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2. Clinical Phenotypes in NSAID-Induced Urticaria/Angioedema

Author

Quiralte, Joaquin, del Robledo Ávila, María, and Cimbollek, Stefan

Subjects
Medical
Abstract

The skin clinical phenotypes of nonsteroidal anti-inflammatory drug (NSAID) hypersensitivity (NH) are very heterogeneous with several syndromes after NSAID intake, which include different symptoms, different organ involvement and different associated concomitant diseases and possibly different underlying pathophysiology and mechanisms. Making a correct diagnosis in NH is an exciting journey for any allergist. Thus, to classify these diseases properly will be pivotal for appropriate diagnostic and management strategy. Treatment modalities are depending on the clinical phenotypes of NH and they will embrace for each patient: the avoidance of culprit NSAID, the finding of well-tolerated NSAID and in certain cases, desensitization procedures when the NSAID treatment was absolutely needed as well as the control of associated diseases such as spontaneous chronic urticarial or allergic respiratory diseases. This review updates the recent evidence of classification, diagnostic strategies, and management of skin NSAID hypersensitivity reactions.

Published
2022

4. Budesonide/formoterol for maintenance and relief in uncontrolled asthma vs. high-dose salmeterol/fluticasone.

Author

Bousquet, Jean, Boulet, Louis-Philippe, Peters, Matthew J., Magnussen, Helgo, Quiralte, Joaquin, Martinez-Aguilar, Nora E., and Carlsheimer, Åsa

Abstract

Summary: Background: Budesonide/formoterol maintenance and reliever therapy (Symbicort SMART®) improves asthma control compared with fixed-dose inhaled corticosteroid/long-acting β 2-agonist (ICS/LABA) regimens, but its efficacy has not been assessed in comparison with sustained high-dose salmeterol/fluticasone (Seretide™) plus a short-acting β 2-agonist (SABA). Methods: Patients (N=2309) with symptomatic asthma (aged ⩾12 years; forced expiratory volume in 1s ⩾50% predicted), who had experienced an asthma exacerbation in the previous year, were randomised to receive budesonide/formoterol 160/4.5μg two inhalations twice daily and as needed, or one inhalation of salmeterol/fluticasone 50/500μg twice daily plus terbutaline as needed, for 6 months. Results: Time to first severe exacerbation, the pre-specified primary outcome, was not significantly prolonged (risk ratio 0.82; 95% confidence interval 0.63, 1.05). Budesonide/formoterol maintenance and reliever therapy reduced total exacerbations from 31 to 25 events/100 patients/year (P=0.039), and exacerbations requiring hospitalisation/emergency room (ER) treatment from 13 to 9 events/100 patients/year (P=0.046). The treatments showed no difference in measures of lung function or asthma symptoms. The mean dose of ICS received was lower using budesonide/formoterol maintenance and reliever therapy (792μg/day budesonide [1238μg/day beclomethasone dipropionate (BDP) equivalent] versus 1000μg/day fluticasone [2000μg/day BDP equivalent] with salmeterol/fluticasone therapy; P<0.0001). Both treatments were well tolerated. Conclusion: In the treatment of uncontrolled asthma, budesonide/formoterol maintenance and reliever therapy reduces the incidence of severe asthma exacerbations and hospitalisation/ER treatment with similar daily symptom control compared with sustained high-dose salmeterol/fluticasone plus SABA. This benefit is achieved with substantially less ICS exposure. [Copyright &y& Elsevier]

Published
2007
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5. Genetic variations in the TLR3 locus are associated with eosinophilic esophagitis

Author

Alfredo J. Lucendo, Robledo Ávila-Castellano, Stefan Cimbollek, Joaquín Quiralte, Juan-Manuel Bozada, J.R. García-Lozano, [Avila-Castellano, Robledo] Hosp Univ Virgen del Rocio, Div Allergy, UGC Interctr, Seville, Spain, [Cimbollek, Stefan] Hosp Univ Virgen del Rocio, Div Allergy, UGC Interctr, Seville, Spain, [Quiralte, Joaquin] Hosp Univ Virgen del Rocio, Div Allergy, UGC Interctr, Seville, Spain, [Garcia-Lozano, Jose-Raul] Univ Seville, CSIC, Hosp Univ Virgen del Rocio, Serv Inmunol,Unidad Gest Clin Labs Clin,Inst Biom, Seville, Spain, [Lucendo, Alfredo J.] Hosp Gen Tomelloso, Dept Gastroenterol, Tomelloso, Spain, [Lucendo, Alfredo J.] Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid, Spain, [Bozada, Juan-Manuel] Hosp Univ Virgen del Rocio, Div Gastroenterol, Seville, Spain, Alergosur, Sociedad Andaluza de Alergologia e Inmunologia Clinica, Plan Andaluz de Investigacion, and El Fondo Europeo de Desarrollo Regional (FEDER)

Subjects
0301 basic medicine, Thymic stromal lymphopoietin, Cells, Population, Locus (genetics), Single-nucleotide polymorphism, 03 medical and health sciences, 0302 clinical medicine, Toll-like receptor, single nucleotide polymorphism, Genetic variation, Food allergy, Genetic predisposition, medicine, Eosinophilic esophagitis, Children, business.industry, Gastroenterology, Variants, medicine.disease, 030104 developmental biology, Oncology, Immunology, 030211 gastroenterology & hepatology, business, Esophagitis, genetic susceptibility
Abstract

Background Eosinophilic esophagitis (EoE) is an antigen-driven disease mediated by an abnormal immune Th2 response. Objective The objective of this article is to investigate genes associated with regulating immune responses leading to disease susceptibility. Methods Twenty-seven tag single nucleotide polymorphisms (tSNPs) selected in five candidate genes ( TLR3, TLR4, FOXP3, FLG and TSLP) were genotyped in 218 EoE patients and 376 controls. Skin prick tests were carried out in EoE patients with a panel of 17 aeroallergens and 22 plant- and animal-derived foods. Results Five tSNPs located in the TSLP locus and one tSNP located in the TLR3 locus were significantly associated with EoE. The interactions between TLR3 and TSLP loci were analyzed. TLR3+/TSLP– and TLR3–/TSLP+ individuals showed a significantly reduced susceptibility to EoE compared to TLR3–/TSLP– individuals (OR = 0.66, p = 0.036 and OR = 0.23, p = 0.00014, respectively). Likewise, TLR3+/TSLP+ individuals showed the most decreased susceptibility of developing EoE (OR = 0.16, p = 0.0001). However, the interaction gain attributed to the combination of both genes was negative (IG = –4.52%), which indicated redundancy or independent effect. Additionally, TLR3 locus was found to be associated with aeroallergen and food sensitization in EoE patients (OR = 9.67, pc = 0.025 and OR = 0.53, pc = 0.048, respectively). Conclusion TLR3 constitutes a novel genetic susceptibility locus for developing EoE, and the effects would be independent of TSLP.

Published
2018

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