Delayed Type Hypersensitivity Reaction Induced By Liraglutide With Tolerance to Semaglutide.

Liraglutide is a glucagon-like peptide-1 (GLP-1) receptor agonist used for the management of type 2 diabetes and obesity. It was the first GLP-1 receptor agonist to be approved by the US Food and Drug Administration and the European Medicines Agency for the treatment of obesity. To date, numerous skin adverse reactions to liraglutide have been reported, but data regarding hypersensitivity reactions are scarce, raising concerns about its safety and clinical management. We present the case of a 56-year-old female patient with class 3 obesity who was started on subcutaneous liraglutide (Saxenda) by her endocrinologist. One month after starting the aforementioned treatment, the patient presented well-defined, round, erythematous pruriginous plaques surrounding the injection site, around 24 hours after the drug administration. A liraglutide-induced, delayed-type hypersensitivity reaction was suspected, which could be subsequently confirmed by allergy testing and histopathological study. This paper explores the clinical use of liraglutide, the occurrence of hypersensitivity reactions, diagnosis, management, and implications for future research. Understanding and managing liraglutide hypersensitivity is crucial to ensuring the safety and efficacy of this medication.

Serum tryptase monitoring in indolent systemic mastocytosis: association with disease features and patient outcome.

BACKGROUND: Serum baseline tryptase (sBT) is a minor diagnostic criterion for systemic mastocytosis (SM) of undetermined prognostic impact. We monitored sBT levels in indolent SM (ISM) patients and investigated its utility for predicting disease behaviour and outcome. METHODS: In total 74 adult ISM patients who were followed for ≥48 months and received no cytoreductive therapy were retrospectively studied. Patients were classified according to the pattern of evolution of sBT observed. RESULTS: Overall 16/74 (22%) cases had decreasing sBT levels, 48 (65%) patients showed increasing sBT levels and 10 (13%) patients showed a fluctuating pattern. Patients with significantly increasing sBT (sBT slope ≥0.15) after 48 months of follow-up showed a slightly greater rate of development of diffuse bone sclerosis (13% vs. 2%) and hepatomegaly plus splenomegaly (16% vs. 5%), as well as a significantly greater frequency of multilineage vs. mast cells (MC)-restricted KIT mutation (p = 0.01) together with a greater frequency of cases with progression of ISM to smouldering and aggressive SM (p = 0.03), and a shorter progression-free survival (p = 0.03). CONCLUSIONS: Monitoring of sBT in ISM patients is closely associated with poor prognosis disease features as well as with disease progression, pointing out the need for a closer follow-up in ISM patients with progressively increasing sBT values.

Pathophysiological bases of eosinophilic esophagitis therapy.

Eosinophilic esophagitis (EoE) is a chronic inflammatory disease of unknown etiology, presenting a dense mucosal infiltration of eosinophils that is not reversible with proton pump inhibitor therapy. Endoscopy has reported EoE commonly polymorphous disease with subtle mucosal changes, accompanied by variations in the caliber of the esophagus. The suggestion of EoE as an allergic disease is still short of evidence and recently, it has only been confirmed that the esophagus mucosal layer infiltrated by eosinophils may determine an association with allergy after exposure to allergens. A comprehensive review of symptoms, risk factors, diagnoses and mechanisms involved in the pathogenesis of EoE was carried out, with an analysis of the different treatment options available for this disease firmly maximizing in incidence and prevalence. The management of EoE is multidisciplinary and can involve gastroenterologists, pathologists, allergists and dietitians, particularly in pediatric patients, because dietary food restrictions appear to be more beneficial in children versus adults. EoE can successfully be treated with topical corticosteroids, which eliminate the clinical manifestations and histological lesions in most cases. Prolonged treatment is advised for EoE because it recurs frequently, particularly on discontinuation of therapy. Experimental treatments using immunotherapy are being investigated, but their safety and efficacy are yet to be defined.

[Hepatic involvement in celiac disease]. / Afectación hepática en la enfermedad celíaca.

Celiac disease (CD) is an autoimmune enteropathy triggered by gluten ingestion in genetically susceptible individuals. Hypertransaminasemia has been observed in up to 40% of untreated celiac patients and is usually resolved by a gluten-free diet. The most common type of liver disease associated with CD is non-specific reactive hepatitis, while association with viral hepatitis or autoimmune-mediated liver diseases such as autoimmune hepatitis, primary biliary cirrhosis or primary sclerosing cholangitis is less frequent. Therefore, a practical recommendation would be to look for liver disfunction in patients with CD as well as to perform diagnostic tests for CD in patients with hypertransaminasemia or cholestasis of unknown etiology.

Afectación hepática en la enfermedad celíaca / Hepatic involvement in coeliac disease

La enfermedad celíaca (EC) es una enteropatía autoinmune desencadenada por la ingestión de gluten en individuos con susceptibilidad genética. Se ha observado la existencia de una hipertransaminasemia en aproximadamente el 40% de los pacientes celíacos no tratados, que suele resolverse al excluir el gluten de la dieta. La forma más frecuente de afectación hepática en estos pacientes es una hepatitis reactiva inespecífica, y es menos común su asociación con las hepatitis virales o las hepatopatías autoinmunes, como la hepatitis autoinmune, la cirrosis biliar primaria o la colangitis esclerosante primaria. Por tanto, sería recomendable la búsqueda de hepatopatía en enfermos celíacos y, de igual modo, la realización de pruebas diagnósticas de EC en pacientes con hipertransaminasemia o colestasis de causa no filiada

Celiac disease (CD) is an autoimmune enteropathy triggered by gluten ingestion in genetically susceptible individuals. Hypertransaminasemia has been observed in up to 40% of untreated celiac patients and is usually resolved by a gluten-free diet. The most common type of liver disease associated with CD is non-specific reactive hepatitis, while association with viral hepatitis or autoimmune-mediated liver diseases such as autoimmune hepatitis, primary biliary cirrhosis or primary sclerosing cholangitis is less frequent. Therefore, a practical recommendation would be to look for liver disfunction in patients with CD as well as to perform diagnostic tests for CD in patients with hypertransaminasemia or cholestasis of unknown etiology