Treatment with IL5-/IL-5 receptor antagonists in drug reaction with eosinophilia and systemic symptoms (DRESS).

Purpose Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe delayed drug hypersensitivity reaction with exanthema, eosinophilia, and organ manifestations. After culprit drug withdrawal, systemic corticosteroids (CS) are the most widely used treatment, often requiring high doses for months. Blocking the IL-5/IL‑5 receptor axis with mepolizumab, reslizumab, and benralizumab is a promising targeted treatment with a good safety profile and no immunosuppressive effect. The aim of this study is to summarize current experience with the anti-IL5/IL-5-receptor therapy in DRESS. Methods A retrospective analysis of all patients diagnosed with DRESS and treated with mepolizumab, reslizumab, or benralizumab in DRESS was performed. In addition, a PubMed-Medline search for publications on DRESS with anti-IL-5/IL‑5 receptor treatment was performed. Results Of the 14 cases identified, 6 patients were treated with mepolizumab, 6 with benralizumab, 1 patient with reslizumab, and 1 patient was switched from benralizumab to mepolizumab. The main indication for an IL‑5 blockade was a therapy-refractory course (7/14 [50.0%]), recurrent relapses (3/14 [21.4%]), and severe organ dysfunction (2/14 [14.3%]). In 13/14 (93%) cases, a rapid clinical improvement with suppression of eosinophilia and reduction of CS could be achieved. In all but two cases under mepolizumab (dose 100-600 mg) or reslizumab (dose according to body weight), two or more doses were necessary until resolution of DRESS. In 4/7 cases under benralizumab, a single 30 mg dose was sufficient. Conclusion Blockade of the IL-5/IL‑5 receptor axis appears to be a promising treatment in DRESS with fast clinical improvement, which may allow more rapid reduction of CS, and a good safety profile. In addition, a summary of recommendations on when to use blockade of the IL-5/IL‑5 receptor axis in DRESS treatment is provided

Humoral response to mRNA vaccines against SARS-CoV-2 in patients with humoral immunodeficiency disease.

OBJECTIVES Although mRNA-based vaccines against SARS-CoV-2 induce a robust immune response and prevent infections and hospitalizations, there are limited data on the antibody response in individuals with humoral immunodeficiency. The aim of this study was to evaluate the humoral immune response after two vaccine doses with BNT162b2 or mRNA-1273 in patients with humoral immunodeficiency disease. METHODS This cross-sectional study assessed 39 individuals with hypogammaglobulinemia under immunoglobulin replacement therapy. IgG anti-SARS-CoV-2 spike protein antibodies (anti-S) were measured 4 weeks to 4 months after two doses of an mRNA vaccine against SARS-CoV-2. The proportion of patients, who developed a humoral immune response to the spike protein were evaluated and compared to 19 healthy controls. RESULTS After vaccination with two vaccine doses, 26/39 patients (66.7%) with humoral immunodeficiency disease and all healthy controls developed anti-S. In subjects with baseline IgG 5 g/l: 151.5 AU/ml (95%CI 109.0-400.0), healthy controls 250.0 AU/ml (95%CI 209.0-358.0), p = 0.007. CONCLUSION In most patients with mild to moderate humoral immunodeficiency we found only slightly lower anti-S antibodies compared with healthy controls after two vaccine doses with BNT162b2 and mRNA-1273. However, in patients with a decreased baseline IgG below 3 g/l and/or under immunosuppressive drugs, we found severely impaired humoral immune responses

Concert recording 2017-12-01

[Tracks 1-15]. 15 etudes op. 76(a) / David Popper -- [Track 16]. Suite no. 1, BWV 1007. Prelude [Track 17]. Sarabande [Track 18]. Minuet. / Johann Sebastian Bach -- [Track 19]. Suite no. 2, BWV 1008. Prelude [Track 20]. Gigue [Track 21]. Allemande [Track 22]. Courante [Track 23]. Sarabande [Track 24]. Minuet. / Johann Sebastian Bach -- [Track 25]. Suite no. 3, BWV 1009. Prelude [Track 26]. Allemande [Track 27]. Courante [Track 28]. Bourreé [Track 29]. Sarabande [Track 30]. Gigue / Johann Sebastian Bach -- [Track 31]. Suite no. 1, BWV 1007.Prelude [Track 32]. Courante [Track 33]. Sarabande / Johann Sebastian Bach -- [Track 34] Suite No. 4, BWV 1010. Prelude [Track 35]. Sarabande / Johann Sebastian Bach -- [Track 36]. Sicilienne / Maria Theresia von Paradis arranged by Dominic K Na -- [Track 37]. Ständchen / Franz Schubert arranged by Dominic K Na -- [Track 38]. The ragtime dance / Scott Joplin arranged by Dominic K Na

Concert recording 2017-04-25

[Track 1] Silent woods for cello and piano op.68/5 from the Bohemian forest / Antonín Dvořák -- [Track 2] Concerto for cello and piano in E minor, op. 85. II. Lento - allegro molto / E[Track 1]. Silent woods for cello and piano op.68/5 from the Bohemian forest / Antonín Dvořák -- [Track 2]. Concerto for cello and piano in E minor, op. 85. II. Lento - allegro molto / Edward Elgar -- [Track 3]. Concerto for cello and piano in B minor, op. 104. II. Adagio ma non troppo / Dvořák -- [Track 4]. Suite for cello and piano, op. 16. II. Sérénade (andantino) ; [Track 5]. III. Gavotte (allegro non troppo) / Camille Saint-Saëns -- [Track 6]. Polonaise de concert for cello and piano, op. 14 / David Popper -- [Track 7]. Suite for three cellos. I. Allegro ; [Track 8]. IV. Lento / Fernand de La Tombelle -- [Track 9]. Sonata for cello and piano, op. 43/2 in C major. I. Allegro / Bernhard Romberg ; arranged by F. Gustav Jansen -- [Track 10]. Impromptu no. 3 in G major, D. 899 / Franz Schubert -- [Track 11]. Sonata 3 for cello and piano in A major, op. 69. I. Allegro ma non tanto / L.V. Beethoven -- [Track 12]. Two pieces from The blizzard. I. Romance ; [Track 13]. II. Waltz / Georgy Sviridov ; story by Alexander Pushkin

Healthcare provision for insect venom allergy patients during the COVID-19 pandemic

The population prevalence of insect venom allergy ranges between 3–5%, and it can lead to potentially life-threatening allergic reactions. Patients who have experienced a systemic allergic reaction following an insect sting should be referred to an allergy specialist for diagnosis and treatment. Due to the widespread reduction in outpatient and inpatient care capacities in recent months as a result of the COVID-19 pandemic, the various allergy specialized centers in Germany, Austria, and Switzerland have taken different measures to ensure that patients with insect venom allergy will continue to receive optimal allergy care. A recent data analysis from the various centers revealed that there has been a major reduction in newly initiated insect venom immunotherapy (a 48.5% decline from March–June 2019 compared to March–June 2020: data from various centers in Germany, Austria, and Switzerland). The present article proposes defined organizational measures (e.g., telephone and video appointments, rearranging waiting areas and implementing hygiene measures and social distancing rules at stable patient numbers) and medical measures (collaboration with practice-based physicians with regard to primary diagnostics, rapid COVID-19 testing, continuing already-initiated insect venom immunotherapy in the outpatient setting by making use of the maximal permitted injection intervals, prompt initiation of insect venom immunotherapy during the summer season, and, where necessary, using outpatient regimens particularly out of season) for the care of insect venom allergy patients during the COVID-19 pandemic