Allergy Notes

Allergy and Immunology News of the Day

2009-12-07T10:41:00.001-05:00

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.

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

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

Literature review: No signs of a declining trend in asthma prevalence http://bit.ly/3HjEDy - Google Trends tells a different story however.

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

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

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

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

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:

Saline Nasal Irrigation: 2009 Review

2009-12-07T03:46:00.001-05:00

From AFP and Medscape:

Saline nasal irrigation bathes the nasal cavity with liquid or spray by instilling saline into 1 nostril and allowing it to drain out of the other nostril (typically, it drains from both nostrils and the mouth - author's note).

Techniques and devices

Techniques and devices include:

- low positive pressure from a spray or squirt bottle

- gravity-based pressure using a neti pot or other vessel with a nasal spout

SinusRinse video.

Solution concentration

0.9% (normal saline) to 3% (hypertonic) saline solutions are used. Optimal salinity (solution concentration), pH, and temperature are unknown.

Nasal irrigation may be helpful to manage symptoms of chronic rhinosinusitis (symptoms for more than 12 weeks) and this is the most common indication.

In one study, daily use of 2% liquid (not spray) was associated with a 64% reduction in symptom severity vs routine care alone.

Indications

A range of conditions may respond to saline nasal irrigation but the evidence supporting its use is less conclusive:

- allergic rhinitis

- acute upper respiratory tract infections (URTI)

- rhinitis of pregnancy

- acute rhinosinusitis

The exact mechanism of action of saline nasal irrigation is unknown. Saline nasal irrigation may improve nasal mucosa function through direct cleansing; removal of inflammatory mediators, and improved mucociliary function, as suggested by increased ciliary beat frequency.

Adverse effects

Fewer than 10% of patients reported adverse effects:

- self-limited sensation of ear fullness

- "stinging" of the nasal mucosa

- rarely epistaxis

Contraindications

Contraindications for saline nasal irrigation include:

- incompletely healed facial trauma

- increased risk for aspiration, such as intention tremor or other neurologic or musculoskeletal problems.

Recommendations

- For chronic rhinosinusitis, nasal irrigation is an effective adjunctive therapy (level of evidence, A).

- Limited evidence for effective adjunctive treatment of irritant or allergic rhinitis, viral upper respiratory tract infection, and postoperative care after endoscopic sinus surgery (level of evidence, B).

- rhinitis of pregnancy, acute rhinosinusitis, sinonasal sarcoidosis, and Wegener's granulomatosis (level of evidence, C).

References:
Use of Saline Nasal Irrigation Reviewed. Laurie Barclay, MD. Medscape, 2009.

Allergy and Immunology News of the Day

2009-12-05T10:37:00.001-05:00

The Buteyko method: A Breathing Technique Offers Help for People With Asthma http://bit.ly/3ueFU

Early trials of anti-IL-13 therapies in asthma have shown promise, results of further efficacy studies are awaited http://bit.ly/1mZZsC

Vinegar addition during the cooking process may decrease lentil and chicken allergenicity http://bit.ly/1cqOQC

Subcutaneous allergen immunotherapy restores dendritic cell innate immune function http://bit.ly/YAcWI

Paracetamol might be a risk factor for the development of asthma http://bit.ly/4BPdL

Asthma associated with more sweating during exercise in boys, and ICS decrease the amount of sweating http://bit.ly/2E2SJT

Potential treatment for priapism (painful erections longer than 4 hours): adenosine deaminase used for SCID therapy http://bit.ly/1QgPUf

Treatment of psoriasis with etanercept is linked to suppression of IL-17 signaling http://bit.ly/1E3ssJ

Epicutaneous allergen administration as a novel method of allergen-specific immunotherapy, different approach from SCIT http://bit.ly/2CogxY

Asociation between antibiotic use in the first year of life and asthma, rhinoconjunctivitis, eczema at 6-7 years old http://bit.ly/2CZ0ZE

Allergy and Immunology News of the Day

2009-12-04T10:28:00.002-05:00

T Helper 17 Cells Promote Cytotoxic T Cell Activation in Tumor Immunity http://bit.ly/1I4XYC

Pertussis (Whooping Cough) Immunity May Last 30 Years or More http://bit.ly/18M8m1

The viral march: a connection between early life wheezing and subsequent asthma http://bit.ly/2oFgMw

Budesonide may decrease episodes of wheezing in infants/preschoolers with recurrent wheezing, independently of atopy http://bit.ly/1wNIqS

24 million in US have COPD, but only half know it. Follow NHLBI campaign at http://bit.ly/29IOOp

Beneficial effect of grass allergy immunotherapy tablet on rhinoconjunctivitis quality of life http://bit.ly/2aP0c4

RSS feeds of all Allergy and Immunology journals by the University of Wisconsin http://bit.ly/1QQpQg and http://bit.ly/4zxxdg -- (better view) http://bit.ly/4C9KeM

My list of allergists on Twitter - please reply to this tweet if you want to be included http://bit.ly/2QJLK7

Omalizumab-associated anaphylactic reactions

2009-12-04T04:20:00.004-05:00

The FDA reports for 2007-2008 were queried for new adverse reactions suspected to be due to omalizumab.

There were 85 cases with an anaphylaxis descriptor and additional 33 cases consistent with anaphylaxis (118 total).

32 reactions occurred after the first dose and 14 were after the second dose of omalizumab.

19 reactions occurred within 1 hour of omalizumab injection.

You can read our case description here: Anaphylactic Reaction to Omalizumab (Xolair) in a Patient with Severe Asthma.

References:

Omalizumab-associated anaphylactic reactions reported between January 2007 and June 2008. Lin RY, Rodriguez-Baez G, Bhargave GA. Ann Allergy Asthma Immunol. 2009 Nov;103(5):442-5.

Image source: Wikipedia, public domain.

Allergy and Immunology News of the Day

2009-12-03T10:26:00.002-05:00

Negative predictive value of PCN provocation isn't 100% but none of false negatives had a life-threatening reaction http://bit.ly/3xVAvD

Should common variable immunedeficiency (CVID) patients receive chemoprophylaxis for influenza? http://bit.ly/4coHdD - No good evidence.

High sensitization rate to food allergens in breastfed infants with atopic dermatitis. http://bit.ly/VYCNf

Differences in physicians' knowledge and attitudes toward the black box warning on long-acting beta-agonists http://bit.ly/hbpLU

Improved sleep after treatment of allergic rhinitis. http://bit.ly/2eDBVW

Atopic march is a useful paradigm to describe the clinically observed progression of atopy in certain children. http://bit.ly/8Vkub

Smoking cessation toolbox for allergists - tobacco use treatment 5 A's (ask, advise, assess, assist, and arrange) http://bit.ly/XX2KP

Homozygous mutations in the CARD9 gene are associated with chronic mucocutaneous candidiasis. Dysfunction of CARD9 impairs the innate signaling of dectin-1, an antifungal pattern-recognition receptor http://bit.ly/2JilD5

Cold-Induced Urticaria: Positive ice-cube test & early hive marking edge up cup filled with ice http://twitpic.com/nikxz via @MatthewBowdish

Allergy 2.0: Medical Web 2.0 Guidance Package http://bit.ly/4DouhA

Intranasal antihistamines as first-line treatment of allergic rhinitis

2009-12-03T06:22:00.000-05:00

Azelastine nasal spray, 0.1%, and olopatadine nasal spray, 0.6%, have rapid onsets of action, are well tolerated, and have clinical efficacy for treating allergic rhinitis that is equal or superior to oral second-generation antihistamines.

Both have a significant effect on nasal congestion. Azelastine is also approved for nonallergic rhinitis.

Medications for Allergic Rhinitis (click to enlarge the image).

Older data suggest that intranasal steroids have greater efficacy than nasal antihistamines but more recent comparisons in mild to moderate allergic rhinitis have shown equal or noninferior efficacy.

In addition, the combination of a nasal antihistamine and intranasal steroid may provide additive benefits in more severe rhinitis. Premixed antihistamine-steroid combinations may offer additional benefits in the treatment of mixed (AR/non-AR) rhinitis.

Azelastine. Image source: Wikipedia, public domain.

Olopatadine. Image source: Wikipedia, public domain.

This literature review supports current recommendations for nasal antihistamines as first-line therapy for allergic rhinitis.

References:

Azelastine and olopatadine in the treatment of allergic rhinitis. Kaliner MA. Ann Allergy Asthma Immunol. 2009 Nov;103(5):373-80.
Allergic Rhinitis: A Short Review
Mind Maps: Allergic Rhinitis
Mnemonics: Allergic Rhinitis
Image source: Wikipedia, a Creative Commons license.

Subcutaneous kallikrein inhibitor ecallantide (Kalbitor) approved for treatment of hereditary angioedema (HAE)

2009-12-02T11:50:00.003-05:00

What is HAE?

Between 8,000 and 10,000 people in the U.S. are affected by the most common form of HAE which is caused by an autosomal dominant mutation that decreases C1 inhibitor levels.

Plasma kallikrein plays a major role in the kallikrein-kinin cascade producing bradykinin. Bradykinin is a vasodilator, which increases vascular permeability, activates inflammation and produces pain.

Ecallantide (DX-88, Kalbitor)

Ecallantide (DX-88, Kalbitor) is a subcutaneous kallikrein inhibitor which was approved for treatment of hereditary angioedema (HAE) in patients 16 years of age and older on December 2, 2009.

New therapies for hereditary angioedema (HAE) (click to enlarge the image).

The drug is to be launched in the first quarter of 2010 and see an ex-U.S. partnership in the first half of next year. Kalbitor is the only approved treatment for life-threatening laryngeal attacks.

The drug's short half-life is the main reason for its suitability as a treatment for acute attacks only and not as a preventive therapy.

Kalbitor has a half-life of about two hours, while Cinryze has a half-life of about 56 hours and Berinert has about 22 hours.

Black-box warning

The labelling of the drug includes a black-box warning for possible allergic reactions which usually occur within 10 minutes of the injection. This means that the injections will typically be administered in a supervised setting (doctor's office) rather than by the patient at home.

As a condition of the FDA approval, Dyax is required to set up a risk management program to warn patients that Kalbitor can cause severe allergic reactions.

Other treatments of HAE

Cinryze is only approved as a preventive therapy.

Berinert was approved by the FDA in October 2009 for only acute abdominal and facial attacks of the disease.

References:

Dyax shrs soar after FDA approves genetic-disorder drug. Reuters.

Subcutaneous kallikrein inhibitor ecallantide as a treatment for hereditary angioedema (HAE)

FDA Approves Two New Drugs: BioBuzz. TheStreet.com.

Allergy and Immunology News of the Day

2009-12-02T10:22:00.002-05:00

People with difficult-to-control asthma are often not taking their anti-asthma medication as prescribed by their doctor. Even when prescribed high doses of inhaled steroids, 5% of adults with asthma remain difficult to control. Women were most apt to be lax in taking their asthma controller medication as prescribed. Among 51 asthma patients who were supposed to be using oral steroids, blood tests showed that 45% were nonadherent http://bit.ly/2Ak9ce -- Difficult asthma may be due to difficult patients http://is.gd/4zFka

Recombinant Major Cat Allergen, Fel d 1, becomes available for immunological investigations, diagnosis and treatment http://bit.ly/v0eac

New antihistamine bilastine 20 mg as effective as levocetirizine 5 mg for treatment of chronic idiopathic urticaria http://bit.ly/4bt89z

The Longest Wheal Diameter Is the Optimal Measurement for the Evaluation of Skin Prick Tests http://bit.ly/3SETBH

Allergy Treatment Pyramid http://bit.ly/AbFMQ

Anaphylaxis action plans http://bit.ly/3SBXWm and Food Allergy Action Plan http://bit.ly/5KryG

If you have asthma, be sure to get the injectable influenza vaccines, not the vaccine nasal spray - AAAAI http://bit.ly/4rQEEQ -- Live attenuated influenza vaccine (nasal spray) not recommended for patients with asthma - it can trigger exacerbation http://bit.ly/4rQEEQ

Sample online appointment form: http://bit.ly/3WcuiK

Dysphagia and anorexia/early satiety may distinguish eosinophilic esophagitis from GERD

2009-12-02T05:16:00.000-05:00

Eosinophilic esophagitis (EE) is difficult to distinguish clinically from other causes of esophagitis, especially gastroesophageal reflux disease (GERD).

A prospective study evaluated a symptom scoring tool in patients with EE and patients with GERD, allergic and nonallergic controls.

The total symptom score was higher among patients with EE and GERD.

Only dysphagia and anorexia/early satiety in EE patients helped discriminate EE from GERD. These symptoms also correlated with the severity of histologic and endoscopic findings.

The study authors concluded that dysphagia and anorexia/early satiety identify pediatric patients with EE and correlate symptoms with tissue inflammation.

References:

A symptom scoring tool for identifying pediatric patients with eosinophilic esophagitis and correlating symptoms with inflammation. Aceves SS, Newbury RO, Dohil MA, Bastian JF, Dohil R. Ann Allergy Asthma Immunol. 2009 Nov;103(5):401-6.

Eosinophilic Esophagitis: A Short Review
Mind Maps: Eosinophilic Esophagitis
Mnemonics: Eosinophilic Esophagitis

Image source: Eosinophilic esophagitis, Wikipedia, GNU Free Documentation License.

Allergy and Immunology News of the Day

2009-12-01T10:20:00.001-05:00

Prophylactic antipyretics at the time of vaccination may reduce antibody responses to several vaccine antigens http://bit.ly/BR3XR

FDA requests more information from Novartis prior to QAB149 (indacaterol) approval http://bit.ly/3w6bpH -- QAB149, indacaterol, the first once-daily LABA is already approved in Europe. Noavrtis to address FDA's dosing concerns http://bit.ly/3w6bpH

Omalizumab Highly Effective for Refractory Urticaria in Randomized Trial http://bit.ly/2KCtEX

ICS fluticasone decreases inflammation and FEV1 decline in COPD. Adding LABAs does not enhance these effects. http://bit.ly/1uK7Q4

How does a tick bite trigger a sudden allergy to meat? WaPost http://bit.ly/15CqtN

Belimumab (Benlysta) is a human monoclonal antibody that could become the first new drug for SLE in five decades http://bit.ly/4CSdAq -- Belimumab inhibits B-Lymphocyte stimulator (BLyS), also known as B cell activation factor of the TNF family (BAFF) http://bit.ly/C9aEz

It can happen: Methylprednisolone-induced anaphylaxis http://bit.ly/1Trki9

Eosinophilic panniculitis: a new form of local reaction with specific immunotherapy http://bit.ly/4ev0tC

Th17 immunity may be also involved in the pathogenesis of allergic asthma http://bit.ly/3fIX2s

Video: Be Safe from Anaphylaxis

2009-12-01T06:36:00.001-05:00

From Mayo Clinic:

"Every year up to two thousand people in the United States and Canada die from anaphylaxis -- a serious allergic reaction. The most common causes are allergies to peanuts, insect bites and seafood. But not all anaphylactic reactions are severe. They can be mild with subtler symptoms. And most people don't know that if you've had a mild reaction in the past, you're at risk of having a life threatening one in the future."

Allergy and Immunology News of the Day

2009-11-30T10:18:00.001-05:00

ICS/LABA in COPD increase risk of pneumonia by 63%, viral respiratory infections by 22%, oral fungal infections by 59%. ICS/LABA did not reduce overall death rates in COPD compared to LABA alone http://bit.ly/4sDzI9

Minority children less likely to take ICS for asthma, leading to more ER visits http://bit.ly/4jYelC

Subcutaneous heparin will induce skin lesions in about one in 13 patients, usually as a result of an allergic reaction http://bit.ly/VkKlb

Converting Advair to the equivalent Symbicort dosage - conversion table http://bit.ly/2fBQCr

Videos show T cells breaching the central nervous system's defences. http://bit.ly/EkC3N

Immunology flashcards http://bit.ly/2DanMh

CNN: "Are there any treatments for hyperthyroidism when patient is allergic to iodine?" http://bit.ly/3I2NSN - There's no true iodine allergy. "Asking a patient if he/she is "allergic to iodine" should be avoided because its significance is null" http://bit.ly/4Cu59e -- Allergic contact dermatitis from povidone-iodine: it is important to rule out false-positive patch test reactions http://bit.ly/20Y2Kf

Study tries to explain the relative immunity to H1N1 in people older than 60 http://bit.ly/3s2Kxg

Acetaminophen, the active ingredient in Tylenol, weakens infants' immune responses to vaccines http://bit.ly/4CzhTU

Food-Dependent Exercise-Induced Anaphylaxis (FDEIA)

2009-11-30T05:55:00.004-05:00

Food-dependent exercise-induced anaphylaxis (FDEIA) is a special form of food allergy where a food-intake alone does not induce any symptoms. Anaphylaxis occurs only when triggering factors such as exercise or aspirin-intake are added after ingestion of the causative food.

The most frequent causative food in FDEIA in Japan is wheat. Both exercise and aspirin-intake facilitate allergen absorption from the gastrointestinal tract.

80% of the patients with wheat-induced FDEIA have IgE reacting to omega-5 gliadin and the remaining of the patients to high molecular weight glutenin (HMW-glutenin).

References:
Food-Dependent Exercise-Induced Anaphylaxis-Importance of Omega-5 Gliadin and HMW-Glutenin as Causative Antigens for Wheat-Dependent Exercise-Induced Anaphylaxis. Morita E, Matsuo H, Chinuki Y, Takahashi H, Dahlström J, Tanaka A. Allergol Int. 2009 Oct 25;58(4).

Image source: OpenClipart.org, public domain.

Allergy and Immunology News of the Day

2009-11-26T10:12:00.002-05:00

Among children diagnosed with multiple allergic diseases there is a number of variants of 'the allergic march'. Eczema followed by asthma, which is in turn followed by rhinitis, is the most common trajectory of the allergic march http://bit.ly/GD7wK

Treating pregnant mothers, and then their infants, with probiotics may help prevent eczema in children http://bit.ly/XcTk4

Bee venom immunotherapy is effective in most patients immediately after the maintenance dose has been reached http://bit.ly/3so0zT

Researchers trying to create "mutant" allergens that one day may be used to treat allergy sufferers - WSJ http://bit.ly/SE6ml

Risk of Afib may double with systemic steroids taken for chronic diseases http://bit.ly/QCL1V

IgE-independent hypersensitivity mediated by immunoglobulin free light chains (FLCs) http://bit.ly/4lyCdU

An adverse reaction seemingly associated with a vaccine should not preclude receiving that same vaccine in the future http://bit.ly/Z1UwP

Kyle and family document their trip to The Hill where they lobby for laws to manage food allergies in school - CNN http://bit.ly/3fjVWA

Allergy and Immunology News of the Day

2009-11-25T10:10:00.002-05:00

Deficiency of circulating plasmacytoid dendritic cells (pDC) during infancy appears to be a risk factor for asthma. Infants with higher numbers of circulating plasmacytoid dendritic cells (pDC) appear "protected" against asthma http://bit.ly/2xUexA

The minimally important difference in Asthma Control Test (ACT) used for comparison between test samples is 3 points http://bit.ly/hv04A

Inhibition of IL-4–STAT6 might explain the mechanism of aspirin desensitization http://bit.ly/13A9v2

People who clean their homes with bleach are less likely to be atopic but more likely to have respiratory symptoms. http://bit.ly/nMAAj

Immunotherapy studies have demonstrated that a local reaction does not predict a systemic reaction. Local reactions to immunotherapy do not predict local reactions at the next immunotherapy injection. http://bit.ly/WYTgN

Factors associated with uncontrolled asthma were different in ICS users and non-ICS users. In ICS users: chronic cough/phlegm, female sex. Factors associated with uncontrolled asthma in non-ICS users: high total IgE and sensitization to molds http://bit.ly/unKon

There is a need for better designed sublingual immunotherapy (SLIT) clinical trials. Several unpublished oral and sublingual immunotherapy studies in the United States failed to meet primary endpoints. http://bit.ly/ttaIB

Environmental exposure chamber determines triggers in non-allergic rhinitis

2009-11-25T06:29:00.003-05:00

From MedPage Today:

In a study of 41 patients with non-allergic rhinitis exposed sequentially to a range of triggers, researchers found:

- 51% responded to cold dry air
- 70% reacted to a change from warm humid air to cold and dry air
- 47% responded to a two-hour exposure to ozone
- 32% responded to a 15-minute exposure to acetic acid, described as "smelling like a fish and chip shop"
- 43% responded to a potpourri fragrance

References:
ACAAI: New Method Tackles Nonallergic Rhinitis. Michael Smith, North American Correspondent, MedPage Today.

Allergy and Immunology News of the Day

2009-11-24T10:08:00.002-05:00

Being overweight, especially around the middle, linked to risk for developing asthma http://bit.ly/pEmSZ

Normal reference values for serum mast cell tryptase are 1-15 ng/mL, with an average of approximately 5 ng/mL http://bit.ly/cTSYL

Incidence of anaphylaxis has increased over the past few decades, lifetime prevalence is 0.05% to 2.0%. Higher incidence of pediatric anaphylaxis in northern areas of the United States http://bit.ly/3lxAhd

C1 esterase inhibitor 20 U/kg IV is effective, rapid and safe treatment for acute abdominal and facial attacks in HAE http://bit.ly/ag64n

IL-2, IL-6, IL-10, TNF receptor I, MCT, and histamine were significantly elevated in patients with severe anaphylaxis. Levels of IL-6, IL-10, TNF receptor I, MCT, and histamine correlated with hypotension in anaphylaxis http://bit.ly/vKHI

Lipid transfer protein (Ara h 9) as a new peanut allergen relevant for a Mediterranean allergic population http://bit.ly/mLA4m

Expression of CCR5 and CCR6 of Langerin-negative CD1a+ dendritic cells was characteristic for acute atopic dermatitis http://bit.ly/1QuOCo

A wasp in a sticky situation in Milton Keynes. http://bit.ly/4cBJTx

ACP has created a COPD Portal http://bit.ly/2X7jC

Adherence to allergen-specific immunotherapy is better for SLIT than SCIT

2009-11-24T06:59:00.001-05:00

Allergen-specific immunotherapy can modify the natural history of the allergic diseases, reducing the development of asthma and new sensitizations after 3-4 years of treatment. In order for immunoterapy to work however, adherence to the therapy is mandatory.

Rate of adherence to subcutaneous immunotherapy (SCIT) is low, at less than 70%. The possible explanations for that fact include the following factors:

- inconvenience
- lack of perceived efficacy
- costs and loss of working hours

In comparison, local nasal immunotherapy has a even lower adherence rate (27%), due to the local nasal side effects.

For sublingual immunotherapy (SLIT), the rates of compliance are greater than 75%.

The reasons for discontinuation of SLIT are:

- costs
- inconvenience
- feeling of inefficacy
- side effects

In real life, costs and patient education are crucial issues in adherence to this SCIT and SLIT. Reduction of costs and more efforts in education of patients may improve the adherence to immunotherapy.

References:
Evidence of adherence to allergen-specific immunotherapy. Senna G, Ridolo E, Calderon M, Lombardi C, Canonica GW, Passalacqua G. Curr Opin Allergy Clin Immunol. 2009 Dec;9(6):544-8.
Image source: OpenClipArt.org, public domain.

Allergy and Immunology News of the Day

2009-11-23T10:05:00.001-05:00

The Claim: With a Runny Nose, Green Calls for an Antibiotic. http://bit.ly/1gD5ka - Answer: Not really.

Arg16 genotype associated with exacerbations in asthmatic children and young adults exposed daily to beta(2)-agonists http://bit.ly/2lvW7A

Alarmin - Alarmin(g) news about danger - cells release high-mobility-group box (HMGB) proteins that signal tissue damage http://bit.ly/uw725

Mammalian target of rapamycin (mTOR) is a serine–threonine kinase that senses nutrition status to control cell growth http://bit.ly/BSgjs

Pulmonary alveolar proteinosis (PAP) is rare: accumulation of pulmonary surfactant, respiratory failure, infections. Pulmonary alveolar proteinosis is a primary immunodeficiency of impaired GM-CSF stimulation of macrophages http://bit.ly/WgJe9

Regulatory T Cells in Asthma: ability to enhance regulatory function may represent a treatment for asthma http://bit.ly/SwUlc

New research: Forkhead box transcription factor Foxo and the cycle of life and death http://bit.ly/r27nr

Properdin, a plasma component, is critical in the stabilization of alternative complement pathway convertases. Properdin is a pattern recognition molecule that binds to certain microbial surfaces, apoptotic and necrotic cells http://bit.ly/2lSfaY

Dogs are getting food allergies too http://bit.ly/iVOjM

Patients who are allergic to eggs may still receive the flu shot after an allergist evaluation

2009-11-23T06:23:00.000-05:00

From MedPage Today:

"Egg-allergic patients can get a flu shot if its egg protein content is 1.2 mcg/mL or less. It should, however, be given in graded doses -- an initial 10% of the full dose, then the remaining 90% a half-hour later if no reaction occurs.

Unlike MMR vaccine, which is made in chick embryo fibroblast cell cultures, influenza viruses are grown directly in eggs, so by the time it turns into the 'flu shot,' there is a little egg protein left over."

References:
ACAAI: Egg Allergy No Excuse for Skipping Flu Shot. Kristina Fiore, Staff Writer, MedPage Today.

Allergy and Immunology News of the Day

2009-11-22T09:58:00.003-05:00

Intralymphatic immunotherapy (ILIT) reduces the dose and the number of allergen injections http://bit.ly/QXzz9

Allergic disorders may be associated with microalbuminuria in men with type 2 diabetes. Blood eosinophil count is a better predictor of microalbuminuria than blood pressure, HbA1c, or duration of diabetes http://bit.ly/qeQN2

T cells require Foxo1 transcription factor to populate the peripheral lymphoid organs http://bit.ly/r5s26

Thymic stromal lymphopoietin (TSLP) is a critical mediator of IL-13-driven allergic inflammationhttp://bit.ly/4DzZvL

The occupant as a source of house dust bacteria: human-derived bacteria account for 69-88% of mattress dust samples http://bit.ly/10lJDF

Interleukin-33 – cytokine of dual function or novel alarmin? IL-33 is a ligand for the Th2-associated ST2 receptor http://bit.ly/kblld

New and Existing Therapeutic Options for Hand Eczema - Medscape Skin Therapy Letter http://bit.ly/rYzVx

Allergic rhinitis with negative skin tests: Does it exist? Is localized IgE-mediated allergy in play? http://bit.ly/FfKdF

Allergy and Immunology News of the Day

2009-11-21T09:54:00.002-05:00

Levalbuterol versus albuterol: no clinical superiority was proven http://bit.ly/1UzHLo

Registration for the 2010 ABAI exams starts January 1st via the web portal http://bit.ly/4ynXRS

High-dose SLIT with 5 grasses (Oralair Grasses) decreases rhinitis symptoms from the first month of treatment forward. Oralair Grasses by Stallergenes includes 5 grasses: orchard, meadow, perennial rye, sweet vernal and timothy http://bit.ly/soFU0

Unilateral Rhinorrhea in Allergic Rhinitis Due to... Cerebrospinal Fluid Leak http://bit.ly/3WycEP

Antismoking drug Chantix has been linked to suicide but a new study shows that such risk is nonexistent or small http://bit.ly/Pijaf

ABAI Board Review Course online http://bit.ly/cukSf and PDFs http://bit.ly/183QYt

100 Worst Cities for Fall Allergies http://bit.ly/2SrIir

RT @AllergyZoneCEO: "Projected 20% growth in out-patient visits in next 10 years. 500M will be eVisits. Can Twitter play a role?"

In children with a cough that lasts more than 8 weeks, the most likely causes are allergy (?), reflux, and asthma http://bit.ly/3vAk8B

Allergy and Immunology News of the Day

2009-11-20T09:52:00.001-05:00

Combined Immunodeficiency Associated with DOCK8 Mutations http://bit.ly/RzeJ3

Anaphylaxis after ingesting an omeprazole capsule - not due to omeprazole allergy but soybean oil hypersensitivity http://bit.ly/1hndk1

A diagnosis of soy allergy should not be overlooked in cases of drug hypersensitivity http://bit.ly/1hndk1

Large waist was associated with increased asthma prevalence even among women considered to have normal body weight http://bit.ly/ppaCW

Intal Inhaler (cromolyn sodium inhalation aerosol) is discontinued, the company has not found a HFA MDI manufacturer http://bit.ly/z1oBa

Urticaria pigmentosa on Flickr http://bit.ly/1jk23 via @MatthewBowdish

Mother of a boy with food allergy is fighting the city's decision that park officials can't use EpiPen in emergencies http://bit.ly/I94pe

Allergen rules may alter scents of great perfumes http://bit.ly/14kuFz

Contact dermatitis on Flickr: http://bit.ly/3AqI29

Subcutaneous kallikrein inhibitor ecallantide as a treatment for hereditary angioedema (HAE)

2009-11-20T06:35:00.001-05:00

From MedPage Today:

Between 8,000 and 10,000 people in the U.S. are affected by the most common form of HAE which is caused by an autosomal dominant mutation that decreases C1 inhibitor levels.

Plasma kallikrein plays a major role in the contact (kallikrein-kinin) cascade producing bradykinin. Bradykinin is a vasodilator, which increases vascular permeability, activates inflammation and produces pain.

New therapies for hereditary angioedema (HAE) (click to enlarge the image).

Ecallantide (DX-88) is a subcutaneous kallikrein inhibitor which is under investigation for treatment of hereditary angioedema (HAE).

In the clinical trials, the proportion of patients who said they had complete or near-complete resolution varied by attack site:

- For abdominal attacks, 65.2% of those on the drug reported such an outcome, compared with 31.7% for those on placebo (P=0.01).

- For laryngeal attacks, the comparable proportion were 60% versus 11.1% (P=0.03).

- For peripheral attacks, there was no significant difference within the first four hours.

However, the median times -- 67 minutes for the drug versus 105 minutes for placebo -- were not significantly different.

References:
ACAAI: HAE Drug Offers Faster Relief. Michael Smith, North American Correspondent, MedPage Today.
Ecallantide (DX-88), a plasma kallikrein inhibitor for the treatment of hereditary angioedema and the prevention of blood loss in on-pump cardiothoracic surgery. Lehmann A. Expert Opin Biol Ther. 2008 Aug;8(8):1187-99.