RESUMO
Allergen immunotherapy (AIT) is an effective method in the treatment of respiratory allergic diseases (asthma, rhinitis and conjunctivitis). In addition to reducing symptoms, AIT can alter the course of allergic disease and remains efficient long after it has been discontinued by inducing specific tolerance to the allergen. In current clinical practice, immunotherapy is administered by subcutaneous or sublingual routes. The duration of efficacy is 7 to 12 years. It can prevent the development of both asthma and sensitization to new allergens. Despite recent progresses, other approaches are needed, especially for allergies (atopic dermatitis, food allergies). The new AIT improvement approaches involve the use of adjuvants or recombinant allergies, peptides and new routes of administration.
Assuntos
Dessensibilização Imunológica , Hipersensibilidade Respiratória/terapia , Terapias em Estudo , Administração Sublingual , Alérgenos/administração & dosagem , Asma/terapia , Dermatite Atópica/terapia , Dessensibilização Imunológica/métodos , Dessensibilização Imunológica/tendências , Hipersensibilidade Alimentar/terapia , Humanos , Terapias em Estudo/métodos , Terapias em Estudo/tendênciasRESUMO
Asthma and allergic diseases generally start early in life and persist throughout life but, for reasons we do not yet understand, they sometimes appear later Prevention, early diagnosis and treatment of these major chronic respiratory diseases is a recognized priority for EU public health policy and for the United Nations. As factors favoring allergy (rapid urbanization, pollution, climate change and infections) are not expected to change in the foreseeable future, it is crucial to develop, strengthen and optimize prevention and treatment. We have developed tools to control asthma but are still unable to prevent children from developing asthma and allergic diseases. This article examines what works and what does not, and analyzes the "missing links" between the creation and effective implementation of a prevention program, otherwise known as the implementation gap.
Assuntos
Asma/prevenção & controle , Asma/terapia , Adolescente , Adulto , Alérgenos/efeitos adversos , Antiasmáticos/administração & dosagem , Antiasmáticos/uso terapêutico , Asma/diagnóstico , Asma/economia , Biodiversidade , Criança , Efeitos Psicossociais da Doença , Diagnóstico Precoce , Exposição Ambiental , Finlândia/epidemiologia , França , Promoção da Saúde/economia , Promoção da Saúde/organização & administração , Humanos , Higiene , Hipersensibilidade Imediata/epidemiologia , Hipersensibilidade Imediata/etiologia , Intestinos/microbiologia , Adesão à Medicação , Microbiota , Animais de EstimaçãoRESUMO
Drug allergies are heterogeneous and multifactorial. They can be life-threatening and lead to market withdrawal of particularly risky drugs. Immunological research has improved our understanding of drug allergies but has not yet been able to prevent them. In contrast, epidemiological research not only provides information on the incidence and risk factors of such reactions, but can now, in conjunction the most recent immunological data, also help to prevent some of them. For example, prior pholcodine consumption has been shown to increase the risk of anaphylaxis due to neuromuscular blocking agents during general anesthesia. This review examines the place of interventional epidemiology in the field of drug allergy, taking as examples both myorelaxant-induced anaphylaxis and abacavir-induced DRESS.
Assuntos
Hipersensibilidade a Drogas/prevenção & controle , Hipersensibilidade a Drogas/epidemiologia , Projetos de Pesquisa Epidemiológica , Humanos , Fatores de RiscoRESUMO
Allergen-specific immunotherapy or desensitization represents an etiological treatment option for patients with allergic respiratory diseases. First introduced in 1911, it was widely disparaged until its mechanism of action was better understood and its efficacy on both allergic rhinoconjunctivitis and allergic asthma was demonstrated in double-blind placebo-controlled studies. Its indications are now widely agreed and practical rules have been established. Several factors have contributed to its increasing use in patients with respiratory allergies, including better-quality allergen extracts, better understanding of the mechanism of action, the introduction of oral tablet forms, and rationalization of prescriptions. Specific immunotherapy can benefit patients with severe allergic respiratory diseases in whom pharmacological treatment is ineffective or poorly accepted. Further well-designed and strictly conducted randomized trials in adults and children with allergic rhinitis and asthma are needed, using patient-important endpoints. More information is also needed on patient selection, the treatment duration, and dosing schedules.
Assuntos
Alérgenos/uso terapêutico , Dessensibilização Imunológica , Hipersensibilidade/imunologia , Hipersensibilidade/terapia , Alérgenos/imunologia , HumanosRESUMO
Epidemiological studies have shown that rhinitis and asthma are associated. At least four out of five asthmatics suffer from rhinitis and one out of four rhinitic subjects develop asthma. Recent progress in cellular and molecular biology confirms that the same inflammatory cells and similar mechanisms participate in the pathophysiology of the two diseases. Histological findings show that although nasal inflammation resembles bronchial inflammation, specific remodelling features that are present in asthma are lacking in rhinitis. This may be due to the different embryologic origin of the two organs. These similarities explain certain clinical interactions and are the basis of the ARIA (Allergic Rhinitis and its Impact on Asthma)--WHO guidelines recommending that symptoms of rhinitis be sought in asthmatic subjects and symptoms of asthma in rhinitic subjects.
Assuntos
Asma/diagnóstico , Hipersensibilidade Respiratória/classificação , Rinite Alérgica Perene/diagnóstico , Rinite Alérgica Sazonal/diagnóstico , Antialérgicos/uso terapêutico , Antiasmáticos/uso terapêutico , Anticorpos Monoclonais/uso terapêutico , Asma/imunologia , Asma/patologia , Asma/terapia , Brônquios/patologia , Hiper-Reatividade Brônquica/diagnóstico , Hiper-Reatividade Brônquica/fisiopatologia , Testes de Provocação Brônquica , Terapia Combinada , Dessensibilização Imunológica , Diagnóstico Diferencial , Humanos , Inflamação/fisiopatologia , Testes de Provocação Nasal , Hipersensibilidade Respiratória/fisiopatologia , Rinite Alérgica Perene/imunologia , Rinite Alérgica Perene/fisiopatologia , Rinite Alérgica Perene/terapia , Rinite Alérgica Sazonal/imunologia , Rinite Alérgica Sazonal/fisiopatologia , Rinite Alérgica Sazonal/terapia , Sinusite/diagnósticoAssuntos
Dessensibilização Imunológica , Asma/terapia , Dessensibilização Imunológica/normas , Humanos , Guias de Prática Clínica como Assunto/normas , Ensaios Clínicos Controlados Aleatórios como Assunto , Rinite Alérgica Perene/terapia , Resultado do Tratamento , Vacinas/normas , Vacinas/uso terapêuticoRESUMO
Drug hypersensitivity reactions frequently occur in hospitalized and out-patients. Clinical presentations are numerous and heterogeneous, from a mild urticaria to a dramatic anaphylactic shock and an extensive bullous skin disease. Allergic reactions are unpredictable reactions, related to immunologic mechanisms. Some reactions mimic allergic reactions but no drug specific antibody or T cell proliferation can be demonstrated. A true diagnosis is rarely set up and the tools for it are lacking. In this review, we will focus on the available epidemiological data concerning these reactions, including data on incidence and mortality and on the most recent advances in the pathophysiology and allergy diagnosis of drug hypersensitivity reactions.
Assuntos
Hipersensibilidade a Drogas/imunologia , Anafilaxia/etiologia , Diagnóstico Diferencial , Hipersensibilidade a Drogas/epidemiologia , Hipersensibilidade a Drogas/fisiopatologia , Humanos , Incidência , MortalidadeRESUMO
La alergología ha adquirido considerable predicamento.Explican aquí los misterios de esas afecciones desconcertantes y caprichosas, responsables todos los años de millones de jornadas de trabajo perdidas y de millones de malestares entre la gente. Nuevas técnicas de desensibilización y medicamentos irreemplazables. Contiene:Alergia, una palabra de moda. La alergia imnmediata. Polvo doméstico, acaros y mohos. La alergia a los animales. De insectos a serpientes, picaduras, mordeduras. La alergia polínica. Alergias alimentarias: las verdaderas y las falsas. La alergia debida a los medicamentos. Algo mas para asociar con la alergia. La alergia: diagnóstico, principios de tratamiento y prevención. Medicamentos y medicinas antialérgicas. El asma alergica. Alergias de la nariz. De los ojos. De la piel. Otras alergias imprevistas. Alergia y sol
Assuntos
Humanos , Alergia e Imunologia/educação , Hipersensibilidade/terapia , Hipersensibilidade/diagnóstico , Hipersensibilidade/etiologia , Hipersensibilidade a Drogas/diagnóstico , Hipersensibilidade a Drogas/etiologia , Hipersensibilidade a Drogas/terapia , Hipersensibilidade Alimentar/diagnóstico , Hipersensibilidade Alimentar/etiologia , Hipersensibilidade Alimentar/terapia , Hipersensibilidade a Leite/diagnóstico , Hipersensibilidade a Leite/etiologia , Hipersensibilidade a Leite/terapia , Hipersensibilidade Imediata/diagnóstico , Hipersensibilidade Imediata/etiologia , Hipersensibilidade Imediata/terapia , Hipersensibilidade Respiratória/diagnóstico , Hipersensibilidade Respiratória/etiologia , Hipersensibilidade Respiratória/terapia , Hipersensibilidade Tardia/diagnóstico , Hipersensibilidade Tardia/etiologia , Hipersensibilidade Tardia/terapia , Dermatite de Contato/diagnóstico , Dermatite de Contato/etiologia , Dermatite de Contato/terapia , Transtornos de Fotossensibilidade/diagnóstico , Transtornos de Fotossensibilidade/etiologia , Transtornos de Fotossensibilidade/terapiaRESUMO
La alergología ha adquirido considerable predicamento.Explican aquí los misterios de esas afecciones desconcertantes y caprichosas, responsables todos los años de millones de jornadas de trabajo perdidas y de millones de malestares entre la gente. Nuevas técnicas de desensibilización y medicamentos irreemplazables. Contiene:Alergia, una palabra de moda. La alergia imnmediata. Polvo doméstico, acaros y mohos. La alergia a los animales. De insectos a serpientes, picaduras, mordeduras. La alergia polínica. Alergias alimentarias: las verdaderas y las falsas. La alergia debida a los medicamentos. Algo mas para asociar con la alergia. La alergia: diagnóstico, principios de tratamiento y prevención. Medicamentos y medicinas antialérgicas. El asma alergica. Alergias de la nariz. De los ojos. De la piel. Otras alergias imprevistas. Alergia y sol