Biologics as treatment options for anaphylaxis

Cafarotti, Arianna; Fiocchi, Alessandro; Arasi, Stefania

doi:10.1097/aci.0000000000000779

Cited by 8 publications

(9 citation statements)

References 77 publications

(103 reference statements)

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“…In steroid-refractory mastocytosis of the skin, ultraviolent phototherapy in combination with or without oral psoralen can be an effective alternative treatment option [ 36 ]. The use of other novel medications such as omalizumab as an intervention has been recommended on a case-by-case basis [ 105 , 106 , 107 , 108 , 109 , 110 , 111 , 112 , 113 ].…”

Section: Management Of Mast Cell Disordersmentioning

confidence: 99%

“…An epinephrine autoinjector should always be prescribed for patients presenting with anaphylaxis or severe systemic reactions including syncope [ 82 , 83 ]. For patients with recurrent episodes of anaphylaxis, the anti-IgE monoclonal antibody omalizumab has been shown to significantly improve symptom control and improve quality of life [ 105 , 106 , 107 , 108 , 109 , 110 , 111 , 112 , 113 ]. Other biologicals that target mast cell regulatory proteins and receptors—KIT, IgE, SIGLEC-8, IL-4 receptors, IL-6 receptors, IL-9, IL-33, tryptase, CD25, and CD30— are in development or undergoing clinical trials [ 117 ].…”

Section: Management Of Mast Cell Disordersmentioning

confidence: 99%

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Mastocytosis and Mast Cell Activation Disorders: Clearing the Air

Jackson

Pratt

Rupprecht

et al. 2021

IJMS

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Mast cells are derived from hematopoietic stem cell precursors and are essential to the genesis and manifestations of the allergic response. Activation of these cells by allergens leads to degranulation and elaboration of inflammatory mediators, responsible for regulating the acute dramatic inflammatory response seen. Mast cells have also been incriminated in such diverse disorders as malignancy, arthritis, coronary artery disease, and osteoporosis. There has been a recent explosion in our understanding of the mast cell and the associated clinical conditions that affect this cell type. Some mast cell disorders are associated with specific genetic mutations (such as the D816V gain-of-function mutation) with resultant clonal disease. Such disorders include cutaneous mastocytosis, systemic mastocytosis (SM), its variants (indolent/ISM, smoldering/SSM, aggressive systemic mastocytosis/ASM) and clonal (or monoclonal) mast cell activation disorders or syndromes (CMCAS/MMAS). Besides clonal mast cell activations disorders/CMCAS (also referred to as monoclonal mast cell activation syndromes/MMAS), mast cell activation can also occur secondary to allergic, inflammatory, or paraneoplastic disease. Some disorders are idiopathic as their molecular pathogenesis and evolution are unclear. A genetic disorder, referred to as hereditary alpha-tryptasemia (HαT) has also been described recently. This condition has been shown to be associated with increased severity of allergic and anaphylactic reactions and may interact variably with primary and secondary mast cell disease, resulting in complex combined disorders. The role of this review is to clarify the classification of mast cell disorders, point to molecular aspects of mast cell signaling, elucidate underlying genetic defects, and provide approaches to targeted therapies that may benefit such patients.

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Section: Management Of Mast Cell Disordersmentioning

confidence: 99%

Section: Management Of Mast Cell Disordersmentioning

confidence: 99%

Mastocytosis and Mast Cell Activation Disorders: Clearing the Air

Jackson

Pratt

Rupprecht

et al. 2021

IJMS

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“…Researchers are searching for more proactive treatments due to the burden of the condition on patients, their caregivers and healthcare systems. There are promising results from allergen‐specific immunotherapy and biological therapies 2,3 …”

Section: Introductionmentioning

confidence: 99%

“…There are promising results from allergenspecific immunotherapy and biological therapies. 2,3 Biological therapies are medications derived or synthesised from biological sources. Recombinant monoclonal antibodies are a class of biologicals with targeted application against molecules of intercellular communication, which may be useful in treating inflammatory and allergic diseases.…”

Section: Introductionmentioning

confidence: 99%

Systematic review of monotherapy with biologicals for children and adults with IgE‐mediated food allergy

Silva¹,

Singh²,

Arasi

et al. 2022

Clinical & Translational All

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Background Biological therapies relieve symptoms in allergic inflammatory diseases so we systematically reviewed the evidence about whether biological monotherapy could benefit people with IgE‐mediated food allergy. Methods We searched six bibliographic databases from 1946 to 30 September 2021 for randomised and non‐randomised controlled trials about biological monotherapy in people with IgE‐mediated food allergy confirmed by oral food challenge. We used the Grading of Recommendations, Assessment, Development and Evaluation approach to narratively summarise findings from three trials with 118 participants. The studies were too heterogeneous and sparse to conduct meta‐analysis. Results We included one randomised trial about etokimab, one about omalizumab and one about the discontinued TNX‐901. All were in people with peanut allergy in the USA, mostly aged 13+ years. There was a trend towards improved tolerance of peanut during treatment, with few side effects. However, we have very low certainty about the evidence due to the small number of trials and participants. No included trial reported on quality of life or cost‐effectiveness. Conclusions There is not yet enough certainty to support offering etokimab or omalizumab widely for food allergy. Clinicians may consider the merits for individuals, but large randomised trials with standardised measures are needed to confirm the safety, efficacy and most suitable candidates, doses and durations of treatment before more universal use.

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“…According to international guidelines, the current standard of care in the management of FA is the strict elimination diet and the use of adrenaline as rescue medication in case of severe allergic reactions, such as anaphylaxis ( 28 ). Alternative treatment strategies to the avoidance diet have been investigated; the most promising therapeutic strategies are currently oral immunotherapy (OIT) and biologicals (such as omalizumab) ( 29 – 31 ). Other routes of administrations other than the oral [such as epicutaneous (EPIT, epicutaneous immunotherapy) and sublingual ones (SLIT, sublingual immunotherapy)] have been investigated.…”

Section: Introductionmentioning

confidence: 99%

Oral Immunotherapy in Food Allergy: A Critical Pediatric Perspective

et al. 2022

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There is evidence that in children with persistent IgE-mediated food allergy (FA) to cow's milk, hen's egg, and peanut, oral allergen-specific immunotherapy (OIT) may increase the reaction threshold to the culprit food allergen(s). OIT may protect patients from the occurrence of severe reactions in case of accidental ingestion of the culprit food during treatment. Notwithstanding, many gaps are still unsolved, including safety issues, identification of predictive biomarkers, and post-desensitization efficacy. In this perspective, the use of omalizumab (Anti-IgE monoclonal antibody) has been proposed as an adjunctive treatment to OIT in order to reduce the risk of allergic reactions related to OIT. This review aims to summarize the current evidence and unmet needs on OIT in children with FA to enhance the development of longitudinal, prospective, and well-designed studies able to fill the current gaps soon.

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Biologics as treatment options for anaphylaxis

Cited by 8 publications

References 77 publications

Mastocytosis and Mast Cell Activation Disorders: Clearing the Air

Mastocytosis and Mast Cell Activation Disorders: Clearing the Air

Systematic review of monotherapy with biologicals for children and adults with IgE‐mediated food allergy

Oral Immunotherapy in Food Allergy: A Critical Pediatric Perspective

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