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Prieto-García A, Peligros MI, Pérez Tamayo I, Zubeldia JM, Álvarez-Sala L, Lavilla C. Long-term use of mepolizumab in a case of chronic eosinophilic pneumonia: extending interval dosing. J Asthma 2024; 61:69-71. [PMID: 37467753 DOI: 10.1080/02770903.2023.2239343] [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: 05/25/2023] [Revised: 07/01/2023] [Accepted: 07/17/2023] [Indexed: 07/21/2023]
Abstract
INTRODUCTION Mepolizumab, a humanized anti IL-5 monoclonal antibody, has been used off-label for chronic eosinophilic pneumonia (CEP), inducing disease remission and saving systemic corticosteroids. CASE STUDY We present a case of CEP, requiring long-term corticosteroids therapy due to relapse upon withdrawal. Mepolizumab was started and maintained for 2 years and 6 months. RESULTS Corticosteroids could be withdrawn and mepolizumab dose interval was spared up to 10 wk with no disease relapse. CONCLUSION Mepolizumab is shown to be useful for chronic eosinophilic pneumonia, allowing corticosteroid withdrawal. Dose interval may be individualized under close monitoring, for a more efficient treatment, reducing medical costs while improving patients' quality of life.
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Affiliation(s)
- Alicia Prieto-García
- Allergy Service, Gregorio Marañón University Hospital, Gregorio Marañón Health Research Institute, Madrid, Spain
| | - María Isabel Peligros
- Pathology Department, Gregorio Marañón University Hospital, Gregorio Marañón Health Research Institute, Madrid, Spain
| | - Isabel Pérez Tamayo
- Internal Medicine Department, Gregorio Marañón University Hospital, Gregorio Marañón Health Research Institute, Madrid, Spain
| | - José Manuel Zubeldia
- Allergy Service, Gregorio Marañón University Hospital, Gregorio Marañón Health Research Institute, Madrid, Spain
- Biomedical Research Network on Rare Diseases (CIBERER)-U761, Madrid, Spain
| | - Luis Álvarez-Sala
- Internal Medicine Department, Gregorio Marañón University Hospital, Gregorio Marañón Health Research Institute, Madrid, Spain
| | - Cristina Lavilla
- Internal Medicine Department, Gregorio Marañón University Hospital, Gregorio Marañón Health Research Institute, Madrid, Spain
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Prieto-García A, Rojas-Pérez-Ezquerra P, Noguerado-Mellado B, Zambrano G, Cuevas C, Juárez A, Tornero-Molina P. Adyuvant Use of Omalizumab in Desensitization to Chemotherapeutics: Beyond IgE-Mediated Reactions. J Investig Allergol Clin Immunol 2023; 33:497-499. [PMID: 37082897 DOI: 10.18176/jiaci.0911] [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] [Indexed: 04/22/2023] Open
Affiliation(s)
- A Prieto-García
- Allergy Department, University Hospital Gregorio Marañón, Madrid, Spain
- Institute for Health Research Gregorio Marañón, Madrid, Spain
| | - P Rojas-Pérez-Ezquerra
- Allergy Department, University Hospital Gregorio Marañón, Madrid, Spain
- Institute for Health Research Gregorio Marañón, Madrid, Spain
| | - B Noguerado-Mellado
- Allergy Department, University Hospital Gregorio Marañón, Madrid, Spain
- Institute for Health Research Gregorio Marañón, Madrid, Spain
| | - G Zambrano
- Allergy Department, University Hospital Gregorio Marañón, Madrid, Spain
- Institute for Health Research Gregorio Marañón, Madrid, Spain
| | - C Cuevas
- Allergy Department, University Hospital Gregorio Marañón, Madrid, Spain
- Institute for Health Research Gregorio Marañón, Madrid, Spain
| | - A Juárez
- Allergy Department, University Hospital Gregorio Marañón, Madrid, Spain
- Institute for Health Research Gregorio Marañón, Madrid, Spain
| | - P Tornero-Molina
- Allergy Department, University Hospital Gregorio Marañón, Madrid, Spain
- Institute for Health Research Gregorio Marañón, Madrid, Spain
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Branco Ferreira M, Baeza ML, Spínola Santos A, Prieto-García A, Leal R, Alvarez J, Caballero T. Evolution of Guidelines for the Management of Hereditary Angioedema due to C1 Inhibitor Deficiency. J Investig Allergol Clin Immunol 2023; 33:332-362. [PMID: 37171188 DOI: 10.18176/jiaci.0909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Abstract
Hereditary angioedema (HAE) is a severe and disabling condition characterized by recurrent episodes of subcutaneous or mucosal swelling in the skin and respiratory and gastrointestinal tracts. HAE due to C1-esterase inhibitor deficiency (C1-INH-HAE) is the most prevalent subtype. The present Iberian study compared C1-INH-HAE treatment guidelines published between 2010 and 2022 to identify the main differences in therapeutic approaches for on-demand treatment and short- and long-term prophylaxis (LTP). HAE guidelines evolved with the availability of new treatments and with a change in the management paradigm towards an individualized, patient-centered approach, where quality of life (QOL) is central. A parallel trend was observed towards increasingly frequent home-based treatment, which potentially facilitates timely interventions, provides greater flexibility and convenience, and is associated with increased QOL, enabling patients to lead more normal lives. Most innovations over the years were made for LTP, together with the advent of new therapies and awareness of patients' needs. Several prophylactic therapies with a high level of evidence became available, although formal head-to-head comparisons are lacking. The treatment goals became more ambitious, ranging from a reduction in the frequency, severity, and duration of attacks to achieving total disease control and normalization of patients' lives. The document also addresses relevant items such as changes in terminology (eg, the introduction of designations as "first-line") and the introduction of patient-reported outcome measures to assess patients' perceptions of their self-experienced QOL and well-being. Unmet needs in the management of C1-INH-HAE are identified.
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Affiliation(s)
- M Branco Ferreira
- Serviço de Imunoalergologia, Centro Hospitalar Universitário de Lisboa Norte, Lisbon, Portugal
- Clínica Universitária de Imunoalergologia da Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - M L Baeza
- Department of Allergy, Gregorio Marañón University General Hospital, Madrid, Spain
- Institute for Health Research Gregorio Marañón, IiSGM, Madrid, Spain
- Biomedical Research Network on Rare Diseases (CIBERER, U761), Madrid, Spain
| | - A Spínola Santos
- Serviço de Imunoalergologia, Centro Hospitalar Universitário de Lisboa Norte, Lisbon, Portugal
- Clínica Universitária de Imunoalergologia da Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - A Prieto-García
- Department of Allergy, Gregorio Marañón University General Hospital, Madrid, Spain
- Institute for Health Research Gregorio Marañón, IiSGM, Madrid, Spain
| | - R Leal
- Medical Department Iberia, CSL Behring LDA, Lisbon, Portugal
| | - J Alvarez
- Medical Department Iberia, CSL Behring SA, Barcelona, Spain
| | - T Caballero
- Department of Allergy, La Paz University Hospital, Madrid, Spain
- Hospital La Paz Institute for Health Research IdiPAZ - Group 44, Madrid, Spain
- Biomedical Research Network on Rare Diseases - CIBERER U754, Madrid, Spain
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Baeza ML, González-Quevedo T, Caballero T, Guilarte M, Lleonart R, Varela S, Castro M, Díaz C, Escudero E, García MG, Laffond E, Muñoz-Bellido FJ, Núñez R, Prior N, Sala-Cunill A, Sáenz de San Pedro B, Prieto-García A. Angioedema Due to Acquired Deficiency of C1-Inhibitor: A Cohort Study in Spain and a Comparison With Other Series. J Allergy Clin Immunol Pract 2022; 10:1020-1028. [PMID: 34844023 DOI: 10.1016/j.jaip.2021.11.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 10/25/2021] [Accepted: 11/15/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Data on acquired angioedema due to C1-inhibitor deficiency (C1-INH-AAE) from 4 European countries (France, Italy, Germany, and Hungary) were recently published. OBJECTIVE To report data from a group of 50 patients with acquired C1-INH deficiency from Spain, of whom 46 had angioedema, and compare them with other European series. METHODS We performed a retrospective observational study of 46 patients with C1-INH-AAE and 4 asymptomatic patients. Clinical and biological characteristics and associated diseases were assessed and compared with other European series. RESULTS Women accounted for 73.9% of cases. The prevalence of C1-INH-AAE related to hereditary forms was 1/10.1. Overall, 8.7% patients were aged <40 years. Diagnostic delay was 1.1 years. Angioedema mainly affected the face (91.3%), followed by the oropharynx (63%), extremities (50%), and abdomen (37%). Only 1 patient underwent orotracheal intubation. Erythema marginatum was present in 1 patient. A hematologic disorder was recorded in 50% of patients. Angioedema preceded all benign conditions, mostly monoclonal gammopathy of undetermined significance, but appeared very close to or after malignant hematologic diseases (median, 2.2 and 0.29 years). Autoimmune diseases were associated in 50% (autoimmune thyroiditis, 21.5%; systemic lupus erythematosus, 10.9%). Half of them coexisted with hematologic disorders. Anti-C1-INH antibodies were found in 67% of tested patients and were not related to the associated disease. Long-term prophylaxis was necessary in 52.2%, most of whom responded to tranexamic acid. CONCLUSIONS This study emphasizes the possibility of C1-INH-AAE in patients younger than 40 and in autoimmune diseases other than systemic lupus erythematosus such as autoimmune thyroiditis.
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Affiliation(s)
- Maria L Baeza
- Hospital General Universitario Gregorio Marañón, Allergy Section, Madrid, Spain; Biomedical Research Network on Rare Diseases (CIBERER, U761), Madrid, Spain; Institute for Health Research Gregorio Marañón, Madrid, Spain.
| | - Teresa González-Quevedo
- Hospital Universitario Virgen del Rocío, Allergy Section, Sevilla, Spain; Instituto de Biomedicina de Sevilla, Sevilla, Spain
| | - Teresa Caballero
- Hospital Universitario La Paz, Allergy Section, Madrid, Spain; Hospital La Paz Institute for Health Research (IdiPaz), Madrid, Spain; Biomedical Research Network on Rare Diseases (CIBERER, U754), Madrid, Spain
| | - Mar Guilarte
- Hospital Universitari Vall d'Hebron, Allergy Section, Barcelona, Spain; Vall d'Hebron Research Institute, Allergy Section, Barcelona, Spain
| | - Ramon Lleonart
- Hospital Universitario Bellvitge de L'Hospitalet de Llobregat, Allergy Section, Barcelona, Spain
| | - Susana Varela
- Complexo Hospitalario de Ourense, Allergy Section, Ourense, Spain
| | - Monica Castro
- Complejo Hospitalario Universitario de Ferrol, Allergy Section, Ferrol, Spain
| | - Carmen Díaz
- Hospital Universitario Central de Asturias, Allergy Section, Oviedo, Spain
| | - Elena Escudero
- Complejo Hospitalario de Pontevedra, Allergy Section, Pontevedra, Spain
| | - Marimar G García
- Complexo Hospitalario de Ourense, Allergy Section, Ourense, Spain
| | - Elena Laffond
- Complejo Asistencial Universitario de Salamanca, Allergy Section, Salamanca, Spain
| | | | - Ramon Núñez
- Hospital Universitario Lucus Augusti, Allergy Section, Lugo, Spain
| | - Nieves Prior
- Hospital Universitario Severo Ochoa de Leganés, Allergy Section, Madrid, Spain
| | - Anna Sala-Cunill
- Hospital Universitari Vall d'Hebron, Allergy Section, Barcelona, Spain; Vall d'Hebron Research Institute, Allergy Section, Barcelona, Spain
| | | | - Alicia Prieto-García
- Hospital General Universitario Gregorio Marañón, Allergy Section, Madrid, Spain; Institute for Health Research Gregorio Marañón, Madrid, Spain
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González-de-Olano D, Esteban-López MI, Alonso-Díaz-de-Durana MD, González-Mancebo E, Prieto-García A, Gandolfo-Cano M, Mohedano-Vicente E, Balugo-López V, Fiandor A, Mielgo-Ballesteros R, Vega-Castro A, García-Montero A, Orfao A, Escribano L, Álvarez-Twose I. Frequency of clonal mast cell diseases among patients presenting with anaphylaxis: A prospective study in 178 patients from 5 tertiary centers in Spain. J Allergy Clin Immunol Pract 2019; 7:2924-2926.e1. [PMID: 31146019 DOI: 10.1016/j.jaip.2019.05.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 05/08/2019] [Accepted: 05/17/2019] [Indexed: 01/01/2023]
Affiliation(s)
- David González-de-Olano
- Allergy Unit, Hospital de Fuenlabrada, Madrid, Spain; Spanish Network on Mastocytosis (REMA), Toledo and Salamanca, Spain.
| | | | | | | | | | | | | | | | - Ana Fiandor
- Allergy Department, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | | | - Arantza Vega-Castro
- Spanish Network on Mastocytosis (REMA), Toledo and Salamanca, Spain; Allergy Department, Hospital de Guadalajara, Madrid, Spain
| | - Andres García-Montero
- Spanish Network on Mastocytosis (REMA), Toledo and Salamanca, Spain; Cancer Research Center (IBMCC, CSIC-USAL), CIBERONC, IBSAL, Cytometry Service (NUCLEUS) and Department of Medicine, University of Salamanca, Salamanca, Spain
| | - Alberto Orfao
- Spanish Network on Mastocytosis (REMA), Toledo and Salamanca, Spain; Cancer Research Center (IBMCC, CSIC-USAL), CIBERONC, IBSAL, Cytometry Service (NUCLEUS) and Department of Medicine, University of Salamanca, Salamanca, Spain
| | - Luis Escribano
- Spanish Network on Mastocytosis (REMA), Toledo and Salamanca, Spain; Instituto de Estudios de Mastocitosis de Castilla La Mancha (CLMast), Hospital Virgen del Valle, and CIBERONC, Toledo, Spain
| | - Iván Álvarez-Twose
- Spanish Network on Mastocytosis (REMA), Toledo and Salamanca, Spain; Instituto de Estudios de Mastocitosis de Castilla La Mancha (CLMast), Hospital Virgen del Valle, and CIBERONC, Toledo, Spain
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García-Gutiérrez I, Acevedo M, Tornero P, Matilla A, Márquez L, Sánchez-Herrero A, Prieto-García A. Severe Maculopapular Exanthema Induced by Regorafenib: Successful Desensitization and Adaptation of a Dosage Regimen. J Investig Allergol Clin Immunol 2019; 29:300-302. [DOI: 10.18176/jiaci.0377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Prieto-García A, Noguerado B, Rojas P, Torrado I, Rodríguez-Fernández A, Tornero P. Unexpected Anaphylaxis After Completing a Desensitization Protocol to Oxaliplatin: Successful Adjuvant Use of Omalizumab. J Investig Allergol Clin Immunol 2019; 29:53-55. [PMID: 30785102 DOI: 10.18176/jiaci.0326] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- A Prieto-García
- Servicio de Alergia, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - B Noguerado
- Servicio de Alergia, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - P Rojas
- Servicio de Alergia, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - I Torrado
- Servicio de Alergia, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - A Rodríguez-Fernández
- Servicio de Alergia, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - P Tornero
- Servicio de Alergia, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
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8
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Basagaña M, Prieto-García A, Miquel S, Micozzi S, Bartolomé B, Labrador-Horrillo M, Roger A. Anaphylaxis Induced by Conlinin, a 2S Storage Protein in Flaxseed. J Investig Allergol Clin Immunol 2018; 28:56-58. [DOI: 10.18176/jiaci.0208] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Morales-Cabeza C, Roa-Medellín D, Torrado I, De Barrio M, Fernández-Álvarez C, Montes-Aceñero JF, De La Riva I, Prieto-García A. Immediate reactions to iodinated contrast media. Ann Allergy Asthma Immunol 2017; 119:553-557. [PMID: 29017901 DOI: 10.1016/j.anai.2017.08.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 08/16/2017] [Accepted: 08/21/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Immediate hypersensitivity reactions (IHRs) to iodinated contrast media (ICMs) remain a common clinical concern. Positive skin test and basophil activation test results suggest a specific IgE-mediated mechanism in some cases. Skin test and controlled challenge test (CCT) are useful to manage these patients. OBJECTIVE To study clinical and allergologic features of IHRs to ICMs in a Spanish tertiary hospital during a 7-year period. METHODS Demographic and clinical data concerning the reaction were recorded. Patients treated at the Allergy Department of Hospital General Universitario Gregorio Marañón, Madrid, Spain, underwent skin tests. In those with positive results, CCTs with an alternative skin-test-negative ICM was performed. Global reaction rate was calculated and compared for each ICM. RESULTS A total of 342 reactions occurred in 329 patients. Cutaneous symptoms were the most common (87.7%). A total of 196 patients underwent an allergy workup, 15 (7.6%) of whom had positive skin test results. Reactions were more severe in patients with positive vs negative skin test results (grade 1, 46.7% vs 73.6%; grade 2, 33.3% vs 20.9%; grade 3, 20% vs 5.46%; P < .05). Three patients had cross-reactivity to 3 ICMs, all including ioversol and iomeprol. Six patients allergic to iopamidol tolerated ioversol and 1 tolerated iomeprol. Four patients allergic to ioversol and 1 allergic to iomeprol tolerated iopamidol. The global reaction rate was 0.2%, differing for each ICM (iopamidol, 0.14%; ioversol, 0.2%; and iomeprol, 0.4%; P < .001). Positive skin test results were found in a low percentage of patients in whom skin test-based CCT identified an alternative non-cross-reactive ICM. Low-grade cross-reactivity was found, especially between iopamidol and ioversol. Reactions were more severe in patients with positive skin test results. The reaction rate was greater for iomeprol compared with iopamidol (reaction rate, 2.8%) and ioversol (reaction rate, 2%). CONCLUSION This study identified a possible underlying specific IgE-mediated mechanism by positive skin test result in a low percentage of patients with IHRs to ICMs. In these patients, the CCT based on skin test results was useful for identifying an alternative non-cross-reactive ICM. More studies are needed to investigate the underlying mechanism in patients with IHRs and negative skin test results.
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Affiliation(s)
| | - Dasha Roa-Medellín
- Allergy Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Inés Torrado
- Allergy Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Manuel De Barrio
- Allergy Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Carmen Fernández-Álvarez
- Quality Service, Radiology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Inmaculada De La Riva
- Quality Service, Radiology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Alicia Prieto-García
- Allergy Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
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10
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Prieto-García A, Pérez-David E, Devesa C, Tornero P, Schwartz LB, Pascual C, Castells MC. Fatal anaphylaxis caused by gadolinium due to beta-tryptase–induced hemorragic diathesis. The Journal of Allergy and Clinical Immunology: In Practice 2017. [DOI: 10.1016/j.jaip.2017.05.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Prieto-García A, Roa Medellín D, Baeza ML. Angioedema attacks related to endometrial hyperplasia in a case of estrogen-dependent factor XII hereditary angioedema. Ann Allergy Asthma Immunol 2017; 118:736-737. [PMID: 28476524 DOI: 10.1016/j.anai.2017.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 03/30/2017] [Accepted: 04/02/2017] [Indexed: 01/22/2023]
Affiliation(s)
- Alicia Prieto-García
- Allergy Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
| | - Dasha Roa Medellín
- Allergy Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Maria Luisa Baeza
- Allergy Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; Biomedical Research Network on Rare Diseases (CIBERER) U761, Madrid, Spain
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12
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Morales-Cabeza C, Prieto-García A, Acero S, Bartolomé-Zavala B, Morgado JM, Matito A, Sánchez-Muñoz L, Alvarez-Twose I. Systemic mastocytosis presenting as occupational IgE-mediated anaphylaxis to pine processionary caterpillar. Ann Allergy Asthma Immunol 2016; 117:333-334.e1. [PMID: 27474119 DOI: 10.1016/j.anai.2016.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 06/29/2016] [Accepted: 07/05/2016] [Indexed: 01/30/2023]
Affiliation(s)
| | - Alicia Prieto-García
- Allergy Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Health Research Institute Gregorio Marañón, Madrid, Spain
| | - Sara Acero
- Department of Allergy, Complejo Hospitalario de Ávila, Ávila, Spain
| | | | - José Mário Morgado
- Instituto de Estudios de Mastocitosis de Castilla La Mancha, Hospital Virgen del Valle, Toledo, Spain
| | - Almudena Matito
- Instituto de Estudios de Mastocitosis de Castilla La Mancha, Hospital Virgen del Valle, Toledo, Spain
| | - Laura Sánchez-Muñoz
- Instituto de Estudios de Mastocitosis de Castilla La Mancha, Hospital Virgen del Valle, Toledo, Spain
| | - Iván Alvarez-Twose
- Instituto de Estudios de Mastocitosis de Castilla La Mancha, Hospital Virgen del Valle, Toledo, Spain
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13
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Prieto-García A, Marcos C, Caballero T. Classification of angioedema without wheals. Ann Allergy Asthma Immunol 2016; 116:177. [PMID: 26815713 DOI: 10.1016/j.anai.2015.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 11/05/2015] [Indexed: 11/17/2022]
Affiliation(s)
- Alicia Prieto-García
- Department of Allergy, Hospital General Universitario Gregorio Marañón Health Research Institute Gregorio Marañón, Madrid, Spain.
| | - Carmen Marcos
- Department of Allergy, Complejo Hospitalario Universitario de Vigo, Vigo, Spain
| | - Teresa Caballero
- Department of Allergy, Complejo Hospitalario Universitario de Vigo, Vigo, Spain; Department of Allergy, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
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14
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Pedrosa M, Prieto-García A, Sala-Cunill A, Baeza ML, Cabañas R, Campos A, Cimbollek S, Gómez-Traseira C, González Quevedo T, Guilarte M, Jurado-Palomo J, Lobera T, López-Serrano MC, Marcos C, Piñero-Saavedra M, Prior N, Sáenz de San Pedro B, Ferrer M, Barceló JM, Daschner A, Echechipía M, Garcés M, Iriarte P, Jáuregui I, Lázaro M, Quiñones M, Veleiro B, Villareal O. Management of angioedema without urticaria in the emergency department. Ann Med 2014; 46:607-18. [PMID: 25580506 DOI: 10.3109/07853890.2014.949300] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Angioedema refers to a localized, transient swelling of the deep skin layers or the upper respiratory or gastrointestinal mucosa. It develops as a result of mainly two different vasoactive peptides, histamine or bradykinin. Pathophysiology, as well as treatment, is different in each case; nevertheless, the resulting signs and symptoms may be similar and difficult to distinguish. Angioedema may occur at any location. When the affected area involves the upper respiratory tract, both forms of angioedema can lead to an imminent upper airway obstruction and a life-threatening emergency. Emergency physicians must have a basic understanding of the pathophysiology underlying this process. Angioedema evaluation in the emergency department (ED) should aim to distinguish between histamine- and bradykinin-induced angioedema, in order to provide appropriate treatment to patients. However, diagnostic methods are not available at the ED setting, neither to confirm one mechanism or the other, nor to identify a cause. For this reason, the management of angioedema should rely on clinical data depending on the particular features of the episode and the patient in each case. The history-taking should be addressed to identify a possible etiology or triggering agent, recording complete information for an ulterior diagnostic study in the outpatient clinic. It is mandatory quickly to recognize and treat a potential life-threatening upper airway obstruction or anaphylaxis. This review focuses on the underlying mechanisms and management of histamine- and bradykinin-induced angioedema at the emergency department and provides an update on the currently available treatments.
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Affiliation(s)
- Maria Pedrosa
- Department of Allergy, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain.
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15
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Prieto-García A, Castells MC, Hansbro PM, Stevens RL. Mast cell-restricted tetramer-forming tryptases and their beneficial roles in hemostasis and blood coagulation. Immunol Allergy Clin North Am 2014; 34:263-81. [PMID: 24745673 DOI: 10.1016/j.iac.2014.01.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Tetramer-forming tryptase (hTryptase-β) was recently discovered to have a prominent role in preventing the internal accumulation of life-threatening fibrin deposits and fibrin-platelet clots. The anticoagulant activity of hTryptase-β is an explanation for the presence of hemorrhagic disorders in some patients with anaphylaxis or mastocytosis. The fragments of hFibrinogen formed by the proteolysis of this prominent protein by hTryptase-β could be used as biomarkers in the blood and/or urine for the identification and monitoring of patients with mast cell-dependent disorders. Recombinant hTryptase-β has potential to be used in clinical settings where it is desirable to inhibit blood coagulation.
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Affiliation(s)
- Alicia Prieto-García
- Allergy Service, Hospital Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Dr Esquerdo 46, Madrid 28007, Spain.
| | - Mariana C Castells
- Division of Rheumatology, Immunology, and Allergy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 1 Jimmy Fund Way, Smith Building, Boston, MA 02115, USA
| | - Philip M Hansbro
- Priority Research Centre for Asthma and Respiratory Disease, Hunter Medical Research Institute and University of Newcastle, 1 Kookaburra Circuit, Newcastle, NSW 2300, Australia
| | - Richard L Stevens
- Division of Rheumatology, Immunology, and Allergy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 1 Jimmy Fund Way, Smith Building, Boston, MA 02115, USA
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16
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Prieto-García A, Castells MC, Stevens RL. Mast cell-derived htryptase-beta functions as a potent anticoagulant by proteolytically damaging fibrinogen. J Investig Allergol Clin Immunol 2014; 24:286-287. [PMID: 25219118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
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17
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Prieto-García A, Tomás M, Pineda R, Tornero P, Herrero T, Fuentes V, Zapatero L, de Barrio M. Skin test-positive immediate hypersensitivity reaction to iodinated contrast media: the role of controlled challenge testing. J Investig Allergol Clin Immunol 2013; 23:183-189. [PMID: 23967757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Immediate hypersensitivity reactions (IHR) to iodinated contrast media (ICM) have traditionally been considered nonallergic; however, the increasingly frequent reporting of positive skin test and basophil activation test results suggests a specific allergic mechanism in some patients. Skin tests have been proposed as a useful tool for diagnosis, although their sensitivity and predictive values remain to be determined. The role of controlled challenge testing has not been assessed. OBJECTIVE We aimed to evaluate the role of controlled challenge testing in skin test-positive IHR to ICM. PATIENTS AND METHODS We evaluated 106 patients with IHR to ICM by performing skin tests with the agent that caused the reaction. Patients with a positive result were selected. Skin tests were extended to a series of 8 ICMs; 5 patients underwent controlled challenge test with an alternative skin test-negative ICM; a further 2 patients underwent computed tomography with an alternative skin test-negative ICM. No premedication was administered. RESULTS Intradermal test results were positive to the ICM that caused the reaction in 11 out of 106 patients (10.4%). Five of the 11 patients tolerated a controlled challenge test with an alternative skin test-negative ICM. The 2 patients who underwent computed tomography with an alternative skin test-negative ICM tolerated the medium. CONCLUSIONS Skin tests are useful for the diagnostic workup in patients with an allergic IHR to ICM. Since ICM cannot be avoided in many patients because they are irreplaceable in some diagnostic or therapeutic techniques, an alternative safe ICM should be investigated for future procedures. We propose the use of controlled challenge tests based on skin test results to address this need in skin test-positive reactions in order to identify an alternative non-cross-reactive ICM.
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Affiliation(s)
- A Prieto-García
- Allergy Service, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
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18
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Prieto-García A, Zheng D, Adachi R, Xing W, Lane WS, Chung K, Anderson P, Hansbro PM, Castells M, Stevens RL. Mast cell restricted mouse and human tryptase·heparin complexes hinder thrombin-induced coagulation of plasma and the generation of fibrin by proteolytically destroying fibrinogen. J Biol Chem 2012; 287:7834-44. [PMID: 22235124 DOI: 10.1074/jbc.m111.325712] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The mouse and human TPSB2 and TPSAB1 genes encode tetramer-forming tryptases stored in the secretory granules of mast cells (MCs) ionically bound to heparin-containing serglycin proteoglycans. In mice these genes encode mouse MC protease-6 (mMCP-6) and mMCP-7. The corresponding human genes encode a family of serine proteases that collectively are called hTryptase-β. We previously showed that the α chain of fibrinogen is a preferred substrate of mMCP-7. We now show that this plasma protein also is highly susceptible to degradation by hTryptase-β· and mMCP-6·heparin complexes and that Lys(575) is a preferred cleavage site in the protein α chain. Because cutaneous mouse MCs store substantial amounts of mMCP-6·heparin complexes in their secretory granules, the passive cutaneous anaphylaxis reaction was induced in the skin of mMCP-6(+)/mMCP-7(-) and mMCP-6(-)/mMCP-7(-) C57BL/6 mice. In support of the in vitro data, fibrin deposits were markedly increased in the skin of the double-deficient mice 6 h after IgE-sensitized animals were given the relevant antigen. Fibrinogen is a major constituent of the edema fluid that accumulates in tissues when MCs degranulate. Our discovery that mouse and human tetramer-forming tryptases destroy fibrinogen before this circulating protein can be converted to fibrin changes the paradigm of how MCs hinder fibrin deposition and blood coagulation internally. Because of the adverse consequences of fibrin deposits in tissues, our data explain why mice and humans lack a circulating protease inhibitor that rapidly inactivates MC tryptases and why mammals have two genes that encode tetramer-forming serine proteases that preferentially degrade fibrinogen.
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Affiliation(s)
- Alicia Prieto-García
- Department of Medicine, Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA
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de Benito V, de Barrio M, de López-Sáez MP, Ordoqui E, Prieto-García A, Sainza T, Baeza ML. Anaphylactic shock caused by impurities in orgotein preparations. Allergol Immunopathol (Madr) 2001; 29:272-5. [PMID: 11834186 DOI: 10.1016/s0301-0546(01)79069-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Previously reported allergic reactions to orgotein (superoxide dismutase) injections has assigned responsibility to this molecule, which is obtained from bovine liver. We report an anaphylactic shock probably caused by impurities contained in an orgotein preparation. Prick test to Peroxinorm (orgotein), BSA, and cow liver extract were positive but resulted negative with chymotrypsin, milk, meat and cow epithelium extracts. Tryptase levels determined 3, 24 hours and 15 days after the shock measured 6.32, 0.81 and 0.84 U/L respectively. Detection of specific IgE to Peroxinorm, BSA and chymotrypsin by ELISA was negative and positive to cow liver. Specific IgE to milk and cow epithelium by Pharmacia CAP system was negative. Immunoblotting with Peroxinorm revealed IgE specific bands at an apparent M.W of 67, 51, 56 and 16 kDa; immunoblotting with cow liver revealed bands at 72, 56, 50 and 36 kDa; immunoblotting with BSA and chymotypsin were negative. This case emphasises the role that 20 % of impurities of the pharmaceutical preparation may have in immediate hypersensitivity reactions.
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Affiliation(s)
- V de Benito
- Sección de Alergia, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
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