Application of Precision Medicine to the Treatment of Anaphylaxis

Marina Labella; Marlene Garcia-Neuer; Mariana Castells

Disclosures

Curr Opin Allergy Clin Immunol. 2018;18(3):190-197. 

In This Article

Abstract and Introduction

Abstract

Purpose of review: Recognize the presentation of anaphylaxis for prompt management and treatment and to provide tools for the diagnosis of the underlying cause(s) and set up a long-term treatment to prevent recurrence of anaphylaxis.

Recent findings: The recent description of phenotypes provides new insight and understanding into the mechanisms and causes of anaphylaxis through a better understanding of endotypes and biomarkers for broad clinical use.

Summary: Anaphylaxis is the most severe hypersensitivity reaction and can lead to death. Epinephrine is the first-line treatment of anaphylaxis and it is life-saving. Patients with first-line therapy-induced anaphylaxis are candidates for desensitization to increase their quality of life and life expectancy. Desensitization is a breakthrough novel treatment for patients with anaphylaxis in need of first-line therapy, including chemotherapy, mAbs, aspirin and others. Ultrarush with venom immunotherapy should be considered in patients who present with life-threatening anaphylaxis after Hymenoptera sting with evidence of IgE-mediated mechanisms. Food desensitization is currently being expanded to provide increased safety to adults and children with food-induced anaphylaxis.

Introduction

Anaphylaxis is the most serious manifestation of an allergic reaction and due to misdiagnosis, anaphylaxis is undertreated leading to fatalities. Epinephrine is the first-line life-saving therapy. The aim of this review is to raise awareness to help patients and clinicians identify, treat and prevent anaphylaxis.

A new clinical approach based on precision medicine through phenotypes, endotypes and biomarkers provides clinicians with new tools to understand the mechanisms involved in hypersensitivity reactions (HSR).[1–3] Phenotypes are based on symptoms and timing of the clinical presentation and are classified into Type-1 reactions, cytokine release reactions (CRR), mixed reactions and complement reactions. Endotypes, underlying these phenotypes, are based on biological and molecular mediators supported by biomarkers. These endotypes include IgE and non-IgE, cytokine, mast cell, bradykinin and complement-mediated mechanisms. Desensitization is a treatment modality which can decrease and prevent anaphylaxis.

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