RESUMEN
BACKGROUND: Clinical trials of the mRNA coronavirus disease 2019 (COVID-19) vaccines excluded individuals with primary antibody deficiencies. OBJECTIVE: To evaluate whether antibody and T-cell responses to mRNA COVID-19 vaccination in patients with common variable immunodeficiency (CVID) and specific antibody deficiency (SAD) were comparable to those in healthy controls. METHODS: We measured antibody responses against the spike glycoprotein and the receptor-binding domain (RBD) in addition to severe acute respiratory syndrome coronavirus 2 specific T-cell responses using peripheral blood mononuclear cells 2 to 8 weeks after the subjects completed the primary 2-dose vaccine series. RESULTS: The study comprised 12 patients with CVID, 7 patients with SAD, and 10 controls. Individuals with CVID had lower immunoglobulin (Ig) G and Ig A levels against spike glycoprotein than did both individuals with SAD (P = .27 and P = .01, respectively) and controls (P = .01 and P = .004, respectively). The CVID group developed lower IgG titers against the RBD epitope than did the control group (P = .01). Participants with CVID had lower neutralizing titers than did the control group (P = .002). All participants with SAD developed neutralizing titers. All 3 groups (SAD, CVID, and control) developed antigen-specific CD4+ and CD8+ T-cell responses after vaccination. CONCLUSION: Our results suggest that patients with CVID may have impaired antibody responses to COVID-19 vaccination but intact T-cell responses, whereas patients with SAD would be expected to have both intact antibody and T-cell responses to vaccination.
Asunto(s)
COVID-19 , Inmunodeficiencia Variable Común , Enfermedades de Inmunodeficiencia Primaria , Humanos , COVID-19/prevención & control , Vacunas contra la COVID-19 , Leucocitos Mononucleares , Vacunación , Inmunoglobulina G , GlicoproteínasAsunto(s)
Alergia e Inmunología , Asma , Hipersensibilidad , Escolaridad , Humanos , Estados Unidos/epidemiologíaAsunto(s)
Anafilaxia/epidemiología , Vacunas contra la COVID-19/efectos adversos , Vacunas contra la COVID-19/inmunología , Hipersensibilidad a las Drogas/inmunología , COVID-19/prevención & control , Humanos , Polietilenglicoles/efectos adversos , Polisorbatos/efectos adversos , SARS-CoV-2/inmunología , Estados Unidos/epidemiologíaAsunto(s)
Asma/epidemiología , COVID-19/epidemiología , Enfermedad de la Arteria Coronaria/epidemiología , Diabetes Mellitus/epidemiología , Insuficiencia Cardíaca/epidemiología , Hipertensión/epidemiología , Pandemias , Insuficiencia Renal Crónica/epidemiología , Adulto , Anciano , Asma/mortalidad , Asma/patología , Asma/virología , COVID-19/mortalidad , COVID-19/patología , COVID-19/virología , Comorbilidad , Enfermedad de la Arteria Coronaria/mortalidad , Enfermedad de la Arteria Coronaria/patología , Enfermedad de la Arteria Coronaria/virología , Diabetes Mellitus/mortalidad , Diabetes Mellitus/patología , Diabetes Mellitus/virología , Registros Electrónicos de Salud , Insuficiencia Cardíaca/mortalidad , Insuficiencia Cardíaca/patología , Insuficiencia Cardíaca/virología , Humanos , Hipertensión/mortalidad , Hipertensión/patología , Hipertensión/virología , Unidades de Cuidados Intensivos , Intubación Intratraqueal/estadística & datos numéricos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Prevalencia , Insuficiencia Renal Crónica/mortalidad , Insuficiencia Renal Crónica/patología , Insuficiencia Renal Crónica/virología , Estudios Retrospectivos , SARS-CoV-2/patogenicidad , España/epidemiología , Análisis de SupervivenciaRESUMEN
Cephalosporins are commonly used antibiotics both in hospitalized patients and in outpatients. Hypersensitivity reactions to cephalosporins are becoming increasingly common with a wide range of immunopathologic mechanisms. Cephalosporins are one of the leading causes for perioperative anaphylaxis and severe cutaneous adverse reactions. Patients allergic to cephalosporins tend to tolerate cephalosporins with disparate R1 side chains but may react to other beta-lactams with common R1 side chains. Skin testing for cephalosporins has not been well validated but appears to have a good negative predictive value for cephalosporins with disparate R1 side chains. In vitro tests including basophil activation tests have lower sensitivity when compared with skin testing. Rapid drug desensitization procedures are safe and effective and have been used successfully for immediate and some nonimmediate cephalosporin reactions. Many gaps in knowledge still exist regarding cephalosporin hypersensitivity.
Asunto(s)
Anafilaxia/inmunología , Cefalosporinas/efectos adversos , Reacciones Cruzadas/inmunología , Erupciones por Medicamentos/inmunología , Hipersensibilidad a las Drogas/inmunología , Anafilaxia/inducido químicamente , Anafilaxia/epidemiología , Prueba de Desgranulación de los Basófilos , Cefalosporinas/química , Cefalosporinas/inmunología , Desensibilización Inmunológica , Erupciones por Medicamentos/epidemiología , Erupciones por Medicamentos/etiología , Hipersensibilidad a las Drogas/diagnóstico , Hipersensibilidad a las Drogas/epidemiología , Hipersensibilidad a las Drogas/terapia , Humanos , Periodo Perioperatorio , Variantes Farmacogenómicas , Enfermedad del Suero , Pruebas Cutáneas , beta-Lactamas/efectos adversos , beta-Lactamas/inmunologíaRESUMEN
For decades, health care policy experts have wrestled with ways to solve problems of access, cost, and quality in US health care. The current consensus is that the solution to all three lies in changing financial incentives for providers and delivering care through integrated systems. The currently favored vehicle for this, both in the public and private sectors, is through Accountable Care Organizations (ACOs). Medicare has several models and has fostered rapid growth in the number of operative ACOs. At least an equal number of private ACOs are in operation. Whether or not these organizations will fulfill their promise is unknown but there is reason for cautious optimism. Allergists can and should be part of the process of this transformation in our health care system. They can be integral to helping these organizations save money by reducing hospitalizations and improving the quality of allergy and asthma care in the populations served. In order to accomplish this, allergists must become more involved in their medical communities and hospitals.
Asunto(s)
Organizaciones Responsables por la Atención/organización & administración , Alergia e Inmunología/organización & administración , Reforma de la Atención de Salud/organización & administración , Administración de la Práctica Médica/organización & administración , Organizaciones Responsables por la Atención/economía , Organizaciones Responsables por la Atención/legislación & jurisprudencia , Alergia e Inmunología/economía , Alergia e Inmunología/legislación & jurisprudencia , Prestación Integrada de Atención de Salud/organización & administración , Planes de Aranceles por Servicios/organización & administración , Costos de la Atención en Salud , Reforma de la Atención de Salud/economía , Reforma de la Atención de Salud/legislación & jurisprudencia , Gastos en Salud , Accesibilidad a los Servicios de Salud/organización & administración , Humanos , Asociaciones de Práctica Independiente/organización & administración , Medicaid/organización & administración , Medicare/organización & administración , Modelos Organizacionales , Objetivos Organizacionales , Paquetes de Atención al Paciente , Patient Protection and Affordable Care Act/organización & administración , Atención Dirigida al Paciente/organización & administración , Administración de la Práctica Médica/economía , Administración de la Práctica Médica/legislación & jurisprudencia , Calidad de la Atención de Salud/organización & administración , Estados UnidosRESUMEN
OBJECTIVE: To review major milestones in the development of subcutaneous allergen immunotherapy in 20-year segments. DATA SOURCES: Review of the literature available in textbooks and journals. STUDY SELECTION: Articles and books addressing major achievements in the development of subcutaneous allergy immunotherapy were selected for inclusion in this review. RESULTS: Immunotherapy administration has improved the lives of possibly millions of patients with hay fever. Asthmatic symptoms have been relieved if not ablated in millions as well. Insect venom hypersensitivity became treatable and highly effective. In the beginning years of immunotherapy, it was clear that immunotherapy worked; in the later years, the mechanisms for this efficacy were discovered. In this case, the therapy preceded its validation. Methods, materials, and safety have vastly improved. Postulated mechanisms explain much but not everything. CONCLUSIONS: There is still research to be accomplished, improvements to be made, and, of course, patients to be made well.