[The efficacy and safety of protein A immunoadsorption combined with rituximab treatment for highly sensitized patients undergoing haplo-hematopoietic stem cell transplantation].

Objective: To investigate the efficacy and safety of protein A immunoadsorption (PAIA) combined with rituximab (RTX) in highly sensitized patients who underwent haplo-hematopoietic stem cell transplantation (haplo-HSCT) . Methods: The clinical data of 56 highly sensitized patients treated with PAIA and RTX before haplo-HSCT at the First Affiliated Hospital of Soochow University and Soochow Hopes Hematonosis Hospital between March 2021 and June 2023 were retrospectively analyzed. The number of human leukocyte antigen (HLA) antibody types and the mean fluorescence intensity (MFI), humoral immunity, adverse reactions during adsorption, and survival within 100 days before and after adsorption were measured. Results: After receiving the PAIA treatment, the median MFI of patients containing only HLA Ⅰ antibodies decreased from 7 859 (3 209-12 444) to 3 719 (0-8 275) (P<0.001), and the median MFI of HLA Ⅰ+Ⅱ antibodies decreased from 5 476 (1 977-12 382) to 3 714 (0-11 074) (P=0.035). The median MFI of patients with positive anti-donor-specific antibodies decreased from 8 779 (2 697-18 659) to 4 524 (0-15 989) (P<0.001). The number of HLA-A, B, C, DR, and DQ antibodies in all patients decreased after the PAIA treatment, and the differences were statistically significant (A, B, C, DR: P<0.001, DQ: P<0.01). The humoral immune monitoring before and after the PAIA treatment showed a significant decrease in the number of IgG and complement C3 (P<0.001 and P=0.002, respectively). Forty-four patients underwent HLA antibody monitoring after transplantation, and the overall MFI and number of antibody types decreased. However, five patients developed new antibodies with low MFI, and nine patients continued to have high MFI. The overall survival, disease-free survival, non-recurrent mortality, and cumulative recurrence rates at 100 days post-transplantation were 83.8%, 80.2%, 16.1%, and 4.5%, respectively. Conclusions: The combination of PAIA and RTX has a certain therapeutic effect and good safety in the desensitization treatment of highly sensitive patients before haplo-HSCT.

Ofatumumab Desensitization Protocol: A Case of Refractory Immune Thrombocytopenic Purpura.

Chronic immune thrombocytopenic purpura (ITP) is an acquired hematologic condition that involves immune-mediated platelet destruction with resultant bleeding of variable severity. Refractory ITP occurs when patients fail to tolerate and/or respond to multiple treatment modalities. In this case, we examine the clinical course of a 39-year-old female with refractory ITP and discuss how we navigated a multitude of challenges by adapting an established desensitization protocol to meet our patient's needs. To our knowledge, we describe the first successful desensitization to ofatumumab for use in ITP in the current literature.

Triple Therapy for Cystic Fibrosis (Elexacaftor, Tezacaftor, and Ivacaftor): Desensitization After Skin Rash.

Cystic fibrosis (CF) is an autosomal recessive disorder of the CF transmembrane conductance regulator (CFTR) gene. CFTR modulators are novel approved therapies, and triple therapy with elexacaftor/tezacaftor/ivacaftor (ELX/TEZ/IVA) is the current gold standard for patients with at least one F508del mutation. CFTR modulators are usually well-tolerated, but some adverse effects may occur, including skin rash. We report a case of a female patient who developed a severe skin rash after initiating treatment with ELX/TEZ/IVA. Modulator therapy and contraception were discontinued, and consequently, there was a drop in lung function and reappearance of respiratory symptoms. After rash resolution, a gradual reintroduction of ELX/TEZ/IVA was started, and this is the protocol the authors have summarized. Triple therapy with CFTR modulators has a significant impact on lung function and the quality of life of CF patients who have at least one F508del mutation, justifying its reintroduction and desensitization even after a severe adverse effect.

Heterogeneity in Parent Preferences for Peanut Desensitization Therapy.

BACKGROUND: Recently developed peanut desensitization treatment reduces the incidence of allergic reactions, the anxiety associated with the risk of accidental exposure, and the burden of precautionary behavior. Eliciting parent preferences for tradeoffs involving treatment effectiveness, tolerability, costs, and convenience quantifies the burden of juvenile peanut allergy and the perceived value of peanut desensitization therapies. OBJECTIVE: To understand heterogeneity in parents' treatment preferences and the role of personal characteristics in explaining differences. METHODS: An Internet-based, discrete-choice experiment survey was administered to a national sample of 500 parents of children aged 4 to 17 years with peanut allergy to quantify parents' preferences for peanut desensitization therapies for their children. Latent-class, mixed-logit analysis estimated relative importance coefficients for groups of participants with distinctly different preferences. RESULTS: Parents' choice patterns fell into 1 of 4 preference subgroups: (1) Cost-sensitive, (2) Protreatment (but Side-Effect-Averse), (3) Trader, and (4) Inconsistent. Mode of administration had little relative importance across all subgroups. Characteristics associated with belonging to a given preference subgroup included parent age, child age, income, parent perception of child risk and ability to manage allergic reactions, past allergic reactions, and changes in precautionary behaviors posttreatment. CONCLUSIONS: We found distinct differences in parent preferences for tradeoffs involving effectiveness, tolerability, and costs of peanut desensitization treatments. Parents' treatment preferences help quantify the burden of juvenile peanut allergy and the perceived value of new therapies. Such information can inform patient-centric clinical and regulatory decision making.

Effective desensitization for a strong donor-specific HLA antibody in a case of HLA-mismatched allogeneic hematopoietic cell transplantation.

We describe a unique ABO compatible and 9/10 HLA-matched case of successful allogeneic hematopoietic cell transplantation (HCT) after effective desensitization of a strong anti-HLA-A24 donor-specific antibody (DSA) with mean fluorescence intensity of approximately 18 000. Due to absence of a suitable matched unrelated donor the patient sibling was considered the best available donor, and it was decided to desensitize patient prior to transplant. The strength of HLA-A24 DSA slowly decreased over the course of treatment, necessitating a total of 23 sessions of therapeutic plasma exchange in order to bring the DSA strength to undetectable levels, followed by a successful transplant. In summary, the outcome of this case shows effective application of desensitization treatment to remove strong DSA in HCT patients.

Research progress in laser treatment of dentin hypersensitivity / 口腔疾病防治

@#Dentin hypersensitivity is mainly associated with abrasion, wear, acid etching, cracking, wedge-shaped defects, enamel hypoplasia, caries, a lack of neck enamel, and cementum coverage accompanied by gingival recession, resulting in direct exposure of dentin tubules to the oral environment. Dentin hypersensitivity is mainly treated by sealing the exposed dentin tubules and reducing the excitability of the pulpal nerves. Laser therapy, as a safe, fast and convenient treatment measure, has achieved good results both alone and in combination with other medicines and has attracted increasing attention. This paper reviews the research progress in the treatment of dentin hypersensitivity using several common laser therapy mechanisms with parameter selections in various scopes of application. A review of the literature shows that the Nd:YAG laser has a strong penetrating power and a large thermal effect and can denature and coagulate proteins in dentin tubules in a very short time; while the CO2 laser causes little damage to the dental pulp and has an obvious immediate curative effect by high absorption of water molecules in hydroxyapatite and the dentin surface is melted and recrystallized; the Er:YAG laser has high water absorption and a large thermal effect and can block the tubules by evaporating the fluid in the tubules and depositing salts; Er, Cr:YSGG laser energy can be fully absorbed by hydroxyapatite and water and result in desensitization by cutting hard tissues and melting periodontal dentin of the tube simultaneously; The Ga-Al-As semiconductor laser and He:Ne laser are low energy. The laser dosage mainly changes the permeability of nerve fibers to potassium and sodium ions and depolarizes the nerve fibers, producing an analgesic effect. The combination of a laser with a desensitizer can improve the clinical efficacy of treating dentin hypersensitivity.

A clinic study on desensitization treatment of bronchial asthma with positive specific IgE to dust mite in children / 实用医学杂志

Objective To investigate the efficacy and the course of desensitization treatment in bronchial asthma with positive specific IgE to dust mite in children. Methods A total of 105 children with bronchial asthma with positive specific IgE to dermatophagoides farinae allergens were randomized into the observation group and the control group. Children in the control group were treated to continue anti-asthma according to the routine of prevention and treatment children with asthma. Chinldren in the observation group were treated by dermatophagoides farinae drops in addition to the treatment of children in the control group. The recurrence of asthma was compared between two groups at 25 weeks post-treatment. At 25 weeks post-treatment , children in the observation group was randomly divided into the observation groupⅠand group Ⅱ. Children in the observation groupⅠreceived continuous treatment except for desensitization treatment. Children in the observation group II received the sublingual immunotherapy with dermatophagoides farinae drops (No.4) for 1 year in addition to the treatment in the observation groupⅠ. The recurrence of asthma was also compared between the two sub-groups. Results The rate and times of recurrence of asthma were lower in the observation group than those in the control group(P 0.05). Conclusion The recurrent rate and frequency of asthma could be reduced by the sublingual immunotherapy with dermatophagoides farinae drops in children with asthma of positive specific IgE to dust mite. The course of treatment may be half year long.

Aspirin 300 mg/day is effective for treating aspirin-exacerbated respiratory disease.

BACKGROUND: Aspirin desensitization (AD) treatment at doses of up to 1300 mg/day improves outcomes in aspirin-exacerbated respiratory disease (AERD). The aim of this study was to investigate the efficacy of aspirin 300 mg/day in the treatment of patients with AERD. METHODS: The study included 40 patients diagnosed in our clinic as AERD that were desensitized and treated with aspirin 300 mg/day between December 2005 and December 2012. Changes from the baseline status were analyzed at 1 year and at 3 years of follow-up. RESULTS: Of the 40 patients included, 24 (60%) were female and median (interquartile range [IQR]) age was 45 (40-51) years. Median (IQR) duration of AD was 31.5 (10.5-48.5) months. In total, 29 patients continued treatment for at least 1 year and 18 patients for at least 3 years. The annual rate of use of systemic corticosteroid regimens, episodes of sinusitis, and surgery was significantly lower both at 1 year (P = 0.002, P = 0.01, and P < 0.001, respectively) and at 3 years (P = 0.001, P = 0.03, and P = 0.002, respectively). Significant improvement was observed in the nasal congestion score (P = 0.01) and sense of smell score (P = 0.05) at 1 year and in the postnasal drainage score (P = 0.01) at 3 years. CONCLUSION: Daily treatment with aspirin 300 mg had beneficial effects in patients with AERD, especially for the control of upper airway disease.

Sulfanilamide desensitization treatment for systemic lupus erythematosus complicated with Pneumocystis pneumonia: a case report and case analysis / 中国药学杂志

OBJECTIVE: To report the clinical manifestations of one case systemic lupus erythematosus (SLE) complicated with Pneumocystis pneumonia(PCP), and the process that in accordance with the treatment guidelines of the patients who had a history of sulfa allergy in patients with sulfa desensitization program treatment. METHODS: Involved in the discussion of treatment of a patient in our hospitals intensive care unit who has systemic lupus erythematosus(SLE) complicated with Pneumocystis pneumonia(PCP) and history of sulfur allergy, and analyze the clinical data of the patient retrospectively. RESULTS: The middle-aged women suffering from systemic lupus erythematosus (systemic lupus erythematosus; SLE) combined Pneumocystis pneumonia (Pneumocystis pneumonia, PCP) infection. Due to her history of sulfa drug allergies, antibiotics and sulfa desensitization treatment were given. Symptoms were eased sputum smear PCP (negative). CONCLUSION: The infection is generally the main life-threatening reason to patients with autoimmune disease in clinical, taking a comprehensive treatment is a necessary measure for patients with SLE combined PCP for the patients who are allergic to Sulfa drugs with contraindications or undesirable effects using alternative drug. Desensitization treatment may be one of the choices for these patients. Copyright 2012 by the Chinese Pharmaceutical Association.