I-Omalizumab yokuPhathwa kwe-Chronic Idiopathic Urticaria
Yintoni i-Urticaria engapheliyo?
I-Urticaria , igama lesigqirha semingxube , ngumqathango onokuchaphazela umntu omnye kwabahlanu ngexesha elithile ngexesha lokuphila kwabo. Ukugqithisa kwe-urticaria ngokuqhelekileyo kuqhuma, kubomvu kunye nokuhlambalaza. Iimvumba zingaba ubukhulu bezilumko zokukhahlela ubungakanani bemali okanye ezinkulu, kwaye zidibanisa ndawonye zibe ziimo ezingaqhelekanga, ezibizwa ngokuba yi-coalescing.
Ukukhawuleza kuya kufana nokuza emva kweeyure ezimbalwa, ukusuka kwindawo enye kumzimba ukuya kwenye.
Ukuvuvukala ngamanye amaxesha kuhamba i-urticaria, ebizwa ngokuba yi- angioedema , kunokukhokelela ekuvupheni ubuso, izandla kunye neenyawo. I-Angioedema ngokuqhelekileyo ayibomvu okanye ihlaziye, kodwa iyancipha ukutshitshisa nokutshisa, kwaye inokuchazwa ngokuthi "yincinci." Ukuvuvukala kunokuba nzima, kwaye xa kuchaphazela ukuphefumula komntu, kunokusongela ubomi.
Bobabini i-urticaria kunye ne-angioedema yimbangela ye- histamine kunye nezinye iikhemikhali ezikhutshwe kwiiseli ezigciniweyo kwesikhumba kunye neembumba. Oku kungenzeka ngeprogram yokugulisa okanye enye apho iisitrafini zikhupha iikhemikhali ngaphandle kwe- IgE ukubandakanyeka.
Iimeko ze-urticaria kunye ne-angioedema ziba nzima, zihlala zingaphantsi kweeveki ezi-6, okanye zingapheliyo, zihlala ngaphezu kweeveki ezi-6. Ngokungafani ne-urticaria enamandla, kuphela ama-5 ukuya kwe-10 ekhulwini lwe-urticaria engapheliyo kunye ne-angioedema kubangelwa ukugula.
Isizathu se-urticaria esingapheliyo asinakuhlala sichazwa, esibizwa ngokuba ngu-chronic idiopathic urticaria (CIU). I-CIU inokwenzeka kakhulu ukuba inxulumene nezizathu ezizimelayo kunezifo. Kwifom ye-CIU ye-autoimmune, umntu uvame ukwenza i-antibodies ngokubhekiselele kwecandelo leesistim zabo (mhlawumbi kwi-receptor yamathambo e-IgE, okanye kwi-IgE yangempela eboshwe kwiseli yesigxina), ebangela ukukhululwa kwe-histamine kunye nokubangela iimpawu.
Unyango oluphambili lwe-CIU unomlomo we- antihistamines ngomlomo. Ezi zivame ukunikezwa ngamafomu omlomo, kwaye zifuna ukunikezwa ngamayeza amakhulu okanye amaninzi ukulawula iimpawu. Nangona kunjalo, ngaphezu kwama-50% abantu abane-CIU abanakho ukuphendula unyango kunye ne-usual dosing ye-antihistamines yomlomo. Iinkqubo ezongezelelweyo ze-CIU zidla ngokufunekayo, kodwa azivunyelwanga yi-US Food and Drug Administration (FDA) kule njongo. Ngoko ke, unyango olongezelelweyo lwe-CIU, oluvunyiweyo yi-FDA, luyadingeka ukuba abo bantu bangaphenduli kwii-anti-stistamines zomlomo.
Yintoni iXolair?
I-Xolair (i-omalizumab) yicirisi ejoyiweyo evunywe yi-FDA ukuphatha imodareyitha ukuya kwi- asthma ye- inflammatory epilisi kubantu abaneminyaka eli-12 ubudala nangaphezulu. Izifungo zinikezelwa kwiofisi yegqirha zonke ii-2 ukuya kwiiveki ezi-4, ngokuxhomekeke kwisisindo somntu kunye ne-antigenic antibody (IgE). I-Xolair i-anti-IgE yintsholongwane yamanqunu, ehlangene ne-IgE egazini, evumela umzimba ukuba uwasuse. Oku kuvimbela i-IgE ukuba idibanise kumaseli amancinci (kwaye ngoko ke ibophezela kumanzi) oko ekugqibeleni kukuphumela ekukhululweni kwe-histamine nezinye iikhemikhali. Zizo ezo makhemikhali ezibangela ukonakala kwe-asthma kunye nezinye izibonakaliso zokungabikho komzimba, kuquka urticaria kunye ne-angioedema.
Ngaba i-Xolair ingasetyenziselwa ukuphatha i-urticaria engapheliyo?
Izifundo zokuqala ziqinisekile ngokuqinisekileyo. Izifundo ezahlukeneyo zihlolisise i-Xolair ngenzuzo yokunyangwa kwe-CIU. Uphando olutshanje luhlolisise izigulane ezingama-300 ezine-CIU ezisezibonakaliso nangona zithatha amayeza aqhelekileyo ama-antihistamines. Baye balawulwa i-Xolair kwii-doages ezahlukahlukeneyo kwiiveki ezi-4. Amashumi amane anesine abantu abafumana i-dose ephezulu ye-Xolair, kunye ne-22% yabantu abafumana i-dose ye-dola Xolair, banesisombululo esipheleleyo semifuno kwinyanga enye ukuya kweyonyango. Iimpawu zandipha kancinci emva kokuba i-Xolair igqitywe, ngoko kwakungabikho mqondiso wexesha elide.
Ezinye izifundo zifumene iinzuzo ezifanayo, kunye namazinga "wokuxolelwa" kwi-Xolair malunga nama-30% abantu abaneCIU. Idatha engcono kakhulu ibonakala ivela kwisifundo esincinci apho i-dola ye-Xolair yayifana neyokunikezelwa komntu onesifo se-asthma. Izigulana kwezi zifundo zinebubungqina beCIU ngokuzenzekelayo ngokusekelwe kumlinganiselo we-autoantibodies (iintsholongwane ngokumelene nawe) malunga namahomoni e-thyroid. Amashumi asixhenxe eepesenti zabantu abafumana i-Xolair babezilungelelanise ngokupheleleyo iimpawu zabo zeCIU.
Ngoko ke, uphando lubonisa ukuba i-Xolair yinkqubo ekhuselekileyo neyonyango kwizigulane ezine-CIU, kwaye impendulo kwonyango ibonakala ingaxhomekeke kumlinganiselo womntu, inqanaba le-IgE ye-serum, okanye isimo se-autoimmune. Izinzuzo ze-Xolair zihlala zihlala nje ngelixa itywala ithatyathwa, oku kuthetha ukuba akunakwenzeka ukuba kubekho ixesha elide lokuxolelwa olwenziwa ngu-Xolair kubantu abane-CIU. Ngelishwa, kuba i-Xolair iyabiza kakhulu, kwaye abantu abaninzi abaneCIU banokulawulwa ngamaqondo aphezulu e-antihistamines yomlomo, bambalwa abantu banokufumana i-Xolair ye-CIU. I-US Food and Drug Administration ivumile ukusebenzisa i-Xolair ye-CIU ngo-Matshi 2014.
Imithombo:
Casale TB. I-Omalizumab ye-Urticaria engapheliyo. J Allergy Clin Immunol Pract. 2014; 1: 118-9.
DA Kahn. I-Alternative Agents kwi-Refractory Chronicly Urticaria: Ubungqina kunye nokuqwalasela ngokukhetha kwabo kunye nokusetyenziswa. J Allergy Clin Immunol Pract. 2013; 1: 443-40.