Intradermal Immunoglobulin E (IgE) Injection in a Specific Interval With Emollient in the Control of Chronic Idiopathic Urticaria and Allergic Rhinitis

Sumi F, Bhuiyan M A, Mukit M, et al. (November 06, 2023)  Cureus 15(11): e48358. doi:10.7759/cureus.48358

Abstract

Background and objective: Urticaria is distinguished by the activation of mast cells and basophils via degranulation, predominantly induced by the cross-linkage of allergens with specific immunoglobulin E (IgE) antibodies. Several hypotheses propose that intradermal injections of IgE stimulate the production of antibodies that are specifically targeted towards the histamine/immunoglobulin complex. Subsequently, these antibodies exhibit binding affinity towards and exert inhibitory effects on the generation of histamine during the occurrence of allergic responses. The administration of many histaglobulin injections results in an increase in the concentration of these specific antibodies. Consequently, the present study was devised to assess the effectiveness of intradermal IgE injection in conjunction with an emollient for managing chronic idiopathic urticaria and allergic rhinitis at varying time intervals.

Exogenous IL-25 ameliorates airway neutrophilia via suppressing macrophage M1 polarization and the expression of IL-12 and IL-23 in asthma.

Chang, C., Chen, G., Wu, W. et al. Respir Res 24, 260 (2023). https://doi.org/10.1186/s12931-023-02557-5

Abstract

Background

Severe asthma is associated with substantial mortality and has unmet therapeutic need. A subset of severe asthma is characterized by neutrophilic airway inflammation. Classically activated (or M1) macrophages which express IL-12 and IL-23 are associated with airway neutrophilia in asthma. Exogenous IL-25 was reported to suppress intestinal inflammation in animal models of inflammatory bowel diseases via suppressing IL-12 and IL-23 production. We hypothesize that IL-25 ameliorates airway neutrophilia via inhibiting macrophage M1 polarization and the expression of IL-12 and IL-23 in asthma.

Outdoor airborne allergens: Characterization, behavior and monitoring in Europe

Grewling Ł, Ribeiro H, Antunes C et al. Sci Total Environ. 2023 Sep 12;905:167042. doi: 10.1016/j.scitotenv.2023.167042. 

Abstract

Aeroallergens or inhalant allergens, are proteins dispersed through the air and have the potential to induce allergic conditions such as rhinitis, conjunctivitis, and asthma. Outdoor aeroallergens are found predominantly in pollen grains and fungal spores, which are allergen carriers. Aeroallergens from pollen and fungi have seasonal emission patterns that correlate with plant pollination and fungal sporulation and are strongly associated with atmospheric weather conditions. They are released when allergen carriers come in contact with the respiratory system, e.g. the nasal mucosa. In addition, due to the rupture of allergen carriers, airborne allergen molecules may be released directly into the air in the form of micronic and submicronic particles (cytoplasmic debris, cell wall fragments, droplets etc.) or adhered onto other airborne particulate matter.

Understanding the economic burden of chronic cough: a systematic literature review

Research  - Open access

Vishal Bali, Ada Adriano, Aidan Byrne, Katherine G. Akers, Andrew Frederickson & Jonathan Schelfhout. BMC Pulmonary Medicine volume 23, Article number: 416 (2023) 

Abstract

Chronic cough (CC) is associated with high healthcare resource utilization (HCRU) due to challenges in diagnosis and treatment and is anticipated to have a substantial economic impact. This systematic literature review (SLR) sought to identify evidence on the cost-effectiveness of treatments and the economic burden associated with CC. Electronic database searches were supplemented with searches of conference proceedings and health technology assessment body websites. Two independent reviewers assessed all citations for inclusion based on predefined inclusion/exclusion criteria. Key inclusion criteria were patient population with CC, and outcomes related to cost-effectiveness and HCRU and costs. After screening, one cost-effectiveness analysis was identified, alongside eight studies reporting HCRU and costs related to CC. Though evidence was limited, studies suggest that patients with CC incur higher costs and use more resources than those with acute cough. Types of resource use reported included healthcare contacts and prescriptions, diagnostic tests, referrals and specialist evaluations, and treatment use. There is a paucity of literature on HCRU and costs in CC, and very limited cost-effectiveness analyses. The economic burden appears higher in these patients however, without direct comparison to the general population it is difficult to determine the total impact. The increased burden is expected to be a result of the challenges with diagnosis and lack of approved treatments. However, limited conclusions can be drawn in the absence of further data. Future studies should endeavor to quantify the HCRU and cost attributable to patients with CC.

Take home message

Patients with CC encounter multiple physicians and specialists to seek a definitive diagnosis, resulting in delayed diagnosis and appropriate treatment. This SLR reported a paucity of economic data; however, it found patients with CC to incur higher costs and more resource use than those with acute cough.

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Optimising the Utility of In Vitro Tests for the Diagnosis of Drug Allergy: Insights from a Clinical Perspective

Sabaté-Brescó, M., Quan, P.L. & Goikoetxea, M.J. Curr Treat Options Allergy 10, 267–282 (2023).

Abstract

Purpose of review

To outline currently validated in vitro tests for the diagnosis of drug hypersensivity reactions (DHRs) and to provide useful strategies to optimise the utility of these tools.

Most commonly used in vitro tests for the diagnosis of drug hypersensitivity.

Recent findings

Regarding in vitro tests for DHR, the main concern, at present, is low sensitivity. Thus, most of the efforts are currently directed towards improving the existing techniques and developing new assays with better diagnostic performance.

Summary

The management of DHRs is particularly challenging. Current strategies for diagnosis are focused on taking a thorough clinical history, evaluating sensitization using skin testing and performing supervised challenges. In vitro tests may potentially add information to the diagnostic algorithms for the management of DHRs.

Respiratory Exposure Tests in Aspirin Exacerbated Respiratory Disease

Bobolea, I., Rubira, N. & Mullol, J.  Curr Treat Options Allergy (2023). https://doi.org/10.1007/s40521-023-00346-5

Abstract

Purpose of review

Controlled oral provocation test with aspirin is considered the “gold standard” for diagnosing hypersensitivity to NSAIDs (non-steroid anti-inflammatory drugs). Newer techniques of respiratory exposure tests, bronchial and nasal respectively, have been nonetheless developed, as they are safer, less likely to cause a systemic reaction, and less time-consuming than the oral provocation test with aspirin (acetyl-salicylic acid). These tests are also particularly useful when oral challenge testing is contraindicated. The aim of this paper is to review and update the detailed protocols of bronchial and nasal challenges with lysine-aspirin, a salt of acetyl-salicylic acid, more soluble and less irritative.

Self-Management in Allergic Rhinitis: Strategies, Outcomes and Integration into Clinical Care

Ciprandi G. J Asthma Allergy. 2023 Oct 5;16:1087-1095. doi: 10.2147/JAA.S273478.

Abstract: Allergic rhinitis (AR) is a common disease, characterized by typical symptoms and type 2 inflammation. Standard treatment is usually effective and safe, and most medications are available as over-the-counter (OTC). Therefore, AR patients, mostly at the AR onset or if symptoms are mild, prefer to manage symptoms themselves. However, self-management could be associated with problems, including inadequate control or medication abuse. Therefore, this paper aimed at presenting and discussing this issue. Ideally, self-management should be conducted under medical supervision. In this regard, telemedicine could represent a valuable tool for implementing self-management.

The impact of implementing an allergic rhinitis clinical management pathway (AR-CMaP) in the community pharmacy

House R, Kritikos V, Cvetkovski B, Rimmer J, Yan K, Cheong L, Bousquet J, Lourenco O, Bosnic-Anticevich S. Explor Res Clin Soc Pharm. 2023 Oct 5;12:100340. doi: 10.1016/j.rcsop.2023.100340.

Free PMC article

Abstract

Background: The Allergic Rhinitis Clinical Management Pathway (AR-CMaP) was developed to overcome the challenge of implementing current AR guidelines in the Australian community pharmacy practice and support pharmacists in optimally managing patients' AR.

Objectives: To evaluate the impact of AR-CMaP on patients' behaviour and pharmacists' needs in managing AR in the pharmacy.

Methods: This study used a cross-sectional, pre-post study design in which the primary outcome was the appropriateness of medications purchased from community pharmacies in Australia. Patient data were collected before and after the implementation of AR-CMaP.