Claudio Parisi

Urticaria crónica autoinmunitaria: tratamiento con omalizumab

UNLABELLEDnWe report the case of a child with diagnosis of chronic urticaria/angioedema and its evolution upon omalizumab treatment.nnnCASE REPORTnOur patient is a 12-years-old female who suffered for 14 months severe chronic urticaria/angioedema. She had a poor response to the highest doses of combined therapy with 3 antihistamines, steroids and anti-leukotrienes and great impairment of her quality of life. An autologous serum skin test was positive until 1:100 dilutions, leading to the diagnosis of chronic autoimmune urticaria. Due to the lack of response to treatment, therapy with omalizumab was administered. A notable reduction in symptoms toward the third dose was observed. After 12 months of this treatment, the patient is asymptomatic and has a negative autologous serum test.nnnCONCLUSIONnOmalizumab could be a therapeutic option for patients with autoimmune urticaria unresponsive to other treatments.

National clinical practice guidelines for allergen immunotherapy: An international assessment applying AGREE-II

Since 1988, numerous allergen immunotherapy guidelines (AIT‐GLs) have been developed by national and international organizations to guide physicians in AIT. Even so, AIT is still severely underused.

Direct Medical Costs of Chronic Urticaria in a Private Health Organization of Buenos Aires, Argentina

BACKGROUNDnScarce studies address the issue of resource consumption and direct health care costs of patients diagnosed with adult-onset chronic urticaria (CU).nnnOBJECTIVESnTo estimate medical resource consumption and direct health care costs of affected patients in a private health maintenance organization in Buenos Aires, Argentina.nnnMETHODSnPatients diagnosed with adult-onset CU (International Classification of Diseases, Ninth Revision, Clinical Modification code 708.1, 708.8, or 708.9) and who were members of the Italian Hospital Medical Care Program were included in the study. All data on hospitalizations, drug prescription, outpatient episodes, consultations, and investigations/tests in the 12 months before inclusion in the study were considered for the estimation of medical resource consumption and direct health care costs. Third-quarter 2014 costs were obtained from the Italian Hospital Medical Care Program and converted into US dollars (using the November 2014 exchange rate).nnnRESULTSnA total of 232 patients were included in the study. The mean age at diagnosis was 54.2 ± 20.0 years, and the mean disease duration was 5.4 ± 2.6 years (range, 2-22 years). Of the total number of patients, 75% had allergists as their usual source of care, 23% had dermatologists, 18% had internists, and 3% had rheumatologists. Only 7.8% of the patients had an emergency room admission to manage CU symptoms. To manage the disease, 57.8% of patients used antihistamines and 11.6% used oral corticosteroids. The most relevant source of cost was the medical treatment received, followed by physician visits. The average yearly direct cost per patient was US

Update on Omalizumab for Urticaria: What’s New in the Literature from Mechanisms to Clinic

1015 ±

Prevalence of latex allergy in a population of patients diagnosed with myelomeningocele

752 (95% confidence interval 803-2003).nnnCONCLUSIONSnThis is the first Argentine study that evaluated the costs of CU considering the direct medical costs of the disease. The study provides information on resource utilization and the disease-related economic burden, which is valuable to better understand CU in the local setting. Future research that takes into consideration the direct and indirect costs of the disease will expand knowledge and improve management of the disease.

Allergic Rhinitis and Other Atopic Diseases in Children With Attention Deficit Hyperactivity Disorder

Purpose of ReviewSince omalizumab has been approved for urticaria, numerous randomized and real-life observational trials have been published. We reviewed the period January 2017–February 2018.Recent FindingsOmalizumab is effective for the control of urticaria recalcitrant to antihistamines in different populations globally. The ratio of total serum IgE 4-week/baseline ≥2 can predict response with a high likelihood. In observational real-life trials, doses have been adjusted on an individual basis: in some populations, up to two-thirds of the patients can be controlled with 150xa0mg/month; however, others are still not controlled with 300xa0mg/month. In these, 150xa0mg bimonthly could be tried, before up-dosing to 450xa0mg/month. On the long run (up to 3xa0years) omalizumab kept its efficacy. In many patients, dosing intervals could be augmented (6–8xa0weeks, some even more). After a 12-month treatment, about 20% showed long-term remission without relapse.SummarySome biomarkers are being detected. Adjusting omalizumab doses in urticaria patients could enhance efficacy (shortening dosing interval and/or augmenting dose) and save costs (after 12xa0months: extending dosing interval and/or reducing dose).

Chronic urticaria in a health maintenance organization of Buenos Aires, Argentina - new data that increase global knowledge of this disease

INTRODUCTIONnLatex allergy is one of the main reasons of anaphylaxis in the operating room. The prevalence of this condition is higher among patients with myelomeningocele. Epidemiological data obtained from Argentine patients is scarce.nnnOBJECTIVEnTo estimate the prevalence of latex sensitivity and latex allergy in a population of patients with myelomeningocele and to describe associated risk factors.nnnPOPULATION AND METHODSnDescriptive, cross-sectional, observational study. Family and personal history of allergy, number of surgeries, history of symptoms caused by having been in contact with latex or cross-reactive foods, eosinophil count, measurement of total immunoglobulin E and specific immunoglobulin E levels by means of skin and serologic testing for latex, aeroallergens and cross-reactive fruit.nnnRESULTSnEighty-two patients diagnosed with myelomeningocele were assessed: 41 were males and their average age was 15.3 ± 7.66 years old. Out of all patients, two did not complete skin and serologic testing. Among the remaining 80 patients, 16 (19.51%) had latex allergy, 46 (57.5%) were not allergic, and 18 (22%) showed sensitivity but not allergy. Having undergone more than five surgeries was a risk factor associated with latex allergy (p= 0.035). No significant association was observed with the remaining outcome measures.nnnCONCLUSIONnAccording to this study, the prevalence of latex allergy in this population of patients is 19.51% and the most important risk factor for this condition is a history of having undergone more than five surgeries.

Prevalencia de alergia al látex en una población de pacientes con diagnóstico de mielomeningocele

Purpose of reviewAttention deficit hyperactivity disorder (ADHD) and allergic rhinitis (AR) constitute high-prevalence entities in the pediatric population, and both affect the quality of life of children and their families. Over the last decade, it has been stated that a high number of patients with ADHD show comorbidities with allergic diseases. The aim of this review is to assess the current information about the relationship between both entities.Recent findingsAccording to some authors, a causal association between them has been proposed since they have genetic, environmental, and inflammatory physiopathological mechanisms in common. However, there is still some controversy on this issue. Sleeping disorders are present in both and should be assessed in patients who suffer these conditions. Therefore, proper treatment of AR and other atopic diseases may be beneficial for the clinical progress of ADHD. Reduction of AR unpleasant symptoms and improvements of sleep quality decrease the child’s irritability, and they may further improve their behavior pattern.SummaryEven though this association has not been clearly proven, the allergic conditions and sleep features have to be taken into account in order to improve the patients’ quality of life.

Congestion And Rhinitis Are Common In Fibromyalgia Patients

Background In spite of the frequency of chronic urticaria, there are no epidemiological studies on its prevalence in Argentina. Objective The objective of this study was to define the prevalence and epidemiological characteristics of chronic urticaria patients in Buenos Aires. Methods The population studied were the members of the Italian Hospital Medical Care Program, a prepaid health maintenance organization located in the urban areas around the Autonomous City of Buenos Aires, Argentina. All patients with diagnosis of chronic urticaria members of the Italian Hospital Medical Care Program, and with at least 12 months of follow up were included in the study. All medical records obtained between January 1st, 2012 and December 31, 2014 were analyzed. The prevalence ratio for chronic urticaria per 100,000 population with 95% CI for December 31, 2014 was calculated. The prevalence rate for the entire population and then discriminated for adults and pediatric patients (less than 18 years old at diagnosis) was assessed. Results 158,926 members were analyzed. A total of 463 cases of chronic urticaria were identified on prevalence date (68 in pediatrics, 395 in adults), yielding a crude point prevalence ratio of 0.29% (CI 95% 0.26-0.31%). The observed prevalence of chronic urticaria in the adult population was 0.34 % (95% CI 0.31-0.38%), while in pediatrics it was 0.15 % (95% CI 0.11-0.20%). Study limitations the main weakness is that the results were obtained from an HMO and therefore the possibility of selection bias. Conclusions chronic urticaria is a global condition. Its prevalence in Buenos Aires is comparable with other countries.BACKGROUNDnIn spite of the frequency of chronic urticaria, there are no epidemiological studies on its prevalence in Argentina.nnnOBJECTIVEnThe objective of this study was to define the prevalence and epidemiological characteristics of chronic urticaria patients in Buenos Aires.nnnMETHODSnThe population studied were the members of the Italian Hospital Medical Care Program, a prepaid health maintenance organization located in the urban areas around the Autonomous City of Buenos Aires, Argentina. All patients with diagnosis of chronic urticaria members of the Italian Hospital Medical Care Program, and with at least 12 months of follow up were included in the study. All medical records obtained between January 1st, 2012 and December 31, 2014 were analyzed. The prevalence ratio for chronic urticaria per 100,000 population with 95% CI for December 31, 2014 was calculated. The prevalence rate for the entire population and then discriminated for adults and pediatric patients (less than 18 years old at diagnosis) was assessed.nnnRESULTSn158,926 members were analyzed. A total of 463 cases of chronic urticaria were identified on prevalence date (68 in pediatrics, 395 in adults), yielding a crude point prevalence ratio of 0.29% (CI 95% 0.26-0.31%). The observed prevalence of chronic urticaria in the adult population was 0.34 % (95% CI 0.31-0.38%), while in pediatrics it was 0.15 % (95% CI 0.11-0.20%).nnnSTUDY LIMITATIONSnthe main weakness is that the results were obtained from an HMO and therefore the possibility of selection bias.nnnCONCLUSIONSnchronic urticaria is a global condition. Its prevalence in Buenos Aires is comparable with other countries.

Quality Evaluation of Allergen Immunotherapy Guidelines Worldwide Using AGREE-II

Resumen Introducción: La alergia al látex se encuentra dentro de las primeras causas de anafilaxia en el quirófano. La prevalencia de esta enfermedad es más elevada en pacientes con mielomenigocele. Existen escasos datos epidemiológicos en pacientes argentinos. Objetivo: Estimar la prevalencia de la sensibilidad y de la alergia al látex en una población de pacientes con mielomeningocele y describir los factores de riesgo asociados. Pacientes y métodos: Estudio descriptivo, transversal, observacional. Se analizaron los antecedentes familiares y personales de alergia, el número de procedimientos quirúrgicos, la historia de síntomas ante el contacto con látex o alimentos con reactividad cruzada, el recuento de eosinófilos, la inmunoglobulina E total y la inmunoglobulina E específica mediante pruebas serológicas y cutáneas para el látex, los aeroalérgenos y las frutas con reactividad cruzada. Resultados: Se evaluaron 82 pacientes con diagnóstico de mielomeningocele, 41 del sexo masculino (50%), con edad promedio de 15,3 ± 7,66 años. Del total de los pacientes, 2 no realizaron las pruebas cutáneas y serológicas. De los 80 restantes, 16 (19,51%) presentaban alergia al látex, 46 (57,5%) no eran alérgicos y 18 (22%) fueron sensibles pero no alérgicos. Se observó que haber tenido más de 5 cirugías representaba un factor de riesgo asociado a alergia al látex (p= 0,035). No se encontró una asociación significativa con el resto de las variables evaluadas. El estudio estima que la prevalencia de alergia al látex en esta población de pacientes es de 19,51% y que el factor de riesgo más importante para el desarrollo de esta patología es el antecedente de haber sido sometido a más de 5 intervenciones. Palabras clave: mielomeningocele, alergia, látex, factores de riesgo, cirugía.