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Staubach P, Bilo B, Fluhr JW, Krause K, Kulthanan K, Salman A, Katelaris C, Bernstein JA, Maurer M, Mann C. UCOMB-real life data: treatment strategies for chronic urticaria patients with comorbidities. J DERMATOL TREAT 2024; 35:2329784. [PMID: 38508226 DOI: 10.1080/09546634.2024.2329784] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
BACKGROUND There is a lack of real-life safety data on treatment options for chronic urticaria in the presence of comedication and comorbidities. METHODS We present a single-center UCARE pilot study of 212 outpatients with chronic urticaria. Patients were divided into three groups according to different CU therapies according to international guidelines. RESULTS Of 212 patients, 108 (mean age 48.9 years, 71.3% female) had 59 comorbidities, including cardiovascular, autoimmune and malignant diseases. Patients were followed for a mean of 24.6 months (SD ± 21.3). Urticaria therapies were divided into three groups: A: 105 (97.2%) with omalizumab and 2nd generation antihistamines), B: 16 patients (14.8%): dual therapy with antihistamines and cyclosporine in 10 (9.3%), montelukast in five (4. 6%), dapsone in four (3.7%), hydroxychloroquine in one patient (0.9%), C: 12 (11.1%) patients received a third drug for 4.9 months (SD ± 3.2) and one quadruple therapy (2.1 months). 10 out of 12 (83.3%) patients received montelukast, two (16.7%) cyclosporine, two (16.7%) dapsone and one (8.3%) hydroxychloroquine as a third drug for chronic urticaria. CONCLUSIONS Combining treatment modalities for chronic urticaria and comorbidities are available and feasible with a good safety profile.
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Affiliation(s)
- Petra Staubach
- Department of Dermatology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Benedikt Bilo
- Department of Dermatology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Joachim W Fluhr
- Urticaria Center of Reference and Excellence (UCARE), Institute of Allergology IFA, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Fraunhofer Insitute for Translational Medicine and Pharmacology, ITMP Berlin, Immunology and Allergology IA, Berlin, Germany
| | - Karoline Krause
- Urticaria Center of Reference and Excellence (UCARE), Institute of Allergology IFA, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Fraunhofer Insitute for Translational Medicine and Pharmacology, ITMP Berlin, Immunology and Allergology IA, Berlin, Germany
| | - Kanokvalai Kulthanan
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Andac Salman
- Department of Dermatology, Acıbadem University School of Medicine, Istanbul, Turkey
| | - Connie Katelaris
- Department of Medicine, Campbelltown Hospital and Western Sydney University Sydney, Campbelltown, Australia
| | - Jonathan A Bernstein
- Division of Rheumatology, Allergy and Immunology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Marcus Maurer
- Urticaria Center of Reference and Excellence (UCARE), Institute of Allergology IFA, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Fraunhofer Insitute for Translational Medicine and Pharmacology, ITMP Berlin, Immunology and Allergology IA, Berlin, Germany
| | - Caroline Mann
- Department of Dermatology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
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Bacak BJ, Castle MS, Barbot C, Srikantha L, Stern NA, Vandjelovic ND. Airway Involvement and Intervention in Non-ACE-Inhibitor-Induced Angioedema. Laryngoscope 2024; 134:2282-2287. [PMID: 37902118 DOI: 10.1002/lary.31127] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 09/29/2023] [Accepted: 10/10/2023] [Indexed: 10/31/2023]
Abstract
OBJECTIVES Characterize the presentation of patients with non-angiotensin-converting enzyme inhibitor (ACEI)-induced angioedema and determine risk factors associated with patient disposition and possible need for airway intervention. METHODS The medical records of adult patients in the Emergency Department (ED) and diagnosed with non-ACEI-induced angioedema over 4.5 years were included. Demographics, vital signs, etiology, timeline, presenting symptoms, physical exam including flexible laryngoscopy, medical management, and disposition were examined. Statistical analyses were conducted using SPSS V 23.0 software calculating and comparing means, standard deviations, medians, and correlation of categorical and ordinate variables. RESULTS A total of 181 patients with non-ACEI-induced angioedema were evaluated with flexible laryngoscopy by otolaryngology. Notably, 11 patients (6.1%) required airway intervention and were successfully intubated. Statistically significant factors (p ≤ 0.05) associated with airway intervention included the diastolic blood pressure (DBP) and mean arterial pressure (MAP) (p = 0.006 and 0.01 respectively), symptoms of dysphonia (p = 0.018), the presence of oropharyngeal, supraglottic, and hypopharyngeal edema (p ≤ 0.001 for each site), and the number of edematous anatomic subsites documented on physical exam (p < 0.001). Other patient demographics, prior history of angioedema, heart rate, systolic blood pressure, symptom onset, number of symptoms at presentation, and medication administered in the ED did not correlate with airway intervention. CONCLUSION Dysphonia, DBP, MAP, anatomic location of edema and edema in multiple sites are associated with airway intervention and a higher level of care in non-ACEI-induced angioedema and can be useful in risk assessment in patient management. LEVEL OF EVIDENCE 4 Laryngoscope, 134:2282-2287, 2024.
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Affiliation(s)
- Bartholomew J Bacak
- Department of Otolaryngology - Head and Neck Surgery, University of Rochester Medical Center, Rochester, New York, U.S.A
| | - Michael S Castle
- Department of Otolaryngology - Head and Neck Surgery, University of Rochester Medical Center, Rochester, New York, U.S.A
| | - Chantal Barbot
- Department of Otolaryngology - Head and Neck Surgery, Detroit Medical Center, Detroit, Michigan, U.S.A
| | - Luxman Srikantha
- Department of Otolaryngology - Head and Neck Surgery, Detroit Medical Center, Detroit, Michigan, U.S.A
| | - Noah A Stern
- Department of Otolaryngology - Head and Neck Surgery, Detroit Medical Center, Detroit, Michigan, U.S.A
| | - Nathan D Vandjelovic
- Department of Otolaryngology - Head and Neck Surgery, University of Rochester Medical Center, Rochester, New York, U.S.A
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Vincent D, Parsopoulou F, Martin L, Gaboriaud C, Demongeot J, Loules G, Fischer S, Cichon S, Germenis AE, Ghannam A, Drouet C. Hereditary angioedema with normal C1 inhibitor associated with carboxypeptidase N deficiency. J Allergy Clin Immunol Glob 2024; 3:100223. [PMID: 38445235 PMCID: PMC10912455 DOI: 10.1016/j.jacig.2024.100223] [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] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 11/18/2023] [Accepted: 11/19/2023] [Indexed: 03/07/2024]
Abstract
Background Hereditary angioedema (HAE) is a potentially life-threatening disorder characterized by recurrent episodes of subcutaneous or submucosal swelling. HAE with normal C1 inhibitor (HAE-nC1-INH) is an underdiagnosed condition. Although the association with genetic variants has been identified for some families, the genetic causes in many patients with HAE-nC1-INH remain unknown. The role of genes associated with bradykinin catabolism is not fully understood. Objective We sought to investigate the biological parameters and the genes related to kallikrein-kinin system in families with a clinical phenotype of HAE-nC1-INH and presenting with a carboxypeptidase N (CPN) deficiency. Methods This study includes 4 families presenting with HAE-nC1-INH and CPN deficiency. Patients' clinical records were examined, biological parameters of kallikrein-kinin system were measured, and genetics was analyzed by next-generation sequencing and Sanger sequencing. Predictive algorithms (Human Splicing Finder, Sorting Intolerant From Tolerant, Polymorphism Phenotyping v2, MutationTaster, and ClinPred) were used to classify variants as affecting splicing, as benign to deleterious, or as disease-causing. Results Patients presented with angioedema and urticaria, mainly on face/lips, but also with abdominal pain or laryngeal symptoms. Affected patients displayed low CPN activity-30% to 50% of median value in plasma. We identified 3 variants of the CPN1 gene encoding the catalytic 55-kDa subunit of CPN: c.533G>A, c.582A>G, and c.734C>T. CPN deficiency associated with genetic variants segregated with HAE-nC1-INH symptoms in affected family members. Conclusions CPN1 gene variants are associated with CPN deficiency and HAE-nC1-INH symptoms in 4 unrelated families. Genetic CPN deficiency may contribute to bradykinin and anaphylatoxin accumulation, with synergistic effects in angioedema and urticarial symptoms.
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Affiliation(s)
- Denis Vincent
- Allergy and Internal Medicine Unit, University Hospital, Nîmes, France
- Centre de compétence, Centre de Référence des Angioedèmes (CREAK), Nîmes
| | | | - Ludovic Martin
- Dermatology Department, University Hospital, Angers, France
- Centre de Référence des Maladies Rares de la peau et des muqueuses d’origine génétique-Nord (MAGEC), filière FIMARAD, CHU Angers, Angers, France
| | | | | | | | - Sascha Fischer
- Human Genomics Research Group, Department of Biomedicine, University of Basel, Basel, Switzerland
- Institute of Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland
| | - Sven Cichon
- Human Genomics Research Group, Department of Biomedicine, University of Basel, Basel, Switzerland
- Institute of Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland
| | - Anastasios E. Germenis
- Department of Immunology and Histocompatibility, University of Thessaly, Larissa, Greece
| | | | - Christian Drouet
- Université Grenoble Alpes, CHU Grenoble Alpes, Grenoble, France
- Institut Cochin, INSERM, CNRS, Université Paris Cité, 75679, Paris, France
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Dellabella A, May A, Sofio B. Angioedema Following Tenecteplase for Acute Ischemic Stroke. Stroke 2024. [PMID: 38660788 DOI: 10.1161/strokeaha.123.045508] [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: 04/26/2024]
Affiliation(s)
| | - Alyssa May
- Division of Pharmacy, Atrium Health Carolinas Medical Center, Charlotte, NC
| | - Britany Sofio
- Division of Pharmacy, Atrium Health Carolinas Medical Center, Charlotte, NC
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Werner R, Wöhrle JC. Orolingual Angioedema in Stroke Without r-tPA Treatment: Evidence for Insular and Opercular Contribution. Stroke 2024. [PMID: 38606554 DOI: 10.1161/strokeaha.124.046401] [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: 04/13/2024]
Affiliation(s)
- Ralph Werner
- Department of Neurology and Stroke Unit, Katholisches Klinikum Koblenz-Montabaur, Germany
| | - Johannes C Wöhrle
- Department of Neurology and Stroke Unit, Katholisches Klinikum Koblenz-Montabaur, Germany
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Mathey CM, Maj C, Eriksson N, Krebs K, Westmeier J, David FS, Koromina M, Scheer AB, Szabo N, Wedi B, Wieczorek D, Amann PM, Löffler H, Koch L, Schöffl C, Dickel H, Ganjuur N, Hornung T, Buhl T, Greve J, Wurpts G, Aygören-Pürsün E, Steffens M, Herms S, Heilmann-Heimbach S, Hoffmann P, Schmidt B, Mavarani L, Andresen T, Sørensen SB, Andersen V, Vogel U, Landén M, Bulik CM, Bygum A, Magnusson PKE, von Buchwald C, Hallberg P, Rye Ostrowski S, Sørensen E, Pedersen OB, Ullum H, Erikstrup C, Bundgaard H, Milani L, Rasmussen ER, Wadelius M, Ghouse J, Sachs B, Nöthen MM, Forstner AJ. Meta-analysis of ACE inhibitor-induced angioedema identifies novel risk locus. J Allergy Clin Immunol 2024; 153:1073-1082. [PMID: 38300190 DOI: 10.1016/j.jaci.2023.11.921] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 10/20/2023] [Accepted: 11/13/2023] [Indexed: 02/02/2024]
Abstract
BACKGROUND Angioedema is a rare but potentially life-threatening adverse drug reaction in patients receiving angiotensin-converting enzyme inhibitors (ACEis). Research suggests that susceptibility to ACEi-induced angioedema (ACEi-AE) involves both genetic and nongenetic risk factors. Genome- and exome-wide studies of ACEi-AE have identified the first genetic risk loci. However, understanding of the underlying pathophysiology remains limited. OBJECTIVE We sought to identify further genetic factors of ACEi-AE to eventually gain a deeper understanding of its pathophysiology. METHODS By combining data from 8 cohorts, a genome-wide association study meta-analysis was performed in more than 1000 European patients with ACEi-AE. Secondary bioinformatic analyses were conducted to fine-map associated loci, identify relevant genes and pathways, and assess the genetic overlap between ACEi-AE and other traits. Finally, an exploratory cross-ancestry analysis was performed to assess shared genetic factors in European and African-American patients with ACEi-AE. RESULTS Three genome-wide significant risk loci were identified. One of these, located on chromosome 20q11.22, has not been implicated previously in ACEi-AE. Integrative secondary analyses highlighted previously reported genes (BDKRB2 [bradykinin receptor B2] and F5 [coagulation factor 5]) as well as biologically plausible novel candidate genes (PROCR [protein C receptor] and EDEM2 [endoplasmic reticulum degradation enhancing alpha-mannosidase like protein 2]). Lead variants at the risk loci were found with similar effect sizes and directions in an African-American cohort. CONCLUSIONS The present results contributed to a deeper understanding of the pathophysiology of ACEi-AE by (1) providing further evidence for the involvement of bradykinin signaling and coagulation pathways and (2) suggesting, for the first time, the involvement of the fibrinolysis pathway in this adverse drug reaction. An exploratory cross-ancestry comparison implicated the relevance of the associated risk loci across diverse ancestries.
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Affiliation(s)
- Carina M Mathey
- Institute of Human Genetics, University of Bonn, School of Medicine and University Hospital Bonn, Bonn, Germany
| | - Carlo Maj
- Institute for Genomic Statistics and Bioinformatics, University Hospital Bonn, Bonn, Germany; Centre for Human Genetics, University of Marburg, Marburg, Germany
| | - Niclas Eriksson
- Uppsala Clinical Research Center, Uppsala, Sweden; Department of Medical Sciences, Clinical Pharmacogenomics and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Kristi Krebs
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Julia Westmeier
- Institute of Human Genetics, University of Bonn, School of Medicine and University Hospital Bonn, Bonn, Germany
| | - Friederike S David
- Institute of Human Genetics, University of Bonn, School of Medicine and University Hospital Bonn, Bonn, Germany
| | | | - Annika B Scheer
- Institute of Human Genetics, University of Bonn, School of Medicine and University Hospital Bonn, Bonn, Germany
| | - Nora Szabo
- Institute of Human Genetics, University of Bonn, School of Medicine and University Hospital Bonn, Bonn, Germany
| | - Bettina Wedi
- Department of Dermatology and Allergy, Comprehensive Allergy Center, Hannover Medical School, Hannover, Germany
| | - Dorothea Wieczorek
- Department of Dermatology and Allergy, Comprehensive Allergy Center, Hannover Medical School, Hannover, Germany
| | - Philipp M Amann
- Department of Medicine, Faculty of Medicine and Dentistry, Danube Private University, Krems, Austria
| | - Harald Löffler
- Department of Dermatology, SLK Hospital Heilbronn, Heilbronn, Germany
| | - Lukas Koch
- Department of Dermatology and Venereology, Medical University Graz, Graz, Austria
| | - Clemens Schöffl
- Department of Dermatology and Venereology, Medical University Graz, Graz, Austria
| | - Heinrich Dickel
- Department of Dermatology, Venereology and Allergology, St Josef Hospital, University Medical Center, Ruhr University Bochum, Bochum, Germany
| | - Nomun Ganjuur
- Department of Dermatology, Venereology and Allergology, St Josef Hospital, University Medical Center, Ruhr University Bochum, Bochum, Germany; Institute of Health Care Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thorsten Hornung
- Department of Dermatology and Allergy, University Hospital of Bonn, Bonn, Germany
| | - Timo Buhl
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany
| | - Jens Greve
- Department of Otorhinolaryngology-Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
| | - Gerda Wurpts
- Department of Dermatology and Allergy, Aachen Comprehensive Allergy Center, University Hospital RWTH Aachen, Aachen, Germany
| | - Emel Aygören-Pürsün
- Department for Children and Adolescents, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Michael Steffens
- Research Division, Federal Institute for Drugs and Medical Devices, Bonn, Germany
| | - Stefan Herms
- Institute of Human Genetics, University of Bonn, School of Medicine and University Hospital Bonn, Bonn, Germany
| | - Stefanie Heilmann-Heimbach
- Institute of Human Genetics, University of Bonn, School of Medicine and University Hospital Bonn, Bonn, Germany
| | - Per Hoffmann
- Institute of Human Genetics, University of Bonn, School of Medicine and University Hospital Bonn, Bonn, Germany
| | - Börge Schmidt
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
| | - Laven Mavarani
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
| | - Trine Andresen
- Molecular Diagnostics and Clinical Research Unit, Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Signe Bek Sørensen
- Molecular Diagnostics and Clinical Research Unit, Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Vibeke Andersen
- Molecular Diagnostics and Clinical Research Unit, Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark; Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark; OPEN, University of Southern Denmark, Odense, Denmark
| | - Ulla Vogel
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Mikael Landén
- Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Cynthia M Bulik
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC; Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Anette Bygum
- Department of Clinical Institute, University of Southern Denmark, Odense, Denmark; Department of Clinical Genetics, Odense University Hospital, Odense, Denmark
| | - Patrik K E Magnusson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Christian von Buchwald
- Department of Otorhinolaryngology-Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Pär Hallberg
- Department of Medical Sciences, Clinical Pharmacogenomics and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Sisse Rye Ostrowski
- Department of Clinical Immunology, Copenhagen Hospital Biobank Unit, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Erik Sørensen
- Department of Clinical Immunology, Copenhagen Hospital Biobank Unit, Rigshospitalet, Copenhagen, Denmark
| | - Ole B Pedersen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Christian Erikstrup
- Departments of Clinical Immunology, Aarhus University, Aarhus, Denmark; Departments of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Henning Bundgaard
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lili Milani
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Eva Rye Rasmussen
- Department of Otorhinolaryngology-Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Departments of Private Practice Ølsemaglevej, Køge, Denmark
| | - Mia Wadelius
- Department of Medical Sciences, Clinical Pharmacogenomics and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Jonas Ghouse
- Laboratory for Molecular Cardiology, Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Laboratory for Molecular Cardiology, Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Bernhardt Sachs
- Department of Dermatology and Allergy, Aachen Comprehensive Allergy Center, University Hospital RWTH Aachen, Aachen, Germany; Research Division, Federal Institute for Drugs and Medical Devices, Bonn, Germany
| | - Markus M Nöthen
- Institute of Human Genetics, University of Bonn, School of Medicine and University Hospital Bonn, Bonn, Germany
| | - Andreas J Forstner
- Institute of Human Genetics, University of Bonn, School of Medicine and University Hospital Bonn, Bonn, Germany; Institute of Neuroscience and Medicine (INM-1), Research Center Jülich, Jülich, Germany.
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Petersen RS, Fijen LM, Kelder JP, Cohn DM. Deucrictibant for angioedema due to acquired C1-inhibitor deficiency: A randomized-controlled trial. J Allergy Clin Immunol 2024:S0091-6749(24)00271-9. [PMID: 38494092 DOI: 10.1016/j.jaci.2024.03.007] [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: 10/11/2023] [Revised: 02/14/2024] [Accepted: 03/01/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Angioedema due to acquired C1-inhibitor deficiency is a very rare but serious disease, with an estimated prevalence of 1 per 500,000 persons. There are no approved therapies to treat or prevent angioedema swelling in patients with this condition. Deucrictibant is a specific, orally bioavailable, competitive antagonist of the bradykinin B2 receptor currently under investigation for hereditary angioedema. OBJECTIVE Our aim was to assess the efficacy and safety of deucrictibant as acute and prophylactic treatment for angioedema due to acquired C1-inhibitor deficiency. METHODS A 2-part, randomized, double-blind, placebo-controlled crossover study was conducted. In Part 1, 4 consecutive angioedema attacks were treated with 3 doses of deucrictibant (10 mg, 20 mg, and 30 mg) or placebo. In Part 2, deucricibant, 20 mg, or placebo was administered twice daily for 2 treatment periods of 8 weeks. RESULTS Three patients were enrolled; of those 3 patients, 1 completed both study parts and 2 completed only Part 2. In Part 1, a reduction in attack severity was observed in the 3 attacks treated with deucrictibant as opposed to an increase in severity of the attack treated with placebo. In Part 2, the individual mean monthly attack rates were 2.0, 0.6, and 1.0 during the placebo period and 0.0 across all patients during treatment with deucrictibant. There were no severe adverse events and 1 self-limiting treatment-emergent adverse event (abdominal pain). CONCLUSIONS Deucrictibant has the potential to effectively and safely treat and prevent angioedema attacks due to acquired C1-inhibitor deficiency.
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Affiliation(s)
- Remy S Petersen
- Amsterdam University Medical Center, Department of Vascular Medicine, Amsterdam, and Cardiovascular Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - Lauré M Fijen
- Amsterdam University Medical Center, Department of Vascular Medicine, Amsterdam, and Cardiovascular Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - Johannes P Kelder
- Amsterdam University Medical Center, Department of Vascular Medicine, Amsterdam, and Cardiovascular Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - Danny M Cohn
- Amsterdam University Medical Center, Department of Vascular Medicine, Amsterdam, and Cardiovascular Sciences, University of Amsterdam, Amsterdam, The Netherlands.
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Peter JG, Ntusi NAB, Ntsekhe M. Are Recommendations That Favor Other Agents Over Angiotensin-Converting Enzyme Inhibitors in Africans With Hypertension Justified? Circulation 2024; 149:804-806. [PMID: 38466787 DOI: 10.1161/circulationaha.123.065887] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Affiliation(s)
- Jonathan G Peter
- Division of Allergy and Clinical Immunology, Department of Medicine, University of Cape Town, South Africa (J.G.P.)
- Allergy and Immunology Unit, University of Cape Town Lung Institute, South Africa (J.G.P.)
| | - Ntobeko A B Ntusi
- Division of Cardiology, Department of Medicine, University of Cape Town, South Africa (N.A.B.N., M.N.)
| | - Mpiko Ntsekhe
- Division of Cardiology, Department of Medicine, University of Cape Town, South Africa (N.A.B.N., M.N.)
- South African Medical Research Council/University of Cape Town Extramural Research Unit on the Intersection of Noncommunicable Diseases and Infectious Diseases (N.A.B.N.)
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Tsutsui E, Gomez-Hernandez C, Nguyen D, Yang Y, Ma S. Recurrent Isolated Uvular Angioedema Associated With Intranasal Cocaine Use: A Case Report. Cureus 2024; 16:e56818. [PMID: 38654800 PMCID: PMC11036027 DOI: 10.7759/cureus.56818] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2024] [Indexed: 04/26/2024] Open
Abstract
Isolated uvular angioedema, or Quincke's disease, is a rare manifestation with various potential causes. This article presents the first documented case of recurrent isolated uvular angioedema associated with intranasal cocaine use. The patient, a 43-year-old man, exhibited acute symptoms of sore throat, throat swelling, and difficulty breathing, with a history of a similar episode a few years prior. Both episodes occurred following intranasal cocaine use. Examination revealed an enlarged uvula obstructing the airway. The patient was treated with epinephrine, antihistamines, and corticosteroids with resolution of the uvular edema. This case highlights the importance of considering cocaine as a potential causative agent in isolated uvular angioedema and emphasizes the need for patient education to avoid further cocaine use.
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Affiliation(s)
- Erika Tsutsui
- Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
| | | | - Destiny Nguyen
- Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Yuhong Yang
- Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Songhui Ma
- Allergy and Immunology, Icahn School of Medicine at Mount Sinai, New York, USA
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Heldin J, Malinovschi A, Hägg SA, Gíslason T, Benediktsdóttir B, Movérare R, Hallgren J, Molin M, Jogi R, Janson C. Urticaria and angioedema in Estonia, Iceland and Sweden. Clin Exp Allergy 2024; 54:228-230. [PMID: 38191145 DOI: 10.1111/cea.14449] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/12/2023] [Accepted: 12/27/2023] [Indexed: 01/10/2024]
Affiliation(s)
- Johanna Heldin
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Andrei Malinovschi
- Department of Medical Sciences, Clinical Physiology, Uppsala Universitet, Uppsala, Sweden
| | - Shadi Amid Hägg
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Thorarinn Gíslason
- The Medical Faculty, University of Iceland, Reykjavik, Iceland
- Department of Sleep, Landspitali University Hospital Reykjavik, Reykjavik, Iceland
| | - Bryndís Benediktsdóttir
- The Medical Faculty, University of Iceland, Reykjavik, Iceland
- Department of Sleep, Landspitali University Hospital Reykjavik, Reykjavik, Iceland
| | - Robert Movérare
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
- Thermo Fisher Scientific, Uppsala, Sweden
| | - Jenny Hallgren
- Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
| | - Magnus Molin
- Thermo Fisher Scientific, Uppsala, Sweden
- Readily Diagnostics, Uppsala, Sweden
| | - Rain Jogi
- Lung Clinic, Tartu University Hospital, Tartu, Estonia
| | - Christer Janson
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
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Demir S, Eyice‐Karabacak D, Kocatürk E, Ünal D, Toprak İD, Korkmaz P, Aslan AF, İmren IG, Dikicier B, Kahveci N, Öztop N, Kara RÖ, İşsever H, Maurer M, Weller K, Gelincik A. Monitoring recurrent angioedema: Findings from the Turkish angioedema control test validation study. Clin Transl Allergy 2024; 14:e12342. [PMID: 38415974 PMCID: PMC10900914 DOI: 10.1002/clt2.12342] [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: 11/15/2023] [Revised: 01/29/2024] [Accepted: 01/31/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Determination of control level in recurrent angioedema (RAE) is necessary to guide management. Here, we validated a Turkish version of the angioedema control test (AECT) for 4-week (AECT-4wk) and for 3-month (AECT-3mth) and assessed their utility in monitoring RAE. METHOD The recommended structured translation process for patient-reported outcome measures was completed. The final versions were administered to 51 patients with mast cell-mediated angioedema (MMAE) and 38 patients with hereditary angioedema, and the minimal clinically important difference (MCID) was determined. Additionally, anchor surveys comprising angioedema activity score for 28 days (AAS-28 day), visual analog score for angioedema control, Likert scale for the control level from the patient's perspective (LS-AEC), angioedema quality of life, short form-12 (SF-12) and patients' assessment of treatment sufficiency were applied. RESULTS The Turkish AECT versions showed good convergent validity with a substantial correlation with anchor tools and known-group validity. Excellent internal consistency and reproducibility were observed. Equal or more than 10 of 16 points scored with the AECT-4wk and AECT-3mth identified patients with well-controlled disease. The disease activity, control and burden parameters were consistent with the disease control level defined depending on the cut-off point 10 of AECT. Three-point changes in AECT-4wk and -3 mt could detect MCID in disease control in all patients. CONCLUSIONS Turkish AECT versions are valid and reliable tools for assessing and monitoring disease control in patients with RAE. The use of the Turkish versions of the AECT in routine patient care, clinical trials and angioedema research is recommended.
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Affiliation(s)
- Semra Demir
- Division of Immunology and Allergy DiseasesDepartment of Internal MedicineIstanbul Faculty of MedicineIstanbul UniversityIstanbulTurkey
| | - Deniz Eyice‐Karabacak
- Division of Immunology and Allergy DiseasesDepartment of Internal MedicineIstanbul Faculty of MedicineIstanbul UniversityIstanbulTurkey
| | - Emek Kocatürk
- Department of DermatologyKoç University Faculty of MedicineIstanbulTurkey
- Institute of AllergologyCharite‐UniversitatsmedizinCorporate Member of Freie Universitat Berlin and Humboldt‐Universitat zu BerlinBerlinGermany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and AllergologyBerlinGermany
| | - Derya Ünal
- Division of Immunology and Allergy DiseasesDepartment of Internal MedicineIstanbul Faculty of MedicineIstanbul UniversityIstanbulTurkey
| | - İlkim Deniz Toprak
- Division of Immunology and Allergy DiseasesDepartment of Internal MedicineIstanbul Faculty of MedicineIstanbul UniversityIstanbulTurkey
| | - Pelin Korkmaz
- Division of Immunology and Allergy DiseasesDepartment of Internal MedicineIstanbul Faculty of MedicineIstanbul UniversityIstanbulTurkey
| | - Ayşe Feyza Aslan
- Division of Immunology and Allergy DiseasesDepartment of Internal MedicineIstanbul Faculty of MedicineIstanbul UniversityIstanbulTurkey
| | - Işıl Göğem İmren
- Division of Immunology and Allergy DiseasesDepartment of Internal MedicineIstanbul Faculty of MedicineIstanbul UniversityIstanbulTurkey
| | - Bahar Dikicier
- Faculty of MedicineDepartment of DermatologySakarya UniversitySakaryaTurkey
| | - Nevzat Kahveci
- Division of Immunology and Allergy DiseasesDepartment of Internal MedicineIstanbul Faculty of MedicineIstanbul UniversityIstanbulTurkey
| | - Nida Öztop
- Adult Allergy and Immunology ClinicBaşakşehir Pine and Sakura City HospitalIstanbulTurkey
| | - Rabia Öztaş Kara
- Faculty of MedicineDepartment of DermatologySakarya UniversitySakaryaTurkey
| | - Halim İşsever
- Istanbul Faculty of MedicineDepartment of Public HealthIstanbul UniversityIstanbulTurkey
| | - Marcus Maurer
- Institute of AllergologyCharite‐UniversitatsmedizinCorporate Member of Freie Universitat Berlin and Humboldt‐Universitat zu BerlinBerlinGermany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and AllergologyBerlinGermany
| | - Karsten Weller
- Institute of AllergologyCharite‐UniversitatsmedizinCorporate Member of Freie Universitat Berlin and Humboldt‐Universitat zu BerlinBerlinGermany
| | - Aslı Gelincik
- Division of Immunology and Allergy DiseasesDepartment of Internal MedicineIstanbul Faculty of MedicineIstanbul UniversityIstanbulTurkey
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12
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Allihien SM, Ibrahim S, Chaparala S, Singireddy S, Kesiena O. A Case of Trauma-Related Angioedema of the Airway in a Patient on an Angiotensin Receptor Blocker. Am J Case Rep 2024; 25:e943407. [PMID: 38414232 PMCID: PMC10914075 DOI: 10.12659/ajcr.943407] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 02/08/2024] [Accepted: 01/31/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND Angioedema is non-pitting edema that occurs in the deep layers of the skin and subcutaneous tissue due to vascular leakage of plasma resulting from 1 of 2 major pathophysiological processes: mast cell-mediated angioedema and bradykinin-mediated angioedema. While it is a well-recognized adverse reaction of angiotensin-converting enzyme inhibitors, the association of angioedema with angiotensin receptor blockers is relatively less studied. Direct local trauma, although rarely, has been suggested to induce angioedema under certain conditions. We present a unique case of direct, local, trauma-related angioedema in a patient on an angiotensin receptor blocker. CASE REPORT The patient, an 83-year-old woman on telmisartan for hypertension, hit her neck against the edge of a chair during a fall. Shortly thereafter, she developed progressive airway compromise due to airway angioedema, as noted on direct laryngoscopy. A contrast CT scan of the neck also noted edema of the periglottic and supraglottic regions. She required intravenous corticosteroid administration and intubation in the emergency room and was successfully extubated 3 days after admission. She had no prior history of angioedema or allergy. We hypothesize that increased levels of circulatory bradykinin in the setting of telmisartan, combined with a local release of bradykinin from trauma, was the main pathophysiologic cause of the angioedema. CONCLUSIONS This case report highlights the rare and often forgotten adverse reaction of angioedema with use of angiotensin receptor blockers and confirms the finding of local trauma as a possible trigger.
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Myoken Y, Sasaki R, Kawamoto T, Fujita Y, Myoken Y. Orolabial angioedema as a rare complication of dental resin cement. Int J Dermatol 2024. [PMID: 38402534 DOI: 10.1111/ijd.17096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 01/15/2024] [Accepted: 02/05/2024] [Indexed: 02/26/2024]
Affiliation(s)
- Yoshinari Myoken
- Department of Oral Surgery, Hiroshima Red Cross & Atomic-Bomb Survivors Hospital, Hiroshima, Japan
| | - Ryou Sasaki
- Department of Dermatology, Hiroshima Red Cross & Atomic-Bomb Survivors Hospital, Hiroshima, Japan
| | | | - Yoshinori Fujita
- Department of Oral Surgery, Hiroshima Red Cross & Atomic-Bomb Survivors Hospital, Hiroshima, Japan
| | - Yoshiko Myoken
- Department of Oral Surgery, Hiroshima Red Cross & Atomic-Bomb Survivors Hospital, Hiroshima, Japan
- Private Practice Myoken Dental Clinic, Hiroshima, Japan
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Ghebrehiwet B, Joseph K, Kaplan AP. The bradykinin-forming cascade in anaphylaxis and ACE-inhibitor induced angioedema/airway obstruction. Front Allergy 2024; 5:1302605. [PMID: 38332896 PMCID: PMC10850323 DOI: 10.3389/falgy.2024.1302605] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 01/15/2024] [Indexed: 02/10/2024] Open
Abstract
Anaphylaxis is a potentially life-threatening multi-system allergic reaction to a biological trigger resulting in the release of potent inflammatory mediators from mast cells and basophils and causing symptoms in at least two organ systems that generally include skin, lungs, heart, or gastrointestinal tract in any combination. One exception is profound hypotension as an isolated symptom. There are two types of triggers of anaphylaxis: immunologic and non-Immunologic. Immunologic anaphylaxis is initiated when a foreign antigen directly binds to IgE expressed on mast cells or basophils and induces the release of histamine and other inflammatory substances resulting in vasodilation, vascular leakage, decreased peripheral vascular resistance, and heart muscle depression. If left untreated, death by shock (profound hypotension) or asphyxiation (airway obstruction) can occur. The non-immunologic pathway, on the other hand, can be initiated in many ways. A foreign substance can directly bind to receptors of mast cells and basophils leading to degranulation. There can be immune complex activation of the classical complement cascade with the release of anaphylatoxins C3a and C5a with subsequent recruitment of mast cells and basophils. Finally, hyperosmolar contrast agents can cause blood cell lysis, enzyme release, and complement activation, resulting in anaphylactoid (anaphylactic-like) symptoms. In this report we emphasize the recruitment of the bradykinin-forming cascade in mast cell dependent anaphylactic reactions as a potential mediator of severe hypotension, or airway compromise (asthma, laryngeal edema). We also consider airway obstruction due to inhibition of angiotensin converting enzyme with a diminished rate of endogenous bradykinin metabolism, leading not only to laryngeal edema, but massive tongue swelling with aspiration of secretions.
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Affiliation(s)
- Berhane Ghebrehiwet
- Division of Rheumatology, Allergy, and Clinical Immunology, SUNY-Stony Brook, Stony Brook, NY, United States
| | | | - Allen P. Kaplan
- Division of Pulmonary and Critical Care Medicine, The Medical University of South Carolina, Charleston, SC, United States
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15
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Zajac M, Bozek A, Grzanka A. The Occurrence of Atopy in Patients with Isolated Spontaneous Mast Cell (or Nonallergic) Angioedema. J Clin Med 2024; 13:477. [PMID: 38256611 PMCID: PMC10815980 DOI: 10.3390/jcm13020477] [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: 12/12/2023] [Revised: 01/10/2024] [Accepted: 01/13/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Isolated mast cell angioedema (MC-AE) can be divided into allergic and nonallergic (spontaneous) forms. The former is often associated with food, Hymenoptera venoms or drug allergies. This study aimed to evaluate the relationship between the occurrence of atopic diseases and the risk of angioedema. METHODS A retrospective study analyzed 304 patients with confirmed MC-AE and 1066 controls. All were analyzed for allergic asthma (AA), atopic dermatitis (AD) and allergic rhinitis (AR) based on ICD-10 codes. In addition, total IgE and peripheral eosinophilia were calculated. RESULTS The analyzed atopic diseases were more frequent in the group of patients diagnosed with MC-AE than in the controls: 78 (25.7%) vs. 173 (16.2%) for p < 0.01. Patients diagnosed with AD had a higher risk of MC-AE (hazard ratio (HR) = 1.48,) similar to those diagnosed with AR (HR = 1.51). However, in patients with two or three atopic comorbidities, the risk increased significantly to HR = 2.45 or HR = 4.1, respectively. There was a positive correlation between the serum total IgE concentration or eosinophilia and the risk of angioedema (p < 0.01). CONCLUSION Patients with MC-AE had a more frequent occurrence of atopic diseases associated with inhalant allergies. This risk increased in patients with IgE-mediated polymorphic disease.
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Affiliation(s)
| | - Andrzej Bozek
- Clinical Department of Internal Diseases, Dermatology and Allergology, Medical University of Silesia, 40-055 Katowice, Poland; (M.Z.); (A.G.)
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Beaini H, Bjorkman C, Johnson K, Araj FG. Sirolimus potentiated angioedema: A case report and review of the literature. Open Med (Wars) 2024; 19:20230884. [PMID: 38205154 PMCID: PMC10775924 DOI: 10.1515/med-2023-0884] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/11/2023] [Accepted: 12/12/2023] [Indexed: 01/12/2024] Open
Abstract
Introduction In the realm of organ transplantation, particularly heart transplantation, angioedema presents a significant challenge. This clinical condition ranges from minor facial edema to life-threatening swelling of vital structures. Its multifactorial etiology involves various factors and mechanisms, including C1 esterase inhibitor deficiency, food allergen hypersensitivity, and adverse drug reactions, notably involving angiotensin-converting enzyme (ACE) inhibitors and mechanistic target of rapamycin inhibitors (mTOR-Is). We present a rare case of sirolimus potentiated angioedema in a patient with long-standing ACE inhibitor therapy. Case A 52-year-old male with a history of heart transplant developed severe upper and lower lip edema. The patient had been on Lisinopril without any adverse events. However, sirolimus was recently added to his drug regimen. Sirolimus potentiated angioedema was suspected. Intervention Intravenous methylprednisolone, famotidine, and diphenhydramine were initiated, and both lisinopril and sirolimus were discontinued. The patient showed improvement and was discharged with oral antihistamines. Lessons Transplant physicians should be aware of the life-threatening interaction between ACE inhibitors and mTOR-Is like sirolimus. Consideration should be given to switching from an ACE inhibitor to an angiotensin-receptor blocker when initiating patients on mTOR-Is.
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Affiliation(s)
- Hadi Beaini
- Division of Cardiology, Department of Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, United States
| | - Carol Bjorkman
- Division of Cardiology, Department of Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, United States
| | - Kelly Johnson
- Division of Cardiology, Department of Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, United States
| | - Faris G. Araj
- Division of Cardiology, Department of Internal Medicine, The University of Texas Southwestern Medical Center, Professional Office Bldg. 2 Suite 600, 5939 Harry Hines Blvd.Dallas, TX, 75390-9252, United States
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17
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Sychev IV, Denisenko NP, Kachanova AA, Lapshtaeva AV, Abdullaev SP, Goncharova LN, Mirzaev KB, Sychev DA. Pharmacogenetic markers of development of angioneurotic edema as a secondary side effect to enalapril in patients with essential arterial hypertension. Int J Risk Saf Med 2024; 35:37-47. [PMID: 37742663 DOI: 10.3233/jrs-230006] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
BACKGROUND Angioneurotic edema is the most dangerous complication in angiotensin-converting enzyme inhibitors (ACEIs) therapy. Based on the current data, the clinical and genetic predictors of angioedema development are still understudied, which demonstrates the relevance of this study. OBJECTIVE To reveal the pharmacogenetic predictors of the angioedema as a secondary side effect to enalapril in patients with essential arterial hypertension. METHODS The study enrolled 111 subjects randomized into two groups: study group, patients with the angioedema as a secondary side effect to enalapril; and control group, patients without adverse drug reaction. All patients underwent pharmacogenetic testing. RESULTS An association between the development of the angioneurotic edema and the genotypes AA rs2306283 of gene SLCO1B1, TT rs4459610 of gene ACE, and CC rs1799722 of gene BDKRB2 in patients was revealed. CONCLUSION The findings justify further investigations of the revealed genetic predictors of angioedema with larger-size patient populations.
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Affiliation(s)
- Ivan V Sychev
- Department of Faculty Therapy, Ogarev Mordovia State University, Saransk, Russian Federation
| | - Natalia P Denisenko
- Research Institute of Molecular and Personalized Medicine, Department of Clinical Pharmacology and Therapy named after Academician B.E. Votchal, Russian Medical Academy of Continuous Professional Education, Moscow, Russian Federation
| | - Anastasiya A Kachanova
- Predictive and Prognostic Biomarkers Department, Russian Medical Academy of Continuous Professional Education, Moscow, Russian Federation
| | - Anna V Lapshtaeva
- Department of Immunology, Microbiology and Virology, Ogarev Mordovia State University, Saransk, Russian Federation
| | - Sherzod P Abdullaev
- Research Institute of Molecular and Personalized Medicine, Russian Medical Academy of Continuous Professional Education, Moscow, Russian Federation
| | - Ludmila N Goncharova
- Department of Faculty Therapy, Ogarev Mordovia State University, Saransk, Russian Federation
| | - Karin B Mirzaev
- Research Institute of Molecular and Personalized Medicine, Russian Medical Academy of Continuous Professional Education, Moscow, Russian Federation
| | - Dmitry A Sychev
- Clinical Pharmacology and Therapy Department named after Academician B.E. Votchal, Russian Medical Academy of Continuous Professional Education, Moscow, Russian Federation
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Bernstein JA, Maurer M, Saini SS. BTK signaling-a crucial link in the pathophysiology of chronic spontaneous urticaria. J Allergy Clin Immunol 2023:S0091-6749(23)02460-0. [PMID: 38141832 DOI: 10.1016/j.jaci.2023.12.008] [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: 08/02/2023] [Revised: 12/18/2023] [Accepted: 12/18/2023] [Indexed: 12/25/2023]
Abstract
Chronic spontaneous urticaria (CSU) is an inflammatory skin disorder that manifests with itchy wheals, angioedema, or both for more than 6 weeks. Mast cells and basophils are the key pathogenic drivers of CSU; their activation results in histamine and cytokine release with subsequent dermal inflammation. Two overlapping mechanisms of mast cell and basophil activation have been proposed in CSU: type I autoimmunity, also called autoallergy, which is mediated via IgE against various autoallergens, and type IIb autoimmunity, which is mediated predominantly via IgG directed against the IgE receptor FcεRI or FcεRI-bound IgE. Both mechanisms involve cross-linking of FcεRI and activation of downstream signaling pathways, and they may co-occur in the same patient. In addition, B-cell receptor signaling has been postulated to play a key role in CSU by generating autoreactive B cells and autoantibody production. A cornerstone of FcεRI and B-cell receptor signaling is Bruton tyrosine kinase (BTK), making BTK inhibition a clear therapeutic target in CSU. The potential application of early-generation BTK inhibitors, including ibrutinib, in allergic and autoimmune diseases is limited owing to their unfavorable benefit-risk profile. However, novel BTK inhibitors with improved selectivity and safety profiles have been developed and are under clinical investigation in autoimmune diseases, including CSU. In phase 2 trials, the BTK inhibitors remibrutinib and fenebrutinib have demonstrated rapid and sustained improvements in CSU disease activity. With phase 3 studies of remibrutinib ongoing, it is hoped that BTK inhibitors will present an effective, well-tolerated option for patients with antihistamine-refractory CSU, a phenotype that presents a considerable clinical challenge.
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Affiliation(s)
- Jonathan A Bernstein
- Department of Internal Medicine, Allergy and Immunology Section, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Marcus Maurer
- Institute of Allergology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - Sarbjit S Saini
- Johns Hopkins Asthma and Allergy Center, Division of Allergy and Clinical Immunology, The Johns Hopkins University School of Medicine, Baltimore, Md.
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Li PH, Au EYL, Cheong SL, Chung L, Fan KI, Ho MHK, Leung ASY, Chung MMH, Wong JCY, Coelho R. Hong Kong-Macau Severe Hives and Angioedema Referral Pathway. Front Allergy 2023; 4:1290021. [PMID: 38125294 PMCID: PMC10731021 DOI: 10.3389/falgy.2023.1290021] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 11/20/2023] [Indexed: 12/23/2023] Open
Abstract
Background Urticaria (defined as the presence of hives, angioedema, or both) can be caused by a variety of etiologies ranging from more common conditions such as chronic spontaneous urticaria (CSU) to rarer conditions such as hereditary angioedema (HAE). Specialist referral may be necessary in cases of severe urticaria or HAE, but access to specialist services remains limited in certain regions, such as the Greater Bay Area (GBA) of China. To address this, the Hong Kong-Macau Severe Hives and Angioedema Referral Pathway (SHARP) was initiated by the Hong Kong Institute of Allergy and Macau Society of Dermatology to promote multidisciplinary collaboration and regional exchange of expertise in the diagnosis and management of severe urticaria. Methods A nominated task force of dermatologists and immunologists who manage patients with severe urticaria formulated the consensus statements (CS) using the Delphi method. The consensus was defined a priori as an agreement of ≥80%. Results A total of 24 CS were formulated, including four statements on classifications and definitions, seven statements on diagnosis, and 13 statements on management and referral. The definitions for acute/chronic urticaria and severe CSU were stated. Unnecessary investigations and inappropriate medications were discouraged. The characteristics and recommended approach to suspected bradykinergic angioedema were specified. Stepwise treatment options using second-generation antihistamines, omalizumab, or cyclosporin for patients with CSU were addressed, and the importance of access to HAE-specific medications was emphasized. Furthermore, an integrated referral pathway for patients with severe hives and angioedema was constructed. Conclusion The SHARP provides guidance for the management and specialist referral of patients with severe hives and angioedema in Hong Kong and Macau.
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Affiliation(s)
- Philip H. Li
- Division of Rheumatology and Clinical Immunology, Department of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Elaine Y. L. Au
- Division of Clinical Immunology, Department of Pathology, Queen Mary Hospital, Hong Kong, Hong Kong SAR, China
| | - Si-Leong Cheong
- Department of Dermatology, Centro Hospitalar Conde de São Januário, Macau, Macao SAR, China
| | - Ling Chung
- Department of Dermatology, Centro Hospitalar Conde de São Januário, Macau, Macao SAR, China
| | - Ka I. Fan
- Department of Dermatology, Centro Hospitalar Conde de São Januário, Macau, Macao SAR, China
| | - Marco H. K. Ho
- Lee Tak Hong Allergy Centre, Hong Kong Sanatorium & Hospital, Hong Kong, Hong Kong SAR, China
| | - Agnes S. Y. Leung
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Martin M. H. Chung
- Division of Dermatology, Department of Medicine, Queen Mary Hospital, Hong Kong, Hong Kong SAR, China
| | - Jane C. Y. Wong
- Division of Rheumatology and Clinical Immunology, Department of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Ricardo Coelho
- Department of Dermatology, Centro Hospitalar Conde de São Januário, Macau, Macao SAR, China
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20
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Naik H, O'Connor MY, Sanderson SC, Pinnell N, Dong M, Wiegand A, Obeng AO, Abul-Husn NS, Scott SA. Pharmacogenomic knowledge and awareness among diverse patients treated with angiotensin converting enzyme inhibitors. Pharmacogenomics 2023; 24:921-930. [PMID: 38054855 PMCID: PMC10794943 DOI: 10.2217/pgs-2023-0191] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 11/10/2023] [Indexed: 12/07/2023] Open
Abstract
We developed novel electronic phenotyping algorithms for the BioMe biobank data, which accurately identified angiotensin converting enzyme inhibitor (ACEi)-induced angioedema cases and controls. A survey was mailed to all 1075 patients and 91 were returned. Over a third reported that prescribing physicians had not discussed with them the concepts of interindividual drug response variability or adverse event risk, and 73% of patients were previously unaware of pharmacogenomics; however, most patients were interested in having pharmacogenomic testing. Moreover, 67% of patients indicated that pharmacogenomic testing would positively influence their medication compliance. In addition to identifying an innovative approach to define biobank cohorts for pharmacogenomic studies, these results indicate that patients are interested in pharmacogenomic testing, which could translate to improved adherence.
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Affiliation(s)
- Hetanshi Naik
- Department of Genetics & Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Michelle Y O'Connor
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Saskia C Sanderson
- Department of Genetics & Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Nancy Pinnell
- Department of Genetics & Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Mingshu Dong
- Department of Genetics & Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Amy Wiegand
- Department of Genetics & Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Aniwaa Owusu Obeng
- Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Pharmacy Department, Mount Sinai Health System, New York, NY 10029, USA
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Noura S Abul-Husn
- Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Stuart A Scott
- Department of Genetics & Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
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21
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Adamu M, Saka F. Atypical Myasthenia gravis in an older person resulting in delayed diagnosis: a case report. Age Ageing 2023; 52:afad230. [PMID: 38156973 DOI: 10.1093/ageing/afad230] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 09/11/2023] [Indexed: 01/03/2024] Open
Abstract
Myasthenia gravis (MG) is a rare autoimmune neuromuscular disorder characterised by varying degrees of skeletal muscle weakness. Diagnosing MG represents a challenge for clinicians due to the diversity of disease manifestations. We present an unusual case of this disease in an older gentleman in which the patient reported swollen tongue and lips which was incorrectly diagnosed and treated as angioedema. Months later, he developed progressive dysphagia, dysarthria and weight loss. The diagnosis was further delayed by the identification of a hiatal hernia and Zenker's diverticulum after extensive investigation for dysphagia. A total of 15 months on prompted by persistent symptoms, the patient was found to have MG by positive antibody test and Electromyogram. Treatment was initiated which led to a rapid and significant relief of his symptoms.
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Affiliation(s)
- Maimuna Adamu
- Department of Medicine, Peterborough City Hospital, Northwest Anglia NHS Foundation Trust, Peterborough, Cambridgeshire, UK
| | - Felix Saka
- Medicine for Older People, Peterborough City Hospital, Northwest Anglia NHS Foundation Trust, Peterborough, Cambridgeshire, UK
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22
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Escobar JJ, Aguirre J, Ibáñez S, Cid BJ, Campillay R, Gallardo AM, Grau M, Hoyos-Bachiloglu R. Universal Access to On-Demand Treatment of Patients with Hereditary Angioedema, the Chilean Experience. Pediatr Allergy Immunol Pulmonol 2023; 36:130-132. [PMID: 37917067 DOI: 10.1089/ped.2023.0083] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
Background: In Chile, patients with hereditary angioedema (HAE) type I and type II are protected under Ley Ricarte Soto (LRS), which guarantees access to on demand plasma-derived C1-INH (pdC1-INH) since 2018. We aimed to analyze the first 3 years of LRS. Methods: Review of the LRS database between 2018 and 2021. Results: During the study period, 154 patients were covered by LRS, with an estimated prevalence of HAE in Chile at 0.8:100,000 inhabitants. A delay in diagnosis of 22 years was noted, 50 patients received epinephrine during an attack before the diagnosis of HAE. Mean number of attacks per year was 8, with 50% of adults and 42% of children experiencing more than 1 attack per month. Conclusion: Disease awareness must improve to reduce the diagnostic delay of HAE. Long-term prophylactic medications should be included in LRS to treat patients with high attack rates and control the costs of frequent on-demand treatment with pdC1-INH.
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Affiliation(s)
- Juan J Escobar
- Department of Pediatrics, Pontificia Universidad Católica de Chile, Santiago, Chile
- School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Joaquín Aguirre
- School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Samuel Ibáñez
- School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Rolando Campillay
- Complejo Asistencial Barros Luco, Santiago, Chile
- Clínica Alemana de Santiago, Santiago, Chile
| | | | - Masumi Grau
- Clínica Alemana de Santiago, Santiago, Chile
- Department of Rheumatology, Hospital San Juan de Dios, Santiago, Chile
| | - Rodrigo Hoyos-Bachiloglu
- Department of Pediatric Infectious Diseases and Immunology, Pontificia Universidad Católica de Chile, Santiago, Chile
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23
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Du XL, Martinez J, Yamal JM, Simpson LM, Davis BR. The 18-year risk of cancer, angioedema, insomnia, depression, and erectile dysfunction in association with antihypertensive drugs: post-trial analyses from ALLHAT-Medicare linked data. Front Cardiovasc Med 2023; 10:1272385. [PMID: 38045916 PMCID: PMC10691487 DOI: 10.3389/fcvm.2023.1272385] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 10/31/2023] [Indexed: 12/05/2023] Open
Abstract
Purpose This study aimed to determine the 18-year risk of cancer, angioedema, insomnia, depression, and erectile dysfunction in association with antihypertensive drug use. Methods This is a post-trial passive follow-up study of Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) participants between 1994 and 1998 that was conducted by linking their follow-up data with Medicare claims data until 2017 of subjects who were free of outcomes at baseline on 1 January 1999. The main outcomes were the occurrence of cancer (among n = 17,332), angioedema (among n = 17,340), insomnia (among n = 17,340), depression (among n = 17,330), and erectile dysfunction (among n = 7,444 men) over 18 years of follow-up. Results The 18-year cumulative incidence rate of cancer other than non-melanoma skin cancer from Medicare inpatient claims was 23.9% for chlorthalidone, 23.4% for amlodipine, and 25.3% for lisinopril. There were no statistically significant differences in the 18-year risk of cancer, depression, and erectile dysfunction among the three drugs based on the adjusted hazard ratios. The adjusted 18-year risk of angioedema was elevated in those receiving lisinopril than in those receiving amlodipine (hazard ratio: 1.63, 95% CI: 1.14-2.33) or in those receiving chlorthalidone (1.33, 1.00-1.79), whereas the adjusted 18-year risk of insomnia was statistically significantly decreased in those receiving lisinopril than in those receiving amlodipine (0.90, 0.81-1.00). Conclusions The 18-year risk of angioedema was significantly higher in patients receiving lisinopril than in those receiving amlodipine or chlorthalidone; the risk of insomnia was significantly lower in patients receiving lisinopril than in those receiving amlodipine; and the risk of cancer, depression, and erectile dysfunction (in men) was not statistically significantly different among the three drug groups.
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Affiliation(s)
- Xianglin L. Du
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Journey Martinez
- Department of Biostatistics and Data Science, Coordinating Center for Clinical Trials, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Jose-Miguel Yamal
- Department of Biostatistics and Data Science, Coordinating Center for Clinical Trials, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Lara M. Simpson
- Department of Biostatistics and Data Science, Coordinating Center for Clinical Trials, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Barry R. Davis
- Department of Biostatistics and Data Science, Coordinating Center for Clinical Trials, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, United States
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24
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Al Hasan D, Al Hasan S. The epidemiology of food allergy in primary care clinic: A cross-sectional study. Medicine (Baltimore) 2023; 102:e35641. [PMID: 37986319 PMCID: PMC10659696 DOI: 10.1097/md.0000000000035641] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 09/04/2023] [Accepted: 09/22/2023] [Indexed: 11/22/2023] Open
Abstract
Food allergy (FA) is an increasing global public health concern. Little is known about FA counsel in primary care clinics. The objective of this study is to describe the characteristics of FA in primary care clinics. It also aims to report the national primary care physicians' current knowledge and practices. An electronic cross-sectional questionnaire was distributed to primary care physicians working at the Ministry of Health primary care clinics, across Kuwait's' 6 health districts, between May and June 2023. The questionnaire was made of 3 sections: participants' demographic, FA counsel characteristics, participants' knowledge and practices during FA counsel, and 37 variable tools. Eight-seven percent of primary care physicians counseled a patient with FA within the last 12 months. Most FA patients were children and infants. Approximately 2 out of 10 primary physicians counseled > 1 FA case/week. Prevalence of clinical presentation was: angioedema (23%), many skin hives (21%), few skin hives (19%), and mouth itch (9.4%). Prevalence of allergens was; peanuts (46%), shellfish (37%), eggs (36%), and tree nuts (36%), respectively. The mean of primary care physicians' correct answers about FA was 58% and only 26% of primary care physicians acquired a sufficient amount of knowledge about FA, scoring above 67%. Their Knowledge scores about FA: clinical presentation 7 ± 1.6, diagnostic tests 2 ± 1, treatment 2.6 ± 1, and prevention 3 ± 1. In practice, correct treatment was offered by 30% of physicians, and 55% made the right referrals 86% are longing for training about FA. FA is a common counsel in primary care clinics. The most common FA presentation is a severe allergic reaction in the pediatric population. The current primary care physicians have insufficient knowledge about counseling FA and long for further training. Collectively, protocols and training for FA counseling should be launched in primary care.
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Affiliation(s)
| | - Sara Al Hasan
- Al-Adan Specialty Clinic, Ministry of Health, Shwaikh, State of Kuwait
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25
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Corazza M, Monti A, Schettini N, Pacetti L, Borghi A. Angioedema-like contact dermatitis due to methylisothiazolinone in a mouthwash. Contact Dermatitis 2023; 89:384-385. [PMID: 37538007 DOI: 10.1111/cod.14392] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 07/25/2023] [Indexed: 08/05/2023]
Affiliation(s)
- Monica Corazza
- Section of Dermatology and Infectious Diseases, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Alberto Monti
- Section of Dermatology and Infectious Diseases, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Natale Schettini
- Section of Dermatology and Infectious Diseases, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Lucrezia Pacetti
- Section of Dermatology and Infectious Diseases, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Alessandro Borghi
- Section of Dermatology and Infectious Diseases, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
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26
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Avila PC. Patient-reported outcome measures for urticaria and angioedema. J Allergy Clin Immunol 2023; 152:1090-1091. [PMID: 37660988 DOI: 10.1016/j.jaci.2023.08.020] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 08/24/2023] [Indexed: 09/05/2023]
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27
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Cesarz T, Ganti L. Kounis syndrome: ST elevations in the setting of anaphylaxis. J Allergy Clin Immunol Glob 2023; 2:100152. [PMID: 37781662 PMCID: PMC10509885 DOI: 10.1016/j.jacig.2023.100152] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 04/27/2023] [Accepted: 05/08/2023] [Indexed: 10/03/2023]
Abstract
Acute coronary syndrome in the presence of an allergic reaction is known as Kounis syndrome, which is an underdiagnosed disorder and has nuances regarding management. We present a patient brought to the hospital as an ST segment elevation myocardial infarction (STEMI) alert in the setting of an allergic reaction triggered by food.
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Affiliation(s)
- Taylor Cesarz
- University of Central Florida College of Medicine, Orlando, Fla
| | - Latha Ganti
- University of Central Florida College of Medicine, Orlando, Fla
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28
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Rosa A, Franco R, Miranda M, Casella S, D’Amico C, Fiorillo L, Cervino G. The role of anxiety in patients with hereditary angioedema during oral treatment: a narrative review. Front Oral Health 2023; 4:1257703. [PMID: 37927822 PMCID: PMC10620504 DOI: 10.3389/froh.2023.1257703] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 10/09/2023] [Indexed: 11/07/2023] Open
Abstract
Objective The present study investigated the clinical potential of managing anxiety during dental procedures to reduce acute attacks in patients with hereditary angioedema (HAE). HAE is a rare disease, little known to physicians and dentists, but with an increased hospitalization rate over the years. HAE is due to a deficiency/dysfunction of the C1 esterase inhibitor, leading to increased vascular permeability. Recommendations for HAE management include long-term and short-term prophylaxis and treatment of acute attacks, but the importance of anxiety control is underestimated. Materials and methods The authors reviewed the literature to provide the scientific community with an overview of possible protocols for managing anxiety in dental practice and their effectiveness. Management can be used in prosthetics, periodontal and implant surgery, endodontics, and oral surgery. Discussions Our analysis shows that although there are few articles in the indexed literature, protocols for managing anxiety in HAE patients in dentistry will become increasingly prevalent in the daily clinical practice of dentists due to its benefits. Conclusions The benefits and better control of intraoperative complications and risks may lead clinicians to use sedation, assessment, or anxiety control techniques in daily clinical practice to reduce such attacks. Clinical relevance: This study suggests that controlling and managing anxiety can help prevent and reduce acute angioedema attacks.
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Affiliation(s)
- Alessio Rosa
- Materials for Health, Environment and Energy, Department of Chemical Science and Technologies, Dentistry, University of Tor Vergata, Rome, Italy
| | - Rocco Franco
- Department of Life, Health and Environment Sciences, University of L’Aquila, L’Aquila, Italy
| | - Michele Miranda
- Department of Clinical Sciences and Translational Medicine, University of Rome “Tor Vergata”, Rome, Italy
| | - Sergio Casella
- Department of Clinical Sciences and Translational Medicine, University of Rome “Tor Vergata”, Rome, Italy
| | - Cesare D’Amico
- Department of Biomedical and Dental Sciences, Morphological and Functional Images, University of Messina, Messina, Italy
| | - Luca Fiorillo
- Department of Biomedical and Dental Sciences, Morphological and Functional Images, University of Messina, Messina, Italy
- Department of Public Health Dentistry, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Pimpri, Pune, India
- Multidisciplinary Department of Medical-Surgical and Odontostomatological Specialties, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Gabriele Cervino
- Department of Biomedical and Dental Sciences, Morphological and Functional Images, University of Messina, Messina, Italy
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29
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Aksakal S. Isolated angioedema due to face mask and other cases of isolated angioedema. Postgrad Med J 2023; 99:1167-1172. [PMID: 37474797 DOI: 10.1093/postmj/qgad057] [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: 05/31/2023] [Revised: 06/17/2023] [Accepted: 06/22/2023] [Indexed: 07/22/2023]
Abstract
Isolated angioedema can be divided into two groups as mast cell-mediated angioedema and bradykinin-mediated angioedema according to the known mechanisms of occurrence. However, angioedema can also occur with mechanisms whose cause is unknown. Treatment varies according to the mechanism of angioedema formation. In this prospective study, we present the causes of 80 isolated angioedema cases admitted to our clinic during the pandemic period. We would like to emphasize the causes that we found in our cases but which are rare in the literature. For example: angioedema due to allergy to nickel in the mask used during the pandemic period, T cell-mediated angioedema, alpha adrenergic receptor blocker use, and patients diagnosed with collagen tissue disease presenting with angioedema as the first clinical finding.
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Affiliation(s)
- Sengul Aksakal
- Department of Immunology and Allergy, Samsun Training and Research Hospital, Samsun, 55090, Turkey
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30
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Lima H, Zheng J, Wong D, Waserman S, Sussman GL. Pathophysiology of bradykinin and histamine mediated angioedema. Front Allergy 2023; 4:1263432. [PMID: 37920409 PMCID: PMC10619149 DOI: 10.3389/falgy.2023.1263432] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 09/26/2023] [Indexed: 11/04/2023] Open
Abstract
Angioedema is characterized by swelling localized to the subcutaneous and submucosal tissues. This review provides an overview of angioedema, including the different types, triggers, and underlying pathophysiologic mechanisms. Hereditary and acquired angioedema are caused by dysregulation of the complement and kinin pathways. In contrast, drug-induced and allergic angioedema involve the activation of the immune system and release of vasoactive mediators. Recent advances in the understanding of the pathophysiology of angioedema have led to the development of targeted therapies, such as monoclonal antibodies, bradykinin receptor antagonists, and complement inhibitors, which promise to improve clinical outcomes in patients with this challenging condition. To accurately diagnose and manage angioedema, an understanding of this condition's complex and varied pathophysiology is both necessary and critical.
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Affiliation(s)
- Hermenio Lima
- LEADER Research Inc., Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | | | - Dennis Wong
- Division of Clinical Immunology and Allergy, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Susan Waserman
- Division of Clinical Immunology and Allergy, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Gordon L. Sussman
- Department of Medicine and Division of Clinical Immunology & Allergy, University of Toronto, Toronto, ON, Canada
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31
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Nunes LR, Anselmo MP, Brito TS. A challenging case of bradykinin-mediated angioedema with airway obstruction: management and therapeutic strategies. Arch Clin Cases 2023; 10:138-141. [PMID: 37795171 PMCID: PMC10546096 DOI: 10.22551/2023.40.1003.10260] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023] Open
Abstract
Angioedema is a potentially life-threatening condition that can have an allergic origin, usually mediated by histamine or a non-allergic origin, mediated by bradykinin. The distinction between these origins may present a clinical challenge at first approach, especially in cases that appear as an emergency and the outcome is time dependent. The authors describe a rare case of bradykinin angioedema associated with airway obstruction and discuss the right approach and therapeutic options. A 46-year-old patient under ACE inhibitor, renin-angiotensin-aldosterone blocker and beta blocker presented with difficulty swallowing, shortness of breath and angioedema, associated with inspiratory stridor, incapacity of talking, plantar pruritus and vomits minutes after ingestion of shrimp. The symptoms did not respond to epinephrine, anti-histamines or steroids. The airway quickly became an emergency and the authors discuss the importance of airway obstruction management and having a multidisciplinary well-defined plan of approach with backup plans. Exuberant angioedema persisted leading to the suspicion of drug induced angioedema. Treatment with tranexamic acid 1g 6/6h and icatibant 30 mg 6/6h (3 doses) was started with resolution. In these cases, the rapid institution of the right pharmacological line will relate significantly to a better outcome. It is particularly important because, as their underlying physiopathologic mechanism differ, bradykinin mediated angioedema does not respond to drugs that histamine mediated angioedema does, like corticosteroids and antihistaminic. In severe and life-threatening cases icatibant and tranexamic acid have proven to be an effective therapy.
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32
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Wan L, Thomas J, Yan A, Mann J, Szema A. A Case Report of Steroid-Induced Angioedema and Urticaria. Cureus 2023; 15:e46515. [PMID: 37927648 PMCID: PMC10625174 DOI: 10.7759/cureus.46515] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2023] [Indexed: 11/07/2023] Open
Abstract
Physicians regularly use corticosteroids to treat various conditions, attributing their anti-inflammatory and immunosuppressive properties. Cases of allergic sensitivity reactions and dermatitis induced by corticosteroids are relatively uncommon. We present a case regarding an 81-year-old male with a history of actinic keratosis, atopic dermatitis, and psoriasis, who experienced a Type I hypersensitivity reaction with facial angioedema and urticaria on his axilla, torso, and popliteal fossa that developed after treatment with oral prednisolone. This episode also exacerbated his previously diagnosed psoriasis. To treat psoriasis, a dermatologist prescribed clobetasol topical ointment, which did not alleviate the symptoms; instead, it only exacerbated the rash, and he was subsequently referred for corticosteroid allergy testing. North American 85 Comprehensive Series patch testing revealed a positive test for various classes of steroids, including clobetasol-17-propionate, budesonide, and dexamethasone, thus proving a T cell-mediated allergy to corticosteroids.
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Affiliation(s)
- Leo Wan
- Medical School, West Virginia School of Osteopathic Medicine, Lewisburg, USA
| | - John Thomas
- Medical School, West Virginia School of Osteopathic Medicine, Lewisburg, USA
| | - Audrey Yan
- Medical School, West Virginia School of Osteopathic Medicine, Lewisburg, USA
| | - Jake Mann
- Department of Medicine, West Virginia School of Osteopathic Medicine, Lewisburg, USA
| | - Anthony Szema
- Department of Occupational Medicine, Epidemiology, and Prevention, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, USA
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33
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Kartal D, Orujova S, Ertaş R. Clinical effects of COVID-19 vaccines on chronic spontaneous urticaria patients: a study on two Turkish centers. Front Med (Lausanne) 2023; 10:1222126. [PMID: 37841021 PMCID: PMC10568618 DOI: 10.3389/fmed.2023.1222126] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 08/16/2023] [Indexed: 10/17/2023] Open
Abstract
BackgroundThe relationship between CSU and vaccines is reported in the literature. The post-vaccine clinical effect of COVİD-19 vaccines on CSU patients is still unclear. we aimed to evaluate clinical effects of COVID-19 Vaccines on CSU patients.Materials and methodsCSU patients under treatment and follow-up in our outpatient clinic were evaluated retrospectively. To determine disease activity the urticaria activity score over seven days (UAS7) was used. The details of demographic information, CSU treatment, history of COVID-19 infection and exacerbation of urticaria during infection, COVID-19 vaccinations, type of vaccine, side effect reaction time after vaccination, hospital admission requirement were also assessed.ResultsTotal of 190 patients with a mean age of The mean age of patients was 41,7±14,0 years (range = 18–72) were enrooled. The patient sample consisted of 50 males and 140 females (male/female ratio 1:2.8). 181 (CoronaVac 77, Pfizer-BioNTech 104) patients were vaccinated. Urticarial exacerbation was occurred in 25 patients. The median UAS value was 5 before vaccination, it was 12 in patients with post-vaccine urticaria. Two patients had angioedema and one patient had anaphylaxis after vaccinated with Pfizer-BioNTech.ConclusionCOVID-19 vaccination in the CSU can be considered safe. Cases with urticarial exacerbation appear to be transient and can be managed by antihistamine and/or systemic steroid therapies. More extensive studies are needed for the relationship with CSU and post-coronavirus vaccination anaphylaxy.
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Affiliation(s)
- Demet Kartal
- Dermatology and Venereology Department, Erciyes University Medical School, Kayseri, Türkiye
| | - Shahzada Orujova
- Dermatology and Venereology Department, Erciyes University Medical School, Kayseri, Türkiye
| | - Ragıp Ertaş
- Kayseri City Hospital Kayseri, Kayseri, Türkiye
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34
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Rostaher A, Fischer NM, Vigani A, Steblaj B, Martini F, Brem S, Favrot C, Kosnik M. Hymenoptera Venom Immunotherapy in Dogs: Safety and Clinical Efficacy. Animals (Basel) 2023; 13:3002. [PMID: 37835609 PMCID: PMC10571593 DOI: 10.3390/ani13193002] [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: 08/21/2023] [Revised: 09/17/2023] [Accepted: 09/18/2023] [Indexed: 10/15/2023] Open
Abstract
Hymenoptera allergens are the main triggers for anaphylaxis in susceptible dogs and humans. Hymenoptera venom specific immunotherapy (VIT), the only disease-modifying treatment, has the potential to prevent future life-threatening reactions in human patients. Prospective clinical data on VIT efficacy in dogs are currently lacking. Therefore, the aim of this study was to show that VIT is not only safe but also efficacious in preventing anaphylaxis in dogs allergic to Hymenoptera. This uncontrolled prospective clinical trial included 10 client-owned dogs with a history of anaphylaxis following repeated Hymenoptera stings. The sensitization to bee and wasp allergens was demonstrated by intradermal testing (IDT) and allergen-specific IgE serology. For VIT induction (induction phase), dogs received a shortened rush immunotherapy protocol with aqueous allergens, which was then followed by monthly injections of 100 µg of alum-precipitated allergen (maintenance phase). VIT efficacy was determined by observing patients' clinical reactions to re-stings. No systemic adverse events were seen during the induction and maintenance phases. From the seven re-stung dogs, only one developed a mild angioedema at the site of the sting; the remaining dogs were asymptomatic. These results show that VIT represents a safe and effective treatment option for Hymenoptera-allergic dogs.
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Affiliation(s)
- Ana Rostaher
- Dermatology Unit, Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, 8057 Zurich, Switzerland; (N.M.F.); (F.M.); (S.B.); (C.F.)
| | - Nina Maria Fischer
- Dermatology Unit, Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, 8057 Zurich, Switzerland; (N.M.F.); (F.M.); (S.B.); (C.F.)
| | - Alessio Vigani
- Division of Small Animal Emergency and Critical Care, Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, 8057 Zurich, Switzerland;
| | - Barbara Steblaj
- Section of Anaesthesiology, Department of Clinical Diagnostics and Services, Vetsuisse Faculty, University of Zurich, 8057 Zurich, Switzerland;
| | - Franco Martini
- Dermatology Unit, Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, 8057 Zurich, Switzerland; (N.M.F.); (F.M.); (S.B.); (C.F.)
| | - Salina Brem
- Dermatology Unit, Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, 8057 Zurich, Switzerland; (N.M.F.); (F.M.); (S.B.); (C.F.)
| | - Claude Favrot
- Dermatology Unit, Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, 8057 Zurich, Switzerland; (N.M.F.); (F.M.); (S.B.); (C.F.)
| | - Mitja Kosnik
- Division of Allergy, University Clinic of Respiratory and Allergic Diseases Golnik, 4204 Golnik, Slovenia;
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
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Miniello A, Casella R, Loverre T, Aloia D, Di Bona D, Nettis E. An update on nonsteroidal anti-inflammatory drug-induced urticaria. Endocr Metab Immune Disord Drug Targets 2023; 23:EMIDDT-EPUB-134329. [PMID: 37691219 DOI: 10.2174/1871530323666230907112453] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 07/08/2023] [Accepted: 07/20/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND Hypersensitivity reactions to non-steroidal anti-inflammatory drugs (HR-NSAIDs) are common adverse events related to the widespread use of over-the-counter NSAIDs for the treatment of a variety of inflammatory conditions. Urticaria is the most commonly reported immediate cutaneous clinical sign of HR-NSAIDs, but it can be a manifestation of pathophysiologically different clinical entities that require different therapeutic strategies. The aim of this study is to ease the identification of the correct phenotype of HR-NSAIDs in patients reporting urticaria associated with the intake of NSAIDs and provide updated information about their diagnosis and management. METHODS The study is a narrative review conducted by collecting the most relevant and up-to-date data related to the classification, pathophysiology, severity, and prognosis of NSAID hypersensitivity reactions. PubMed and Embase scientific databases were used as search engines to select relevant articles. RESULTS Patients developing HR-NSAIDs can be divided into two categories: selective responders (SR), who develop reactions after the administration of a single specific NSAID due to an underlying IgE or T-cell mediated hypersensitivity mechanism, or cross-intolerant (CI), who develop reactions to more than one chemically unrelated NSAIDs due to abnormalities in the biochemical pathways related with prostaglandin metabolism, independently from an underlying immunological mechanism. Five major different categories of HR-NSAIDs have been identified: NSAIDs-exacerbated cutaneous disease (NECD), NSAIDs-induced urticaria/angioedema with/without respiratory and systemic symptoms of anaphylaxis (NIUAA), and NSAIDs-exacerbated respiratory disease (NERD), which are developed by CI patients, and single NSAIDs-induced urticaria, angioedema and/ or anaphylaxis (SNIUAA) and single NSAIDs-induced delayed hypersensitivity reactions (SNIDHR), which are developed by CI patients. In vivo and in vitro diagnostic tests have rarely been shown to be reliable in all these entities and therefore are not routinely used in clinical practice. The management in SR patients consists of strict avoidance of the culprit drug, while for cross-intolerance reactions oral tolerance tests with safe alternative drugs (e.g. weak COX-1 inhibitors or selective COX-2 inhibitors) can be performed. CONCLUSION HR-NSAIDs are being observed with increasing frequency, however, the pathogenesis behind some NSAIDS-associated clinical entities is still unclear. Diagnosis is mostly based on a thorough clinical history and confirmed by a drug challenge test. Clinical management is based on strict avoidance and use of alternative tolerated medications. Overall, all therapeutic decisions depend on the correct identification of the type of reaction the patient experienced.
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Affiliation(s)
- Andrea Miniello
- Department of Emergency and Organ Transplantation, School of Allergology and Clinical Immu-nology, University of Bari Aldo Moro, Policlinico di Bari, Bari, Italy
| | - Rossella Casella
- Department of Emergency and Organ Transplantation, School of Allergology and Clinical Immu-nology, University of Bari Aldo Moro, Policlinico di Bari, Bari, Italy
| | - Teresa Loverre
- Department of Emergency and Organ Transplantation, School of Allergology and Clinical Immu-nology, University of Bari Aldo Moro, Policlinico di Bari, Bari, Italy
| | - Dario Aloia
- Department of Emergency and Organ Transplantation, School of Allergology and Clinical Immu-nology, University of Bari Aldo Moro, Policlinico di Bari, Bari, Italy
| | - Danilo Di Bona
- Department of Emergency and Organ Transplantation, School of Allergology and Clinical Immu-nology, University of Bari Aldo Moro, Policlinico di Bari, Bari, Italy
| | - Eustachio Nettis
- Department of Emergency and Organ Transplantation, School of Allergology and Clinical Immu-nology, University of Bari Aldo Moro, Policlinico di Bari, Bari, Italy
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Podlecka D, Socha-Banasiak A, Jerzynska J, Nodzykowska J, Brzozowska A. Practical Approach to Hypersensitivity to Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) in Children. Pharmaceuticals (Basel) 2023; 16:1237. [PMID: 37765044 PMCID: PMC10535469 DOI: 10.3390/ph16091237] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/27/2023] [Accepted: 08/30/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND We aimed to assess the real-life prevalence, patient profile, and clinical presentation of drug hypersensitivity to NSAIDs in children after an incidence of an adverse event during treatment, verified by a drug challenge test. METHODS We included 56 children, aged 4-18 years, referred to our allergy clinic due to the incidence of adverse reaction during treatment. Skin prick tests and a drug provocation test were performed in all patients. Diagnostics for persistent urticaria were performed. RESULTS In 56 patients suspected of drug allergy, we proved NSAID hypersensitivity in 17 patients (30.1%). In 84.9% (n = 47) of patients, the clinical manifestations of hypersensitivity revealed angioedema and urticaria. The most common culprit drug among NSAIDs in children was ibuprofen. Thirty-one (55.4%) reactions were immediate, and 25 (44.6%) were delayed or late. Previous history of allergy was a risk factor for NSAID hypersensitivity (p = 0.001). Vitamin D deficiency in the blood serum was a risk factor for NASID hypersensitivity (OR = 5.76 (95% Cl: 1.42-23.41)). CONCLUSIONS Hypersensitivity to NSAIDs is a difficult diagnostic problem in pediatric allergy. The most common manifestation of hypersensitivity to ibuprofen in children is acute urticaria and angioedema. Two important problems in the differential diagnosis are cofactors such as vitamin D levels and viral infections, which require further research.
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Affiliation(s)
- Daniela Podlecka
- Department of Pediatrics and Allergy, Copernicus Memorial Hospital in Lodz, Medical University of Lodz, 90-419 Lodz, Poland; (D.P.); (J.J.); (J.N.)
| | - Anna Socha-Banasiak
- Department of Gastroenterology, Allergology and Pediatrics, Polish Mother’s Memorial Hospital Research Institute, 93-338 Lodz, Poland;
| | - Joanna Jerzynska
- Department of Pediatrics and Allergy, Copernicus Memorial Hospital in Lodz, Medical University of Lodz, 90-419 Lodz, Poland; (D.P.); (J.J.); (J.N.)
| | - Joanna Nodzykowska
- Department of Pediatrics and Allergy, Copernicus Memorial Hospital in Lodz, Medical University of Lodz, 90-419 Lodz, Poland; (D.P.); (J.J.); (J.N.)
- Military Medical Academyy Memorial Teaching Hospital of the Medical, University of Lodz-Central Veteran’s Hospital, 90-549 Lodz, Poland
| | - Agnieszka Brzozowska
- Department of Pediatrics and Allergy, Copernicus Memorial Hospital in Lodz, Medical University of Lodz, 90-419 Lodz, Poland; (D.P.); (J.J.); (J.N.)
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Dhaliwal G, Batra J, Ankireddypalli AR, Gorle S, Kanugula AK, Kaur J. Progesterone Hypersensitivity Induced by Exogenous Progesterone Exposure. Cureus 2023; 15:e44776. [PMID: 37680259 PMCID: PMC10481886 DOI: 10.7759/cureus.44776] [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] [Accepted: 09/06/2023] [Indexed: 09/09/2023] Open
Abstract
Progesterone hypersensitivity (PH) is a rare hypersensitivity reaction to either endogenous or exogenous progesterone. There are around 200 reported cases of progesterone hypersensitivity in the medical literature. We present the case of a 31-year-old female who presented with cyclical urticaria and angioedema after exogenous progesterone exposure. Her symptoms would begin a few days before her menstrual cycle began and resolve after menstruation. She only had partial recovery of her symptoms with antihistamines, steroids, montelukast, and omalizumab. She needed treatment with oral contraceptives and had a resolution of symptoms, but subsequently developed a recurrence again. Given the rarity of this condition, the diagnosis is often delayed. This diagnosis should be considered for women of reproductive age who present with cyclic hypersensitivity or allergic symptoms.
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Affiliation(s)
| | - Jaskaran Batra
- Internal Medicine, University of Pittsburgh Medical Center (UPMC), McKeesport, USA
| | | | - Swathi Gorle
- Internal Medicine, Wellstar Spalding Regional Medical Center, Griffin, USA
| | | | - Jasleen Kaur
- Endocrinology, Diabetes and Metabolism, HealthPartners, Minneapolis, USA
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Long C, Scott JL, Flamm A. The dermatologic and histologic spectrum of hypereosinophilic syndrome. JAAD Case Rep 2023; 39:21-25. [PMID: 37560139 PMCID: PMC10407024 DOI: 10.1016/j.jdcr.2023.06.020] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023] Open
Affiliation(s)
- Calista Long
- Department of Dermatology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Jennifer L. Scott
- Department of Dermatology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Alexandra Flamm
- Department of Dermatology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
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Lepore N, Carpenter T, Wolff A. Angioedema From Triple Therapy: A Case Report. Cureus 2023; 15:e46247. [PMID: 37908932 PMCID: PMC10614077 DOI: 10.7759/cureus.46247] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2023] [Indexed: 11/02/2023] Open
Abstract
Angioedema is a rare but potentially life-threatening complication associated with angiotensin-converting enzyme (ACE) inhibitors. Although the pathophysiology is well understood, cases involving the concurrent use of other medications are less explored. We present a unique case of ACE inhibitor-induced angioedema in a 57-year-old male, which developed soon after receiving intravenous contrast. The patient's medication list included a dipeptidyl peptidase-IV inhibitor and a calcium channel blocker. Studies have shown an increased risk of angioedema with the combined use of these medications, likely due to alterations in bradykinin metabolism. This case highlights the importance of medication review and consideration of potential drug interactions when prescribing ACE inhibitors. It emphasizes the significance of diagnostic accuracy to avoid the mislabeling of allergies and consideration of other etiologies in angioedema. Healthcare providers ought to be mindful of the increased risk of angioedema when prescribing dipeptidyl peptidase-IV inhibitors and calcium-channel blockers with ACE inhibitors, as these are frequently used medications.
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Affiliation(s)
- Nicholas Lepore
- Internal Medicine - Pediatrics, Rutgers New Jersey Medical School, Newark, USA
| | - Taya Carpenter
- Pulmonary & Critical Care Medicine and Allergy & Rheumatology, Rutgers New Jersey Medical School, Newark, USA
| | - Alan Wolff
- Pulmonary & Critical Care Medicine and Allergy & Rheumatology, Rutgers New Jersey Medical School, Newark, USA
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Fijen LM, Vera C, Buttgereit T, Bonnekoh H, Maurer M, Magerl M, Weller K. Sensitivity to change and minimal clinically important difference of the angioedema control test. Clin Transl Allergy 2023; 13:e12295. [PMID: 37746798 PMCID: PMC10472988 DOI: 10.1002/clt2.12295] [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: 05/26/2023] [Revised: 07/20/2023] [Accepted: 08/07/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND The Angioedema Control Test (AECT) is a patient-reported outcome measure developed and validated for the assessment of disease control in patients with recurrent angioedema. Its sensitivity to change and minimal clinically important difference (MCID) have hitherto not been established. METHODS Patients with recurrent angioedema due to chronic spontaneous urticaria, hereditary angioedema, or acquired C1-inhibitor deficiency were repeatedly asked to complete the AECT along with the Angioedema Quality of Life Questionnaire (AE-QoL), Dermatology Life Quality Index (DLQI), and anchors for disease control and whether treatment was sufficient during routine care visits. The sensitivity to the change of the AECT was determined by correlating changes in its scores over time with changes in the applied anchors. The MCID was determined using anchor-based and distributional criterion-based approaches. RESULTS Eighty-six cases were used for this analysis. Changes in AECT scores correlated well with AE-QoL changes (but less with changes in the DLQI) as well as other applied anchors, demonstrating its sensitivity to change. The MCID was found to be three points for improvement of angioedema control. The available number of cases with meaningful deterioration in our dataset was too low to reach a definite conclusion on the MCID for deterioration of angioedema control. CONCLUSION The AECT is a valuable tool to assess changes in disease control in patients with recurrent angioedema over time. The lowest AECT score change that reflects a meaningful improvement of disease control to patients (MCID) is three points.
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Affiliation(s)
- Lauré M. Fijen
- Department of Vascular MedicineAmsterdam Cardiovascular SciencesAmsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
- Institute of AllergologyCharité ‐ Universitätsmedizin Berlincorporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMPImmunology and AllergologyBerlinGermany
| | - Carolina Vera
- Institute of AllergologyCharité ‐ Universitätsmedizin Berlincorporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMPImmunology and AllergologyBerlinGermany
| | - Thomas Buttgereit
- Institute of AllergologyCharité ‐ Universitätsmedizin Berlincorporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMPImmunology and AllergologyBerlinGermany
| | - Hanna Bonnekoh
- Institute of AllergologyCharité ‐ Universitätsmedizin Berlincorporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMPImmunology and AllergologyBerlinGermany
| | - Marcus Maurer
- Institute of AllergologyCharité ‐ Universitätsmedizin Berlincorporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMPImmunology and AllergologyBerlinGermany
| | - Markus Magerl
- Institute of AllergologyCharité ‐ Universitätsmedizin Berlincorporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMPImmunology and AllergologyBerlinGermany
| | - Karsten Weller
- Institute of AllergologyCharité ‐ Universitätsmedizin Berlincorporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMPImmunology and AllergologyBerlinGermany
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Itani S, Malick H, Nangrani PC, Lai T, Sims P. Isolated Ulnar Neuropathy After Acute Angioedema. Cureus 2023; 15:e44872. [PMID: 37814739 PMCID: PMC10560135 DOI: 10.7759/cureus.44872] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2023] [Indexed: 10/11/2023] Open
Abstract
Ulnar neuropathy commonly causes hand paresthesia, often associated with mechanical compression or repetitive movements across the elbow or wrist. There are a few cases that document ulnar nerve injury from rapid compression in the absence of trauma. We present a 30-year-old previously healthy male who developed bilateral hand and forearm swelling, numbness, and pain after an allergic reaction initially treated with epinephrine and steroids. Following treatment, swelling improved; however, paresthesia and weakness persisted. Electrodiagnostic studies performed two months later showed severe ulnar neuropathy prominent at the left proximal wrist, confirmed by ulnar motor inching studies. Signs of acute or subacute denervation and active reinnervation were noted in the left flexor digitorum profundus and abductor digiti minimi. Right-sided studies were unrevealing, although magnetic resonance imaging (MRI) showed an acute flexor pollicis longus tear. Given the timing of events, it was felt that the ulnar neuropathy and acute muscle tear were related to the rapid onset of angioedema. Further research should be conducted on how acute episodes of angioedema (allergy) can cause nerve compression in different extremities. There are very scant reports of different types of angioedema (such as vibratory or hereditary) associated with neuropathy; however, there are no reports of acute allergic angioedema associated with neuropathy. A more comprehensive understanding of the pathophysiology of neuropathy following acute angioedema will help guide treatment approaches both acutely and after symptom presentation.
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Affiliation(s)
- Sabine Itani
- Medicine, Texas A&M College of Medicine, Bryan, USA
| | - Hamza Malick
- Medicine, Texas A&M College of Medicine, Bryan, USA
| | - Priya C Nangrani
- Physical Medicine and Rehabilitation, Baylor University Medical Center, Dallas, USA
| | - Tony Lai
- Physical Medicine and Rehabilitation, Baylor University Medical Center, Dallas, USA
| | - Patrick Sims
- Physical Medicine and Rehabilitation, Baylor University Medical Center, Dallas, USA
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Bulut EA, Ozden G, Isik AT. An atypical presentation of COVID-19: Hidden risk for seniors to misdiagnose. North Clin Istanb 2023; 10:521-523. [PMID: 37719254 PMCID: PMC10500241 DOI: 10.14744/nci.2022.35336] [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: 02/02/2022] [Accepted: 04/04/2022] [Indexed: 11/20/2022] Open
Abstract
The outbreak of coronavirus disease (COVID-19) was announced as a pandemic by the World Health Organization in March 2020. Clinical manifestations include cough, fever, dyspnea, myalgia, and loss of sense of smell and taste. Less common extrapulmonary signs and symptoms such as cutaneous manifestations, diarrhea, confusion, functional decline have been reported in the literature. Older patients with multiple comorbidities are at a greater risk for severe disease and death and are vulnerable to atypical presentations due to changes in organ systems, multimorbidity, cognitive impairment, and sensory disturbances. In this case, a 77-year-old patient diagnosed with COVID-19 pneumonia presented with atypically acute urticaria with angioedema was reported. Although there were no typical signs of the disease, such as cough or shortness of breath, the patient's laboratory values, and chest imaging were compatible with COVID-19. Therefore, the diagnosis of COVID-19 should be considered in older patients presenting with subtle signs or cutaneous manifestations.
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Affiliation(s)
- Esra Ates Bulut
- Department of Geriatric Medicine, Adana City Training and Research Hospital, Adana, Turkiye
| | - Guzin Ozden
- Department of Allergy and Immunology, Adana City Training and Research Hospital, Adana, Turkiye
| | - Ahmet Turan Isik
- Department of Geriatric Medicine, Dokuz Eylul University Faculty of Medicine, Izmir, Turkiye
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Sampson CS, Schwarz E. Delayed-onset Angioedema Following a Snakebite in a Patient on ACE Inhibitors: A Case Report. Clin Pract Cases Emerg Med 2023; 7:178-181. [PMID: 37595314 PMCID: PMC10438947 DOI: 10.5811/cpcem.1463] [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: 01/24/2022] [Revised: 03/17/2022] [Accepted: 03/17/2022] [Indexed: 08/20/2023] Open
Abstract
INTRODUCTION Angiotensin converting enzyme inhibitors (ACEI) are a common class of medications prescribed to patients for hypertension. Anti-hypertensive use is not normally considered an important factor when treating patients with crotalid envenomations; however, in combination with the venom in this patient, it may have resulted in angioedema. CASE REPORT A 65-year-old male on ACEI presented to his community emergency department following a snake envenomation to his thumb. Six vials of Crotalidae polyvalent immune fab were administered, and he was transferred to a referral center. Approximately 18 hours after the envenomation, the patient complained of tongue swelling and difficulty speaking. There was evidence of angioedema, with the right side of the tongue significantly enlarged compared to the left. He was intubated for airway protection and remained on a ventilator for three days. CONCLUSION Angiotensin converting enzyme inhibitors may potentiate the effects of exogenous bradykinin as some snake venom has naturally occurring bradykinin, which may further amplify its effects. Extra vigilance may be warranted for the development of angioedema in patients receiving ACEI.
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Affiliation(s)
| | - Evan Schwarz
- Washington University School of Medicine in Saint Louis, Department of Emergency Medicine, Saint Louis, Missouri
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Kocatürk E, Muñoz M, Elieh-Ali-Komi D, Criado PR, Peter J, Kolkhir P, Can P, Wedi B, Rudenko M, Gotua M, Ensina LF, Grattan C, Maurer M. How Infection and Vaccination Are Linked to Acute and Chronic Urticaria: A Special Focus on COVID-19. Viruses 2023; 15:1585. [PMID: 37515272 PMCID: PMC10386070 DOI: 10.3390/v15071585] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/11/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
Since more than a century ago, there has been awareness of the connection between viral infections and the onset and exacerbation of urticaria. Our knowledge about the role of viral infection and vaccination in acute and chronic urticaria improved as a result of the COVID-19 pandemic but it has also highlighted knowledge gaps. Viral infections, especially respiratory tract infections like COVID-19, can trigger the onset of acute urticaria (AU) and the exacerbation of chronic urticaria (CU). Less frequently, vaccination against viruses including SARS-CoV-2 can also lead to new onset urticaria as well as worsening of CU in minority. Here, with a particular focus on COVID-19, we review what is known about the role of viral infections and vaccinations as triggers and causes of acute and chronic urticaria. We also discuss possible mechanistic pathways and outline the unmet needs in our knowledge. Although the underlying mechanisms are not clearly understood, it is believed that viral signals, medications, and stress can activate skin mast cells (MCs). Further studies are needed to fully understand the relevance of viral infections and vaccinations in acute and chronic urticaria and to better clarify causal pathways.
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Affiliation(s)
- Emek Kocatürk
- Institute of Allergology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 12203 Berlin, Germany
- Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, 12203 Berlin, Germany (D.E.-A.-K.)
- Department of Dermatology, Koç University School of Medicine, Istanbul 34010, Turkey
| | - Melba Muñoz
- Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, 12203 Berlin, Germany (D.E.-A.-K.)
- Department of Dermatology, Koç University School of Medicine, Istanbul 34010, Turkey
| | - Daniel Elieh-Ali-Komi
- Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, 12203 Berlin, Germany (D.E.-A.-K.)
- Department of Dermatology, Koç University School of Medicine, Istanbul 34010, Turkey
| | - Paulo Ricardo Criado
- Department of Dermatology, School of Medicine, Centro Universitário Faculdade de Medicina do ABC (CUFMABC), Santo André 09060-870, Brazil
| | - Jonny Peter
- Lung Institute, Division of Allergy and Clinical Immunology, Groote Schuur Hospital, University of Cape Town, Cape Town 7925, South Africa
| | - Pavel Kolkhir
- Institute of Allergology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 12203 Berlin, Germany
- Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, 12203 Berlin, Germany (D.E.-A.-K.)
| | - Pelin Can
- Department of Dermatology, Bahçeşehir University, Istanbul 34070, Turkey;
| | - Bettina Wedi
- Department of Dermatology and Allergy, Comprehensive Allergy Center, Hannover Medical School, 30625 Hannover, Germany
| | | | - Maia Gotua
- Center of Allergy and Immunology, David Tvildiani Medical University, Tbilisi 0159, Georgia
| | - Luis Felipe Ensina
- Division of Allergy, Clinical Immunology and Rheumatology, Department of Pediatrics, Federal University of São Paulo, São Paulo 01308-000, Brazil
| | - Clive Grattan
- Guy’s Hospital, St John’s Institute of Dermatology, London SE1 7EP, UK
| | - Marcus Maurer
- Institute of Allergology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 12203 Berlin, Germany
- Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, 12203 Berlin, Germany (D.E.-A.-K.)
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Banerjee A, Bermudez N, Gould MB, Ramlatchan SR, Ganti L. Hereditary Angioedema. Cureus 2023; 15:e42088. [PMID: 37602066 PMCID: PMC10435005 DOI: 10.7759/cureus.42088] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2023] [Indexed: 08/22/2023] Open
Abstract
The authors present the case of a 22-year-old female who reported having a persistent sore throat. The patient had a history of recurring episodes of hereditary angioedema and arrived at the emergency department with her C1-esterase inhibitor. The epidemiology, clinical presentation, and treatment strategies are presented.
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Affiliation(s)
- Anjali Banerjee
- Emergency Medicine, University of Central Florida, Orlando, USA
| | | | | | | | - Latha Ganti
- Emergency Medicine, Hospital Corporation of America (HCA) Florida Ocala Hospital, Ocala, USA
- Emergency Medicine, Envision Physician Services, Plantation, USA
- Emergency Medicine, University of Central Florida College of Medicine, Orlando, USA
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McSweeney SM, Kloczko E, Chadha M, Sarkany R, Fassihi H, Tziotzios C, McGrath JA. Systematic review of the clinical characteristics and natural history of solar urticaria. J Am Acad Dermatol 2023; 89:138-140. [PMID: 36796725 DOI: 10.1016/j.jaad.2023.01.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 12/29/2022] [Accepted: 01/02/2023] [Indexed: 02/17/2023]
Affiliation(s)
| | - Ewa Kloczko
- Department of Dermatology, University College Hospital, London, UK
| | | | - Robert Sarkany
- St. John's Institute of Dermatology, Guy's Hospital, London, UK
| | - Hiva Fassihi
- St. John's Institute of Dermatology, Guy's Hospital, London, UK
| | | | - John A McGrath
- St. John's Institute of Dermatology, Guy's Hospital, London, UK
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Obayashi N, Shintani T, Kamegashira A, Oka H, Ando T, Miyata R, Kawaguchi H, Kajiya M. A case report of allergic reaction with acute facial swelling: a rare complication of dental acrylic resin. J Int Med Res 2023; 51:3000605231187819. [PMID: 37480276 PMCID: PMC10363870 DOI: 10.1177/03000605231187819] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2023] Open
Abstract
Resin components, such as methyl methacrylate (MMA) can cause allergic contact dermatitis (ACD). Allergic reactions to resin are usually delayed. Only a few studies have reported dental resin allergy with acute symptoms. Here, a case of ACD with acute facial swelling after dental treatment using resin material is reported. A 55-year-old woman with a history of periungual inflammation when using gel nail polish had repeated episodes of facial swelling after dental treatment with resin material. The resin temporary crown was removed, and symptoms were alleviated with antihistamines and corticosteroids. With the suspicion of resin allergy, skin tests were performed. Patch testing revealed positive reactions to self-adhesive resin cement (primer and polymerized), self-curing acrylic resin (liquid and polymerized), 2-hydroxyethyl methacrylate (2-HEMA), and ethylene glycol dimethacrylate (EGDMA), whereas the prick test was negative for all allergens. Complement C4 and C1 inhibitor activity were reference values in the tests for hereditary angioedema. Based on these findings, the patient was diagnosed with ACD to 2-HEMA and EGDMA. Since diagnosis, no similar symptoms have been observed in subsequent dental treatment with non-resin materials. The use of dental resin materials may cause ACD with an acute reaction. This report alerts dentists who routinely use resin materials.
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Affiliation(s)
- Nami Obayashi
- Centre of Oral Clinical Examination, Hiroshima University, Hiroshima, Japan
- Department of General Dentistry, Hiroshima University Hospital, Hiroshima, Japan
| | - Tomoaki Shintani
- Centre of Oral Clinical Examination, Hiroshima University, Hiroshima, Japan
| | - Akiko Kamegashira
- Department of Dermatology, Hiroshima University Hospital, Hiroshima, Japan
| | - Hiroko Oka
- Centre for Cause of Death Investigation Research and Education, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Toshinori Ando
- Centre of Oral Clinical Examination, Hiroshima University, Hiroshima, Japan
| | - Rie Miyata
- Centre of Oral Clinical Examination, Hiroshima University, Hiroshima, Japan
| | - Hiroyuki Kawaguchi
- Department of General Dentistry, Hiroshima University Hospital, Hiroshima, Japan
| | - Mikihito Kajiya
- Centre of Oral Clinical Examination, Hiroshima University, Hiroshima, Japan
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Christopher DJ, Natania A, Daniel J, Balamugesh T, Isaac B, Krishna MT. Prevalence of drug allergy labels in a tertiary pulmonary service in South India. Clin Exp Allergy 2023. [PMID: 37365847 DOI: 10.1111/cea.14365] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/02/2023] [Accepted: 06/05/2023] [Indexed: 06/28/2023]
Affiliation(s)
| | - Arin Natania
- Department of Pulmonary Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Jefferson Daniel
- Department of Pulmonary Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Barney Isaac
- Department of Pulmonary Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Mamidipudi Thirumala Krishna
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
- Department of Allergy and Immunology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Ameer MA, Mushtaq J, Chaudhry H, Patel N, Khan SI. Angiotensin-Converting Enzyme Inhibitor-Induced Angioedema: A Case Report With a Review of Management Options. Cureus 2023; 15:e40320. [PMID: 37448396 PMCID: PMC10337988 DOI: 10.7759/cureus.40320] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2023] [Indexed: 07/15/2023] Open
Abstract
Angiotensin-converting enzyme inhibitors (ACEIs) are widely used for heart failure, renal failure, diabetic nephropathy, stroke, arterial hypertension, and a number of other cardiovascular or related conditions. ACEI-induced angioedema is a rare entity but can result in life-threatening emergencies. It mainly occurs in patients starting on ACEI as an antihypertensive. We present a case of lisinopril-induced angioedema in an African American patient managed in the emergency department. After appropriate evaluation, the patient was declared safe to be observed in the emergency department. Intubation was not performed. Early identification of angioedema is paramount, and emergency physicians should maintain airways or intubate such patients if indicated. There should be a high level of suspicion of angioedema in patients taking ACEIs if they present with symptoms of respiratory compromise.
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Affiliation(s)
| | - Javaria Mushtaq
- Cell Biology and Neuroscience, Rowan University, Stratford, USA
| | - Haroon Chaudhry
- Internal Medicine, Suburban Community Hospital, East Norriton, USA
| | - Nimi Patel
- Internal Medicine, Suburban Community Hospital, East Norriton, USA
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50
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Liu L, Yu Y, Xia J, Ning Y. A rare presentation of Sintilimab-induced swelling along the vessels: Case report. Medicine (Baltimore) 2023; 102:e33859. [PMID: 37233405 PMCID: PMC10219706 DOI: 10.1097/md.0000000000033859] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 05/05/2023] [Indexed: 05/27/2023] Open
Abstract
RATIONALE Immune-related adverse events are occasionally reported in Sintilimab treatment. This study reports a forward and reverse swelling case along the vein after infusion of Sintilimab. At present, swelling along the vascular direction during peripheral infusion are limitedly reported at home and abroad, especially when choosing a vein with thick, elastic, and good blood return. PATIENT CONCERNS A 56-year-old male who suffered from esophageal cancer and liver cancer and received albumin-bound paclitaxel and nedaplatin chemotherapy in combination with Sintilimab immunotherapy appeared swelling along the vessel after infusion of Sintilimab. The patient was punctured 3 times. DIAGNOSES Sintilimab-induced vascular edema may be a side effect resulted from a combination of variables such as relatively poor vascular function of the patient, chemical extravasation, allergic skin reactions, venous valves, vascular intima, and diameter stenosis. Sintilimab rarely causes vascular edema only when drug allergic reaction is the underlying factor. As only a few cases of vascular edema caused by Sintilimab have been reported, causes to such a drug-induced vascular edema remained unclear. INTERVENTIONS The swelling was controlled by an intravenous specialist nurse according to delayed extravasation treatment and the doctor anti-allergy treatment, but the uncertainty of repeated puncture and symptom diagnosis caused pain and anxiety to the patient and his family. OUTCOMES The symptom of swelling was gradually relieved after the anti-allergic treatment. The patient completed the following drug infusion without discomfort after the third puncture. When the patient was discharged the next day, swelling in his both hands disappeared, and the patient had no anxiety or discomfort. LESSONS The side effects of immunotherapy may accumulate over time. Early identification and appropriate nursing management are the keys to minimizing patients' pain and anxiety. To effectively treat symptoms, nurses could benefit from quickly identifying the source of swelling.
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Affiliation(s)
- Liqiong Liu
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Yang Yu
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Juan Xia
- Intensive Care Unit, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Yanting Ning
- Department of nursing administration, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
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