The Alarmin Triad-IL-25, IL-33, and TSLP-Serum Levels and Their Clinical Implications in Chronic Spontaneous Urticaria.

This study delves into the critical role of alarmins in chronic spontaneous urticaria (CSU), focusing on their impact on disease severity and the quality of life (QoL) of patients. We investigated the alterations in alarmin levels in CSU patients and their correlations with the Urticaria Activity Score (UAS7) and the Dermatology Life Quality Index (DLQI). We analyzed serum levels of interleukin-25 (IL-25), interleukin-33 (IL-33), and thymic stromal lymphopoietin (TSLP) in 50 CSU patients, comparing these to 38 healthy controls. The study examined the relationship between alarmin levels and clinical outcomes, including disease severity and QoL. Elevated levels of IL-33 and TSLP in CSU patients (p < 0.0001) highlight their potential role in CSU pathogenesis. Although IL-25 showed higher levels in CSU patients, this did not reach statistical significance (p = 0.0823). Crucially, IL-33's correlation with both UAS7 and DLQI scores underscores its potential as a biomarker for CSU diagnosis and severity assessment. Of the alarmins analyzed, IL-33 emerges as particularly significant for further exploration as a diagnostic and prognostic biomarker in CSU. Its substantial correlation with disease severity and impact on QoL makes it a compelling candidate for future research, potentially serving as a target for therapeutic interventions. Given these findings, IL-33 deserves additional investigation to confirm its role and effectiveness as a biomarker and therapeutic target in CSU.

Successful desensitization in a patient with hypersensitivity to multiple insulin preparations - case report.

Hypersensitivity to insulin has decreased substantially in the past three decades, since purified human insulin was introduced to replace heterogeneous porcine and bovine preparations. However, human insulin and its analogs still have immunogenic potential that may prove detrimental for hypersensitive insulin-dependent diabetics. In cases of anaphylactic reactions to insulin, rapid desensitization may be considered as a treatment strategy. We present the first case of successful insulin desensitization in Romania for an uncontrolled diabetic patient with type I hypersensitivity to multiple insulin analogs.

Could FeNO Predict Asthma in Patients with House Dust Mites Allergic Rhinitis?

Background and Objectives: The evolution of allergic rhinitis to asthma is a part of "atopic march". The aim of this study was to analyze possible predictive markers for asthma occurrence in patients with allergic rhinitis to house dust mites (HDM). Materials and Methods: Fifty-eight patients with persistent allergic rhinitis (PAR) were included. The clinical, biological evaluation and fractionated exhaled nitric oxide (FeNO) measurement were performed at enrolment. The patients were clinically evaluated after one year to determine asthma occurrence. Results: The severity of rhinitis symptoms, levels of total immunoglobulin E (IgE), ICAM-1, VCAM-1, E-selectin and IL-6, but not IL-8 and TNF-α were higher in patients with allergic rhinitis who developed asthma compared to non-asthmatics, but the differences were not significant to considered them as predictive factors for asthma occurrence. The risk of asthma was independently influenced by patients aged over 30 years ((OR-3.74; CI95% 0.86-16.31; p = 0.07), a duration of allergic rhinitis over 12 months ((OR-4.20; CI95% 0.88-20; p = 0.07) and a basal FeNO over 28 parts per billion (pbb) ((OR-18.68; CI95% 3.79-92.05; p < 0.001). Conclusion: Clinical and biological parameters may predict asthma occurrence in patients with persistent allergic rhinitis to HDM. Adult patients with a longer duration of rhinitis symptoms and a high level of FeNO have a greater risk to develop asthma.

Clinical impact of omalizumab in refractory chronic urticaria: One centre experience.

Chronic spontaneous urticaria is a debilitating disorder, which has a major impact on the quality of life of affected individuals, and is a substantial global burden. Refractory, difficult to treat cases pose a difficult challenge to patients and clinicians alike. Advances in the field of immunotherapy have led to novel and effective therapeutic strategies. Omalizumab, an immunomodulatory anti-IgE monoclonal antibody, inaugurated a new era in the treatment of refractory chronic urticaria. Several multicenter clinical trials have proven omalizumab to be a safe and effective option for the treatment of refractory symptoms of chronic spontaneous urticaria, while some small studies have shown its efficacy in chronic inductible urticaria as well. In this study, we bring forth updates in chronic urticaria approach, with a focus on our experience with anti-IgE therapy in different forms of chronic urticaria treated at the Allergy Department of the Professor Doctor Octavian Fodor Regional Institute of Gastroenterology and Hepatology (Cluj-Napoca, Romania).

Knowledge influences attitudes toward vaccination in Romania.

Despite proven effectiveness and safety of vaccinations, immunization rates are decreasing across Europe, most countries having suboptimal vaccination coverage, leading to an increase in the number of cases of preventable contagious diseases. In recent years, the number of parents who have refused to vaccinate their children in Romania has decreased substantially, while the number of fatal complications due to measles outbreak is one of the highest in Europe. Since healthcare professionals have been identified as the main advocates for immunization, knowledge and attitudes of medical students and nurses is of particular interest. A cross-sectional survey was carried out on 278 participants, divided into three groups: 183 medical students, 54 nurses and 41 non-medical professionals. The questionnaire included questions on demographics of participants, personal experience with vaccines, knowledge and attitude toward vaccination. The data was collected, centralized and analyzed using statistical methods. The survey was given to the medical students at the beginning of the Immunology course and again at the end, to test whether information received influenced their responses. The study revealed that a great majority of participants were themselves vaccinated [N=262 (94%)] and had/or would vaccinate their children [N=247 (95%)]. Satisfactory overall knowledge about effectiveness and safety concerns was observed, with 98% (N=270) considering vaccines as useful and over 96% (N=276) correctly identified their usefulness. When asked about adverse effects, concerning numbers [N=32, (19%)] of medical students answered incorrectly. After the Immunology course, however, there was significant improvement in knowledge on this topic (P<0.001), correlating with a positive shift in attitude towards current and future vaccines. We predict that better knowledge about vaccines, their efficacy and safety would help build the health provider's confidence in recommending vaccination and thus increased coverage rates.

Isolated angioedema: An overview of clinical features and etiology.

Angioedema can occur in isolation, accompanied by urticaria, or as a feature of anaphylaxis in mast cell-mediated disorders, bradykinin-mediated disorders, as well as in others with unknown mechanisms, such as infections, rare disorders, or idiopathic angioedema. In mast cell-mediated angioedema, other signs and symptoms of mast cell-mediator release are frequently seen. However, clear evidence of mast cell degranulation may be absent in histaminergic angioedema. Bradykinin-induced angioedema is not associated with urticaria or other symptoms of type I hypersensitivity reactions. For many of the known triggers of angioedema, the mechanism is unclear. While mast cell and bradykinin-mediated angioedema are relatively well defined in terms of diagnostic and therapeutic approach, angioedema with unknown mechanisms represents a challenge for patients and clinicians alike. Elucidating the clinical pattern and the possible causes of isolated angioedema is the key to a correct diagnosis. This review summarizes the causes, and clinical features of angioedema, with a focus on isolated angioedema.

Biological therapies for atopic dermatitis: An update.

Severe atopic dermatitis, which affects both adults and children, is a debilitating disorder with a significant decline of patients' quality of life. Although aetiopathogenic factors are currently a topic of study and interpretation, the main features of atopic eczema are skin barrier disturbance and immune dysregulation. Severe refractory disease that fails to improve with conventional therapy may benefit from biologic therapy. Progress in understanding immunopathology of atopic dermatitis have allowed identification of therapeutic molecular targets in the field of biological therapy. We reviewed the different biological treatments with a focus on novel targeted agents: Systemic immunotherapy (Omalizumab, Dupilumab, Lebrikizumab, Tralokinumab, Nemolizumab, Ustekinumab, Fezakinumab, Tezepelumab, Apremilast, allergen specific immunotherapy), and topical agents (Tofacitinib, Crisaborole).