EUFOREA pocket guide on the diagnosis and management of asthma: An educational and practical tool for general practitioners, non-respiratory physicians, paramedics and patients

Respiratory Medicine, Journal Year: 2023, Volume and Issue: 218, P. 107361 - 107361

Published: July 28, 2023

•EUFOREA asthma pocket guide is an educational and practical tool for non-respiratory physicians, paramedics patients.•EUFOREA provides a simplified algorithm on diagnosis, treatment specialist referral.•EUFOREA living document which can be accessed at www.euforea.eu/news/asthma-pocket-guide. International national initiatives management provide extensive information pathophysiology, offering expert guidance diagnosis recommendations treatment, highlighting contemporary therapeutic options [1www.ginasthma.comGoogle Scholar, 2www.nice.org.uk/guidance/indevelopment/gid-ng10186Google 3Muraro A. Roberts G. Halken S. Agache I. Angier E. Fernandez-Rivas M. Gerth van Wijk R. Jutel Lau Pajno Pfaar O. Ryan D. Sturm G.J. Ree Varga E.M. Bachert C. Calderon Canonica G.W. Durham S.R. Malling H.J. Wahn U. Sheikh EAACI guidelines allergen immunotherapy: executive statement.Allergy. 2018 Apr; 73: 739-743https://doi.org/10.1111/all.13420Crossref PubMed Scopus (120) Google Scholar]. Likewise, there are several high-impact task force articles reviews related topics, including exacerbations, treatable traits, comorbid conditions, biomarkers, biologics corticosteroids [4Bourdin Bjermer L. Brightling Brusselle G.G. Chanez P. Chung K.F. Custovic Diamant Z. Diver Djukanovic Hamerlijnck Horváth Johnston S.L. Kanniess F. Papadopoulos N. Papi Russell R.J. Samitas K. Tonia T. Zervas Gaga ERS/EAACI statement severe exacerbations in adults: facts, priorities key research questions.Eur. Respir. J. 2019 Sep 28; 541900900https://doi.org/10.1183/13993003.00900-2019Crossref (48) 5Diamant Vijverberg Alving Bakirtas Dahlen S.E. Giacco S.D. Hamelmann Heaney L.G. Heffler Ö Kalayci Kostikas Lutter Olin A.C. Sergejeva Simpson Sterk P.J. Tufvesson Seys S.F. Towards clinically applicable biomarkers asthma: position paper.Allergy. Oct; 74: 1835-1851https://doi.org/10.1111/all.13806Crossref (125) 6Heaney Busby Hanratty C.E. Woodcock Walker S.M. Hardman T.C. Arron J.R. Choy D.F. Bradding Chaudhuri Cowan D.C. Mansur A.H. Fowler S.J. Niven R.M. Howarth P.H. Lordan J.L. Menzies-Gow Harrison T.W. Robinson D.S. Holweg C.T.J. Matthews J.G. Pavord I.D. Investigators the MRC Refractory Asthma Stratification Programme. Composite type-2 biomarker strategy versus symptom-risk-based to adjust corticosteroid dose patients with multicentre, single-blind, parallel group, randomised controlled trial.Lancet Med. 2021 Jan; 9: 57-68https://doi.org/10.1016/S2213-2600(20)30397-0Abstract Full Text PDF (77) 7Khatri S.B. Iaccarino J.M. Barochia Soghier Akuthota Brady Covar R.A. Debley J.S. Fitzpatrick A.M. Kaminsky D.A. Kenyon N.J. Khurana Lipworth B.J. McCarthy Peters Que Ross K.R. Schneider-Futschik E.K. Sorkness C.A. Hallstrand T.S. American thoracic society assembly Allergy, immunology, inflammation. Use of fractional exhaled nitric oxide official clinical practice guideline.Am. Crit. Care Nov 15; 204 (PMID: 34779751): e97-e109https://doi.org/10.1164/rccm.202109-2093STCrossref (47) 8Porsbjerg Melén Lehtimäki Shaw Asthma. Lancet. 2023 Mar 11; 401: 858-873https://doi.org/10.1016/S0140-6736(22)02125-0Abstract (36) 9Brusselle Koppelman G.H. Biologic therapies asthma.N. Engl. 2022 Jan 13; 386: 157-171https://doi.org/10.1056/NEJMra2032506Crossref (214) 10García-Marcos Chiang C.Y. Asher M.I. Marks G.B. El Sony Masekela Bissell Ellwood Pearce Strachan D.P. Mortimer Morales Global Network Phase I Study GroupAsthma control children, adolescents, adults 25 countries: cross-sectional study.Lancet Health. Feb; 11 36669806): e218-e228https://doi.org/10.1016/S2214-109X(22)00506-XAbstract (10) 11Papaioannou A.I. Bakakos Loukides precision medicine algorithms based traits.Respir. Sep; 142 (Epub Jul 17): 15-22https://doi.org/10.1016/j.rmed.2018.07.006Abstract (19) 12Ulrik C.S. Hanania N.A. Precision traits chronic airway diseases - where do we stand?.Curr. Opin. Pulm. 2020 26: 33-39https://doi.org/10.1097/MCP.0000000000000639Crossref (12) However, majority these very comprehensive require profound background knowledge, hence, mainly suitable experts field respiratory medicine. In contrast, lack concise non-specialists, general practitioners (GPs), nurse-practitioners, pharmacists, who see first instance. line previously well-received concept guides allergic rhinitis (AR) [[13]Hellings P.W. Scadding et al.EUFOREA rhinitis.Rhinology. 2020; 58 (10): 618-622Crossref Scholar,[14]Scadding G.K. Smith P.K. Blaiss al.Allergic childhood new EUFOREA algorithm.Frontiers Allergy. 14; 2706589Crossref (24) Scholar] rhinosinusitis (CRS) [[15]Hellings Fokkens W.J. Orlandi Adriaensen G.F. Alobid Baroody F.M. Senior B.A. Cervin Cohen Constantinidis De Corso Desrosiers Douglas R.G. Gane Gevaert Han J.K. Harvey Hopkins Kern R.C. Landis B.N. Lee J.T. Leunig Lund V.J. Bernal-Sprekelsen Mullol Philpott Prokopakis Reitsma Salmi Schlosser Steinsvik Tomazic P.V. Van Staeyen Zele Vanderveken Viskens A.S. Conti Wagenmann The rhinosinusitis.Rhinology. Feb 1; 61: 85-89https://doi.org/10.4193/Rhin22.344Crossref Scholar], panel European Forum Research & Education Allergy Airway Diseases (EUFOREA), collaboration global opinion leaders inflammatory airways disease, developed [[16]www.euforea.eu/news/asthma-pocket-guideGoogle largely international complemented by professional experience. overall aim this summary cornerstones and, thus, promote awareness, educate support non-specialist stakeholders patients. To end, listings tables common manifestations triggers asthma, differential diagnoses, commonly encountered should proactively explored addressed [Table 1]. Furthermore, included shortlist essential diagnostic tools: i.e. lung function tests assessment inflammation facilitate subtyping (phenotyping, endotyping) individual leading more personalized approach 2; Table 3]. All features implemented simple algorithms: one specifically linking [Fig. 1], while second focuses (GP) (respiratory specialist) care 2].Table 1Key GP Scholar].Table 2Asthma pheno-/endotyping point-of-care inflammometric 3Linking tests/markers Scholar].Fig. 1Algorithm Scholar].View Large Image Figure ViewerDownload Hi-res image Download (PPT)Fig. 2Treatment (≥12 years) Scholar].Show full captionACO: COPD overlap.AIT: immunotherapy.AR: rhinitis.COPD: obstructive pulmonary disease.BT: bronchial thermoplasty.ICS: inhaled corticosteroids.LABA: long-acting beta2 agonists.LAMA: muscarinic antagonists.OSA: sleep apnea.SABA: short-acting agonists.TLA: temperature-controlled laminar airflow.TT: traits.View (PPT) ACO: overlap. AIT: immunotherapy. AR: rhinitis. COPD: disease. BT: thermoplasty. ICS: corticosteroids. LABA: agonists. LAMA: antagonists. OSA: apnea. SABA: TLA: airflow. TT: traits. Apart from use high doses, even infrequent short bursts systemic (SCS) associated increased risk potentially serious side effects [[17]Foster Aucott der Werf R.H. Meijden M.J. Schraa Postma Molen Higher patient perceived higher daily doses community: analysis.Respir. 2006 Aug; 100: 1318-1336https://doi.org/10.1016/j.rmed.2005.11.029Abstract (34) Scholar,[18]Wallace B.I. Waljee A.K. Burst case scenario: why shorter may not any better when it comes corticosteroids.Ann. Intern. 173: 390https://doi.org/10.7326/M20-4234Crossref (8) These include osteoporosis, fractures, ocular disorders (glaucoma, cataracts), skin bruising, gastro-intestinal bleeding, infections, metabolic syndrome, diabetes, obesity cardiovascular recent publication, steroid-induced health issues have been collectively referred as ''people remodeling'' [[19]St-Germain Lachapelle 1 Couillard Tackling 'people remodelling' corticosteroid-dependent targeting formal weaning protocol.touchREVIEWS Respiratory Pulmonary Diseases. 2022; 7: 44-47https://doi.org/10.17925/USRPD.2022.7.2.44Crossref Therefore, awareness education chronicity preventive (lifestyle) measures, combination adequate inhaler technique intake controller (or, cf updated GINA2023: maintenance or (ICS)-containing [[1]www.ginasthma.comGoogle Scholar]) crucial optimized avoid sequelae SCS well frequent exacerbations. Inhaled remain cornerstone mild disease symptoms respect, GINA2023 has issued two terminologies, ''AIR'' ''MART'', reflect dual purpose so-termed 'anti-inflammatory reliever' (AIR) consisting as-needed ICS-formoterol recently added ICS-SABA, 'maintenance reliever therapy' (MART). AIR-only recommended Steps 1–2, MART 3–5 adolescents adults. While steps serve AIR top MART, ICS-SABA combinations part regimen. Although most reach satisfactory level control, distinct group after assuring adherence inhalation technique, will re-evaluation confirm explore comorbidities, assess environmental factors perform additional tests, inflammometry, if available routine 2]. At level, referral initiation next step multidisciplinary team required Fig. our guide, indications differ (slightly) across countries. Depending immunological profile (type (T)2 non-T2) local availability, eligible prescribed biologics. Presently, target type2-inflammatory components (omalizumab, mepolizumab, benralizumab, reslizumab dupilumab) registered tezepelumab seems demonstrate efficacy both T2- non-T2 [[9]Brusselle Scholar,[20]Striz Golebski Strizova Jesenak New insights into pathophysiology targets without nasal polyposis.Clin. Sci. (Lond.). May 18; 137: 727-753https://doi.org/10.1042/CS20190281Crossref Patients allergen-driven considered immunotherapy (AIT, sublingual (SLIT) tablets) early stages Scholar,[3]Muraro Scholar,[21]Diamant Maaren Muraro Striz Allergen future bright.Respir. Apr-May; 210107125https://doi.org/10.1016/j.rmed.2023.107125Abstract (5) Switching between biologics, and/or concomitant application biologic needed some [[22]Pavord Corren Controversies Allergy: choosing asthma.J. Clin. Immunol. Pract. 10: 410-419https://doi.org/10.1016/j.jaip.2021.12.014Abstract (20) Close monitoring manifestations, evaluation effects, comorbidities function, combined patient's expectations satisfaction pivotal aspects As consequence lay-out, despite input experts, aware that initiative also limitations hence does (fully) replace ongoing concepts (inter)national subject quick turnover upon emerging evidence preferences availability resources. Soon launch was online consequently, latest (yet) fully implemented. aims present versions regular basis. Conceptualization: ZD LB conceived panel: MJ, SQ, LH, RD, NH, DR, IP, VB, MG. GKS, DR RD performed linguistic corrections. EvS skilfully crafted format figures. Resources: Funding acquisition PH, ZD, LB., Writing: wrote manuscript approval all co-authors., authors contributed development review approved manuscript. ZD: received consultancy fees/lecture fees/fees attending advisory boards ALK, Antabio, Foresee Pharmaceuticals, GlaxoSmithKline, Hippo-Dx, QPS-Netherlands, Sanofi-Genzyme; she served Director QPS-NL CRO grants trials HAL Janssen Development LLC, Patara pharma, Cerbios, Merck Sharp Dohme, Novartis, Pharmaceuticals ERA4TB (IMI-project). MJ: Stallergenes-Greer, Chiesi, GSK, Pfizer, AstraZeneca SANOFI. NH: Received honoraria serving advisor consultant AstraZeneca, Sanofi, Regeneron, Amgen, Genentech, Novartis Teva. His institution grant his behalf Teva, AstraZeneca. LH: Has funding, participated given lectures meetings supported Boehringer Ingelheim, Circassia, Hoffmann la Roche, Theravance, Evelo Biosciences, Teva; he MedImmune, UK, Roche/ Genentech Inc, Glaxo Kline, Genentech/Hoffman Astra Zeneca, Aerocrine Vitalograph; sponsorship scientific GSK Napp Pharmaceuticals; taken sponsored GlaxoSmithKline remuneration; Academic Lead Medical Council Stratified Medicine UK Consortium Severe involves industrial partnerships number pharmaceutical companies Janssen. RD: Declares consulting fees Synairgen, Sanofi Galapagos, lecture AZ Airways Vista holds shares Synairgen. DR: No COIs work. SQ: Therapeutics, Leti, Mundipharma, Sanofi-Genzyme, VB: worked advisor, supervisor, investigator studies, unrestricted grants, others with: MSD Shering Plough, ALK-Abello; Chiesi,Novartis, Pharmaxis, Aerocrine, Birk NPC as. MG: IP: last 5 years IDP speaker's speaking Almirall, Sanofi/Regeneron, Menarini payments organising events AZ, Sanofi/Regeneron He panels Sanofi/ Merck, Chiesi Knopp FDA GSK. attend Teva Chiesi. phase 2 trial Oxford. DAA: grants/contracts Sociedad Española de Alergología e Inmunología Clínica (SEAIC), ALK-Abelló, Gebro, speaker Leti Pharma, Roxall, Sanofi. AS: 2021-ongoing. PB: presentations ELPEN, Menarini, Gilead. AB: Takeda, Viatris, Zentiva, MERCK, Stallergenes Greer, Ewopharma, S&D Berlin Chemie. WB: Regeneron. JK: Grants personal Boerhinger, Stallergen, Abbot, outside submitted SL: Honorarium AstraZeneka, Hellas, Elpen, Guidoti. MVM: PP: Stallergenes. HP: Reports consultancies B.I., Zambon, HS: IS: MKV: Diego Conti: WF: department Otorhinolaryngology Amsterdam University centre, location AMC Rhinology from: AllergyTherapeutics, EU, MYLAN, Sanofi-Aventis, Zon-MW; COIs: consultation Dianosic, Sanofi-Aventis/Regeneron. Advisory Board Sanof-Aventis, Leo-Pharma. Honoraria DBV Technologies, Allergopharma, Nutricia, Sanofi-Aventis. GKS: articles, boards: Capnia, Church Dwight, Noucor, Meda/Mylan/Viatris, Sanofi- Scientific Chief Editor, Section, Frontiers Member, Allergic Rhinitis, EUFOREA. Chair Data Monitoring Paediatric AR HDM SLIT. EVS: PH: Recipient Novartis. LB: provided via Belgium.

Language: Английский

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Effectiveness of allergen-specific immunotherapy in children with bronchial asthma sensitized to house dust mites

CHILD`S HEALTH, Journal Year: 2024, Volume and Issue: 19(2), P. 58 - 67

Published: April 24, 2024

Background. The only method of treatment that can change the natural course allergies is allergen-specific immunotherapy, which allows reducing sensitivity child’s body to causative allergen and decreasing activity chronic inflammation. evidence base for effectiveness immunotherapy in bronchial asthma (BA) has significantly expanded recently. However, truly important results remain too limited make clinically useful conclusions about efficacy sublingual (SLIT) people with BA further needed. purpose study evaluate SLIT as an additional atopic varying severity children sensitized house dust mites. Materials methods. main group consisted 80 aged from 5 17 years, they were divided into three groups according disease: 1 — 20 mild intermittent asthma, 2 30 persistent 3 moderately severe asthma. Thirty practically healthy without also examined a control group. For SLIT, ORALTEK spray produced by Inmunotek (Spain) was used, mixture mite allergens Dermatophagoides pteronyssinus 50 %/Dermatophagoides farinae %, ml solution contains 30,000 IU extract. To assess treatment, we conducted analysis total score clinical manifestations allergic rhinitis degree Asthma Control Test. We analyzed state cellular humoral immunity dynamics therapy. These indicators evaluated within month before beginning after end one-year validity reliability obtained results, statistical data processing carried out using Microsoft Excel 2016 Statistica Windows 10 programs. Student’s t-test applied results. difference between compared values considered statistically significant at p < 0.05. Results. confirmed improvement patients who received SLIT: reduction manifestations, frequency symptoms use emergency drugs (p 0.05). By study, decrease these start (according above list) follows: 82.5, 91.8, 94.5 80.5, 88.4, 92.7 76.7, 85.3, 91.2 %. After addition basic therapy, reliable increase IgE sIgA observed, spontaneous proliferative response T-lymphocytes mitogen all level controls, probable eosinophilic inflammation 0.001). Conclusions. prescription BA, perennial rhinitis, moderate provides opportunity obtain stable disease, reduces number visits doctor justifies wide this allergy practice.

Language: Английский

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Evaluation and Comparison of the Efficacy of Subcutaneous and Sublingual Immunotherapy for the Treatment of Allergic Asthma in Children

Children, Journal Year: 2024, Volume and Issue: 11(6), P. 692 - 692

Published: June 5, 2024

Specific immunotherapy represents the only potentially curative treatment for allergic asthma. Allergens can be administered subcutaneously (SCIT) or sublingually (SLIT). The aim of current study was to evaluate and compare efficacy SCIT SLIT asthma in children. Our included 69 children with who underwent house dust mites pollen at least 3 consecutive years. After years SLIT, median number exacerbations last three months decreased from 2 0 (p < 0.01) 1 0.01), respectively. When comparing our revealed a significantly better terms increasing lung function. increase forced expiratory volume one second (FEV1) after 8% −1% 0.01). Daily controller therapy could withdrawn reduced 9 out 16 (56.3%) received it before 19 29 (65.6%) but difference not significant = 0.88). Both are effective treatments

Language: Английский

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Allergen Immunotherapy

Elsevier eBooks, Journal Year: 2024, Volume and Issue: unknown

Published: Jan. 1, 2024

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Brazilian guidelines for allergen immunotherapy in the treatment of allergic asthma

Revista da Associação Médica Brasileira, Journal Year: 2024, Volume and Issue: 70(11)

Published: Jan. 1, 2024

Language: Английский

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Suppression of Pathological Allergen-Specific B Cells by Protein-Engineered Molecules in a Mouse Model of Chronic House Dust Mite Allergy

International Journal of Molecular Sciences, Journal Year: 2024, Volume and Issue: 25(24), P. 13661 - 13661

Published: Dec. 20, 2024

Der p1 is one of the major allergens causing house dust mite (HDM) allergy. Pathological p1-specific B cells play a key role in allergic inflammation as producers allergen-specific antibodies. Crosslinking inhibitory FcγRIIb with cell receptor triggers high-affinity suppressive signal cells. Selective elimination could potentially be achieved by administering chimeric molecules that combine, through protein engineering, FcγRIIb-targeting monoclonal 2.4G2 antibody epitope-carrying Dp52-71 peptides from p1. We tested this hypothesis, chronic mouse model HDM allergy induced BalB/c mice, using FACS and ELISA assays, along histopathological correlational analyses. Dp52-71chimera treatment HDM-challenged mice led to decrease serum anti-HDM IgG1 antibodies, reduction BALF β-hexosaminidase levels, lowered number SiglecFhigh CD11clow eosinophils, an improved lung PAS score. Furthermore, we observed overexpression on surface CD19 lungs animals, which negatively correlated levels alveolar macrophages, neutrophils, IL-13. Taken together, these results suggest use overexpression, combined expansion technology include more epitopes, improve outcome inflammation.

Language: Английский

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Efficacy and Safety of Subcutaneous Allergen-Specific Immuno-Therapy in Horses with Allergic Cutaneous and Respiratory Diseases—A Systematic Review

Veterinary Sciences, Journal Year: 2023, Volume and Issue: 10(10), P. 613 - 613

Published: Oct. 10, 2023

Allergen-specific immunotherapy (AIT) is the only current intervention that has ability to modify immune response toward a tolerogenic state. This study aimed assess efficacy and safety of AIT in horses with allergic diseases systematic manner. Three databases were searched identify articles reporting clinical outcomes adverse events associated AIT. The evaluated for beneficial responses AIT, defined as ≥50% reduction signs, remission. Horses respiratory diseases, urticaria, pruritic dermatitis receiving insect monotherapy or multi-allergen included. All graded, analytical confounding biases assessed. results showed had 75% 88% 56% dermatitis. However, treated solely lower rate (36%). Self-limiting local reactions most common events, systemic grade II accounting 11% reported events. Analytical identified major limitations available studies. Further research needed address these provide stronger evidence on diseases.

Language: Английский

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Effectiveness of Anti-mite Allergen-specific Immunotherapy in Children with Persistent Allergic Rhinitis

Family medicine European practices, Journal Year: 2023, Volume and Issue: 4, P. 34 - 41

Published: Dec. 29, 2023

The objective: to study the effectiveness of allergen-specific immunotherapy (ASIT) in children with persistent allergic rhinitis (AR) and sensitization house dust mite (HDM) allergens using administered subcutaneously. Materials methods. involved 149 aged 5 17 years AR combined bronchial asthma (BA), who were sensitized HDM allergens, underwent clinical anamnestic laboratory examination. All examined patients (89 (59.7%) boys 60 (40.3%) girls) divided into two groups. first group included received basic therapy combination ASIT. second includes only therapy. Molecular component immunoenzymatic analysis venous blood ALEX2 test system (Macro Array Diagnostics GmbH, Austria) was used determine profile allergens. Sensitization is established case detection specific IgE levels above 0.3 kUA/L allergen molecules. Basic three treatment steps. Results. In during ACIT therapy, positive dynamics severity main complaints according VAS scale determined, starting from 6th month treatment. After 24 months a statistically significant (p<0.05) decrease found ASIT compared prescribed Conclusions. results conducted research indicate high efficiency use highly polymerized extracts adsorbed on aluminum hydroxide gel for ASIT, measures eradicate HDM.

Language: Английский

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