Allergy

Stream The genomic origins of asthma by BMJ talk medicine from desktop or your mobile device  

Asthma affects almost 20 million people in the United States and more than 300 million people worldwide. Of these, 10-15% have severe asthma, which is refractory to commonly available drugs. New drugs are needed because those that are currently available cannot control symptoms and exacerbations in all patients and can cause adverse reactions. In the past 10 years, there have been substantial advances in the understanding of asthma genetics, airway biology, and immune cell signaling. These advances have led to the development of small molecule therapeutics and biologic agents that may improve asthma care in the future. Several new classes of asthma drugs—including ultra long acting β agonists and modulators of the interleukin 4 (IL-4), IL-5, IL-13, and IL-17 pathways—have been evaluated in randomized controlled trials. Other new drug classes—including dissociated corticosteroids, CXC chemokine receptor 2 antagonists, toll-like receptor 9 agonists, and tyrosine kinase inhibitors—remain in earlier phases of development. Despite some preliminary efficacy data, there is insufficient evidence to make strong recommendations about the use of these newer agents. Future research on the clinical efficacy of these biologic agents, the effect of newer agents on severe asthma in pediatric patients, and the biology of non-eosinophilic and corticosteroid resistant asthma is needed to reduce the morbidity of asthma worldwide.  

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Stream Journal club: Lebrikizumab treatment in adults with asthma by BMJ talk medicine from desktop or your mobile device  

Stream Bronchi and the bugs: what kickstarts asthma by BMJ talk medicine from desktop or your mobile device  

Asthma is characterised by paroxysmal and reversible obstruction of the airways. It is increasingly understood as an inflammatory condition combined with bronchial hyper-responsiveness. Acute asthma involves:  

This document provides guidance for healthcare providers who are expected to deal with an anaphylactic reaction. It describes the recognition and treatment of an anaphylactic reaction including the delivery of drugs for treatment.  

In problematic cases of childhood asthma, rather than escalating treatment, a systematic approach is needed, including a review of the diagnosis; adherence, including ability to take drugs correctly; and the child’s environment  

In problematic cases of childhood asthma, rather than escalating treatment, a systematic approach is needed, including a review of the diagnosis; adherence, including ability to take drugs correctly; and the child’s environment  

In problematic cases of childhood asthma, rather than escalating treatment, a systematic approach is needed, including a review of the diagnosis; adherence, including ability to take drugs correctly; and the child’s environment  

A review of the adverse effects of fungal mycotoxins, allergic disorders triggered by fungal exposure (including ABPA), and the quackery and pseudoscience co...  

I heard that more people are being diagnosed with alleges, such as nut allergies. Is there any really understanding of why this is?  

The anesthetists loves magnesium. But when I asked of the mechanism from A&E consultants, I got replies that it is wonder drug, or not well understood. Anyone got a more comprehensive answer than that?  

First thing you do is increase the inhaled steroid dose, but then you can consider adding a theophylline, leukotriene receptor antagonist or B2 agonist. Is there any preference over which one to choose when, or do you literally pick one and see if it suits the patient, if not pick another?  

Many may be familiar with aspergillosis as the infecting agent in acute cases where the patient is severely immunocompromised - but there is more to this fungus' repertoire. There are rare cases where the patient's immune system is overwhelmed by a large inhalation of spores e.g. after gardening, but these are insignificant in terms of total numbers effected. The following are far more common:- Aspergillus and other fungi are increasingly identified as the active agent in sinusitis - if you have cases that don't respond to antibiotics this is worth thinking about. Chronic pulmonary aspergillosis (CPA & aspergilloma) is an infection of immunocompetent people, causing respiratory difficulty, coughing and haemoptysis. The UK NHS has a specialist centre for these patients In Manchester (National Aspergillosis Centre (NAC)). NAC has particular expertise and extensive facilities for the diagnosis of CPA, ABPA, SAFS and use of systemic antifungal drugs. Allergic infection (Allergic Bronchopulmonary Aspergillosis - ABPA and chronic sinusitis) is thought to be heavily underdiagnosed and undertreated. ABPA is particularly common in Asthma, Cystic Fibrosis patients and those with bronchiectasis. There is estimated to be 25 000 cases in the UK alone. Many (50%) of the most severe asthma cases are sensitive to fungi (SAFS) - in particular Aspergillus. These tend to be the most unstable cases that don't respond to antibiotics and several studies have been published that show giving an antifungal helps reduce the use of steroids for these patients. Last but not least - Tuberculosis is on the rise in the UK and the rest of the world. It is estimated that 2% of cases progress to CPA and should be treated using an antifungal - this is usually not done until considerable time has passed and much damage has been done. In total it is estimated that many millions of people across the world suffer from aspergillus - ABPA - 5 million, Tb - 400 000 per year and Asthma (SAFS - 1 - 4 million cases in EU & US). Sinusitis cases may number many tens of millions worldwide. So - the next time you assume aspergillus infections and aspergillosis are rare and confined to those who are profoundly immunocompromised - think again! If you have a patient who has increasingly severe respiratory symptoms, doesn't respond to multiple courses of antibiotics then give aspergillus a thought. Browse around these articles for further information Aspergillus Website Treatment Section. NB For a broader look at the prevalence of fungal diseases worldwide the new charity Leading International Fungal Education (LIFE) website is worth looking at.  

A boy with no previous allergies suddenly found himself allergic to nuts and fish after receiving a blood transfusion for a medical condition.  

In problematic cases of childhood asthma, rather than escalating treatment, a systematic approach is needed, including a review of the diagnosis; adherence, including ability to take drugs correctly; and the child’s environment  

In problematic cases of childhood asthma, rather than escalating treatment, a systematic approach is needed, including a review of the diagnosis; adherence, including ability to take drugs correctly; and the child’s environment  

Dr. Gerald Lee is an Assistant Professor on faculty at the University of Louisville. He is the Division Chief of both the adult and pediatrics department of ...  

http://usmlefasttrack.com/?p=6084 Asthma, Drugs, -, Omalizumab, Findings, symptoms, findings, causes, mnemonics, review, what is, video, study, Rapid Review,...