TNF-α inhibitors as therapy for drug-induced severe cutaneous adverse reactions: a case series

Chu Y, Xu M, Dong X, Zhou J. J Dermatolog Treat. 2024 Dec;35(1):2422924. doi: 10.1080/09546634.2024.2422924. 

Abstract

Process of the 40-year-old male patient diagnose as TEN.

Background: Severe cutaneous adverse reactions (SCARs) including acute generalized exanthematous pustulosis (AGEP), drug reaction with eosinophilia and systemic symptoms (DRESS), Stevens-Johnson syndrome (SJS) and its related diseases, and toxic epidermal necrolysis (TEN) are of great concern due to their high mortality rates. While systemic corticosteroids have been widely used to treat SCARs, their efficacy has been debated due to the increased risk of infection. In recent years, tumor necrosis factor (TNF)-α inhibitors have emerged as a new therapeutic option.

Objectives: This study aimed to report the clinical outcomes of different types of SCARs treated with TNF-α inhibitors.

EAACI guidelines on the management of IgE-mediated food allergy

Santos AF, Riggioni C, Agache I, et al. Allergy. 2024; 00: 1-23. doi:10.1111/all.16345

Abstract

Management of IgE-mediated food allergy.

This European Academy of Allergy and Clinical Immunology (EAACI) guideline provides recommendations for the management of IgE-mediated food allergy and was developed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. Following the confirmation of IgE-mediated food allergy diagnosis, allergen avoidance and dietary advice (with support of a specialised dietitian, if possible) together with the provision of a written treatment plan, education on the recognition of allergic symptoms and prescription of medication including adrenaline using an auto-injector are essential.

Idiopathic Hypereosinophilic Syndrome Presenting as Eosinophilic Hepatitis

Drake Seccurro, Debra W. Yen, Yashu Dhamija, et al. AIM Clinical Cases.2024;3:e240539. [Epub 19 November 2024]. doi:10.7326/aimcc.2024.0539

Abstract

Idiopathic hypereosinophilic syndrome (IHES) is defined by peripheral eosinophilia of more than 1500 eosinophils/µL for a 6-month duration with signs of organ involvement in the absence of parasitic infection, allergic reaction, or other recognized causes of eosinophilia. 

Portal inflammation with eosinophilic infiltration.

It is known to affect multiple organs with activated eosinophils that may lead to organ failure. Thirty percent of patients have liver involvement described as hepatomegaly and mildly elevated liver enzymes. We describe a rare case in which IHES was diagnosed after our patient presented with isolated acute hepatitis and was found to have peripheral eosinophilia and prominent eosinophils on liver biopsy.

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Roflumilast Cream, 0.15%, for Atopic Dermatitis in Adults and Children INTEGUMENT-1 and INTEGUMENT-2 Randomized Clinical Trials

Simpson EL, Eichenfield LF, Alonso-Llamazares J et al. JAMA Dermatol. 2024;160(11):1161-1170. doi:10.1001/jamadermatol.2024.3121

Key Points

Question  What is the efficacy and safety of once-daily roflumilast cream, 0.15%, in patients with atopic dermatitis (AD)?

Findings  In 2 phase 3 randomized clinical trials of 1337 individuals with AD, significantly more patients treated with once-daily roflumilast cream, 0.15%, achieved Validated Investigator Global Assessment for Atopic Dermatitis success at 4 weeks than patients treated with vehicle cream. Roflumilast was well tolerated with low rates of adverse events in both trials.

Meaning  An effective, well-tolerated, once-daily, nonsteroidal treatment like roflumilast cream, 0.15%, may address several unmet needs and substantially improve the treatment landscape for patients with AD.

Abstract

Importance  Safe, effective, and well-tolerated topical treatment options available for long-term use in patients with atopic dermatitis (AD) are limited and associated with low adherence rates.

Allergen Immunotherapy for a Year Can Effectively Reduce the Risk of Postoperative Recurrence of Adenoid Hypertrophy in Children with Concurrent Allergic Rhinitis (IMPROVEII)

 Hua HL, Deng YQ, Tang YC, Wang Y, Tao ZZ.  J Asthma Allergy. 2024;17:1115-1125

https://doi.org/10.2147/JAA.S477376

Abstract:

Background: Adenoid hypertrophy (AH) and allergic rhinitis (AR) are common pediatric diseases, seriously affecting the quality of life and growth of children. The recurrence rate of AH is higher for patients with than for those without concurrent AR. Allergen specific immunotherapy (AIT) is the only effective therapy for modifying the course of allergic diseases. This study sought to investigate the efficacy of AIT in preventing AH recurrence in patients with AR who underwent adenoidectomy.

Methods: This study included 134 children aged 5– 12 years with concurrent AH and AR. They were separated into the subcutaneous immunotherapy (SCIT) group treated with a double-mite allergen preparation or the non-AIT group treated symptomatically with only medications. The adenoid/nasopharyngeal ratio at one year after adenoidectomy was used to assess AH recurrence.

Label-free biosensor assay decodes the dynamics of Toll-like receptor signaling

Holze, J., Lauber, F., Soler, S. et al.  Nat Commun 15, 9554 (2024). https://doi.org/10.1038/s41467-024-53770-9

Abstract

Optical biosensor decodes signaling of endosomal TLRs.

The discovery of Toll-like receptors (TLRs) represented a significant breakthrough that paved the way for the study of host-pathogen interactions in innate immunity. However, there are still major gaps in understanding TLR function, especially regarding the early dynamics of downstream TLR pathways. Here, we present a label-free optical biosensor-based assay as a method for detecting TLR activation in a native and label-free environment and defining the dynamics of TLR pathway activation.

Calculated globulin can be used as a screening test for antibody deficiency in children and adolescents

Frias Sartorelli de Toledo Piza C, Aranda CS, Solé D, Jolles S, Condino-Neto A.  Front Immunol. 2024 Oct 23;15:1495564. doi: 10.3389/fimmu.2024.1495564.

Abstract

Purpose: Calculated globulin (CG, total protein minus albumin levels) correlate well with IgG levels and has been proposed as a suitable screening method for individuals with primary antibody deficiencies (PADs). We aimed to show the correlation of CG with IgG levels in children and adolescents, utilizing a common method for albumin measurement, bromocresol green.

Methods: Individuals from two Allergy and Immunology clinics were invited to participate. Inclusion criteria were age < 18, stable conditions, and signed informed consent. We included 1084 individuals. Immunoglobulin G values were determined by immunoturbidimetry; the colorimetric bromocresol green method and the Architect Biuret method were utilized for the albumin and total protein (TP) measurements, respectively.

Predictive value of Der p 2-specific IgE for subcutaneous immunotherapy in children with allergic rhinitis

Wang J, Xu B, Jia X, He Y, Jia B, Li J, Xu M.  Sci Rep. 2024 Oct 26;14(1):25467. doi: 10.1038/s41598-024-73575-6.

Abstract

Dermatophagoides pteronyssinus (Der p) subcutaneous immunotherapy (SCIT) has demonstrated efficacy in clinical trials of childhood allergic rhinitis (AR). Currently, there is a lack of some generally accepted biomarkers that may predict the clinical response to SCIT to eventually achieve personalized therapy. In this study, 28 children with AR received Der p SCIT for 26–30 months at baseline, and four efficacy endpoints, serum interleukin (IL)-5, periostin, Der p-specific IgE (sIgE), and Der p sIgG4, were measured by ELSIA. Clinical symptoms and characteristics were assessed by questionnaires, and the associations among periostin, Der p 2 sIgE and clinical efficacy were analyzed. The results showed that SCIT demonstrated a significant reduction in Der p 1 sIgE (P < 0.05) and Der p 2 sIgE (P < 0.01), an increase in Der p sIgG4 (P < 0.001) and an improvement in clinical efficacy at the fourth efficacy endpoint compared with that at baseline.

Correlations between the changes in clinical indices in childhood with AR treatment with SCIT.