Journal of Investigational Allergology and Clinical Immunology最新文献

Background and objectives: Allergic conjunctivitis is the most common type of ocular allergy. The objective of this study was to evaluate the efficacy of a new once-daily, preservative-free, bilastine 0.6% eye drop formulation for the treatment of allergic conjunctivitis.

Methods: Two double-masked, vehicle-controlled, clinical studies (a phase 2 dose-ranging study and a phase 3 efficacy study) were conducted to assess the efficacy of bilastine ophthalmic solution for treatment of the signs and symptoms of allergic conjunctivitis. Both studies used the Ora-CAC® Conjunctival Allergen Challenge (CAC) model to enable observation of allergic responses under controlled conditions. Each study was analyzed separately and then combined to create an integrated data set.

Results: Efficacy was achieved for the primary efficacy endpoint of ocular itching with 3 bilastine concentrations (0.2%, 0.4%, and 0.6%) at 15 minutes and 8 hours after instillation. Bilastine 0.6% ophthalmic solution was also efficacious at 16 hours after instillation. Bilastine 0.6% ophthalmic solution demonstrated noninferiority to ketotifen 0.025% at the onset of action. According to the integrated data set, differences between vehicle and bilastine 0.6% after instillation were significant at all time points both at onset (15 minutes) and after a prolonged duration (16 hours).

Conclusion: This multitrial assessment suggests that bilastine 0.6% ophthalmic solution is efficacious for the treatment of the signs and symptoms of allergic conjunctivitis, with a rapid onset and prolonged duration of action, and has a favorable safety profile. The added convenience of once-daily dosing may contribute to adherence and improve quality of life.

Background and objectives: Patients sensitized to lipid transfer protein (LTP) are characterized by wide clinical variability. The lack of practical diagnostic and therapeutic guidelines complicates their management. The aim of the study was to describe the clinical approach of Spanish allergists to sensitization to LTP.

Methods: We used a survey designed following the PICO method and subsequent validation using the Delphi approach.

Results: The survey was completed by 224 allergists (75% women; 57.1% with >20 years of professional experience). Clinical practice for the main points of diagnosis of LTP allergy was homogeneous, except for patients with suspected hypersensitivity to nonsteroidal anti-inflammatory drugs (44.6% frequently included skin testing with LTP). Oral food challenges were not frequently performed (63.6% occasionally to never) and were generally (75.5%) used to confirm tolerance. It was common to recommend fruit skin avoidance (77.2%) and to maintain consumption of foods to which patients were sensitized but tolerant (99.1%). The results were heterogeneous for other dietary indications, modifications due to cofactors, and trace avoidance. Peach sublingual immunotherapy (SLIT) was considered very/quite effective by 55.9% of allergists. Most (79.5%) consider SLIT indicated in <25% of LTP-allergic patients based on severity (95.2%), frequency of reactions (99.4%), allergy to multiple food families (97.4%), and impairment of quality of life/nutrition (91.5%). Practice with respect to prescription of SLIT varied based on cofactor involvement.

Conclusions: These data suggest that there is a need to increase evidence to reduce heterogeneity in the clinical management of LTP allergy.

De novo food allergy is a common phenomenon among pediatric solid organ recipients (8.5%-57%) when compared with the general population (0.45%-10%). Other associated disorders include non-IgE-mediated immune reactions and clinical predisposition to asthma and alterations in the oral mucosa. Originally, passive mechanisms (passive transfer of IgE and immune cells) were thought to be responsible for acute, transient cases of food allergies with a previous history of sensitization for a specific allergen in the donor. Recently proposed pathophysiological mechanisms to explain de novo allergies include TH2/B-cell imbalance, regulatory T-cell (Treg) disruption, gastrointestinal immaturity, and altered gastrointestinal permeability. Recent studies also suggest that immunosuppressive drugs, especially tacrolimus, promote naïve T-cell differentiation into TH2 cells, IgE-promoting cytokine production, decreased IL-5 and IL-10 levels, increased IgA levels, and Treg disruption. Such immunological interactions, in conjunction with altered intestinal permeability, intestinal immaturity in children, history of viral infection, and a personal history of allergies or eczema, are thought to explain most clinical cases of pediatric de novo food allergy after solid organ transplantation reported in the literature. A better understanding of the immunological mechanisms underpinning organ donors and recipients may unveil some of the caveats concerning therapeutic management and improve the quality of life of affected individuals.

Asthma, a prevalent chronic respiratory disease, manifests in heterogeneous phenotypes and endotypes, necessitating bespoke therapeutic approaches. Asthma exacerbations are characterized by worsening of symptoms and decline in lung function and present substantial challenges despite advances in understanding and treatment. Viral respiratory infections, notably those caused by rhinovirus, serve as primary triggers, with allergic sensitization and environmental exposures increasing susceptibility. Deficient antiviral responses in asthmatic airway epithelial cells, particularly impaired interferon production, perpetuate inflammation and hyperresponsiveness, contributing to exacerbations. Additionally, genetic polymorphisms influence host responses and susceptibility. Recent studies underscore the association between specific inflammatory profiles, particularly eosinophil-mediated inflammation, and the frequency of exacerbations. Biologic therapies targeting inflammatory pathways show promise in reducing the frequency of exacerbations, thus underscoring the importance of understanding inflammatory phenotypes when selecting treatment. Notably, T2 inhibitors may modulate immune responses, potentially mitigating viral exacerbations. Characterizing exacerbations is crucial for optimizing therapeutic strategies. Evidence suggests a dissociation between baseline inflammatory profiles and exacerbation phenotypes, highlighting the need for individualized management. Phenotyping exacerbations using sputum analysis helps to identify predominant inflammatory patterns and thus inform treatment decisions. The varied responses to biologic therapies further emphasize the importance of phenotyping exacerbations in refining treatment algorithms. In conclusion, phenotyping asthma exacerbations provides valuable insights into underlying inflammatory mechanisms and enables personalized therapy. Understanding the complex interplay between viral triggers, inflammatory pathways, and responses to treatment is essential if we are to effectively manage severe asthma and reduce the burden of exacerbations. Further research into the mechanistic actions of biologic therapies in mitigating viral exacerbations is warranted to optimize asthma management strategies.