This educational material from Juan Carlos Aldave Becerra aims to provide updated knowledge for allergy/immunology physicians. It discusses recent studies on various topics: the potential relationship between allergic rhinitis and erectile dysfunction; the role of extracellular DNA traps in allergic, infectious and autoimmune diseases; and the identification of galactose-α-1,3-galactose in ticks which may be related to red meat allergy. It also reviews several other recent articles on topics like food allergy, drug allergy, asthma treatments and immunodeficiencies. The author welcomes any feedback to improve the educational value.
Pearls in Allergy and Immunology, December 2013Juan Aldave
The purpose of this summary is exclusively educational, to provide practical updated knowledge for Allergy/Immunology Physicians. It does not intend to replace the clinical criteria of the physician.
- A study of 204 patients with delayed hypersensitivity to penicillins found that all patients tolerated drug challenges with carbapenems, suggesting an absence of cross-reactivity. Skin tests and graded challenges are still advised for patients needing carbapenems who experienced severe penicillin reactions.
- Anaphylaxis is an acute severe allergic reaction potentially fatal. Most common triggers are foods, drugs, insects. Factors influencing severity include pathogenic mechanism, allergen properties, dose, route of exposure, sensitization level.
Pearls in Allergy and Immunology - May 2014Juan Aldave
This document provides an overview of recent literature on drug allergies and hypersensitivity reactions. It discusses the definition and classification of drug hypersensitivity reactions based on symptoms, timing and pathogenic mechanisms. Drug hypersensitivity reactions can be either immune-mediated (allergic) involving specific antibodies or T cells against the drug, or non-immune mediated involving non-allergic mechanisms like nonspecific mast cell activation. The document also discusses pathogenic mechanisms for different types of drug allergies classified from type I to type IV, as well as mechanisms of immune activation against drugs like the hapten concept.
Pearls in Allergy and Immunology, March 2014Juan Aldave
The document summarizes a systematic review on the acute and long-term management of food allergy. Key points include:
- Food allergy can be IgE-mediated, non-IgE mediated, or both IgE- and cell-mediated. The most common allergenic foods are milk, egg, peanut, tree nuts, wheat, soy, and seafood.
- Diagnosis involves skin prick tests, in vitro IgE tests, and food challenges. Treatment focuses on avoidance, epinephrine autoinjectors, and monitoring for tolerance development.
- The review found weak evidence that antihistamines may help non-life threatening reactions and mast cell stabilizers may reduce symptoms. Extensively hydro
Pearls in Allergy and Immunology - August 2014Juan Aldave
The document summarizes recent guidelines on anaphylaxis from the European Academy of Allergy and Clinical Immunology. It discusses:
1) The definition, prevalence, mechanisms, common triggers, factors influencing severity, diagnosis and treatment of anaphylaxis.
2) The mechanisms of action of epinephrine and its role as first-line treatment.
3) Common cofactors ("augmentation factors") that can lower the threshold for anaphylaxis, including physical exercise, alcohol, infections, NSAIDs and certain drugs.
Pearls in Allergy and Immunology - July 2014Juan Aldave
The purpose of the document is to provide educational material for Allergy/Immunology physicians. It summarizes several recent journal articles on topics related to allergy and immunology. Specifically, it discusses that allergic rhinitis is a risk factor for decreased traffic safety due to impaired cognitive and psychomotor functions. It also summarizes articles on differences in IgE sensitization patterns between atopic dermatitis and other hyper-IgE syndromes. Additionally, it discusses the efficacy of IgE-targeted versus empirical elimination diets for eosinophilic esophagitis.
Pears in Allergy and Immunology, April 2014Juan Aldave
The document provides an educational summary of recent articles in allergy and immunology from April 2014. It includes summaries of articles on:
1) A position paper on work-related chronic cough that describes its causes, diagnosis, and management depending on etiology. Common causes include work-related asthma, rhinosinusitis, and COPD.
2) A review on the roles of histamine in the gut, including its pro-inflammatory and anti-inflammatory effects depending on receptor activation, and metabolism by diamine oxidase and histamine-N-methyltransferase.
3) A potential novel mechanism of allergen-specific desensitization involving IgG-mediated down-regulation of IgE bound to mast cells
Pearls in Allergy and Immunology - June 2014Juan Aldave
The document provides an overview of recent literature on allergic diseases and immunology from the journal Allergy in June 2014. It summarizes several articles, including on the classification, diagnosis and treatment of angioedema, guidelines on the primary prevention of food allergy, a global survey on the classification and coding of hypersensitivity diseases, and gaps in evidence around factors that may influence the development of food allergies. The purpose is to provide updated practical knowledge for physicians in allergy and immunology.
Pearls in Allergy and Immunology - February 2014 Juan Aldave
The document summarizes recent literature on allergic diseases from the journal Allergy and Annals of Allergy, Asthma and Immunology. It discusses topics such as atopic dermatitis, the atopic march, food allergy epidemiology and diagnosis, asthma phenotypes, new therapies for atopic dermatitis and allergic asthma, and the role of filaggrin mutations and phospholipids in omalizumab treatment efficacy for atopic dermatitis. The purpose is to provide updated knowledge for allergy/immunology physicians, though it does not replace clinical judgment. Any corrections or suggestions should be sent directly to the author.
Pearls in Allergy and Immunology, December 2013Juan Aldave
The purpose of this summary is exclusively educational, to provide practical updated knowledge for Allergy/Immunology Physicians. It does not intend to replace the clinical criteria of the physician.
- A study of 204 patients with delayed hypersensitivity to penicillins found that all patients tolerated drug challenges with carbapenems, suggesting an absence of cross-reactivity. Skin tests and graded challenges are still advised for patients needing carbapenems who experienced severe penicillin reactions.
- Anaphylaxis is an acute severe allergic reaction potentially fatal. Most common triggers are foods, drugs, insects. Factors influencing severity include pathogenic mechanism, allergen properties, dose, route of exposure, sensitization level.
Pearls in Allergy and Immunology - May 2014Juan Aldave
This document provides an overview of recent literature on drug allergies and hypersensitivity reactions. It discusses the definition and classification of drug hypersensitivity reactions based on symptoms, timing and pathogenic mechanisms. Drug hypersensitivity reactions can be either immune-mediated (allergic) involving specific antibodies or T cells against the drug, or non-immune mediated involving non-allergic mechanisms like nonspecific mast cell activation. The document also discusses pathogenic mechanisms for different types of drug allergies classified from type I to type IV, as well as mechanisms of immune activation against drugs like the hapten concept.
Pearls in Allergy and Immunology, March 2014Juan Aldave
The document summarizes a systematic review on the acute and long-term management of food allergy. Key points include:
- Food allergy can be IgE-mediated, non-IgE mediated, or both IgE- and cell-mediated. The most common allergenic foods are milk, egg, peanut, tree nuts, wheat, soy, and seafood.
- Diagnosis involves skin prick tests, in vitro IgE tests, and food challenges. Treatment focuses on avoidance, epinephrine autoinjectors, and monitoring for tolerance development.
- The review found weak evidence that antihistamines may help non-life threatening reactions and mast cell stabilizers may reduce symptoms. Extensively hydro
Pearls in Allergy and Immunology - August 2014Juan Aldave
The document summarizes recent guidelines on anaphylaxis from the European Academy of Allergy and Clinical Immunology. It discusses:
1) The definition, prevalence, mechanisms, common triggers, factors influencing severity, diagnosis and treatment of anaphylaxis.
2) The mechanisms of action of epinephrine and its role as first-line treatment.
3) Common cofactors ("augmentation factors") that can lower the threshold for anaphylaxis, including physical exercise, alcohol, infections, NSAIDs and certain drugs.
Pearls in Allergy and Immunology - July 2014Juan Aldave
The purpose of the document is to provide educational material for Allergy/Immunology physicians. It summarizes several recent journal articles on topics related to allergy and immunology. Specifically, it discusses that allergic rhinitis is a risk factor for decreased traffic safety due to impaired cognitive and psychomotor functions. It also summarizes articles on differences in IgE sensitization patterns between atopic dermatitis and other hyper-IgE syndromes. Additionally, it discusses the efficacy of IgE-targeted versus empirical elimination diets for eosinophilic esophagitis.
Pears in Allergy and Immunology, April 2014Juan Aldave
The document provides an educational summary of recent articles in allergy and immunology from April 2014. It includes summaries of articles on:
1) A position paper on work-related chronic cough that describes its causes, diagnosis, and management depending on etiology. Common causes include work-related asthma, rhinosinusitis, and COPD.
2) A review on the roles of histamine in the gut, including its pro-inflammatory and anti-inflammatory effects depending on receptor activation, and metabolism by diamine oxidase and histamine-N-methyltransferase.
3) A potential novel mechanism of allergen-specific desensitization involving IgG-mediated down-regulation of IgE bound to mast cells
Pearls in Allergy and Immunology - June 2014Juan Aldave
The document provides an overview of recent literature on allergic diseases and immunology from the journal Allergy in June 2014. It summarizes several articles, including on the classification, diagnosis and treatment of angioedema, guidelines on the primary prevention of food allergy, a global survey on the classification and coding of hypersensitivity diseases, and gaps in evidence around factors that may influence the development of food allergies. The purpose is to provide updated practical knowledge for physicians in allergy and immunology.
Pearls in Allergy and Immunology - February 2014 Juan Aldave
The document summarizes recent literature on allergic diseases from the journal Allergy and Annals of Allergy, Asthma and Immunology. It discusses topics such as atopic dermatitis, the atopic march, food allergy epidemiology and diagnosis, asthma phenotypes, new therapies for atopic dermatitis and allergic asthma, and the role of filaggrin mutations and phospholipids in omalizumab treatment efficacy for atopic dermatitis. The purpose is to provide updated knowledge for allergy/immunology physicians, though it does not replace clinical judgment. Any corrections or suggestions should be sent directly to the author.
2013 August - Pearls in Allergy and ImmunologyJuan Aldave
This summary discusses two articles from the Annals of Allergy, Asthma & Immunology. The first article reports a case of relapsing polychondritis, an immune-mediated cartilage inflammation, in a patient who also had hypogammaglobulinemia of unknown origin. The patient's polychondritis significantly improved with corticosteroids and methotrexate. The second article reviews advances in the diagnosis and management of insect sting allergy, noting epidemiology, risk stratification of patients, diagnostic tests and their limitations, and novel diagnostic approaches such as basophil activation testing.
Pearls in Allergy and Immunology October 2013Juan Aldave
This article discusses cofactors that can lower the threshold for anaphylaxis in sensitized individuals. Common cofactors include physical exercise, alcohol, infections, NSAIDs, and certain drugs. Mechanisms by which cofactors can induce anaphylaxis include increasing allergen absorption, lowering the activation threshold of mast cells and basophils, increasing leukotriene synthesis, and stimulating the immune system during infections. Understanding cofactors is important for managing anaphylaxis risk.
This document provides a summary of recent publications in allergy and immunology. It discusses the results of studies on the effects of acupuncture for allergic rhinitis, the lack of correlation between blood and airway eosinophil counts in children with severe asthma, and new insights into eosinophil-derived cytokines and their selective secretion. The purpose is to provide updated practical knowledge for allergy/immunology physicians.
The document provides an educational summary of recent literature on allergy and immunology for physicians. It includes brief summaries of multiple journal articles on topics like drug allergy diagnosis, anaphylaxis, asthma, food allergy, primary immunodeficiencies, and more. The purpose is stated as being exclusively educational to provide practical knowledge for physicians, while not replacing clinical judgment. Contact information is provided for the author in case of questions.
Pearls in Allergy and Immunology, January 2014Juan Aldave
The purpose of this educational material is to provide updated knowledge for Allergy/Immunology Physicians. It summarizes recent articles from peer-reviewed journals. If there are any corrections needed, they should be sent directly to the authors by email.
The document summarizes several articles from recent issues of peer-reviewed journals, including:
1) A case report of anaphylaxis induced by streptomycin skin testing, highlighting the risks of systemic reactions from skin testing.
2) An overview of aspirin-exacerbated respiratory disease and approaches to aspirin desensitization, which can effectively improve asthma and sinusitis outcomes.
3) A discussion of the low adherence rates to asthma
2013 July - Pearls in Allergy and ImmunologyJuan Aldave
The document provides a summary of recent literature on allergy and immunology. It discusses several topics:
1) A consensus report that recommends the term "allergen immunotherapy" to describe therapy of allergic diseases with allergen-containing products.
2) Research on eosinophils and their role in allergic inflammation, including potential new treatment targets.
3) A position paper on desensitization for patients with delayed drug hypersensitivity reactions.
4) A study finding frequent sensitization to Candida albicans and profilins in adult eosinophilic esophagitis patients.
The purpose is to provide updated practical knowledge for physicians, though it does not replace clinical judgment
The document provides an educational summary of recent literature on allergies and clinical immunology. It includes summaries of several articles: 1) "Basophils Unlimited" describes a new method for generating large quantities of mouse basophils for research; 2) "Dog Saliva" shows that dog saliva contains more diverse allergenic proteins than dander and may improve diagnostics; 3) An EAACI position paper analyzes the quality and standardization of skin prick testing solutions for occupational allergies. The summary also briefly outlines additional articles on basophil functions, the impact of intranasal corticosteroids on asthma outcomes in patients with allergic rhinitis, and low-dose aspirin desensitization
2013 june Pearls in Allergy and Clinical ImmunologyJuan Aldave
This document provides a summary of recent literature on allergy and immunology. It discusses several topics, including adherence to immunotherapy during financial crises, allergic reactions after immunization, and diagnosing gelatin allergy following vaccine reactions. The purpose is exclusively educational to provide updated knowledge for physicians, and does not replace clinical judgment. Suggestions to improve the content are welcome.
This document provides a summary of recent literature on allergic diseases from the journal Allergy in January 2013. It includes the following key points:
- A study found that uncontrolled asthma and nasal congestion are independent risk factors for insomnia.
- Studies showed that sublingual grass tablet immunotherapy had similar efficacy and safety in both mono- and polysensitized individuals with grass pollen allergy.
- A study found that higher maternal vitamin D levels during pregnancy were associated with increased risk of food allergy in children in the first 2 years of life.
- Mechanisms of peripheral tolerance to allergens were summarized, including the roles of regulatory T cells, dendritic cells, cytokines, and cell surface
1) The document discusses X-linked agammaglobulinemia, a primary immunodeficiency characterized by severe hypogammaglobulinemia and antibody deficiency.
2) It is caused by mutations in the BTK gene which result in arrested B cell development and absence of mature B cells.
3) Clinical manifestations include recurrent bacterial infections, particularly of the respiratory and gastrointestinal tracts, beginning in infancy. Chronic lung disease can develop if not treated.
FPIAP is a non-IgE mediated gastrointestinal food allergy that is the mildest form. It is characterized by the presence of blood and sometimes mucus in the stools of otherwise healthy infants. It affects infants under 6 months of age, with symptoms appearing between 2-8 weeks of life. The most common triggering foods are cow's milk protein in breastfed infants and soy, cow's milk protein, and extensively hydrolyzed formulas in formula-fed infants. The diagnosis is based on clinical history and resolution of symptoms with dietary elimination of trigger foods. Prognosis is excellent, with tolerance developing in most children by 1-3 years of age.
Pearls in Allergy and Immunology 2013 SeptemberJuan Aldave
This document provides a summary of recent literature on allergy and immunology. It discusses several topics:
- Thermal processing can reduce the allergenicity of some tree nuts but not others. Skin testing is useful for diagnosing proton pump inhibitor allergies.
- Atopic eczema is caused by skin barrier defects, innate immune dysregulation that promotes TH2 inflammation, and adaptive immune dysregulation from genetic and environmental factors.
- The document is intended for educational purposes for allergy/immunology physicians and does not replace their clinical judgement. Suggestions to improve the content should be sent to the author.
This document summarizes research on drug-induced anaphylaxis in Latin America. Some key findings include:
- Drugs are a leading cause of anaphylaxis in Latin America, reported in 34% of cases in one study. NSAIDs and beta-lactams are among the most common culprits.
- Studies in Latin America found cardiovascular involvement in over 45% of anaphylaxis cases, and was more frequent in elderly patients. Shock and severe reactions were also more common in the elderly.
- A study of over 800 anaphylaxis cases across Latin America found NSAIDs to be the predominant cause in adults, while beta-lactams were more common in children and
- The document discusses chronic granulomatous disease (CGD), an immunodeficiency caused by a defect in the NADPH oxidase complex resulting in recurrent infections.
- It covers the genetics, clinical presentation including infections by bacteria, fungi and mycobacteria, diagnostic testing such as NBT and DHR, and management including antimicrobial prophylaxis and IFN-γ therapy.
- Mendelian susceptibility to mycobacterial disease is also discussed, which is caused by defects in IFN-γ signaling and results in selective predisposition to mycobacterial infections despite otherwise normal health. Causative genes involved in IFN-γ production and response are identified.
Dr. José Antonio Ortega Martell presented on allergic rhinitis (AR) and the role of intranasal corticosteroids (INS) in its treatment. AR is a common condition worldwide that can impair quality of life. While symptoms can be relieved by various medications, INS are the most effective treatment due to their ability to reduce inflammation and prevent exacerbations. INS work both acutely and prevent persistent minimal inflammation. Potential side effects are typically minor and can be reduced by proper administration. INS should be used as the preferred treatment for AR due to their efficacy and ability to alter the disease course over time.
1. The document summarizes various studies on prevention of allergy through modulation of the gut microbiota from early life.
2. Key areas of focus include the gut microbiota of pregnant women and its impact on the infant, early introduction of foods like peanuts and eggs to induce tolerance, use of probiotics and breastfeeding to influence the infant gut microbiota, and effects of a farm environment and dietary fibers on allergy risk.
3. Studies found that probiotics started prenatally and combined with breastfeeding were most effective in preventing eczema, and that early introduction of peanuts and eggs reduced the risk of developing an allergy to those foods.
This document discusses biomarkers in asthma and the 2020 Mexican consensus on fractional exhaled nitric oxide (FeNO) in asthma. It provides background on the population affected by asthma and the economic burden. Biomarkers can help identify asthma phenotypes and endotypes, guiding treatment. Fractional exhaled nitric oxide (FeNO) is a non-invasive marker of eosinophilic airway inflammation and can help monitor asthma control and response to treatment. The document reviews the use of FeNO and other biomarkers to identify inflammation phenotypes and optimize asthma management.
This document summarizes a study on the relationship between atopic dermatitis and food allergy. It notes that while some studies have found a link between food allergies exacerbating atopic dermatitis symptoms, there is disagreement between dermatologists and allergologists on this relationship. The study performed a literature review and found many more reports on the topic in allergy journals compared to dermatology journals. It concludes that food elimination diets may be appropriate for some refractory atopic dermatitis patients, especially if testing finds clinical relevance between symptoms and specific foods, but their use requires careful implementation and follow-up.
Pearls in Allergy and Immunology, November 2013Juan Aldave
- The document summarizes recent articles from Allergy and Annals of Allergy, Asthma & Immunology journals. It discusses topics such as exercise-induced bronchoconstriction in athletes, effectiveness of low-dose aspirin for treating aspirin-exacerbated respiratory disease, and diversity of allergens in dog saliva. The author is Juan Carlos Aldave Becerra, an allergy/immunology physician providing this educational summary for other physicians. Any feedback or questions should be directed to the author by email.
This document discusses risk factors and mechanisms of anaphylaxis. It notes that while symptoms are generally similar across age groups, the elderly are at higher risk due to comorbidities and polypharmacy. Cardiovascular conditions can complicate anaphylaxis through effects on coronary flow and contractility. Prompt recognition through careful history and potential biomarker testing is important for diagnosis and management.
2013 August - Pearls in Allergy and ImmunologyJuan Aldave
This summary discusses two articles from the Annals of Allergy, Asthma & Immunology. The first article reports a case of relapsing polychondritis, an immune-mediated cartilage inflammation, in a patient who also had hypogammaglobulinemia of unknown origin. The patient's polychondritis significantly improved with corticosteroids and methotrexate. The second article reviews advances in the diagnosis and management of insect sting allergy, noting epidemiology, risk stratification of patients, diagnostic tests and their limitations, and novel diagnostic approaches such as basophil activation testing.
Pearls in Allergy and Immunology October 2013Juan Aldave
This article discusses cofactors that can lower the threshold for anaphylaxis in sensitized individuals. Common cofactors include physical exercise, alcohol, infections, NSAIDs, and certain drugs. Mechanisms by which cofactors can induce anaphylaxis include increasing allergen absorption, lowering the activation threshold of mast cells and basophils, increasing leukotriene synthesis, and stimulating the immune system during infections. Understanding cofactors is important for managing anaphylaxis risk.
This document provides a summary of recent publications in allergy and immunology. It discusses the results of studies on the effects of acupuncture for allergic rhinitis, the lack of correlation between blood and airway eosinophil counts in children with severe asthma, and new insights into eosinophil-derived cytokines and their selective secretion. The purpose is to provide updated practical knowledge for allergy/immunology physicians.
The document provides an educational summary of recent literature on allergy and immunology for physicians. It includes brief summaries of multiple journal articles on topics like drug allergy diagnosis, anaphylaxis, asthma, food allergy, primary immunodeficiencies, and more. The purpose is stated as being exclusively educational to provide practical knowledge for physicians, while not replacing clinical judgment. Contact information is provided for the author in case of questions.
Pearls in Allergy and Immunology, January 2014Juan Aldave
The purpose of this educational material is to provide updated knowledge for Allergy/Immunology Physicians. It summarizes recent articles from peer-reviewed journals. If there are any corrections needed, they should be sent directly to the authors by email.
The document summarizes several articles from recent issues of peer-reviewed journals, including:
1) A case report of anaphylaxis induced by streptomycin skin testing, highlighting the risks of systemic reactions from skin testing.
2) An overview of aspirin-exacerbated respiratory disease and approaches to aspirin desensitization, which can effectively improve asthma and sinusitis outcomes.
3) A discussion of the low adherence rates to asthma
2013 July - Pearls in Allergy and ImmunologyJuan Aldave
The document provides a summary of recent literature on allergy and immunology. It discusses several topics:
1) A consensus report that recommends the term "allergen immunotherapy" to describe therapy of allergic diseases with allergen-containing products.
2) Research on eosinophils and their role in allergic inflammation, including potential new treatment targets.
3) A position paper on desensitization for patients with delayed drug hypersensitivity reactions.
4) A study finding frequent sensitization to Candida albicans and profilins in adult eosinophilic esophagitis patients.
The purpose is to provide updated practical knowledge for physicians, though it does not replace clinical judgment
The document provides an educational summary of recent literature on allergies and clinical immunology. It includes summaries of several articles: 1) "Basophils Unlimited" describes a new method for generating large quantities of mouse basophils for research; 2) "Dog Saliva" shows that dog saliva contains more diverse allergenic proteins than dander and may improve diagnostics; 3) An EAACI position paper analyzes the quality and standardization of skin prick testing solutions for occupational allergies. The summary also briefly outlines additional articles on basophil functions, the impact of intranasal corticosteroids on asthma outcomes in patients with allergic rhinitis, and low-dose aspirin desensitization
2013 june Pearls in Allergy and Clinical ImmunologyJuan Aldave
This document provides a summary of recent literature on allergy and immunology. It discusses several topics, including adherence to immunotherapy during financial crises, allergic reactions after immunization, and diagnosing gelatin allergy following vaccine reactions. The purpose is exclusively educational to provide updated knowledge for physicians, and does not replace clinical judgment. Suggestions to improve the content are welcome.
This document provides a summary of recent literature on allergic diseases from the journal Allergy in January 2013. It includes the following key points:
- A study found that uncontrolled asthma and nasal congestion are independent risk factors for insomnia.
- Studies showed that sublingual grass tablet immunotherapy had similar efficacy and safety in both mono- and polysensitized individuals with grass pollen allergy.
- A study found that higher maternal vitamin D levels during pregnancy were associated with increased risk of food allergy in children in the first 2 years of life.
- Mechanisms of peripheral tolerance to allergens were summarized, including the roles of regulatory T cells, dendritic cells, cytokines, and cell surface
1) The document discusses X-linked agammaglobulinemia, a primary immunodeficiency characterized by severe hypogammaglobulinemia and antibody deficiency.
2) It is caused by mutations in the BTK gene which result in arrested B cell development and absence of mature B cells.
3) Clinical manifestations include recurrent bacterial infections, particularly of the respiratory and gastrointestinal tracts, beginning in infancy. Chronic lung disease can develop if not treated.
FPIAP is a non-IgE mediated gastrointestinal food allergy that is the mildest form. It is characterized by the presence of blood and sometimes mucus in the stools of otherwise healthy infants. It affects infants under 6 months of age, with symptoms appearing between 2-8 weeks of life. The most common triggering foods are cow's milk protein in breastfed infants and soy, cow's milk protein, and extensively hydrolyzed formulas in formula-fed infants. The diagnosis is based on clinical history and resolution of symptoms with dietary elimination of trigger foods. Prognosis is excellent, with tolerance developing in most children by 1-3 years of age.
Pearls in Allergy and Immunology 2013 SeptemberJuan Aldave
This document provides a summary of recent literature on allergy and immunology. It discusses several topics:
- Thermal processing can reduce the allergenicity of some tree nuts but not others. Skin testing is useful for diagnosing proton pump inhibitor allergies.
- Atopic eczema is caused by skin barrier defects, innate immune dysregulation that promotes TH2 inflammation, and adaptive immune dysregulation from genetic and environmental factors.
- The document is intended for educational purposes for allergy/immunology physicians and does not replace their clinical judgement. Suggestions to improve the content should be sent to the author.
This document summarizes research on drug-induced anaphylaxis in Latin America. Some key findings include:
- Drugs are a leading cause of anaphylaxis in Latin America, reported in 34% of cases in one study. NSAIDs and beta-lactams are among the most common culprits.
- Studies in Latin America found cardiovascular involvement in over 45% of anaphylaxis cases, and was more frequent in elderly patients. Shock and severe reactions were also more common in the elderly.
- A study of over 800 anaphylaxis cases across Latin America found NSAIDs to be the predominant cause in adults, while beta-lactams were more common in children and
- The document discusses chronic granulomatous disease (CGD), an immunodeficiency caused by a defect in the NADPH oxidase complex resulting in recurrent infections.
- It covers the genetics, clinical presentation including infections by bacteria, fungi and mycobacteria, diagnostic testing such as NBT and DHR, and management including antimicrobial prophylaxis and IFN-γ therapy.
- Mendelian susceptibility to mycobacterial disease is also discussed, which is caused by defects in IFN-γ signaling and results in selective predisposition to mycobacterial infections despite otherwise normal health. Causative genes involved in IFN-γ production and response are identified.
Dr. José Antonio Ortega Martell presented on allergic rhinitis (AR) and the role of intranasal corticosteroids (INS) in its treatment. AR is a common condition worldwide that can impair quality of life. While symptoms can be relieved by various medications, INS are the most effective treatment due to their ability to reduce inflammation and prevent exacerbations. INS work both acutely and prevent persistent minimal inflammation. Potential side effects are typically minor and can be reduced by proper administration. INS should be used as the preferred treatment for AR due to their efficacy and ability to alter the disease course over time.
1. The document summarizes various studies on prevention of allergy through modulation of the gut microbiota from early life.
2. Key areas of focus include the gut microbiota of pregnant women and its impact on the infant, early introduction of foods like peanuts and eggs to induce tolerance, use of probiotics and breastfeeding to influence the infant gut microbiota, and effects of a farm environment and dietary fibers on allergy risk.
3. Studies found that probiotics started prenatally and combined with breastfeeding were most effective in preventing eczema, and that early introduction of peanuts and eggs reduced the risk of developing an allergy to those foods.
This document discusses biomarkers in asthma and the 2020 Mexican consensus on fractional exhaled nitric oxide (FeNO) in asthma. It provides background on the population affected by asthma and the economic burden. Biomarkers can help identify asthma phenotypes and endotypes, guiding treatment. Fractional exhaled nitric oxide (FeNO) is a non-invasive marker of eosinophilic airway inflammation and can help monitor asthma control and response to treatment. The document reviews the use of FeNO and other biomarkers to identify inflammation phenotypes and optimize asthma management.
This document summarizes a study on the relationship between atopic dermatitis and food allergy. It notes that while some studies have found a link between food allergies exacerbating atopic dermatitis symptoms, there is disagreement between dermatologists and allergologists on this relationship. The study performed a literature review and found many more reports on the topic in allergy journals compared to dermatology journals. It concludes that food elimination diets may be appropriate for some refractory atopic dermatitis patients, especially if testing finds clinical relevance between symptoms and specific foods, but their use requires careful implementation and follow-up.
Pearls in Allergy and Immunology, November 2013Juan Aldave
- The document summarizes recent articles from Allergy and Annals of Allergy, Asthma & Immunology journals. It discusses topics such as exercise-induced bronchoconstriction in athletes, effectiveness of low-dose aspirin for treating aspirin-exacerbated respiratory disease, and diversity of allergens in dog saliva. The author is Juan Carlos Aldave Becerra, an allergy/immunology physician providing this educational summary for other physicians. Any feedback or questions should be directed to the author by email.
This document discusses risk factors and mechanisms of anaphylaxis. It notes that while symptoms are generally similar across age groups, the elderly are at higher risk due to comorbidities and polypharmacy. Cardiovascular conditions can complicate anaphylaxis through effects on coronary flow and contractility. Prompt recognition through careful history and potential biomarker testing is important for diagnosis and management.
Correlation study between steroid responsive nephrotic syndrome with clinical...Shreesh Bhat
This study examined the relationship between steroid-responsive nephrotic syndrome and clinical allergies in children. It found that 64% of cases of nephrotic syndrome presented with clinical allergies such as allergic rhinitis, dermatitis, asthma and food allergies. Serum IgE levels were also elevated in 95% of nephrotic syndrome cases presenting with clinical allergies. There was a significant family history of allergies in nephrotic syndrome cases. The study concludes that there is a strong association between nephrotic syndrome and clinical allergies in children.
Correlation study between steroid responsive nephrotic syndrome with clinical...Shreesh Bhat
This study examined the relationship between steroid-responsive nephrotic syndrome and clinical allergies in children. It found that 64% of cases of nephrotic syndrome presented with clinical allergies such as allergic rhinitis, dermatitis, asthma and food allergies. Serum IgE levels were also elevated in 95% of nephrotic syndrome cases presenting with clinical allergies. There was a significant family history of allergies in nephrotic syndrome cases. The study concludes that there is a strong association between nephrotic syndrome and clinical allergies in children.
This document discusses ascariasis, a common helminth infection caused by the roundworm Ascaris lumbricoides. It infects over 25% of the world's population, predominantly children. Symptoms can include growth retardation, pneumonia, and intestinal obstruction. The life cycle and immunosuppressive effects of ascariasis are described, including its role in modulating the immune system and suppressing inflammatory responses through molecules like PAS-1. The hygiene hypothesis, which proposes that lack of early childhood exposure to pathogens like helminths may increase risk for allergic diseases, is also discussed.
Salon b 18 kasim 2011 11.30 11.50 benan bayrakcityfngnc
1. Hemophagocytosis frequently occurs during systemic inflammation and is associated with increased heme oxygenase-1 (HO-1) expression.
2. Within bone marrow of sepsis patients, macrophages constitute the principal source of HO-1 expression, which reflects heme breakdown.
3. Very high serum ferritin levels in pediatric patients with systemic inflammation are associated with increased risk of critical care and death.
Genetic Resistance to Infectious Diseases in the Era of Personalized Medicine...CrimsonpublishersCJMI
Genetic Resistance to Infectious Diseases in the Era of Personalized Medicine by Andrei Alimov in Cohesive Journal of Microbiology & Infectious Disease
This document provides guidelines for the diagnosis and management of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). It outlines the definition, epidemiology, etiology, pathogenesis, symptoms, examination findings, investigations, management, complications and prognosis. Key points include that anti-fas drugs may be promising treatments and steroids are still controversial. Management involves supportive care, stopping causative medications, and intravenous immunoglobulin may improve survival. Complications can include infections, ocular issues, strictures and death.
Immunological Aspects of Myasthenia Gravis Ade Wijaya
MG is an antibody-mediated neuromuscular junction disease caused by IgG antibodies against acetylcholine receptors or the muscle-specific kinase in some cases. The thymus often exhibits structural changes like tumors or follicular hyperplasia and plays an important role in the pathogenesis by impairing regulatory T cells and conventional T cells, creating a pro-inflammatory environment. Understanding the immunological mechanisms involved helps manage patients.
The document discusses gastrointestinal issues in autism from several perspectives:
- Autism is considered a neuroimmune condition affecting the gut and brain, with inflammation originating in the gut. Treating gut issues is one of the most successful biomedical interventions.
- The gut microbiome plays an important role in digestion, immune function, and communication with the brain. Dysbiosis and infections like measles virus and clostridia have been linked to autism.
- Common gastrointestinal dysfunctions seen in autism include maldigestion, malabsorption, immune dysregulation, and motility issues. Treatment focuses on cleaning up the diet, supporting digestion and the microbiome.
This document provides information on atopic dermatitis (AD), including its definition, epidemiology, pathophysiology, clinical manifestations, and treatment. Some key points:
1. AD is a chronic inflammatory skin disease associated with other atopic disorders like asthma. It is characterized by dry skin and sensitization to allergens.
2. The prevalence of AD has increased in recent decades, commonly starting early in life. Genetic factors like mutations in the filaggrin gene contribute to impaired skin barrier function which increases allergen sensitization risk.
3. Clinical features include severe pruritus, chronic relapsing course, and characteristic rash typically located in flexural areas. Complications can include
This document discusses approaches to preventing allergic diseases in children. It mentions that allergic diseases have increased rapidly in recent decades likely due to environmental and lifestyle changes. Early life exposure to allergens and microbes may influence the development of allergic immune responses. The document discusses genetic and environmental risk factors for atopic dermatitis and reviews evidence on the role of various allergens like food, aeroallergens and bacteria. It proposes that primary prevention aims to prevent sensitization to allergens, secondary prevention prevents disease progression after sensitization and tertiary prevention reduces symptoms after disease onset through allergen avoidance and treatment.
This document provides a summary of the education and experience of Arzu Didem Yalcin, including:
- Yalcin received her M.D. from Antalya Training and Research Hospital in 2013 and has since worked in clinical immunology and allergy in Turkey, Cyprus, and Taiwan.
- Her research has focused on topics like oxidative stress, allergic diseases, tumor immunology, and clinical immunology.
- She has over 180 publications and has received several awards and scholarships for her research on topics such as anti-IgE therapy, asthma, and infections.
This document discusses allergies in the adult population of Pakistan. It aims to identify the most common allergy categories and factors causing different allergies by conducting skin prick tests on 377 patients visiting the Allergy Center of the National Institute of Health in Islamabad over 3 months. The study hopes to provide data on allergy prevalence in Pakistani adults and determine specific allergens linked to different allergies to inform health policy. Gaps in literature on allergies in Pakistan are also discussed due to the country facing a double disease burden and allergies being a neglected area.
Search engine for E NEU network science 080817Chirag Patel
The document describes building a search engine to discover environmental factors associated with disease and health outcomes using large epidemiological datasets like the National Health and Nutrition Examination Survey. It outlines how existing genome-wide association studies were used to discover genetic factors but similar approaches are lacking for environmental exposures. The author advocates developing high-throughput environmental exposure assessment methods and conducting environmental-wide association studies to discover environmental influences in a systematic and reproducible way.
Food allergy has been long recognized and well documented. Other adverse reactions to foods first referred to as “toxic idiopathies” by John Freeman, co inventor of immunotherapy, at the early part of the 1900s can be mediated by and have their impact on the nervous and endocrine systems. It can also be mediated by pharmacologic mechanisms and can also affect any part of the body. There’s a great clinical need to accurately identify triggers of adverse reactivity as they have now been linked with even the most serious of modern maladies and diseases. In fact, inflammation is the hallmark of metabolic syndrome. Given the multitude of pathogenic mechanisms underlying adverse reactions to foods and other environmental exposures it is necessary that a utilizable and cost effective technology be understood so that its application be utilized under the appropriate circumstances.
KEY LEARNING POINTS
• The natural ability of certain foods to initiate an inflammatory response and induce metabolic disruptions and counterbalancing mechanisms to prevent that
• How foods can trigger “danger signals” for the immune system
Pharmacologic vs. immunologic reactions to foods
• Is there a common final pathway of all these mechanisms that can reliably indicate triggers of clinical pathology?
• Cellular testing vs. serologic testing: The advantages of cellular testing
Immune Response The Key to BoneResorption in Periodontal Di.docxwilcockiris
Immune Response: The Key to Bone
Resorption in Periodontal Disease
Martin A. Taubman,* Paloma Valverde,† Xiaozhe Han,* and Toshihisa Kawai*
Periodontal disease infection with oral biofilm microorganisms initiates
host immune response and signs of periodontitis, including bone resorp-
tion. This review delineates some mechanisms underlying the host im-
mune response in periodontal infection and alveolar bone resorption.
Activated T lymphocytes have been historically implicated in experimen-
tal periodontal bone resorption. An experimental rat adoptive transfer/
gingival challenge periodontal disease model has been demonstrated to
require antigen-specific T lymphocytes and gingival instillation of antigen
and LPS for bone resorption. Interference with costimulatory interactions
between T cells and antigen-presenting cells abrogated bone resorption,
further emphasizing the significance of immune response in periodontal
disease. Receptor activator of nuclear factor kB ligand (RANKL), a critical
osteoclast differentiation factor, is expressed on T lymphocytes in human
periodontal disease as determined by immunohistochemical and confo-
cal microscopic analyses. Interference with RANKL by systemic adminis-
tration of osteoprotegerin (OPG), the decoy receptor for (and inhibitor of)
RANKL, resulted in abrogation of periodontal bone resorption in the rat
model. This finding indicated that T cell-mediated bone resorption is
RANKL-dependent. In additional experiments, treatment of T cell-trans-
ferred rats with kaliotoxin (a scorpion venom potassium channel inhibi-
tor) resulted in decreases in T-cell RANKL expression, diminished
induction of RANKL-dependent osteoclastogenesis, and abrogation of
bone resorption, implicating an important role of immune response/
RANKL expression in osteoclastogenesis/bone resorption. In other ex-
periments, adoptive transfer of antigen-specific, RANKL-expressing
B cells, and infection with the antigen-bearing Actinobaccillus actinomy-
cetemcomitans gave rise to periodontal bone resorption, indicating that B
cells also have the capacity to mediate bone resorption, probably via
RANKL expression. In humans, prominent T lymphocytes have been
identified in periodontal disease, and diseased tissues showed elevated
RANKL mRNA expression, as well as decreased OPG mRNA expression.
Mononuclear cells from periodontal lesions involving T cells and B cells of
patients induced osteoclastogenesis in vitro. In summary, a biofilm inter-
face initiates immune cell infiltration, stimulating osteoclastogenesis/
bone resorption in periodontal disease. This resorption can be amelio-
rated by inhibition of RANKL activity or by diminishing immune cell stim-
ulation. These two procedures, if localized, have the potential to lead to
the prevention or therapeutic management of periodontal disease and
therefore require further study. J Periodontol 2005;76:2033-2041.
KEY WORDS
B lymphocytes; osteoprotegerin; periodontal disease; T lymphocytes.
P
.
This document discusses diagnostic approaches and investigations for perioperative allergies. It addresses the roles of anesthesiologists and allergologists in investigating suspected cases of anaphylaxis during anesthesia. Skin testing, in vitro testing, and mediators sampling are described as important diagnostic procedures. Skin prick and intradermal tests are considered the reference standard for diagnosing immediate drug hypersensitivity when performed 4-6 weeks post-reaction using the recommended maximum non-reactive drug concentrations. Close collaboration between anesthesiology and allergy specialists is emphasized.
Actualización en Inmunología, 04 de abril de 2014Juan Aldave
Este documento presenta un resumen de varios artículos recientes sobre inmunología. El primer artículo describe una mutación en el gen STAT1 encontrada en un niño con fusariosis cutánea recalcitrante. Otro artículo encuentra mutaciones en el gen CARD9 vinculadas a feohifomicosis subcutánea y deficiencias de células T TH17. Finalmente, se discuten opciones de tratamiento para urticaria crónica como el uso de omalizumab o desensibilización.
Actualización en Inmunología, 07-marzo-2014Juan Aldave
El documento presenta un programa de actualización en inmunología dirigido a médicos del Hospital Nacional Edgardo Rebagliati Martins en Perú, con el objetivo de fortalecer sus conocimientos en inmunología básica e inmunología clínica. El programa consiste en revisiones y discusiones de artículos recientes sobre inmunología con conclusiones prácticas que se llevarán a cabo cada segundo viernes de mes.
Actualización en Inmunología, 07-feb-2014Juan Aldave
Este documento presenta un programa de actualización en inmunología dirigido a médicos en el Hospital Nacional Edgardo Rebagliati Martins en Lima, Perú. El programa tiene como objetivos fortalecer los conocimientos en inmunología básica e inmunología clínica de los médicos, promover el trabajo interdisciplinario, y fomentar la investigación. Se llevará a cabo reuniones mensuales para revisar artículos recientes y casos clínicos. El contenido educativo busca brindar conocimientos actualizados sobre
1) La exposición a aeroalérgenos y agentes infecciosos activa el epitelio para secretar citocinas que generan un ambiente pro-Th2; 2) Las células dendríticas atrapan antígenos y los presentan a los linfocitos Th0 induciendo su diferenciación a Th2; 3) Los linfocitos Th2 activan a otros actores como linfocitos B para producir IgE y mastocitos, causando inflamación y síntomas alérgicos. La inmunoterapia sublingual busca educar al sistema in
Inmunomodulación en reacciones alérgicas a fármacos antituberculosis - JCJuan Aldave
La inmunomodulación puede servir para tratar reacciones adversas inmunológicas a fármacos antituberculosis. La manera de inmunomodular depende de la fisiopatología subyacente y puede incluir desensibilización, anti-IgE, inmunoglobulina intravenosa u otras opciones. Sin embargo, la inmunomodulación no siempre funciona debido a la falta de protocolos estandarizados, por lo que se requiere mayor investigación.
Generalidades sobre el diagnóstico de rinitis alérgica - JCJuan Aldave
La rinitis alérgica es una reacción de hipersensibilidad mediada por IgE frente a aeroalérgenos como ácaros y pólenes, que causa inflamación nasal y posibles complicaciones. Su diagnóstico requiere detección de IgE específica mediante pruebas cutáneas o en suero, y su tratamiento incluye evitación de alérgenos, fármacos e inmunoterapia según la gravedad de los síntomas.
El documento resume los principales factores patogénicos de la dermatitis atópica: 1) defectos en la barrera cutánea como proteínas de diferenciación epidérmica; 2) disregulación inmunitaria como respuestas TH2 elevadas y TH1/TH17 disminuidas; 3) sensibilización a antígenos extraños como ácaros y alimentos, y antígenos propios. Conocer estos factores es importante para entender, desarrollar y personalizar tratamientos para la dermatitis atópica.
Perlas en Alergia e Inmunología, Noviembre 2013Juan Aldave
Este documento presenta varios artículos recientes sobre Inmunología Clínica y Alergología. El propósito es brindar conocimiento actualizado a médicos para mejorar el diagnóstico y tratamiento de enfermedades alérgicas e inmunológicas. Se resumen estudios sobre epidemiología de la anafilaxia, desensibilización a fármacos, efecto de suplementos de aceite de pescado durante el embarazo, alérgenos en el polvo doméstico y su relación con sensibilización al maní,
Perlas en Alergia e Inmunología Octubre 2013Juan Aldave
Este documento presenta un resumen de varios artículos recientes sobre Inmunología Clínica y Alergología. Cubre temas como los factores que pueden influir en la gravedad de las reacciones anafilácticas, el diagnóstico de anafilaxia inducida por cofactores, las causas de abandono de la inmunoterapia sublingual y estrategias para mejorar la adherencia, y nuevos hallazgos sobre mastocitos, basófilos y células T en enfermedades alérgicas. El documento busca capacitar
Actualización en Inmunología 11 Octubre 2013Juan Aldave
Este documento presenta un programa de actualización en inmunología dirigido a médicos en el Hospital Nacional Edgardo Rebagliati Martins en Lima, Perú. Los objetivos son fortalecer conocimientos en inmunología básica y clínica, promover el trabajo interdisciplinario, y fomentar la investigación. El programa consiste en revisiones y discusiones de artículos recientes sobre inmunología el primer y segundo viernes de cada mes, con conclusiones prácticas. También incluye invitaciones a médicos para futuras actualiz
Actualización en Inmunología 11-Oct-2013Juan Aldave
Este documento presenta un programa de actualización en inmunología dirigido a médicos del Hospital Nacional Edgardo Rebagliati Martins en Lima, Perú. El programa tiene como objetivos fortalecer los conocimientos en inmunología básica y clínica, promover el trabajo interdisciplinario, y fomentar la investigación. El programa consiste en revisiones y discusiones de artículos recientes sobre inmunología el primer y segundo viernes de cada mes, con conclusiones prácticas y sugerencias para investigación.
Actualización en Inmunología 04-Oct-2013Juan Aldave
Este documento presenta un programa de actualización en inmunología dirigido a médicos del Hospital Nacional Edgardo Rebagliati Martins. El programa se llevará a cabo los primeros viernes de cada mes y consistirá en la revisión y discusión de artículos recientes, conclusiones prácticas, ideas para investigación y trabajo interdisciplinario. El objetivo es fortalecer los conocimientos en inmunología clínica y promover la investigación entre los servicios del departamento de especialidades médicas.
Perlas en Alergia e Inmunología Septiembre 2013Juan Aldave
Este material educativo tiene el propósito de brindar conocimientos actualizados sobre Inmunología Clínica y Alergología de manera práctica. No sustituye el criterio clínico del médico. Se prohíbe la reproducción total o parcial con fines distintos de los académicos o lucrativos. El contenido incluye resúmenes de artículos recientes sobre diversos temas como alergias alimentarias, inmunodeficiencias, asma y dermatitis atópica.
Actualización en Inmunología - 13-Set-2013Juan Aldave
Este documento presenta un programa de actualización en inmunología dirigido a médicos del Hospital Nacional Edgardo Rebagliati Martins en Lima, Perú. El programa incluye revisiones y discusiones de artículos recientes sobre inmunología con el objetivo de fortalecer los conocimientos de los médicos, promover el trabajo interdisciplinario y la investigación. Se discuten varios temas como receptores nucleares activados por lípidos, pustulosis exantemática generalizada aguda, riesgos de la obesidad, esofagitis eosinof
Actualización en Inmunología 06-09-2013Juan Aldave
Este documento presenta un programa de actualización en inmunología en el Hospital Nacional Edgardo Rebagliati Martins en Lima, Perú. El programa tiene como objetivos fortalecer y actualizar conocimientos en inmunología básica y clínica entre los médicos, y promover la investigación e interdisciplinariedad. Se llevará a cabo reuniones mensuales para revisar artículos recientes y casos clínicos con el fin de brindar conocimiento actualizado sobre inmunología clínica y alergología.
2013 agosto - Perlas en Alergia e InmunologíaJuan Aldave
Este documento presenta un resumen de varios artículos recientes sobre Inmunología Clínica y Alergología con el propósito de brindar conocimiento actualizado a los médicos. Incluye casos clínicos, estudios y revisiones sobre temas como policondritis recidivante, alergia a venenos de himenópteros, reacción a medicamentos para TDAH manifestada como tos crónica, comparación de la biodisponibilidad de epinefrina de diferentes autoinyectores y más. El contenido no sustituye el criterio clínico del médico
Actualización en Alergia e Inmunología 16/08/2013Juan Aldave
Este documento presenta un programa de actualización en inmunología en el Hospital Nacional Edgardo Rebagliati Martins en Lima, Perú. El objetivo es fortalecer y actualizar los conocimientos de los médicos en inmunología básica e inmunología clínica a través de revisiones y discusiones de artículos recientes. El programa se llevará a cabo los primeros viernes de cada mes para promover el trabajo interdisciplinario y la investigación.
Storyboard on Skin- Innovative Learning (M-pharm) 2nd sem. (Cosmetics)MuskanShingari
Skin is the largest organ of the human body, serving crucial functions that include protection, sensation, regulation, and synthesis. Structurally, it consists of three main layers: the epidermis, dermis, and hypodermis (subcutaneous layer).
1. **Epidermis**: The outermost layer primarily composed of epithelial cells called keratinocytes. It provides a protective barrier against environmental factors, pathogens, and UV radiation.
2. **Dermis**: Located beneath the epidermis, the dermis contains connective tissue, blood vessels, hair follicles, and sweat glands. It plays a vital role in supporting and nourishing the epidermis, regulating body temperature, and housing sensory receptors for touch, pressure, temperature, and pain.
3. **Hypodermis**: Also known as the subcutaneous layer, it consists of fat and connective tissue that anchors the skin to underlying structures like muscles and bones. It provides insulation, cushioning, and energy storage.
Skin performs essential functions such as regulating body temperature through sweat production and blood flow control, synthesizing vitamin D when exposed to sunlight, and serving as a sensory interface with the external environment.
Maintaining skin health is crucial for overall well-being, involving proper hygiene, hydration, protection from sun exposure, and avoiding harmful substances. Skin conditions and diseases range from minor irritations to chronic disorders, emphasizing the importance of regular care and medical attention when needed.
- Video recording of this lecture in English language: https://youtu.be/RvdYsTzgQq8
- Video recording of this lecture in Arabic language: https://youtu.be/ECILGWtgZko
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Selective alpha1 blockers are Prazosin, Terazosin, Doxazosin, Tamsulosin and Silodosin majorly used to treat BPH, also hypertension, PTSD, Raynaud's phenomenon, CHF
Nutritional deficiency Disorder are problems in india.
It is very important to learn about Indian child's nutritional parameters as well the Disease related to alteration in their Nutrition.
The Children are very vulnerable to get affected with respiratory disease.
In our country, the respiratory Disease conditions are consider as major cause for mortality and Morbidity in Child.
Dr. Tan's Balance Method.pdf (From Academy of Oriental Medicine at Austin)GeorgeKieling1
Home
Organization
Academy of Oriental Medicine at Austin
Academy of Oriental Medicine at Austin
Academy of Oriental Medicine at Austin
About AOMA: The Academy of Oriental Medicine at Austin offers a masters-level graduate program in acupuncture and Oriental medicine, preparing its students for careers as skilled, professional practitioners. AOMA is known for its internationally recognized faculty, award-winning student clinical internship program, and herbal medicine program. Since its founding in 1993, AOMA has grown rapidly in size and reputation, drawing students from around the nation and faculty from around the world. AOMA also conducts more than 20,000 patient visits annually in its student and professional clinics. AOMA collaborates with Western healthcare institutions including the Seton Family of Hospitals, and gives back to the community through partnerships with nonprofit organizations and by providing free and reduced price treatments to people who cannot afford them. The Academy of Oriental Medicine at Austin is located at 2700 West Anderson Lane. AOMA also serves patients and retail customers at its south Austin location, 4701 West Gate Blvd. For more information see www.aoma.edu or call 512-492-303434.
Nano-gold for Cancer Therapy chemistry investigatory projectSIVAVINAYAKPK
chemistry investigatory project
The development of nanogold-based cancer therapy could revolutionize oncology by providing a more targeted, less invasive treatment option. This project contributes to the growing body of research aimed at harnessing nanotechnology for medical applications, paving the way for future clinical trials and potential commercial applications.
Cancer remains one of the leading causes of death worldwide, prompting the need for innovative treatment methods. Nanotechnology offers promising new approaches, including the use of gold nanoparticles (nanogold) for targeted cancer therapy. Nanogold particles possess unique physical and chemical properties that make them suitable for drug delivery, imaging, and photothermal therapy.
Can Traditional Chinese Medicine Treat Blocked Fallopian Tubes.pptxFFragrant
There are many traditional Chinese medicine therapies to treat blocked fallopian tubes. And herbal medicine Fuyan Pill is one of the more effective choices.
Giloy in Ayurveda - Classical Categorization and SynonymsPlanet Ayurveda
Giloy, also known as Guduchi or Amrita in classical Ayurvedic texts, is a revered herb renowned for its myriad health benefits. It is categorized as a Rasayana, meaning it has rejuvenating properties that enhance vitality and longevity. Giloy is celebrated for its ability to boost the immune system, detoxify the body, and promote overall wellness. Its anti-inflammatory, antipyretic, and antioxidant properties make it a staple in managing conditions like fever, diabetes, and stress. The versatility and efficacy of Giloy in supporting health naturally highlight its importance in Ayurveda. At Planet Ayurveda, we provide a comprehensive range of health services and 100% herbal supplements that harness the power of natural ingredients like Giloy. Our products are globally available and affordable, ensuring that everyone can benefit from the ancient wisdom of Ayurveda. If you or your loved ones are dealing with health issues, contact Planet Ayurveda at 01725214040 to book an online video consultation with our professional doctors. Let us help you achieve optimal health and wellness naturally.
Applications of NMR in Protein Structure Prediction.pptxAnagha R Anil
This presentation explores the pivotal role of Nuclear Magnetic Resonance (NMR) spectroscopy in predicting protein structures. It delves into the methodologies, advancements, and applications of NMR in determining the three-dimensional configurations of proteins, which is crucial for understanding their function and interactions.
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdfOsvaldo Bernardo Muchanga
GASTROINTESTINAL INFECTIONS AND GASTRITIS
Osvaldo Bernardo Muchanga
Gastrointestinal Infections
GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
Among the factors that lead to the occurrence of gastrointestinal infections are the hygienic and sanitary deficiencies that characterize our markets and other places where raw or cooked food is sold, poor environmental sanitation in communities, deficiencies in water treatment (or in the process of its plumbing), risky hygienic-sanitary habits (not washing hands after major and/or minor needs), among others.
These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
To prevent this, it is necessary to promote health education, improve the hygienic-sanitary conditions of markets and communities in general as a way of promoting, preserving and prolonging PUBLIC HEALTH.
Gastritis and Gastric Health
Gastric Health is one of the most relevant concerns in human health, with gastrointestinal infections being among the main illnesses that affect humans.
Among gastric problems, we have GASTRITIS AND GASTRIC ULCERS as the main public health problems. Gastritis and gastric ulcers normally result from inflammation and corrosion of the walls of the stomach (gastric mucosa) and are generally associated (caused) by the bacterium Helicobacter pylor, which, according to the literature, this bacterium settles on these walls (of the stomach) and starts to release urease that ends up altering the normal pH of the stomach (acid), which leads to inflammation and corrosion of the mucous membranes and consequent gastritis or ulcers, respectively.
In addition to bacterial infections, gastritis and gastric ulcers are associated with several factors, with emphasis on prolonged fasting, chemical substances including drugs, alcohol, foods with strong seasonings including chilli, which ends up causing inflammation of the stomach walls and/or corrosion. of the same, resulting in the appearance of wounds and consequent gastritis or ulcers, respectively.
Among patients with gastritis and/or ulcers, one of the dilemmas is associated with the foods to consume in order to minimize the sensation of pain and discomfort.
Storyboard on Acne-Innovative Learning-M. pharm. (2nd sem.) CosmeticsMuskanShingari
Acne is a common skin condition that occurs when hair follicles become clogged with oil and dead skin cells. It typically manifests as pimples, blackheads, or whiteheads, often on the face, chest, shoulders, or back. Acne can range from mild to severe and may cause emotional distress and scarring in some cases.
**Causes:**
1. **Excess Oil Production:** Hormonal changes during adolescence or certain times in adulthood can increase sebum (oil) production, leading to clogged pores.
2. **Clogged Pores:** When dead skin cells and oil block hair follicles, bacteria (usually Propionibacterium acnes) can thrive, causing inflammation and acne lesions.
3. **Hormonal Factors:** Fluctuations in hormone levels, such as during puberty, menstrual cycles, pregnancy, or certain medical conditions, can contribute to acne.
4. **Genetics:** A family history of acne can increase the likelihood of developing the condition.
**Types of Acne:**
- **Whiteheads:** Closed plugged pores.
- **Blackheads:** Open plugged pores with a dark surface.
- **Papules:** Small red, tender bumps.
- **Pustules:** Pimples with pus at their tips.
- **Nodules:** Large, solid, painful lumps beneath the surface.
- **Cysts:** Painful, pus-filled lumps beneath the surface that can cause scarring.
**Treatment:**
Treatment depends on the severity and type of acne but may include:
- **Topical Treatments:** Such as benzoyl peroxide, salicylic acid, or retinoids to reduce bacteria and unclog pores.
- **Oral Medications:** Antibiotics or oral contraceptives for hormonal acne.
- **Procedures:** Such as chemical peels, extraction of comedones, or light therapy for more severe cases.
**Prevention and Management:**
- **Cleanse:** Regularly wash skin with a gentle cleanser.
- **Moisturize:** Use non-comedogenic moisturizers to keep skin hydrated without clogging pores.
- **Avoid Irritants:** Such as harsh cosmetics or excessive scrubbing.
- **Sun Protection:** Use sunscreen to prevent exacerbation of acne scars and inflammation.
Acne treatment can take time, and consistency in skincare routines and treatments is crucial. Consulting a dermatologist can help tailor a treatment plan that suits individual needs and reduces the risk of scarring or long-term skin damage.
Milan J. Anadkat, MD, and Dale V. Reisner discuss generalized pustular psoriasis in this CME activity titled "Supporting Patient-Centered Care in Generalized Pustular Psoriasis: Communications Strategies to Improve Shared Decision-Making." For the full presentation, please visit us at www.peervoice.com/HUM870.
Supporting Patient-Centered Care in Generalized Pustular Psoriasis: Communica...
2013 march
1. March 2013
General considerations:
• The purpose of this educational material is exclusively
educational, to provide practical updated knowledge
for Allergy/Immunology Physicians.
• The content of this educational material does not
intend to replace the clinical criteria of the physician.
• If there is any correction or suggestion to improve the
quality of this educational material, it should be done
directly to the author by e-mail.
• If there is any question or doubt about the content of
this educational material, it should be done directly to
the author by e-mail.
Juan Carlos Aldave Becerra, MD
Allergy and Clinical Immunology
Hospital Nacional Edgardo Rebagliati Martins, Lima-Peru
jucapul_84@hotmail.com
Juan Félix Aldave Pita, MD
Medical Director
Luke Society International, Trujillo-Peru
2. Juan Carlos Aldave Becerra, MD
Allergy and Clinical Immunology
Rebagliati Martins National Hospital, Lima-Peru
March 2013 – content:
• ALLERGIC RHINITIS (AR) AND RISK OF ERECTILE DYSFUNCTION (ED) – A NATIONWIDE
POPULATION-BASED STUDY (Su VY-F, Liu C-J, Lan M-Y, Chen Y-M, Su K-C, Lee Y-C, Chen T-J, Chou K-
T. Allergy 2013; 68: 440–445).
• EXTRACELLULAR DNA TRAPS IN ALLERGIC, INFECTIOUS, AND AUTOIMMUNE DISEASES (Simon D,
Simon H-U, Yousefi S. Allergy 2013; 68: 409–416).
• IDENTIFICATION OF GALACTOSE-α-1,3-GALACTOSE IN THE GASTROINTESTINAL TRACT OF THE
TICK IXODES RICINUS; POSSIBLE RELATIONSHIP WITH RED MEAT ALLERGY (Su VY-F, Liu C-J, Lan
M-Y, Chen Y-M, Su K-C, Lee Y-C, Chen T-J, Chou K-T. Allergy 2013; 68: 440–445).
• INTRODUCTION OF COMPLEMENTARY FOODS IN INFANCY AND ATOPIC SENSITIZATION AT THE
AGE OF 5 YEARS: TIMING AND FOOD DIVERSITY IN A FINNISH BIRTH COHORT (Nwaru BI, Takkinen H-
M, Niemelä O, Kaila M, Erkkola M, Ahonen S, Tuomi H, Haapala A-M, Kenward MG, Pekkanen J, Lahesmaa
R, Kere J, Simell O, Veijola R, Ilonen J, Hyöty H, Knip M, Virtanen SM. Allergy 2013; 68: 507–516).
• MAST CELL ACTIVATION SYNDROMES: DEFINITION AND CLASSIFICATION (Valent P. Allergy 2013; 68:
417–424).
• WEIGHT LOSS INTERVENTIONS IN ASTHMA: EAACI EVIDENCE-BASED CLINICAL PRACTICE
GUIDELINE (PART I) (Moreira A, Bonini M, Garcia-Larsen V, Bonini S, Del Giacco SR, Agache I, Fonseca J,
Papadopoulos NG, Carlsen K-H, Delgado L, Haahtela T. Allergy 2013; 68: 425–439).
• A UNIQUE CASE OF PERONEUS BREVIS/LONGUS MYOSITIS IN A PATIENT WITH A STAT3 MUTATION
(Sterbank J, Marino J, Jhaveri D, Horbal J, Tcheurekdijian H, Hostoffer R. Ann Allergy Asthma Immunol 2013;
110: 204–205).
• ANALYSIS OF HEREDITARY ANGIOEDEMA (HAE) ATTACKS REQUIRING A SECOND DOSE OF
ECALLANTIDE (Henry Li H, Campion M, Craig TJ, Soteres DF, Riedl M, Lumry WR, MacGinnitie AJ, Shea
EP, Bernstein JA. Ann Allergy Asthma Immunol 2013; 110: 168–172).
• BENEFITS OF EXERCISE IN ASTHMA (Craig TJ, Dispenza MC. Ann Allergy Asthma Immunol 2013; 110:
133–140).
• EFFECT OF ALLERGIC RHINITIS ON THE EXPRESSION OF HUMAN β-DEFENSIN 2 IN TONSILS (Joon
Choi I, Rhee CS, Hee Lee C, Kim DY. Ann Allergy Asthma Immunol 2013; 110: 178–183).
• IN VIVO TESTS WITH “TAHINI” SAUCE: NEW ALLERGENIC SOURCE TO EVALUATE IGE-MEDIATED
HYPERSENSITIVITY TO SESAME (Della-Torre E, Pignatti P, Yacoub MR, Sabbadini MG, Colombo G. Ann
Allergy Asthma Immunol 2013; 110: 209–210).
• INTRACTABLE SHELLFISH ANAPHYLAXIS: SENSITIZATION BY CROSS-REACTIVE SUBSTANCES IN A
COMPLEMENTARY “IMMUNE STIMULANT” AND ACRYLIC NAILS (Rolland JM, Varese N, Zubrinich CM,
O’Hehir RE. Ann Allergy Asthma Immunol 2013; 110: 211–212).
• PERCEPTION AND PRACTICE OF SUBLINGUAL IMMUNOTHERAPY (SLIT) AMONG PRACTICING
ALLERGISTS IN THE UNITED STATES: A FOLLOW-UP SURVEY (Sikora JM, Tankersley MS, Ann Allergy
Asthma Immunol 2013; 110: 194–197).
• STEVENS-JOHNSON SYNDROME (SJS): A REVIEW OF 14 ADULT CASES WITH ONE FATAL OUTCOME
(Sawicki J, Ellis AK. Ann Allergy Asthma Immunol 2013; 110: 207–209).
• TERMINOLOGY, CLOSE-CALLS, AND BRACKETOLOGY FOR ALLERGY, ASTHMA, AND IMMUNOLOGY
(Greenberger PA. Ann Allergy Asthma Immunol 2013; 110: 141–145).
• ADVANCES IN BASIC AND CLINICAL IMMUNOLOGY IN 2012 (Chinen J, Notarangelo LD, Shearer WT. J
Allergy Clin Immunol 2013; 131).
• CLINICAL PHENOTYPES OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) AND ASTHMA:
RECENT ADVANCES (Carolan BJ, Sutherland ER. J Allergy Clin Immunol 2013; 131: 627-634).
• CORTICOSTEROID RESISTANCE IN PATIENTS WITH ASTHMA AND CHRONIC OBSTRUCTIVE
PULMONARY DISEASE (Barnes PJ. J Allergy Clin Immunol 2013; 131: 636-645).
PEARLS IN ALLERGY AND IMMUNOLOGY March 2013
3. The purpose of this summary is exclusively educational, to provide practical updated knowledge for Allergy/Immunology Physicians. It does not
intend to replace the clinical criteria of the physician.
• INITIAL DESCRIPTION OF PORK-CAT SYNDROME IN THE UNITED STATES (Posthumus J, James HR,
Lane CJ, Matos LA, Platts-Mills TAE, Commins SP. J Allergy Clin Immunol 2013; 131: 923-925).
• INTERFERON REGULATORY FACTOR 3 ACTIVATION MEDIATES VIRAL STIMULUS-INDUCED
BRONCHIAL PRODUCTION OF THYMIC STROMAL LYMPHOPOIETIN (TSLP) (Uller L. J Allergy Clin
Immunol 2013; 131: 926).
• POSSIBLE ROLE OF TH17 CELLS IN THE PATHOGENESIS OF STEVENS-JOHNSON SYNDROME (SJS)
AND TOXIC EPIDERMAL NECROLYSIS (TEN) (Teraki Y, Kawabe M, Izaki S. J Allergy Clin Immunol 2013;
131: 907-909).
• THE EXOSOME IN LUNG DISEASES: MESSAGE IN A BOTTLE (Eissa NT. J Allergy Clin Immunol 2013;
131: 904-905).
• TOLERANCE TO WHEAT IN WHOLE-GRAIN CEREAL BISCUIT IN WHEAT-ALLERGIC CHILDREN (Turner
PJ, Wong M, Varese N, Rolland JM, O’Hehir RE, Campbell DE. J Allergy Clin Immunol 2013; 131: 920-923).
• TREATMENT OF ATTACKS WITH PLASMA-DERIVED C1-INHIBITOR (C1-INH) CONCENTRATE IN
PEDIATRIC HEREDITARY ANGIOEDEMA (HAE) PATIENTS (Farkas H, Csuka D, Zotter Z, Szabó E, Czaller
I, Varga L, Fejes J, Füst G, Harmat G. J Allergy Clin Immunol 2013; 131: 909-911).
• DEVELOPMENT OF NATURAL TOLERANCE AND INDUCED DESENSITIZATION IN COW’S MILK
ALLERGY (Savilahti EM, Savilahti E. Pediatr Allergy Immunol 2013: 24: 114–121).
• DRUG PROVOCATION TESTS IN THE DIAGNOSIS OF HYPERSENSITIVITY REACTIONS TO NON-
STEROIDAL ANTI-INFLAMMATORY DRUGS IN CHILDREN (Zambonino MA, Torres MJ, Muñoz C, Requena
G, Mayorga C, Posadas T, Urda A, Blanca M, Corzo JL. Pediatr Allergy Immunol 2013: 24: 151–159).
• PEACH ALLERGY IN SPANISH CHILDREN: TOLERANCE TO THE PULP AND MOLECULAR
SENSITIZATION PROFILE (Boyano-Martínez T, Pedrosa M, Belver T, Quirce S, García-Ara C. Pediatr Allergy
Immunol 2013: 24: 168–172).
• PLASMA-MEDIATED IMMUNE SUPPRESSION: A NEONATAL PERSPECTIVE (Belderbos ME, Levy O,
Meyaard L, Bont L. Pediatr Allergy Immunol 2013: 24: 102–113).
• PREVALENCE OF CONFIRMED IMMEDIATE TYPE DRUG HYPERSENSITIVITY REACTIONS AMONG
SCHOOL CHILDREN (Erkocoglu M, Kaya A, Civelek E, Ozcan C, Cakır B, Akan A, Toyran M, Ginis T,
Kocabas CN. Pediatr Allergy Immunol 2013: 24: 160–167).
• TESTING CHILDREN FOR ALLERGIES: WHY, HOW, WHO AND WHEN (Eigenmann PA, Atanaskovic-
Markovic M, O’B Hourihane J, Lack G, Lau S, Matricardi PM, Muraro A, Namazova Baranova L, Nieto A,
Papadopoulos NG, Réthy LA, Roberts G, Rudzeviciene O, Wahn U, Wickman M, Høst A. Pediatr Allergy
Immunol 2013: 24: 195–209).
PEARLS IN ALLERGY AND IMMUNOLOGY March 2013
4. Juan Carlos Aldave Becerra, MD
Allergy and Clinical Immunology
Rebagliati Martins National Hospital, Lima-Peru
ALLERGY:
• ALLERGIC RHINITIS (AR) AND RISK OF ERECTILE DYSFUNCTION (ED) – A NATIONWIDE
POPULATION-BASED STUDY (Su VY-F, Liu C-J, Lan M-Y, Chen Y-M, Su K-C, Lee Y-C, Chen T-J,
Chou K-T. Allergy 2013; 68: 440–445):
• Authors suggest that AR may be a risk factor for ED, possibly in a severity-dependent manner.
• Hypothesis: AR → systemic inflammation → atherosclerosis → ED.
• Study limitations: (i) diagnosis of AR and ED relied on administrative data; (ii) some information,
including BMI and smoking, was not available; c) subjects were only of Chinese ethnicity.
• EXTRACELLULAR DNA TRAPS IN ALLERGIC, INFECTIOUS, AND AUTOIMMUNE DISEASES
(Simon D, Simon H-U, Yousefi S. Allergy 2013; 68: 409–416):
• Extracellular DNA traps: host defense mechanism against extracellular (bacteria, fungi) and
intracellular (e.g. Toxoplasma, Leishmania) pathogens; contain DNA (nuclear or mitochondrial),
histones and other antimicrobial proteins (e.g. cathelicidin, tryptase); produced by viable
neutrophils, eosinophils, mast cells and monocytes 5 to 60 minutes after activation; may require
NADPH oxidase activity; may contribute to immunopathology (endothelial and epithelial
damage, cross-talk between immune cells).
• PIDs with impaired formation of extracellular DNA traps: complete MPO deficiency, CGD.
• Staphylococci and S. pneumoniae produce DNases → destroy NETs → severe infections,
such as necrotizing fasciitis and pneumonia.
• Extracellular DNA traps are observed in tissues affected by allergic diseases (asthma, atopic
dermatitis, contact dermatitis, drug hypersensitivity), autoimmune diseases (bullous
pemphigoid, psoriasis, SLE), vasculitis and thrombosis → target for therapies.
• Research questions: Ho do cells release DNA? Is the DNA mitochondrial, nuclear or both?
Does cell death play a role in extracellular DNA traps? Do these traps play a role in cancer?
• IDENTIFICATION OF GALACTOSE-α-1,3-GALACTOSE IN THE GASTROINTESTINAL TRACT
OF THE TICK IXODES RICINUS; POSSIBLE RELATIONSHIP WITH RED MEAT ALLERGY (Su
VY-F, Liu C-J, Lan M-Y, Chen Y-M, Su K-C, Lee Y-C, Chen T-J, Chou K-T. Allergy 2013; 68: 440–
445):
• Authors show that the epitope galactose-α-1,3-galactose (α-Gal) is present within the
gastrointestinal tract of the tick Ixodes ricinus.
• Tick bite → production of specific IgE to α-Gal → severe allergic reactions after ingestion of
red meat (beef, pork or lamb), which contain α-Gal; severe allergic reactions to Cetuximab (a
chimeric mouse-human mAb that targets EGF; contains the α-Gal epitope on the Fab portion).
• Northern Europe: expanding deer and rodent populations (major tick vectors), climate changes
→ increased exposure to ticks → more people will be at risk of developing red meat allergy.
• INTRODUCTION OF COMPLEMENTARY FOODS IN INFANCY AND ATOPIC SENSITIZATION AT
THE AGE OF 5 YEARS: TIMING AND FOOD DIVERSITY IN A FINNISH BIRTH COHORT (Nwaru
PEARLS IN ALLERGY AND IMMUNOLOGY March 2013
5. The purpose of this summary is exclusively educational, to provide practical updated knowledge for Allergy/Immunology Physicians. It does not
intend to replace the clinical criteria of the physician.
BI, Takkinen H-M, Niemelä O, Kaila M, Erkkola M, Ahonen S, Tuomi H, Haapala A-M, Kenward MG,
Pekkanen J, Lahesmaa R, Kere J, Simell O, Veijola R, Ilonen J, Hyöty H, Knip M, Virtanen SM.
Allergy 2013; 68: 507–516):
• In a Finnish cohort of 3674 children, authors analyzed (i) timing of infant feeding up to the age
of 2 years, and (ii) serum specific IgE to 4 food allergens (egg, cow’s milk, fish and wheat) and
4 inhalant allergens (HDM, cat, timothy grass and birch) measured at the age of 5 years →
• Early introduction of foods (cereals, fish and egg) may protect against atopic sensitization in
childhood, particularly among high-risk children.
• Less food diversity as already at 3 months of age may increase the risk of atopic sensitization.
• MAST CELL ACTIVATION SYNDROMES: DEFINITION AND CLASSIFICATION (Valent P. Allergy
2013; 68: 417–424):
• Mast cells: tissue cells that mediate allergic and inflammatory reactions; can be activated by
different ways (IgE receptor, complement receptors, opioid receptors, etc.).
• Mast cells can activate in acute/episodic states (e.g. allergic reactions) or in a chronic state (e.g.
mastocytosis). Severity of symptoms depends on: (i) number of activated mast cells; (ii) local or
systemic activation of mast cells; (iii) clonal state of mast cells due to genetic mutations; (iv)
amount of specific IgE and allergen; (v) cytokine environment.
• How to diagnose mast cell activation (MCA)? (i) Symptoms: wheals, pruritus, flushing,
bronchospasm, hypotension, abdominal cramping, diarrhea (symptoms of chronic MCA are less
specific, including headache, fatigue, nausea and insomnia); (ii) good response to antimediator
drugs (not only antihistamines); (iii) ↑ levels of mast cell mediators in biological fluids (e.g. ↑
serum tryptase ≥20% above baseline + additional 2 ng/ml; histamine or metabolites; PGD2);
(iv) MCA assays (limitation: mast cells are not accessible unless a tissue biopsy is performed).
• 3 criteria to diagnose MCA syndrome (MCAS): (i) clinical signs of severe recurrent or chronic
systemic MCA; (ii) positive biochemical measurements (preferably ↑ tryptase following the 20%
+ 2 formula); (iii) good response to mast cell-stabilizing agents or antimediator drugs.
• Classification of MCAS: (i) Primary MCAS: caused by KIT-mutated monoclonal mast cells,
usually CD25+; most patients have systemic or cutaneous mastocytosis. (ii) Secondary MCAS:
caused by an underlying inflammatory disease, often an IgE-dependent allergy. (iii) Idiopathic
MCAS: neither underlying inflammatory disease, nor KIT-mutated mast cells.
• A primary mast cell disease and an IgE-dependent allergy may coexist in the same patient →
dangerous situation (e.g. hymenoptera venom or food allergy in patients with mastocytosis).
• Considerations: (i) lack of response to antimediator drugs does not exclude MCAS (e.g.
mastocytosis + anaphylactic shock refractory to antihistamines); (ii) ↑ tryptase level alone is not
indicative of MCA; (iii) less severe or local forms of MCA represent clinical challenges.
• WEIGHT LOSS INTERVENTIONS IN ASTHMA: EAACI EVIDENCE-BASED CLINICAL PRACTICE
GUIDELINE (PART I) (Moreira A, Bonini M, Garcia-Larsen V, Bonini S, Del Giacco SR, Agache I,
Fonseca J, Papadopoulos NG, Carlsen K-H, Delgado L, Haahtela T. Allergy 2013; 68: 425–439):
• Obesity has shown to: ↑ asthma incidence, ↑ asthma severity, ↓ sensitivity to corticosteroids.
PEARLS IN ALLERGY AND IMMUNOLOGY March 2013
6. Juan Carlos Aldave Becerra, MD
Allergy and Clinical Immunology
Rebagliati Martins National Hospital, Lima-Peru
• Obesity: ↑ serum leptin, ↓ serum adiponectin, ↓ respiratory system compliance → ↑ allergic
airway inflammation, ↓ lung function.
• Authors performed a systematic review of 31 studies to assess the impact of weight changes on
asthma → obesity ↑ the odds for incident asthma by 1.82 in adults and 1.98 in children; one
RCT showed benefits of losing weight on asthma control and lung function; several
observational studies provided limited evidence of these beneficial effects.
• It is recommended to target obesity as part of asthma treatment.
PEARLS IN ALLERGY AND IMMUNOLOGY March 2013
7. The purpose of this summary is exclusively educational, to provide practical updated knowledge for Allergy/Immunology Physicians. It does not
intend to replace the clinical criteria of the physician.
ANNALS OF ASTHMA, ALLERGY & IMMUNOLOGY:
• A UNIQUE CASE OF PERONEUS BREVIS/LONGUS MYOSITIS IN A PATIENT WITH A STAT3
MUTATION (Sterbank J, Marino J, Jhaveri D, Horbal J, Tcheurekdijian H, Hostoffer R. Ann Allergy
Asthma Immunol 2013; 110: 204–205):
• STAT3 mutation → autosomal dominant (AD) hyper-IgE syndrome (HIES): markedly ↑ serum
IgE; recurrent infections (S. aureus abscesses, pneumonias, candidiasis), eczema, coarse
facial features, pneumatoceles, delayed shedding of primary teeth, joint hyperextensibility,
scoliosis, osteopenia; NIH STAT3 score >40.
• Authors report a 36-yr-old man with AD HIES (pneumonias, empyema, knee abscess, right arm
abscess, candidiasis, pneumatocele, characteristic facies, hyperextensibility; IgE: 2,728 Ku/L;
NIH STAT3 score: 53; mutation in exon 12 of STAT3) complicated by right peroneous
brevis/longus myiositis: leg pain and swelling; no history of trauma, except for scratching in
nearby areas; no local warmth or erythema; no fever or systemic symptoms; no leukocytosis;
negative blood cultures; MRI: inflammation of the peroneus brevis and longus muscle bellies;
elevated CPK; rapid response to IV vancomycin and cefepime.
• Always look for bacterial infection in patients with AD HIES, despite absence of inflammation.
• ANALYSIS OF HEREDITARY ANGIOEDEMA (HAE) ATTACKS REQUIRING A SECOND DOSE
OF ECALLANTIDE (Henry Li H, Campion M, Craig TJ, Soteres DF, Riedl M, Lumry WR, MacGinnitie
AJ, Shea EP, Bernstein JA. Ann Allergy Asthma Immunol 2013; 110: 168–172):
• HAE: low C1-inh levels (type 1 HAE) or function (type 2 HAE) → ↓ inhibition of kallikrein → ↑
bradykinin production → recurrent attacks of angioedema (skin and mucosa) without urticaria;
can be life-threatening. Drugs to treat attacks: C1-inh concentrate, kallikrein inhibitor
(ecallantide), bradykinin receptor blocker (icatibant).
• Authors analyzed 732 HAE attacks treated with ecallantide → a single dose (30 mg) was
effective for most attacks (88%); a 2nd
dose was required in 12% of attacks; peripheral attacks
were more likely to require a 2nd
dose after 4 hours.
• BENEFITS OF EXERCISE IN ASTHMA (Craig TJ, Dispenza MC. Ann Allergy Asthma Immunol
2013; 110: 133–140):
• Exercise-induced bronchospam (EIB): bronchospasm symptoms within or after physical
exertion; tend to resolve within 1 hour; diagnosis: ↓ FEV1 (10-15%) with exercise; risk factors:
atopy, exercising in dry air, exhaustive exercise (e.g. elite athletes), sports with high minute
ventilation (basketball, cycling, soccer), cold weather sports (cross-country skiing, hockey,
skating), respiratory irritants.
• EIB may occur in individuals with or without asthma → patients with uncontrolled asthma must
be careful with exercise.
• Benefits of exercise (low-evidence data): ↓ inflammatory mediators, ↑ Treg responses, ↑
cardiopulmonary fitness, ↑ quality of life → patients with controlled asthma should do exercise;
it is not well defined the type and intensity; definitive data is lacking.
PEARLS IN ALLERGY AND IMMUNOLOGY March 2013
8. Juan Carlos Aldave Becerra, MD
Allergy and Clinical Immunology
Rebagliati Martins National Hospital, Lima-Peru
• EFFECT OF ALLERGIC RHINITIS ON THE EXPRESSION OF HUMAN β-DEFENSIN 2 IN
TONSILS (Joon Choi I, Rhee CS, Hee Lee C, Kim DY. Ann Allergy Asthma Immunol 2013; 110:
178–183):
• Antimicrobial peptides (AMPs): small molecules with activity against bacteria, fungi and
enveloped viruses.
• Human β-defensins (HBDs): family of AMPs expressed by epithelial cells on mucosal surfaces;
wide range of antimicrobial activities (gram-positive and gram-negative bacteria, fungi, viruses).
HBD-2 is strongly expressed in tonsil tissue, compared with nasal sinus mucosa and adenoids.
• Authors analyzed tonsils and adenoids from 30 patients with no history of recurrent tonsillitis or
asthma → patients with allergic rhinitis had ↓ levels of HBD-2.
• Hypothesis: allergic rhinitis → ↓ expression of HBD-2 in tonsils → ↓ innate immunity → ↑
predisposition to respiratory infections.
• IN VIVO TESTS WITH “TAHINI” SAUCE: NEW ALLERGENIC SOURCE TO EVALUATE IGE-
MEDIATED HYPERSENSITIVITY TO SESAME (Della-Torre E, Pignatti P, Yacoub MR, Sabbadini
MG, Colombo G. Ann Allergy Asthma Immunol 2013; 110: 209–210):
• Sesame seed: “emerging” food allergen; used in some perfumes, cosmetics and lubricants;
may cause IgE- and non-IgE-mediated allergic reactions, ranging from contact dermatitis to
severe anaphylaxis; diagnosis: sIgE detection by skin or in vitro tests, oral provocation tests.
• Tahini: 100% sesame creamy sauce; produced in India; commercialized in Italy by Alimenta Srl.
• Authors report a 55-yr-old man with suspected anaphylaxis to sesame → conventional SPT
and ISAC testing did not detect specific IgE to sesame → SPT with “Tahini” was positive →
diagnosis of sesame allergy was confirmed by a positive BAT to commercial sesame extracts
→ electrophoretic analysis detected an allergenic protein in “Tahini” source that was not
present in conventional sesame extracts → hypothesis: roasting increases the allergenicity of
sesame proteins contained in “Tahini”.
• Skin tests with “Tahini” should be considered in patients with high suspicion of sesame allergy
and negative sIgE detection by conventional tests.
• INTRACTABLE SHELLFISH ANAPHYLAXIS: SENSITIZATION BY CROSS-REACTIVE
SUBSTANCES IN A COMPLEMENTARY “IMMUNE STIMULANT” AND ACRYLIC NAILS (Rolland
JM, Varese N, Zubrinich CM, O’Hehir RE. Ann Allergy Asthma Immunol 2013; 110: 211–212):
• Authors report a 46-yr-old woman with shellfish anaphylaxis → despite shellfish avoidance she
presented 20 new episodes of severe anaphylaxis over 30 months; no identified trigger; normal
random serum tryptase; patient used acrylic fingernails and daily “immune stimulant” powder →
positive sIgE and BAT to shrimp extracts, chitin powder and the “immune stimulant” powder →
final diagnosis: anaphylaxis to chitin → avoidance of shellfish, acrylic nails and the “immune
stimulant” prevented new episodes of anaphylaxis.
• The “immune stimulant” contained arabinogalactan, aloe vera gel extract, gum ghatti
(containing glucosamine), gum tragacanth, glucosamine hydrochloride (from shrimp), lecithin
powder, calcium carbonate, dibasic calcium phosphate, gelatin, brown rice flour, cellulose,
silicon dioxide, magnesium stearate and wakame.
PEARLS IN ALLERGY AND IMMUNOLOGY March 2013
9. The purpose of this summary is exclusively educational, to provide practical updated knowledge for Allergy/Immunology Physicians. It does not
intend to replace the clinical criteria of the physician.
• Patients with shellfish allergy must be careful with chitin-associated products.
• Keep in mind that allergy to complementary products is increasing.
• PERCEPTION AND PRACTICE OF SUBLINGUAL IMMUNOTHERAPY (SLIT) AMONG
PRACTICING ALLERGISTS IN THE UNITED STATES: A FOLLOW-UP SURVEY (Sikora JM,
Tankersley MS, Ann Allergy Asthma Immunol 2013; 110: 194–197):
• SLIT represents 45% of specific immunotherapy practice in Europe.
• Authors surveyed >520 allergists to assess SLIT practice in the US → 11.4% of allergists
reported experience using SLIT (compared to 5.9% in 2007); 66.7% of allergists believed that
SLIT was safer than SCIT (compared to 73.4% in 2007).
• Main barrier to use SLIT: lack of FDA approval → it is anticipated that once an FDA-approved
product is available, there will be widespread use of SLIT in the US.
• STEVENS-JOHNSON SYNDROME (SJS): A REVIEW OF 14 ADULT CASES WITH ONE FATAL
OUTCOME (Sawicki J, Ellis AK. Ann Allergy Asthma Immunol 2013; 110: 207–209):
• SJS: severe immune reaction that affects skin and mucosas; may be fatal; drugs are the causal
agent in most cases; diagnosis: mainly clinical, histology may help; treatment: removal of the
causal agent, immunosuppressive agents, supportive care.
• Authors describe 14 cases of SJS → average age: 51 yrs (range: 27 to 82 yr); 13 cases were
drug-induced; average time from initiation of the culprit agent to onset of eruption: 15 days
(range: 1 to 34 days), excluding one case (many years taking allopurinol); 3 cases had some
features of DRESS (eosinophilia and mild liver dysfunction); 3 patients received IVIG and
corticoids, 3 only IVIG, 4 only corticoids, 4 only supportive therapy; 1 patient died.
• TERMINOLOGY, CLOSE-CALLS, AND BRACKETOLOGY FOR ALLERGY, ASTHMA, AND
IMMUNOLOGY (Greenberger PA. Ann Allergy Asthma Immunol 2013; 110: 141–145):
• Authors present an interesting list of 64 allergy/immunology terms linked in pairs, so that it
would be easier to remember them. For example:
• α-Gal vs tick bites: some tick bites induce synthesis of IgE against α-gal (galactose-α1,3-
galactose) → α-gal can be present on beef, pork and lamb → patients who eat these foods
may have nonimmediate (3-6 hrs later) urticaria or anaphylaxis. α-gal is present in cetuximab.
• Lebrikizumab vs periostin: lebrikizumab (anti-IL-13) ↑ FEV1 in patients with asthma not
controlled by ICS. A target of lebrikizumab is periostin, a matrix protein involved in airway
remodeling. Patients with higher levels of periostin had better response to lebrikizumab.
PEARLS IN ALLERGY AND IMMUNOLOGY March 2013
10. Juan Carlos Aldave Becerra, MD
Allergy and Clinical Immunology
Rebagliati Martins National Hospital, Lima-Peru
JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY:
• ADVANCES IN BASIC AND CLINICAL IMMUNOLOGY IN 2012 (Chinen J, Notarangelo LD,
Shearer WT. J Allergy Clin Immunol 2013; 131):
• Atopic children → lower expression of thymic TSLP → slower thymic Treg differentiation.
• Spleen tyrosine kinase (SYK) has an essential role in activation of human memory B cells →
target for B-cell-mediated diseases (e.g. autoimmune diseases).
• PIDs with ↑ susceptibility to HPV infection: 1) warts as a major clinical finding: EVER 1 and 2
deficiency, WHIM syndrome, GATA2 deficiency, DOCK8 deficiency, idiopathic T-cell
lymphopenia, Netherton syndrome, STK4 deficiency; 2) warts as a common occurrence: SCID,
WAS, A-T, NEMO deficiency, CVID, CD40L deficiency, LAD-I.
• Screening methods for SCID: a) absolute lymphocyte counts: high availability, risk of false-
negative results (maternal lymphocytes, oligoclonal cells, elevated B cells), unclear cost/benefit
ratio; b) TREC measurement: currently the best method.
• ADA deficiency → dermatofibrosarcoma, pulmonary alveolar proteinosis.
• Dyskeratosis congenita → defects in telomere length or function.
• SP110 deficiency → venoocclusive disease and immunodeficiency (VODI) syndrome: ↓ B cell
activation; ↓ IL-10 secretion by B cells; association with Crohn disease.
• Lymphocyte-specific protein tyrosine kinase (LCK) deficiency: recurrent infections, panniculitis,
autoimmunity; low CD4 and CD8 expression; the 1st
reported patient inherited 2 maternal copies
of the entire chromosome 1 that carried the mutant allele.
• Panhypogammaglobulinemia → antibiotics might be required to complement IVIG replacement.
• X-linked agammaglobulinemia → ↑ production of inflammatory cytokines by monocyte-derived
cells after TLR activation → Bruton tyrosine kinase may have a role in controlling inflammation.
• Screening method for agammaglobulinemia: k-deleting recombination excision circles (KRECs).
• CD40L deficiency → ↓ expression of activation markers against fungal antigens in monocytes.
• 848 CVID patients → 4 phenotypes: (1) no complications other than infections; (2) autoimmune
cytopenias; (3) polyclonal lymphoproliferation; (4) unexplained persistent enteropathy. 69%
increase in lymphoproliferation risk for every 100 mg/dL increase in serum IgA; 14% increase in
cytopenias risk for every 100 mg/dL increase in serum IgG. Survival expectancy was least in
the enteropathic group, followed by the lymphoproliferation group and the autoimmune group.
• Consider CMV infection in patients with CVID and inflammatory complications.
• LPS-responsive beige-like anchor (LRBA) deficiency: autosomal recessive syndrome that
resembles severe CVID; hypogammaglobulinemia, autoimmune cytopenias, IBD.
• CD21 deficiency: recurrent infections, moderate hypogammaglobulinemia, impaired responses
to polysaccharides, reduction of memory B cells.
PEARLS IN ALLERGY AND IMMUNOLOGY March 2013
11. The purpose of this summary is exclusively educational, to provide practical updated knowledge for Allergy/Immunology Physicians. It does not
intend to replace the clinical criteria of the physician.
• CD27 deficiency: humoral and cellular dysfunction, severe EBV infection, lack of CD27
expression in T and B lymphocytes.
• Child with selective polysaccharide antibody deficiency → impaired production of antibodies to
polysaccharides by the CD20+CD43+CD27+CD70- B cell subset (analog to murine B-1 cells).
• 11 patients with CGD were treated with HSCT from matched related or matched unrelated
donors → 100% survival with minimal graft-versus-host disease.
• Gene defects associated with CMC: CARD9, IL17F, IL17R, STAT3, STAT1, AIRE.
• β-glucan from Candida → recognition by dectin 1 → intracellular signalling that involves AIRE
→ TNF-β production by PBMCs. This may explain why patients with AIRE defect have CMC
(apart from autoantibody production to IL-17 and IL-22).
• STAT3-deficiency → ↓ IgG+ and IgA+ memory B cells → IgG substitution may be important.
• TGF-β regulates TH17 response; IL-6, IL-23, IL-1β induce a more inflammatory TH17 response.
• Blau syndrome associated with NOD2 mutations → TH17 and TH1 environment in the
granulomas; systemic inflammatory manifestations.
• Crohn disease associated with NOD2 mutations → TH1 environment in the granulomas;
manifestations limited to the gastrointestinal tract.
• Tocilizumab (anti–IL-6 mAb) was successful for 3 patients with Schnitzler syndrome who were
resistant to conventional treatment, including IL-1 inhibitors.
• Patients with HIV infection → increased asthma prevalence.
• CLINICAL PHENOTYPES OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE AND ASTHMA:
RECENT ADVANCES (Carolan BJ, Sutherland ER. J Allergy Clin Immunol 2013; 131: 627-634):
• COPD: adult patients with dyspnea, chronic cough and sputum production; history of significant
tobacco exposure; expiratory airflow limitation (post bronchodilator FEV1/FVC <0.70).
• Asthma and COPD: the 2 most prevalent chronic lung diseases; high clinical, molecular and
radiographic heterogeneity; significant clinical overlap between them.
• It is important to classify specific asthma and COPD phenotypes → personalized management.
• CORTICOSTEROID RESISTANCE IN PATIENTS WITH ASTHMA AND CHRONIC OBSTRUCTIVE
PULMONARY DISEASE (Barnes PJ. J Allergy Clin Immunol 2013; 131: 636-645):
• Asthma: 10% of patients require maximal ICS dose; 1% need regular OCS (corticosteroid-
dependent asthma); some patients are refractory to high doses of OCS (corticosteroid-resistant
asthma). Genetic factors may contribute to corticosteroid resistance.
• COPD patients are less sensitive to corticosteroids. Steroid resistance may also occur in
rheumatoid arthritis, IBD and SLE.
• Mechanism of action of corticosteroids: diffusion across the cell membrane → binding to the
glucocorticoid receptor α (GRα) in the cytoplasm → GRα liberates from chaperone proteins
PEARLS IN ALLERGY AND IMMUNOLOGY March 2013
12. Juan Carlos Aldave Becerra, MD
Allergy and Clinical Immunology
Rebagliati Martins National Hospital, Lima-Peru
(HSP90) → GRα enters the nucleus through nuclear import proteins (importin α) → GRα
homodimerizes and binds to promoter region of many genes → GR complex switches off many
activated inflammatory genes (cytokines, chemokines, adhesion molecules, etc.).
• Mechanisms of corticosteroid resistance: 1) phosphorylation of the GRα by kinases (p38MAPK,
JNK1), ↓ activity of phosphatases (MKP-1, PP2A) → ↓ nuclear translocation; 2) ↑ expression
of GRβ, which competes with activated GRα; 3) ↑ proinflammatory transcription factors (AP-1,
JNK); 4) oxidative stress → activation of PI3Kδ → ↓ expression of histone deacetylase 2
(HDAC2), which normally switches off activated inflammatory genes.
• Strategies for managing steroid resistance: 1) anti-inflammatory drugs: phosphodiesterase 4
inhibitors (e.g. oral roflumilast for COPD), p38MAPK inhibitors, NF-kB inhibitors, macrolides; 2)
drugs that ↑ HDAC2 expression: theophylline, nortriptyline, PI3Kδ inhibitors; 3) LABA: ↑ PP2A,
↓ GRα phosphorylation, ↑ GRα translocation to the nucleus; 4) antioxidants: Nrf2 activators.
• INITIAL DESCRIPTION OF PORK-CAT SYNDROME IN THE UNITED STATES (Posthumus J,
James HR, Lane CJ, Matos LA, Platts-Mills TAE, Commins SP. J Allergy Clin Immunol 2013; 131:
923-925):
• Authors report 8 cases of pork-cat syndrome. Diagnosis was done by clinical history, skin tests
and in vitro IgE detection. Oral challenges were not performed.
• Pork-cat syndrome: specific IgE to cat serum albumin (SA) → cross-reaction with porcine SA
→ severe allergic reactions after eating pork; most patients are >8 yr of age; patients may
tolerate well-cooked pork; reactions are immediate (30-45 min), to differentiate from delayed
anaphylaxis caused by IgE to α-gal; some patients have no clinical allergy to cat; some patients
do not tolerate beef.
• Protein homology between porcine and cat SA = 82%.
• Suspicion of allergy to a mammalian meat → request sIgE to pork, beef, cat SA and α-gal.
• INTERFERON REGULATORY FACTOR 3 ACTIVATION MEDIATES VIRAL STIMULUS-INDUCED
BRONCHIAL PRODUCTION OF THYMIC STROMAL LYMPHOPOIETIN (TSLP) (Uller L. J Allergy
Clin Immunol 2013; 131: 926):
• Hypothesis: respiratory syncytial virus infection in asthma or COPD patients → stimulation of
NF-κB and IRF3 in bronchial epithelial cells → overproduction of TSLP and type I IFN →
respiratory exacerbation.
• Simvastatin inhibited this pathway by interfering with IRF3 phosphorylation.
• POSSIBLE ROLE OF TH17 CELLS IN THE PATHOGENESIS OF STEVENS-JOHNSON
SYNDROME (SJS) AND TOXIC EPIDERMAL NECROLYSIS (TEN) (Teraki Y, Kawabe M, Izaki S. J
Allergy Clin Immunol 2013; 131: 907-909):
• SJS and TEN: severe immune cytotoxic reaction against keratinocytes → massive apoptosis;
mostly induced by drugs.
• Authors report 7 patients with SJS/TEN and 7 patients with erythema multiforme major (EMM)
→ SJS/NET patients had increased circulating IL-17–producing CD4+ T cells compared to
PEARLS IN ALLERGY AND IMMUNOLOGY March 2013
13. The purpose of this summary is exclusively educational, to provide practical updated knowledge for Allergy/Immunology Physicians. It does not
intend to replace the clinical criteria of the physician.
patients with EMM and healthy subjects; these cells were also present in the blister fluid and
decreased significantly after SJS/TEN improvement.
• Skin-homing TH17 cells might be involved in the pathogenesis of SJS/TEN.
• THE EXOSOME IN LUNG DISEASES: MESSAGE IN A BOTTLE (Eissa NT. J Allergy Clin Immunol
2013; 131: 904-905):
• Exosomes: secreted membranous nanovesicles (30-100 nm) that arise from endosomal
compartments; might participate in intercellular communication; might be involved in physiologic
and pathologic processes, including cancer; have been detected in saliva, breast milk,
bronchoalveolar lavage fluid (BALF), blood and urine; contain miRNAs (regulators of
intracellular signalling); potential diagnostic biomarkers and therapeutic targets.
• Exosomes from BALF of patients with asthma promoted leukotriene and IL-8 release from
bronchial epithelial cells.
• 16 miRNAs contained in the BALF exosomes differentiated asthmatics from healthy subjects.
• Less invasive methods of sampling exosomal miRNA are needed (induced sputum, exhaled
breath condensates, blood, urine).
• TOLERANCE TO WHEAT IN WHOLE-GRAIN CEREAL BISCUIT IN WHEAT-ALLERGIC
CHILDREN (Turner PJ, Wong M, Varese N, Rolland JM, O’Hehir RE, Campbell DE. J Allergy Clin
Immunol 2013; 131: 920-923):
• IgE-mediated wheat allergy: typically starts in infancy and resolves by 3-5 yrs of age; culprit
proteins are not well defined; cross-reactivity with other grains is possible; diagnosis: clinical
history, IgE detection, oral food challenge (OFC). OFCs are frequently performed with whole-
grain wheat cereal biscuits (WWCBs).
• Authors report 2 children with confirmed wheat allergy who tolerated an OFC with WWCBs but
continued reacting to other wheat-containing products. Possible explanation: pressure cooking
degraded allergenic wheat proteins in WWCBs.
• Some wheat-allergic children are able to tolerate WWCBs → a negative OFC to WWCBs does
not rule out allergy to other wheat products.
• TREATMENT OF ATTACKS WITH PLASMA-DERIVED C1-INHIBITOR (C1-INH) CONCENTRATE
IN PEDIATRIC HEREDITARY ANGIOEDEMA (HAE) PATIENTS (Farkas H, Csuka D, Zotter Z,
Szabó E, Czaller I, Varga L, Fejes J, Füst G, Harmat G. J Allergy Clin Immunol 2013; 131: 909-911):
• HAE: autosomal-dominant disease resulting from mutation of the C1-INH gene; type I HAE:
reduced C1-INH protein; type II HAE: dysfunctional protein; clinical history: recurrent attacks of
angioedema in the skin and mucosas due to excessive bradykinin production; drugs to treat
attacks: plasma-derived (pd) or recombinant human C1-INH, ecallantide (kallikrein inhibitor),
icatibant (bradykinin B2 receptor antagonist).
• pdC1-INH (Berinert, CSL Behring) is the only approved drug for pediatric use; half-life in
children: 33 h.
PEARLS IN ALLERGY AND IMMUNOLOGY March 2013
14. Juan Carlos Aldave Becerra, MD
Allergy and Clinical Immunology
Rebagliati Martins National Hospital, Lima-Peru
• Authors analyzed the efficacy and safety of pdC1-INH for HAE attacks in 27 pediatric patients
(<18 yr old) → onset of symptom relief: 15-60 min; maximal time for resolution: 48 h;
subcutaneous edema usually responded slower; upper airway edema responded quicker;
attacks did not progress or recur during the next 48 h; no adverse events potentially related to
treatment; no antibodies to pdC1-INH concentrate were generated; repeated dosing was
infrequent.
• pdC1-INH concentrate was effective and safe for the treatment of HAE attacks in children.
PEARLS IN ALLERGY AND IMMUNOLOGY March 2013
15. The purpose of this summary is exclusively educational, to provide practical updated knowledge for Allergy/Immunology Physicians. It does not
intend to replace the clinical criteria of the physician.
PEDIATRIC ALLERGY AND IMMUNOLOGY:
• DEVELOPMENT OF NATURAL TOLERANCE AND INDUCED DESENSITIZATION IN COW’S
MILK ALLERGY (Savilahti EM, Savilahti E. Pediatr Allergy Immunol 2013: 24: 114–121):
• Normal gut immune system: a) eliminates pathogens; b) tolerates harmless environmental
antigens (e.g. food proteins, drugs); c) tolerates commensal bacterial flora.
• Risk factors in infants for impaired oral tolerance: (i) immature gut barrier → more antigenic
access; (ii) lower secretion of gastric acid and proteolytic enzymes → less antigenic degrading;
(iii) lower gut IgA levels; (iv) Th2 deviation in pregnancy; (v) atopy; (vi) disturbed gut microbiota.
• Physiological response to CM: Treg response; predominant IgG1 and IgG4 production (peaks
3-4 months after CM initiation); low IgE production.
• Optimal timing and dosage of CM exposure to avoid sensitization is unknown.
• Cow’s milk allergy (CMA): abnormal immunologic reaction to CM (about 20 allergenic proteins);
2-3% of infants; can be IgE-mediated, non-IgE-mediated or both; Teff responses predominate
over Treg responses; most children outgrow CMA spontaneously.
• IgE-mediated CMA: immediate symptoms after exposure (urticaria, angioedema,
bronchospasm, anaphylaxis); diagnosis: SPT, sIgE detection, BAT, oral challenge.
• Non-IgE-mediated CMA: delayed reactions (hours or days) after exposure; probably T cell
mediated; diagnosis is more difficult; typically resolves earlier than IgE-mediated allergy.
• Early exposure to small amounts of CM appears to ↑ risk of IgE-mediated CMA.
• Early exposure to large amounts of CM appears to ↑ risk of non-IgE-mediated CMA.
• Exposure to CM may occur through skin or breast milk → CMA can occur in exclusively
breastfed infants; CMA may be sustained by cross-reactivity to proteins in human breast milk.
• Specific IgE to bovine serum albumin (BSA) is associated with allergy to both CM and beef.
• Risk factors for CMA persistence: severe reactions, small eliciting doses, allergy to heated CM,
high (or increasing) positivity of sIgE or SPT to CM, low levels of CM-specific IgG4, allergy to
other foods, asthma, allergic rhinitis.
• Subjects who outgrow CMA: ↓Th2 response to CM, ↑ Th1 and Treg response; ↓ specific IgE
production; ↑ specific IgG4 and IgA production.
• IL-4: ↑ IgG4 and ↑ IgE production; IL-10: ↑ IgG4 and ↓ IgE production.
• CM-specific IgE levels ↓ as tolerance develops, but may remain at increased levels even in
tolerant individuals.
• High intestinal IgA in infancy may ↓ risk of IgE-mediated allergies. IgA production is induced
rather by innate immunity signals than T helper cells.
• Probiotics (e.g. Lactobacillus rhamnosus) may accelerate development of tolerance to CM.
PEARLS IN ALLERGY AND IMMUNOLOGY March 2013
16. Juan Carlos Aldave Becerra, MD
Allergy and Clinical Immunology
Rebagliati Martins National Hospital, Lima-Peru
• Oral CM immunotherapy (OIT) induces desensitization in most cases where spontaneous
recovery has not yet occurred. Evidence for long-time tolerance is limited. Problem: risk of
adverse reactions during OIT.
• DRUG PROVOCATION TESTS (DPT) IN THE DIAGNOSIS OF HYPERSENSITIVITY REACTIONS
TO NON-STEROIDAL ANTI-INFLAMMATORY DRUGS IN CHILDREN (Zambonino MA, Torres MJ,
Muñoz C, Requena G, Mayorga C, Posadas T, Urda A, Blanca M, Corzo JL. Pediatr Allergy Immunol
2013: 24: 151–159):
• Hypersensitivity reactions to NSAIDs: 0.3% of the general population. (i) Pharmacological
mechanisms: COX inhibition; patients are generally cross-intolerant (CI) to other NSAIDs. (ii)
Immunologic mechanisms: IgE or T cell production; patients are usually selective reactors (SR).
• Facial angioedema is the main symptom reported by children with NSAID hypersensitivity,
especially in CI patients; this symptom ↑ in frequency with age till 21 yr of age.
• Reactions to paracetamol in CI patients are estimated at between 4 and 25%.
• Authors performed 119 DPT in 63 children with a history of NSAID hypersensitivity → 68.2% of
the children were confirmed as having hypersensitivity (58.1% classified as CI and 41.9% as
SR); angioedema occurred in 86.3% of cases; all CI patients tolerated paracetamol; atopy was
more frequent in CI patients, compared with SR patients and non-allergic controls.
• PEACH ALLERGY IN SPANISH CHILDREN: TOLERANCE TO THE PULP AND MOLECULAR
SENSITIZATION PROFILE (Boyano-Martínez T, Pedrosa M, Belver T, Quirce S, García-Ara C.
Pediatr Allergy Immunol 2013: 24: 168–172):
• Peach allergy: main cause of vegetable food allergy in the Mediterranean area; Pru p 3 (a
nonspecific lipid transfer protein) is the major allergen (mainly found in the peel).
• Authors studied 57 children with allergic reactions after peach ingestion or contact → 88% of
children had positive SPT with peach peel, 35% with peach pulp; 100% of children had ↑ sIgE
to peach, 96% had ↑ sIgE to rPru p 3; OFC with peeled peach was negative in 93% of children.
• PLASMA-MEDIATED IMMUNE SUPPRESSION: A NEONATAL PERSPECTIVE (Belderbos ME,
Levy O, Meyaard L, Bont L. Pediatr Allergy Immunol 2013: 24: 102–113):
• Antiinflammatory molecules in human plasma: IL-10, TGF-β, antagonists of cytokine receptors,
IgG, IgA, galectins, adenosine, lipids, vit A, vit D, adiponectin, etc.
• Immunomodulatory role of plasma is especially important in neonates to: (i) maintain feto-
maternal tolerance; (ii) tolerate microbial colonization after birth.
• Plasma is a potential immunoregulatory therapy for autoimmune, allergic, and inflammatory
disease. Advantages: easily accessible, affordable, widely available.
• Research questions: What are the immune suppressive factors in plasma? Where are they
produced? By which mechanism do they mediate their effect?
• PREVALENCE OF CONFIRMED IMMEDIATE TYPE DRUG HYPERSENSITIVITY REACTIONS
AMONG SCHOOL CHILDREN (Erkocoglu M, Kaya A, Civelek E, Ozcan C, Cakır B, Akan A, Toyran
M, Ginis T, Kocabas CN. Pediatr Allergy Immunol 2013: 24: 160–167):
PEARLS IN ALLERGY AND IMMUNOLOGY March 2013
17. The purpose of this summary is exclusively educational, to provide practical updated knowledge for Allergy/Immunology Physicians. It does not
intend to replace the clinical criteria of the physician.
• Previous studies show that only 5% of patients with suspected drug allergy have a real allergy.
• Authors evaluated 10,096 children → 7.87% had parent-reported immediate drug allergy →
diagnostic work-up confirmed allergy in only 0.11% of children.
• A positive clinical history is not enough to diagnose drug allergy; a careful diagnostic work-up is
essential to confirm diagnosis.
• TESTING CHILDREN FOR ALLERGIES: WHY, HOW, WHO AND WHEN (Eigenmann PA,
Atanaskovic-Markovic M, O’B Hourihane J, Lack G, Lau S, Matricardi PM, Muraro A, Namazova
Baranova L, Nieto A, Papadopoulos NG, Réthy LA, Roberts G, Rudzeviciene O, Wahn U, Wickman
M, Høst A. Pediatr Allergy Immunol 2013: 24: 195–209):
• Authors provide a 15-page document with practical recommendations for diagnostic testing in
children with suspected or confirmed food, drug and respiratory allergies.
• The information is outstanding all over the document. I strongly suggest reading it all. Some
summarized recommendations are:
• Skin prick and specific IgE testing should be directed by the clinical history.
• Allergy test results should always be interpreted in correlation with clinical relevance.
• If performed by experienced allergists, allergen challenges are usually safe and confirm/exclude
diagnosis, reducing unnecessary avoidance of medications or foods.
• Food challenges might be necessary to assess the clinical relevance of a positive IgE test
before introducing exclusion diets.
• Infants with early onset severe eczema are at high risk for developing food allergies.
• Food allergies must be considered in children <3 yr old with moderate-severe atopic eczema.
• An allergic cause for acute urticaria/angioedema is likely when: (i) symptoms occur within 2 h of
a potential allergic trigger; (ii) symptoms last for <24 h.
• Some aeroallergens (pollens, cat, dog, HDM) may give rise to urticaria ± angioedema.
• Chronic urticaria is primarily caused by excessive sensitivity of the skin leading to spontaneous
mast cell degranulation.
• Allergy testing in chronic urticaria is very rarely diagnostic and has high risk of false-positive
results.
• Allergy work-up for anaphylaxis during anaesthesia (immediate or non-immediate) must include
neuromuscular blocking agents, latex, hypnotics, antibiotics, opioids and other agents.
• Seasonal rhinitis/conjunctivitis should be tested for allergy in treatment-resistant cases;
perennial rhinitis/conjunctivitis should be tested in all cases.
• All children with asthma should be tested for allergies.
• Allergy testing for rhinitis/conjunctivitis and asthma should be guided by the clinical history and
include the most relevant local allergens.
PEARLS IN ALLERGY AND IMMUNOLOGY March 2013
18. Juan Carlos Aldave Becerra, MD
Allergy and Clinical Immunology
Rebagliati Martins National Hospital, Lima-Peru
• In a child with cough, other causes should be considered prior to allergy testing.
• Chronic vomiting and diarrhoea as primary symptoms of allergy are uncommon; other causes
must be excluded. Celiac or eosinophilic GI diseases should be considered in the differential
diagnosis. Testing may include non-IgE tests, food exclusion/challenges and endoscopy.
• Colic: 5-19% of infants; defined as excessive crying >3 h/day, >3 days/wk and lasting >3 wks.
Colic may occur in 30–46% of infants with cow’s milk allergy.
• Natural course of crying in infancy: (i) little crying between 0 and 2 wks; (ii) 2–3 h crying per day
between 2–6 wks; (iii) <1 h crying per day at 12 wks.
• Infants with extreme crying and signs of atopic diseases should be investigated for food allergy.
• Diagnosis of food allergy in infants with colic should be confirmed by elimination/challenge
procedures.
• Suspicion of food allergy in exclusively breast-fed infants → supervised elimination of maternal
intake of relevant food protein for at least 1 wk followed by controlled challenge.
• Allergy diagnosis should be considered in young atopic children with failure-to-thrive and other
GI symptoms after excluding other causes and optimizing nutritional input. Diagnosis will mostly
be based on exclusion/reintroduction of suspected foods.
• Anaphylaxis occurring in an otherwise healthy child should be investigated with allergy tests.
• Only children with a history of systemic reaction after an insect sting will need an allergy work-
up. Allergy diagnosis will provide guidance for immunotherapy and preventive measures.
• Siblings of food allergic children might be considered for allergy testing to foods, especially if
they have moderate-severe eczema.
PEARLS IN ALLERGY AND IMMUNOLOGY March 2013