| 2020 | A case report of Kounis syndrome presenting with a rash, very late stent thrombosis and coronary evaginations. | Eur Heart J Case Rep | Very late stent thrombosis (ST) is a concern in the era of drug-eluting stents (DESs), and ST is associated with peri-DES coronary artery aneurysmal lesions or coronary evaginations. An increasing number of cases of concurrent systemic allergic reaction and ST have been reported as Kounis syndrome (KS) in the literature. The number of patients with very late ST caused by KS is small, and further investigation of the potential pathophysiology is required.We report a case of KS that manifested as systemic urticaria followed by very late ST 14 years after placement of two sirolimus-eluting stents (SESs). Three months after the event of ST, coronary evaginations at the stented segments were detected on intravascular optical coherence tomography.Coronary evaginations are associated with local hypersensitivity, stent malapposition, uncovered strut, and flow disturbance that may predispose to ST. Systemic allergic reactions are known to promote platelet adhesion and aggregation. This case of KS suggests a pathophysiology in which the synergic effects between the coronary evaginations and a systemic allergic reaction may contribute to very late ST. For patients with Type 3 KS, performing follow-up intracoronary imaging tests may be important to confirm potential coronary evaginations, especially in patients with SESs. |
| 2019 | Glucocorticoids for acute urticaria: study protocol for a double-blind non-inferiority randomised controlled trial. | BMJ Open | This study protocol describes a trial designed to investigate whether antihistamine alone in patients with acute urticaria does not increase the 7-day Urticaria Activity Score (UAS7) in comparison with an association of antihistamine and glucocorticoids and reduces short-term relapses and chronic-induced urticaria.This is a prospective, double-blind, parallel-group, multicentre non-inferiority randomised controlled trial. Two-hundred and forty patients with acute urticaria admitted to emergency department will be randomised in a 1:1 ratio to receive levocetirizine or an association of levocetirizine and prednisone. Randomisation will be stratified by centre. The primary outcome will be the UAS7 at day 7. The secondary outcomes will encompass recurrence of hives and/or itch at day 7; occurrence of spontaneous hives or itch for >6 weeks; patients with angioedema at day 7, and 2, 6, 12 and 24 weeks; new emergency visits for acute urticaria recurrences at days 7 and 14, and 3 months; Dermatology Life Quality Index at days 7 and 14, and 3 and 6 months; and Chronic Urticaria Quality of Life Questionnaire at 6 weeks.The protocol has been approved by the and will be carried out in accordance with the Declaration of Helsinki and Good Clinical Practice guidelines. A steering committee will oversee the progress of the study. Findings will be disseminated through national and international scientific conferences and publication in peer-reviewed journals.NCT03545464. |
| 2013 | [An uncommon cutaneous presentation of cat scratch disease]. | Ann Dermatol Venereol | Herein we report a case of cat scratch disease on account of its atypical presentation.A 21-year-old woman presented erythema nodosum associated with painful bilateral inguinal adenopathy, odynophagia, joint pain and evening urticaria in a setting of impaired general condition. Initial serological testing for Bartonella henselae was negative. PCR for Bartonella henselae performed on an adenectomy fragment was positive. A favourable outcome was achieved with azithromycin.This case shows an atypical and severe presentation of cat scratch disease and raises the problem of sensitivity of serotyping. |
| 2009 | Analysis of dermatologic events in patients with cancer treated with lapatinib. | Breast Cancer Res Treat | Dermatologic events (DEs) in patients with cancer treated with lapatinib, a small-molecule dual tyrosine kinase inhibitor (TKI) of epidermal growth factor receptor (EGFR [ErbB1]) and HER2 (ErbB2), were characterized.Nine clinical trials of metastatic cancer were included in this analysis. Lapatinib was administered at doses ranging from 1000 to 1500 mg/day as monotherapy (n=928) or in combination with paclitaxel or capecitabine (n=491). Patients not treated with lapatinib comprised the control group. Dermatologic events included hand-foot syndrome, rash, hair disorder, dry skin, pruritus/urticaria, skin disorder, skin infection, and nail disorder; DEs were characterized based on type, time to onset, severity, duration, and required interventions.Fifty-eight percent of patients treated with lapatinib monotherapy, 74% treated with lapatinib plus paclitaxel or capecitabine, and 53% in the control group developed DEs. Among patients receiving lapatinib monotherapy, 55% experienced grade 1/2 DEs, 3% had grade 3 DEs, and no grade 4 DEs were observed. The most common DE was rash (43%); all other events occurred in |
| 2005 | Predicting and establishing the clinical efficacy of a histamine h(1)-receptor antagonist : desloratadine, the model paradigm. | Clin Drug Investig | Antihistamines are well established as a mainstay for treating allergic diseases, including seasonal and perennial allergic rhinitis as well as other conditions, such as chronic idiopathic urticaria. The development of new antihistamines is a multistage process that includes in vitro and in vivo assessments of the antihistaminic, anti-inflammatory and antiallergic properties of new therapies. Results of these assessments are critical for predicting and establishing the clinical efficacy of an antihistamine. The focus of this article is to review the investigational methods used to assess the efficacy, safety and tolerability of newer histamine H(1)-receptor antagonists. Desloratadine, a new-generation H(1)-receptor antagonist, was chosen to illustrate the use of this model paradigm. Data obtained from two large observational studies are presented, confirming results obtained from clinical trials that the in vitro inhibition of release of inflammatory mediators such as histamine, prostaglandins, leukotrienes and the reduction of secretion of cytokines such as IL-4 and IL-13 at physiological concentrations is reflected in increased efficacy, particularly upon nasal obstruction. A recent discovery that des- loratadine inhibits nuclear factor-kappaB may be the underlying explanation for much of this extra anti-inflammatory activity. |
| 1987 | The properties of human C5a anaphylatoxin. The significance of C5a formation during hemodialysis. | Contrib Nephrol | Human C5a anaphylatoxin is a potent bioactive molecule that possesses both spasmogenic and leukocyte-related properties. As such, it normally serves as a local mediator of the acute inflammatory response. Additionally, C5a, through its actions of mononuclear phagocytes, may act to bridge the gap in the acute-chronic inflammatory continuum. While these properties are critical to normal host defense mechanisms, it is now apparent that this anaphylatoxin and/or its des-Arg74 derivative, may exert significant systemic effects that are manifest as cardiopulmonary abnormalities and intravascular activation of granulocytes. Knowledge of these properties is critically important for understanding the clinical sequelae exhibited by patients undergoing extracorporeal circulation since we now know that both hemodialysis and cardiopulmonary bypass [28-30] procedures promote intravascular complement activation and C5a formation. Viewed in this context, it seems reasonable to postulate that many of the immediate and delayed responses to extracorporeal circulation might be mediated by C5a formed in the extracorporeal circuit (table IV). For example, it is now recognized that a few particularly susceptible patients display adverse reactions during the initial phases of hemodialysis. The symptoms of this so-called 'first-use syndrome' may range from severe urticaria and angioedema to life-threatening bronchospasm, hypotension, and cardiopulmonary collapse. Some investigators have presented data which suggest that complement-derived products may be causative of these symptoms in some patients [31]. While this hypothesis remains to be confirmed, present evidence clearly demonstrates that C5a alone may produce many of the observed phenomena. In addition to the acute effects produced by C5a, both our own basic studies and the clinical investigations presented by others at this conference suggest that the long-term effects of repeated C5a exposure in the dialyzed patient may be considerable. Thus, there has been a great deal of interest in the role of complement-derived mediators as initiators of leukocyte degranulation and toxic oxygen radical production and an exploration of the significance of these events in the eventual development of chronic pulmonary fibrosis in the dialyzed patient. Similarly, the effects of repeated exposure to IL-1 that has been postulated to occur as a result of C5a triggering of monocytes during dialysis is currently an active area of investigation.(ABSTRACT TRUNCATED AT 400 WORDS) |
| 1985 | Assessment of histamine release and kinin formation in man: identification of kinin degradation products and characterization of a lymphocyte-dependent histamine releasing factor. | Int Arch Allergy Appl Immunol | Factors traditionally associated with histamine release include IgE antibody plus antigen and the anaphylatoxins C3a, C4a, and C5a. Yet histamine release is thought to occur in disorders such as chronic urticaria, atopic dermatitis, and contact dermatitis in which the above mechanisms do not appear operative. We have partially purified a factor from stimulated human mononuclear cells which causes basophil histamine release. It is homogeneous by gel filtration with a molecular weight of about 35,000 daltons and has two molecular forms when assessed by ion exchange chromatography, isoelectrofocusing in gels and chromatofocusing. The purified material, when radiolabeled, gives a single band upon two-dimensional gel electrophoresis and radioautography. This factor may therefore represent one mechanism in which delayed hypersensitivity and histamine release are linked. We are also developing methods to better assess the kinin-forming system in allergic diseases. Assays for enzyme inhibitor complexes are the most sensitive and specific methods for inferring activation in plasma. These include quantitation of activated Hageman factor-C1 INH complexes and kallikrein-C1 INH complexes each of which appears elevated in cutaneous late-phase reactions. However, bradykinin assessment is fraught with difficulties including spurious generation and rapid inactivation. Using high performance liquid chromatography we have separated bradykinin from kallidin, des-Arg9-bradykinin (the degradation product of carboxypeptidase N) as well as the fragments Arg-Pro-Pro-Gly-Phe, Ser-Pro, and Phe-Arg, the degradation products formed by angiotensin-converting enzyme. These can be assayed in purified mixtures, can be detected upon addition of bradykinin to human plasma and are formed by kaolin treatment of plasma. |
| 1981 | Characterization of human anti-luteinizing hormone-releasing hormone (LRH) antibodies in the serum of a patient with isolated gonadotropin deficiency treated with synthetic LRH. | J Clin Endocrinol Metab | In this report we describe the characteristics of human anti-LRH antibodies detected in the serum of a male patient with isolated gonadotropin deficiency. He had received 90 days of therapy with LRH (1 mg, sc, three times daily) and was then placed on three cycles of intermittent therapy (3 weeks of LRH daily, followed by hCG every 3 days for 15 days). At the start of the fourth cycle of therapy with LRH, he developed urticaria at the site of injection, at sites of previous LRH injections, and at distant sites. Upon direct skin testing, the patient reacted positively to 0.02 ng LRH intradermally. A positive intradermal reaction was induced in a normal adult male by preparing his skin with 0.1 ml of the patient's serum and, 24 h later, injecting 0.2 microgram LRH at that site. A binding factor for LRH was detected in the patient's serum by incubation with [125I]LRH. The serum bound 33% of tracer compared to 6% in control serum. We have detected both immunoglobulin G and immunoglobulin E antibodies against LRH in the patient's serum. We have compared displacement of tracer by synthetic LRH with displacement achieved by a series of analogs. Displacements of tracer by LRH, [Lys8]LRH, [D-Trp6,Pro9-NEt]LRH, [des-Gly10]LRH, and [Phe2]LRH were similar, whereas the potencies of Ac-LRH5-10 and AcLRH2-10 were 0.1% or less. |