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Clinics in Chest Medicine Mar 2024Sarcoidosis is an immune-mediated multisystem granulomatous disorder. Neurosarcoidosis (NS) accounts for 5% to 35% of cases. The diagnostic evaluation of NS can be a... (Review)
Review
Sarcoidosis is an immune-mediated multisystem granulomatous disorder. Neurosarcoidosis (NS) accounts for 5% to 35% of cases. The diagnostic evaluation of NS can be a clinical challenge. Gadolinium-enhanced magnetic resonance imaging (MRI) is the gold standard to evaluate central nervous system NS. In almost all cases treatment is warranted. Although glucocorticoids remain the first-line therapy in patients with sarcoidosis, in NS timely initiation of second- or third-line treatment is strongly recommended. Of these, tumor necrosis factor-alpha inhibitors are the most promising. However, the treatment itself may be responsible for/associated with developing neurologic symptoms mimicking NS. Thus, it is important to consider the possibility of drug-induced neurologic symptoms in sarcoidosis.
Topics: Humans; Central Nervous System Diseases; Sarcoidosis; Immunosuppressive Agents; Glucocorticoids; Magnetic Resonance Imaging
PubMed: 38245373
DOI: 10.1016/j.ccm.2023.08.005 -
The New England Journal of Medicine Feb 2024
Topics: Humans; Lung Diseases, Interstitial; Sarcoidosis, Pulmonary
PubMed: 38416432
DOI: 10.1056/NEJMicm2308650 -
Journal of Cardiac Failure Aug 2023Although sex- and race-based patterns have been described in the extracardiac organ involvement of sarcoidosis, cardiac sarcoidosis (CS)-specific studies are lacking.
BACKGROUND
Although sex- and race-based patterns have been described in the extracardiac organ involvement of sarcoidosis, cardiac sarcoidosis (CS)-specific studies are lacking.
METHODS
We studied CS presentation, treatment and outcomes based on sex and race in a tertiary-center cohort. Multivariable adjusted Cox proportional hazards and survival analyses were performed for primary composite outcomes (left ventricular assist device, heart transplantation, all-cause death) and for secondary outcomes (ventricular arrhythmia and all-cause death.
RESULTS
We identified 252 patients with CS (108 female, 109 Black). At presentation with CS, females vs males (P = 0.001) and Black vs White individuals (P = 0.001) more commonly had symptomatic heart failure (HF), with HF most common in Black females (ANOVA P < 0.001). Treatment differences included more corticosteroid use (90% vs 79%; P = 0.020), higher 1-year prednisone dosage (13 vs 10 mg; P = 0.003) and less frequent early steroid-sparing agent use in males (29% vs 40%; P = 0.05). Black participants more frequently received a steroid-sparing agent (75% vs 60%; P = 0.023). Composite outcome-free survival did not differ by sex or race. Male sex had an adjusted hazard ratio of 2.34 (95% CI 1.13, 4.80; P = 0.021) for ventricular arrhythmia.
CONCLUSION
CS course may differ by sex and race and may contribute to distinct clinical CS phenotypes.
Topics: Male; Female; Humans; Heart Failure; Cardiomyopathies; Race Factors; Retrospective Studies; Sarcoidosis; Myocarditis; Arrhythmias, Cardiac; Treatment Outcome
PubMed: 37062472
DOI: 10.1016/j.cardfail.2023.03.022 -
Clinics in Chest Medicine Mar 2024Sarcoidosis is a multisystem inflammatory disorder with unclear etiology and can often pose a diagnostic challenge. A tissue diagnosis is often necessary to illustrate... (Review)
Review
Sarcoidosis is a multisystem inflammatory disorder with unclear etiology and can often pose a diagnostic challenge. A tissue diagnosis is often necessary to illustrate the non-caseating granulomas on histopathology. This review aims to synthesize current evidence related to tissue diagnosis of sarcoidosis using various bronchoscopic techniques. We start by discussing standard bronchoscopic techniques which have remained the cornerstone of diagnostic workup such as bronchoalveolar lavage (BAL), endobronchial biopsy (EBB), conventional transbronchial needle aspiration (cTBNA) and transbronchial lung biopsy (TBLB) followed by newer modalities that incorporate real-time image guidance using endobronchial and endoscopic ultrasound. Although BAL, EBB, and TBLB have been employed as a diagnostic tool for several decades, their sensitivity and diagnostic yield is inferior to ultrasound-based endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). More recently, convincing evidence has also emerged to support the diagnostic accuracy and tissue yield of transbronchial lung cryobiopsy which will also be discussed in this review. These advances in bronchoscopic equipment and techniques over the last 2 decades have made it possible to obtain tissue samples using minimally invasive techniques thus avoiding invasive open lung biopsy and the risks that inherently follow. Up-to-date knowledge of these modalities is imperative for ensuring evidence-based medicine and improving patient-centric outcomes.
Topics: Humans; Bronchoscopy; Sarcoidosis, Pulmonary; Sarcoidosis; Lung; Endoscopic Ultrasound-Guided Fine Needle Aspiration; Dimercaprol; Lymph Nodes
PubMed: 38245368
DOI: 10.1016/j.ccm.2023.08.001 -
Frontiers in Immunology 2023Tuberculosis (TB) and sarcoidosis are both granulomatous diseases. Here, we compared the immunological microenvironments of granulomas from TB and sarcoidosis patients...
Tuberculosis (TB) and sarcoidosis are both granulomatous diseases. Here, we compared the immunological microenvironments of granulomas from TB and sarcoidosis patients using sequencing (ISS) transcriptomic analysis and multiplexed immunolabeling of tissue sections. TB lesions consisted of large necrotic and cellular granulomas, whereas "multifocal" granulomas with macrophages or epitheloid cell core and a T-cell rim were observed in sarcoidosis samples. The necrotic core in TB lesions was surrounded by macrophages and encircled by a dense T-cell layer. Within the T-cell layer, compact B-cell aggregates were observed in most TB samples. These B-cell clusters were vascularized and could contain defined B-/T-cell and macrophage-rich areas. The ISS of 40-60 immune transcripts revealed the enriched expression of transcripts involved in homing or migration to lymph nodes, which formed networks at single-cell distances in lymphoid areas of the TB lesions. Instead, myeloid-annotated regions were enriched in , , , , and mRNA. and mRNA were observed in granulocytic areas in which was also detected. In line with ISS data indicating tertiary lymphoid structures, immune labeling of TB sections expressed markers of high endothelial venules, follicular dendritic cells, follicular helper T cells, and lymph-node homing receptors on T cells. Neither ISS nor immunolabeling showed evidence of tertiary lymphoid aggregates in sarcoidosis samples. Together, our finding suggests that despite their heterogeneity, the formation of tertiary immune structures is a common feature in granulomas from TB patients.
Topics: Humans; Granuloma; Tuberculosis; Sarcoidosis, Pulmonary; Sarcoidosis; Mycobacterium tuberculosis; Lung; RNA, Messenger
PubMed: 38385142
DOI: 10.3389/fimmu.2023.1332733 -
Revista Alergia Mexico (Tecamachalco,... Dec 2023Food allergens are capable of producing adverse reactions through multiple mechanisms of an allergic or non-allergic nature, and through different routes of exposure;... (Review)
Review
Food allergens are capable of producing adverse reactions through multiple mechanisms of an allergic or non-allergic nature, and through different routes of exposure; generally by ingestion or contact, as in protein contact dermatitis or contact urticaria, including inhalation. Food allergy reactions, in turn, can be mediated by immediate hypersensitivity mechanisms, delayed hypersensitivity or mixed immediate-delayed mechanisms. The reference diagnostic method in food allergy is the double-blind placebo-controlled food challenge test (DBPCFC), but skin and serological tests are important in the clinical context. The diagnosis of immediate food allergy depends on well-standardized allergological tests, such as the skin prick test (SPT) or specific IgE dosing, which are ideally tested by food challenge testing. However, the diagnosis of delayed mechanism food allergy and mixed allergies, which combine both immune mechanisms, is more complex. Delayed hypersensitivity reactions are evaluated with the epicutaneous patch test, or patch testing, for the diagnosis of contact dermatitis. The atopy patch test is initially used for the investigation of inflammatory reactions, which may be linked to food allergens in patients with atopic dermatitis. It was later applied in other diseases, whose pathogenesis is mainly mediated by a mechanism of delayed hypersensitivity to protein allergens: eosinophilic esophagitis, enterocolitis induced by food proteins, protein contact dermatitis, contact urticaria, among other disorders.
Topics: Humans; Dermatitis, Atopic; Dermatitis, Contact; Food Hypersensitivity; Hypersensitivity, Delayed; Patch Tests; Urticaria
PubMed: 38506867
DOI: 10.29262/ram.v70i4.1336 -
Current Opinion in Allergy and Clinical... Apr 2024Occupational allergic contact dermatitis (OACD) is an important work-related skin disease. Information about the causative agents comes from many sources, including... (Review)
Review
PURPOSE OF REVIEW
Occupational allergic contact dermatitis (OACD) is an important work-related skin disease. Information about the causative agents comes from many sources, including patch test databases, registries, case series and case reports. This review summarizes new information about common causative allergens and diagnosis.
RECENT FINDINGS
Common causes of OACD include rubber components, epoxies and preservatives. New exposure sources for these allergens continue to be described. Often these exposure sources are related to the changing world around us, such as allergens related to smartphones and technology, and personal protective equipment-related exposures during the COVID-19 pandemic. New allergens are also being described, some of which are related to known allergens (e.g. a new epoxy or acrylate component).Accurate diagnosis is critical to effective management of OACD, which may include removing the worker from exposure to the causative allergen. Safety data sheets may not contain complete information and patch testing with specialized series of allergens and workplace materials may be necessary.
SUMMARY
This review provides current evidence about causes of OACD and important aspects of diagnosis. This is important for clinical practice to ensure cases of OACD are not missed.
Topics: Humans; Dermatitis, Allergic Contact; Pandemics; Dermatitis, Occupational; Allergens; Patch Tests
PubMed: 38037883
DOI: 10.1097/ACI.0000000000000961 -
Cutis Mar 2024Carpet beetle larvae of the family Dermestidae have been documented to cause both acute and delayed hypersensitivity reactions in susceptible individuals. These larvae...
Carpet beetle larvae of the family Dermestidae have been documented to cause both acute and delayed hypersensitivity reactions in susceptible individuals. These larvae have specialized horizontal rows of spear-shaped hairs called hastisetae, which detach easily into the surrounding environment and are small enough to travel by air. Exposure to hastisetae has been tied to adverse effects ranging from dermatitis to rhinoconjunctivitis and acute asthma, with treatment being mostly empiric and symptom based. Due to the pervasiveness of carpet beetles in homes, improved awareness of dermestid-induced manifestations is valuable for clinicians.
Topics: Animals; Coleoptera; Humans; Larva
PubMed: 38648592
DOI: 10.12788/cutis.0979 -
Journal of the European Academy of... Sep 2023
Topics: Humans; T-Lymphocytes; Antibodies, Monoclonal, Humanized; Hypersensitivity, Delayed
PubMed: 37170927
DOI: 10.1111/jdv.19182 -
Cutis Dec 2023Acrylates are synthetic thermoplastic resins used in numerous industries since their discovery in the mid-19th century. Known for their versatility in formulating...
Acrylates are synthetic thermoplastic resins used in numerous industries since their discovery in the mid-19th century. Known for their versatility in formulating various consumer, health care, and industrial products, acrylates also have come under scrutiny for their potential to cause allergic contact dermatitis (ACD). Allergic contact dermatitis to acrylates previously was largely occupational in nature, but the expanded use of acrylates in products ranging from nail cosmetics to medical devices has increasingly brought this allergy to the general population. Herein, we discuss the chemistry and allergenicity of acrylates and highlight common sources of exposure, clinical presentations, pertinent considerations for patch testing, and tips for the management/prevention of acrylate ACD. We hope to emphasize the shifting trend of exposure sources from the workplace to consumers, underlining the need for increased vigilance from physicians. Collaborative efforts among health care providers and patient education about allergen avoidance strategies are essential to mitigate potential complications arising from acrylate sensitization.
Topics: Humans; Acrylates; Dermatitis, Allergic Contact; Allergens; Nails; Patch Tests; Dermatitis, Occupational
PubMed: 38290071
DOI: 10.12788/cutis.0909