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Maurer M, Aberer W, Caballero T, Bouillet L, Grumach AS, Botha J, Andresen I, Longhurst HJ. The Icatibant Outcome Survey: 10 years of experience with icatibant for patients with hereditary angioedema. Clin Exp Allergy 2022; 52:1048-1058. [PMID: 35861129 DOI: 10.1111/cea.14206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 06/24/2022] [Accepted: 06/26/2022] [Indexed: 11/28/2022]
Abstract
In patients with hereditary angioedema (HAE), bradykinin causes swelling episodes by activating bradykinin B2 receptors. Icatibant, a selective bradykinin B2 receptor antagonist, is approved for on-demand treatment of HAE attacks. The Icatibant Outcome Survey (IOS; NCT01034969) is an ongoing observational registry initiated in 2009 to monitor effectiveness/safety of icatibant in routine clinical practice. As of March 2019, 549 patients with HAE type 1 or 2 from the IOS registry had been treated, for 5995 total attacks. This article reviews data published from IOS over time which have demonstrated that effectiveness of icatibant in a real-world setting is comparable to efficacy in clinical trials; one dose is effective for the majority of attacks; early treatment (facilitated by self-administration) leads to faster resolution and shorter attack duration; effectiveness/safety of icatibant has been shown across a broad range of patient subgroups, including children/adolescents and patients with HAE with normal C1 inhibitor levels; and tolerability has been demonstrated in patients aged ≥65 years. Additionally, this review highlights how IOS data have provided valuable insights into patients' diagnostic journeys and treatment behaviors across individual countries. Such findings have helped to inform clinical strategies and guidelines to optimize HAE management and limit disease burden. This research was sponsored by Takeda Development Center Americas, Inc. Takeda Development Center Americas, Inc., provided funding to Excel Medical Affairs for support in writing and editing this manuscript.
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Affiliation(s)
- M Maurer
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - W Aberer
- Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria
| | - T Caballero
- Department of Allergy, Hospital Universitario La Paz, Hospital La Paz Institute for Health Research (IdiPaz), Biomedical Research Network on Rare Diseases (CIBERER, U754), Madrid, Spain
| | - L Bouillet
- National Reference Centre for Angioedema, Internal Medicine Department, Grenoble University Hospital, Grenoble, France
| | - A S Grumach
- Clinical Immunology, Faculdade de Medicina, Centro Universitario Saude ABC, Santo Andre, Brazil
| | - J Botha
- Takeda Pharmaceuticals International AG, Zurich, Switzerland
| | - I Andresen
- Takeda Pharmaceuticals International AG, Zurich, Switzerland
| | - H J Longhurst
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, and University College London Hospitals, London, UK
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Maurer M, Caballero T, Aberer W, Zanichelli A, Bouillet L, Bygum A, Grumach AS, Botha J, Andresen I, Longhurst HJ. Variability of disease activity in patients with hereditary angioedema type 1/2: longitudinal data from the Icatibant Outcome Survey. J Eur Acad Dermatol Venereol 2021; 35:2421-2430. [PMID: 34506666 DOI: 10.1111/jdv.17654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 08/13/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Hereditary angioedema due to C1 inhibitor deficiency (HAE-1/2) is a chronic and debilitating disease. The unpredictable clinical course represents a significant patient burden. OBJECTIVE To analyse longitudinal registry data from the Icatibant Outcome Survey (IOS) in order to characterize temporal changes in disease activity in patients with HAE-1/2. METHODS Icatibant Outcome Survey (NCT01034969) is an international observational registry monitoring the clinical outcomes of patients eligible for icatibant treatment. The current analyses are based on data collected between July 2009 and July 2019. Retrospective data for attacks recorded in the 12 months prior to IOS enrolment and for each 12-month period up to 7 years were analysed. RESULTS Included patients reported angioedema attacks without long-term prophylaxis (LTP; n = 315) and with LTP (n = 292) use at the time of attack onset. Androgens were the most frequently used LTP option (80.8%). At the population level, regardless of LTP use, most patients (52-80%) reporting <5 attacks in Year 1 continued experiencing this rate; similarly, many patients (25-76%) who reported high attack frequency continued reporting ≥10 attacks/year. However, year on year, 31-51% of patients experienced notable changes (increase/decrease of ≥5 attacks) in annual attack frequency. Of patients who reported an absolute change of ≥10 attacks from Year 1 to 2, 17-50% continued to experience a change of this magnitude in subsequent years. CONCLUSION At the population level, attack frequency was generally consistent over 7 years. At the small group level, 28.8-34.5% of patients reported a change in attack frequency of ≥5 attacks from Year 1 to Year 2; up to half of these patients continued to experience this magnitude of variation in disease activity in later years, reflecting high intra-patient variability.
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Affiliation(s)
- M Maurer
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - T Caballero
- Department of Allergy, Hospital Universitario La Paz, Hospital La Paz Institute for Health Research (IdiPaz), Biomedical Research Network on Rare Diseases (CIBERER, U754), Madrid, Spain
| | - W Aberer
- Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria
| | - A Zanichelli
- Department of Internal Medicine, Ospedale Luigi Sacco, ASST Fatebenefratelli Sacco, University of Milan, Milan, Italy
| | - L Bouillet
- National Reference Centre for Angioedema, Internal Medicine Department, Grenoble University Hospital, Grenoble, France
| | - A Bygum
- Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Clinical Institute, University of Southern Denmark, Odense, Denmark
| | - A S Grumach
- Clinical Immunology, Medical School, University Center Health ABC, Santo Andre, Brazil
| | - J Botha
- Takeda Pharmaceuticals International AG, Zurich, Switzerland
| | - I Andresen
- Takeda Pharmaceuticals International AG, Zurich, Switzerland
| | - H J Longhurst
- Formerly Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.,Formerly University College London Hospitals, London, UK.,Auckland District Health Board, Auckland, New Zealand
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3
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Riedl MA, Maurer M, Bernstein JA, Banerji A, Longhurst HJ, Li HH, Lu P, Hao J, Juethner S, Lumry WR, Hébert J, Ritchie B, Sussman G, Yang WH, Escuriola Ettingshausen C, Magerl M, Martinez‐Saguer I, Maurer M, Staubach P, Zimmer S, Cicardi M, Perego F, Wu MA, Zanichelli A, Al‐Ghazawi A, Shennak M, Zaragoza‐Urdaz RH, Ghurye R, Longhurst HJ, Zinser E, Anderson J, Banerji A, Baptist AP, Bernstein JA, Boggs PB, Busse PJ, Christiansen S, Craig T, Davis‐Lorton M, Gierer S, Gower RG, Harris D, Hong DI, Jacobs J, Johnston DT, Levitch ES, Li HH, Lockey RF, Lugar P, Lumry WR, Manning ME, McNeil DL, Melamed I, Mostofi T, Nickel T, Otto WR, Petrov AA, Poarch K, Radojicic C, Rehman SM, Riedl MA, Schwartz LB, Shapiro R, Sher E, Smith AM, Smith TD, Soteres D, Tachdjian R, Wedner HJ, Weinstein ME, Zafra H, Zuraw BL. Lanadelumab demonstrates rapid and sustained prevention of hereditary angioedema attacks. Allergy 2020; 75:2879-2887. [PMID: 32452549 PMCID: PMC7689768 DOI: 10.1111/all.14416] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 04/15/2020] [Accepted: 04/20/2020] [Indexed: 02/06/2023]
Abstract
Background Lanadelumab demonstrated efficacy in preventing hereditary angioedema (HAE) attacks in the phase 3 HELP Study. Objective To assess time to onset of effect and long‐term efficacy of lanadelumab, based on exploratory findings from the HELP Study. Methods Eligible patients with HAE type I/II received lanadelumab 150 mg every 4 weeks (q4wks), 300 mg q4wks, 300 mg q2wks, or placebo. Ad hoc analyses evaluated day 0‐69 findings using a Poisson regression model accounting for overdispersion. Least‐squares mean monthly HAE attack rate for lanadelumab was compared with placebo. Intrapatient comparisons for days 0‐69 versus steady state (days 70‐182) used a paired t test for continuous endpoints or Kappa statistics for categorical endpoints. Results One hundred twenty‐five patients were randomized and treated. During days 0‐69, mean monthly attack rate was significantly lower with lanadelumab (0.41‐0.76) vs placebo (2.04), including attacks requiring acute treatment (0.33‐0.61 vs 1.66) and moderate/severe attacks (0.31‐0.48 vs 1.33, all P ≤ .001). More patients receiving lanadelumab vs placebo were attack free (37.9%‐48.1% vs 7.3%) and responders (85.7%‐100% vs 26.8%). During steady state, the efficacy of lanadelumab vs placebo was similar or improved vs days 0‐69. Intrapatient differences were significant with lanadelumab 300 mg q4wks for select outcomes. Lanadelumab efficacy was durable—HAE attack rate was consistently lower vs placebo, from the first 2 weeks of treatment through study end. Treatment emergent adverse events were comparable during days 0‐69 and 70‐182. Conclusion Protection with lanadelumab started from the first dose and continued throughout the entire study period.
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Affiliation(s)
- Marc A. Riedl
- Division of Rheumatology, Allergy and Immunology University of California, San Diego San Diego CA USA
| | - Marcus Maurer
- Dermatological Allergology Allergie‐Centrum‐Charité Department of Dermatology and Allergy Charité – Universitätsmedizin Berlin Berlin Germany
| | - Jonathan A. Bernstein
- Division of Immunology/Allergy Section Department of Internal Medicine University of Cincinnati Cincinnati OH USA
- Bernstein Clinical Research Center Cincinnati OH USA
| | - Aleena Banerji
- Division of Rheumatology, Allergy and Immunology Department of Medicine Massachusetts General Hospital Harvard Medical School Boston MA USA
| | - Hilary J. Longhurst
- Addenbrooke's Hospital Cambridge University Hospitals NHS Foundation Trust, Cambridge and University College London Hospitals London UK
| | - H. Henry Li
- Institute for Asthma and Allergy, P.C. Chevy Chase MD USA
| | - Peng Lu
- Shire, a Takeda company Lexington MA USA
| | - James Hao
- Shire, a Takeda company Lexington MA USA
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Shillitoe B, Bangs C, Guzman D, Gennery AR, Longhurst HJ, Slatter M, Edgar DM, Thomas M, Worth A, Huissoon A, Arkwright PD, Jolles S, Bourne H, Alachkar H, Savic S, Kumararatne DS, Patel S, Baxendale H, Noorani S, Yong PFK, Waruiru C, Pavaladurai V, Kelleher P, Herriot R, Bernatonienne J, Bhole M, Steele C, Hayman G, Richter A, Gompels M, Chopra C, Garcez T, Buckland M. The United Kingdom Primary Immune Deficiency (UKPID) registry 2012 to 2017. Clin Exp Immunol 2019; 192:284-291. [PMID: 29878323 DOI: 10.1111/cei.13125] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2018] [Indexed: 01/25/2023] Open
Abstract
This is the second report of the United Kingdom Primary Immunodeficiency (UKPID) registry. The registry will be a decade old in 2018 and, as of August 2017, had recruited 4758 patients encompassing 97% of immunology centres within the United Kingdom. This represents a doubling of recruitment into the registry since we reported on 2229 patients included in our first report of 2013. Minimum PID prevalence in the United Kingdom is currently 5·90/100 000 and an average incidence of PID between 1980 and 2000 of 7·6 cases per 100 000 UK live births. Data are presented on the frequency of diseases recorded, disease prevalence, diagnostic delay and treatment modality, including haematopoietic stem cell transplantation (HSCT) and gene therapy. The registry provides valuable information to clinicians, researchers, service commissioners and industry alike on PID within the United Kingdom, which may not otherwise be available without the existence of a well-established registry.
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Affiliation(s)
- B Shillitoe
- On behalf of the UKPIN Registry Committee, UKPIN, London, UK.,Great North Children's Hospital, Newcastle upon Tyne, UK.,Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - C Bangs
- On behalf of the UKPIN Registry Committee, UKPIN, London, UK.,Manchester University NHS Foundation Trust, Manchester, UK
| | - D Guzman
- On behalf of the UKPIN Registry Committee, UKPIN, London, UK.,UCL Centre for Immunodeficiency, Royal Free Hospital, London, UK
| | - A R Gennery
- On behalf of the UKPIN Registry Committee, UKPIN, London, UK.,Great North Children's Hospital, Newcastle upon Tyne, UK.,Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - H J Longhurst
- Addenbrooke's Hospital, Cambridge Universities NHS Foundation Trust, Cambridge, UK
| | - M Slatter
- Great North Children's Hospital, Newcastle upon Tyne, UK.,Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | | | - M Thomas
- NHS Greater Glasgow and Clyde, Glasgow, UK
| | - A Worth
- On behalf of the UKPIN Registry Committee, UKPIN, London, UK.,Great Ormond Street Hospital and Institute of Child Health, London, UK
| | - A Huissoon
- Heart of England NHS Foundation Trust, Birmingham, Birmingham, UK
| | - P D Arkwright
- Manchester University NHS Foundation Trust, Manchester, UK
| | - S Jolles
- University Hospital of Wales, Cardiff, UK
| | - H Bourne
- The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - H Alachkar
- Salford Royal NHS Foundation Trust, Salford, UK
| | - S Savic
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - D S Kumararatne
- Addenbrooke's Hospital, Cambridge Universities NHS Foundation Trust, Cambridge, UK
| | - S Patel
- John Radcliffe Hospital, Headington, Oxford, UK
| | - H Baxendale
- Papworth NHS Foundation Trust, Cambridge, UK
| | - S Noorani
- Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - P F K Yong
- Frimley Health NHS Foundation Trust, Frimley, UK
| | - C Waruiru
- Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - V Pavaladurai
- Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - P Kelleher
- Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | | | - J Bernatonienne
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - M Bhole
- The Dudley Group NHS Foundation Trust, Dudley, UK
| | | | - G Hayman
- Epsom and St Helier University Hospitals NHS Trust, St Helier, UK
| | - A Richter
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - M Gompels
- North Bristol NHS Trust, Southmead Hospital, Bristol, UK
| | | | - T Garcez
- Manchester University NHS Foundation Trust, Manchester, UK
| | - M Buckland
- On behalf of the UKPIN Registry Committee, UKPIN, London, UK.,UCL Centre for Immunodeficiency, Royal Free Hospital, London, UK.,Great Ormond Street Hospital and Institute of Child Health, London, UK
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Evans C, Bateman E, Steven R, Ponsford M, Cullinane A, Shenton C, Duthie G, Conlon C, Jolles S, Huissoon AP, Longhurst HJ, Rahman T, Scott C, Wallis G, Harding S, Parker AR, Ferry BL. Measurement of Typhi Vi antibodies can be used to assess adaptive immunity in patients with immunodeficiency. Clin Exp Immunol 2018; 192:292-301. [PMID: 29377063 PMCID: PMC5980364 DOI: 10.1111/cei.13105] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2017] [Indexed: 02/06/2023] Open
Abstract
Vaccine‐specific antibody responses are essential in the diagnosis of antibody deficiencies. Responses to Pneumovax II are used to assess the response to polysaccharide antigens, but interpretation may be complicated. Typhim Vi®, a polysaccharide vaccine for Salmonella typhoid fever, may be an additional option for assessing humoral responses in patients suspected of having an immunodeficiency. Here we report a UK multi‐centre study describing the analytical and clinical performance of a Typhi Vi immunoglobulin (Ig)G enzyme‐linked immunosorbent assay (ELISA) calibrated to an affinity‐purified Typhi Vi IgG preparation. Intra‐ and interassay imprecision was low and the assay was linear, between 7·4 and 574 U/ml (slope = 0·99–1·00; R2 > 0·99); 71% of blood donors had undetectable Typhi Vi IgG antibody concentrations. Of those with antibody concentrations > 7·4 U/ml, the concentration range was 7·7–167 U/ml. In antibody‐deficient patients receiving antibody replacement therapy the median Typhi Vi IgG antibody concentrations were < 25 U/ml. In vaccinated normal healthy volunteers, the median concentration post‐vaccination was 107 U/ml (range 31–542 U/ml). Eight of eight patients (100%) had post‐vaccination concentration increases of at least threefold and six of eight (75%) of at least 10‐fold. In an antibody‐deficient population (n = 23), only 30% had post‐vaccination concentration increases of at least threefold and 10% of at least 10‐fold. The antibody responses to Pneumovax II and Typhim Vi® correlated. We conclude that IgG responses to Typhim Vi® vaccination can be measured using the VaccZyme Salmonella typhi Vi IgG ELISA, and that measurement of these antibodies maybe a useful additional test to accompany Pneumovax II responses for the assessment of antibody deficiencies.
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Affiliation(s)
- C Evans
- Clinical Immunology Laboratory, Oxford University Hospitals Foundation Trust, Oxford, UK
| | - E Bateman
- Clinical Immunology Laboratory, Oxford University Hospitals Foundation Trust, Oxford, UK
| | - R Steven
- Immunodeficiency Centre for Wales, University Hospital of Wales, Cardiff, UK
| | - M Ponsford
- Immunodeficiency Centre for Wales, University Hospital of Wales, Cardiff, UK
| | - A Cullinane
- Clinical Immunology Laboratory, Oxford University Hospitals Foundation Trust, Oxford, UK
| | - C Shenton
- Clinical Immunology Laboratory, Oxford University Hospitals Foundation Trust, Oxford, UK
| | - G Duthie
- Infectious Disease Department, Oxford University Hospitals Foundation Trust, Oxford, UK
| | - C Conlon
- Infectious Disease Department, Oxford University Hospitals Foundation Trust, Oxford, UK
| | - S Jolles
- Immunodeficiency Centre for Wales, University Hospital of Wales, Cardiff, UK
| | - A P Huissoon
- West Midlands Primary Immunodeficiency Centre, Birmingham Heartlands Hospital, Birmingham, UK
| | - H J Longhurst
- Department of Immunology, Barts Health NHS Trust, London, UK
| | - T Rahman
- Department of Immunology, Barts Health NHS Trust, London, UK
| | - C Scott
- Department of Immunology, Barts Health NHS Trust, London, UK
| | - G Wallis
- Binding Site Group Limited, Birmingham, UK
| | - S Harding
- Binding Site Group Limited, Birmingham, UK
| | - A R Parker
- Binding Site Group Limited, Birmingham, UK
| | - B L Ferry
- Clinical Immunology Laboratory, Oxford University Hospitals Foundation Trust, Oxford, UK
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Caballero T, Maurer M, Longhurst HJ, Aberer W, Bouillet L, Fabien V. Triggers and Prodromal Symptoms of Angioedema Attacks in Patients With Hereditary Angioedema. J Investig Allergol Clin Immunol 2017; 26:383-386. [PMID: 27996949 DOI: 10.18176/jiaci.0102] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- T Caballero
- Allergy Department, Hospital La Paz Institute for Health Research (IdiPaz), Biomedical Research Network on Rare Diseases (CIBERER, U754), Madrid, Spain
| | - M Maurer
- Department of Dermatology and Allergy, Allergie-Centrum- Charité, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - H J Longhurst
- Department of Immunology, Barts Health NHS Trust, London, UK
| | - W Aberer
- Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria
| | - L Bouillet
- National Reference Centre for Angioedema, Internal Medicine Department, Grenoble University Hospital, Grenoble, France
| | - V Fabien
- Shire, Zug, Switzerland.,At the time of data analysis. Now with Vifor Pharma, Glattbrugg, Switzerland
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Zanichelli A, Maurer M, Aberer W, Caballero T, Longhurst HJ, Bouillet L, Fabien V, Andresen I. Long-term safety of icatibant treatment of patients with angioedema in real-world clinical practice. Allergy 2017; 72:994-998. [PMID: 27926986 PMCID: PMC5434903 DOI: 10.1111/all.13103] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2016] [Indexed: 11/25/2022]
Abstract
The Icatibant Outcome Survey (IOS) is an observational study monitoring safety and effectiveness of icatibant in the real‐world setting. We analyzed safety data from 3025 icatibant‐treated attacks in 557 patients (enrolled between July 2009 and February 2015). Icatibant was generally well tolerated. Excluding off‐label use and pregnancy, 438 patients (78.6%) did not report adverse events (AEs). The remaining 119 (21.4%) patients reported 341 AEs, primarily gastrointestinal disorders (19.6%). Of these, 43 AEs in 17 patients (3.1%) were related to icatibant. Serious AEs (SAEs) occurred infrequently. A total of 143 SAEs occurred in 59 (10.6%) patients; only three events (drug inefficacy, gastritis, and reflux esophagitis) in two patients were considered related to icatibant. Notably, no SAEs related to icatibant occurred in patients with cardiovascular disease, nor in those using icatibant at a frequency above label guidelines. Additionally, no major differences were noted in AEs occurring in on‐label vs off‐label icatibant users.
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Affiliation(s)
- A. Zanichelli
- Department of Biomedical and Clinical Sciences Luigi Sacco; University of Milan; ASST Fatebenefratelli Sacco; Milan Italy
| | - M. Maurer
- Department of Dermatology and Allergy; Charité-Universitätsmedizin Berlin; Berlin Germany
| | - W. Aberer
- Department of Dermatology and Venerology; Medical University of Graz; Graz Austria
| | - T. Caballero
- Department of Allergy; Hospital La Paz Institute for Health Research (IdiPaz); Biomedical Research Network on Rare Diseases (CIBERER, U754); Madrid Spain
| | | | - L. Bouillet
- National Reference Centre for Angioedema; Internal Medicine Department; Grenoble University Hospital; Grenoble France
| | - V. Fabien
- Shire; Zug Switzerland at time of data analysis; now with Vifor Pharma, Glattbrugg, Switzerland
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8
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Caballero T, Aberer W, Longhurst HJ, Maurer M, Zanichelli A, Perrin A, Bouillet L, Andresen I. The Icatibant Outcome Survey: experience of hereditary angioedema management from six European countries. J Eur Acad Dermatol Venereol 2017; 31:1214-1222. [PMID: 28370444 PMCID: PMC5575527 DOI: 10.1111/jdv.14251] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 03/07/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Hereditary angioedema (HAE) due to C1-inhibitor deficiency (C1-INH-HAE) is a rare, potentially fatal, bradykinin-mediated disease. Icatibant is a bradykinin B2 receptor antagonist originally approved in 2008 in the European Union and 2011 in the United States as an acute therapy option for HAE attacks in adults. OBJECTIVE To compare demographics, disease characteristics and treatment outcomes of icatibant-treated HAE attacks in patients with C1-INH-HAE enrolled in the Icatibant Outcome Survey across six European countries: Austria, France, Germany, Italy, Spain and the UK. METHODS The Icatibant Outcome Survey [IOS; Shire, Zug, Switzerland (NCT01034969)] is an international observational study monitoring the safety and effectiveness of icatibant. Descriptive, retrospective analyses compared IOS country data derived during July 2009-April 2015. RESULTS Overall, 481 patients with C1-INH-HAE provided demographic data. A significant difference across countries in age at onset (P = 0.003) and baseline attack frequency (P < 0.001) was found although no significant differences were found with respect to gender (majority female; P = 0.109), age at diagnosis (P = 0.182) or delay in diagnosis (P = 0.059). Icatibant was used to treat 1893 attacks in 325 patients with majority self-administration in all countries. Overall, significant differences (all P < 0.001) were found across countries in time to treatment [median 1.8 h; median range: 0.0 (Germany-Austria) to 4.4 (France) h], time to resolution [median 6.5 h; median range: 3 (Germany-Austria) to 12 (France) h] and attack duration [median 10.5 h; median range: 3.1 (Germany-Austria) to 18.5 (France) h]. CONCLUSION These data form the first European cross-country comparison of disease characteristics and icatibant use in patients with C1-INH-HAE who are enrolled in IOS. International variation in icatibant practice and treatment outcomes across the six European countries assessed highlight the need to further investigate the range of country-specific parameters driving regional variations in icatibant use.
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Affiliation(s)
- T Caballero
- Allergy Department, Hospital La Paz Institute for Health Research (IdiPaz), Biomedical Research Network on Rare Diseases (CIBERER, U754), Madrid, Spain
| | - W Aberer
- Department of Dermatology and Venerology, Medical University of Graz, Graz, Austria
| | - H J Longhurst
- Department of Immunology, Barts Health NHS Trust, London, UK
| | - M Maurer
- Department of Dermatology and Allergy, Allergy Center Charité, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - A Zanichelli
- Department of Biomedical and Clinical Science, Luigi Sacco Hospital, Milan, Italy
| | | | - L Bouillet
- Internal Medicine Department, National Reference Centre for Angioedema, Grenoble University Hospital, Grenoble, France
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Longhurst HJ, Zanichelli A, Caballero T, Bouillet L, Aberer W, Maurer M, Fain O, Fabien V, Andresen I. Comparing acquired angioedema with hereditary angioedema (types I/II): findings from the Icatibant Outcome Survey. Clin Exp Immunol 2017; 188:148-153. [PMID: 27936514 PMCID: PMC5343339 DOI: 10.1111/cei.12910] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2016] [Indexed: 11/26/2022] Open
Abstract
Icatibant is used to treat acute hereditary angioedema with C1 inhibitor deficiency types I/II (C1-INH-HAE types I/II) and has shown promise in angioedema due to acquired C1 inhibitor deficiency (C1-INH-AAE). Data from the Icatibant Outcome Survey (IOS) were analysed to evaluate the effectiveness of icatibant in the treatment of patients with C1-INH-AAE and compare disease characteristics with those with C1-INH-HAE types I/II. Key medical history (including prior occurrence of attacks) was recorded upon IOS enrolment. Thereafter, data were recorded retrospectively at approximately 6-month intervals during patient follow-up visits. In the icatibant-treated population, 16 patients with C1-INH-AAE had 287 attacks and 415 patients with C1-INH-HAE types I/II had 2245 attacks. Patients with C1-INH-AAE versus C1-INH-HAE types I/II were more often male (69 versus 42%; P = 0·035) and had a significantly later mean (95% confidence interval) age of symptom onset [57·9 (51·33-64·53) versus 14·0 (12·70-15·26) years]. Time from symptom onset to diagnosis was significantly shorter in patients with C1-INH-AAE versus C1-INH-HAE types I/II (mean 12·3 months versus 118·1 months; P = 0·006). Patients with C1-INH-AAE showed a trend for higher occurrence of attacks involving the face (35 versus 21% of attacks; P = 0·064). Overall, angioedema attacks were more severe in patients with C1-INH-HAE types I/II versus C1-INH-AAE (61 versus 40% of attacks were classified as severe to very severe; P < 0·001). Median total attack duration was 5·0 h and 9·0 h for patients with C1-INH-AAE versus C1-INH-HAE types I/II, respectively.
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Affiliation(s)
- H J Longhurst
- Department of Immunology, Barts Health NHS Trust, London, UK
| | - A Zanichelli
- Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Luigi Sacco Hospital Milan, Milan, Italy
| | - T Caballero
- Department of Allergy, Hospital La Paz Institute for Health Research (IdiPaz), Biomedical Research Network on Rare Diseases (CIBERER, U754), Madrid, Spain
| | - L Bouillet
- National Reference Centre for Angioedema, Internal Medicine Department, Grenoble University Hospital, Grenoble, France
| | - W Aberer
- Department of Dermatology and Venerology, Medical University of Graz, Graz, Austria
| | - M Maurer
- Department of Dermatology and Allergy, Allergie-Centrum-Charité, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - O Fain
- Department of Internal Medicine, DHU i2B, Saint Antoine Hospital, University Paris 6, Paris, France
| | - V Fabien
- Shire, Zug, Switzerland at the time of data analysis. Now with Vifor Pharma, Glattbrugg, Switzerland
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Zuraw BL, Cicardi M, Longhurst HJ, Bernstein JA, Li HH, Magerl M, Martinez‐Saguer I, Rehman SMM, Staubach P, Feuersenger H, Parasrampuria R, Sidhu J, Edelman J, Craig T. Phase II study results of a replacement therapy for hereditary angioedema with subcutaneous C1-inhibitor concentrate. Allergy 2015; 70:1319-28. [PMID: 26016741 PMCID: PMC4755045 DOI: 10.1111/all.12658] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Hereditary angioedema (HAE) due to C1 inhibitor deficiency manifests as recurrent swelling attacks that can be disabling and sometimes fatal. Long-term prophylaxis with twice-weekly intravenous injections of plasma-derived C1-inhibitor (pdC1-INH) has been established as an effective treatment. Subcutaneous (SC) administration of pdC1-INH has not been studied in patients with HAE. METHODS This open-label, dose-ranging, crossover study (COMPACT Phase II) was conducted in 18 patients with type I or II HAE who received two of twice-weekly 1500, 3000, or 6000 IU SC doses of highly concentrated volume-reduced CSL830 for 4 weeks each. The mean trough plasma levels of C1-INH functional activity, C1-INH and C4 antigen levels during Week 4, and overall safety and tolerability were evaluated. The primary outcome was model-derived steady-state trough C1-INH functional activity. RESULTS After SC CSL830 administration, a dose-dependent increase in trough functional C1-INH activity was observed. C1-INH and C4 levels both increased. The two highest dose groups (3000 and 6000 IU) achieved constant C1-INH activity levels above 40% values, a threshold that was assumed to provide clinical protection against angioedema attacks. Compared with intravenous injection, pdC1-INH SC injection with CSL830 showed a lower peak-to-trough ratio and more consistent exposures. All doses were well tolerated. Mild-to-moderate local site reactions were noted with pain and swelling being the most common adverse event. CONCLUSIONS Subcutaneous volume-reduced CSL830 was well tolerated and led to a dose-dependent increase in physiologically relevant functional C1-INH plasma levels. A clinical outcome study of SC CSL830 in patients with HAE warrants further investigation.
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Affiliation(s)
- B. L. Zuraw
- Department of Medicine University of California, San Diego La Jolla CA USA
| | - M. Cicardi
- Department of Internal Medicine Universita degli Studi di Milano Ospedale L. Sacco Milan Italy
| | | | - J. A. Bernstein
- Department of Immunology/Allergy University of Cincinnati College of Medicine Cincinnati OH USA
| | - H. H. Li
- Institute for Asthma and Allergy Chevy Chase MD USA
| | - M. Magerl
- Charité, Universitätsmedizin Berlin Berlin Germany
| | | | | | | | | | | | - J. Sidhu
- CSL Limited Parkville Vic. Australia
| | | | - T. Craig
- Departments of Medicine and Pediatrics Penn State University Hershey PA USA
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11
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Duraisingham SS, Manson A, Grigoriadou S, Buckland M, Tong CYW, Longhurst HJ. Immune deficiency: changing spectrum of pathogens. Clin Exp Immunol 2015; 181:267-74. [PMID: 25677249 PMCID: PMC4516442 DOI: 10.1111/cei.12600] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Revised: 01/15/2015] [Accepted: 01/19/2015] [Indexed: 11/28/2022] Open
Abstract
Current UK national standards recommend routine bacteriology surveillance in severe antibody-deficient patients, but less guidance exists on virology screening and viral infections in these patients. In this retrospective audit, we assessed the proportion of positive virology or bacteriology respiratory and stool samples from patients with severe, partial or no immune deficiency during a 2-year period. Medical notes were reviewed to identify symptomatic viral infections and to describe the course of persistent viral infections. During the 2-year period, 31 of 78 (39·7%) severe immune-deficient patients tested had a positive virology result and 89 of 160 (55.6%) had a positive bacteriology result. The most commonly detected pathogens were rhinovirus (12 patients), norovirus (6), Haemophilus influenzae (24), Pseudomonas spp. (22) and Staphylococcus aureus (21). Ninety-seven per cent of positive viral detection samples were from patients who were symptomatic. Low serum immunoglobulin IgA levels were more prevalent in patients with a positive virology sample compared to the total cohort (P = 0·0078). Three patients had persistent norovirus infection with sequential positive isolates for 9, 30 and 16 months. Virology screening of symptomatic antibody-deficient patients may be useful as a guide to anti-microbial treatment. A proportion of these patients may experience persistent viral infections with significant morbidity.
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Affiliation(s)
| | - A Manson
- Immunology Department, Barts Health NHS Trust, London, UK
| | - S Grigoriadou
- Immunology Department, Barts Health NHS Trust, London, UK
| | - M Buckland
- Immunology Department, Barts Health NHS Trust, London, UK
| | - C Y W Tong
- Department of Infection, Barts Health NHS Trust, London, UK
| | - H J Longhurst
- Immunology Department, Barts Health NHS Trust, London, UK
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12
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Longhurst HJ, Tarzi MD, Ashworth F, Bethune C, Cale C, Dempster J, Gompels M, Jolles S, Seneviratne S, Symons C, Price A, Edgar D. C1 inhibitor deficiency: 2014 United Kingdom consensus document. Clin Exp Immunol 2015; 180:475-83. [PMID: 25605519 PMCID: PMC4449776 DOI: 10.1111/cei.12584] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2014] [Indexed: 12/18/2022] Open
Abstract
C1 inhibitor deficiency is a rare disorder manifesting with recurrent attacks of disabling and potentially life-threatening angioedema. Here we present an updated 2014 United Kingdom consensus document for the management of C1 inhibitor-deficient patients, representing a joint venture between the United Kingdom Primary Immunodeficiency Network and Hereditary Angioedema UK. To develop the consensus, we assembled a multi-disciplinary steering group of clinicians, nurses and a patient representative. This steering group first met in 2012, developing a total of 48 recommendations across 11 themes. The statements were distributed to relevant clinicians and a representative group of patients to be scored for agreement on a Likert scale. All 48 statements achieved a high degree of consensus, indicating strong alignment of opinion. The recommendations have evolved significantly since the 2005 document, with particularly notable developments including an improved evidence base to guide dosing and indications for acute treatment, greater emphasis on home therapy for acute attacks and a strong focus on service organization.
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Affiliation(s)
- H J Longhurst
- Department of Immunology, Barts Health NHS Trust and Medical Adviser HAE, UK
| | - M D Tarzi
- Department of Medicine, Brighton and Sussex Medical School, Brighton, UK
| | - F Ashworth
- Department of Immunology, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - C Bethune
- Department of Immunology, Plymouth Hospitals NHS Trust, Plymouth, UK
| | - C Cale
- Department of Immunology, Great Ormond Street Hospital for Children, London, UK
| | - J Dempster
- Department of Immunology, Barts Health NHS Trust and Medical Adviser HAE, UK
| | - M Gompels
- Department of Immunology, North Bristol NHS Trust, Bristol, UK
| | - S Jolles
- Department of Immunology, University Hospital of Wales, Cardiff, UK
| | - S Seneviratne
- Department of Immunology, Royal Free London NHS Trust, London, UK
| | - C Symons
- Department of Immunology, Plymouth Hospitals NHS Trust, Plymouth, UK
| | - A Price
- Herditary Angioedema, UK (HAE UK)
| | - D Edgar
- UK Primary Immunodeficiency Network (UK PIN), Newcastle upon Tyne, UK
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13
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Makatsori M, Kiani-Alikhan S, Manson AL, Verma N, Leandro M, Gurugama NP, Longhurst HJ, Grigoriadou S, Buckland M, Kanfer E, Hanson S, Ibrahim MAA, Grimbacher B, Chee R, Seneviratne SL. Hypogammaglobulinaemia after rituximab treatment-incidence and outcomes. QJM 2014; 107:821-8. [PMID: 24778295 DOI: 10.1093/qjmed/hcu094] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Rituximab, a chimeric monoclonal antibody against CD20, is increasingly used in the treatment of B-cell lymphomas and autoimmune conditions. Transient peripheral B-cell depletion is expected following rituximab therapy. Although initial clinical trials did not show significant hypogammaglobulinaemia, reports of this are now appearing in the literature. METHODS We performed a retrospective review of patients previously treated with rituximab that were referred to Clinical Immunology with symptomatic or severe hypogammaglobulinaemia. Patient clinical histories, immunological markers, length of rituximab treatment and need for intravenous immunoglobulin replacement therapy (IVIG) were evaluated. An audit of patients receiving rituximab for any condition in a 12-month period and frequency of hypogammaglobulinaemia was also carried out. RESULTS We identified 19 post-rituximab patients with persistent, symptomatic panhypogammaglobulinaemia. Mean IgG level was 3.42 ± 0.4 g/l (normal range 5.8-16.3 g/l). All patients had reduced or absent B-cells. Haemophilus Influenzae B, tetanus and Pneumococcal serotype-specific antibody levels were all reduced and patients failed to mount an immune response post-vaccination. Nearly all of them ultimately required IVIG. The mean interval from the last rituximab dose and need for IVIG was 36 months (range 7 months-7 years). Of note, 23.7% of 114 patients included in the audit had hypogammaglobulinaemia. CONCLUSION With the increasing use of rituximab, it is important for clinicians treating these patients to be aware of hypogammaglobulinaemia and serious infections occurring even years after completion of treatment and should be actively looked for during follow-up. Referral to clinical immunology services and, if indicated, initiation of IVIG should be considered.
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Affiliation(s)
- M Makatsori
- From the Allergy Department, Royal Brompton and Harefield NHS Trust, London, UK, Department of Immunology, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK, Department of Immunology, Barts Health NHS Trust, London, UK, Department of Immunology, Royal Free London NHS Foundation Trust, London, UK, Department of Rheumatology, University College London Hospital, London, UK, King's College London, King's Health Partners, King's College Hospital NHS Foundation Trust, School of Medicine, Division of Asthma, Allergy & Lung Biology, Department of Immunological Medicine, London, UK, Department of Haematology, Imperial College Healthcare NHS Trust, London, UK and Center for Chronic Immunodeficiency, University Medical Center Freiburg, Freiburg, Germany
| | - S Kiani-Alikhan
- From the Allergy Department, Royal Brompton and Harefield NHS Trust, London, UK, Department of Immunology, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK, Department of Immunology, Barts Health NHS Trust, London, UK, Department of Immunology, Royal Free London NHS Foundation Trust, London, UK, Department of Rheumatology, University College London Hospital, London, UK, King's College London, King's Health Partners, King's College Hospital NHS Foundation Trust, School of Medicine, Division of Asthma, Allergy & Lung Biology, Department of Immunological Medicine, London, UK, Department of Haematology, Imperial College Healthcare NHS Trust, London, UK and Center for Chronic Immunodeficiency, University Medical Center Freiburg, Freiburg, Germany
| | - A L Manson
- From the Allergy Department, Royal Brompton and Harefield NHS Trust, London, UK, Department of Immunology, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK, Department of Immunology, Barts Health NHS Trust, London, UK, Department of Immunology, Royal Free London NHS Foundation Trust, London, UK, Department of Rheumatology, University College London Hospital, London, UK, King's College London, King's Health Partners, King's College Hospital NHS Foundation Trust, School of Medicine, Division of Asthma, Allergy & Lung Biology, Department of Immunological Medicine, London, UK, Department of Haematology, Imperial College Healthcare NHS Trust, London, UK and Center for Chronic Immunodeficiency, University Medical Center Freiburg, Freiburg, Germany
| | - N Verma
- From the Allergy Department, Royal Brompton and Harefield NHS Trust, London, UK, Department of Immunology, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK, Department of Immunology, Barts Health NHS Trust, London, UK, Department of Immunology, Royal Free London NHS Foundation Trust, London, UK, Department of Rheumatology, University College London Hospital, London, UK, King's College London, King's Health Partners, King's College Hospital NHS Foundation Trust, School of Medicine, Division of Asthma, Allergy & Lung Biology, Department of Immunological Medicine, London, UK, Department of Haematology, Imperial College Healthcare NHS Trust, London, UK and Center for Chronic Immunodeficiency, University Medical Center Freiburg, Freiburg, Germany
| | - M Leandro
- From the Allergy Department, Royal Brompton and Harefield NHS Trust, London, UK, Department of Immunology, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK, Department of Immunology, Barts Health NHS Trust, London, UK, Department of Immunology, Royal Free London NHS Foundation Trust, London, UK, Department of Rheumatology, University College London Hospital, London, UK, King's College London, King's Health Partners, King's College Hospital NHS Foundation Trust, School of Medicine, Division of Asthma, Allergy & Lung Biology, Department of Immunological Medicine, London, UK, Department of Haematology, Imperial College Healthcare NHS Trust, London, UK and Center for Chronic Immunodeficiency, University Medical Center Freiburg, Freiburg, Germany
| | - N P Gurugama
- From the Allergy Department, Royal Brompton and Harefield NHS Trust, London, UK, Department of Immunology, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK, Department of Immunology, Barts Health NHS Trust, London, UK, Department of Immunology, Royal Free London NHS Foundation Trust, London, UK, Department of Rheumatology, University College London Hospital, London, UK, King's College London, King's Health Partners, King's College Hospital NHS Foundation Trust, School of Medicine, Division of Asthma, Allergy & Lung Biology, Department of Immunological Medicine, London, UK, Department of Haematology, Imperial College Healthcare NHS Trust, London, UK and Center for Chronic Immunodeficiency, University Medical Center Freiburg, Freiburg, Germany
| | - H J Longhurst
- From the Allergy Department, Royal Brompton and Harefield NHS Trust, London, UK, Department of Immunology, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK, Department of Immunology, Barts Health NHS Trust, London, UK, Department of Immunology, Royal Free London NHS Foundation Trust, London, UK, Department of Rheumatology, University College London Hospital, London, UK, King's College London, King's Health Partners, King's College Hospital NHS Foundation Trust, School of Medicine, Division of Asthma, Allergy & Lung Biology, Department of Immunological Medicine, London, UK, Department of Haematology, Imperial College Healthcare NHS Trust, London, UK and Center for Chronic Immunodeficiency, University Medical Center Freiburg, Freiburg, Germany
| | - S Grigoriadou
- From the Allergy Department, Royal Brompton and Harefield NHS Trust, London, UK, Department of Immunology, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK, Department of Immunology, Barts Health NHS Trust, London, UK, Department of Immunology, Royal Free London NHS Foundation Trust, London, UK, Department of Rheumatology, University College London Hospital, London, UK, King's College London, King's Health Partners, King's College Hospital NHS Foundation Trust, School of Medicine, Division of Asthma, Allergy & Lung Biology, Department of Immunological Medicine, London, UK, Department of Haematology, Imperial College Healthcare NHS Trust, London, UK and Center for Chronic Immunodeficiency, University Medical Center Freiburg, Freiburg, Germany
| | - M Buckland
- From the Allergy Department, Royal Brompton and Harefield NHS Trust, London, UK, Department of Immunology, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK, Department of Immunology, Barts Health NHS Trust, London, UK, Department of Immunology, Royal Free London NHS Foundation Trust, London, UK, Department of Rheumatology, University College London Hospital, London, UK, King's College London, King's Health Partners, King's College Hospital NHS Foundation Trust, School of Medicine, Division of Asthma, Allergy & Lung Biology, Department of Immunological Medicine, London, UK, Department of Haematology, Imperial College Healthcare NHS Trust, London, UK and Center for Chronic Immunodeficiency, University Medical Center Freiburg, Freiburg, Germany
| | - E Kanfer
- From the Allergy Department, Royal Brompton and Harefield NHS Trust, London, UK, Department of Immunology, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK, Department of Immunology, Barts Health NHS Trust, London, UK, Department of Immunology, Royal Free London NHS Foundation Trust, London, UK, Department of Rheumatology, University College London Hospital, London, UK, King's College London, King's Health Partners, King's College Hospital NHS Foundation Trust, School of Medicine, Division of Asthma, Allergy & Lung Biology, Department of Immunological Medicine, London, UK, Department of Haematology, Imperial College Healthcare NHS Trust, London, UK and Center for Chronic Immunodeficiency, University Medical Center Freiburg, Freiburg, Germany
| | - S Hanson
- From the Allergy Department, Royal Brompton and Harefield NHS Trust, London, UK, Department of Immunology, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK, Department of Immunology, Barts Health NHS Trust, London, UK, Department of Immunology, Royal Free London NHS Foundation Trust, London, UK, Department of Rheumatology, University College London Hospital, London, UK, King's College London, King's Health Partners, King's College Hospital NHS Foundation Trust, School of Medicine, Division of Asthma, Allergy & Lung Biology, Department of Immunological Medicine, London, UK, Department of Haematology, Imperial College Healthcare NHS Trust, London, UK and Center for Chronic Immunodeficiency, University Medical Center Freiburg, Freiburg, Germany
| | - M A A Ibrahim
- From the Allergy Department, Royal Brompton and Harefield NHS Trust, London, UK, Department of Immunology, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK, Department of Immunology, Barts Health NHS Trust, London, UK, Department of Immunology, Royal Free London NHS Foundation Trust, London, UK, Department of Rheumatology, University College London Hospital, London, UK, King's College London, King's Health Partners, King's College Hospital NHS Foundation Trust, School of Medicine, Division of Asthma, Allergy & Lung Biology, Department of Immunological Medicine, London, UK, Department of Haematology, Imperial College Healthcare NHS Trust, London, UK and Center for Chronic Immunodeficiency, University Medical Center Freiburg, Freiburg, Germany
| | - B Grimbacher
- From the Allergy Department, Royal Brompton and Harefield NHS Trust, London, UK, Department of Immunology, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK, Department of Immunology, Barts Health NHS Trust, London, UK, Department of Immunology, Royal Free London NHS Foundation Trust, London, UK, Department of Rheumatology, University College London Hospital, London, UK, King's College London, King's Health Partners, King's College Hospital NHS Foundation Trust, School of Medicine, Division of Asthma, Allergy & Lung Biology, Department of Immunological Medicine, London, UK, Department of Haematology, Imperial College Healthcare NHS Trust, London, UK and Center for Chronic Immunodeficiency, University Medical Center Freiburg, Freiburg, Germany From the Allergy Department, Royal Brompton and Harefield NHS Trust, London, UK, Department of Immunology, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK, Department of Immunology, Barts Health NHS Trust, London, UK, Department of Immunology, Royal Free London NHS Foundation Trust, London, UK, Department of Rheumatology, University College London Hospital, London, UK, King's College London, King's Health Partners, King's College Hospital NHS Foundation Trust, School of Medicine, Division of Asthma, Allergy & Lung Biology, Department of Immunological Medicine, London, UK, Department of Haematology, Imperial College Healthcare NHS Trust, London, UK and Center for Chronic Immunodeficiency, University Medical Center Freiburg, Freiburg, Germany
| | - R Chee
- From the Allergy Department, Royal Brompton and Harefield NHS Trust, London, UK, Department of Immunology, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK, Department of Immunology, Barts Health NHS Trust, London, UK, Department of Immunology, Royal Free London NHS Foundation Trust, London, UK, Department of Rheumatology, University College London Hospital, London, UK, King's College London, King's Health Partners, King's College Hospital NHS Foundation Trust, School of Medicine, Division of Asthma, Allergy & Lung Biology, Department of Immunological Medicine, London, UK, Department of Haematology, Imperial College Healthcare NHS Trust, London, UK and Center for Chronic Immunodeficiency, University Medical Center Freiburg, Freiburg, Germany
| | - S L Seneviratne
- From the Allergy Department, Royal Brompton and Harefield NHS Trust, London, UK, Department of Immunology, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK, Department of Immunology, Barts Health NHS Trust, London, UK, Department of Immunology, Royal Free London NHS Foundation Trust, London, UK, Department of Rheumatology, University College London Hospital, London, UK, King's College London, King's Health Partners, King's College Hospital NHS Foundation Trust, School of Medicine, Division of Asthma, Allergy & Lung Biology, Department of Immunological Medicine, London, UK, Department of Haematology, Imperial College Healthcare NHS Trust, London, UK and Center for Chronic Immunodeficiency, University Medical Center Freiburg, Freiburg, Germany
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Edgar JDM, Buckland M, Guzman D, Conlon NP, Knerr V, Bangs C, Reiser V, Panahloo Z, Workman S, Slatter M, Gennery AR, Davies EG, Allwood Z, Arkwright PD, Helbert M, Longhurst HJ, Grigoriadou S, Devlin LA, Huissoon A, Krishna MT, Hackett S, Kumararatne DS, Condliffe AM, Baxendale H, Henderson K, Bethune C, Symons C, Wood P, Ford K, Patel S, Jain R, Jolles S, El-Shanawany T, Alachkar H, Herwadkar A, Sargur R, Shrimpton A, Hayman G, Abuzakouk M, Spickett G, Darroch CJ, Paulus S, Marshall SE, McDermott EM, Heath PT, Herriot R, Noorani S, Turner M, Khan S, Grimbacher B. The United Kingdom Primary Immune Deficiency (UKPID) Registry: report of the first 4 years' activity 2008-2012. Clin Exp Immunol 2014; 175:68-78. [PMID: 23841717 PMCID: PMC3898556 DOI: 10.1111/cei.12172] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2013] [Indexed: 12/11/2022] Open
Abstract
This report summarizes the establishment of the first national online registry of primary immune deficency in the United Kingdom, the United Kingdom Primary Immunodeficiency (UKPID Registry). This UKPID Registry is based on the European Society for Immune Deficiency (ESID) registry platform, hosted on servers at the Royal Free site of University College, London. It is accessible to users through the website of the United Kingdom Primary Immunodeficiency Network (www.ukpin.org.uk). Twenty-seven centres in the United Kingdom are actively contributing data, with an additional nine centres completing their ethical and governance approvals to participate. This indicates that 36 of 38 (95%) of recognized centres in the United Kingdom have engaged with this project. To date, 2229 patients have been enrolled, with a notable increasing rate of recruitment in the past 12 months. Data are presented on the range of diagnoses recorded, estimated minimum disease prevalence, geographical distribution of patients across the United Kingdom, age at presentation, diagnostic delay, treatment modalities used and evidence of their monitoring and effectiveness.
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Affiliation(s)
- J D M Edgar
- Regional Immunology Service, The Royal Hospitals, Belfast, East Yorkshire; Centre for Infection and Immunity, Queen's University Belfast, Belfast, East Yorkshire
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15
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Manson AL, Price A, Dempster J, Clinton-Tarestad P, Greening C, Enti R, Hill S, Grigoriadou S, Buckland MS, Longhurst HJ. In pursuit of excellence: an integrated care pathway for C1 inhibitor deficiency. Clin Exp Immunol 2013; 173:1-7. [PMID: 23607500 PMCID: PMC3694529 DOI: 10.1111/cei.12083] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2013] [Indexed: 01/22/2023] Open
Abstract
There are estimated to be approximately 1500 people in the United Kingdom with C1 inhibitor (C1INH) deficiency. At BartsHealth National Health Service (NHS) Trust we manage 133 patients with this condition and we believe that this represents one of the largest cohorts in the United Kingdom. C1INH deficiency may be hereditary or acquired. It is characterized by unpredictable episodic swellings, which may affect any part of the body, but are potentially fatal if they involve the larynx and cause significant morbidity if they involve the viscera. The last few years have seen a revolution in the treatment options that are available for C1 inhibitor deficiency. However, this occurs at a time when there are increased spending restraints in the NHS and the commissioning structure is being overhauled. Integrated care pathways (ICP) are a tool for disseminating best practice, for facilitating clinical audit, enabling multi-disciplinary working and for reducing health-care costs. Here we present an ICP for managing C1 inhibitor deficiency.
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Affiliation(s)
- A L Manson
- Department of Immunopathology, Barts Health NHS Trust, London, UK
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16
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Cicardi M, Craig TJ, Martinez-Saguer I, Hébert J, Longhurst HJ. Review of recent guidelines and consensus statements on hereditary angioedema therapy with focus on self-administration. Int Arch Allergy Immunol 2013; 161 Suppl 1:3-9. [PMID: 23689238 DOI: 10.1159/000351232] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Consensus meetings and the resulting recommendations shape treatment choices in rare diseases such as hereditary angioedema (HAE) because they combine the experience of prescribing physicians and the patients who are receiving therapy. Self-administration of HAE therapy was recognised as a potential treatment option in the first consensus publication in 2003. Recent studies have confirmed that self-administration of therapy resolves attacks quickly, safely and minimises burden of disease; however, the discovery of inconsistent treatment approaches is a concern and warrants investigation into the barriers that prevent adherence with current recommendations.
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Affiliation(s)
- M Cicardi
- Department of Biomedical and Clinical Sciences, University of Milan and Luigi Sacco Hospital, Milan, Italy.
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Longhurst HJ. Hereditary and other orphan angioedemas: a new prophylactic option at last? Clin Exp Allergy 2013; 43:380-2. [DOI: 10.1111/cea.12088] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Accepted: 12/17/2012] [Indexed: 11/27/2022]
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Bright P, Grigoriadou S, Kamperidis P, Buckland M, Hickey A, Longhurst HJ. Changes in B cell immunophenotype in common variable immunodeficiency: cause or effect - is bronchiectasis indicative of undiagnosed immunodeficiency? Clin Exp Immunol 2013; 171:195-200. [PMID: 23286946 DOI: 10.1111/cei.12010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2012] [Indexed: 12/01/2022] Open
Abstract
Common variable immunodeficiency (CVID) is the most common severe primary immunodeficiency, but the pathology of this condition is poorly understood. CVID involves a defect in the production of immunoglobulin from B cells, with a subsequent predisposition to infections. Approximately 10-20% of cases are inherited, but even in families with a genetic defect the penetrance is far from complete. A classification system for CVID has been suggested (EUROclass) based on B cell immunophenotyping, but it has not been shown that altered B cell immunophenotype is not a consequence of the complications and treatment of CVID. This study compares the EUROclass B cell immunophenotype of CVID patients (n = 30) with suitable disease controls with bronchiectasis (n = 11), granulomatous disease (Crohn's disease) (n = 9) and neurological patients on immunoglobulin treatment (n = 6). The results of this study correlate with previous literature, that alterations in B cell immunophenotype are associated strongly with CVID. Interestingly, three of the 11 bronchiectasis patients without known immunodeficiency had an altered B cell immunophenotype, suggesting the possibility of undiagnosed immunodeficiency, or that bronchiectasis may cause a secondary alteration in B cell immunophenotype. This study showed a significant difference in B cell immunophenotype between CVID patients compared to disease control groups of granulomatous disease and immunoglobulin treatment. This suggests that granulomatous disease (in Crohn's disease) and immunoglobulin treatment (for chronic neurological conditions) are not causal of an altered B cell immunophenotype in these control populations.
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Affiliation(s)
- P Bright
- Immunology Department, Barts Health NHS Trust, London, UK
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Dua J, Elliot E, Bright P, Grigoriadou S, Bull R, Millar M, Wijesuriya N, Longhurst HJ. Pyoderma gangrenosum-like ulcer caused by Helicobacter cinaedi in a patient with x-linked agammaglobulinaemia. Clin Exp Dermatol 2012; 37:642-5. [DOI: 10.1111/j.1365-2230.2011.04293.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Abstract
Angio-oedema is a common reason for attendance at the accident and emergency department and for referral to immunology/allergy clinics. Causative factors should always be sought, but a large proportion of patients have the idiopathic form of the disease. A minority of patients represent a diagnostic and treatment challenge. Failure to identify the more unusual causes of angio-oedema may result in life-threatening situations. Common and rare causes of angio-oedema will be discussed in this article, as well as the diagnostic and treatment pathways for the management of these patients. A comprehensive history and close monitoring of response to treatment are the most cost-effective diagnostic and treatment tools.
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Affiliation(s)
- S Grigoriadou
- Barts and The London NHS Trust, Royal London Hospital, London, UK
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Tarzi MD, Grigoriadou S, Carr SB, Kuitert LM, Longhurst HJ. Clinical immunology review series: An approach to the management of pulmonary disease in primary antibody deficiency. Clin Exp Immunol 2009; 155:147-55. [PMID: 19128358 PMCID: PMC2675244 DOI: 10.1111/j.1365-2249.2008.03851.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2008] [Indexed: 11/29/2022] Open
Abstract
The sinopulmonary tract is the major site of infection in patients with primary antibody deficiency syndromes, and structural lung damage arising from repeated sepsis is a major determinant of morbidity and mortality. Patients with common variable immunodeficiency may, in addition, develop inflammatory lung disease, often associated with multi-system granulomatous disease. This review discusses the presentation and management of lung disease in patients with primary antibody deficiency.
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Affiliation(s)
- M D Tarzi
- Department of Clinical Immunology, The Royal London Hospital, Whitechapel, UK
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Tarzi MD, Hickey A, Förster T, Mohammadi M, Longhurst HJ. An evaluation of tests used for the diagnosis and monitoring of C1 inhibitor deficiency: normal serum C4 does not exclude hereditary angio-oedema. Clin Exp Immunol 2007; 149:513-6. [PMID: 17614974 PMCID: PMC2219337 DOI: 10.1111/j.1365-2249.2007.03438.x] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.6] [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: 11/29/2022] Open
Abstract
Reduced levels of serum C4 have been considered a ubiquitous finding in hereditary angio-oedema (HAE), and consequently low C4 is often used to 'request manage' access to C1 inhibitor assays in the United Kingdom. However, in our experience normal C4 may occasionally be compatible with HAE. We audited the results of serum C4, C1 inhibitor antigen (C1inhA) and C1 inhibitor function (C1inhF) in 49 HAE patients, compared to a control group of 58 unaffected subjects. The sensitivity of low serum C4 for HAE among untreated patients was 81%; levels of complement C4 were within the normal range on nine separate occasions in five untreated HAE patients. Molecular genetic analysis of these individuals demonstrated novel mutations in the C1 inhibitor gene. The supplied reference ranges for the Quidel C1inhF enzyme-linked immunosorbent assay (ELISA) system appear to be too low, with a sensitivity of just 57% for HAE. Following optimization of the reference ranges using receiver operating characteristic analysis, low C1inhF was found to be 78% sensitive and 100% specific for HAE. The diagnosis of HAE is not excluded by normal levels of complement C4. We conclude that C1 inhibitor studies should be performed regardless of serum C4 where a high index of clinical suspicion exists.
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Affiliation(s)
- M D Tarzi
- Department of Immunopathology, St Barts and the London NHS Trust, London, UK.
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Abstract
Economic and political factors have led to the increased use of home therapy programmes for patients who have traditionally been treated in hospital. Many patients with hereditary angioedema (HAE) experience intermittent severe attacks that affect their quality of life and may be life-threatening. These attacks are treated with C1-inhibitor concentrate which, for most patients, is infused at the local hospital. Home therapy programmes for HAE are currently being established. This paper reviews the extent of use of these programmes and summarizes the advantages and potential disadvantages of the concept so far.
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Affiliation(s)
- H J Longhurst
- Barts and The London NHS Trust, Department of Immunopathology, London, UK.
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Buckland MS, Mylonaki M, Rampton D, Longhurst HJ. Serological markers (anti-Saccharomyces cerevisiae mannan antibodies and antineutrophil cytoplasmic antibodies) in inflammatory bowel disease: diagnostic utility and phenotypic correlation. Clin Diagn Lab Immunol 2006; 12:1328-30. [PMID: 16275949 PMCID: PMC1287772 DOI: 10.1128/cdli.12.11.1328-1330.2005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We have evaluated the utility of antineutrophil cytoplasmic antibodies and anti-Saccharomyces cerevisiae mannan antibodies for distinguishing Crohn's disease from ulcerative colitis and other diarrheal illnesses by evaluating sera from 396 patients. Sensitivity, specificity, and phenotypic correlations were investigated. The implications of our findings for implementing these tests in routine clinical testing are discussed.
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Affiliation(s)
- M S Buckland
- Department of Clinical Immunology, 1st Floor, 51-53 Barts Close, W. Smithfield, St. Bartholomew's, London EC1A 7BE, United Kingdom.
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Abstract
Hereditary angioedema (HAE) is caused by a deficiency in C1 esterase-inhibitor (C1-INH) and is characterised by skin swelling, abdominal pain and episodes of upper respiratory tract obstruction. Oedema of the larynx can result in rapid asphyxiation and requires emergency treatment. Three treatment options for emergency treatment of HAE are reviewed: fresh frozen plasma, solvent/detergent-treated plasma and C1-INH concentrate. It is concluded that while all three treatment options are theoretically effective in the emergency treatment of HAE, C1-INH is the treatment of choice.
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Affiliation(s)
- H J Longhurst
- Department of Immunology, Barts and The London NHS Trust, London, UK.
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Gompels MM, Lock RJ, Abinun M, Bethune CA, Davies G, Grattan C, Fay AC, Longhurst HJ, Morrison L, Price A, Price M, Watters D. C1 inhibitor deficiency: consensus document. Clin Exp Immunol 2005; 139:379-94. [PMID: 15730382 PMCID: PMC1809312 DOI: 10.1111/j.1365-2249.2005.02726.x] [Citation(s) in RCA: 323] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
We present a consensus document on the diagnosis and management of C1 inhibitor deficiency, a syndrome characterized clinically by recurrent episodes of angio-oedema. In hereditary angio-oedema, a rare autosomal dominant condition, C1 inhibitor function is reduced due to impaired transcription or production of non-functional protein. The diagnosis is confirmed by the presence of a low serum C4 and absent or greatly reduced C1 inhibitor level or function. The condition can cause fatal laryngeal oedema and features indistinguishable from gastrointestinal tract obstruction. Attacks can be precipitated by trauma, infection and other stimulants. Treatment is graded according to response and the clinical site of swelling. Acute treatment for severe attack is by infusion of C1 inhibitor concentrate and for minor attack attenuated androgens and/or tranexamic acid. Prophylactic treatment is by attenuated androgens and/or tranexamic acid. There are a number of new products in trial, including genetically engineered C1 esterase inhibitor, kallikrein inhibitor and bradykinin B2 receptor antagonist. Individual sections provide special advice with respect to diagnosis, management (prophylaxis and emergency care), special situations (childhood, pregnancy, contraception, travel and dental care) and service specification.
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Affiliation(s)
- M M Gompels
- Department of Immunology and Immunogenetics, North Bristol NHS Trust, Southmead Hospital, Bristol, UK.
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Longhurst HJ, O'Grady C, Evans G, De Lord C, Hughes A, Cavenagh J, Helbert MR. Anti-D immunoglobulin treatment for thrombocytopenia associated with primary antibody deficiency. J Clin Pathol 2002; 55:64-6. [PMID: 11825928 PMCID: PMC1769561 DOI: 10.1136/jcp.55.1.64] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [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: 11/03/2022]
Abstract
AIMS To review our experience of anti-D immunoglobulin for immune thrombocytopenia (ITP) in patients with primary antibody deficiency. METHODS/PATIENTS A retrospective case notes review of four Rhesus positive patients with ITP and primary antibody deficiency, treated with anti-D. Patients were refractory to steroids and high dose intravenous immunoglobulin (IVIG). Two patients were previously splenectomised. RESULTS All patients responded to anti-D immunoglobulin. Improved platelet counts were sustained for at least three months. Side effects included a fall in haemoglobin in all cases; one patient required red blood cell transfusion. Two patients had transient neutropenia (< 1 x 10(9)/litre). CONCLUSION Anti-D immunoglobulin may be an effective treatment for antibody deficiency associated thrombocytopenia, even after splenectomy. Anti-D immunoglobulin may have considerable clinical advantages in this group of patients, where treatments resulting in further immunosuppression are relatively contraindicated.
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Affiliation(s)
- H J Longhurst
- Department of Immunopathology, Barts and The London NHS Trust, London EC1A 7BE, UK.
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Longhurst HJ, Letellier E, D'Cruz D, McCurdie I. Parvovirus arthropathy masquerading as the arthritis of Behçet's disease. Ann Rheum Dis 2001; 60:1080. [PMID: 11688492 PMCID: PMC1753409 DOI: 10.1136/ard.60.11.1080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
A quick and simple method of purifying the histones from Plasmodium falciparum culture supernatant or from infected erythrocytes is described. The proteins were present only in preparations rich in P. falciparum nuclear material and were soluble at acid pH and in strongly anionic detergents. Four proteins, of 14-18 kDa were identified as the P. falciparum core histones. N-terminal sequence analysis of the 16 and 18 kDa proteins and of a tryptic fragment of the protein mixture revealed strong homologies with deduced cDNA or protein sequences of histones H2A, H2B, and H3 of P. falciparum and other species. Antibodies raised against the proteins cross-reacted weakly with histones of other species and, on immunofluorescence, localized the proteins to schizont nuclei. Anti-P. falciparum histone antibodies were detected in sera of semi-immune human adults but these antibodies did not react with human histones on a Western blot. The large quantities of P. falciparum histone released and the chronic nature of malarial infection, together with the unusually high avidity of histones for ligands found in renal and vascular basement membrane, raise the question of a role for histones in the pathogenesis of malarial infection. We suggest that histones or histone-antibody complexes may contribute to disease pathology.
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Affiliation(s)
- H J Longhurst
- Division of Parasitology, National Institute for Medical Research, London, UK
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Affiliation(s)
- H J Longhurst
- Division of Parasitology, National Institute for Medical Research, Mill Hill, London, UK
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Longhurst HJ, Flower N, Thomas BJ, Munday PE, Elder A, Constantinidou M, Wilton J, Taylor-Robinson D. A simple method for the detection of Chlamydia trachomatis infections in general practice. J R Coll Gen Pract 1987; 37:255-6. [PMID: 3329225 PMCID: PMC1710881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Chlamydial infection is an important cause of genital tract disease in women and is often silent. Collection, storage and transportation of specimens required for culture pose problems which have made studies difficult and diagnosis impractical outside hospitals or sexually transmitted disease clinics.The direct monoclonal antibody test (MicroTrak, Syva) for detecting chlamydiae is comparable with the traditional culture method in sensitivity and specificity. The test requires only the preparation of a smear on a slide, making it convenient for use in general practice. The feasibility of using this procedure in an inner city practice was demonstrated in tests on 188 women who required pelvic examination. Of 169 women from whom valid specimens were obtained 18 (10.7%) were found to have a chlamydial infection. Only three of the infected women were asymptomatic and the organisms were associated particularly with dysuria. The value of the test in comparison with other procedures currently available for detecting chlamydiae is emphasized.
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