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Camperdown, Australia

Manzotti G.,Allergy Outpatients Service | Lombardi C.,Allergy Unit
European Annals of Allergy and Clinical Immunology | Year: 2013

Currently, sublingual immunotherapy (SLIT) may be performed by a number of allergen extract in different preparations but in a near future only products fulfilling the requirements from the regulatory agencies, that make mandatory a pharmaceutical quality, will be authorized. Indeed, two products with such characteristics are already available for SLIT in grass pollen allergic patients, Grazax® from Alk-Abellò and Oralair® from Stallergenes. The data from registrative trials as well as from postmarketing studies provide evidence of efficacy and safety of such products. This articles reviews the similarities and the differences of Grazax® and Oralair®, both designed as drugs for the treatment of grass pollen allergy with the aim, which is exclusive of allergen immunotherapy, to work on the natural history of allergy and not only on symptoms as rescue medications do. The aim of this paper is to evaluate the available trials with Grazax® and Oralair® in terms of pre-seasonal schedule approach to support their use in clinical practice.Such kind of treatment makes possible a continuous dialogue between clinical investigators and clinical practitioners, and is the only way for scientific progress that puts the patient's health at the first place.

Bonadonna P.,Allergy Unit | Zanotti R.,Azienda Ospedaliera Universitaria Integrata of Verona | Muller U.,Bern Medical
Current Opinion in Allergy and Clinical Immunology | Year: 2010

Purpose of Review: To analyse the association of systemic allergic hymenoptera sting reactions with mastocytosis and elevated baseline serum tryptase and to discuss diagnosis and treatment in patients with both diseases. Recent findings: In recent large studies on patients with mastocytosis a much higher incidence of severe anaphylaxis following hymenoptera stings than in the normal population was documented. In patients with hymenoptera venom allergy, elevated baseline tryptase is strongly associated with severe anaphylaxis. Fatal sting reactions were reported in patients with mastocytosis, notably after stopping venom immunotherapy. During venom immunotherapy most patients with mastocytosis are protected from further sting reactions. Based on these observations immunotherapy for life is recommended for patients with mastocytosis and venom allergy. The incidence of allergic side-effects is increased in patients with mastocytosis and elevated baseline tryptase, especially in those allergic to Vespula venom. Premedication with antihistamines, or omalizumab in cases with recurrent severe side-effects, can be helpful. Summary: In all patients with anaphylaxis following hymenoptera stings, baseline serum tryptase should be determined. A value above 11.4 μg/l is often due to mastocytosis and indicates a high risk of very severe anaphylaxis following re-stings. Venom immunotherapy is safe and effective in this situation. © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Brockow K.,TU Munich | Bonadonna P.,Allergy Unit
Current Opinion in Allergy and Clinical Immunology | Year: 2012

PURPOSE OF REVIEW: Mastocytosis in adults is associated with a history of anaphylaxis in 22-49%. In addition, monoclonal mast cell activation syndrome has been described presenting with anaphylaxis, especially in patients with hymenoptera venom anaphylaxis. Data on patients with drug hypersensitivity and mast cell diseases are scarce. RECENT FINDINGS: Drugs are elicitors of anaphylaxis in patients with mastocytosis. Drug hypersensitivity is only seldom described as associated with undetected mast cell disease in the literature. Together with a single-centred retrospective study, this data suggests that from all patients with drug-induced anaphylaxis, probably only a minority are associated with mast cell disease. Most of these cases in the literature are related to general anaesthesia. Thus, for patients with mastocytosis, general anaesthesia appears to be a procedure associated with risk of mast cell degranulation, and special precautions should be considered. SUMMARY: The association between immediate drug hypersensitivity and undetected mast cell diseases appears to be moderate, but nevertheless basal serum tryptase determination and examination for skin signs of mast cell disorders are recommended. An ongoing European multicenter study by the European Network for Drug Allergy will provide more information on this topic. © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Romano A.,Allergy Unit | Caubet J.-C.,University of Geneva
Journal of Allergy and Clinical Immunology: In Practice | Year: 2014

Hypersensitivity reactions to β-lactam and non-β-lactam antibiotics are commonly reported. They can be classified as immediate or nonimmediate according to the time interval between the last drug administration and their onset. Immediate reactions occur within 1 hour after the last drug administration and are manifested clinically by urticaria and/or angioedema, rhinitis, bronchospasm, and anaphylactic shock; they may be mediated by specific IgE-antibodies. Nonimmediate reactions occur more than 1 hour after the last drug administration. The most common manifestations are maculopapular exanthems; specific T lymphocytes may be involved in this type of manifestation. The diagnostic evaluation of hypersensitivity reactions to antibiotics is usually complex. The patient's history is fundamental; the allergic examination is based mainly on in vivo tests selected on the basis of the clinical features and the type of reaction, immediate or nonimmediate. Immediate reactions can be assessed by immediate-reading skin tests and, in selected cases, drug provocation tests. Nonimmediate reactions can be assessed by delayed-reading skin tests, patch tests, and drug provocation tests. However, skin tests have been well validated mainly for β-lactams but less for other classes of antibiotics. © 2014 American Academy of Allergy, Asthma & Immunology.

Chiriac A.M.,Allergy Unit | Demoly P.,Allergy Unit | Demoly P.,Montpellier University
Current Opinion in Allergy and Clinical Immunology | Year: 2013

PURPOSE OF REVIEW: The multiple drug hypersensitivity syndrome (MDH) is a distinct clinical entity, different from cross-reactivity and flare-up reactions. Following its initial description in 1989 by Sullivan et al., several authors have addressed the issues surrounding this peculiar form of drug hypersensitivity. Whether this syndrome is single or can be further classified in several entities is still a matter of debate. RECENT FINDINGS: Case reports, case series or studies involving large populations on MDH are few. The use of this term in the literature is heterogeneous, and the definitions variable. Given the major advances in the study of drug hypersensitivities in general, and ongoing research regarding severe cutaneous adverse reactions in particular, careful study of the subgroup of patients with demonstrated immunological basis of MDH has enabled the generation of possible pathogenetic hypotheses. Together with the studies (despite their limitations) to estimate the prevalence of this syndrome in adult and paediatric patients these emerging data need confirmation through larger studies with well defined populations. SUMMARY: Bringing together the experience of groups involved in the field of drug allergy should help to move knowledge regarding this peculiar form of drug hypersensitivity forward. © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins.

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