Comparative evaluation of nasal blood flow and airflow in the decongestant response to oxymetazoline.
Ann Allergy Asthma Immunol. 2012 Feb;108(2):77-80
Authors: Vaidyanathan S, Williamson P, Lipworth B
Abstract
BACKGROUND: Nasal blood flow (NBF) plays a crucial role in many physiological and pathological processes but its regulation and relation to other rhinological outcomes is poorly understood.
OBJECTIVES: We measured nasal airway patency, nasal blood flow, and subjective and objective measures of decongestion and assessed their reproducibility and responsiveness.
METHODS: 19 healthy adults attended twice. A dose-response curve was constructed using doubling doses of oxymetazoline of 25μg, 50μg, 100μg, and 200μg at 20 minute intervals. Peak nasal inspiratory flow (PNIF) and nasal airway resistance (NAR) were measured at baseline and after each successive dose, NBF using laser Doppler flowmetry at baseline, 50 μg and 200 μg and a decongestion visual analogue scale after the final dose.
RESULTS: After the final dose of oxymetazoline, NBF decreased by a mean (95% CI, P value) of 139.6 (108.3-170.8, P < .001) units and 99.4 (68.1-130.7, P < .001) units, PNIF increased by 48.9 (22.0-75.8, P < .001) L.min-1 and 38.9 (12.0-65.8, P = .003) L.min-1, and NAR decreased by 0.1 (0.02-0.15, P < .001) Pa/s/cm(3) and 0.09 (0.02-0.15, P = .002) Pa.s.cm-3 at the first and second visits respectively. The area under the curve of decongestion was not significantly different between visits for each variable. The standardized response means for the decongestant response were as follows: NBF, 1.41; PNIF, 1.03; and NAR, 0.97.
CONCLUSIONS: Nasal blood flow using laser Doppler flowmetry is a sensitive and reproducible outcome to decongestion with oxymetazoline, similar to nasal patency and symptoms.
Evaluation of the National Heart, Lung, and Blood Institute guidelines impairment domain for classifying asthma control and predicting asthma exacerbations.
Ann Allergy Asthma Immunol. 2012 Feb;108(2):81-87.e3
Authors: Zeiger RS, Yegin A, Simons FE, Haselkorn T, Rasouliyan L, Szefler SJ, Chipps BE,
Abstract
BACKGROUND: Accurate assessment of asthma control may help predict future asthma exacerbations.
OBJECTIVE: To evaluate asthma guidelines impairment domain components as predictors of exacerbations in severe/difficult-to-treat asthma.
METHODS: Children (aged 6-11 years; n = 289) and adolescents/adults (aged ≥12 years; n = 2,094) with complete baseline and 12-month data from The Epidemiology and Natural History of Asthma Outcomes and Treatment Regimens study were included. Asthma was categorized as very poorly controlled, not well-controlled, and well-controlled using impairment domain components. Effects of omitting each component on very poorly controlled and not well controlled groups were examined. Multivariable logistic regression determined the relationship of components in predicting asthma exacerbations.
RESULTS: Omission of individual impairment domain components led to misclassification of asthma control in 11% to 39% of patients. A baseline exacerbation was the strongest independent predictor of exacerbation at month 12 in children (odds ratio = 2.94; P < .001) and adolescents/adults (odds ratio = 2.93; P < .001). In children, very poorly controlled asthma-based short-acting β2-agonist use was associated with a 2-fold higher exacerbation risk (odds ratio = 2.03; P = .011). In adolescents/adults, not well controlled or very poorly controlled asthma based on short-acting β2-agonist use (odds ratio = 1.49), lung function (odds ratio = 1.66), and the Asthma Therapy Assessment Questionnaire (odds ratio = 1.94) were also independent predictors of exacerbations (P < .001).
CONCLUSIONS: Although the combined use of individual components of the impairment domain increases the sensitivity of identifying patients at high risk for future asthma exacerbations, specific components may be more important than others in severe/difficult-to-treat asthma. Prior exacerbations, short-acting β2-agonist use, lung function, and (in adolescents/adults) the Asthma Therapy Assessment Questionnaire were independent predictors of exacerbations.
Multiple drug intolerance syndrome: prevalence, clinical characteristics, and management.
Ann Allergy Asthma Immunol. 2012 Feb;108(2):88-93
Authors: Macy E, Ho NJ
Abstract
BACKGROUND: Population-based data on the demographics and clinical characteristics of patients with multiple unrelated drug class intolerances noted in their medical records are lacking.
OBJECTIVES: To provide population-based drug “allergy” incidence rates and prevalence, and to identify individuals with multiple drug intolerance syndrome (MDIS) defined by 3 or more unrelated drug class “allergies,” and to provide demographic and clinical information on MDIS cases.
METHODS: Electronic medical record data from 2,375,424 Kaiser Permanente Southern California health plan members who had a health care visit and at least 11 months of health care coverage during 2009 were reviewed. Population-based drug “allergy” incidence rates and prevalence were determined for 23 unrelated medication classes.
RESULTS: On January 1, 2009, 478,283 (20.1%) health plan members had at least one reported “allergy.” Individuals with a history of at least 1 “allergy” and females, in general, reported higher population-based new “allergy” incidence rates. Multiple drug intolerance syndrome was present in 49,582 (2.1%). The MDIS cases were significantly older, 62.4 ± 16.1 years; heavier, body mass index 29.3 ± 7.1; and likely to be female, 84.9%, compared with average health plan members. They had high rates of health care utilization, medication usage, and new drug “allergy” incidence. They sought medical attention for common nonmorbid conditions.
CONCLUSIONS: Multiple drug intolerance syndrome is in part iatrogenic. It is associated with overweight elderly women who have high rates of health care and medication usage. Urticarial syndromes only explain a small fraction of MDIS cases. Multiple drug intolerance syndrome is associated with anxiety, but not predominately with immunoglobulin E (IgE)-mediated allergy or life-threatening illness. Multiple drug intolerance syndrome can be managed by medication avoidance and judicious rechallenge.
Analysis of available diagnostic tests for latex sensitization in an at-risk population.
Ann Allergy Asthma Immunol. 2012 Feb;108(2):94-7
Authors: Accetta Pedersen DJ, Klancnik M, Elms N, Wang ML, Hoffmann RG, Kurup VP, Kelly KJ
Abstract
BACKGROUND: Lack of a Food and Drug Administration (FDA)-approved skin testing reagent for latex allergy in the United States requires reliance on patient history and serologic assays for diagnosis.
OBJECTIVE: To determine the diagnostic sensitivity, specificity, and predictive values of an FDA-cleared antilatex IgE serology test and an enzyme-linked immunosorbent assay (ELISA) with various sources of latex protein antigens in an at-risk but unselected population of health care workers.
METHODS: Health care workers underwent duplicate latex and serologic testing for latex specific IgE with the CAP assay and ELISA from June 1, 1998, through December 31, 2002. Logistic regression with receiver operating characteristic curve analysis determined the values, resulting in 98% and 99% specificity for the CAP assay and ELISA, respectively.
RESULTS: Results of paired skin and serologic tests were available for 792 participants. Forty duplicate skin test results (5%) were positive. For the CAP assay, sensitivity was 35%; specificity, 98%; positive predictive value, 48.3%; and negative predictive value, 96.6%. ELISA demonstrated similar results. Multivariable logistic regression yielding a 98% or 99% specificity for the various ELISAs demonstrated that the adjusted odds of a positive skin test result significantly increased with positive CAP assay and ELISA results using a powdered glove extract.
CONCLUSIONS: The performance of the FDA-cleared antilatex IgE serologic test for latex allergy has much lower sensitivity than previously reported. This finding confirms that this serologic test should be used only for patients with a history of latex allergy and not for screening the population with a low prevalence of latex sensitization.
Cost, utilization, and patterns of medication use associated with chronic idiopathic urticaria.
Ann Allergy Asthma Immunol. 2012 Feb;108(2):98-102
Authors: Zazzali JL, Broder MS, Chang E, Chiu MW, Hogan DJ
Abstract
BACKGROUND: The literature on chronic idiopathic urticaria (CIU) lacks large-scale population-based studies.
OBJECTIVE: To characterize an insured population with CIU, including their demographic characteristics and comorbidities.
METHODS: We conducted a cross-sectional analysis using insurance claims. We included patients with 1 outpatient claim with an International Classification of Diseases, 9(th)Edition, Clinical Modification (ICD-9-CM) code for idiopathic, other specified, or unspecified urticaria (ICD-9-CM 708.1, 708.8, or 708.9) and either (1) another of these claims 6 or more weeks later; (2) a claim for angioedema (ICD-9-CM 995.1) 6 or more weeks from the urticaria diagnosis; or (3) overlapping claims for 2 prescription medications commonly used for CIU.
RESULTS: We identified 6,019 patients who had claims consistent with CIU. The mean age was 36 years. Fifty-six percent of patients had primary care physicians as their usual source of care, 14% had allergists, and 5% had dermatologists. Allergic rhinitis was diagnosed in 48%, asthma in 21%, other allergy in 19%, and atopic dermatitis in 8%. Sixty-seven percent of patients used prescription antihistamines, 54% used oral corticosteroids (OCSs), 24% used montelukast, and 9% used oral doxepin. Antihistamine users received a mean of 152 days of prescription antihistamines, OCS users 30 days of OCSs, montelukast users 190 days of montelukast, and oral doxepin users 94 days of doxepin.
CONCLUSIONS: Primary care physicians managed most patients with CIU. Antihistamines were the most common treatment for CIU, although OCSs were frequently prescribed. Thirty days of OCS supply among users may represent multiple steroid bursts each year. Given the known risks of OCSs, identifying other CIU treatments with more favorable safety profiles may be beneficial.
Influence of Orai1 intervention on mouse airway epithelium reactions in vivo and in vitro.
Ann Allergy Asthma Immunol. 2012 Feb;108(2):103-112.e1
Authors: Lin L, Zhao X, Yan W, Qi W
Abstract
BACKGROUND: Orai1 is crucial for store-operated Ca2(+) entry and Ca2(+) release-activated Ca2(+) channel activities. However, little is known about its function in allergic diseases.
OBJECTIVE: To assess the influence of Orai1 intervention on mouse airway epithelium reactions in vivo and in vitro.
METHODS: We used immunohistochemical staining, enzyme-linked immunosorbent assay, and real-time reverse transcription-polymerase chain reaction to evaluate Orai1 expression in nasal and tracheal mucosa epithelium of nonsensitized, control, and 2-aminoethoxydiphenyl borate (2-APB)-treated groups in vivo and in vitro. In addition, we analyzed concentrations of interleukin 1β, interleukin 6, macrophage inflammatory protein 2, and tumor necrosis factor α in nasal lavage fluid, bronchoalveolar lavage fluid, and culture supernatant and their messenger RNAs in nasal and tracheal mucosa and cultured nasal and tracheal epithelium.
RESULTS: Administration of 2-APB into the nostrils suppressed Orai1 expression in nasal and tracheal mucosa of treated mice compared with that in control mice and restrained the mediators in nasal lavage fluid, bronchoalveolar lavage fluid, and airway mucosa of treated groups compared with those in control groups. Similarly, the 2-APB intervention also alleviated Orai1 and the production of the mediators in culture supernatant and cultured airway epithelium under allergic conditions.
CONCLUSIONS: Our results indicate that 2-APB could effectively ameliorate reactions of upper and lower airway epithelial cells in mice in allergic states in vivo and in vitro.
Plant chitinase III Ziz m 1 stimulates multiple cytokines, most predominantly interleukin-13, from peripheral blood mononuclear cells of latex-fruit allergic patients.
Ann Allergy Asthma Immunol. 2012 Feb;108(2):113-6
Authors: Lee MF, Lin SJ, Wang NM, Wu HJ, Chen YH
Abstract
BACKGROUND: Indian jujube is a fruit abundantly cultivated in Taiwan. Its major allergen in latex-fruit syndrome is Ziz m 1 of the chitinase III family. The Ziz m 1 Pichia (rZiz m 1-P) has chitinase activity but not Ziz m 1 E. coli (rZiz m 1-E).
OBJECTIVE: This study examined whether plant chitinase III, using rZiz m 1-P and rZiz m 1-E, can stimulate allergic inflammation similar to that of mammalian chitinases.
METHODS: Five patients allergic to latex-Indian jujube and five nonallergic controls were evaluated. Their peripheral blood mononuclear cells (PBMC) were cultured with rZiz m 1-E or rZiz m 1-P and pulsed with phorbol 12-myristate 13-acetate. Eleven cytokines were measured by FlowCytomix human Th1/Th2 plex kit and interleukin (IL)-13 by sandwich enzyme-linked immunosorbent assay (ELISA).
RESULTS: Interleukin-13 significantly increased in rZiz m 1-P stimulated PBMC of allergic subjects but was undetectable when stimulated with rZiz m 1-E. The stimulation index significantly increased in IL-13 (380.6 ± 77.33 vs 13.70 ± 6.92), IL-5 (6.70 ± 0.59 vs 0.70 ± 0.37), IL-1β (32.70 ± 0.83 vs 2.10 ± 1.29), and tumor necrosis factor beta (TNF-β) (17.10 ± 2.66 vs 1.50 ± 0.66) between allergic and nonallergic subjects after rZiz m 1-P stimulation. There was no difference in terms of IL-2, IFN-γ, IL-8, and TNF-α production.
CONCLUSIONS: The biological function of chitinase activity is required for Ziz m 1 to induce a Th2-specific immune response. This is the first report on PBMC responses of latex-fruit syndrome subjects toward an active exogenous plant class III chitinase that can stimulate multiple cytokines, especially IL-13, from allergic subjects. This implies the role of cross-reactive food allergens in propagating allergic inflammation among allergic subjects.
Anti-inflammatory effects of sacran, a novel polysaccharide from Aphanothece sacrum, on 2,4,6-trinitrochlorobenzene-induced allergic dermatitis in vivo.
Ann Allergy Asthma Immunol. 2012 Feb;108(2):117-122.e2
Authors: Ngatu NR, Okajima MK, Yokogawa M, Hirota R, Eitoku M, Muzembo BA, Dumavibhat N, Takaishi M, Sano S, Kaneko T, Tanaka T, Nakamura H, Suganuma N
Abstract
BACKGROUND: Sacran is a newly discovered sulfated polysaccharide extracted from an algae, Aphanothece sacrum, grown in a river of the Kyushu region in Japan.
OBJECTIVE: To evaluate sacran’s inhibitory effect in 2,4,6-trinitrochlorobenzene (TNCB)-induced allergic dermatitis in NC/Nga mice.
METHODS: Sacran was extracted by acid and alkaline treatment of A sacrum cyanobacterial biomaterials. To sensitize mice, 150 μL of 5% TNCB was applied epicutaneously on the abdomen of each mouse on day 1 and challenged with 15 μL of 1% TNCB applied on the ear skin of mice on day 8 and then every other day to induce skin lesions. Serum levels of inflammatory markers were measured and histopathologic examination of ear skin specimens performed. On the other hand, sacran’s transepidermal water loss was evaluated in 11 volunteer women with dry skin.
RESULTS: Epicutaneous application of sacran in mice has significantly inhibited the development of allergic dermatitis skin lesions and reduced the number of scratching behavior episodes (P < .01). In addition, sacran efficiently inhibited IgE (P < .001), tumor necrosis factor α (P = .02), interleukin 4, interleukin 5, and interferon γ (P < .01; vs buffer in the TNCB group) production and eosinophilic infiltration in the chemical allergen-exposed ear skin. In addition, sacran-treated body regions of human volunteers with dry skin significantly reduced transepidermal water loss levels compared with exogenous hyaluronic acid (P < .01), which is known to improve skin moisture and exert skin barrier repair activity.
CONCLUSIONS: This study suggests that sacran exerts anti-inflammatory effects by improving skin barrier function and reducing T(H)2 cytokine production.
PMID: 22289731 [PubMed - in process]
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