Bibliographic updates

The Monthly Choice
February 2015
Claude Molina, Jacques Gayraud

1.    Basophil Activation Test in peanut allergy
2.    Biomarkers of corticosteroid response to Asthma
3.    Icatibant in ACE- inhibitor induced
4.    Eosinophilic Chronic Rhinosinusitis with Nasal Polyposis treated by budesonide transnasal nebulization
5.    Misuse of medical devices : a persistent problem in self-management of asthma and allergic disease


1.    Basophil Activation Test (BAT) in Peanut Allergy (PA)
A.F.Santos et al : JACI 2015 135 179-86
Theme: Immunology – Food Allergy - Peanut
Key words: Basophil Activation Test – Oral Food Challenge – Peanut

In order to assess the utility of the BAT to predict the severity and threshold of reactivity to peanut, during Oral Food Challenge , the British authors submitted 124 children, on the same day, to clinical evaluation, skin prick-tests, specific IgE dosage and BAT before and after the Challenge. 52 (median age 5 years) reacted with clinical symptoms ranged from mild oral symptoms to anaphylaxis; 57% reacted to 0,1g or less of peanut protein. The percentage of activated basophils (CD63+) measures basophil reactivity at different allergen concentrations whereas the concentration of allergen at which basophils become activated measures basophil sensitivity. This study demonstrates that reactivity is independently associated with severity of allergic reactions to peanut, whereas the threshold sensitivity is significantly associated with the threshold of allergic reactions during the Challenge. These two distinct parameters of BAT may be used to predict severity of PA and the threshold of allergic reactions during Oral Food Challenge.

2.    Biomarkers of corticosteroid response to Asthma
D.C.Cowan et al : JACI 2015 January in press
Theme: Asthma – Allergy treatment
Key words: Asthma – Corticosteroid response - Bromotyrosin
 
Using a panel of 3 biomarkers in steroid-naïve asthmatic patients in order to predict clinical responsiveness to inhaled corticosteroids, (FENO, sputum eosinophil count, urinary bromotyrosin) the authors demonstrated on 46 patients (between 18 and 75 years old , with stable persistent asthma, 80.4% are atopic and 65.2% eosinophilic), that each of the biomarkers had utility for predicting steroid responsiveness but the combination of high FeNO values and high urinary Bromotyrosin levels (BrTyr ) had the best power to predict a favorable response. BrTyr is a noninvasive marker of oxidant stress and eosinophil activation and its association with FENo measurement avoid the need for sputum induction, processing and analysis which are time-consuming, and discomfortable for the patient.

3.    Icatibant in ACE- inhibitor induced Angioedema      
M.Bas et al   New England J.Med.2015 January 25 132 418-25
Theme: Drug Allergology
Key words: Bradykinin angioedema – ACE inhibitor - Icatibant
 
In a, multicenter, double blind, double dummy, randomized phase 2 trial, 27 patients, 18-95 years old, were assigned to treatment with 30mg of subcutaneous Icatibant (selective bradykinin β2 receptor antagonist (13 cases) or to the current off-label, standard therapy (Prednisolone 500mg IV + Clemastine (anti-histamine - 14 cases).                         

All 27 patients had complete resolution of edema (one patient required tracheotomy) but the time to complete resolution of edema was significantly shorter with Icatibant than with combination therapy glucocorticoid- antihistamine.

4.    Eosinophilic Chronic Rhinosinusitis with Nasal Polyposis treated by budesonide transnasal nebulization
C.Wang et al JACI January 2014 in press
Theme: ENT Allergology
Key words: Eosinophilic chronic rhinoinusitis – Nasal Polyposis – Budesonide
 
Short term treatment (14 days) in a randomized trial on sixty patients (19-76 years old) significantly reduced polyp size and improved symptoms. Polyp IL5 and eotaxin expression decreased significantly whereas TGFβ and IL 10 expression increased. Budesonide reduced polyp eosinophil infiltration and Th2 cell frequencies. Indices of remodeling were decreased whereas collagen deposition increased. This treatment did not suppress the hypothalamic-pituitary-adrenal axis or cause any serious side-effects. It is an effective and safe option of corticosteroid therapy for this type of Rhinosinusitis.

5.   Misuse of medical devices : a persistent problem in self-management of asthma and allergic disease              
R.S.Bonds et al Ann.All.Asthma.Immunol 2015 114 63-76
Theme: Allergy treatment
Key words: Self management – Asthma -

This study sought to identify factors associated to misuse of epinephrine auto-injectors (102 patients) and Metered-dose inhalers (MDI) and/or spacers (44 children or adult asthmatics). Only 16% of patients used epinephrine auto-injector properly, missing 3 or more steps of the technique. Only 7% of MDI users demonstrated perfect technique despite allergist/ immunologist care. So, the rate of correct use of these devices since earlier reports did not show any improvement. Novel methods of providing repetitive training for patients are highly recommended.

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Last updated 26 May 2015