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4 results on '"Manana Chikhladze, PhD"'

1. Standards for practical intravenous rapid drug desensitization & delabeling: A WAO committee statement

Author

Emilio Alvarez-Cuesta, MD, PhD, MQM, Ricardo Madrigal-Burgaleta, LMS, MD, PhD, Ana D. Broyles, MD, Javier Cuesta-Herranz, MD, PhD, Maria Antonieta Guzman-Melendez, MD, PhD, Michelle C. Maciag, MD, Elizabeth J. Phillips, MD, Jason A. Trubiano, MBBS, PhD, Johnson T. Wong, MD, Ignacio Ansotegui, MD, PhD, F. Runa Ali, MBBS, PhD, FRCP, Denisse Angel-Pereira, MD, Aleena Banerji, MD, Maria Pilar Berges-Gimeno, MD, PhD, Lorena Bernal-Rubio, MD, Knut Brockow, MD, Ricardo Cardona Villa, MD, Mariana C. Castells, MD, PhD, Jean-Christoph Caubet, MD, Yoon-Seok Chang, MD, PhD, Luis Felipe Ensina, MD, MSc, PhD, Manana Chikhladze, PhD, Anca Mirela Chiriac, MD, PhD, Weng-Hung Chung, MD, PhD, Motohiro Ebisawa, MD, PhD, Bryan Fernandes, MBBS, MRCP, Lene Heise Garvey, MD, PhD, Maximiliano Gomez, MD, PhD, Javier Gomez Vera, MD, Sandra Gonzalez Diaz, MD, PhD, David I. Hong, MD, Juan Carlos Ivancevich, MD, Hye-Ryun Kang, MD, PhD, David A. Khan, MD, Merin Kuruvilla, MD, Jose Ignacio Larco Sousa, MD, Patricia Latour-Staffeld, MD, Anne Y. Liu, MD, Eric Macy, MD, Hans Jorgen Malling, MD, Jorge Maspero, MD, Sara M. May, MD, Cristobalina Mayorga, PhD, Miguel A. Park, MD, Jonathan Peter, MBChB, PhD, Matthieu Picard, MD, FRCPC, Tito Rodriguez-Bouza, MD, PhD, Antonino Romano, MD, Mario Sanchez-Borges, MD, Luciana Kase Tanno, MD, PhD, Maria Jose Torres, MD, PhD, Alicia Ureña-Tavera, MD, Rocco L. Valluzzi, MD, Gerald W. Volcheck, MD, and Masao Yamaguchi, MD, PhD

Subjects
Drug allergy, Drug desensitization, Drug challenge, Drug provocation test, Delabeling, Chemotherapy, Immunologic diseases. Allergy, RC581-607
Abstract

Drug hypersensitivity reactions (DHRs) to intravenous drugs can be severe and might leave patients and doctors in a difficult position where an essential treatment or intervention has to be suspended. Even if virtually any intravenous medication can potentially trigger a life-threatening DHR, chemotherapeutics, biologics, and antibiotics are amongst the intravenous drugs most frequently involved in these reactions. Admittedly, suspending such treatments may negatively impact the survival outcomes or the quality of life of affected patients.Delabeling pathways and rapid drug desensitization (RDD) can help reactive patients stay on first-choice therapies instead of turning to less efficacious, less cost-effective, or more toxic alternatives. However, these are high-complexity and high-risk techniques, which usually need expert teams and allergy-specific techniques (skin testing, in vitro testing, drug provocation testing) to ensure safety, an accurate diagnosis, and personalized management. Unfortunately, there are significant inequalities within and among countries in access to allergy departments with the necessary expertise and resources to offer these techniques and tackle these DHRs optimally.The main objective of this consensus document is to create a great benefit for patients worldwide by aiding allergists to expand the scope of their practice and support them with evidence, data, and experience from leading groups from around the globe.This statement of the Drug Hypersensitivity Committee of the World Allergy Organization (WAO) aims to be a comprehensive practical guide on the technical aspects of implementing acute-onset intravenous hypersensitivity delabeling and RDD for a wide range of drugs. Thus, the manuscript does not only focus on clinical pathways. Instead, it also provides guidance on topics usually left unaddressed, namely, internal validation, continuous quality improvement, creating a healthy multidisciplinary environment, and redesigning care (including a specific supplemental section on a real-life example of how to design a dedicated space that can combine basic and complex diagnostic and therapeutic techniques in allergy).

Published
2022
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2. WAO-ARIA consensus on chronic cough – Part III: Management strategies in primary and cough-specialty care. Updates in COVID-19

Author

Philip W. Rouadi, MD, Samar A. Idriss, MD, Jean Bousquet, MD, PhD, Tanya M. Laidlaw, MD, Cecilio R. Azar, MD, Mona S. Al-Ahmad, MD, FRCPCP, Anahi Yañez, MD, Maryam Ali Y. Al-Nesf, MD, MSc R, CABHS, Talal M. Nsouli, MD, FACAAI, FAAAAI, Sami L. Bahna, MD, DrPH, Eliane Abou-Jaoude, MD, Fares H. Zaitoun, MD, FACAAI, Usamah M. Hadi, MD, FACS, ERS, PARS, Peter W. Hellings, MD, PhD, Glenis K. Scadding, MD, FRCP, Peter K. Smith, BMedSci, MBBS, FRACP, PhD, Mario Morais-Almeida, MD, René Maximiliano Gómez, MD, PhD, Sandra N. Gonzalez Diaz, MD, PhD, Ludger Klimek, MD, PhD, Georges S. Juvelekian, MD, FCCP, D’ABSM, Moussa A. Riachy, MD, FCCP, Giorgio Walter Canonica, MD, David Peden, MD, Gary W.K. Wong, MD, James Sublett, MD, Jonathan A. Bernstein, MD, Lianglu Wang, MD, Luciana K. Tanno, MD, PhD, Manana Chikhladze, PhD, Michael Levin, MD, Yoon-Seok Chang, MD, PhD, Bryan L. Martin, DO, Luis Caraballo, MD, PhD, Adnan Custovic, MD, PhD, Jose Antonio Ortego-Martell, MD, Olivia J.Ly Lesslar, MBBS BIR, Erika Jensen-Jarolim, MD, Motohiro Ebisawa, MD, Alessandro Fiocchi, MD, and Ignacio J. Ansotegui, MD, PhD

Subjects
Upper airway cough syndrome, Lower airway disease, Reflux cough, Chronic cough management, Neuromodulators, Speech therapy, Immunologic diseases. Allergy, RC581-607
Abstract

Background: Chronic cough management necessitates a clear integrated care pathway approach. Primary care physicians initially encounter the majority of chronic cough patients, yet their role in proper management can prove challenging due to limited access to advanced diagnostic testing. A multidisciplinary approach involving otolaryngologists and chest physicians, allergists, and gastroenterologists, among others, is central to the optimal diagnosis and treatment of conditions which underly or worsen cough. These include infectious and inflammatory, upper and lower airway pathologies, or gastro-esophageal reflux. Despite the wide armamentarium of ancillary testing conducted in cough multidisciplinary care, such management can improve cough but seldom resolves it completely. This can be due partly to the limited data on the role of tests (eg, spirometry, exhaled nitric oxide), as well as classical pharmacotherapy conducted in multidisciplinary specialties for chronic cough. Other important factors include presence of multiple concomitant cough trigger mechanisms and the central neuronal complexity of chronic cough. Subsequent management conducted by cough specialists aims at control of cough refractory to prior interventions and includes cough-specific behavioral counseling and pharmacotherapy with neuromodulators, among others. Preliminary data on the role of neuromodulators in a proof-of-concept manner are encouraging but lack strong evidence on efficacy and safety. Objectives: The World Allergy Organization (WAO)/Allergic Rhinitis and its Impact on Asthma (ARIA) Joint Committee on Chronic Cough reviewed the recent literature on management of chronic cough in primary, multidisciplinary, and cough-specialty care. Knowledge gaps in diagnostic testing, classical and neuromodulator pharmacotherapy, in addition to behavioral therapy of chronic cough were also analyzed. Outcomes: This third part of the WAO/ARIA consensus on chronic cough suggests a management algorithm of chronic cough in an integrated care pathway approach. Insights into the inherent limitations of multidisciplinary cough diagnostic testing, efficacy and safety of currently available antitussive pharmacotherapy, or the recently recognized behavioral therapy, can significantly improve the standards of care in patients with chronic cough.

Published
2022
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3. WAO-ARIA consensus on chronic cough - Part II: Phenotypes and mechanisms of abnormal cough presentation — Updates in COVID-19

Author

Philip W. Rouadi, MD, Samar A. Idriss, MD, Jean Bousquet, MD, PhD, Tanya M. Laidlaw, MD, Cecilio R. Azar, MD, Mona S. Al-Ahmad, MD, FRCPCP, Anahi Yañez, MD, Maryam Ali Y. Al-Nesf, MD, MSc R, CABHS, Talal M. Nsouli, MD, FACAAI, FAAAAI, Sami L. Bahna, MD, DrPH, Eliane Abou-Jaoude, MD, Fares H. Zaitoun, MD, FACAAI, Usamah M. Hadi, MD, FACS, ERS, PARS, Peter W. Hellings, MD, PhD, Glenis K. Scadding, MD, FRCP, Peter K. Smith, BMedSci, MBBS, FRACP, PhD, Mario Morais-Almeida, MD, René Maximiliano Gómez, MD, PhD, Sandra N. Gonzalez Diaz, MD, PhD, Ludger Klimek, MD, PhD, Georges S. Juvelekian, MD, FCCP, D'ABSM, Moussa A. Riachy, MD, FCCP, Giorgio Walter Canonica, MD, David Peden, MD, Gary W.K. Wong, MD, James Sublett, MD, Jonathan A. Bernstein, MD, Lianglu Wang, MD, Luciana K. Tanno, MD, PhD, Manana Chikhladze, PhD, Michael Levin, MD, Yoon-Seok Chang, MD, PhD, Bryan L. Martin, DO, Luis Caraballo, MD, PhD, Adnan Custovic, MD, PhD, Jose Antonio Ortega-Martell, MD, Erika Jensen-Jarolim, MD, Motohiro Ebisawa, MD, Alessandro Fiocchi, MD, and Ignacio J. Ansotegui, MD, PhD

Subjects
Multifactorial cough, Cough phenotypes, Type 2 inflammation, COVID 19, Reflux-cough, Upper airway cough syndrome, Immunologic diseases. Allergy, RC581-607
Abstract

Background: Chronic cough can be triggered by respiratory and non-respiratory tract illnesses originating mainly from the upper and lower airways, and the GI tract (ie, reflux). Recent findings suggest it can also be a prominent feature in obstructive sleep apnea (OSA), laryngeal hyperresponsiveness, and COVID-19. The classification of chronic cough is constantly updated but lacks clear definition. Epidemiological data on the prevalence of chronic cough are informative but highly variable. The underlying mechanism of chronic cough is a neurogenic inflammation of the cough reflex which becomes hypersensitive, thus the term hypersensitive cough reflex (HCR). A current challenge is to decipher how various infectious and inflammatory airway diseases and esophageal reflux, among others, modulate HCR. Objectives: The World Allergy Organization/Allergic Rhinitis and its Impact on Asthma (WAO/ARIA) Joint Committee on Chronic Cough reviewed the current literature on classification, epidemiology, presenting features, and mechanistic pathways of chronic cough in airway- and reflux-related cough phenotypes, OSA, and COVID-19. The interplay of cough reflex sensitivity with other pathogenic mechanisms inherent to airway and reflux-related inflammatory conditions was also analyzed. Outcomes: Currently, it is difficult to clearly ascertain true prevalence rates in epidemiological studies of chronic cough phenotypes. This is likely due to lack of standardized objective measures needed for cough classification and frequent coexistence of multi-organ cough origins. Notwithstanding, we emphasize the important role of HCR as a mechanistic trigger in airway- and reflux-related cough phenotypes. Other concomitant mechanisms can also modulate HCR, including type2/Th1/Th2 inflammation, presence or absence of deep inspiration-bronchoprotective reflex (lower airways), tissue remodeling, and likely cough plasticity, among others.

Published
2021
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4. WAO-ARIA consensus on chronic cough – Part 1: Role of TRP channels in neurogenic inflammation of cough neuronal pathways

Author

Philip W. Rouadi, MD, Samar A. Idriss, MD, Jean Bousquet, MD, PhD, Tanya M. Laidlaw, MD, Cecilio R. Azar, MD, Mona Sulaiman AL-Ahmad, MD, FAAAI, FRCPCP, Anahí Yáñez, MD, Maryam Ali Y. AL-Nesf, MD, MSc, R, CABHS, Talal M. Nsouli, MD, FACAAI, FAAAAI, Sami L. Bahna, MD, DrPH, Eliane Abou-Jaoude, MD, Fares H. Zaitoun, MD, FACAAI, Usamah M. Hadi, MD, FACS, ERS, PARS, Peter W. Hellings, MD, PhD, Glenis K. Scadding, MD, FRCP, Peter K. Smith, BMedSci, MBBS, FRACP, PhD, Mario Morais-Almeida, MD, R. Maximiliano Gómez, MD, PhD, Sandra N. González Díaz, MD, PhD, Ludger Klimek, MD, PhD, Georges S. Juvelekian, MD, FCCP, D'ABSM, Moussa A. Riachy, MD, FCCP, Giorgio Walter Canonica, MD, David Peden, MD, Gary W.K. Wong, MD, James Sublett, MD, Jonathan A. Bernstein, MD, Lianglu Wang, MD, Luciana Kase Tanno, MD, PhD, Manana Chikhladze, PhD, Michael Levin, MD, PhD, Yoon-Seok Chang, MD, PhD, Bryan L. Martin, DO, Luis Caraballo, MD, PhD, Adnan Custovic, MD, PhD, José Antonio Ortega-Martell, MD, Erika Jensen-Jarolim, MD, Motohiro Ebisawa, MD, PhD, Alessandro Fiocchi, MD, and Ignacio J. Ansotegui, MD, PhD

Subjects
TRP channel, P2X3, Pathogenesis, Chronic cough, Chemoreceptors, Mechanoreceptors, Immunologic diseases. Allergy, RC581-607
Abstract

Background: Cough features a complex peripheral and central neuronal network. The function of the chemosensitive and stretch (afferent) cough receptors is well described but partly understood. It is speculated that chronic cough reflects a neurogenic inflammation of the cough reflex, which becomes hypersensitive. This is mediated by neuromediators, cytokines, inflammatory cells, and a differential expression of neuronal (chemo/stretch) receptors, such as transient receptor potential (TRP) and purinergic P2X ion channels; yet the overall interaction of these mediators in neurogenic inflammation of cough pathways remains unclear. Objectives: The World Allergy Organization/Allergic Rhinitis and its Impact on Asthma (WAO/ARIA) Joint Committee on Chronic Cough reviewed the current literature on neuroanatomy and pathophysiology of chronic cough. The role of TRP ion channels in pathogenic mechanisms of the hypersensitive cough reflex was also examined. Outcomes: Chemoreceptors are better studied in cough neuronal pathways compared to stretch receptors, likely due to their anatomical overabundance in the respiratory tract, but also their distinctive functional properties. Central pathways are important in suppressive mechanisms and behavioral/affective aspects of chronic cough. Current evidence strongly suggests neurogenic inflammation induces a hypersensitive cough reflex marked by increased expression of neuromediators, mast cells, and eosinophils, among others. TRP ion channels, mainly TRP V1/A1, are important in the pathogenesis of chronic cough due to their role in mediating chemosensitivity to various endogenous and exogenous triggers, as well as a crosstalk between neurogenic and inflammatory pathways in cough-associated airways diseases.

Published
2021
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