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Papadopoulos N.G.,University of Manchester | Papadopoulos N.G.,National and Kapodistrian University of Athens | Bernstein J.A.,University of Cincinnati | Demoly P.,Montpellier University | And 6 more authors.
Allergy: European Journal of Allergy and Clinical Immunology | Year: 2015

Rhinitis is an umbrella term that encompasses many different subtypes, several of which still elude complete characterization. The concept of phenotyping, being the definition of disease subtypes on the basis of clinical presentation, has been well established in the last decade. Classification of rhinitis entities on the basis of phenotypes has facilitated their characterization and has helped practicing clinicians to efficiently approach rhinitis patients. Recently, the concept of endotypes, that is, the definition of disease subtypes on the basis of underlying pathophysiology, has emerged. Phenotypes/endotypes are dynamic, overlapping, and may evolve into one another, thus rendering clear-cut definitions difficult. Nevertheless, a phenotype-/endotype-based classification approach could lead toward the application of stratified and personalized medicine in the rhinitis field. In this PRACTALL document, rhinitis phenotypes and endotypes are described, and rhinitis diagnosis and management approaches focusing on those phenotypes/endotypes are presented and discussed. We emphasize the concept of control-based management, which transcends all rhinitis subtypes. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.


Sanz M.L.,University of Navarra | Blazquez A.B.,Laboratorio Of Investigacion | Garcia B.E.,Servicio de Alergologia
Current Opinion in Allergy and Clinical Immunology | Year: 2011

Purpose of review: The determination of specific IgE (sIgE) against allergenic components fixed in a solid support that is provided as a microarray of high capacity and allows a more precise evaluation in the food allergy diagnosis. In this review, we will analyze the results obtained to date with this technology applied to the component-based diagnosis of food allergy. Recent findings: Microarrays of proteins or glycoproteins allow us to know the profile of sensitization of a patient with food allergy. At present, a commercially available technique exists which allows sIgE to be detected against 103 allergenic molecules. Several laboratories worldwide have explored and optimized this technique for few allergen extracts and the results have been promising with high reliabilities and sensitivities and above all, good correlations with previous existing conventional assays. Summary: In recent years, as a result of advances in molecular biology, together with the development of new technologies of producing high-capacity solid-phase matrices such as microarrays, the diagnosis of food allergy has improved and the basic situation of analyzing sIgE against an allergenic source has now become real the possibility of analyzing sIgE against an allergenic protein or glycoprotein. This change has not only led to a more precise diagnosis of sensitization, but can also be used to explain the different hazards of certain molecular sensitizations, crossreactivity phenomena in many cases and can even change the clinical management according to the information provided. Further studies are clearly needed to evaluate more precisely the scope of this new technique. © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.


Prieto L.,University of Valencia | Ruiz-Jimenez L.,Servicio de Alergologia | Marin J.,University of Valencia
Journal of Asthma | Year: 2013

Objective. The effect of spirometric maneuvers on exhaled nitric oxide (NO) at the constant flow rate of 50 ml/s (FENO) has been studied with equivocal results. Furthermore, the effects of spirometry on bronchial NO flux (J'awNO) and alveolar NO (CANO), two measurements increasingly being used in clinical and research protocols, are unknown. The aim of this study was to evaluate the effect of spirometry on FENO, J'awNO, and CANO in adults with asthma. Methods. Forty-four adults with asthma were studied. To assess the impact of exhaled NO measurement itself on exhaled NO values, FENO, J'awNO, and CANO were obtained twice, at baseline and after a resting period of 10 min. Then spirometry (with or without bronchodilator) was performed followed by exhaled NO measurements at 10 min. Results. In the group with pre-bronchodilator study only (n = 26), mean (95% CI) values before spirometry were 37.3 ppb (22.2-52.4) for FENO, 2375 pl/s (1613-3137) for J'awNO, and 1.65 ppb (0.95-2.35) for CANO, compared with 35.5 ppb (21.1-49.0, p = .10), 2402 pl/s (1663-3141, p = .85), and 1.60 ppb (0.64-2.56, p = .87) after spirometry, respectively. Spirometry-induced changes in exhaled NO values were also not significant in the group with both pre- and post-bronchodilators (n = 18). Furthermore, changes in FENO, J'awNO, and CANO values were similar in the two groups. Conclusions. Our findings demonstrate that spirometry (with or without bronchodilator) does not induce significant changes in bronchial NO flux or alveolar NO values. Therefore, exhaled NO values may be obtained after spirometric maneuvers. © 2013 Informa Healthcare USA, Inc.


Segura C.,Servicio de Alergologia | Prieto L.,University of Valencia | Lopez V.,Hospital Universitario Dr Peset | Barato D.,Hospital Universitario Dr Peset | And 2 more authors.
Respiratory Medicine | Year: 2011

Background: The methacholine challenge test performed with the tidal breathing method induces a greater fall in FEV 1 than the dosimeter method; however, the effect of the challenge method on methacholine-induced fall in FVC has not been investigated. Objective: To determine the influence of the challenge method on methacholine-induced changes in FEV 1 and FVC. Methods: Airway responsiveness to methacholine was determined by dosimeter method and tidal breathing method in 37 subjects with suspected asthma. The dosimeter was modified to deliver an identical volume to that obtained with the tidal breathing method and the same nebulizer model was used for the two challenges. The response was expressed by the provocative concentration of methacholine causing a 20% fall in FEV 1 (PC 20) and by the percent fall in FVC at the PC 20 value relative to FVC after saline inhalation. Results: The PC 20 values obtained with the tidal breathing method and the dosimeter method were similar, with geometric mean values of 3.15 (95%CI, 1.85-5.34 mg/mL) and 2.51 (1.37-4.61 mg/mL, P = 0.092), respectively. The percent fall in FVC at the PC 20 value obtained with the dosimeter was significantly greater than that obtained with the tidal breathing method, with mean values of 11.8 (95%CI, 10.0-13.5%) and 9.4 (95%CI, 8.1-10.8, P = 0.002), respectively. Conclusions: Differences in methacholine PC 20 values obtained with the two challenge methods recommended in guidelines may be overcome by introducing some technical modifications in the dosimeter method. However, the technical factors that affect methacholine sensitivity and air trapping are at least partially different. © 2010 Elsevier Ltd. All rights reserved.


Alvarez-Twose I.,Institute Estudios Of Mastocitosis Of Castilla La Mancha Clmast | Gonzalez-De-Olano D.,Servicio de Alergologia | Sanchez-Munoz L.,Institute Estudios Of Mastocitosis Of Castilla La Mancha Clmast | Matito A.,Institute Estudios Of Mastocitosis Of Castilla La Mancha Clmast | And 6 more authors.
International Archives of Allergy and Immunology | Year: 2012

Background: A variable percentage of patients with systemic mast cell (MC) activation symptoms meet criteria for systemic mastocytosis (SM). We prospectively evaluated the clinical utility of the REMA score versus serum baseline tryptase (sBt) levels for predicting MC clonality and SM in 158 patients with systemic MC activation symptoms in the absence of mastocytosis in the skin (MIS). Methods: World Health Organization criteria for SM were applied in all cases. MC clonality was defined as the presence of KIT -mutated MC or by a clonal HUMARA test. The REMA score consisted of the assignment of positive or negative points as follows: male (+1), female (-1), sBt < 15 μ g /l (-1) or 1 25 μ g /l (+2), presence (-2) or absence (+1) of pruritus, hives or angioedema and presence (+3) of presyncope or syncope. Efficiency of the REMA score for predicting MC clonality and SM was assessed by receiver operating characteristic (ROC) curve analyses and compared to those obtained by means of sBt levels alone. Results: Molecular studies revealed the presence of clonal MC in 68/80 SM cases and in 11/78 patients who did not meet the criteria for SM. ROC curve analyses confirmed the greater sensitivity and a similar specificity of the REMA score versus sBt levels (84 vs. 59% and 74 vs. 70% for MC clonality and 87 vs. 62% and 73 vs. 71% for SM, respectively). Conclusions: Our results confirm the clinical utility of the REMA score to predict MC clonality and SM in patients suffering from systemic MC activation symptoms without MIS. Copyright © 2011 S. Karger AG, Basel.

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