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Expert Review of Clinical Immunology

Donald C Vinh
Fungal diseases are a threat to human health. Therapies targeting the fungus continue to lead to disappointing results. Strategies targeting the host response represent unexplored opportunities for innovative treatments. To do so rationally requires the identification and neat delineation of critical mechanistic pathways that underpin human antifungal immunity. The study of humans with single-gene defects of the immune system, i.e. inborn errors of immunity (IEIs), provides a foundation for these paragdims...
February 18, 2019: Expert Review of Clinical Immunology
Amanda Agyemang, Scott Sicherer
Peanut allergy appears to have increased in prevalence, is often severe and is typically life-long. Therefore, reducing its incidence through a primary prevention strategy is a priority. Guidelines on peanut introduction have evolved with time and given evidence of peanut allergy risk reduction with early infant ingestion exposure, the current US advice promotes early introduction for infants, particularly targeting those at highest risk. Areas covered: This article describes the evolution of peanut introduction guidelines in infants in the US, as shaped by key research over the last 20-30 years and culminates in the landmark LEAP study It also compares and contrasts current iterations of peanut introduction guidelines in infants globally...
February 14, 2019: Expert Review of Clinical Immunology
Karen M MacDonald, Abhishek Kavati, Benjamin Ortiz, Abdulaziz Alhossan, Christopher S Lee, Ivo Abraham
Omalizumab is a recombinant monoclonal anti-IgE antibody approved in the US as add-on treatment in moderate-to-severe allergic asthma (in severe allergic asthma [SAA] in Europe). A 2016 review of 24 real-world effectiveness studies in SAA published between 2008-2015 concluded that omalizumab was associated with significant improvements in objective and subjective outcomes with benefits extending beyond 2 years. Several new real-world studies have been published since, bringing the total to 42 studies. Areas covered: This systematic review of 42 studies published since 2008 updates and extends the 2016 review on the real-word evidence on omalizumab in SAA...
February 14, 2019: Expert Review of Clinical Immunology
Manuel Pombo-Suarez, Juan J Gomez-Reino
Rheumatoid arthritis (RA) is a complex disease in which different mechanisms are involved. Studies suggest a key role for aberrant pathways of T-cell activation in the initiation and perpetuation of disease. Abatacept is a fusion protein composed of the Fc region of the immunoglobulin G1 (IgG1) fused to the extracellular domain of cytotoxic T lymphocyte-associated antigen (CTLA4). It has the ability to modulate T-cell activation by interfering with co-stimulation of these cells, a necessary step to become activated...
February 7, 2019: Expert Review of Clinical Immunology
Emmerik F Leijten, Timothy R Radstake, Iain B McInnes, Johannes W Jacobs
No abstract text is available yet for this article.
February 7, 2019: Expert Review of Clinical Immunology
Francesca Del Bufalo, Pietro Merli, Iside Alessi, Franco Locatelli
The last few years have witnessed what can certainly be defined as a 'period of renaissance' for immunotherapy in the field of hematological malignancies. In particular, antibody-mediated and cell-mediated immunotherapy have significantly changed the treatment approach of patients with B-cell lymphoproliferative disorders. These therapies, initially employed in patients with refractory/relapsed disease, are now integrated in the treatment of newly diagnosed patients. Together with the therapeutic success, we have also learnt that these innovative therapies can induce relevant, sometimes life-threatening or even fatal, side effects...
February 6, 2019: Expert Review of Clinical Immunology
Melanie A Ruffner, Peter Capucilli, David A Hill, Jonathan M Spergel
No abstract text is available yet for this article.
February 5, 2019: Expert Review of Clinical Immunology
Shadi Gholizadeh, Annie Meier, Vanessa L Malcarne
Systemic sclerosis (SSc, scleroderma) is a progressive, autoimmune, connective tissue disease of unknown etiology that can cause changes in appearance in socially important areas of the body (e.g., face and hands). Social concerns related to changes in appearance can contribute to anxiety specific to situations where one's appearance will be evaluated, or appearance anxiety. Appearance anxiety is a relevant but underexplored construct in SSc. Areas Covered: We review the current knowledge on appearance anxiety in SSc, including assessment of the construct and interventions...
January 25, 2019: Expert Review of Clinical Immunology
Tabata T França, Lucila A Barreiros, Basel K Al-Ramadi, Hans D Ochs, Otavio Cabral-Marques, Antonio Condino-Neto
CD40 ligand (CD40L) deficiency or X-linked Hyper-IgM syndrome is a severe primary immunodeficiency caused by mutations in the CD40L gene. Despite current available treatments, CD40L-deficient patients remain susceptible to life-threatening infections and have poor long term survival. Areas covered: Here, we discuss clinical and immunological characteristics of CD40L deficiency as well as current therapeutic strategies used for patient management. This review highlights that beyond B cell defects, patients' susceptibility to opportunistic pathogens might be due to impaired T cell and innate immune responses...
January 25, 2019: Expert Review of Clinical Immunology
Johan Noble, Thomas Jouve, Bénédicte Janbon, Lionel Rostaing, Paolo Malvezzi
Since the approval of belatacept in 2011 for use in the setting of de novo kidney transplantation, this CD80/86 - CD28 co-stimulation blocker has been shown to be a valuable treatment option for maintenance immunosuppression. Areas covered: In this setting, belatacept has been associated with superior glomerular filtration rate as compared to calcineurin inhibitor-based treatments because of the absence of nephrotoxicity. Additionally, belatacept avoids the cardiovascular side effects (e.g. hypertension and dyslipidemia) caused by a CNI-based-regimen...
January 24, 2019: Expert Review of Clinical Immunology
Christian G Bien
Autoimmune encephalitides have been accepted as a reproducible and treatable new group of diseases. At present, there is concern that such diagnoses might be made too liberally. Areas covered: This article suggests how to make valid diagnoses. They should consist of three elements: the clinical syndrome, the associated antibody and the presumed cause or predisposition. Recently, an international consortium published formal clinical criteria for autoimmune encephalitides to enable diagnoses even if antibody testing is not (immediately) available and to prevent overinterpretation of questionable antibody results...
January 24, 2019: Expert Review of Clinical Immunology
Manfred Harth, Warren R Nielson
Most arthritides are associated with pain and psychological distress (clinically significant depression and anxiety). Pain and depression are mutually exacerbating; both may continue even when joint involvement appears well controlled. Area covered: There is strong evidence that arthritis-related stress impacts the central nervous system and, together with peripheral inflammatory changes, can cause central sensitization that can lead to chronic pain and worsening of affective distress. Cytokines and chemokines participate both in joint inflammation and in central sensitization...
January 23, 2019: Expert Review of Clinical Immunology
Judith Sánchez-Manubens, Estibaliz Iglesias, Jordi Anton
Mevalonate Kinase Deficiency (MKD) is a rare monogenic autoinflammatory disorder (AID) with autosomal recessive inheritance caused by mutations in the MVK gene. It includes hyperimmunoglobulinemia D syndrome (HIDS) and mevalonic aciduria (a severe form). Patients have recurrent inflammatory attacks with high fever, gastrointestinal symptoms, lymphadenopathy, splenomegaly, arthralgia, rash, pharyngitis, aphtosis and constitutional complaints. Heightened understanding of molecular mechanisms in monogenic autoinflammatory disorders has provided the opportunity for targeted treatment...
January 17, 2019: Expert Review of Clinical Immunology
Vasiliki Koulouri, Michael Koutsilieris, Clio P Mavragani
Cardiovascular (CV) events, as a result of accelerated atherosclerosis, are an important cause of mortality in patients with Systemic lupus erythematosus (SLE). The etiology of SLE is multifactorial and still unclear; among other potential culprits, excessive B cell activation seems to play a crucial role. Accumulating evidence supports a contributory role of B cells in the pathogenesis of atherosclerosis as well. Areas covered: This article focuses on the contribution of B cells and of several autoantibodies in the pathogenesis of atherosclerosis in both general and lupus populations...
January 17, 2019: Expert Review of Clinical Immunology
Manuel Ramos-Casals, Soledad Retamozo, Antoni Sisó-Almirall, Roberto Pérez-Alvarez, Lucio Pallarés, Pilar Brito-Zerón
Sarcoidosis is a complex systemic disease with a silent, long-term evolution, and a heterogeneous clinical presentation. The diagnostic approach is complex with no single diagnostic test that may confirm the disease. Areas Covered: A large list of serum biomarkers has been tested during the last 40 years. In this review, we analyse the potential usefulness in the diagnosis and prognosis of sarcoidosis of serum biomarkers classified according to their corresponding cellular source. Expert commentary: Diagnosis of sarcoidosis must always be approached as a multistep process based on a case-by-case integration of clinical, radiological, histological and serological data, none of which being pathognomonic...
January 11, 2019: Expert Review of Clinical Immunology
Jaqueline Cristina de Amorim, Renan Bazuco Frittoli, Danilo Pereira, Mariana Postal, Sergio San Juan Dertkigil, Fabiano Reis, Lilian Tl Costallat, Simone Appenzeller
Neuropsychiatric systemic lupus erythematosus (NPSLE) is characterized by a heterogeneity of clinical manifestations. The absence of diagnostic criteria and the lack of clinical trials is a challenge in clinical practice. Areas covered: A literature review was performed to describe epidemiology, characterization (clinical, immunological and imaging), diagnosis and treatment of NPSLE. Classification criteria have been the first step towards a uniform definition. More recently, different attribution models have been developed to help to determine if the NP event is due to SLE...
January 11, 2019: Expert Review of Clinical Immunology
Michael Mahler, Luis E Andrade, Carlos A Casiano, Kishore Malyavantham, Marvin J Fritzler
Anti-DFS70 antibodies and their clinical associations remain an immunological paradox. Unlike other antinuclear antibodies (ANA), there is a growing body of evidence that anti-DFS70 antibodies, when present in high titres and in isolation (without accompanying other antibodies), are useful to aid in the exclusion of ANA associated rheumatic diseases. Areas covered: This review aims to analyse and interpret the current published knowledge and recent findings to provide guidance in the use of anti-DFS70 antibodies to analyse associations of this unique autoantibody...
January 9, 2019: Expert Review of Clinical Immunology
Amelia Ruffatti, Maria Favaro, Antonia Calligaro, Alessandra Zambon, Teresa Del Ross
Important advancements in pregnancy outcome have been reported in women with antiphospholipid antibodies (aPL), despite the fact that the treatment of aPL related pregnancy morbidity is not guided by consistent findings from well-designed trials. Areas covered: The current study draws a picture of the studies in the literature by performing a Medline search of relevant English language articles and reports our experience in managing different subsets of obstetric antiphospholipid syndrome (APS), defined on the basis of their clinical and laboratory characteristics...
January 8, 2019: Expert Review of Clinical Immunology
Morten J Christensen, Esben Eller, Henrik F Kjaer, Sigurd Broesby-Olsen, Charlotte G Mortz, Carsten Bindslev-Jensen
Exercise induced anaphylaxis (EIA) denotes a range of disorders where anaphylaxis occurs in relation to physical exercise. Typical symptoms include flushing, pruritus, urticaria, angioedema, respiratory symptoms, gastro-intestinal symptoms, hypotension, and collapse during or after exercise. The far best described entity within EIA is food-dependent exercise-induced anaphylaxis (FDEIA), where symptoms only occur in combination with food intake. Frequency and predictability of symptoms vary, and some patients experience symptoms only if exercise is accompanied by other co-factors Areas covered: In the present review, we aimed to provide an overview of EIA, diagnostic workup, causes, management and discuss areas in need of further research...
January 2, 2019: Expert Review of Clinical Immunology
Man Luo, Hong Peng, Ping Chen, Yong Zhou
Fibrosis makes numerous diseases in all organs more complicated and leads to severe consequences in the lung, liver, heart, kidney and skin. In essence, fibrosis results from excessive, persistent and oftentimes nonreversible aggregation of extracellular matrix (ECM) or simply as collagen during the process of tissue injury and repair. Recent studies suggest the pathology of fibrosis, especially in pulmonary and liver fibrosis, involves various types of immune cells and soluble mediators including interleukin (IL)-35, a recently identified heterodimeric cytokine that belongs to the IL-12 cytokine family...
December 27, 2018: Expert Review of Clinical Immunology
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