH levels and/or function, lack of family history and SERPING1 mutations, age at onset and low or undetectable C1q levels, none of which is specific for AAE. We tested the diagnostic value of a novel enzyme-linked immunosorbent assay (ELISA) for the detection of circulating complexes between C1INH and antiC1INHAbs (C1INH-antiC1INHAb) in the serum of 20 European AAE patients characterized on the basis of their complement levels and function. Free antiC1INHAbs were detected in nine of 20 patients [six of immunoglobulin (Ig)G class, two of IgM class and one simultaneously presenting IgG and IgM classes], whereas C1INH-antiC1INHAb complexes were found in 18 of 20 of the AAE cases, regardless of the presence or absence of detectable free anti-C1INHAbs. Of note, nine of 20 patients showed negative free antiC1INHabs, but positive C1INH-antiC1INHAb complexes in their first measurement. In the cohort presented, IgM-class C1INH-antiC1INHAb are specifically and strongly associated with low C1q serum levels. Detection of C1INH-antiC1-INHAbs provides an added value for AAE diagnosis, especially in those cases in whom no free anti-C1INH antibodies are detected. The link between IgM-class C1INH-antiC1INHAb complexes and C1q consumption could have further implications for the development of autoimmune manifestations in AAE.
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Affiliation(s)
- A López-Lera
- Instituto de Investigación Sanitaria del Hospital La Paz (IdiPaz), Madrid, Spain.,Centre for Biomedical Network Research on Rare Diseases (CIBERER) U-754, Hospital Universitario La Paz, Madrid, Spain
| | - S Garrido
- Centre for Biomedical Network Research on Rare Diseases (CIBERER) U-754, Hospital Universitario La Paz, Madrid, Spain.,Immunology Unit, Hospital Universitario La Paz, Madrid, Spain
| | - P Nozal
- Centre for Biomedical Network Research on Rare Diseases (CIBERER) U-754, Hospital Universitario La Paz, Madrid, Spain.,Immunology Unit, Hospital Universitario La Paz, Madrid, Spain
| | - L Skatum
- Clinical Immunology and Transfusion Medicine, Office for Medical Services, Lund, Sweden
| | - A Bygum
- National HAE Centre, Odense University Hospital, Denmark
| | - T Caballero
- Instituto de Investigación Sanitaria del Hospital La Paz (IdiPaz), Madrid, Spain.,Centre for Biomedical Network Research on Rare Diseases (CIBERER) U-754, Hospital Universitario La Paz, Madrid, Spain.,Department of Allergy, Hospital Universitario La Paz, Madrid, Spain
| | - M López Trascasa
- Instituto de Investigación Sanitaria del Hospital La Paz (IdiPaz), Madrid, Spain.,Departamento de Medicina, Universidad Autónoma de Madrid, Madrid, Spain
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13
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Marbán Bermejo E, Caballero T, López-Trascasa M, Caballero Peregrín P, Gil Herrera J. Acquired Angioedema With Anti-C1-inhibitor Autoantibodies During Assisted Reproduction Techniques. J Investig Allergol Clin Immunol 2019; 28:62-64. [PMID: 29461216 DOI: 10.18176/jiaci.0213] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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)
| | - T Caballero
- Servicio de Alergia, Hospital La Paz Health Research Institute (IdiPaz), Madrid, Spain.,BiomedicalResearch Network on Rare Diseases (CIBERER, U754), Madrid, Spain
| | - M López-Trascasa
- Unidad Inmunología, Hospital La Paz Health Research Institute (Idipaz), Madrid, Spain
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14
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Manning M, Caballero T, Hussain I, Feuersenger H, Chiao J, Jacobs I, Pragst I. LONG-TERM EFFICACY OF SUBCUTANEOUS C1 INHIBITOR IN PEDIATRIC PATIENTS WITH HEREDITARY ANGIOEDEMA. Ann Allergy Asthma Immunol 2018. [DOI: 10.1016/j.anai.2018.09.099] [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: 10/27/2022]
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15
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Lluncor M, Pedrosa M, Cancelliere N, Rivero-Paparoni D, Burgos A, Fiandor A, Pagola MJ, Quirce S, Caballero T. Molecular Sensitization Profile According to Proton Pump Inhibitor Response in Patients With Esophageal Eosinophilia. J Investig Allergol Clin Immunol 2018; 28:354-358. [PMID: 30350796 DOI: 10.18176/jiaci.0289] [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)
- M Lluncor
- Allergy Department, Hospital La Paz Institute for Health Research (IdiPaz), Madrid, Spain
| | - M Pedrosa
- Allergy Department, Hospital La Paz Institute for Health Research (IdiPaz), Madrid, Spain
| | - N Cancelliere
- Allergy Department, Hospital La Paz Institute for Health Research (IdiPaz), Madrid, Spain
| | - D Rivero-Paparoni
- Allergy Department, Hospital La Paz Institute for Health Research (IdiPaz), Madrid, Spain
| | - A Burgos
- Gastroenterology Department, Hospital Universitario La Paz, Madrid, Spain
| | - A Fiandor
- Allergy Department, Hospital La Paz Institute for Health Research (IdiPaz), Madrid, Spain
| | - M J Pagola
- Allergy Department, Hospital La Paz Institute for Health Research (IdiPaz), Madrid, Spain
| | - S Quirce
- Allergy Department, Hospital La Paz Institute for Health Research (IdiPaz), Madrid, Spain
| | - T Caballero
- Allergy Department, Hospital La Paz Institute for Health Research (IdiPaz), Madrid, Spain
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16
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Cabañas R, Calderón O, Ramírez E, Fiandor A, Caballero T, Heredia R, Herranz P, Madero R, Quirce S, Bellón T. Sensitivity and specificity of the lymphocyte transformation test in drug reaction with eosinophilia and systemic symptoms causality assessment. Clin Exp Allergy 2018; 48:325-333. [DOI: 10.1111/cea.13076] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 09/26/2017] [Accepted: 10/24/2017] [Indexed: 12/17/2022]
Affiliation(s)
- R. Cabañas
- Department of Allergy; La Paz University Hospital Health Research Institute (IdiPAZ); Madrid Spain
- PIELenRed Consortium; Madrid Spain
| | - O. Calderón
- Department of Allergy; La Paz University Hospital Health Research Institute (IdiPAZ); Madrid Spain
| | - E. Ramírez
- PIELenRed Consortium; Madrid Spain
- Department of Clinical Pharmacology; School of Medicine; La Paz University Hospital Health Research Institute (IdiPAZ); Autonomous University of Madrid; Madrid Spain
| | - A. Fiandor
- Department of Allergy; La Paz University Hospital Health Research Institute (IdiPAZ); Madrid Spain
- PIELenRed Consortium; Madrid Spain
| | - T. Caballero
- Department of Allergy; La Paz University Hospital Health Research Institute (IdiPAZ); Madrid Spain
| | - R. Heredia
- Department of Allergy; La Paz University Hospital Health Research Institute (IdiPAZ); Madrid Spain
| | - P. Herranz
- PIELenRed Consortium; Madrid Spain
- Department of Dermatology; La Paz University Hospital Health Research Institute (IdiPAZ); Madrid Spain
| | - R. Madero
- Department of Statistics; La Paz University Hospital Health Research Institute (IdiPAZ); Madrid Spain
| | - S. Quirce
- Department of Allergy; La Paz University Hospital Health Research Institute (IdiPAZ); Madrid Spain
| | - T. Bellón
- PIELenRed Consortium; Madrid Spain
- La Paz University Hospital Health Research Institute (IdiPAZ); Madrid Spain
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17
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Caballero T, Maurer M, Longhurst HJ, Aberer W, Bouillet L, Fabien V. Triggers and Prodromal Symptoms of Angioedema Attacks in Patients With Hereditary Angioedema. J Investig Allergol Clin Immunol 2017; 26:383-386. [PMID: 27996949 DOI: 10.18176/jiaci.0102] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- T Caballero
- Allergy Department, Hospital La Paz Institute for Health Research (IdiPaz), Biomedical Research Network on Rare Diseases (CIBERER, U754), Madrid, Spain
| | - M Maurer
- Department of Dermatology and Allergy, Allergie-Centrum- Charité, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - H J Longhurst
- Department of Immunology, Barts Health NHS Trust, London, UK
| | - W Aberer
- Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria
| | - L Bouillet
- National Reference Centre for Angioedema, Internal Medicine Department, Grenoble University Hospital, Grenoble, France
| | - V Fabien
- Shire, Zug, Switzerland.,At the time of data analysis. Now with Vifor Pharma, Glattbrugg, Switzerland
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18
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Lumry W, Bernstein J, Cicardi M, Zuraw B, Craig T, Caballero T, Farkas H, Anderson J, Jacobs J, Riedl M, Manning M, Banerji A, Gower R. P153 Subcutaneous C1 inhibitor prophylaxis substantially reduces the need for rescue medications in the compact study. Ann Allergy Asthma Immunol 2017. [DOI: 10.1016/j.anai.2017.08.140] [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: 10/18/2022]
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19
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Maurer M, Caballero T, Aberer W, Zanichelli A, Bouillet L, Bygum A, Grumach A, Pommie C, Andresen I, Longhurst H. P164 Longitudinal natural history of patients with type I/II hereditary angioedema: icatibant outcome survey data. Ann Allergy Asthma Immunol 2017. [DOI: 10.1016/j.anai.2017.08.151] [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: 10/18/2022]
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20
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Zanichelli A, Longhurst HJ, Maurer M, Bouillet L, Aberer W, Fabien V, Andresen I, Caballero T, Grumach A, Bygum A, Blanchard Delaunay C, Bouillet L, Coppere B, Fain O, Goichot B, Gompel A, Guez S, Jeandel P, Kanny G, Launay D, Maillard H, Martin L, Masseau A, Ollivier Y, Sobel A, Arnolds J, Aygören-Pürsün E, Baş M, Bauer A, Bork K, Martinez I, Maurer M, Papadopoulou-Alataki E, Psarros F, Graif Y, Kivity S, Reshef A, Toubi E, Arcoleo F, Cicardi M, Manconi P, Marone G, Montinaro V, Baeza M, Caballero T, Cabañas R, Guilarte M, Hernandez de Rojas D, Hernando de Larramendi C, Lleonart R, Lobera T, Sáenz de San Pedro B, Bjorkander J, Helbert M, Longhurst H. Misdiagnosis trends in patients with hereditary angioedema from the real-world clinical setting. Ann Allergy Asthma Immunol 2017; 117:394-398. [PMID: 27742086 DOI: 10.1016/j.anai.2016.08.014] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Revised: 08/05/2016] [Accepted: 08/10/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Hereditary angioedema due to C1 inhibitor deficiency (C1-INH-HAE) causes swelling in the skin and upper airways and pain in the abdomen because of mucosal swelling. C1-INH-HAE is frequently misdiagnosed, leading to delays in diagnosis, inadequate treatment, and unnecessary procedures. OBJECTIVE To evaluate the history of misdiagnosis in patients participating in the Icatibant Outcome Survey (IOS). METHODS The IOS is an observational study in which safety and effectiveness of icatibant have been evaluated since 2009. As part of the IOS, patients record any misdiagnoses received before being diagnosed as having C1-INH-HAE. RESULTS In January 2016, a total of 418 of 633 IOS patients with C1-INH-HAE type I or II had provided misdiagnosis data. Of these, 185 of 418 (44.3%) received 1 or more prior misdiagnoses. The most common misdiagnoses were allergic angioedema (103 of 185) and appendicitis (50 of 185). A variety of other misdiagnoses were reported, including a substantial number of gastrointestinal disorders (excluding appendicitis). Misdiagnosis rates were similar between males (41.1%) and females (46.5%) and between C1-INH-HAE type I (43.7%) and type II (51.6%). Patients with family members diagnosed as having C1-INH-HAE were significantly less likely to be misdiagnosed than patients without a family history (140 of 366 [41.7%] vs 38 of 58 [65.5%], respectively; P = .001). Patients with a prior misdiagnosis had longer median delay to C1-INH-HAE diagnosis (13.3 years) than patients without (1.7 years; P < .001). CONCLUSION From this large database, approximately 50% of patients with C1-INH-HAE type I or II have previously had their conditions misdiagnosed, most commonly as allergic angioedema or appendicitis. Misdiagnosis results in marked delays in receiving the correct diagnosis, during which time patients cannot access effective, lifesaving treatment. TRIAL REGISTRATION ClinicalTrials.gov: NCT01034969.
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Affiliation(s)
- Andrea Zanichelli
- Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, ASST Fatebenefratelli Sacco, Milan, Italy.
| | - Hilary J Longhurst
- Department of Immunology, Barts Health NHS Trust, London, United Kingdom
| | - Marcus Maurer
- Department of Dermatology and Allergy, Allergie-Centrum-Charité, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Laurence Bouillet
- National Reference Centre for Angioedema, Internal Medicine Department, Grenoble University Hospital, Grenoble, France
| | - Werner Aberer
- Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria
| | | | | | - Teresa Caballero
- Allergy Department, Hospital La Paz Institute for Health Research, Biomedical Research Network on Rare Diseases (CIBERER, U754), Madrid, Spain
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21
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Zanichelli A, Maurer M, Aberer W, Caballero T, Longhurst HJ, Bouillet L, Fabien V, Andresen I. Long-term safety of icatibant treatment of patients with angioedema in real-world clinical practice. Allergy 2017; 72:994-998. [PMID: 27926986 PMCID: PMC5434903 DOI: 10.1111/all.13103] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2016] [Indexed: 11/25/2022]
Abstract
The Icatibant Outcome Survey (IOS) is an observational study monitoring safety and effectiveness of icatibant in the real‐world setting. We analyzed safety data from 3025 icatibant‐treated attacks in 557 patients (enrolled between July 2009 and February 2015). Icatibant was generally well tolerated. Excluding off‐label use and pregnancy, 438 patients (78.6%) did not report adverse events (AEs). The remaining 119 (21.4%) patients reported 341 AEs, primarily gastrointestinal disorders (19.6%). Of these, 43 AEs in 17 patients (3.1%) were related to icatibant. Serious AEs (SAEs) occurred infrequently. A total of 143 SAEs occurred in 59 (10.6%) patients; only three events (drug inefficacy, gastritis, and reflux esophagitis) in two patients were considered related to icatibant. Notably, no SAEs related to icatibant occurred in patients with cardiovascular disease, nor in those using icatibant at a frequency above label guidelines. Additionally, no major differences were noted in AEs occurring in on‐label vs off‐label icatibant users.
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Affiliation(s)
- A. Zanichelli
- Department of Biomedical and Clinical Sciences Luigi Sacco; University of Milan; ASST Fatebenefratelli Sacco; Milan Italy
| | - M. Maurer
- Department of Dermatology and Allergy; Charité-Universitätsmedizin Berlin; Berlin Germany
| | - W. Aberer
- Department of Dermatology and Venerology; Medical University of Graz; Graz Austria
| | - T. Caballero
- Department of Allergy; Hospital La Paz Institute for Health Research (IdiPaz); Biomedical Research Network on Rare Diseases (CIBERER, U754); Madrid Spain
| | | | - L. Bouillet
- National Reference Centre for Angioedema; Internal Medicine Department; Grenoble University Hospital; Grenoble France
| | - V. Fabien
- Shire; Zug Switzerland at time of data analysis; now with Vifor Pharma, Glattbrugg, Switzerland
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22
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Caballero T, Aberer W, Longhurst HJ, Maurer M, Zanichelli A, Perrin A, Bouillet L, Andresen I. The Icatibant Outcome Survey: experience of hereditary angioedema management from six European countries. J Eur Acad Dermatol Venereol 2017; 31:1214-1222. [PMID: 28370444 PMCID: PMC5575527 DOI: 10.1111/jdv.14251] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 03/07/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Hereditary angioedema (HAE) due to C1-inhibitor deficiency (C1-INH-HAE) is a rare, potentially fatal, bradykinin-mediated disease. Icatibant is a bradykinin B2 receptor antagonist originally approved in 2008 in the European Union and 2011 in the United States as an acute therapy option for HAE attacks in adults. OBJECTIVE To compare demographics, disease characteristics and treatment outcomes of icatibant-treated HAE attacks in patients with C1-INH-HAE enrolled in the Icatibant Outcome Survey across six European countries: Austria, France, Germany, Italy, Spain and the UK. METHODS The Icatibant Outcome Survey [IOS; Shire, Zug, Switzerland (NCT01034969)] is an international observational study monitoring the safety and effectiveness of icatibant. Descriptive, retrospective analyses compared IOS country data derived during July 2009-April 2015. RESULTS Overall, 481 patients with C1-INH-HAE provided demographic data. A significant difference across countries in age at onset (P = 0.003) and baseline attack frequency (P < 0.001) was found although no significant differences were found with respect to gender (majority female; P = 0.109), age at diagnosis (P = 0.182) or delay in diagnosis (P = 0.059). Icatibant was used to treat 1893 attacks in 325 patients with majority self-administration in all countries. Overall, significant differences (all P < 0.001) were found across countries in time to treatment [median 1.8 h; median range: 0.0 (Germany-Austria) to 4.4 (France) h], time to resolution [median 6.5 h; median range: 3 (Germany-Austria) to 12 (France) h] and attack duration [median 10.5 h; median range: 3.1 (Germany-Austria) to 18.5 (France) h]. CONCLUSION These data form the first European cross-country comparison of disease characteristics and icatibant use in patients with C1-INH-HAE who are enrolled in IOS. International variation in icatibant practice and treatment outcomes across the six European countries assessed highlight the need to further investigate the range of country-specific parameters driving regional variations in icatibant use.
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Affiliation(s)
- T Caballero
- Allergy Department, Hospital La Paz Institute for Health Research (IdiPaz), Biomedical Research Network on Rare Diseases (CIBERER, U754), Madrid, Spain
| | - W Aberer
- Department of Dermatology and Venerology, Medical University of Graz, Graz, Austria
| | - H J Longhurst
- Department of Immunology, Barts Health NHS Trust, London, UK
| | - M Maurer
- Department of Dermatology and Allergy, Allergy Center Charité, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - A Zanichelli
- Department of Biomedical and Clinical Science, Luigi Sacco Hospital, Milan, Italy
| | | | - L Bouillet
- Internal Medicine Department, National Reference Centre for Angioedema, Grenoble University Hospital, Grenoble, France
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Longhurst HJ, Zanichelli A, Caballero T, Bouillet L, Aberer W, Maurer M, Fain O, Fabien V, Andresen I. Comparing acquired angioedema with hereditary angioedema (types I/II): findings from the Icatibant Outcome Survey. Clin Exp Immunol 2017; 188:148-153. [PMID: 27936514 PMCID: PMC5343339 DOI: 10.1111/cei.12910] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2016] [Indexed: 11/26/2022] Open
Abstract
Icatibant is used to treat acute hereditary angioedema with C1 inhibitor deficiency types I/II (C1-INH-HAE types I/II) and has shown promise in angioedema due to acquired C1 inhibitor deficiency (C1-INH-AAE). Data from the Icatibant Outcome Survey (IOS) were analysed to evaluate the effectiveness of icatibant in the treatment of patients with C1-INH-AAE and compare disease characteristics with those with C1-INH-HAE types I/II. Key medical history (including prior occurrence of attacks) was recorded upon IOS enrolment. Thereafter, data were recorded retrospectively at approximately 6-month intervals during patient follow-up visits. In the icatibant-treated population, 16 patients with C1-INH-AAE had 287 attacks and 415 patients with C1-INH-HAE types I/II had 2245 attacks. Patients with C1-INH-AAE versus C1-INH-HAE types I/II were more often male (69 versus 42%; P = 0·035) and had a significantly later mean (95% confidence interval) age of symptom onset [57·9 (51·33-64·53) versus 14·0 (12·70-15·26) years]. Time from symptom onset to diagnosis was significantly shorter in patients with C1-INH-AAE versus C1-INH-HAE types I/II (mean 12·3 months versus 118·1 months; P = 0·006). Patients with C1-INH-AAE showed a trend for higher occurrence of attacks involving the face (35 versus 21% of attacks; P = 0·064). Overall, angioedema attacks were more severe in patients with C1-INH-HAE types I/II versus C1-INH-AAE (61 versus 40% of attacks were classified as severe to very severe; P < 0·001). Median total attack duration was 5·0 h and 9·0 h for patients with C1-INH-AAE versus C1-INH-HAE types I/II, respectively.
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Affiliation(s)
- H J Longhurst
- Department of Immunology, Barts Health NHS Trust, London, UK
| | - A Zanichelli
- Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Luigi Sacco Hospital Milan, Milan, Italy
| | - T Caballero
- Department of Allergy, Hospital La Paz Institute for Health Research (IdiPaz), Biomedical Research Network on Rare Diseases (CIBERER, U754), Madrid, Spain
| | - L Bouillet
- National Reference Centre for Angioedema, Internal Medicine Department, Grenoble University Hospital, Grenoble, France
| | - W Aberer
- Department of Dermatology and Venerology, Medical University of Graz, Graz, Austria
| | - M Maurer
- Department of Dermatology and Allergy, Allergie-Centrum-Charité, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - O Fain
- Department of Internal Medicine, DHU i2B, Saint Antoine Hospital, University Paris 6, Paris, France
| | - V Fabien
- Shire, Zug, Switzerland at the time of data analysis. Now with Vifor Pharma, Glattbrugg, Switzerland
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Longhurst H, Aberer W, Bouillet L, Caballero T, Bygum A, Grumach A, Perrin A, Andresen I, Zanichelli A, Maurer M. O004 Childhood presenting hereditary angioedema is diagnosed in adulthood by non-pediatric physicians: Icatibant outcome survey findings. Ann Allergy Asthma Immunol 2016. [DOI: 10.1016/j.anai.2016.09.364] [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: 11/24/2022]
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Caballero T, Fiameni F, Valcarcel A, Buzzi J. Dietary supplementation with coenzyme Q10 in poor responder patients undergoing IVF-ICSI Treatment. Fertil Steril 2016. [DOI: 10.1016/j.fertnstert.2016.07.177] [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: 11/15/2022]
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Canabal J, Caballero T, Caminoa M, Fiandor A, Quirce S, Cabañas R. Anaphylactic Shock Caused by a Hidden Allergen in Blood Sausage. J Investig Allergol Clin Immunol 2016; 26:200-1. [PMID: 27326993 DOI: 10.18176/jiaci.0057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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)
- J Canabal
- Department of Allergy, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | - T Caballero
- Department of Allergy, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | - M Caminoa
- Department of Allergy, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | - A Fiandor
- Department of Allergy, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | - S Quirce
- Department of Allergy, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | - R Cabañas
- Department of Allergy, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
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González-Quevedo T, Larco J, Marcos C, Guilarte M, Baeza M, Cimbollek S, López-Serrano M, Piñero-Saavedra M, Rubio M, Caballero T. Management of Pregnancy and Delivery in Patients With Hereditary Angioedema Due to C1 Inhibitor Deficiency. J Investig Allergol Clin Immunol 2016; 26:161-7. [DOI: 10.18176/jiaci.0037] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [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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Bouillet L, Caballero T, Aberer W, Longhurst H, Maurer M, Zanichelli A, Fabien V. L’enquête sur les résultats de l’icatibant : expérience de la gestion de l’angiœdème héréditaire dans quatre pays européens. Rev Med Interne 2015. [DOI: 10.1016/j.revmed.2015.10.238] [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: 10/22/2022]
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Gómez-Traseira C, Pérez-Fernández E, López-Serrano MC, García-Ara MC, Pedrosa M, López-Trascasa M, Caballero T. Clinical Pattern and Acute and Long-term Management of Hereditary Angioedema Due to C1-Esterase Inhibitor Deficiency. J Investig Allergol Clin Immunol 2015; 25:358-364. [PMID: 26727765] [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
BACKGROUND Hereditary angioedema due to C1-esterase inhibitor deficiency (HAE-C1-INH) is a life-threatening disease. OBJECTIVES To describe the clinical characteristics and management of patients with HAE-C1-INH during routine clinical practice. METHODS An observational, retrospective study was performed in patients with HAE-C1-INH. Demographic, clinical, and analytical data were collected from 2 periods: period A (October 2009-September 2010) and period B (October 2007-September 2009). RESULTS We studied 112 patients with HAE-C1-INH (57.1% females). Age at onset of symptoms was 14.4 years (lower in patients who had experienced attacks in the previous year). In period B (n=87), 62.1% of patients presented at least 1 edema attack (median, 3.5 attacks/patient/2 years), and 19.1% of attacks were treated. In period A (n=77), 58.4% of patients were on maintenance therapy. Stanozolol was the most widely used drug (48.9%), with a mean weekly dose of 6.7 mg. At least 1 attack was recorded in 72.7% of patients (median, 3.0 attacks/patient/year), and 31.5% of the attacks were treated. Treatment of acute attacks increased by 12.4%. CONCLUSION Age at onset of symptoms is associated with clinical expression of disease. The higher age at onset of symptoms, the fewer number of attacks per patient and year, and the lower dose of attenuated androgens necessary to control the disease than in other series lead us to hypothesize that HAE-C1-INH could have a less severe expression in Spain. Acute attacks seem to be treated increasingly often.
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Charignon D, Ghannam A, Defendi F, Ponard D, Monnier N, López Trascasa M, Launay D, Caballero T, Djenouhat K, Fain O, Cichon S, Martin L, Drouet C. Hereditary angioedema with F12 mutation: factors modifying the clinical phenotype. Allergy 2014; 69:1659-65. [PMID: 25134986 DOI: 10.1111/all.12515] [Citation(s) in RCA: 23] [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: 08/12/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Hereditary angioedema (HAE) with normal C1 inhibitor (C1Inh) associated with the c.983C>A and c.983C>G mutations of the F12 gene (FXII-HAE) is a rare condition, and presents with highly variable clinical expression. On the basis of data gathered from a large carrier cohort, we assessed the modifiers affecting the clinical phenotype. METHODS We analyzed clinical and biological data recorded from 118 mutation carriers (80 symptomatic and 38 asymptomatic), 58 noncarrier relatives from 40 families, and 200 healthy donors. Disease severity was scored in relation to frequency and location of edema, as well as age at disease onset. To predict FXII-HAE disease severity, we analyzed the biological phenotype [C1Inh, C4, spontaneous amidase, angiotensin-I-converting enzyme (ACE), aminopeptidase P (APP), and carboxypeptidase N/M (CPN)] by means of logistic regression (Akaike information criterion) and odds ratio (OR). RESULTS Meaningful variables contributed to FXII-HAE, with the kinin catabolism enzymes ACE and CPN exhibiting a significant inverse relationship with disease severity (OR = 0.36, 95% CI 0.23-0.59, P < 0.001; OR = 0.58, 95% CI 0.36-0.91, P < 0.05, respectively). CPN activities were 37.5 (28.5-41.3) nmol/ml/min and 38.5 (32.8-45.6) for FXII-HAE asymptomatic and symptomatic carriers, respectively, and 37.9 (30.5-43.7) nmol/ml/min for noncarriers. Angiotensin-I-converting enzyme activities were 58 (44-76) and 49 (35-59) nmol/ml/min for FXII-HAE asymptomatic and symptomatic carriers, respectively, and 56 (49-66) nmol/ml/min for noncarriers. CONCLUSIONS The FXII-HAE is associated with modifiers, for example kinin catabolism enzymes, ACE and CPN, different from those recognized in HAE with C1Inh deficiency.
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Affiliation(s)
- D. Charignon
- CREAK; Centre de Référence des Angioedèmes; Grenoble France
- GREPI/AGIM CNRS FRE 3405; Université Joseph Fourier; Grenoble France
| | - A. Ghannam
- CREAK; Centre de Référence des Angioedèmes; Grenoble France
- GREPI/AGIM CNRS FRE 3405; Université Joseph Fourier; Grenoble France
| | - F. Defendi
- CREAK; Centre de Référence des Angioedèmes; Grenoble France
- GREPI/AGIM CNRS FRE 3405; Université Joseph Fourier; Grenoble France
| | - D. Ponard
- CREAK; Centre de Référence des Angioedèmes; Grenoble France
| | - N. Monnier
- CREAK; Centre de Référence des Angioedèmes; Grenoble France
| | - M. López Trascasa
- Institute for Health Research (IdiPaz); Hospital Universitario La Paz; Madrid Spain
- Biomedical Research Network on Rare Diseases-U754 (CIBERER); Madrid Spain
| | - D. Launay
- CREAK; Centre de Référence des Angioedèmes; Grenoble France
- Département de Médecine Interne; Université du Droit et de la Santé Lille 2; Lille France
| | - T. Caballero
- Institute for Health Research (IdiPaz); Hospital Universitario La Paz; Madrid Spain
- Biomedical Research Network on Rare Diseases-U754 (CIBERER); Madrid Spain
| | - K. Djenouhat
- Département d'Immunologie; Institut Pasteur; Alger Algeria
| | - O. Fain
- CREAK; Centre de Référence des Angioedèmes; Grenoble France
- Département de Médecine Interne; Université Paris XIII; Bondy France
| | - S. Cichon
- Institute für Humangenetics; Universität Bonn; Bonn Germany
- Departement Biomedizin; Universität Basel; Basel Switzerland
| | - L. Martin
- CREAK; Centre de Référence des Angioedèmes; Grenoble France
- Département de Dermatologie; L'UNAM Université; Hôpital d'Angers; Angers France
| | - C. Drouet
- CREAK; Centre de Référence des Angioedèmes; Grenoble France
- GREPI/AGIM CNRS FRE 3405; Université Joseph Fourier; Grenoble France
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Caballero T, Buzzi P, Zappacosta M, Valcarcel A, Lorenzo F. Reproductive outcome of oocyte activation by calcium ionophore a23187 following intracytoplasmic sperm injection (ICSI) in patients with previous complete fertilization failure. Fertil Steril 2014. [DOI: 10.1016/j.fertnstert.2014.07.684] [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: 10/24/2022]
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Cicardi M, Aberer W, Banerji A, Bas M, Bernstein JA, Bork K, Caballero T, Farkas H, Grumach A, Kaplan AP, Riedl MA, Triggiani M, Zanichelli A, Zuraw B. Classification, diagnosis, and approach to treatment for angioedema: consensus report from the Hereditary Angioedema International Working Group. Allergy 2014; 69:602-16. [PMID: 24673465 DOI: 10.1111/all.12380] [Citation(s) in RCA: 408] [Impact Index Per Article: 40.8] [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: 01/21/2014] [Indexed: 01/13/2023]
Abstract
Angioedema is defined as localized and self-limiting edema of the subcutaneous and submucosal tissue, due to a temporary increase in vascular permeability caused by the release of vasoactive mediator(s). When angioedema recurs without significant wheals, the patient should be diagnosed to have angioedema as a distinct disease. In the absence of accepted classification, different types of angioedema are not uniquely identified. For this reason, the European Academy of Allergy and Clinical Immunology gave its patronage to a consensus conference aimed at classifying angioedema. Four types of acquired and three types of hereditary angioedema were identified as separate forms from the analysis of the literature and were presented in detail at the meeting. Here, we summarize the analysis of the data and the resulting classification of angioedema.
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Affiliation(s)
- M. Cicardi
- Department of Biomedical and Clinical Sciences Luigi Sacco; University of Milan; Luigi Sacco Hospital Milan; Milan Italy
| | - W. Aberer
- Department of Dermatology; Medical University of Graz; Graz Austria
| | - A. Banerji
- Division of Rheumatology, Allergy and Immunology; Massachusetts General Hospital; Boston MA USA
| | - M. Bas
- Department of Otorhinolaryngology; Klinikum rechts der Isar; Technische Universität München; Munich Germany
| | - J. A. Bernstein
- Division of Immunology/Allergy Section; Department of Internal Medicine; University of Cincinnati College of Medicine; Cincinnati OH USA
| | - K. Bork
- Department of Dermatology; Johannes Gutenberg University; Mainz Germany
| | - T. Caballero
- Department of Allergy; Hospital La Paz Institute for Health Research (IdiPaz); Biomedical Research Network on Rare Diseases-U754 (CIBERER); Madrid Spain
| | - H. Farkas
- 3rd Department of Internal Medicine; National Angioedema Center; Semmelweis University; Budapest Hungary
| | - A. Grumach
- Department of Clinical Medicine; Faculty of Medicine ABC; Sao Paulo Brazil
| | - A. P. Kaplan
- Medical University of South Carolina; Charleston SC
| | - M. A. Riedl
- Division of Rheumatology, Allergy and Immunology; Department of Medicine; University of California - San Diego; La Jolla CA USA
| | - M. Triggiani
- Department of Medicine; University of Salerno; Salerno Italy
| | - A. Zanichelli
- Department of Biomedical and Clinical Sciences Luigi Sacco; University of Milan; Luigi Sacco Hospital Milan; Milan Italy
| | - B. Zuraw
- Division of Rheumatology, Allergy and Immunology; Department of Medicine; University of California - San Diego; La Jolla CA USA
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Aberer W, Maurer M, Reshef A, Longhurst H, Kivity S, Bygum A, Caballero T, Bloom B, Nair N, Malbrán A. Open-label, multicenter study of self-administered icatibant for attacks of hereditary angioedema. Allergy 2014; 69:305-14. [PMID: 24438203 DOI: 10.1111/all.12303] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND Historically, treatment for hereditary angioedema (HAE) attacks has been administered by healthcare professionals (HCPs). Patient self-administration could reduce delays between symptom onset and treatment, and attack burden. The primary objective was to assess the safety of self-administered icatibant in patients with HAE type I or II. Secondary objectives included patient convenience and clinical efficacy of self-administration. METHODS In this phase IIIb, open-label, multicenter study, adult patients were trained to self-administer a single 30-mg icatibant subcutaneous injection to treat their next attack. Icatibant-naïve patients were treated by an HCP prior to self-administration. Evaluations included adverse event (AE) reporting, a validated questionnaire for convenience, and visual analog scale for efficacy. RESULTS A total of 151 patients were enrolled; 104 had an attack requiring treatment during the study, and 97 patients (19 naïve) were included in the self-administration cohort. Recurrence or worsening of HAE symptoms (22 of 97) was the most commonly reported AE; rescue medications including icatibant (N = 3) and C1-inhibitor concentrate (N = 6) were used in 13 cases. Overall, 89 of 97 patients used a single injection of icatibant. No serious AEs or hospitalizations were reported. Most patients (91.7%) found self-administration preferable to administration in the clinic. The median time to symptom relief (3.8 h) was comparable with results from controlled trials of icatibant. CONCLUSIONS With appropriate training, patients were successfully able to recognize HAE attacks and decide when to self-administer icatibant. This, coupled with the patient-reported high degree of satisfaction, convenience and ease of use supports the adoption of icatibant self-administration in clinical practice.
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Affiliation(s)
- W. Aberer
- Department of Dermatology and Venerology; Medical University Graz; Graz Austria
| | - M. Maurer
- Allergie-Centrum-Charité; Department of Dermatology and Allergy; Charité - Universitätsmedizin; Berlin Germany
| | - A. Reshef
- Allergy; Clinical Immunology and Angioedema Unit; The Sheba Medical Center; Tel-Hashomer Israel
| | - H. Longhurst
- Immunology Department; Bart's and The London Hospital; London UK
| | - S. Kivity
- The Allergy and Immunology Unit; The Tel Aviv Medical Center; Sackler Medical School; Tel Aviv Israel
| | - A. Bygum
- Department of Dermatology and Allergy Centre; Odense University Hospital; Odense Denmark
| | - T. Caballero
- The Hospital La Paz Health Research Institute (IdiPaz); Biomedical Research Network on Rare Diseases (CIBERER, U754); Madrid Spain
| | - B. Bloom
- Department of Clinical Development; Shire; Lexington MA
| | - N. Nair
- Global Clinical Research; Shire; Lexington MA USA
| | - A. Malbrán
- Department of Allergy, Asthma and Immunology; Hospital Británico de Buenos Aires; Buenos Aires Argentina
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Rijo Y, Palao P, Prior N, Fiandor A, Lopez-serrano M, Olalde S, Torres M, Quirce S, Caballero T. Treatment With Off-Label Omalizumab In Chronic Idiopathic Histaminergic Urticaria - Angioedema Resistant To Conventional Treatment. J Allergy Clin Immunol 2014. [DOI: 10.1016/j.jaci.2013.12.439] [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: 11/28/2022]
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Cabañas R, Calderon O, Ramirez E, Fiandor A, Prior N, Caballero T, Herránz P, Bobolea I, López-Serrano MC, Quirce S, Bellón T. Piperacillin-induced DRESS: distinguishing features observed in a clinical and allergy study of 8 patients. J Investig Allergol Clin Immunol 2014; 24:425-430. [PMID: 25668894] [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
BACKGROUND DRESS (drug reaction with eosinophilia and systemic symptoms) syndrome is characterized by fever, rash, eosinophilia, and multiorgan failure. Previous reports have described differences in clinical and laboratory findings of DRESS syndrome depending on the inducing drug. Piperacillin has been reported as the drug responsible for this syndrome in 3 patients. OBJECTIVE To analyze and describe the clinical, laboratory, and allergy study findings of piperacillin-induced DRESS. PATIENTS AND METHODS Retrospective case series of patients diagnosed with DRESS associated with piperacillin-tazobactam (Pip/Taz) according to the Kardaun diagnostic score criteria. Assessment of causality was established using the Spanish Pharmacovigilance System and the lymphocyte transformation test (LTT). The allergy study included skin and epicutaneous tests. RESULTS Eight patients were diagnosed with DRESS due to Pip/Taz (3 probable and 5 definite cases). Skin rash was observed in all cases and facial edema in 50%; the mean latency period was 18 days. Fever was present in 7 patients. Liver and kidney injuries were detected in 6 and 3 patients, respectively. All patients had eosinophilia and a full recovery. The LTT to Pip/Taz was strongly positive in all patients, with a stimulation index of over 6. Three of 3 patients had a positive intradermal test to Pip/Taz, and 1 of 4 had a positive patch test. All patients had a negative LTT to carbapenems. CONCLUSIONS We have reported on the first case series of piperacillin-induced DRESS. A latency period of 18 days, skin rash, eosinophilia, fever, liver injury, and good prognosis were the most common features. The allergy study, and the LTT in particular, was highly useful for identifying Pip/Taz as the culprit drug and piperacillin as the responsible active ingredient.
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Pedrosa M, Lobera T, Panizo C, Jurado J, Caballero T. Long-term prophylaxis with C1-inhibitor concentrate in patients with hereditary angioedema. J Investig Allergol Clin Immunol 2014; 24:271-273. [PMID: 25219111] [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: 06/03/2023] Open
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Auge L, Caballero T, Buzzi P, Valcarcel A. Clinical live birth after transfer of non selected cleavage embryos from vitrified/thawed oocytes. when embryo cryopreservation is not an option. Fertil Steril 2013. [DOI: 10.1016/j.fertnstert.2013.07.1449] [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: 10/26/2022]
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Caballero T, Sala-Cunill A, Cancian M, Craig TJ, Neri S, Keith PK, Boccon-Gibod I, Bethune C, Bork K. Current status of implementation of self-administration training in various regions of Europe, Canada and the USA in the management of hereditary angioedema. Int Arch Allergy Immunol 2013; 161 Suppl 1:10-6. [PMID: 23689239 DOI: 10.1159/000351233] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Results from a 16-question survey about self-administration of hereditary angioedema (HAE) therapy, administered in Europe, Canada and the USA, were used to guide discussion at an international HAE expert meeting. The aim was to capture information about current practice in self-administered HAE therapy in these countries, including self-administration training, the key benefits of switching to self-administration, the barriers to self-administration and trends in self-administration. Overall, switching to self-administration therapy is looked upon favourably from both patient and clinician perspectives by virtue of the potential improvement in quality of life arising from optimisation of therapy and early intervention. The recent changes to product licences allowing self-administration provide additional options for the management of HAE.
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Affiliation(s)
- T Caballero
- Hospital La Paz Institute for Health Research (IdiPaz), Madrid, Spain. mteresa.caballero @ idipaz.es
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Jurado-Palomo J, Muñoz-Caro JM, López-Serrano MC, Prior N, Cabañas R, Pedrosa M, Burgueño M, Caballero T. Management of dental-oral procedures in patients with hereditary angioedema due to C1 inhibitor deficiency. J Investig Allergol Clin Immunol 2013; 23:1-6. [PMID: 23653967] [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: 06/02/2023] Open
Abstract
BACKGROUND Hereditary angioedema due to C1 inhibitor deficiency (HAE-C1-INH) has considerable implications for dental health care providers, since dental procedures may trigger severe and even life-threatening episodes. The aim of the present study was to analyze the efficacy and safety of premedication with attenuated androgens (AAs), plasma-derived human C1 esterase inhibitor concentrate (pdhC1INH), or both to prevent the development of upper airway angioedema after dental-oral procedures in patients with HAE-C1-INH. MATERIAL AND METHODS All dental-oral procedures performed on patients with HAE-C1-INH who were followed up at La Paz University Hospital, Madrid, Spain were reviewed. Demographic data, maintenance treatment, preprocedure prophylaxis, disease severity, and occurrence of upper airway angioedema were recorded. RESULTS Twenty-four patients (14 male/10 female; mean age, 42.6 years) underwent 66 procedures. Most procedures were performed on patients with severe HAE-C1-INH (20 procedures) or moderate HAE-C1-INH (26 procedures). Only 9 procedures were performed without short-term prophylaxis. Mild upper airway angioedema developed after 3 procedures performed without short-term prophylaxis in patients with minimal or asymptomatic HAE-C1-INH. A statistically significant association was found between development of mild postprocedure upper airway angioedema and lack of maintenance treatment with AA, lack of increased dose of preprocedure AA, and failure to administer preprocedure pdhC1INH (P = .002, Fisher exact test). CONCLUSIONS Increased doses of prophylactic AA, administration of pdhC1INH, or both were good options for ambulatory management of dental-oral procedures in patients with HAE-C1-INH. Prophylaxis with pdC1INH or increased doses of AA is advisable before dental-oral procedures, even in patients with low disease severity.
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Affiliation(s)
- J Jurado-Palomo
- Department of Allergology, Hospital La Paz Health Research Institute (IdiPAZ), Madrid, Spain.
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Valbuena T, Fiandor A, Quirce S, Lucendo AJ, Caballero T. Usefulness of oral food challenge and a visual analog scale in the etiologic diagnosis of eosinophilic esophagitis. J Investig Allergol Clin Immunol 2013; 23:131-132. [PMID: 23654083] [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)
- T Valbuena
- Department of Allergy, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Spain.
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Guillén D, Fiandor-Román A, Caballero T, García-Vena E, Pastor S, Quirce S. Urticaria caused by ingestion of pasta and bread containing buckwheat flour. J Investig Allergol Clin Immunol 2013; 23:206-207. [PMID: 23967763] [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)
- D Guillén
- Department of Allergy, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain.
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Caballero T. Angio-oedema due to hereditary C1 inhibitor deficiency in children. Allergol Immunopathol (Madr) 2013; 41:45-53. [PMID: 22417938 DOI: 10.1016/j.aller.2012.01.002] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Revised: 12/29/2011] [Accepted: 01/02/2012] [Indexed: 11/28/2022]
Abstract
Hereditary angio-oedema due to C1 inhibitor deficiency (HAE-C1-INH) is a rare inherited disorder characterised by recurring and debilitating episodes of cutaneous swelling and abdominal pain and less frequent episodes of laryngeal oedema. Symptom onset is usually in childhood and early adolescence, with earlier disease onset associated with greater disease severity. Although HAE-C1-INH attacks are generally less frequent and less severe in children than in adults, they can cause significant physical and psychological impairment and affect advancement in school. There are often significant delays in the diagnosis of HAE-C1-INH due to its variable clinical presentation and because abdominal symptoms can often mimic other common paediatric gastrointestinal disorders. In recent years, several disease-specific agents have become available for the acute and prophylactic treatment of HAE-C1-INH. Although these treatments have not been evaluated rigorously in controlled clinical trials in children with HAE-C1-INH, paediatric data on efficacy and safety are available for some agents. Early diagnosis and initiation of appropriate therapy in children with HAE-C1-INH can help reduce the burden of this illness in the paediatric population.
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Affiliation(s)
- T Caballero
- Servicio de Alergia, Hospital La Paz Health Research Institute (IdiPaz), Biomedical Research Network on Rare diseases-U754 (CIBERER), Hospital Universitario La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain.
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Caballero T, Gila A, Sánchez-Salgado G, Muñoz de Rueda P, León J, Delgado S, Muñoz JA, Caba-Molina M, Carazo A, Ruiz-Extremera A, Salmerón J. Histological and immunohistochemical assessment of liver biopsies in morbidly obese patients. Histol Histopathol 2012; 27:459-66. [PMID: 22374723 DOI: 10.14670/hh-27.459] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS To study liver lesions in morbidly obese patients who underwent liver biopsy at the time of bariatric surgery to define histological lesions, especially inflammatory infiltrate, diagnostic categories and the possible influence of gender in this respect. METHODS AND RESULTS 110 biopsies (36 males-M- and 76 females -F-) were evaluated and categorised, according to the NAS (NAFLD -non alcoholic fatty liver disease- Activity Score) system and other criteria, as non-NAFLD (15.5%, F predominance), non-alcoholic steatohepatitis (NASH) (16.5%, M predominance), non-alcoholic hepatosteatosis (NAHS) (21%, F predominance) and, the most numerous group, NASH-borderline (NASH-BORD) (47%), with three subgroups, characterised by centrozonal lesions, portal area preferential involvement or affecting both areas. The predominant form of hepatocytesteatosis was mixed with a multivesicular component that was present in most cases with fibroinflammatory portal involvement. Nuclear glycogenosomes were found in greater number of biopsies in patients in the third and sixth decades. Portal inflammation was present in a large number of cases (M predominance); the application of immunohistochemical techniques (myeloperoxidase and CD68 antibodies) to evaluate lobular inflammation revealed "surgical hepatitis" in one third of the cases, and the presence of microgranulomas (CD68+) (M predominance), which were more abundant with increasing lesion severity. CONCLUSIONS Portal inflammation and multivesicular hepatocytesteatosis are highly prevalent in morbidly obese patients. This study identifies a new subtype of NASH-BORD characterized by centrizonal and porto-periportal area involvement and the existence of liver biopsies without steatosis. CD68+ microgranulomas constitute an unequivocal marker of lobular inflammation in surgical biopsies and of lesion severity, which is gender-related.
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Affiliation(s)
- T Caballero
- Pathology Department, San Cecilio University Hospital, Granada (HUSC) and School of Medicine, University of Granada, Spain.
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Cicardi M, Bork K, Caballero T, Craig T, Li HH, Longhurst H, Reshef A, Zuraw B. Evidence-based recommendations for the therapeutic management of angioedema owing to hereditary C1 inhibitor deficiency: consensus report of an International Working Group. Allergy 2012; 67:147-57. [PMID: 22126399 DOI: 10.1111/j.1398-9995.2011.02751.x] [Citation(s) in RCA: 270] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Angioedema owing to hereditary deficiency of C1 inhibitor (HAE) is a rare, life-threatening, disabling disease. In the last 2 years, the results of well-designed and controlled trials with existing and new therapies for this condition have been published, and new treatments reached the market. Current guidelines for the treatment for HAE were released before the new trials and before the new treatments became available and were essentially based on observational studies and expert opinion. To provide evidence-based HAE treatment guidelines supported by the new studies, a conference was held in Gargnano del Garda, Italy, from September 26 to 29, 2010. The meeting hosted 58 experienced HAE expert physicians, representatives of pharmaceutical companies and representatives of HAE patients' associations. Here, we report the topics discussed during the meeting and evidence-based consensus about management approaches for HAE in adult/adolescent patients.
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Affiliation(s)
- M Cicardi
- Dipartimento di Scienze Cliniche "Luigi Sacco", Università di Milano, Ospedale L. Sacco, Milano, Italy.
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Cancelliere N, Guillen D, Olalde S, Caldern O, Caballero T, Fiandor A, Quirse S. Crustacean Allergy: A New Allergen Inside Cephalothorax? J Allergy Clin Immunol 2012. [DOI: 10.1016/j.jaci.2011.12.397] [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: 10/14/2022]
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Barranco P, Olalde S, Caminoa M, Bobolea I, Caballero T, del Pozo V, Quirce S. Occupational asthma due to western red cedar in a guitar maker. J Investig Allergol Clin Immunol 2012; 22:293-294. [PMID: 22812202] [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: 06/01/2023] Open
Affiliation(s)
- P Barranco
- Departament of Allergy, Hospital La Paz Health Research Institute (IdiPAZ), Madrid, Spain.
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Colás C, Montoiro R, Fraj J, Garcés M, Cubero JL, Caballero T. Nonhistaminergic idiopathic angioedema: clinical response to icatibant. J Investig Allergol Clin Immunol 2012; 22:520-521. [PMID: 23397675] [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: 06/01/2023] Open
Affiliation(s)
- C Colás
- Allergy Department, Hospital Clínico Universitario "Lozano Blesa," Zaragoza, Spain.
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García-Ara MC, Bobolea I, Caballero T, Quirce S, Boyano-Martínez MT. Specific immunoglobulin E to Echinococcus granulosus in children allergic to cow's milk proteins. J Investig Allergol Clin Immunol 2012; 22:374-375. [PMID: 23101315] [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: 06/01/2023] Open
Affiliation(s)
- M C García-Ara
- Department of Allergy, Hospital La Paz Institute for Health Research, IdiPAZ, Madrid, Spain
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Prior N, Caminoa M, Gómez-Traseira C, López-Serrano M, Caballero T. Efficacy and Tolerability of Icatibant Acetate in Hereditary Angioedema due To C1 Inhibitor Deficiency (HAE): a Descriptive Study. J Allergy Clin Immunol 2011. [DOI: 10.1016/j.jaci.2010.12.400] [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: 10/18/2022]
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Cancelliere N, Fiandor A, Caminoa M, Valvuena T, Martinez M, Quirce S, Caballero T. Eosinophilic Esophagitis: Allergological-clinical Descriptive Study. J Allergy Clin Immunol 2011. [DOI: 10.1016/j.jaci.2010.12.429] [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: 11/27/2022]
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