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Orchestration of inflammation in contact allergy by innate immune and cellular stress responses 先天性免疫和细胞应激反应协调接触性过敏中的炎症反应
Q3 Medicine Pub Date : 2023-11-09 DOI: 10.1007/s40629-023-00275-4
Stefan F. Martin, Anne-Catherine Rühl-Muth, Philipp R. Esser

Background

Inflammation is central to the initiation of immune responses and to the pathogenesis of many diseases such as allergic contact dermatitis (ACD). ACD is an inflammatory skin disease caused by low molecular weight organic chemicals and metal ions. The immune system plays a decisive role. After protein binding, the triggering chemicals act as contact allergens that are recognized by specific T cells. Before this can happen, however, the chemicals must trigger inflammation in the skin, without which the adaptive immune system in particular is not activated.

Methods

In recent years, the inflammatory mechanisms of contact allergy have been studied at the cellular and molecular level in vivo and in vitro.

Results

Contact allergens activate the innate immune system and additionally cellular stress responses, which in interaction are responsible for skin inflammation. In this context, inflammation is required for both initial sensitization and elicitation of ACD.

Conclusion

Skin inflammation in ACD is orchestrated by the interplay of the innate immune system and cellular stress responses.

背景炎症是引发免疫反应和过敏性接触性皮炎(ACD)等许多疾病的发病机制的核心。过敏性接触性皮炎是一种由低分子量有机化学物质和金属离子引起的炎症性皮肤病。免疫系统起着决定性作用。在与蛋白质结合后,诱发化学物质成为接触过敏原,并被特异性 T 细胞识别。结果接触性过敏原激活了先天性免疫系统,此外还激活了细胞应激反应,两者相互作用导致了皮肤炎症。结论 ACD 中的皮肤炎症是先天性免疫系统和细胞应激反应相互作用的结果。
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引用次数: 0
Hives but no urticaria—what could it be? 有荨麻疹却没有荨麻疹——会是什么呢?
Q3 Medicine Pub Date : 2023-11-02 DOI: 10.1007/s40629-023-00274-5
Mathias Sulk, Carolin C. Albers, Maria Wulf, Stephan A. Braun, Christoph M. Hammers, Guido Heine

Urticaria is a common inflammatory dermatosis characterized by transient, usually intensely itching wheals mediated by mast cells. Urticarial lesions can also be mimicked by other skin diseases. Differential diagnoses of urticaria should be considered if the single urticarial skin lesion persists for more than 24 h, if hyperpigmentation, scaling, or blistering occurs, if the lesions are not itching, or if fever or arthralgias are reported. In these cases, histologic examination and thorough serologic diagnostic may help to differentiate other dermatoses, such as vasculitis, autoimmune bullous skin diseases, drug reactions, or autoinflammatory syndromes. This article summarizes common differential diagnoses of urticaria.

荨麻疹是一种常见的炎症性皮肤病,其特征是由肥大细胞介导的短暂的,通常是强烈的瘙痒。其他皮肤病也可模仿荨麻疹病变。如果单个荨麻疹皮肤病变持续超过24 h,如果出现色素沉着、脱屑或起泡,如果病变不痒,或者报告有发热或关节痛,则应考虑荨麻疹的鉴别诊断。在这些病例中,组织学检查和彻底的血清学诊断可能有助于区分其他皮肤病,如血管炎、自身免疫性大疱性皮肤病、药物反应或自身炎症综合征。本文就荨麻疹的常见鉴别诊断作一综述。
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引用次数: 0
Non-occupational epoxy resin allergy 非职业性环氧树脂过敏
Q3 Medicine Pub Date : 2023-10-30 DOI: 10.1007/s40629-023-00273-6
Johannes Geier

Background

Sensitization to epoxy resin is mostly acquired occupationally, with those employed in the construction industry being particularly affected. Cases of non-occupational epoxy resin allergy are observed less frequently. In the literature, an association between epoxy resin allergy and fragrance allergy is postulated.

Methods

Analysis of corresponding data from the Information Network of Departments of Dermatology (IVDK); literature review.

Results

In the IVDK 2013–2022, the rate of positive reactions to epoxy resin in patients with occupational dermatitis (OD) was 2.4–4.0%, in patients without OD 0.8–1.5%. Accompanying reactions to reactive diluents and hardeners prove an exposure to epoxy resins also in patients without OD. Patients sensitized to epoxy resin have an increased risk of reactions to other baseline series allergens. Case reports of non-occupational epoxy resin allergy concern work with casting resins. However, epoxy resin exposure is also possible, for example, from three-dimensional (3D) printing finishes or products for hoof repair in horses.

Discussion

Non-occupational epoxy resin allergy may be acquired not only from do-it-yourself activities in the narrow sense, which should be considered when taking the medical history. The association between epoxy resin and fragrance allergy does not go beyond the general level of associations between contact allergies with each other.

背景对环氧树脂过敏大多是职业性的,尤其是建筑行业的从业人员。非职业环氧树脂过敏的病例则较少见。方法分析皮肤科信息网络(IVDK)中的相应数据;文献综述。结果在 2013-2022 年的 IVDK 中,职业性皮炎(OD)患者对环氧树脂的阳性反应率为 2.4-4.0%,无 OD 患者为 0.8-1.5%。对活性稀释剂和固化剂的伴随反应证明,无 OD 的患者也接触过环氧树脂。对环氧树脂过敏的患者对其他基线系列过敏原产生反应的风险也会增加。非职业环氧树脂过敏的病例报告涉及浇铸树脂的工作。讨论非职业性环氧树脂过敏不仅可能来自狭义的 DIY 活动,在询问病史时也应考虑到这一点。环氧树脂和香料过敏之间的联系并没有超出接触性过敏之间的一般联系。
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引用次数: 0
Chronic spontaneous urticaria—status quo and future 慢性自发性荨麻疹的现状与未来
Q3 Medicine Pub Date : 2023-10-11 DOI: 10.1007/s40629-023-00272-7
Susanne Melchers,  Jan P. Nicolay

Chronic spontaneous urticaria (CsU) is a chronic inflammatory dermatosis whose etiology is not yet fully understood. In affected patients, it is often associated with a high limitation of health-related quality of life, which necessitates effective therapeutic management. Different immune cell populations such as mast cells, eosinophilic and basophilic granulocytes, and T cells are involved in the pathogenesis of CsU, whereby mast cells playing a key role. In addition, type I autoallergic reactions with auto IgE antibodies or type IIb autoimmune reactions with auto IgG antibodies have been identified in a proportion of patients. The current international guideline initially recommends the use of second-generation H1 antihistamines, first in standard, then in off-label quadruple dosing. Subsequently, the anti-IgE antibody omalizumab should be added. However, this therapy algorithm does not lead to freedom from manifestations in all patients. Therefore, various targeted therapies are currently being evaluated for their efficacy in CsU, such as off-label use of the anti-interleukin receptor alpha (IL4Rα) antibody dupilumab, the anti-IL-17A antibody secukinumab, or interleukin‑5 blockade using mepolizumab, reslizumab, or benralizumab. In addition, new promising compounds such as the Bruton tyrosine kinase (BTK) inhibitors remibrutinib and fenebrutinib, the anti-cKIT antibody barzolvolimab, the anti-SIGLEC8 antibody lirentelimab, the anti-TSLP antibody tezepelumab, the anti-C5aR1 antibody advoralimab, or the topical application of Syk kinase inhibitors are being tested, which were developed according to new insights into the pathogenesis of CsU. The BTK inhibitor fenebrutinib is currently not being pursued due to a less favorable side effect profile compared to remibrutinib, as well as the anti-IgE antibody ligelizumab, which was inferior to omalizumab therapy in a phase 3 study. Overall, there is a high need for new therapeutic strategies to better treat CsU both symptomatically and curatively. This requires a more comprehensive understanding of pathogenesis of the disease in order to develop new targeted therapies.

慢性自发性荨麻疹(CsU)是一种慢性炎症性皮肤病,其病因尚不完全清楚。在受影响的患者中,它通常与健康相关生活质量的高度限制有关,这需要有效的治疗管理。不同的免疫细胞群,如肥大细胞、嗜酸性粒细胞和嗜碱性粒细胞以及T细胞参与了CsU的发病机制,其中肥大细胞起着关键作用。此外,在一定比例的患者中发现了带有自身IgE抗体的I型自身过敏反应或带有自身IgG抗体的IIb型自身免疫反应。目前的国际指南最初建议使用第二代H1抗组胺药,首先是标准剂量,然后是标签外四倍剂量。随后,应添加抗ige抗体omalizumab。然而,这种治疗算法并不能使所有患者都没有表现。因此,目前正在评估各种靶向治疗在CsU中的疗效,例如标签外使用抗白细胞介素受体α (IL4Rα)抗体dupilumab,抗il - 17a抗体secukinumab,或使用mepolizumab, reslizumab或benralizumab阻断白细胞介素- 5。此外,新的有前景的化合物,如布鲁顿酪氨酸激酶(BTK)抑制剂remibrutinib和fenebrutinib,抗ckit抗体barzolvolimab,抗siglec8抗体lirentelimab,抗tslp抗体tezepelumab,抗c5ar1抗体advoralimab,或Syk激酶抑制剂的局部应用正在测试中,这些化合物是根据对CsU发病机制的新见解而开发的。BTK抑制剂fenebrutinib目前没有进行研究,因为与remibrutinib和抗ige抗体ligelizumab相比,fenebrutinib的副作用更小,而ligelizumab在3期研究中优于omalizumab治疗。总的来说,迫切需要新的治疗策略来更好地治疗CsU的症状和治疗。这需要更全面地了解疾病的发病机制,以便开发新的靶向治疗方法。
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引用次数: 0
Cyclophilins and gibberellin-regulated proteins in IgE-mediated allergic diseases IgE介导的过敏性疾病中的亲环素和赤霉素调节蛋白
Q3 Medicine Pub Date : 2023-10-04 DOI: 10.1007/s40629-023-00270-9
Ekaterina Potapova,  Hélène Sénéchal PhD,  Enrico Scala,  Paolo Maria Matricardi,  Pascal Poncet PhD

Summary

The prevalence of immunoglobulin E (IgE)-mediated allergic diseases is currently experiencing an epidemic trend characterized by an increase in both the number of affected individuals and the proportion of patients with multiple sensitizations. The majority of these multiple sensitizations are attributed to IgE reactions to genuine allergenic proteins from unrelated species. However, there is a growing trend of patients becoming sensitized to highly cross-reactive molecules, such as profilins, polcalcins, lipocalins, serum albumins, tropomyosins, and non-specific lipid transfer proteins (nsLTPs). In addition, allergen families that were previously considered of minimal importance are now gaining recognition for their role in the pathogenesis of IgE-mediated allergic diseases. Consequently, these allergen families are increasingly being considered in the diagnostic process. In this review, we aim to provide a comprehensive summary of the biochemical and allergological information about two of these “new” allergen families: cyclophilins (Cyp) and gibberellin-regulated proteins (GRP).

综述免疫球蛋白E(IgE)介导的过敏性疾病的患病率目前正经历一种流行趋势,其特征是受影响的个体数量和多重致敏患者比例都在增加。这些多重致敏大多归因于IgE对来自无关物种的真正致敏蛋白的反应。然而,患者对高度交叉反应分子(如轮廓蛋白、polcalcins、脂质运载蛋白、血清白蛋白、原肌球蛋白和非特异性脂质转移蛋白(nsLTP))越来越敏感。此外,以前被认为最不重要的过敏原家族现在因其在IgE介导的过敏性疾病发病机制中的作用而获得认可。因此,在诊断过程中越来越多地考虑这些过敏原家族。在这篇综述中,我们的目的是提供关于这两个“新”过敏原家族的生化和变态反应学信息的全面总结:亲环蛋白(Cyp)和赤霉素调节蛋白(GRP)。
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引用次数: 0
Urticaria in childhood—what’s new? 儿童荨麻疹有什么新进展?
Q3 Medicine Pub Date : 2023-09-22 DOI: 10.1007/s40629-023-00271-8
Ann-Christin E. Brehler, Andrea Bauer, Bettina Wedi

Urticaria can manifest at any age, including infants and young children. Urticaria is one of the most prevalent skin diseases in childhood. As in adults, a distinction is made between acute and chronic urticaria, with chronic urticaria further classified into chronic spontaneous urticaria and inducible urticaria. According to the current German S3 guideline for classification, diagnosis, and treatment of urticaria, existing literature suggests that the prevalence, disease characteristics, causes, and also the response to treatment are very similar in children and adults. The clinical hallmark of urticaria is the subjective sensation of itch. In young children who may have difficulty expressing itching, it is crucial to observe their scratching behavior during clinical examinations. Particularly in children, mastocytosis and autoinflammatory syndromes (cryopyrin-associated periodic syndromes [CAPS], especially Muckle–Wells syndrome and childhood Still’s disease) are important differential diagnoses. Autoinflammatory syndromes are characterized by additional symptoms such as fever, bone pain, muscle pain, and joint complaints. Cryopyrin-associated periodic syndromes usually manifest in infancy, so that these diseases must be considered, especially if cold-associated urticarial skin lesions are present. Appropriate and early treatment can prevent serious sequelae. In maculopapular mastocytosis (urticaria pigmentosa), reddish macules are characteristic for the disease; especially after elicitation of the Darier’s sign, differentiation from urticaria can be difficult, but the macules are permanent. Clinically, wheals and/or angioedema are found similarly to adults, indicating that mast cell-induced angioedema is also associated with childhood urticaria. In the case of exclusive angioedema, hereditary angioedema must also be considered, which usually manifests for the first time during puberty, often linked to hormone preparation usage.

荨麻疹可以出现在任何年龄,包括婴儿和幼儿。荨麻疹是儿童最常见的皮肤病之一。在成人中,区分急性和慢性荨麻疹,慢性荨麻疹进一步分为慢性自发性荨麻疹和诱导性荨麻疹。根据德国现行的S3荨麻疹分类、诊断和治疗指南,现有文献表明,儿童和成人的患病率、疾病特征、病因以及对治疗的反应非常相似。荨麻疹的临床标志是痒的主观感觉。对于可能难以表达瘙痒的幼儿,在临床检查中观察他们的抓挠行为是至关重要的。特别是在儿童中,肥大细胞增多症和自身炎症综合征(冷冻素相关周期性综合征[CAPS],特别是Muckle-Wells综合征和儿童Still病)是重要的鉴别诊断。自身炎症综合征的特点是附加症状,如发热、骨痛、肌肉痛和关节不适。冷冻素相关的周期性综合征通常表现在婴儿期,因此必须考虑这些疾病,特别是如果存在与冷相关的荨麻疹皮肤病变。适当的早期治疗可以预防严重的后遗症。在斑疹性肥大细胞增多症(色素性荨麻疹)中,红色的斑点是该疾病的特征;特别是在出现达里尔氏征后,与荨麻疹的鉴别可能是困难的,但斑疹是永久性的。临床发现,荨麻疹和/或血管性水肿与成人相似,表明肥大细胞诱导的血管性水肿也与儿童荨麻疹有关。在排他性血管性水肿的情况下,还必须考虑遗传性血管性水肿,通常在青春期首次出现,通常与激素制剂的使用有关。
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引用次数: 0
Abstracts of the 18th German Allergy Congress, Bonn, September 14–16, 2023 第18届德国过敏大会摘要,波恩,2023年9月14日至16日
Q3 Medicine Pub Date : 2023-08-30 DOI: 10.1007/s40629-023-00269-2
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引用次数: 0
Eosinophilic esophagitis—from definition to therapy 嗜酸性食管炎——从定义到治疗
Q3 Medicine Pub Date : 2023-08-28 DOI: 10.1007/s40629-023-00265-6
Ulrike von Arnim

Eosinophilic esophagitis (EoE) is a chronic immune-mediated disorder that is characterized clinically by symptoms of esophageal dysfunction and histologically by a dense eosinophilic inflammation of the esophagus. This article provides an overview of the current knowledge in the field of EoE. EoE has seen significant progress in its understanding, including its definition, clinical presentation, diagnosis, and treatment. Consensus criteria have been established for diagnosing EoE, with symptoms commonly including dysphagia, food impaction, and reflux-like symptoms. Diagnosis involves clinical evaluation, endoscopy, and histological assessment. Therapeutic strategies for EoE aim to alleviate symptoms, induce and maintain remission, and prevent complications. These strategies include dietary modifications, pharmacotherapy, and endoscopic interventions. Treatment choice depends on disease severity, patient preferences, and comorbidities. Despite progress, challenges persist in EoE management. Long-term outcomes and optimal treatment duration are still under investigation. Research efforts focus on identifying predictive markers for treatment response and developing personalized approaches. In conclusion, EoE is a chronic, progressive and recurrent disease with various clinical manifestations and treatment options. Improved understanding has led to better diagnostic criteria and therapeutic strategies. However, further research is necessary to enhance our understanding of disease pathogenesis, refine treatment algorithms, and optimize long-term outcomes for individuals with EoE.

嗜酸性粒细胞食管炎(EoE)是一种由免疫介导的慢性疾病,临床上以食管功能障碍症状为特征,组织学上以食管致密的嗜酸性粒细胞炎症为特征。本文概述了食管炎领域的现有知识。人们对食管水肿的认识取得了重大进展,包括其定义、临床表现、诊断和治疗。诊断胃食管返流的共识标准已经确立,症状通常包括吞咽困难、食物嵌塞和反流样症状。诊断包括临床评估、内窥镜检查和组织学评估。肠易激综合征的治疗策略旨在减轻症状、诱导和维持缓解以及预防并发症。这些策略包括饮食调整、药物治疗和内窥镜干预。治疗方法的选择取决于疾病的严重程度、患者的偏好和合并症。尽管取得了进展,但在治疗咽喉炎方面仍存在挑战。长期疗效和最佳治疗时间仍在研究之中。研究工作的重点是确定治疗反应的预测标志物和开发个性化方法。总之,肠易激综合征是一种慢性、进展性和复发性疾病,具有各种临床表现和治疗方案。随着对该病认识的加深,诊断标准和治疗策略也在不断完善。然而,我们还需要开展进一步的研究,以加强对疾病发病机制的了解、完善治疗算法并优化咽喉炎患者的长期疗效。
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引用次数: 0
Acute urticaria—what to do? 急性荨麻疹怎么办?
Q3 Medicine Pub Date : 2023-08-18 DOI: 10.1007/s40629-023-00266-5
Regina Treudler, Julia Zarnowski, Nicola Wagner

Summary

Acute urticaria (AU) is the most common cause of wheal formation. By definition, it does not persist for more than 6 weeks. It can occur at any age and is more commonly seen in atopic diathesis. Acute spontaneous urticaria is distinguished from inducible forms. This review highlights the clinical presentation, differential diagnosis, possible triggers, and therapeutic strategies. In childhood as in adulthood, viral infections are very frequently associated with acute urticaria, whereas drugs and food are less frequently described as triggers. However, it is not uncommon for multiple triggers to be present simultaneously. Therapeutically, oral nonsedating H1 antihistamines are mainly used. In some patients, concomitant short-term administration of glucocorticosteroids is also necessary.

摘要:急性荨麻疹(AU)是最常见的引起荨麻疹的原因。根据定义,它不会持续超过6周。它可以发生在任何年龄,更常见于特应性素质。急性自发性荨麻疹不同于诱导型荨麻疹。这篇综述强调了临床表现、鉴别诊断、可能的诱因和治疗策略。在儿童期和成年期,病毒感染通常与急性荨麻疹有关,而药物和食物则较少被描述为触发因素。然而,同时出现多个触发器并不罕见。治疗上,主要使用口服非镇静H1抗组胺药。在一些患者中,同时短期使用糖皮质激素也是必要的。
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引用次数: 0
Anti-allergen monoclonal antibodies for the treatment of allergies 抗过敏原单克隆抗体用于治疗过敏
Q3 Medicine Pub Date : 2023-08-15 DOI: 10.1007/s40629-023-00263-8
Niccolo Pengo PhD, Natascha Wuillemin PhD, Dimitri Bieli PhD, Pascal Gasser PhD

Background

To tackle the growing allergy epidemic, novel therapeutic approaches are urgently needed. One promising avenue is the development of anti-allergen antibody therapies. This passive immunization approach stands out from traditional allergen immunotherapy by not exposing patients to the allergen but also by potentially treating patients who are less responsive or even unresponsive to allergen immunotherapies and providing immediate protection.

Methods

After a review of historical and recently published literature on the topic of anti-allergen antibodies, the status quo and recent advancements are presented. Anti-allergen antibody therapies in the context of immunological changes that occur during allergen immunotherapy are also discussed.

Results

While the protective role of anti-allergen antibodies was recognized decades ago, the advancement of antibody discovery technologies has fueled the field, and now different anti-allergen antibody therapies are approaching clinical use. These developments have also broadened our understanding of the allergens and allergenic epitopes responsible in different allergic diseases, and also the role played by immunoglobulins in shaping the immune system.

Conclusion

The development of anti-allergen antibody therapies offers great potential for the treatment of allergies. Of interest, the efficacy of passive immunization approaches will likely extend beyond allergen neutralization as in the presence of the allergen they might contribute to long-lasting disease modification.

背景为了应对日益严重的过敏流行病,迫切需要新的治疗方法。一个有前景的途径是开发抗过敏原抗体疗法。这种被动免疫方法与传统的过敏原免疫疗法不同,它不让患者接触过敏原,还可能治疗对过敏原免疫治疗反应较低甚至无反应的患者,并提供即时保护。方法回顾了抗过敏原抗体的历史和最新发表的文献,介绍了抗过敏源抗体的研究现状和最新进展。还讨论了在过敏原免疫治疗过程中发生的免疫变化的背景下的抗过敏原抗体治疗。结果尽管抗过敏原抗体的保护作用在几十年前就得到了认可,但抗体发现技术的进步推动了这一领域的发展,现在不同的抗过敏原-抗体疗法正在接近临床应用。这些进展也拓宽了我们对不同过敏性疾病中的过敏原和致敏表位的理解,以及免疫球蛋白在形成免疫系统中所起的作用。结论抗过敏原抗体疗法的发展为过敏的治疗提供了巨大的潜力。令人感兴趣的是,被动免疫方法的疗效可能会超越过敏原中和,因为在存在过敏原的情况下,它们可能有助于长期的疾病改变。
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引用次数: 0
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Allergo Journal International
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