Expert review of clinical immunology
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Expert Rev Clin Immunol · Jan 2015
ReviewCurrent treatment recommendations and considerations for cryopyrin-associated periodic syndrome.
Cryopyrin-associated periodic syndrome (CAPS) encompasses a spectrum of three phenotypes of increasing severity. The syndrome is due to dominant mutations in NLRP3, which encodes a key component of the innate immunity that regulates the secretion of IL-1β. ⋯ They have acceptable safety profiles but do have some differences. We review three drugs that are currently marketed for CAPS, give additional information for the practical use of these drugs, and provide some recommendations for management.
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Although three sublingual immunotherapy tablets have been approved in the USA and more are under study, it is not clear that sublingual immunotherapy tablets will answer the needs of many patients in the USA, and this is due to the limited number of allergens that will be offered. Alternatives that employ off-label, currently available extracts hold the greatest likelihood of entering the US allergy practice. Those approaches that employ recombinant technology to produce hypoallergenic products face a long and expensive pathway to approval. Which of the many approaches under study will make it to the market is presently not clear.
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Expert Rev Clin Immunol · Jan 2015
Management of polysensitized patient: from molecular diagnostics to biomolecular immunotherapy.
A panel of Italian allergists gathered to discuss the issue concerning the management of polysensitized patients. The main conclusions were as follows: polysensitization is a relevant clinical characteristic as it affects about 70-80% of the global allergic population; the diagnostic pathway needs the use of an adequate and thorough methodology, based on the demonstration of consistency between history and documented sensitization; polysensitization and polyallergy are not synonymous: true allergy should always be demonstrated; polysensitization does not constitute a limitation to allergen immunotherapy prescription, as 1-2 allergen extracts could be effective in polysensitized patients; the allergen immunotherapy product characteristics should include the following: high efficacy and optimal safety profile, standardized production, and documented presence and titration of the major allergen.