Allergy and Immunology News of the Day

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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.

Only 29% of parents removed their animals from home after allergist told them to do so for their child's health http://bit.ly/46HvCJ

Fatal reactions to SCIT may be on the decline, 6 fatalities between 2001 and 2007 http://bit.ly/2yzWF7

Ovomucoid is the major allergen of egg, strict avoidance is the key in management http://bit.ly/2Q6mbQ

Relationship between hormones and asthma: oral contraceptives may reduce asthma symptoms http://bit.ly/3AtGrM

Lung function at 10 yrs is not improved by early corticosteroid treatment in asthmatic children http://bit.ly/3dfhj4

HRCT is an important diagnostic tool for pulmonary complications in CVID at the time of diagnosis and during follow-up http://bit.ly/30Z4C4

Tricyclic antidepressants should be withheld for 2 to 3 days before allergy skin testing to avoid interference http://bit.ly/1I442X

A boy with severe food allergy and the dog who saved his life http://bit.ly/2dIHtR

RT @wheezemd "We knew it would happen. Onder Law Firm Offers Free XOLAIR Case Review http://is.gd/4VuXa"

Number of children with food allergies has gone up 18% and number seeking treatment at ER has tripled since 1993. 8.9% of U.S. children had experienced atopic dermatitis in 2007, compared with 7.9% in 1997 http://bit.ly/2ywWYL

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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Dendritic cells and Toll-like receptors may be drug targets in atopic dermatitis

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Dendritic cells (DCs) have multifaceted functions. They bridge the gap between innate and adaptive immunity.

Toll-like receptors (TLRs)-expressing DCs may act as promoters of chronic inflammatory immune responses in patients with atopic dermatitis. However, they are also involved in tolerogenic pathways.

TLR-bearing DCs represent promising targets, which might help to improve tolerance induction during immunotherapeutic approaches in the future.


Dendritic cells are the key antigen presenting cells of the immune system. This video describes how they do this. This video is from: Janeway's Immunobiology, 7th Edition.

What are the intracellular TLRs?

TLR 3, 7, 8, and 9 are in the intracellular compartment and detect nucleic acids.

What is MyD88?

MyD88 is an adapter protein that plays a role in TLR signaling. MyD88 is involved in all TLR-signaling pathways except TLR 3.

HIV can attach to dendritic cells through the binding of gp120 to the adhesion molecule DC-SIGN (dendritic cell-specific intercellular adhesion molecule-grabbing nonintegrin).

References:

Dendritic cells: Bridging innate and adaptive immunity in atopic dermatitis. Natalija Novak et al. Journal of Allergy and Clinical Immunology, Volume 125, Issue 1, January 2010, Pages 50-59.

Nickel allergy tracked to a single receptor - Toll-like receptor 4 (TLR4) http://goo.gl/PZic

Related reading:

Nobel Prize in Medicine 2011 - for discovery of dendritic cells and LPS http://goo.gl/JvcYm and http://j.mp/mVxtyJ

Allergy and Immunology News of the Day

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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.

Hematopoietic stem cell transplantation in SCID results in long-term survival even w/o pretransplantation conditioning http://bit.ly/109xXf

Possible association between antibiotic use in first year of life and asthma, AR, and eczema in children 6-7 years old http://bit.ly/4mSZCj 

Broad Spectrum Chemokine Inhibitor FX125L Is "Safe and Well Tolerated" in First Human Trial http://bit.ly/1a9qLx

Gelatin is the Culprit in Some Vaccine Reactions http://bit.ly/42A8rx

Peripheral blood eosinophil counts could serve as a marker of inflammation to guide asthma therapy http://bit.ly/3T40Yk

Treating asthmatic children with montelukast (Singulair) appears effective - but the study was sponsored by Merck http://bit.ly/3Fu5tF

Combination budesonide/formoterol produced a greater improvement in lung function than budesonide MDI alone http://bit.ly/3BdMVs

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.

Follow me on Twitter:

Two new blogs by the Journal of Allergy and Clinical Immunology (JACI)

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In January 2010, the JACI unveiled two new blogs:

JACI Journal Club (http://www.jaci-online.blogspot.com/) selects JACI articles are explored in greater depth, with reader comments, expert opinions, and the authors' responses to your questions.

The News Beyond Our Pages blog (http://www.jaci-nbop.blogspot.com/) highlights news, recently published articles from other journals, and ongoing research and trends in the allergy/immunology community.

Good luck to the blog authors and editors!


This Google video shows that it takes about 2 minutes to start a free blog on Blogger.com. Creating a web site has never been easier.

New developments in atopic dermatitis, urticaria, anaphylaxis, food, drug and insect allergy

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Food allergy

Several westernized countries report that more than 1% of children have peanut allergy, environmental exposure to peanut may be a risk factor.

The role of regulatory T cells, complement, and platelet-activating factor in the development of food allergy were explored.

Oral immunotherapy showed some promise for the treatment of food allergy in 2009. We still do not know if treatment causes tolerance (cure) or temporary desensitization.

Drug hypersensitivity

Delayed anaphylaxis to mammalian meats may be related to IgE binding to the carbohydrate galactose-α-1,3-galactose. Murine (mouse) mAb drugs contain the same oligosaccharide which may explain patient hypersensitivity to mAb.

Venom anaphylaxis

Increased baseline serum tryptase levels may be a risk factor for venom anaphylaxis. Elevated tryptase may also be a risk factor for mast cell disorders in people with episodes of venom anaphylaxis.

Atopic dermatitis

Reduced skin barrier function in atopic dermatitis leads to allergen sensitization and increased infections.

Loss-of-function mutations in filaggrin gene are associated with atopic dermatitis, and now with peanut allergy too. JACI, 2011.

Chronic urticaria

Chronic urticaria can be controlled with increased doses of nonsedating antihistamines (double to quadrable the recommended dose) and omalizumab.

References:
Advances in allergic skin disease, anaphylaxis, and hypersensitivity reactions to foods, drugs, and insects in 2009. Scott H. Sicherer et al. Journal of Allergy and Clinical Immunology, Volume 125, Issue 1, January 2010, Pages 85-97.
Image source: OpenClipArt.org, public domain.

Chilling allergy - cold urticaria and anaphylaxis

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Fox10TV video: Chilling allergy - cold urticaria and anaphylaxis (embedded above).

Patients with cold urticaria "can have symptoms such as drops in blood pressure, redness, blushing, significant itchiness, even to the point with blood pressure drops that they can have a passing out. When people are going swimming, if they jump into a cold pool and they have a reaction where their blood pressure drops, they can actually faint and there have been drownings from it.

If you have it, eating an ice cream cone can cause lips to swell, hands can break out after holding a cold drink. Usually it's when you begin to warm up that symptoms start."

Testing procedures for diagnosis of physical urticarias depend on the cause (stimulus):

- Dermographism: Stroking with narrow object, e.g. a tongue depressor

- Cold urticaria: ice cube test

- Heat urticaria: test tube water at 44°C (111°F)

- Pressure urticaria: Sandbag test or a bag with heavy books (Middleton's Allergy textbook, 2 volumes)

- Vibratory urticaria: vibration with laboratory vortex for four minutes

- Cholinergic urticaria: exercise for 15-20 minutes or leg immersion in 44°C (111°F) bath

- Aquagenic urticaria: challenge with tap water at various temperatures

References:

A chilling allergy. Fox10TV.

"Young mother must wrap up all year round because she is allergic to the cold"http://goo.gl/w25WB - Cold urticaria in Daily Mail.

Treatment of cold urticaria by cold desensitization - AAAAI Ask the Expert, 2011.

CNN video: Winter can worsen asthma

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2010 Review: Role of leukotrienes in asthma

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Leukotrienes are lipid mediators involved in the pathogenesis of asthma:

- Cysteinyl leukotrienes are important in airway remodeling

- Leukotriene B4 has an important role in the development of asthma (sensitization)

Leukotrienes are key mediators of exercise-induced bronchoconstriction and leukotriene modifiers reduce the severity of exercise-induced bronchoconstriction during short-term and long-term use.

Genetic variation in the leukotriene synthetic pathway affects the clinical response to leukotriene modifiers.


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).


Mast cell mediators including (PP-LT): prostaglandins (PG), prostacyclins (PGI), leukotrienes (LT) and thromboxanes (TX). See more Allergy and Immunology mind maps here.

What is the most potent bronchoconstrictor?

(A) LTB4

(B) LTC4

(C) acetylcholine

(D) histamine

(E) thromboxane A2 (TXA2)

(F) methacholine

Answer: B

CysLTs are the most potent bronchoconstrictor agents yet discovered, about 100-1000 times more potent than histamine. The second most potent bronchoconstrictor is thromboxane A2 (TXA2).

Cysteinyl‐LTs and LTB4 are, respectively, the most potent bronchoconstrictor agents and one of the most effective leukocyte chemotaxins yet.

References:
An update on the role of leukotrienes in asthma. Hallstrand, Teal, Henderson, William. Current Opinion in Allergy & Clinical Immunology. 10(1):60-66, February 2010.
Image source: Montelukast, from Wikipedia, the free encyclopedia, public domain.

Food hypersensitivity by inhalation - not widely recognized but it can cause major morbidity

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Though not widely recognized, food hypersensitivity by inhalation can cause major morbidity.

The exposure is usually more obvious in job settings but frequently occurs in homes, schools, restaurants, grocery stores, and commercial flights. The exposure can be trivial, as in mere smelling or being in the vicinity of the food.

The clinical manifestations can vary from a benign respiratory or cutaneous reaction to a systemic one that can be life-threatening. Asthma is a strong predisposing factor and should be well-controlled.

It is of great significance that food inhalation can cause de novo sensitization.

Eight top allergens account for 90 percent of all food allergies. The 8 top allergens can be remembered by the mnemonic TEMPS WFS.

References:
Food hypersensitivity by inhalation. Daniel A Ramirez, Jr#1 and Sami L Bahna#1. Clin Mol Allergy. 2009; 7: 4.

Training Videos from Allergy and Asthma Clinics of Georgia

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Nasal Rinse


Inhaler Use


Inhaler Training


Anaphylaxis and Your Epi Pen

References:
Aacogarward YouTube channel. Jon Ramsey RN. Allergy and Asthma Clinics of Ga., 229-438-7100.

Frequency of thyroid autoimmunity in patients with chronic idiopathic urticaria is 30%

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The study authors evaluated 236 patients with chronic idiopathic urticaria (CIU) seen during a 2-year span. For serum basophil activation testing (BAT-CD203), 5% cell surface expression was considered a positive result.

77% of CIU patients were females with a mean age of 39 years. The mean age of males was 43 years.

Of patients tested for BAT-CD203, 38% of females and 13% of males had positive test results.

Of patients tested for thyroid autoimmunity (TA), 34% of females and 17% of males had underlying TA.

Cyclosporine or corticosteroids were used in 28% of the study population, with another 16% requiring a trial of additional third-line agents, with or without prednisone/cyclosporine.

The study authors concluded that frequency of TA in patients with CIU was 30% -- higher than that previously reported. The frequency of TA and BAT-CD203 positivity was higher in females.

References:
A retrospective review of clinical presentation, thyroid autoimmunity, laboratory characteristics, and therapies used in patients with chronic idiopathic urticaria. Najib, Umer; Bajwa, Zahid H.; Ostro, Martin G.; Sheikh, Javed. Annals of Allergy, Asthma and Immunology, Volume 103, Number 6, December 2009 , pp. 496-501(6).

Image source: Wikipedia, public domain.

2010 Update on genetics of atopic dermatitis: Scratching the surface

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A genetic basis for atopic dermatitis (AD) has long been recognized. Historic documents point to family history as a risk factor.

AD results from a complex interaction between multiple genes and environmental factors.


Human chromosomes (grey) capped by telomeres (white). Image source: Wikipedia, public domain.

More than 81 genes have been implicated in AD. The gene encoding filaggrin (FLG) has been most consistently replicated.

Most candidate genes have focused on immune response, but there is increasing interest in skin barrier genes.

SNPs associated with atopic diseases

Filaggrin gene

Filaggrin is essential for epidermal barrier function. SNP associated with eczema and asthma.

17q12-21 gene

ORMDL3 protein defects associated with asthma.

5q22-32 gene

CD14 is a lipopolysaccharide (LPS) receptor. SNPs associated with asthma and atopy.

3p21-22 gene

CCR5 is a chemokine receptor. SNP can be protective against asthma.

Xp22 gene

TLR7 and TLR8 are recognition receptors for viral ssRNA. SNPs assciated with asthma, rhinitis, atopic dermatitis.

5q31 gene

IL-13 is a cytokine that induces IgE secretion, mucus production, and collagen synthesis (fibrosis). SNPs associated with asthma.

ADRB2 gene

ADRB2 gene encodes β2-adrenergic receptor. Argenteum (Arg) or Arg/Arg phenotype associated with decreased albuterol response compared to Gly/Gly phenotype at residue 16.

ADAM33 gene

Type 1 transmembrane protein involved in cell-to-cell interactions. SNPs associated with asthma.

References:
An update on the genetics of atopic dermatitis: Scratching the surface in 2009. Kathleen C. Barnes. Journal of Allergy and Clinical Immunology, Volume 125, Issue 1, January 2010, Pages 16-29.e11.

Loss-of-function mutations in filaggrin gene are associated with atopic dermatitis, and now with peanut allergy too. JACI, 2011.

Gene defect can triple risk of peanut allergy - filaggrin has already been shown to be a factor in eczema and asthma. BBC, 2011.
Consumer genomics company 23andMe now tests for hay fever, and atopic dermatitis. Clinical relevance is unclear.

New pollen invading Texas on the heels of Mountain Cedar

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While mountain cedar may be the problem in January-February but “the one that is most problematic for people is live oak,” explains Dr. Dilley, and allergist in San Antonio. “That's the one that coats your car and your sidewalk with that yellow residue, and that's the one that makes people very miserable. You can expect to see live oak in mid to late march. Before live oak hits, people will start feeling the effects of the ash tree right after Valentines Day."

References:
WOAI.com

Grass imunotherapy tablet has a long-term clinical efficacy in rhinoconjunctivitis

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The study investigated the efficacy one year after a 3-year period of daily treatment with the grass immunotherapy tablet Grazax (ALK-Abelló, Hørsholm, Denmark).

A randomized, double-blind, placebo-controlled trial included 275 adults with a history of grass pollen-induced rhinoconjunctivitis inadequately controlled by symptomatic medications. Immunologic end points included grass pollen–specific serum IgG4 and IgE-blocking factor.

Symptom improvements were shown during 3 years' treatment. One year after treatment, the active group showed sustained reductions in mean rhinoconjunctivitis symptom scores and medication scores when compared with placebo. This level was similar to the efficacy observed during the 3-year treatment period.

Clinical benefit was accompanied by immunologic changes.

The authors concluded that 3 years of treatment with the grass immunotherapy tablet resulted in persistent clinical improvement and immunologic changes that were sustained 1 year after treatment. This could translate to disease modification and long-term benefits.


Pollen-producing plants (weeds and trees) in Omaha, Nebraska. V. Dimov, M.D.

References:
Long-term clinical efficacy in grass pollen–induced rhinoconjunctivitis after treatment with SQ-standardized grass allergy immunotherapy tablet. Stephen R. Durham et al. Journal of Allergy and Clinical Immunology, Volume 125, Issue 1, January 2010, Pages 131-138.e7.
Interactive Allergy Map by Greer Labs. Click your state to find region-specific, common airborne allergens there.
Timothy grass allergy immunotherapy tablets safe and effective in American children with allergic rhinitis http://goo.gl/tsKL4
Efficacy and safety of timothy grass allergy immunotherapy tablet treatment in North American adults - it works. http://goo.gl/ePOFG
Sustained effects of grass pollen tablet: Combined symptom and medication scores demonstrated a 33% reduction, Allergy, 2011.
Sublingual grass immunotherapy (SLIT): Confirmation of disease modification 2 years after 3 years of treatment. JACI, 2012.
Image source: Fountain grass (Pennisetum setaceum) flowers in Waterloo, Ontario, Wikipedia,
Giligone, Creative Commons Attribution-ShareAlike 3.0 License.

NOD2 variants associated with susceptibility to leprosy

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Mycobacterium leprae (the cause of leprosy) has not been studied well due to:

- narrow host range
- refractoriness to growth in culture

A genomewide association study by genotyping 706 patients and 1225 controls tested three replication sets for an association between the presence of leprosy and 93 single-nucleotide polymorphisms (SNPs).

There was a significant association between SNPs in the genes CCDC122, C13orf31, NOD2, TNFSF15, HLA-DR, and RIPK2.

Variants of genes in the NOD2-mediated signaling pathway (which regulates the innate immune response) are associated with susceptibility to infection with M. leprae.

References:
Genomewide Association Study of Leprosy. Fu-Ren Zhang et al. NEJM Volume 361:2609-2618 December 31, 2009 Number 27.

SNPwatch: Breathe Easier…New Insights From Asthma Research. 23andMe blog, 2010. http://goo.gl/ulJe

Related:

Local allergic rhinitis with negative skin test and serum sIgE - how to diagnose it?

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"Local allergic rhinitis" is a new phenotype of rhinitis that may affect individuals previously diagnosed with nonallergic rhinitis.

Several studies have shown the existence of local allergic rhinitis with nasal production of specific IgE (sIgE) antibodies in the absence of atopy in over 40% of nonallergic rhinitis patients.

Evidence for this entity is supported by:

- symptoms
- local production of sIgE
- leukocyte-lymphocyte inflammatory pattern, with an increase in the nasal fluids of eosinophils, mast cells and T lymphocytes during natural exposure to aeroallergens
- positive nasal allergen provocation test with local production of tryptase and eosinophil cationic protein and an increase of nasal sIgE to inhalant allergens

An advanced diagnostic approach is proposed in patients with symptoms suggestive of allergic rhinitis but negative results in skin prick test and serum sIgE.

This diagnostic approach to local allergic rhinitis includes:

- detection of local sIgE in nasal secretions during natural exposure to aeorallergens
- positive nasal allergen provocation test with local production of tryptase, eosinophil cationic protein and sIgE

References:
Local allergic rhinitis: a new entity, characterization and further studies. Rondon, Carmen, Canto, Gabriela, Blanca, Miguel. Current Opinion in Allergy & Clinical Immunology. 10(1):1-7, February 2010.

Pearls and Pitfalls of Allergen Testing - JCAAI http://goo.gl/6ThcC and http://goo.gl/Bfnhn
Image source: Wikipedia, a Creative Commons license.

Immunodeficiency

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Editor: V. Dimov, M.D., Allergist/Immunologist and Assistant Professor at the University of Chicago

Immunodeficiency Cases, Clinical Notes, Mind Maps and Mnemonics at AllergyCases.org

News About Immunodeficiency at Allergy Notes

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Published: 01/12/2010
Updated: 06/28/2010

Drug Allergy, Drug Hypersensitivity and Adverse Drug Reactions

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Editor: Allergist/Immunologist and Assistant Professor at the University of Chicago

Drug Allergy Cases, Clinical Notes, Mind Maps and Mnemonics at AllergyCases.org

News About Drug Allergy at Allergy Notes

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Published: 01/12/2010
Updated: 03/28/2011

Atopic Dermatitis (Atopic Eczema)

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Editor: Allergist/Immunologist and Assistant Professor at the University of Chicago

Atopic Dermatitis and Other Forms of Dermatitis - Cases, Clinical Notes, Mind Maps and Mnemonics at AllergyCases.org

News About Atopic Dermatitis (Atopic Eczema) at Allergy Notes

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Published: 01/12/2010
Updated: 06/28/2010

Angioedema

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Editor: V. Dimov, M.D., Allergist/Immunologist and Assistant Professor at the University of Chicago

Angioedema Cases, Clinical Notes, Mind Maps and Mnemonics at AllergyCases.org

News About Angioedema at Allergy Notes

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Published: 01/12/2010
Updated: 06/28/2010

Urticaria (Hives)

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Editor: V. Dimov, M.D., Allergist/Immunologist and Assistant Professor at the University of Chicago

Urticaria (Hives) Cases, Clinical Notes, Mind Maps and Mnemonics at AllergyCases.org

News About Urticaria (Hives) at Allergy Notes

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Image source: Urticaria, Wikipedia, public domain.

Published: 01/12/2010
Updated: 03/28/2011

Food Allergy

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Editor: V. Dimov, M.D., Allergist/Immunologist and Assistant Professor at the University of Chicago

Food Allergy Cases, Clinical Notes, Mind Maps and Mnemonics at AllergyCases.org

News About Food Allergy at Allergy Notes

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Published: 01/12/2010
Updated: 06/28/2010

Allergic and Nonallergic Rhinitis

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Editor: V. Dimov, M.D., Allergist/Immunologist and Assistant Professor at the University of Chicago

Allergic (Hay Fever) and Nonallergic Rhinitis Cases, Clinical Notes, Mind Maps and Mnemonics at AllergyCases.org

News About Allergic and Nonallergic Rhinitis at Allergy Notes

How to use a nose spray - videos

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Published: 01/12/2010
Updated: 11/28/2010

Asthma

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Editor: V. Dimov, M.D., Allergist/Immunologist and Assistant Professor at the University of Chicago

Asthma Cases, Clinical Notes, Mind Maps and Mnemonics at AllergyCases.org

News About Asthma at Allergy Notes

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Published: 01/12/2010
Updated: 06/28/2010

Eosinophils as antigen-presenting cells

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The recognition of eosinophils as complex immunomodulatory cells has been increasing in recent years. One new function of eosinophils is their role as antigen-presenting cells (APCs).


Eosinophil. Image source: Wikipedia.

Eosinophils can express major histocompatibility complex class II and costimulatory molecules. They have also been found to traffic to regional lymph nodes and act as professional APCs.

Eosinophils may have more complex immunomodulatory roles in allergic upper airway disease than previously appreciated.

References:
Eosinophils as antigen-presenting cells in allergic upper airway disease. Akuthota, Praveen, Wang, Haibin, Weller, Peter. Current Opinion in Allergy & Clinical Immunology. 10(1):14-19, February 2010.
Eosinophils

Epinephrine (adrenaline) Auto-Injectors in the U.S. include EpiPen, Twinject and now Adrenaclick

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Epinephrine (adrenaline) Auto-Injectors in the U.S. include EpiPen, Twinject and now Adrenaclick (http://www.adrenaclick.com).

EpiPen and Twinject are available as double units (2 doses) but Adrenaclick comes only in single units (1 dose) for now. Adrenaclick is a single dose of epinephrine in otherwise the same delivery device as Twinject.

Twinject (2 units) and Adrenaclick (1 unit) are actually made by the same company for epinephrine auto-injectors, Sciele Pharma. The company is based in Atlanta, Georgia with offices in the U.S. and Japan, where the parent conglomerate is located.


Video: Anaphylaxis and Your Epi Pen. Allergy and Asthma Clinics of Georgia.

Pricing for Epineprhine Auto-Injectors (U.S.)

Epipen
http://www.epipen.com
Manufacturer: Dey Laboratories
0.3 mg (for patients 66 lb and over, more than 30 kg) and 0.15 mg (for patients 33 lb to 66 lb, 15-30 kg)

Epipen
0.3 MG/0.3ML (1:1000) (1 syringe): $65.04
0.3 MG/0.3ML (1:1000) (1 package, 2 ea): $121.80

Epipen Jr
0.15 MG/0.3ML (1:2000) (1 syringe): $64.99
0.15 MG/0.3ML (1:2000) (1 package, 2 ea): $115.49

EpiPen, EpiPen Jr, EpiPen 2-Pak, and EpiPen Jr 2-Pak are all registered trademarks of Dey, L.P.

Twinject
http://www.twinject.com
Manufacturer: Sciele Pharma, Inc.

0.3 MG/0.3ML (1:1000) (1 package, 1 device, 2 doses)
0.15 MG/0.3ML (1:2000) (1 package, 1 device, 2 doses)
$99.99 each

Twinject may also be prescribed as a Two-Pack, which includes 2 Twinject auto-injectors.

Adrenaclick (pronounced, "a-dren-a-click")
http://www.adrenaclick.com
Manufacturer: Sciele Pharma, Inc. (same as Twinject)
Single unit or a Two-Pack (Two-Pack to be available later)
Two dosing options (0.15 mg and 0.3 mg)
Pricing not yet available, more information after February 2010 at http://www.adrenaclick.com

The double-dose devices are called 2-Pak for EpiPen and Two-Pack for Twinject.

Related videos from YouTube:
Epi-Pen and Epi-Pen Trainer Video. Leslea Harmon of allergyware.com.
How to use the Twinject injector. Leslea Harmon of allergyware.com.
How to use a Twinject. OnlineAllergist.
Medication - Epipen. Michael Marcus, MD.
Anaphylaxis and Your Epi Pen Training Video. Allergy and Asthma Clinics of Ga.
Using Epipen. Gerryyen.
Epipen usage in children. Michael Marcus, MD

References:

What are the ‘ideal’ features of an adrenaline (epinephrine) auto-injector in the treatment of anaphylaxis? http://goo.gl/lxCh

Figure: Design overview of currently available auto-injectors for emergency self-administration of adrenaline in the treatment of anaphylaxis.

Training of trainers on epinephrine autoinjector use increases correct use from 23.3% to 74.2% http://goo.gl/lMfSR

How to differentiate ACE inhibitor-induced angioedema from "allergic reactions": no urticaria or itching with ACEi

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Angiotensin-converting enzyme inhibitors (ACE-Is) are associated with angioedema, a potentially life-threatening adverse reaction.

A 5-year medical record review included all patients seen with angioedema at a community hospital ED.

ACE-I-induced angioedema (AIIA) was more likely to be associated with:

- age of 65 years or older
- unilateral symptoms
- absence of urticaria or itching

Community hospital admission rates for AIIA were 14%- significantly lower than those from a tertiary care study (41%). Lack of urticaria or itching may help differentiate AIIA from allergic reactions.

References:

Angiotensin-converting enzyme inhibitor-induced angioedema in a community hospital emergency department. Bluestein, Hazel M.; Hoover, Todd A.; Banerji, Aleena S.; Camargo, Carlos A.; Reshef, Avner; Herscu, Paul. Annals of Allergy, Asthma and Immunology, Volume 103, Number 6, December 2009 , pp. 502-507(6).
Angioedema Due to Angiotensin Converting Enzyme Inhibitors
Abdominal angioedema secondary to acquired C1 esterase functional deficiency
Hereditary Angioedema (HAE) in a Teenager: Diagnosis and Treatment

The first ACE inhibitor (captopril) was developed from viper venom by a Brazilian post-doc. The FASEB Journal, 2003;17:788-789.
Angioedema due to the renin inhibitor aliskiren. CCJM, 2011.

The photographed patient gave a permission for her photograph be taken and used for medical education.

Tc1 cells have a detrimental role and Tc2 cells have a protective role in COPD disease progression

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Tc1 cells are a subpopulation of CD8(+) cytotoxic T-cells characterized by a specific pattern of secreted factors. Like Th1 cells, Tc1 cells secrete IFN-gamma but no IL4, which distinguishes them from another subpopulation, Tc2 cells.

Tc2 cells are a subpopulation of CD8(+) cytotoxic T-cells. Like Th2 cells, Tc2 cells secrete IL4 but do not produce IFN-gamma, which distinguishes them from another subpopulation, Tc1 cells.

Tc1/Tc2 imbalances are implicated in the pathogenesis of chronic obstructive pulmonary disease (COPD).

In this study, 31 patients with COPD and 30 healthy controls underwent blood tests, exhaled nitric oxide (eNO) measurement, pulmonary function tests, and sputum induction.

There was an increased proportion of IFN-gamma-producing and IL-4-producing CD8+ T cells in patients with COPD.

The proportion of IFN-gamma-producing CD4+ T cells was higher in patients with COPD.

The results suggested that Tc1 cells have a detrimental role and that Tc2 cells have a protective role in disease COPD progression.

References:
Correlation between Peripheral Blood T-cell Profiles and Clinical and Inflammatory Parameters in Stable COPD. Shirai T, Suda T, Inui N, Chida K. Allergol Int. 2009 Dec 25;59(1). [Epub ahead of print]
http://www.ncbi.nlm.nih.gov/pubmed/20035145
Tc1 cells. Horst Ibelgaufts' COPE: Cytokines & Cells Online Pathfinder Encyclopaedia.
Image source: Enlarged view of lung tissue showing the difference between healthy lung and COPD, Wikipedia, public domain.

Polyphenols in the skin of red tomatoes may improve asthma by inhibiting Th2 cytokine production from CD4 T cells

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Some polyphenols possess anti-allergic activities. Naringenin chalcone is one of the polyphenols that is present in the skin of red tomatoes.

Japanese researchers investigated the effect of naringenin chalcone in allergic responses using a mouse model of allergic asthma. Allergic airway inflammation was induced by sensitization with ovalbumin. Naringenin chalcone was orally administrated daily.

Eosinophilic airway inflammation, airway hyperreactivity and Th2 cytokine production from CD4 T cells were suppressed by naringenin chalcone.

The study authors concluded that naringenin chalcone suppresses asthmatic symptoms by inhibiting Th2 cytokine production from CD4 T cells. Naringenin chalcone may be a useful supplement for the suppression of allergic symptoms in humans.

References:
Naringenin Chalcone Suppresses Allergic Asthma by Inhibiting the Type-2 Function of CD4 T Cells. Iwamura C, Shinoda K, Yoshimura M, Watanabe Y, Obata A, Nakayama T. Allergol Int. 2009 Dec 25;59(1). [Epub ahead of print]
http://www.ncbi.nlm.nih.gov/pubmed/20035147
Mediterranean diet can protect children from asthma

Why to Eat Like a Greek http://goo.gl/Chpwf - Mediterranean diet improves heart risk factors http://goo.gl/DkPhF
llergenic activity of different tomato cultivars - ‘Matina’ is more allergenic than ‘Reisetomate’ http://goo.gl/A7EfC

Related:

Analysis of Hypoallergenic Cow's Milk Formulas

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During their first year of life, 2% to 3% of children develop hypersensitivity to cow's milk.

Hypoallergenic formulas have considerable variation in their biochemical and immunologic characteristics.

The "degree of hypoallergenicity" can be measured with:

- sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE)

- mass spectrometry

- immunoglobulin (Ig)E reactivity

A recent study (see reference section below) investigated 16 cow's milk formulas to determine their allergenic activity.

The amino acid formulations showed the lowest IgE-binding activity, low T-cell reactivity, and low allergenic activity.

Only 3-5% of children who are allergic to cow's milk are allergic to the extensively hydrolyzed formula.

However, partially hydrolyzed formulas have larger peptides and can cause allergy.

"A person who is truly allergic to cow's milk or milk formula has to go to extensively hydrolyzed formula (EHFs), and probably more than 95% of the formula on the market would be tolerated well. "If it's not tolerated, then they go to amino acid formulas," adds Dr. Bahna, president of the ACAAI.

"The majority of cow's-milk-allergic children would tolerate soy formula, which is similar in price. If a person is highly allergic, we may have to go to the very expensive or the amino acid formulas."

30-50% of infants allergic to cow milk protein will also be allergic to soy protein. These infants should be given protein hydrolysate formula. 5% of infants with hypersensitivity to cow milk formula will also react to hydrolysate formula (EHFs) and will require elemental formula.

Hydrolysate formulas (EHFs) are enzymatically hydrolyzed and contain charcoal-treated casein or whey. Whey or "milk plasma" is the liquid remaining after milk has been curdled and strained.

Extensively hydrolyzed casein protein formulas (EHFs)

Alimentum Similac (Abbott)
Nutramigen LIPIL (Mead Johnson)
Pregestimil LIPIL (Mead Johnson)

Amino acid based formulas (AA)

Neocate Infant (Nutricia)
EleCare Infant (Abbott)
Nutramigen AA Enfamil LIPIL (Mead Johnson)

Note: All Mead Johnson formulas have LIPIL as part of their name.

References:
Study Analyzes "Hypoallergenic" Cow's Milk Formulas for Allergenic Activity. Medscape Medical News, 2009.

Any formula use in the first 6 months of life is associated with increased incidence of otitis media http://goo.gl/LAEJ
Hydrolyzed milk formula may decrease diabetes-associated autoantibodies in infants http://goo.gl/vCXai
Image source: Wikipedia, GNU Free Documentation License.

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