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Introducción: Los inhibidores de la ciclooxigenasa-2 suelen indicarse en pacientes con hipersensibilidad múltiple a los antiinflamatorios no esteroides. Sin embargo, se han descrito reacciones de hipersensibilidad inmediata y retardada, además de posible reactividad cruzada con sulfonamidas. Reporte del caso: Paciente masculino de 66 años, que acudió al servicio de Alergia por una reacción cutánea, luego de haber consumido un comprimido de celecoxib. Previamente, durante el tratamiento con etoricoxib, tuvo una reacción menor, sin establecer la correlación farmacológica. Se realizaron pruebas cutáneas (intraepidérmicas y epicutáneas), con resultados negativos, y un examen de exposición oral controlada con etoricoxib, con resultado positivo. Se comprobó la tolerancia a las sulfamidas. Conclusiones: El caso de reacción cutánea, mediante reactividad cruzada, entre etoricoxib y celecoxib expuesto en este artículo sugiere la necesidad de realizar pruebas de provocación para confirmar la tolerancia de cada fármaco antes de su prescripción. Por el contrario, trimetropim- sulfametoxazol pueden indicarse con seguridad, si fuese necesario.

Asthma is a heterogeneous disease with several phenotypes, endotypes and severity degrees, in which different T-cell subpopulations are involved. These cells express specific miRNAs (i.e. inflamma-miRs) that can be released to serum in exosomes after activation and be used as biomarkers of underlying inflammation. Thus, we aim to evaluate specific T-cell miRNA signatures in serum exosomes from different subgroups of asthmatic patients.Samples from healthy donors (N = 30) and patients (N = 119) with different asthma endotypes (T2We detected five miRNAs with high confidence in serum exosomes: miR-16-5p, miR-21-5p, miR-126-3p, miR146a-5p and miR-215-5p. All of them, except miR-16-5p were upregulated in MSA patients compared to MA. A logistic regression model including each of these miRNAs was created to discriminate both conditions, rendering a ROC curve AUC of 0.896 (0.830-0.961). miR-21-5p and miR-126-3p, both involved in Th1/Th2 differentiation, were specifically augmented in T2Immune-related miRNAs, including miR-21-5p, miR-126-3p, miR-146a-5p and miR-215-5p, can be used as clinically relevant non-invasive biomarkers of the phenotype/endotype and severity of asthma.

Background Poor medication adherence is a major challenge in asthma, and objective assessment of inhaler adherence is needed. The InspirerMundi app aims to monitor adherence while providing a positive experience through gamification and social support. Objective This study aimed to evaluate the feasibility and acceptability of the InspirerMundi app to monitor medication adherence in adolescents and adults with persistent asthma (treated with daily inhaled medication). Methods A 1-month mixed method multicenter observational study was conducted in 26 secondary care centers from Portugal and Spain. During an initial face-to-face visit, physicians reported patients’ asthma therapeutic plan in a structured questionnaire. During the visits, patients were invited to use the app daily to register their asthma medication intakes. A scheduled intake was considered taken when patients registered the intake (inhaler, blister, or other drug formulation) by using the image-based medication detection tool. At 1 month, patients were interviewed by phone, and app satisfaction was assessed on a 1 (low) to 5 (high) scale. Patients were also asked to point out the most and least preferred app features and make suggestions for future app improvements. Results A total of 107 patients (median 27 [P25-P75 14-40] years) were invited, 92.5% (99/107) installed the app, and 73.8% (79/107) completed the 1-month interview. Patients interacted with the app a median of 9 (P25-P75 1-24) days. At least one medication was registered in the app by 78% (77/99) of patients. A total of 53% (52/99) of participants registered all prescribed inhalers, and 34% (34/99) registered the complete asthma therapeutic plan. Median medication adherence was 75% (P25-P75 25%-90%) for inhalers and 82% (P25-P75 50%-94%) for other drug formulations. Patients were globally satisfied with the app, with 75% (59/79) scoring ≥4,; adherence monitoring, symptom monitoring, and gamification features being the most highly scored components; and the medication detection tool among the lowest scored. A total of 53% (42/79) of the patients stated that the app had motivated them to improve adherence to inhaled medication and 77% (61/79) would recommend the app to other patients. Patient feedback was reflected in 4 major themes: medication-related features (67/79, 85%), gamification and social network (33/79, 42%), symptom monitoring and physician communication (21/79, 27%), and other aspects (16/79, 20%). Conclusions The InspirerMundi app was feasible and acceptable to monitor medication adherence in patients with asthma. Based on patient feedback and to increase the registering of medications, the therapeutic plan registration and medication detection tool were redesigned. Our results highlight the importance of patient participation to produce a patient-centered and engaging mHealth asthma app.

BACKGROUND Poor medication adherence is a major challenge in asthma, and objective assessment of inhaler adherence is needed. The InspirerMundi app aims to monitor adherence while providing a positive experience through gamification and social support. OBJECTIVE This study aimed to evaluate the feasibility and acceptability of the InspirerMundi app to monitor medication adherence in adolescents and adults with persistent asthma (treated with daily inhaled medication). METHODS A 1-month mixed method multicenter observational study was conducted in 26 secondary care centers from Portugal and Spain. During an initial face-to-face visit, physicians reported patients’ asthma therapeutic plan in a structured questionnaire. During the visits, patients were invited to use the app daily to register their asthma medication intakes. A scheduled intake was considered taken when patients registered the intake (inhaler, blister, or other drug formulation) by using the image-based medication detection tool. At 1 month, patients were interviewed by phone, and app satisfaction was assessed on a 1 (low) to 5 (high) scale. Patients were also asked to point out the most and least preferred app features and make suggestions for future app improvements. RESULTS A total of 107 patients (median 27 [P25-P75 14-40] years) were invited, 92.5% (99/107) installed the app, and 73.8% (79/107) completed the 1-month interview. Patients interacted with the app a median of 9 (P25-P75 1-24) days. At least one medication was registered in the app by 78% (77/99) of patients. A total of 53% (52/99) of participants registered all prescribed inhalers, and 34% (34/99) registered the complete asthma therapeutic plan. Median medication adherence was 75% (P25-P75 25%-90%) for inhalers and 82% (P25-P75 50%-94%) for other drug formulations. Patients were globally satisfied with the app, with 75% (59/79) scoring ≥4,; adherence monitoring, symptom monitoring, and gamification features being the most highly scored components; and the medication detection tool among the lowest scored. A total of 53% (42/79) of the patients stated that the app had motivated them to improve adherence to inhaled medication and 77% (61/79) would recommend the app to other patients. Patient feedback was reflected in 4 major themes: medication-related features (67/79, 85%), gamification and social network (33/79, 42%), symptom monitoring and physician communication (21/79, 27%), and other aspects (16/79, 20%). CONCLUSIONS The InspirerMundi app was feasible and acceptable to monitor medication adherence in patients with asthma. Based on patient feedback and to increase the registering of medications, the therapeutic plan registration and medication detection tool were redesigned. Our results highlight the importance of patient participation to produce a patient-centered and engaging mHealth asthma app.

Unsupervised methods may unveil the potential of the INSPIRERS studies to comprehend the heterogeneous characteristics of asthma. Therefore, we aimed to identify distinct classes of asthma among the participants, using latent class analysis (LCA), and to compare their characteristics across classes. We applied LCA to 308 adults (≥18 years) with persistent asthma (treated with daily inhaled medication) participants in the observational and prospective INSPIRERS studies, conducted in 26 secondary care outpatient clinics from Portugal and Spain. The classifying variables included asthma-related demographics, unscheduled healthcare use, Control of Allergic Rhinitis and Asthma Test (CARAT), and EuroQol 5 dimensions (EQ-5D) questionnaires. A three-class model was identified. Class 1 (21%) and Class 2 (26%) were characterized by highly symptomatic and uncontrolled asthma, with concomitant upper airways symptoms and reporting problems across all EQ-5D dimensions; they differed on high unscheduled healthcare use (Class 1) and early asthma onset (Class 2). Class 3 (53%): early asthma onset, controlled asthma with upper airways symptoms and without problems in EQ-5D dimensions. Compared to other classes, Class 1 had a higher proportion of subjects with FEV1 Three distinct and clinically meaningful unsupervised classes of asthma were identified among participants of the INSPIRERS studies, revealing the studies’ potential to support and enable patient-centered care and further research.

We assessed the feasibility of the InspirerMundi app to monitor medication adherence in adolescents and adults with persistent asthma (treated with daily inhaled medication). A 1-month multicentre observational study was conducted in 26 hospital outpatient clinics from Portugal and Spain. During medical visits (T0), 107 patients were invited to use the app daily to register their asthma medication intakes. A scheduled intake was considered taken when patients presented the medication (inhaler, blister or other recipients) to an app image detection tool. Physicians reported patients’ asthma therapeutic plan at T0. At 1-month, patients were interviewed by phone and app satisfaction was assessed on a 1(low)-5(high) scale. A total of 99 patients (29±13 years) installed the app (93%) and 79 (74%) completed the 1-month interview. At least one medication was registered in the app by 77 patients (72%): 73 ≥1 inhaler and 42 at least another medication, e.g., pills, nasal spray. Almost 90% of patients registered in the app at least 50% of medications of the therapeutic plan, with 71% registering all prescribed inhalers and 52% all other prescribed medication. Median medication adherence was 75[25-90]% for inhalers and 82[50-94]% for other types. Most patients were satisfied with the features of medication adherence monitoring (70% scored ≥4), but less with the inhaler detection tool (53% ≥4). Half of the patients (53%) stated that the app had motivated them to better adhere to inhaled medication. InspirerMundi app was feasible to monitor medication adherence in patients with asthma. These results led to the redesign of the therapeutic plan registration and of the inhaler detection tool.

For several years, carboplatin has been the most efficacious and safest first-line treatment for paediatric low-grade gliomas (LGGs), although very recently vinblastine has been proven to display a better safety profile with similar efficacy (1). Classically, hypersensitivity reactions to carboplatin appeared in around 27% to 42% of cases (2). These reactions are especially frequent as of the seventh cycle (3) in adults and the ninth in children (4), leading to treatment withdrawal and the use of second-line drugs. This article is protected by copyright. All rights reserved.

Desensitization protocols for chemotherapy agents (taxanes and platinum salts) have been extensively performed to safely administer these drugs to patients who have previously suffered a hypersensitivity reaction (HSR). Standardized protocols have been published using 12 or 16 steps to reach the cumulative dose in every patient. All these protocols were based on the preparation of 3 different solutions at 100-fold, 10-fold, and 1fold dilution of the final target concentration. However, from the pharmacological point of view, a reasonable doubt on the stability of diluted concentrations arises because there are no published data available. For example, concentrations higher than 0.2 and 0.1 mg/mL are known to be stable for paclitaxel and carboplatin, respectively, but no studies have been performed with lower concentrations. Docetaxel is the least stable drug. According to the Food and Drug Administration, a sodium chloride solution or 5% dextrose solution to produce a final docetaxel concentration of 0.3 to 0.74 mg/mL is stable for 4 hours under ambient room temperature and lighting conditions but there are no data for longer periods of time or lower concentrations. To address this potential problem of stability, a new protocol of desensitization with carboplatin and taxanes was developed. We present a proposed protocol that perfectly fits with the recommended published dosages for these chemotherapy agents but using the same solution during the whole procedure. Twelve patients with HSR to taxanes or platinum salts and for whom continued treatment with these drugs was considered advantageous were evaluated between July 2013 and April 2016. All patients were women with a median age of 50 years (range, 35-72 years) and had received antineoplastic treatment due to either ovarian and/or breast cancer. Eight of them had suffered at least 1 reaction with carboplatin and the remaining 4 with taxanes (2, paclitaxel and 2, docetaxel). Nine patients presented severe reactions involving the respiratory and/or the cardiovascular system. Most patients (11 of 12) presented with cutaneous symptoms (pruritus, flushing, or urticaria). During this period we have used different brands according to the availability at the hospital: docetaxel (Taxotere, Sanofi Aventis, Essex, United Kingdom; Docetaxel, Accord, Middlesex, United Kingdom; Docetaxel, Actavis, Devon, United Kingdom), carboplatin (Carboplatin, Pharmacia Nostrum, Madrid, Spain; Carboplatin, Accord, Middlesex, United Kingdom; Carboplatin, Kabi, Hampshire, United Kingdom), and paclitaxel (Taxol, Bristol Myers Squibb, Latina, Italy; Paclitaxel, Hospira, Madrid, Spain).