Review: Hyper-IgE syndrome

Hyper-IgE syndrome (HIES) is a complex primary immunodeficiency characterized by atopic dermatitis associated with extremely high serum IgE levels and susceptibility to infections with extracellular bacteria.


Phagocyte immunodeficiency (click to enlarge the image).

Non-immunological abnormalities in HIES include:

- distinctive facial appearance
- fracture following minor trauma
- scoliosis
- hyperextensive joints
- retention of deciduous teeth

Genetic basis:

- Dominant-negative mutations in the signal transducer and activator of transcription 3 (STAT3) gene result in the classical multisystem form of HIES
- A null mutation in the tyrosine kinase 2 (TYK2) gene causes an autosomal recessive HIES associated with viral and mycobacterial infections

Signal transduction for multiple cytokines, including IL-6 and IL-23, is was defective, resulting in impaired TH17 function.

References:
Hyper-IgE syndrome. Yoshiyuki Minegishia. Current Opinion in Immunology, 2009.
doi:10.1016/j.coi.2009.07.013
Hyper IgE Syndrome (HIES)


Video: Kids Living with Food Allergies



"What is it like to be a kid dealing with food allergies? Find out from these children, who spend every day avoiding peanuts, milk, eggs, and other foods all of us take for granted." From the Food Allergy Initiative.


Related:
Videos from the KFA channel on YouTube -"Kids With Food Allergies"


Levalbuterol versus albuterol: no clinical superiority was proven

Albuterol has been used for more than 40 years to treat acute asthma exacerbations as a racemic mixture of isomers:

- the active form, (R)-albuterol, or levalbuterol
- (S)-albuterol, classically considered inert

The single-isomer formulation, levalbuterol, has been synthesized (Xopenex) and is used when the racemate is deemed less desirable.

Basic science research indicates that racemic albuterol and levalbuterol can produce effects that favor asthma remediation, including corticosteroid amplification and reduction of inflammatory mediators.

In contrast, (S)-albuterol produces opposite effects. With inhalation of racemic albuterol, circulating (S)-albuterol persists 12 times longer than levalbuterol, suggesting potential for paradoxical effects observed clinically.

However, clinical studies suggest no superiority of levalbuterol over racemic albuterol.

The recent adoption of hydrofluoroalkane MDI formulations has narrowed the cost gap between levalbuterol and racemic albuterol metered-dose inhalers (MDI), but it remains for the nebulized formulations.

References:
Levalbuterol versus albuterol. Ameredes BT, Calhoun WJ. Curr Allergy Asthma Rep. 2009 Sep;9(5):401-9.
Image source: Levosalbutamol (INN) or levalbuterol (USAN), trade name Xopenex, is the R-enantiomer of the short-acting β2-adrenergic receptor agonist albuterol (salbutamol). Wikipedia, public domain.


Advantages of indacaterol, once-daily ultra long-acting beta2-agonist for asthma and COPD

Once-daily beta2-agonists or ultra long-acting beta2-agonists (LABAs) are under development for asthma and COPD.

Ultra-LABAs


Ultra-LABAs
under development for treatment of asthma and COPD include:

- carmoterol
- indacaterol. Related: The Risks and Benefits of Indacaterol - NEJM review and 16-min podcast. NEJM, 2011.
- several GSK molecules

Long-acting antimuscarinic agents (LAMAs)

New long-acting antimuscarinic agents (LAMAs) include:

- aclidinium
- LAS-35201
- 2 GSK products
- NVA-237 (glycopyrrolate)
- OrM3

LABA plus LAMA combinations

Several options for once-daily dual-action ultra LABA plus LAMA combination products are currently being evaluated. Dimer molecule in which both LABA and LAMA are present is called M3 antagonist-beta2 agonist (MABA) bronchodilators http://bit.ly/8behH

Indacaterol advantages

Single doses of indacaterol is effective for 24-h bronchodilation and well tolerated in patients with persistent asthma http://bit.ly/1ahQOx. The Risks and Benefits of Indacaterol - NEJM review and 16-min podcast. NEJM, 2011.

Indacaterol had a greater effect than formoterol on FEV1: 17.7% vs. 7.5%, respectively, from pre-dose. Comparison of once daily indacaterol and twice daily formoterol: a greater effect of indacaterol on resting IC and FEV1 http://bit.ly/3kqFL1

Indacaterol showed bronchodilator efficacy throughout the full 24-hour period, rapid onset of action, good safety http://bit.ly/lbW9E

Mast cell stabilization may constitute another therapeutic benefit of indacaterol in addition to bronchodilation http://bit.ly/1mcHFo

Bronchodilator efficacy of indacaterol at 24 h post-dose was at least as efficacious as formoterol 12 microg BID http://bit.ly/lTmpr

Indacaterol trough FEV1 levels compared favorably with the improvement seen with tiotropium in COPD patients http://bit.ly/3DRXK

Indacaterol as a partnering agent for combinations: LABA/ICS and LABA/LAMA

Indacaterol is an attractive partnering agent for fixed combinations in both asthma and COPD, e.g. daily ICS or LAMA http://bit.ly/L70cr

References:

Anticholinergic (Tiotropium) Plus a Low-Dose Glucocorticoid May Effectively Control Asthma http://goo.gl/OGEr
The Risks and Benefits of Indacaterol - NEJM review and 16-min podcast. NEJM, 2011.
Image source: Indacaterol, Wikipedia, public domain.


Adverse effects of salmeterol monotherapy in asthma may be mediated via neurotrophin factor

Regular use of SABA/LABA has been associated with a paradoxical deterioration of airway hyper-responsiveness http://bit.ly/3klZpu


Salmeterol. Image source: Wikipedia, public domain.

Neurotrophin brain-derived neurotrophic factor (BDNF) is identified as a mediator of airway hyper-responsiveness in asthma.


Brain-derived neurotrophic factor. Image source: Wikipedia, Protien Data Bank, GNU Free Documentation License.

Adverse effects of salmeterol monotherapy in asthma may be mediated via
brain-derived neurotrophic factor (BDNF). Salmeterol increased BDNF in serum and platelets. This increase was abolished by the addition of fluticasone.

Nerve growth factor (NGF) is an important mediator of airway hyper-responsiveness http://bit.ly/WixEs


Asthma classification and treatment for each stage. See more Allergy and Immunology mind maps here.


Mast cell: both villain and hero, harms and protects

Mast cells are present in nearly all vascularized tissues, but not the blood.


Mast cells. Image source: Wikipedia.

Mast cells are best known for their prominent in atopic disease but that is not all they do. Mast cells seem to have a more nuanced behavior of both villain and hero.

Although they are implicated in many inflammatory disorders, they also defend us from bacterial pathogens, prevent dangerous overreactions by the immune system, and even protect us from snake venom.

References:
Mast cell modulation of the immune response. Ryan JJ, Fernando JF. Curr Allergy Asthma Rep. 2009 Sep;9(5):353-9.
Mast cells: makers AND breakers of allergic inflammation
Mast Cells and Basophils
Mnemonics: Mast Cells and Basophils
Mind Maps: Mast Cells and Basophils


Thunderstorm-related asthma is increasingly recognized

Thunderstorm-related asthma is increasingly recognized in many parts of the world. Thunderstorms have often been linked to epidemics of asthma, especially during the grass flowering season.

Strong downdrafts and dry, cold outflows distinguish thunderstorm rain from frontal rain.

In particular, fungal spores such as Alternaria, have been implicated in asthma epidemics associated with thunderstorms.

The prerequisites for the phenomenon of thunderstorm-related asthma are:

1) a sensitized, atopic, asthmatic individual
2) prior airway hyperresponsiveness before a sudden, large allergen exposure
3) a large-scale thunderstorm with cold outflow occurring during an allergen season in which large numbers of asthmatics are outdoors
4) sudden release of large amounts of respirable allergenic fragments, particularly fungal spores such as Alternaria.



Alternaria sp. Image source: Wikipedia, CDC, public domain.

Alternaria is a genus of ascomycete fungi that are major plant pathogens. They are also common allergens in humans.

References:

Allergens and thunderstorm asthma. Nasser SM, Pulimood TB. Curr Allergy Asthma Rep. 2009 Sep;9(5):384-90.

Thunderstorm asthma. Taylor PE, Jonsson H. Curr Allergy Asthma Rep. 2004 Sep;4(5):409-13.

Thunderstorm asthma in Australia. MJA, 2011.

Explainer: What is thunderstorm asthma? http://goo.gl/k0AIy

Image source: A typical thunderstorm. Wikipedia, Bidgee, Creative Commons Attribution 3.0 Unported License.


Review: Autoimmunity in common variable immunodeficiency (CVID)

Common variable immunodeficiency (CVID) is the most common primary immune defect.


Humoral immunodeficiency (click to enlarge the image).

Hypogammaglobulinemia is the hallmark of CVID but other defects are also important:

- defective T-cell activation and proliferation
- dendritic cell and cytokine defects

70% to 80% of CVID patients have recurrent sinopulmonary infections. Aautoimmunity and inflammatory complications are also common.

The most common autoimmune conditions n CVID are:

- immune thrombocytopenic purpura and hemolytic anemia
- rheumatoid arthritis
- pernicious anemia
- primary biliary cirrhosis
- thyroiditis
- sicca syndrome
- systemic lupus
- inflammatory bowel disease

Treatment of autoimmunity in CVID includes high-dose immunoglobulins, corticosteroids, and selected immunosuppressants.

References:
Autoimmunity in common variable immunodeficiency. Agarwal S, Cunningham-Rundles C. Curr Allergy Asthma Rep. 2009 Sep;9(5):347-52.
Mind Maps: Primary Immunodeficiency Disorders (PIDD)


Mouse allergen associated with asthma in the community

Mouse allergen has long been recognized as an important cause of occupational allergy and asthma, but only recently has it been implicated as a culprit in community settings.

Mouse allergen is detectable in most US homes, with strikingly high levels in some inner cities. In particular, inner city homes in northeastern and Midwestern US cities have levels as much as 100-fold higher than other geographic regions.

About 25% of inner city children with asthma have evidence of IgE sensitization to mouse.

The combination of sensitization and exposure to higher levels of mouse allergen is associated with asthma, including hospitalizations.

Integrated pest management reduces mouse allergen levels and is recommended for sensitized patients with asthma.


Mind map diagram: Indoor allergens.

References:
Role of mouse allergens in allergic disease. Matsui EC. Curr Allergy Asthma Rep. 2009 Sep;9(5):370-5.
Indoor Allergen Avoidance
Mouse allergen levels higher in schools than in homes

Allergy to rodents in the workplace is an occupational health problem affecting research, pharmaceutical and toxicological sectors. Allergy to rodents: an update. Clin Exp Allergy. 2010 Sep. http://goo.gl/od2p


Neutrophil Extracellular Traps (NETs) are a newly discovered weapon in the neutrophil armamentarium

Neutrophils are key players in the host innate immune response. They are recruited to sites of infection and constitute the first line of defense.

Neutrophils employ 3 strategies to eliminate invading microbes:

- microbial uptake
- secretion of antimicrobials
- release of Neutrophil Extracellular Traps (NETs) - NETs consist of DNA and proteins released by neutrophils as they die

NETs are composed of decondensed chromatin and antimicrobial proteins that bind and kill a variety of microbes.

NETs incorporate histones into the antimicrobial arsenal and their role in innate immunity is only now being uncovered.

NETs
in Alcamo's Fundamentals of Microbiology: Body Systems By Jeffrey C. Pommerville:



NETs in Roitt's essential immunology By Peter J. Delves, Ivan Maurice Roitt:



References:
NETs: a new strategy for using old weapons. Venizelos Papayannopoulos and Arturo Zychlinsky. Trends in Immunology, 21 August 2009.
Image source: Wikipedia, free GNU license.


Regulatory T cells become autoaggressive when Foxp3 is extinguished

Foxp3 expression is not stable and may be extinguished both in vitro and in vivo. Those regulatory T cells with "deleted" Foxp3 then convert into pro-inflammatory effector T cells.

The loss of Foxp3 in regulatory T cells under autoimmune conditions may result in the conversion of suppressor T cells into highly autoaggressive lymphocytes.

References:
Regulatory T cells that become autoaggressive. Daniel Hawiger1 & Richard A Flavell2. Nature Immunology 10, 938 - 939 (2009).
T Lymphocytes
Image source: A scanning electron microscope (SEM) image of a single human lymphocyte. Wikipedia, public domain.


Definition of asthma has evolved - is it time to to move beyond FEV1?

The definition of asthma has evolved from that of an episodic disease characterized by reversible airways constriction to a chronic inflammatory disease of the airways, with at least partially reversible airway constriction.

The contribution of the distal airways to the asthma phenotype carries implications for the delivery of inhaled medications to the appropriate areas of the lung and for the monitoring of the response to asthma treatment.

Common spirometric parameters offer limited information with regard to the peripheral airways, and it is therefore necessary to move beyond FEV1.


Flow-Volume loop showing successful FVC maneuver. Positive values represent expiration, negative values represent inspiration. The trace moves clockwise for expiration followed by inspiration. Image source: Spirometry, from Wikipedia, the free encyclopedia, GNU Free Documentation License.

Several functional parameters and inflammatory markers can be employed to evaluate distal lung function. Extrafine formulations deliver inhaled drugs throughout the bronchial tree (both large and small airways).

References:
The role of small airways in monitoring the response to asthma treatment: what is beyond FEV1? N. Scichilone et al. Allergy, 2009.


Allergy and Immunology News of the Day

Health News of the Day is a daily summary made from the selected links I post on Twitter. It is in a bullet points format with links to the original sources which include 350 RSS feeds that produce about 2,500 items per day.

Pediatric asthma is associated with high health care and prescription costs for both employees and dependents. http://bit.ly/hgsMK

30% of ED patients with acute asthma smoked cigarettes. Asthmatic smokers were more likely to receive antibiotics. http://bit.ly/JaTJV

Study: Risk of asthma hospitalization not related to LABA use but strongly associated with being African American. http://bit.ly/bjAL3

30% of acute childhood urticaria leading to patient hospitalization was related to Mycoplasma pneumoniae infection. Children with urticaria who are not responding to antihistamines should undergo serologic examinations for M pneumoniae http://bit.ly/wqtet

Egg, peanut, and dust mite allergies are significant correlates of atopic dermatitis persisting beyond school age. http://bit.ly/sCTpv

Expansion of FOXP3-positive CD4+CD25+ T cells associated with disease activity in atopic dermatitis. http://bit.ly/75Z4U

Nasal ciclesonide once daily safe and effective for the treatment of seasonal allergic rhinitis http://bit.ly/1HGjgG

Desloratadine relieves nasal congestion and improves quality-of-life in persistent allergic rhinitis after 1 week http://bit.ly/6N7r6

Medical news tweets are not research articles - they are 140-character messages - please always go to the original source, links, etc. Tweets and links do not represent endorsement, approval or support. Image source: OpenClipArt.org, public domain.

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TV report: Practical Tips for Dealing with Food Allergies and Reading Allergen Labels



From ABC News:

"Jill Robins' son suffers from food allergies and she has spent the last few years, working with him, to find what they need to look for on product boxes. They have also come up with their own line of cookies for those with food allergies. To hear Jill's story and how she finally came up with the perfect cookies recipe, check the video above."


Allergy and Immunology News of the Day

Health News of the Day is a daily summary made from the selected links I post on Twitter. It is in a bullet points format with links to the original sources which include 350 RSS feeds that produce about 2,500 items per day.

Caregivers of asthmatic children had significantly more depressive symptoms than the age-specific normal population. Amongst caregivers of asthmatic children, depressive symptoms were represented amongst 39% of men and 33% of women. http://bit.ly/lE5XB

Haemopoietic stem-cell transplantation with antibody-based minimal-intensity conditioning in primary immunodeficiency. Antibody-based minimal-intensity conditioning before BMT consisted of anti-CD45, alemtuzumab (anti-CD52), fludarabine, and cyclophosphamide. http://bit.ly/GiH0J

Children who attend day care are no less likely to develop asthma symptoms later in childhood http://bit.ly/oax9S

Study: Traffic doesn't affect adults' lung health http://bit.ly/14FRI5 - Opposite results were published a few months ago...

Early food sensitization (S-IgE) at 3 -18 months associated with atopic dermatitis and asthma at the age of 6 yr. Early inhalant sensitization (S-IgE) at age 3-18 months did not increase the risk of later allergic disease. http://bit.ly/1IeK1H

Patient Q&A: More allergy shots? From Consumer Reports: http://bit.ly/7TtRG

Medical news tweets are not research articles - they are 140-character messages - please always go to the original source, links, etc. The inclusion of a Twitter update (tweet) is not an endorsement or agreement of any kind. Tweets and links do not represent endorsement, approval or support. Image source: OpenClipArt.org, public domain.

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The term "asthma" is a Greek translation of gasping or panting

It is widely accepted that the medical terminology has its roots in ancient Greek and Latin. Greek words have been used not only in the field of medicine but also in every day language for many centuries.

The actual term asthma is a Greek word that is derived from the verb aazein, meaning to exhale with open mouth, to pant.

The expression asthma appeared for the first time in the Iliad by Homer, with the meaning of a short-drawn breath, but the earliest text where the word is found as a medical term is the Corpus Hippocraticum. However it is difficult to determine whether in referring to "asthma," Hippocrates and his school (460-360 B.C.) meant an autonomous clinical entity or simply a symptom.

The best clinical description of asthma in later antiquity is offered by the master clinician, Aretaeus of Cappadocia (1st century A.D.). The numerous mentions of "asthma" in the extensive writings of Galen (130-200 A.D.) appear to be in general agreement with the Hippocratic texts.

Common terms derived from Greek include diagnosis, from the verb diagignosko, meaning to "discriminate"; symptom, from the verb sympipto, that is, "to coincide"; and the adjectives clinical and clinic, from the noun klini, meaning "bed."

I was not able to find where exactly was asthma mentioned in the Iliad but a copy of the book is embedded below, courtesy of Google Books.

References:
Bronchial asthma in the medical literature of Greek antiquity. Marketos SG, Ballas CN. J Asthma. 1982;19(4):263-9.
Ancient Greek terminology in pediatric surgery: about the word meaning. Soutis M. J Pediatr Surg. 2006 Jul;41(7):1302-8.
Image source: Statue of Homer outside the Bavarian State Library in Munich. Wikipedia, GNU Free Documentation License.

The Iliad
, Volume 1 By Homer, Walter Leaf:


Allergy and Immunology News of the Day

Health News of the Day is a daily summary made from the selected links I post on Twitter. It is in a bullet points format with links to the original sources which include 350 RSS feeds that produce about 2,500 items per day.

Administering the H1N1 influenza vaccine in patients with suspected egg allergy - AAAAI (PDF) http://bit.ly/4k0KHC

RSS feed for AAAAI News & Updates http://bit.ly/2qaUge

Former Australian PM John Howard is recovering after suffering an allergic reaction while at the dentist. http://bit.ly/sHtPM

A pocket guide to SLIT for Stallergenes treatments (PDF) http://bit.ly/zBV91

DRAFT parameter – Stinging Insect Hypersensitivity: A Practice Parameter Update 2009 http://bit.ly/18OwNC

For latex allergy: Nonlatex condoms had higher rates of breakage than their latex comparison condoms http://bit.ly/EaScA -- Average breaking rate per condom for those who used condoms in the prior month was 6.2%, and in the prior year 5.0% http://bit.ly/1F3FRB

83% of people with allergic rhinitis said it affected their sexual activity http://bit.ly/mHZiV

Medical news tweets are not research articles - they are 140-character messages - please always go to the original source, links, etc. The inclusion of a Twitter update (tweet) is not an endorsement or agreement of any kind. Tweets and links do not represent endorsement, approval or support. Image source: OpenClipArt.org, public domain.

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"The fire ants" from Google Books

Walter Tschinkel's passion for fire ants has been stoked by over 30 years of exploring the rhythm and drama of Solenopsis invicta's biology. Since South American fire ants arrived in Mobile, Alabama, in the 1940s, they have spread to become one of the most reviled pests in the Sunbelt. There have been several failed, and heavily politically influenced, eradication campaigns.

Google Books automatically creates a word cloud from the content of every book - scroll down this page to see it.

The fire ants By Walter Reinhart Tschinkel:



Related:
Fire Ant Bites. eMedicine Specialties > Emergency Medicine > Environmental, 2009.


Allergy and Immunology News of the Day

Health News of the Day is a daily summary made from the selected links I post on Twitter. It is in a bullet points format with links to the original sources which include 350 RSS feeds that produce about 2,500 items per day.

CNN photo: A boy with allergies wears a belt with two EpiPens and Benadryl. even at home. Rather than a quick fix, EpiPen should be viewed as a "time management tool" that allows a person time to get to ED http://bit.ly/2QBCsk

Total IgE levels and asthma prevalence in the US population: median total IgE level was 40.8 kU/L http://bit.ly/1a3cGr

56% of adult online users said that an online presence would make a difference in their choice of a physician. http://bit.ly/iqDRl

In presence of TGF-beta, retinoic acid converts peripheral blood naive CD4(+) T cells into FOXP3(+) Treg cells. Retinoic acid/GF-beta can be used to generate CD4(+)FOXP3(+) Treg cells from peripheral blood - Treg-based therapies http://bit.ly/6d8qm

Adaptor protein myeloid differentiation factor-88 (MyD88) adaptor-like (Mal, or TIRAP) is important in TLR4 signaling http://bit.ly/FybUY

Stem-cell transplant without chemotherapy can help avoid treatment toxicity in children born with immunodeficiencies http://bit.ly/qzpSv

Large Waist Size Linked to Asthma in Women http://bit.ly/AlGvJ

Dialyzer reactions can be classified into two types: "Type A" and "Type B" http://bit.ly/sPQcd

Medical news tweets are not research articles - they are 140-character messages - please always go to the original source, links, etc. The inclusion of a Twitter update (tweet) is not an endorsement or agreement of any kind. Tweets and links do not represent endorsement, approval or support. Image source: OpenClipArt.org, public domain.

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CRTH2 receptor antagonist that blocks prostaglandin D2 is under development as new asthma therapy

CRTH2 is a G-protein-coupled Chemoattractant Receptor-homologous molecule on Th2 cells (CRTH2). CRTH2 binds PGD2 http://bit.ly/VRpIq

The major prostanoid generated by mast cells is prostaglandin D2 (PGD2). Prostaglandin D2 (PGD2) binds to the receptor PTGDR, as well as CRTH2 http://bit.ly/Hayhv


Eicosanoid synthesis. Image source: Wikipedia.

Eicosanoids are signaling molecules made by oxygenation of 20-carbon essential fatty acids. There are 4 families of eicosanoids (PP-LT): prostaglandins (PG), prostacyclins (PGI), leukotrienes (LT) and thromboxanes (TX).


Prostaglandin D2. Image source: Wikipedia.

A CRTH2 receptor antagonist that blocks the effects of prostaglandin D2 (PGD2) is under development as asthma therapy http://bit.ly/MTIVb

Related:
DP1 antagonist laropiprant did not demonstrate efficacy in asthmatic patients or patients with allergic rhinitis. J Allergy Clin Immunol. 2009 Sep 11.

Updated: 09/21/2009


Determinants of Asthma Severity According to Global Initiative for Asthma (GINA)

The identification of the factors associated with severe asthma may shed some light on its etiology and mechanisms.

A cross-sectional, population-based sample in Europe (1999-2002) included 1,241 adults with asthma.

About 30% of asthmatic subjects were affected by moderate-to-severe asthma.

Sensitization to Cladosporium was associated with a more than 5-fold greater risk of having persistent asthma.


Cladosporium. Image source: Wikipedia, GNU Free Documentation License.

Persistent asthma was associated with sensitization to:

- house dust mite
- nonseasonal asthma
- an older age at asthma onset
- chronic cough and phlegm

Sensitization to cat increased the risk of severe asthma.

Smoking was associated with asthma severity in men, while rhinitis was associated with asthma severity in women.

The authors concluded that one third of the asthmatic population have moderate-to-severe asthma. Sensitization to perennial indoor allergens, particularly Cladosporium, is associated with asthma severity.

Cladosporium is a genus of fungi including some of the most common indoor and outdoor molds. It produces olive-green to brown or black colonies, and its dark-pigmented conidia are formed in simple or branching chains.

Cladosporium species may grow indoors on surfaces when moisture is present. Cladosporium produces volatile organic compounds (VOCs) associated with odors.

References:
Asthma Severity According to Global Initiative for Asthma and Its Determinants: An International Study. Cazzoletti L, Marcon A, Corsico A, Janson C, Jarvis D, Pin I, Accordini S, Bugiani M, Cerveri I, Gislason D, Gulsvik A, de Marco R. Int Arch Allergy Immunol. 2009 Aug 7;151(1):70-79.
Cladosporium. Wikipedia.


Shellfish allergy is common and persistent

Shellfish allergy is common and persistent in adults, and is an important cause of food induced anaphylaxis http://bit.ly/LvbCD

Shellfish allergy is a frequent, long-lasting, life-threatening disorder. As shellfish consumption increases, the number of allergic reactions to shellfish is expected to continue to rise too http://goo.gl/D2PRx

Most shellfish-allergic children also have sensitivity to dust mite and cockroach allergens. Exposure to cockroach is linked to high shrimp IgE with questionable clinical reactivity - food challenge is needed for diagnosis (JACI, 2011). Shrimp Allergy in Italian Adults: Skin reactivity to house dust mite (HDM) was found 70% (Int Arch Allergy Immunol. 2011),

Diagnostic cut-off levels for skin prick testing in shrimp allergy exist (3 mm larger than the negative control) but there are no diagnostic specific IgE values.

All patients with IgE-mediated reactions to shellfish should receive EpiPens, even if the initial symptoms are mild.


Allergic Reaction to Shrimp on Flickr:

"I had a severe allergic reaction to shrimp. Before that, I have always eaten seafood. But this time, I ate something that my body did not like". Image source: Flickr.

Related:
A puzzle: an Orthodox Jewish patient with an allergy to shellfish. How is that possible?
Update on Seafood Allergy
Image source: A steamed tail-on shrimp, Wikipedia, public domain.


Air pollution causes plants to express stress-induced factors with increased allergenicity

Epidemiologic studies reveal a dramatic increase in allergies in the last decades. Air pollution is considered to be one of the factors responsible for this augmentation.

Air pollution causes plants to express stress-induced factors with increased allergenicity. Extracts from birch pollen collected in urban areas had higher chemotactic activity on human neutrophils.

The increase in proinflammatory substances such as pollen-associated lipid mediators might contribute to the described urban-rural gradient of allergy prevalence.

References:
Impact of Urbanization on the Proteome of Birch Pollen and Its Chemotactic Activity on Human Granulocytes. Bryce M, Drews O, Schenk MF, Menzel A, Estrella N, Weichenmeier I, Smulders MJ, Buters J, Ring J, Görg A, Behrendt H, Traidl-Hoffmann C. Int Arch Allergy Immunol. 2009 Aug 6;151(1):46-55.

Air Pollution as an Emerging Global Risk Factor for Stroke - 2.5% of all deaths, 8th leading risk factor for mortality http://goo.gl/KnezA
Image source: Silver Birch, Wikipedia, GNU Free Documentation License.


MDIs, Spacers, and Dry Powder Inhalers: The Most Common Mistakes Patients Make

Consultant Live has a detailed review about MDIs, Spacers, and Dry Powder Inhalers: What Patients Are Likely to Do Wrong.

In some studies, as many as 89% of asthma patients used MDIs incorrectly. For example, in a 2011 study in the Journal of General Internal Medicine, hospitalized adult patients with asthma or COPD misused MDIs 9 out of 10 times, and Diskus inhalers 7 out of 10 times. In other words, Misuse of Respiratory Inhalers in Hospitalized Patients with Asthma or COPD was 86% for MDI, 71% for Diskus.

Breath activated dry powder inhalers eliminate one of the most common problems in using MDIs: the timing mismatch.

Lower-resistance devices (Diskus) are approved for use in children as young as 4 years. Turbuhaler is for older children. Younger children often cannot generate enough pressure to activate Turbuhaler/Flexihaler.

Fluticasone plasma concentrations are significantly greater after MDI compared with DPI http://bit.ly/g9DAC


Asthma video: "Are you using your inhaler right?" - "Do I look like an idiot?!"


The correct way to use your metered dose inhaler (MDI).

References:
MDIs, Spacers, and Dry Powder Inhalers: What Patients Are Likely to Do Wrong. Consultant Live.
Videos: How to use your asthma inhalers
Video: How to Use Asthma Devices -- Inhalers, Spacers, Peak Flow Meters

Misuse of Respiratory Inhalers in Hospitalized Patients with Asthma or COPD: 86% for MDI, 71% for Diskus http://goo.gl/nukcn
Hospitalized adult patients with asthma or COPD misused MDIs 9 out of 10 times, and Diskus inhalers 7 out of 10 times http://goo.gl/5KLH2


Dispelling Internet Myths About Allergy

See the difference between science and Internet "noise": 114,000 search results for "Caffeine Allergy" from Google http://bit.ly/3JoV6U and zero from PubMed.

There is only one (1) obscure case report of "Anaphylaxis due to caffeine" from 2003 http://bit.ly/eEjYt

The classic Middleton's Allergy textbook mentions caffeine in the section for non-allergic adverse reactions to foods as a cause of tremors, cramps, diarrhea.

There is a similar Internet "pollution" when searching for "Chocolate Allergy" http://bit.ly/11fPke - a condition defined in the current guidelines for food allergy as "vanishingly rare" http://bit.ly/rbaZ4

More about dispelling Internet myths: contrary to popular belief, strawberry allergy is uncommon http://bit.ly/ecoCM

In conclusion,
please be sure to receive your information about allergic diseases from allergists, other physicians and reputable sources.

References:
Chocolate Allergy? It's Vanishingly Rare
Contrary to popular belief, strawberry allergy is uncommon
Food Allergy
Image source: Wikipedia, public domain.


25–45% of patients with COPD have never smoked

WHO estimates that 210 million people have COPD worldwide. COPD is the 4th leading cause of death in the world, but by 2030 it is expected to be the 3rd, behind CAD and stroke http://bit.ly/X5nje

25–45% of patients with COPD have never smoked http://bit.ly/3wAucF - 1 in 4 individuals will develop COPD during their lifetime (Lancet, 2011).

3 billion people, half the worldwide population, are exposed to smoke from biomass fuel compared with 1 billion smokers. Exposure to biomass smoke might be the biggest risk factor for COPD globally rather than cigarette smoke.

Different subsets of patients exist within the broad spectrum of COPD, targeted specific therapies could help http://bit.ly/3nuGuR

Related reading:


Frequent exacerbations in COPD: What to do? BMJ 10-minute consultation, 2011.
Action plan is a key component of self-management programs in patients with COPD. Thorax, 20111.

COPD discharge care bundle - a short list of evidence-based practices to be implemented prior to discharge. Thorax, 2011.

Image source: Emission of soot from a large diesel truck, obviously without particle filters. Wikipedia, public domain.


Allergy and Immunology News of the Day

Health News of the Day is a daily summary made from the selected links I post on Twitter. It is in a bullet points format with links to the original sources which include 350 RSS feeds that produce about 2,500 items per day.

  • Regulatory T cells become autoaggressive when Foxp3 is extinguished http://bit.ly/3whf4T

  • Increases in insect allergy reactions in Alaska have occurred after increases in annual and winter temperatures http://bit.ly/13McrJ

  • Treatment of adrenaline induced digital ischaemia caused by auto-injector devices, for example, EpiPen http://bit.ly/1dVM8X

  • Unintentional injection of epinephrine from autoinjectors: demographics and treatment modalities http://bit.ly/sgpwu

  • Where the Confusion Began: Cloning the First Chemokine Receptors http://bit.ly/thMKk

  • A continuous T-bet expression is required to silence the interleukin-4-producing potential in T helper type 1 cells. http://bit.ly/SDOLD

  • Allergy skin tests in twins...http://twitpic.com/g0fqe - Both had almost identical positives @MatthewBowdish

Medical news tweets are not research articles - they are 140-character messages - please always go to the original source, links, etc. The inclusion of a Twitter update (tweet) is not an endorsement or agreement of any kind. Tweets and links do not represent endorsement, approval or support. Image source: OpenClipArt.org, public domain.

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Phosphodiesterase-4 inhibition for treatment of COPD: Roflumilast

Phosphodiesterase-4 inhibition in COPD is mediated through a family of 11 enzymes that inactivate intracellular 2nd messengers cAMP and cGMP. Antagonists of specific PDE isoenzymes were studied in a wide range of diseases, and are used with a notable success in erectile dysfunction. http://bit.ly/11KbUK

Different subsets of patients exist within the broad spectrum of COPD, targeted specific therapies could help http://bit.ly/3nuGuR

From 2 recent clinical trials published in The Lancet:

Phosphodiesterase-4 inhibitor roflumilast can improve lung function and prevent exacerbations in certain COPD patients http://bit.ly/3nuGuR - Adverse events were more common with roflumilast (67%) than with placebo (62%); 219 (14%) patients in the roflumilast group and 177 (12%) in the placebo group discontinued because of adverse events. The difference in weight change during the study between the roflumilast and placebo groups was −2·17 kg. The most likely cause of weight loss is the nausea and vomiting experienced by the patients. Some of the patients with emphysema, described as "pink puffers" in the classic medical textbooks, are already underweight.

Roflumilast improved lung function in patients with COPD treated with salmeterol or tiotropium http://bit.ly/3M6oZ6 - However, nausea, diarrhoea, weight loss, and, to a lesser extent, headache were more frequent in patients in the roflumilast groups. These adverse events were associated with increased patient withdrawal.

There have been more than 15 trials with roflumilast (Daxas). The incidence of side effects was lower with the lower dose (250 mcg po daily) but also the medication was less effective. The recent studies reported in The Lancet used the higher dose of 500 mcg po daily, which was more effective, but was also associated with more side effects.

Newer, second generation, more selective PDE-4 are currently in development that will have a lower incidence of the known class side effects such as nausea and vomiting.

Related:

Roflumilast (Daliresp) for asthma - not FDA-approved and not recommended at this time - AAAAI Ask the Expert, 2011. Update: Roflumilast has been approved.
Roflumilast decreases allergen-induced inflammation in mild asthma - this is is similar to other PDE4 inhibitors http://goo.gl/Yi740
Image source: Wikipedia, public domain.


Allergy and Immunology News of the Day

Health News of the Day is a daily summary made from the selected links I post on Twitter. It is in a bullet points format with links to the original sources which include 350 RSS feeds that produce about 2,500 items per day.

  • Respiratory infections treated with macrolides or cephalosporines linked to increased the risk for atopic dermatitis http://bit.ly/UPRk3

  • Children with allergic rhinitis had higher serum levels of leptin and lower serum levels of adiponectin http://bit.ly/j43EH

  • Thymocyte-expressed molecule involved in selection (THEMIS) - a previously unknown T cell-specific protein during late thymocyte selection and CD4 versus CD8 lineage choice http://bit.ly/sHUId

  • Inflammation: Finding the T in fat - adipose tissue from obese mice had more activated CD8 T cells but fewer CD4 cells http://bit.ly/gvnVn

  • Promiscuous expression of tissue-specific antigens (TSAs) in the thymus is essential for self-tolerance http://bit.ly/NjdQW

  • Doctor saves nut allergy sufferer on plane: "He doesn't carry adrenalin to inject himself – but he will do now." http://bit.ly/3AbnDQ

  • An example of an allergy practice actively using social media http://bit.ly/7EZBj -- Short allergy videos on YouTube from New England Allergy http://bit.ly/YHsS9

Medical news tweets are not research articles - they are 140-character messages - please always go to the original source, links, etc. The inclusion of a Twitter update (tweet) is not an endorsement or agreement of any kind. Tweets and links do not represent endorsement, approval or support. Image source: OpenClipArt.org, public domain.

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Diagnosis and prognosis of COPD

WHO estimates that 210 million people have COPD worldwide. COPD is the 4th leading cause of death in the world, but by 2030 it is expected to be the 3rd, behind CAD and stroke http://bit.ly/X5nje

COPD is a major drain on health-care budgets with 50% of costs accounted for by hospital admissions http://bit.ly/3F0ZMY

It is time to define the disorders of the syndrome of COPD, and clearly distinguish COPD from asthma. Post-bronchodilator FEV1/FVC ratio of below 0·7 identifies patients with poorly reversible airflow obstruction helps distinguish COPD from asthma. http://bit.ly/SfGjK

COPD mortality is inversely correlated to the forced expiratory volume (FEV1) in 1 second. http://bit.ly/ZYIR7

BODE index (body-mass index, airflow obstruction, dyspnoea, exercise capacity) is a prognostic assessment of COPD patients. A simplified ADO index (including age, dyspnoea, and airflow obstruction) was developed from BODE index for COPD http://bit.ly/14IUDL

Budesonide treatment for 12 months does not increase the risk of pneumonia in patients with COPD http://bit.ly/1PntiS

Different subsets of patients exist within the broad spectrum of COPD, targeted specific therapies could help http://bit.ly/3nuGuR

Related:

Frequent exacerbations in COPD: What to do? BMJ 10-minute consultation, 2011.
Action plan is a key component of self-management programs in patients with COPD. Thorax, 20111.
COPD discharge care bundle - a short list of evidence-based practices to be implemented prior to discharge. Thorax, 2011.


Google for diagnosis of difficult immunology/allergy cases: success rate of 66% for attending, 86% resident, 64% nurse

Web search engines have emerged as an important indirect tool in communication and diffusion of knowledge, with Google.com playing a dominant role.

A 2006 BMJ study reported that Google searches revealed the correct diagnosis in 58% of the diagnostic cases published in the case records of the New England Journal of Medicine.

The aim of this 2009 study including 3 subjects was to evaluate whether searching Google with was effective in the identification and diagnosis of complex immunological and allergic cases.

45 case reports were randomly selected by an independent observer from peer-reviewed medical journals.

Clinical data were presented separately to 3 investigators, blinded to the final diagnoses:

- Investigator A was a Consultant with an expert knowledge in Internal Medicine and Allergy (IM&A) and basic computing skills
- Investigator B was a Registrar in IM&A
- Investigator C was a Research Nurse

Both Investigators B and C were familiar with computers and search engines.

For every clinical case presented, each investigator independently carried out an Internet search using Google to provide a final diagnosis.

Correct diagnoses were provided in 66% of cases, 86% of cases, and in 64% of cases by investigator A, B, and C, respectively. All of the 3 investigators achieved the correct diagnosis in 19 cases (42%), and all of them failed in two cases. Computing skills may help to get better results.

References:
Search engine as a diagnostic tool in difficult immunological and allergologic cases: is Google useful? Lombardi C, Griffiths E, McLeod B, Caviglia A, Penagos M. Intern Med J. 2009 Jul;39(7):459-64.
Googling for a diagnosis--use of Google as a diagnostic aid: internet based study. Tang H, Ng JH. BMJ. 2006 Dec 2;333(7579):1143-5. Epub 2006 Nov 10.
Image source: Google Blogoscoped by Philipp Lenssen, used with permission.


Allergy and Immunology News of the Day

Health News of the Day is a daily summary made from the selected links I post on Twitter. It is in a bullet points format with links to the original sources which include 350 RSS feeds that produce about 2,500 items per day.


  • Exposure to a cat AND a dog (both) during childhood has been linked to a lower risk of developing allergies. Children who owned both a cat and a dog less likely to develop allergy. Living with either cat or dog not protective. http://bit.ly/iuan1
  • Children with a family history of allergies are less likely to develop eczema if they live with a dog starting in infancy http://goo.gl/gost
  • Allergic rhinitis , a chronic inflammatory disease of upper airway, affects 60 million people in the United States http://bit.ly/kayDu

  • Impact of asthma controller medications on clinical, economic, and patient-reported outcomes: ICS best, if you use them http://bit.ly/3PytVv

Medical news tweets are not research articles - they are 140-character messages - please always go to the original source, links, etc. The inclusion of a Twitter update (tweet) is not an endorsement or agreement of any kind. Tweets and links do not represent endorsement, approval or support. Image source: OpenClipArt.org, public domain.

Follow me on Twitter:


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