Application of precision medicine to the treatment of anaphylaxis

Curr Opin Allergy Clin Immunol. 2018 Jun;18(3):190-197. doi: 10.1097/ACI.0000000000000435.

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.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Adult
  • Allergens / administration & dosage
  • Allergens / immunology
  • Anaphylaxis / genetics
  • Anaphylaxis / immunology
  • Anaphylaxis / mortality
  • Anaphylaxis / therapy*
  • Animals
  • Arthropod Venoms / administration & dosage
  • Arthropod Venoms / immunology
  • Biomarkers / analysis
  • Contraceptives, Oral, Hormonal / administration & dosage
  • Contraceptives, Oral, Hormonal / adverse effects
  • Contraceptives, Oral, Hormonal / immunology
  • Desensitization, Immunologic / methods*
  • Drug Hypersensitivity / etiology
  • Drug Hypersensitivity / immunology
  • Drug Hypersensitivity / therapy*
  • Epinephrine / therapeutic use
  • Female
  • Food Hypersensitivity / genetics
  • Food Hypersensitivity / immunology
  • Food Hypersensitivity / therapy*
  • Humans
  • Hymenoptera / immunology
  • Immunoglobulin E / immunology
  • Insect Bites and Stings / complications
  • Insect Bites and Stings / immunology
  • Life Expectancy
  • Phenotype
  • Precision Medicine / methods*
  • Progestins / administration & dosage
  • Progestins / adverse effects
  • Progestins / immunology
  • Quality of Life
  • Recurrence

Substances

  • Allergens
  • Arthropod Venoms
  • Biomarkers
  • Contraceptives, Oral, Hormonal
  • Progestins
  • Immunoglobulin E
  • Epinephrine