Hypersensitivity reactions (HSRs) to paclitaxel, particularly those mediated by the solubilizer Cremophor^® EL, are common, occurring in approximately 10% of patients despite premedication. Nab-paclitaxel, a newer formulation using human serum albumin as the vehicle, is generally considered a safer alternative due to a lower rate of HSRs. We present the case of a 44-year-old woman with breast cancer who developed severe HSRs following multiple doses of paclitaxel and carboplatin. Despite standard premedication, she experienced fever, erythematous skin eruptions, arthralgias, and systemic symptoms following her fourth and fifth cycles of treatment. Subsequent administration of nab-paclitaxel also elicited a similar severe reaction. Skin testing revealed a positive reaction to paclitaxel, but not to carboplatin, suggesting sensitization to paclitaxel. In the context of the similar reaction to nab-paclitaxel, this suggests sensitization to the taxane moiety itself rather than to the solubilizer. The combination of features consistent with both type IV hypersensitivity and cytokine release syndrome further complicates the presentation as well. To our knowledge, this is the first reported case of cross-reactivity between paclitaxel and nab-paclitaxel, challenging the assumption that nab-paclitaxel is always a safe alternative. This emphasizes the need for vigilance and thorough evaluation in patients experiencing atypical chemotherapy reactions, as cytokine release reactions may play a role even in the absence of immunotherapy. It also raises the concern that alternative formulations like nab-paclitaxel may not always be safe in patients with atypical or severe reactions, as they could possibly be sensitized to the taxane moiety itself.

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Respiratory syncytial virus (RSV) is the leading cause of lower respiratory tract infection (LRTI) burden among infants. Maternal vaccination is a promising preventive strategy, conferring passive immunity through transplacental antibody transfer. The current narrative review was conducted to summarize the current evidence of efficacy and safety of maternal RSV vaccination and assess the practical barriers to its implementation. This review was based on a structured literature search of PubMed/MEDLINE and Google Scholar to identify peer-reviewed studies published between January 2022 and March 2025 using terms such as “maternal RSV vaccine”, “efficacy”, “safety”, “pregnancy”, “Abrysvo”, and “hesitancy”. The review included 5 clinical trials evaluating maternal RSV vaccines and 17 observational and survey studies assessing vaccine acceptance across diverse settings. The bivalent RSVpreF vaccine (Abrysvo) is the only licensed maternal RSV vaccine as of May 2025. In the MATISSE phase 3 trial (n = 7,358), the vaccine demonstrated 81.8% efficacy against medically attended RSV-LRTI at 90 days and 69.4% at 180 days, with 57.1% efficacy against severe RSV-LRTI. No major safety concerns were identified; adverse events and preterm birth rates were comparable between groups. In contrast, trials of GSK’s RSVPreF3-Mat vaccine revealed higher rates of preterm birth (6.8% vs. 4.9%) and a numerical imbalance in infant deaths (0.4% vs. 0.2%), prompting early termination. Across 17 studies (n = 14,959), RSV vaccine acceptance ranged from 39% (France) to 87% (Netherlands), with safety concerns and cultural context influencing attitudes. This review highlights that maternal RSV vaccination with RSVpreF offers effective infant protection with an acceptable safety profile. Future research should focus on long-term infant outcomes, comparative effectiveness in diverse settings, and next-generation vaccines. Implementation will require public trust, cultural sensitivity, and equitable global access.

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This mini-review examines the link between climate change, air pollution, and aeroallergen-induced respiratory diseases in Europe. The articles selected in this mini-review highlighted the links between climate change, air pollutants and the impact on aeroallergen-induced respiratory disease. Searching data base PubMed returned results, but not all were relevant. The search conducted for a geographical scope of Europe after 2015 returned a large number of results, clinical studies, manuals, guidelines and recommendations from international recognized institutions or organizations, such as Global Initiative for Asthma (GINA), World Health Organisation (WHO) from which only published texts containing both general information and specific quantifiable information on climate change and air pollutants and their effects on health were selected. The findings highlight how environmental stressors interact to exacerbate allergic respiratory diseases, and emphasize the need for environmental policies.

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Climate change in the form of rising temperatures and pollution can intensify pollen allergies, increasing health burdens and demanding proactive public health policies. Here, we discuss the current perceptions of physicians and patients on the impact of climate change and some of the initiatives to address its impact on global health. Recent surveys suggest growing concern among healthcare professionals and patients over the expanding evidence that climate change is contributing to the onset and exacerbation of respiratory allergies. Limited evidence exists on effective strategies, but some of the proposed public policy solutions include enhanced pollen monitoring networks, promoting climate-health education in medical curricula, development of early warning systems for thunderstorm asthma, and allergen-reducing urban planning. Collaboration among clinicians, researchers, and policymakers is critical for developing targeted measures that build resilience against climate-driven pollen allergy.

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Air pollution is an increasing global concern with serious health and economic impacts. Among its many effects, respiratory health is particularly vulnerable. As the first point of contact with inhaled pollutants, the nasal passages play a crucial role in airway defense, making rhinitis one of the key inflammatory conditions linked to environmental pollution. This review explores the relationship between air pollution and rhinitis, highlighting key pollutants such as particulate matter (PM, PM_2.5, PM₁₀), nitrogen dioxide (NO₂), sulfur dioxide (SO₂), and ozone (O₃), which contribute to airway inflammation, epithelial barrier dysfunction, immune system dysregulation, and epigenetic changes. Epidemiological studies demonstrate a strong association between pollutant exposure and increased prevalence, severity, and healthcare utilization for allergic rhinitis. However, there is limited research focusing on non-allergic rhinitis. Beyond health concerns, air pollution also imposes a significant economic burden due to rising healthcare costs and lost productivity. Effective mitigation strategies include air quality monitoring, indoor air filtration, policy interventions, and lifestyle modifications. Addressing pollution-related rhinitis requires a multidisciplinary approach involving public health initiatives, clinical management, and environmental policies to reduce exposure and improve patient outcomes. Additionally, limitations in current research are discussed, and further studies are recommended to fill existing knowledge gaps.

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Over 330 million people globally have asthma, a chronic disease with multiple endotypes and observable phenotypes. This disease has a substantial socioeconomic impact. A thorough assessment of multiple clinical aspects (such as the presence of atopy, comorbidities, and clinical presentations), characteristics of lung function (such as the degree of bronchial reversibility, the involvement of the airway obstruction, and airway hyperreactivity), and the interaction of sputum and systemic inflammatory factors (such as neutrophilic, eosinophilic, and mixed) are required to determine the specific endotypes of asthma. The precision medicine approach to asthma represents a new paradigm, with improved opportunities for more effective and appropriate personalized therapies and new insights into the immunological aspects of asthma that demand further research. In the world of precision medicine, biomarker-based therapies for individual patients are just the beginning of an exciting and emerging journey in allergy treatment. A collection of biomarkers might be utilized to define and classify the endotypes based on the phenotyping of asthma, which will be more likely with omics information and unbiased clustering. This review will contribute to the development of personalized therapy for asthma, enabling more accurate treatment. It will also serve as a source of novel targets and new treatments for every identified endotype.

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Activation of eosinophils and mast cells in dysregulated type 2 immunity may play key roles in allergic diseases. Eosinophils are linked to the pathobiology of multiple human diseases, including eosinophilic gastrointestinal disorders (EGIDs), functional gastrointestinal disorders (FGIDs), Kimura’s disease, hypereosinophilic syndrome (HES), rheumatoid lesions, allergy, asthma, and some forms of heart disease etc. Eosinophils are part of the innate immune response involved in combating multicellular parasites and some infections. Mast cells play a key role in allergies, allergic conjunctivitis, allergic dermatitis (eczema), allergic rhinitis (hay fever), anaphylaxis, asthma, and mast cell activation syndrome (MCAS). Mast cells can also play a key role in eosinophilic diseases. Eosinophils respond to interleukin 5 (IL-5) and chemotactic chemokine eosinophil chemotactic factor (eotaxin) released from activated mast cells. Mast cells can be activated by fragment crystallizable (Fc) receptor bound immunoglobulin E (IgE) and G (IgG) antibodies bound to allergens and viruses. Cross talk between eosinophils and mast cells can result in chronic inflammations or eosinophilias. Vasoconstriction of capillaries by histamine contracted pericytes is also predicted to contribute to a subset of these diseases. This article proposes that for these diseases, activation of mast cells is a key step in disease pathogenesis. Targeting activated mast cells in these diseases are potential adjunctive therapies to evaluate in clinical studies. A review of relevant eosinophilia literature is presented that supports the role of mast cells in the pathogenesis of multiple allergic and eosinophilia diseases.

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Since January 2024, in Albania, we have noted an increased number of visits because of Bordetella pertussis affecting all age groups. The increased numbers reflect increased circulation of Bordetella pertussis in Albania. Increasing cases of Bordetella pertussis are noticed in different European countries (European Centre for Disease Prevention and Control. Increase of pertussis cases in the EU/EEA. 2024.), and its appearance represents a public health problem to be addressed correctly such as introducing the booster dosage of Bordetella pertussis vaccine in the preschool, teenagers and pregnancy, identifying the contacts and early beginning of post-exposure prophylaxis are very important for preventing the burden of Bordetella pertussis and its fatalities.

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Pediatric and adolescent asthma is a significant health challenge with high prevalence and socioeconomic costs. Telemedicine has emerged as a promising solution for enhancing asthma management, especially in resource-limited settings and in response to the increasing demand for specialized care, particularly after the coronavirus disease 2019 (COVID-19) pandemic. However, its integration into routine clinical practice is hindered by limited evidence and the absence of standardized protocols tailored to younger populations. Telemedicine offers the potential to optimize healthcare delivery, improve access to specialized services, and support continuous patient monitoring. This initiative aims to address current gaps in standardized practices, ensuring equitable, efficient, and personalized care, particularly in underserved regions. A systematic review of literature on telemedicine and asthma was conducted using MEDLINE, EMBASE, Cochrane Library, and PsycINFO databases, up to October 2024. Studies were evaluated for effectiveness, safety, patient satisfaction, and ethical considerations. International guidelines were also reviewed, and recommendations were formulated through a modified Delphi process with a panel of seven experts, adhering to Oxford Evidence-Based Medicine grading. Telemedicine significantly enhances asthma management, improving treatment adherence, quality of life, and patient education while reducing unplanned visits. It is particularly beneficial for regions with limited access to specialized care. However, challenges persist, including insufficient data on cost-effectiveness, gaps in professional training, and technological barriers. Telemedicine is a valuable tool for managing pediatric and adolescent asthma, offering numerous benefits in accessibility and care continuity. Nevertheless, further research is needed to address existing challenges, establish best practices, and ensure its adaptability to diverse clinical settings, ultimately paving the way for more effective and equitable asthma care.

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In the context of severe asthma, one of the causes of poor disease control has been identified in mucus plugs, which are real obstacles to the physiological flow of air in the bronchi. This clinical case will present the efficacy of dupilumab, as measured by respiratory function and chest computed tomography (CT) imaging, in reducing mucus plugs with consequent improvement in symptoms and function.

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Asthma is a prevalent chronic respiratory condition in children, often exacerbated by allergic reactions, with house dust mites (HDMs) being a significant trigger. Traditional asthma management primarily involves inhaled corticosteroids and bronchodilators, which do not address the underlying allergic mechanisms. Allergen immunotherapy, including subcutaneous and sublingual immunotherapy (SLIT), has emerged as a strategy to induce immune tolerance to allergens. This review evaluates the efficacy of HDM immunotherapy in paediatric asthma, focusing on reductions in asthma exacerbations, improvements in lung function, decreases in medication use, and enhancements in quality of life (QoL). The review highlights that both subcutaneous immunotherapy (SCIT) and SLIT significantly reduce asthma exacerbations in children, with SCIT showing superior efficacy in lung function improvement. Combination therapies, particularly SCIT with biologics, demonstrate enhanced outcomes, including exacerbations and medication use reductions. SCIT has also been shown to improve lung function more effectively than SLIT, particularly in children with high baseline levels of HDM-specific IgE. In terms of safety, both SCIT and SLIT are generally well-tolerated, though SCIT is associated with more localized and systemic reactions, which can be mitigated by combination with biologics. Furthermore, HDM immunotherapy significantly enhances the QoL in paediatric patients by reducing asthma symptoms and improving sleep, leading to long-lasting benefits. Despite these positive outcomes, there remain gaps in knowledge, particularly regarding the optimal duration of therapy and long-term effects post-treatment. Future research should standardize treatment protocols, explore personalized approaches, and investigate the long-term sustainability of treatment benefits to fully optimize the use of HDM immunotherapy in paediatric asthma.

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Thanks to improvements in asthma care and availability of new biologic treatments, a relatively novel population of adolescents and young adults (AYA) with severe asthma (SA) is growing. Transition from pediatric to adult care represents a critical phase in the management of SA. We herein describe clinical outcomes, therapeutic adjustments and disease management in a group of SA patients transitioning from the pediatric to the adult care center. This is a retrospective study in which demographic and clinical (comorbidities, baseline treatment, number of asthma attacks, spirometry, airway inflammation [fractional exhaled nitric oxide (FeNO) measurements], patient’s compliance) data of four SA patients during visits in the Pediatric center as well as after transition into the Adult Center, were retrospectively recollected. All patients transitioned at 18 years of age. Clinical parameters, spirometry and FeNO showed significant improvement following the addition of biologics to baseline asthma regimen during pediatric follow-up and the early transition phase. Several months after transition to the Adult Center, two males experienced SA exacerbations following voluntary discontinuation of the biologic treatment. Symptom control was gained after a phenotype driven re-introduction of a biologic drug in the regimen. Male patients were less compliant and independent than females in the adult setting. Transition from pediatric to adult care for patients with SA can be effectively managed with coordinated and structured transition processes. While some patients maintain stable clinical and respiratory outcomes, others risk to lose asthma control. A personalized approach supporting both patient’s independence and adherence to treatment is requested for a successful long-term management.

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A high percentage of patients with severe asthma also suffer from nasal polyposis, with dupilumab, an anti-IL-4R antibody both diseases can be treated due to its role in type 2 (T2) inflammation. When these conditions are associated with eosinophilic vasculitis, they may be classified as eosinophilic granulomatosis with polyangiitis (EGPA), which can be treated with mepolizumab. This case report presents an atypical form of EGPA, following an unusual course that began with the final signs and symptoms and then proceeded backward to the prodromal stages. Our patient, indeed, a 46-year-old woman, was asymptomatic throughout her youth, with the exception of nasal polyps. Later, at the age of 34, she developed late onset asthma, which became increasingly difficult to treat, until old and previously unacknowledged evidence of vasculitis was discovered, giving a twist to our patient’s medical history and, subsequently, to the therapeutic strategy adopted to treat her. This case report aims to highlight the importance of conducting a thorough anamnesis in patients suffering from both severe asthma and nasal polyposis, taking into account the high prevalence of EGPA in this category of patients, as well as its wide range of clinical manifestations, not to mention the various available therapeutic strategies, including mepolizumab.

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Telemedicine (TM) is rapidly gaining recognition as a valuable tool for accessing medical treatments globally. The article aimed to review the latest literature on the role of TM in asthma care. It has been shown that TM offers numerous advantages for patients and clinicians, facilitating an easier access to healthcare resulting in higher patient satisfaction. Telemedicine technology, pushed by the COVID-19 pandemic, has improved asthma management, notably treatment adherence. Smart inhalers, wearable gadgets, and smartphone apps allow doctors to make data-driven decisions and empower patients to manage their diseases. Real-world research shows that TM is effective and patient-friendly. Infrastructure constraints, data security issues, and long-term patient engagement must be addressed. In conclusion, a hybrid strategy combining TM and in-person visits, enabled by AI and secure digital solutions, can provide equal, efficient, and comprehensive asthma management.

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Atopic dermatitis (AD) is a chronic inflammatory skin disease characterized by a compromised epidermal barrier and heightened immunoglobulin E (IgE) levels, often associated with filaggrin (FLG) gene mutations. Genetic factors like FLG mutations and environmental influences, including microbial exposure and pollutants, contribute to the disease’s progression, leading to itchy, inflamed skin. AD frequently coexists with allergic conditions, severely affecting the quality of life. The disease’s pathogenesis involves complex interactions between genetic predispositions, immune responses, and environmental triggers. Despite advances, the development of effective treatments remains challenging due to an incomplete understanding of how FLG mutations influence immune pathways and the variability in AD presentation. Current biomarkers are insufficient to fully capture disease complexity or predict therapeutic responses, highlighting the need for novel biomarkers and personalized approaches. Emerging therapies such as chimeric antigen receptor (CAR)-T cell therapy, stem cell therapy, and regenerative medicine show promise in addressing AD’s root causes. This review explores key aspects of AD pathogenesis, focusing on epidermal barrier dysfunction, immune mechanisms, and the need for innovative therapeutic strategies to improve patient outcomes.

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Gelatin is extracted from beef, pork, and fish tissues. An increasing number of cases of gelatin-induced anaphylaxis are associated with α-Gal syndrome (AGS). Only a few cases of anaphylaxis to bovine gelatin (BG) without AGS (BG-woAG) have been described. We report two new cases of anaphylaxis to BG-woAG, highlight the characteristics of this entity, and propose a procedure in cases of suspected anaphylaxis to BG. We selected articles on gelatin allergy between 1987 and 2024. Results: we report two new cases of severe anaphylaxis BG-woAG. Diagnosis was established using skin tests (ST), IgE, and basophil activation tests (BAT). We confirm the existence of allergies to BG-woAG. The main characteristic of these allergies seems to be the presence of BG IgE which differentiates them from AGS-related allergies. These initial data need to be confirmed by larger case series. We propose a diagnostic algorithm for better patient management. To confirm the diagnosis, ST and IgE to BG and α-Gal should be performed. The role of BAT to Gelofusine^® in the diagnostic strategy remains to be defined.

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