-
Annals of Allergy, Asthma & Immunology... Jun 2024The development of monoclonal antibodies that selectively target IgE and type 2 immunity has opened new possibilities in the treatment of allergies. Although they have... (Review)
Review
The development of monoclonal antibodies that selectively target IgE and type 2 immunity has opened new possibilities in the treatment of allergies. Although they have been used mainly as single therapies that have shown efficacy in the management of asthma and other T2-mediated diseases, there is a growing interest in using these monoclonal antibodies in combination with allergen immunotherapy (AIT). AIT has transformed the treatment of allergic diseases by aiming to modify the underlying immune response to allergens rather than just providing temporary symptom relief. Despite the proven efficacy and safety of AIT, unmet needs call for further research and innovation. Combination strategies involving biologics and AIT exhibit potential in improving short-term efficacy, reducing adverse events, and increasing immunological tolerance. Anti-IgE emerges as the most promising therapeutic strategy, not only enhancing AIT's safety and tolerability but also providing additional evidence of efficacy compared to AIT alone. Anti-IL-4 receptor offers a reduction in side effects and an improved immunological profile when combined with AIT, however its impact on short-term efficacy appears limited. The combination of cat dander subcutaneous immunotherapy with anti-TSLP was synergistic with enhanced efficacy and altered immune responses that persisted for one year after discontinuation compared to AIT alone. Long-term studies are needed to evaluate the sustained benefits and safety profiles of combination strategies.
PubMed: 38897405
DOI: 10.1016/j.anai.2024.06.016 -
International Archives of Allergy and... Jun 2024Chronic inducible urticaria (CIndU) is a subtype of chronic urticaria (CU), which requires specific triggers to occur. Despite their common occurrence, treatment...
INTRODUCTION
Chronic inducible urticaria (CIndU) is a subtype of chronic urticaria (CU), which requires specific triggers to occur. Despite their common occurrence, treatment response rates and predictors of treatment responses are largely lacking in the literature. This study evaluates antihistamine (AH) and omalizumab response rates in the most common CIndU subtypes and examines whether certain features can predict treatment responses.
METHODS
We retrospectively analyzed CU patients with at least one CIndU subtype and performed comparisons between subgroups, in a total of 423 patients (70% CIndU, 30% chronic spontaneous urticaria [CSU] plus CIndU).
RESULTS
The treatment response rates in CIndU were 51.6%, 51.5%, and 86.5% with standard-dose second-generation H1-antihistamines (sgAHs), updosed/combined sgAH, and omalizumab, respectively. Overall AH response was higher in CIndU than CSU plus CIndU (78.3% vs. 62%, p = 0.002) and in symptomatic dermographism (SD) and cold urticaria (ColdU) than cholinergic urticaria (ChoU) (83.2% vs. 78.3 vs. 60.9%, p = 0.04). AH-refractory patients had a longer disease duration (45.2 ± 56.7 months vs. 37 ± 51.9 months, p = 0.04), more angioedema, accompanying CSU, mixed CIndU subtypes (37.5% vs. 21.1%, p = 0.003; 45.1% vs. 27.1%, p = 0.002; 8.8% vs. 2.4%, p = 0.014), and lower baseline urticaria control test scores (5.86 ± 3.3 vs. 8.6 ± 3.6, p < 0.001) than AH-responsive patients.
CONCLUSION
CIndU exhibits a good response to both AHs and omalizumab. Notably, the response to AHs is more pronounced in SD and ColdU compared to ChoU. Disease duration, angioedema, accompanying CSU, mixed CIndU, and lower baseline UCT scores may be used to predict AH treatment outcome in CIndU.
PubMed: 38889696
DOI: 10.1159/000536579 -
The Journal of Asthma : Official... Jun 2024To evaluate the benefits of combining omalizumab with specific immunotherapy (SCIT) in the treatment of children with bronchial asthma. In this study, 83 children with...
To evaluate the benefits of combining omalizumab with specific immunotherapy (SCIT) in the treatment of children with bronchial asthma. In this study, 83 children with asthma were treated at the Allergy Department of Qingdao University from January 2019 to February 2020. Participants were divided into three groups: SCIT, combination (omalizumab + SCIT), and control (standard asthma medications). We assessed Asthma Control Questionnaire (ACQ) scores, Visual Analogue Scale (VAS) scores, and lung function at baseline, 24 weeks, and 48 weeks. Additionally, asthma medication scores were compared at 24 and 48 weeks. Adverse reactions were monitored in both the SCIT and combination groups. The combination group demonstrated lower ACQ scores at both 24 and 48 weeks, and improved VAS scores at 48 weeks compared to the other groups. Additionally, lung function parameters (FEV1 and FEF50) showed significant improvement in the combination group. Reduced asthma medication scores were noted in the combination group at 24 and 48 weeks. Local adverse reactions were fewer in the combination group, and no systemic adverse reactions were reported. Combining omalizumab with SCIT provides quicker asthma control, lowers medication requirements, and enhances lung function with fewer adverse effects, making it a safe and effective treatment for children with bronchial asthma.
PubMed: 38888746
DOI: 10.1080/02770903.2024.2368193 -
Frontiers in Pharmacology 2024We describe the case of a 10-year-old boy with asthma (AS), accompanied by allergic rhinitis (AR), food allergy (FA), and combined attention-deficit/hyperactivity...
Omalizumab in combination with subcutaneous immunotherapy for the treatment of multiple allergies associated with attention-deficit/hyperactivity disorder: a case report and a literature review.
We describe the case of a 10-year-old boy with asthma (AS), accompanied by allergic rhinitis (AR), food allergy (FA), and combined attention-deficit/hyperactivity disorder (ADHD), who was treated at Shanghai Renji Hospital on 11 July 2020. The efficiency of the previous treatment with salmeterol/ticlosone was poor. Treatment with montelukast sodium resulted in development of neurological symptoms. Treatment with omalizumab in combination with subcutaneous immunotherapy (SCIT) was then initiated in our department based on anti-asthmatic therapy. Symptoms of asthma were completely controlled, and FA and AR symptoms improved. The treatment regimen led to a significant improvement in ADHD symptoms and the overall quality of life of the patient. The literature search was done in the PubMed database using "attention deficit/hyperactivity disorder/ADHD" and "asthma" as keywords, and we identified 47 relevant articles. In conclusion, our results show that treating asthma with omalizumab in combination with salmeterol/ticlosone and SCIT is efficient in controlling symptoms of multiple allergies and may lead to the improvement in ADHD symptoms and the overall quality of life of pediatric patients with ADHD. While current studies suggest that allergic diseases are closely related to ADHD, there is still a lack of studies or case reports of complete treatment protocols to provide clinical clues for management of the disease.
PubMed: 38887551
DOI: 10.3389/fphar.2024.1367551 -
Annals of Allergy, Asthma & Immunology... Jun 2024Chronic urticaria can be divided into two subsets: chronic spontaneous urticaria (CSU) with skin lesions occurring without a specific trigger and chronic inducible... (Review)
Review
Chronic urticaria can be divided into two subsets: chronic spontaneous urticaria (CSU) with skin lesions occurring without a specific trigger and chronic inducible urticaria (CIndU) which has an identified specific stimulus. The annual prevalence of CU is 0.5% to 2.3% globally. CSU is a self-limited disorder in most cases, with an average duration of 2 to 5 years, but symptoms persist beyond five years in up to 30% of patients. The first line of treatment is a daily non-sedating, second-generation H1- antihistamines. CSU guidelines recommend using oral non-sedating antihistamines up to 4-fold in patients with CSU unresponsive to standard doses as the next step in treatment. A meta-analysis found that the rate of response in patients with CSU who responded to up-dosing was 63.2%. Therefore, approximately 40% of patients continue to have persistent hives and itching requiring treatment with the biologic omalizumab based on evidence from randomized controlled trials. Although omalizumab has been shown to markedly improve symptoms of CSU, omalizumab is not effective in all patients and has not been shown to induce long-term disease remission. Thus, there is an unmet need for more effective treatments that can lead to cure or long-term remission. In this review, we will provide an overview of new treatment targets and biologics that are under investigation for the treatment of CSU.
PubMed: 38885835
DOI: 10.1016/j.anai.2024.05.020 -
The Journal of Asthma : Official... Jun 2024Specific biomarkers, such as eosinophilia in peripheral blood or fractional exhaled nitric oxide (FeNO), can guide us in the choice of biologic therapy, allowing a more...
BACKGROUND
Specific biomarkers, such as eosinophilia in peripheral blood or fractional exhaled nitric oxide (FeNO), can guide us in the choice of biologic therapy, allowing a more personalized approach. Although there are multiple evidences in the literature about the role of FeNO as a predictor of response to different biologic treatments, there are no data on the relationship between FeNO changes and clinical response to the four biologic drugs currently in use.
OBJECTIVE
To evaluate and to compare the expression of multiple-flows FeNO parameters in a cohort of patients with SA before and during the treatment with biologics to evaluate the performance of these biomarkers in predicting the achievement of clinical remission.
METHODS
We prospectively enrolled 50 patients with severe asthma eligible for biologic therapy. Patients underwent clinical and functional monitoring at baseline (T0) and after 1, 6, and 12 months of treatment (T1, T6, T12), including multiple flows FeNO assessment.
RESULTS
A statistically significant reduction of FeNO50 values and J'awNO was observed only in benralizumab and dupilumab subgroups. Among biomarkers, the reduction of FeNO 50 values at T1 was associated with a higher probability of achieving clinical remission at T12 (p = 0.003), which was also confirmed by ROC curve analysis (AUC 0.758, p = 0.002; sensitivity 60% and specificity 74% for a reduction of 16 ppb).
CONCLUSION
These data confirm the potential of this biomarker in predicting clinical response to biologic treatment in patients with severe asthma in order to guide clinical decisions and evaluate a shift to other biologic therapy.
PubMed: 38884564
DOI: 10.1080/02770903.2024.2370012 -
JAAD Case Reports Jul 2024
PubMed: 38883168
DOI: 10.1016/j.jdcr.2024.04.030 -
Respiratory Medicine Case Reports 2024We present a case of 43-year-old male patient with broadly by Omalizumab, Mepolizumab and Benralizumab pretreated allergic asthma, who suffered a near fatal...
We present a case of 43-year-old male patient with broadly by Omalizumab, Mepolizumab and Benralizumab pretreated allergic asthma, who suffered a near fatal exacerbation, triggered by an influenza A infection. Due to massive bronchoconstriction with consecutive hypercapnic ventilatory failure veno-venous ECMO therapy had to be implemented. Hence, guideline directed asthma therapy a substantial bronchodilatation could not be achieved. After administration of a single dose Tezepelumab, a novel TLSP-inhibitor, and otherwise unchanged therapy we documented a significant reduction in intrinsic PEEP measured via a naso-gastric balloon catheter and a narrowing in the expiratory flow curve of the ventilator within 24 hours. The consecutive ventilatory improvement allowed the successful weaning from veno-venous ECMO therapy and invasive ventilation.
PubMed: 38881777
DOI: 10.1016/j.rmcr.2024.102057 -
Journal of Clinical Apheresis Jun 2024Bullous pemphigoid is the most common autoimmune blistering disease induced by autoantibodies against basement membrane anchoring proteins (anti-BP-180 and anti-BP-230)....
Bullous pemphigoid is the most common autoimmune blistering disease induced by autoantibodies against basement membrane anchoring proteins (anti-BP-180 and anti-BP-230). The disease generally appears after the age of 70 and is associated with a 23.5% 1-year mortality, especially in diabetics, or in the presence of ischemic heart disease and high anti-BP-180. Treatment starts with topical steroids but some patients may require oral steroids and systemic immunosuppression. We, hereby, discuss a diabetic patient on chronic hemodialysis, with severely relapsed bullous pemphigoid under biotherapy with omalizumab, who was successfully treated with five sessions of double filtration plasmapheresis, thus avoiding the need for systemic steroids.
Topics: Humans; Pemphigoid, Bullous; Plasmapheresis; Renal Dialysis; Male; Aged; Female
PubMed: 38881050
DOI: 10.1002/jca.22133 -
The Journal of Dermatological Treatment Dec 2024Amidst the emergence of new therapeutic options, traditional therapeutic plasmapheresis (TPE) used in diseases involving a toxic substance in the plasma, remains a... (Review)
Review
BACKGROUND/PURPOSE
Amidst the emergence of new therapeutic options, traditional therapeutic plasmapheresis (TPE) used in diseases involving a toxic substance in the plasma, remains a viable alternative for cases of recalcitrant solar urticaria (SU). We emphasize the importance of documenting successful experience with repeated plasmapheresis to increase awareness amongst physicians and dermatologists regarding this effective treatment option.
MATERIAL AND METHOD
We reported a case of recalcitrant SU that had not responded to a combination of H1-antihistamines, immunosuppressants, omalizumab and intravenous immunoglobulin. We introduced serial TPE, which involved two consecutive days of procedures for each course was introduced. We detailed the regimen and highlighted the clinical and objective benefits observed with multiple treatments. Additionally, we compared this to other plasmapheresis regimens and their treatment responses previously reported for solar urticaria.
RESULTS
Our patient underwent serial TPE, totaling 42 procedures over five years. Following the last TPE session, phototesting showed a sustained prolongation of minimal urticating doses (MUDS), which exceeded the maximum tested doses across nearly all ultraviolet (UV) and visible light ranges, with the exception of the two short ultraviolet B (UVB) wavelengths. MUDs increased to 25 from 6 mj/cm2 at 307.5± 5nm, and to 500 from 15 mj/cm2 at 320 ± 10nm, before the initial TPE. In our review, we included five articles covering eight SU patients who received TPE. Of these, the five patients with positive intradermal tests responded particularly well immediately after treatment. However, the condition relapsed within two weeks in one patient and within two months in another. In contrast, the other three patients with negative intradermal tests, showed no significant benefits from the treatment. No serious side effects from TPE were reported amongst the patients.
CONCLUSIONS
This review underscores the efficacy of serial plasmapheresis procedures in treating refractory cases of SU, high3lighting the robust results observed.
Topics: Humans; Plasmapheresis; Urticaria; Treatment Outcome; Female; Sunlight; Male; Photosensitivity Disorders; Adult; Middle Aged; Urticaria, Solar
PubMed: 38880493
DOI: 10.1080/09546634.2024.2350229