- MeSH
- Allergens * analysis immunology MeSH
- Biomarkers analysis MeSH
- Dietary Proteins immunology MeSH
- Immunoglobulin E * immunology blood MeSH
- Immunologic Tests * methods MeSH
- Humans MeSH
- Dairy Products adverse effects MeSH
- Nuts MeSH
- Food Hypersensitivity diagnosis immunology blood MeSH
- Predictive Value of Tests MeSH
- Triticum immunology MeSH
- Sensitivity and Specificity MeSH
- Eggs adverse effects MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
- MeSH
- Allergens * immunology therapeutic use MeSH
- Administration, Oral MeSH
- Desensitization, Immunologic * methods adverse effects MeSH
- Diet Therapy MeSH
- Immune Tolerance * MeSH
- Clinical Protocols MeSH
- Humans MeSH
- Food Hypersensitivity * immunology therapy MeSH
- Treatment Outcome MeSH
- Animals MeSH
- Check Tag
- Humans MeSH
- Animals MeSH
- Publication type
- Review MeSH
- MeSH
- Allergens * administration & dosage immunology MeSH
- Administration, Oral MeSH
- Time Factors MeSH
- Risk Assessment methods MeSH
- Immunoglobulin E immunology blood MeSH
- Immune Tolerance immunology MeSH
- Immunologic Tests * methods adverse effects MeSH
- Incidence MeSH
- Humans MeSH
- Food Hypersensitivity * diagnosis epidemiology immunology blood MeSH
- Food * adverse effects MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
Cíl V současné době je pociťována potřeba nových cílených molekulárních léků pro pacienty s nemalobuněčným karcinomem plic (NSCLC), u nichž dojde k progresi onemocnění při terapii erlotinibem, gefitinibem nebo oběma látkami. Afatinib, perorální ireverzibilní blokátor rodiny ErbB, má preklinicky prokázanou aktivitu v modelech mutací receptoru pro epidermální růstový faktor (EGFR [ErbB1]) s aktivujícími mutacemi EGFR včetně mutace T790M. Pacienti a metody Tato studie fáze II s jedním ramenem byla provedena u japonských pacientů s adenokarcinomem plic stadia IIIB–IV, u nichž došlo k progresi onemocnění po ≥ 12 týdnech předchozí terapie erlotinibem a/nebo gefitinibem. Pacienti dostávali 50 mg afatinibu denně. Primárním výsledným ukazatelem byla nezávisle hodnocená četnost objektivních odpovědí (kompletní nebo částečná odpověď). Sekundárními výslednými ukazateli byly přežití bez progrese (PFS), celkové přežití (OS) a bezpečnost. Výsledky Ze 62 pacientů mělo 45 (72,6 %) ve svém primárním nádoru pozitivní mutaci EGFR podle stanovení v místní a/nebo centrální laboratoři. Padesát jedna pacientů (82,3 %) splnilo kritéria přítomnosti získané rezistence na erlotinib a/nebo gefitinib. Z 61 hodnotitelných pacientů dosáhlo pět (8,2 %; 95% CI 2,7–18,1 %) potvrzené četnosti objektivních odpovědí (částečné odpovědi). Medián PFS byl 4,4 měsíce (95% CI 2,8–4,6 měsíce) a medián OS byl 19,0 měsíce (95% CI 14,9 až nedosaženo). Dva pacienti měli získanou mutaci T790M: L858R + T790M, a deleci exonu 19 + T790M; tito pacienti dosáhli stabilního onemocnění trvajícího 9 měsíců, resp. 1 měsíc. Nejčastější nežádoucí příhody (AE) související s afatinibem byly průjem (100 %) a vyrážka/akné (91,9 %). AE související s léčbou vedoucí k přerušení léčby afatinibem mělo 18 pacientů (29 %), z nichž u čtyř došlo také k progresi onemocnění. Závěr Byla prokázána mírná, nicméně významná účinnost afatinibu u pacientů s NSCLC, kteří jej dostávali jako terapii třetí nebo čtvrté linie po progresi onemocnění v průběhu léčby erlotinibem a/nebo gefitinibem, včetně účinnosti u pacientů se získanou rezistencí na erlotinib, gefitinib nebo obě látky.
- MeSH
- Drug Resistance, Neoplasm MeSH
- Quinazolines * therapeutic use MeSH
- ErbB Receptors * antagonists & inhibitors genetics metabolism MeSH
- Erlotinib Hydrochloride therapeutic use MeSH
- Genes, erbB genetics drug effects MeSH
- Protein Kinase Inhibitors therapeutic use MeSH
- Humans MeSH
- Carcinoma, Non-Small-Cell Lung * drug therapy pathology MeSH
- Disease-Free Survival MeSH
- Disease Progression MeSH
- Check Tag
- Humans MeSH
- Publication type
- Clinical Trial, Phase II MeSH
BACKGROUND: Pru p 3 and Pru p 7 have been implicated as risk factors for severe peach allergy. This study aimed to establish sensitization patterns to five peach components across Europe and in Japan, to explore their relation to pollen and foods and to predict symptom severity. METHODS: In twelve European (EuroPrevall project) and one Japanese outpatient clinic, a standardized clinical evaluation was conducted in 1231 patients who reported symptoms to peach and/or were sensitized to peach. Specific IgE against Pru p 1, 2, 3, 4 and 7 and against Cup s 7 was measured in 474 of them. Univariable and multivariable Lasso regression was applied to identify combinations of parameters predicting severity. RESULTS: Sensitization to Pru p 3 dominated in Southern Europe but was also quite common in Northern and Central Europe. Sensitization to Pru p 7 was low and variable in the European centers but very dominant in Japan. Severity could be predicted by a model combining age of onset of peach allergy, probable mugwort, Parietaria pollen and latex allergy, and sensitization to Japanese cedar pollen, Pru p 4 and Pru p 7 which resulted in an AUC of 0.73 (95% CI 0.73-0.74). Pru p 3 tended to be a risk factor in South Europe only. CONCLUSIONS: Pru p 7 was confirmed as a significant risk factor for severe peach allergy in Europe and Japan. Combining outcomes from clinical and demographic background with serology resulted in a model that could better predict severity than CRD alone.
Monitoring is a major component of asthma management in children. Regular monitoring allows for diagnosis confirmation, treatment optimization, and natural history review. Numerous factors that may affect disease activity and patient well-being need to be monitored: response and adherence to treatment, disease control, disease progression, comorbidities, quality of life, medication side-effects, allergen and irritant exposures, diet and more. However, the prioritization of such factors and the selection of relevant assessment tools is an unmet need. Furthermore, rapidly developing technologies promise new opportunities for closer, or even "real-time," monitoring between visits. Following an approach that included needs assessment, evidence appraisal, and Delphi consensus, the PeARL Think Tank, in collaboration with major international professional and patient organizations, has developed a set of 24 recommendations on pediatric asthma monitoring, to support healthcare professionals in decision-making and care pathway design.
- MeSH
- Anti-Asthmatic Agents therapeutic use MeSH
- Asthma * diagnosis therapy MeSH
- Delphi Technique MeSH
- Child MeSH
- Quality of Life MeSH
- Humans MeSH
- Monitoring, Physiologic methods MeSH
- Check Tag
- Child MeSH
- Humans MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
- Review MeSH
- Practice Guideline MeSH
Older adults, especially men and/or those with diabetes, hypertension, and/or obesity, are prone to severe COVID-19. In some countries, older adults, particularly those residing in nursing homes, have been prioritized to receive COVID-19 vaccines due to high risk of death. In very rare instances, the COVID-19 vaccines can induce anaphylaxis, and the management of anaphylaxis in older people should be considered carefully. An ARIA-EAACI-EuGMS (Allergic Rhinitis and its Impact on Asthma, European Academy of Allergy and Clinical Immunology, and European Geriatric Medicine Society) Working Group has proposed some recommendations for older adults receiving the COVID-19 vaccines. Anaphylaxis to COVID-19 vaccines is extremely rare (from 1 per 100,000 to 5 per million injections). Symptoms are similar in younger and older adults but they tend to be more severe in the older patients. Adrenaline is the mainstay treatment and should be readily available. A flowchart is proposed to manage anaphylaxis in the older patients.
- MeSH
- Epinephrine MeSH
- Anaphylaxis * etiology prevention & control MeSH
- COVID-19 * MeSH
- Humans MeSH
- SARS-CoV-2 MeSH
- Aged MeSH
- COVID-19 Vaccines MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Aged MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
Allergen immunotherapy (AIT) is a proven therapeutic option for the treatment of allergic rhinitis and/or asthma. Many guidelines or national practice guidelines have been produced but the evidence-based method varies, many are complex and none propose care pathways. This paper reviews care pathways for AIT using strict criteria and provides simple recommendations that can be used by all stakeholders including healthcare professionals. The decision to prescribe AIT for the patient should be individualized and based on the relevance of the allergens, the persistence of symptoms despite appropriate medications according to guidelines as well as the availability of good-quality and efficacious extracts. Allergen extracts cannot be regarded as generics. Immunotherapy is selected by specialists for stratified patients. There are no currently available validated biomarkers that can predict AIT success. In adolescents and adults, AIT should be reserved for patients with moderate/severe rhinitis or for those with moderate asthma who, despite appropriate pharmacotherapy and adherence, continue to exhibit exacerbations that appear to be related to allergen exposure, except in some specific cases. Immunotherapy may be even more advantageous in patients with multimorbidity. In children, AIT may prevent asthma onset in patients with rhinitis. mHealth tools are promising for the stratification and follow-up of patients.
- MeSH
- Allergens administration & dosage immunology MeSH
- Rhinitis, Allergic epidemiology immunology therapy MeSH
- Cost-Benefit Analysis MeSH
- Biomarkers MeSH
- Asthma epidemiology immunology therapy MeSH
- Desensitization, Immunologic * adverse effects methods MeSH
- Precision Medicine methods MeSH
- Clinical Decision-Making MeSH
- Comorbidity MeSH
- Critical Pathways * MeSH
- Humans MeSH
- Disease Management MeSH
- Disease Susceptibility MeSH
- Cost of Illness MeSH
- Attitude of Health Personnel MeSH
- Practice Guidelines as Topic MeSH
- Treatment Outcome MeSH
- Animals MeSH
- Check Tag
- Humans MeSH
- Animals MeSH
- Publication type
- Journal Article MeSH
- Review MeSH
Background: In all societies, the burden and cost of allergic and chronic respiratory diseases are increasing rapidly. Most economies are struggling to deliver modern health care effectively. There is a need to support the transformation of the health care system into integrated care with organizational health literacy. Main body: As an example for chronic disease care, MASK (Mobile Airways Sentinel NetworK), a new project of the ARIA (Allergic Rhinitis and its Impact on Asthma) initiative, and POLLAR (Impact of Air POLLution on Asthma and Rhinitis, EIT Health), in collaboration with professional and patient organizations in the field of allergy and airway diseases, are proposing real-life ICPs centred around the patient with rhinitis, and using mHealth to monitor environmental exposure. Three aspects of care pathways are being developed: (i) Patient participation, health literacy and self-care through technology-assisted "patient activation", (ii) Implementation of care pathways by pharmacists and (iii) Next-generation guidelines assessing the recommendations of GRADE guidelines in rhinitis and asthma using real-world evidence (RWE) obtained through mobile technology. The EU and global political agendas are of great importance in supporting the digital transformation of health and care, and MASK has been recognized by DG Santé as a Good Practice in the field of digitally-enabled, integrated, person-centred care. Conclusion: In 20 years, ARIA has considerably evolved from the first multimorbidity guideline in respiratory diseases to the digital transformation of health and care with a strong political involvement.
- Publication type
- Journal Article MeSH
- Review MeSH
