January 2007 Archives

asthmaNew research suggests that different treatments may be needed for chronic asthma, depending on whether it results from allergies or lung infections.

Previous studies have shown that certain lung infections such as Mycoplasma pneumoniae can linger on and contribute to a person later experiencing symptoms of asthma.

Researchers have now identified a particular gene that influences how severe a M. pneumoniae infection may be, which in turn suggests that a different strategy might be needed for treating asthma resulting from this and similar lung infections rather than allergies.

“What this shows is that infectious asthma might have a different mechanism than allergic asthma. Most people think asthma is asthma, but it may be multifaceted,” said Dr. Robert Hardy, an infectious disease specialist at UT Southwestern.

hay feverAllergy shots are effective and safe for reducing symptoms of hay fever, according to a new review. The injection series caused no deaths and few serious adverse reactions in 51 controlled studies.

Dr. Moises Calderon, of Royal Brompton Hospital in London, and colleagues evaluated the results from randomized, double-blind, placebo-controlled studies in patients with seasonal allergic rhinitis due to tree, grass or weed pollens. The studies involved 2,871 participants.

The review appears in the current issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

Living Near a Busy Highway Impedes Children's Lung Growth

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busy highwayLOS ANGELES, Jan. 26 -- Freeway traffic pollution can retard lung development of children whose homes are not far from the side of the road, researchers here reported.

Children exposure to traffic pollution during their rapid pulmonary development, from ages 10 to 18, had eight-year lung growth that was significantly stunted, W. James Gauderman, Ph.D., of the University of Southern California here, and colleagues, reported online in The Lancet.

The lung growth was slowed in children who lived within 500 meters (about a third of a mile) of a freeway compared with children who lived 1,500 meters (about one mile) or more away, the investigators found.

AstraZeneca says German asthma drug study inconclusive

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astrazeneca

FRANKFURT (MarketWatch) -- AstraZeneca PLC (AZN) said Thursday the findings of a study on respiratory combination drugs by the German Institute for the Evaluation of Drugs, or IQWIG, are inconclusive.

The study found that patients suffering from asthma didn't respond better to combination drugs, such as AstraZeneca's Symbicort, than to the use of two drugs alone.

The study also included GlaxoSmithkline PLC's (GSK) Viani and Schwarz Pharma AG's (SRZ.XE) Atmadisc.

AstraZeneca said in a statement that the IQWIG findings are preliminary and that the institute didn't use the latest clinical data available for the Symbicort drug.

Association of Mold With Asthma Symptoms

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asthmaby Mark T. O'Hollaren, MD

Alternaria alternata is a saprophytic mold typically found in soil and plants, and is considered to be primarily an outdoor allergen. It has been associated with episodes of severe, life-threatening attacks of asthma, and sensitivity to Alternaria (ie, as demonstrated with a positive allergy skin test) has been associated with an approximate 200-fold increase in the risk of a life-threatening asthma attack.[1] Sensitization to Alternaria has also been found to be more common in patients with asthma than in those without asthma.

Salo and colleagues collected data as part of the National Survey of Lead and Allergens in Housing study, and they surveyed a nationally representative sample of over 800 housing units inhabited by over 2400 individuals. They collected dust samples from bed, sofa, or chair, and from the bedroom, living room and kitchen floors, and analyzed for the presence of Alternaria using a polyclonal anti-Alternaria alternata inhibition assay.

histamine releaseIn a surprise finding, scientists have discovered that histamine, the inflammatory compound released during allergic reactions that causes runny nose, watery eyes, and wheezing, can be produced in large amounts in the lung by neutrophils, the white blood cells that are the major component of pus.

Pus, a fluid found in infected tissue, is produced as a result of inflammation.
The study in mice is the first to show that lung neutrophils can produce histamine in significant quantities, according to principal investigator George Caughey, MD, chief of pulmonary/critical care medicine at the San Francisco VA Medical Center.

Aspirin May Have Role in Asthma Prevention

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aspirinBOSTON, Jan. 15 -- Aspirin may reduce the risk of new-onset asthma in adult males, according to a retrospective analysis of a longitudinal study of thousands of physicians.

A post hoc analysis of data from the Physicians' Health Study, which investigated the role of aspirin in preventing first heart attacks, revealed that men who took 325 mg of aspirin every other day had a 22% reduction in risk of new onset asthma, found Tobias Kurth, M.D., Sc.D., of Brigham and Women's Hospital here, and colleagues.

Moreover, the possible protective effect of aspirin was not modified by baseline risk factors including smoking, body mass index, or age, but the benefit appeared to be greater among younger men, the researchers reported in the January issue of the American Journal of Respiratory and Critical Care Medicine.

Asthma patients prefer fast relief

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asthmaWASHINGTON, Jan. 10 (UPI) -- Asthma sufferers are much more likely to use drugs that offer fast relief of symptoms, according to new U.S. research.

About 31 percent of sufferers said they use fast-acting medications, while only 14 percent said they use longer-term, preventive treatments, according to a new study by Health and Human Services' Agency for Healthcare Research and Quality.

Another 31 percent of people with asthma said they use both types of medications, and 24 percent said they use none, according to the study.

About 20% of schoolchildren and adolescents in Sweden suffer from perceived food hypersensitivity (e.g. allergy or intolerance). Our knowledge of how child food hypersensitivity affects parents HRQL and what aspects of the hypersensitivity condition relate to HRQL deterioration in the family is limited. Thus the aim of this study was to investigate the parent-reported HRQL in families with a schoolchild considered to be food hypersensitive. The allergy-associated parameters we operated with were number of offending food items, adverse food reactions, additional hypersensitivity, allergic diseases and additional family members with food hypersensitivity. These parameters, along with age and gender were assessed in relation to child, parent and family HRQL.

Methods: In May 2004, a postal questionnaire was distributed to parents of 220 schoolchildren with parent-reported food hypersensitivity (response rate 74%). Two questionnaires were used: CHQ-PF28 and a study-specific questionnaire including questions on allergy-associated parameters. In order to find factors that predict impact on HRQL, stepwise multiple linear regression analyses were carried out...

COPDJanuary 8, 2006 — Independent of smoking, chronic cough and phlegm in young adults are strong predictors of increased risk of developing chronic obstructive pulmonary disease (COPD), according to the results of a study reported in the January 1 issue of the American Journal of Respiratory and Critical Care Medicine.

"The few prospective studies aimed at assessing the incidence of chronic obstructive pulmonary disease (COPD) in relation to the presence of chronic cough/phlegm have produced contrasting results," write Roberto de Marco, MD, of the University of Verona in Italy, and colleagues. "The Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines have introduced a stage 0 (normal spirometry, but presence of chronic cough or phlegm) in the COPD staging system as a tool to identify subjects at risk of developing the disease later in life."

Red Tides Worsen Asthma with Breathtaking Seascapes

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red tidesMIAMI -- Harmful algal blooms known as red tides release toxins that can leave people with asthma gasping still harder for air, reported researchers here.

After spending just 60 minutes on a beach where a Florida red tide was present, teens and adults with asthma had small but significant decreases in standard measures of pulmonary function, reported Lora E. Fleming, M.D., Ph.D., of the University of Miami Rosenstiel School of Marine and Atmospheric Science.

"In the normal population, inhaled aerosolized red tide toxins can lead to eye irritation, rhinorrhea, nonproductive cough, and wheezing," Dr. Fleming and colleagues reported in the January issue of Chest.

dynavaxBERKELEY, Calif., Jan. 8 /PRNewswire-FirstCall/ -- Dynavax Technologies Corporation (Nasdaq: DVAX ) announced today that the analysis of interim one-year data from its two-year DARTT ragweed allergy trial indicated that no meaningful ragweed-specific allergic disease was observed in the study population, making it impossible to measure the therapeutic effect of TOLAMBA treatment. In all three arms of the study, including the placebo arm, minimal change from baseline was observed in the main efficacy measure of the study, the total nasal symptom score (TNSS). The company indicated that in the placebo and treated groups, the change from baseline TNSS was very low; not clinically significant; and substantially lower than what has been observed in prior trials.

"In effect, we saw three patient groups with no measurable disease during the ragweed season. This result was unexpected, though these challenges are well known to occur in allergy drug development. Due to the fact that no clinically significant disease was seen in the study population, it was impossible to measure the effect of our intervention," noted Dino Dina, MD, president and chief executive officer. Dina continued, "We are working closely with our consultants and investigators to review the data in detail and determine the future of the program."

Number of infants with asthma rises in Prague

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asthmaPrague, Jan 6 (CTK) - The number of children suffering from asthma and other respiratory disease has been on the rise in the one million Prague as the number of cars and lorries in the city increases and the air is polluted with dust, daily Pravo writes today.

Pediatricians told the daily that the situation in the city is serious and that it has been worse and worse every year.

"For instance, younger children fall ill and the number of children suffering from asthma is rising. Babies and infants under half a year of age are not an exception," Pravo quotes pediatrician Ivana Nulickova who has a surgery in the city centre as saying.

The pill may raise odds of having allergic kids

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oral contraceptiveNEW YORK (Reuters Health) - Mothers who have previously used oral contraceptive pills seem more likely to have children with nasal allergies, Finnish researchers report.

Dr. Leea Keski-Nisula, of Kuopio University, Finland, and colleagues note in the medical journal Allergy that there has been a suggestion of an association between oral contraceptive use and allergic diseases.

To investigate, the researchers studied 618 asthmatic children aged 5 or 6 years and compared them with 564 similar but unaffected children.

Salt reduction may have asthma benefits too

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Reducing salt intake may affect asthma severity and breathing in adults with the condition, says a joint Anglo-American review of the science.

The review looks set to continue to put pressure on the food industry to reach the targets set out by an increasing number of food agencies to cut salt intake. In the USA, UK and Ireland, over 80 per cent of salt intake comes from processed food.

The authors of the new review, Timothy Mickleborough from Indiana University and Andrew Fogarty from the University of Nottingham, analyse both epidemiological and clinical evidence and conclude that, collectively, increased salt intake may increase the severity of asthma for people with the disease.

Metal allergies can affect dental work

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teeth If you have experienced an allergic reaction to the metals in your jewelry, you may want to think twice about what your dentist puts in your mouth! Fairly inexpensive materials like nickel and chromium keep the price down on your dental work, but they can cause more pain and discomfort than they're worth.

Up to 16 percent of women and six percent of men are allergic to the metal used in costume jewelry. These same metals could cause allergic reactions in your mouth if they are used in your dental work. Metals used to make crowns, dentures, onlays and veneers can trigger mouth discomfort.

The most common metal allergy is to nickel, which is used in many dental fixtures. Patients may also experience allergic reactions to gold, chromium and molybdenum.

Total Asthma Control Yields Best Quality of Life

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advairNEW YORK (Reuters Health) Jan 04 - Total control of asthma, in accordance with guidelines from the Global Initiative for Asthma at the National Institutes of Health, results in the best quality of life, a new report indicates.

The results show that a tangible improvement in quality of life is seen when asthma is totally controlled rather than simply well controlled.

As reported in the European Respiratory Journal for January, Dr. E. D. Bateman, from the University of Capetown in South Africa, and colleagues administered the Asthma Quality of Life Questionnaire (AQLQ) to 1994 patients participating in a study comparing the efficacy of fluticasone alone or in combination with salmeterol.

FDA Safety Changes: Allegra, Cymbalta, Concerta

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FDAJanuary 3, 2007 — The US Food and Drug Administration (FDA) has approved safety labeling revisions to advise that administration of fexofenadine HCl products with fruit juice may decrease therapeutic efficacy; concomitant use of duloxetine HCl therapy with other drugs that affect the serotonergic system may increase the risk for serotonin syndrome; and use of central nervous system stimulants may increase the risk for sudden death in patients with serious heart conditions, may cause or exacerbate psychiatric symptoms in certain patients, and may cause temporary growth suppression.

Fexofenadine HCl (Allegra) Taken With Fruit Juices May Reduce Therapeutic Efficacy

On October 13, 2006, the FDA approved safety labeling revisions for fexofenadine HCl tablets and oral suspension (Allegra, made by Sanofi-Aventis US, LLC) to warn that exposure to fexofenadine may be reduced by their administration with fruit juices.

Protection against latex allergy and irritant

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latex allergyA variety of agents, including some hand protection products, can contribute to contact dermatitis among workers. Contact dermatitis is a major problem for employees in many industries. Dermatitis is most often seen among workers involved in activities such as construction, healthcare and cleaning.

A common factor for these activities is the need for hand protection, primarily in the form of rubber gloves.

When contact dermatitis occurs, the first instinct is to blame it on the gloves.

More often than not, however, the reason for the allergic reaction is not contact with one agent but a combination of rubber and another source.

patient with doctorHow well do we manage our patients who have been diagnosed with allergic rhinitis? Do patients and healthcare providers have a similar outlook? This presentation was given at the American College of Allergy, Asthma and Immunology Annual Meeting, and largely is drawn from data obtained from "Allergies in America: A Landmark Survey of Nasal Allergy Sufferers," the largest and most comprehensive national survey of patients with allergic rhinitis, and the healthcare providers who treat them, which was released in 2006.[1]

The purpose of this survey was to describe the symptoms, burden of disease, and treatment of allergic rhinitis. As a brief summary, a national sample of 31,470 American households were screened by telephone interview to obtain a national probability sample of 2500 adults, aged 18 and over, who had been diagnosed by a physician with allergic rhinitis, nasal allergies, or "hay fever" and who had nasal allergy symptoms, or had taken prescription medication for allergies within the past 12 months

Schering-Plough to sell Danish anti-allergy drug

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schering ploughCOPENHAGEN (Reuters) - U.S. drug maker Schering-Plough Corp. <SGP.N> will develop and sell Denmark's ALK-Abello anti-allergy drug Grazax in North America, the Danish company said on Wednesday.

Shares in the Danish company rose 7.1 percent to 1,550 crowns on the news.

The drug treats grass pollen, house dust mite and ragweed allergies. The two companies will develop and sell it in the United States, Canada and Mexico, with Schering-Plough acquiring exclusive license rights.

Tale of a 'Hypoallergenic' Cat and Standby Antihistamines

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Allerca catsSAN DIEGO, Dec. 29 -- Feline allergies' nine lives may be up.

A fluffy white cat named Joshua and brethren would have allergic tabby-lovers, long starved of feline companionship, believe the day of the litter box is just $3,950 away. Some allergists are skeptical. Other are taking a wait-and-sneeze approach.

Joshua, now 20 months old, is touted by a company here called Allerca as "the world's first scientifically proven hypoallergenic cat." Others lacking a key allergenic protein have been bred since Joshua.

According to the company's Web site, "These [hypoallergenic] cats allow some of the millions of people with feline allergies to finally enjoy the love and companionship of a household pet without suffering from allergic symptoms."

CAMBy Hana R. Solomon, MD

Worldwide, only 10% to 30% of healthcare is provided by conventional, Western, biomedical practitioners. The remainder is delivered either through folk beliefs or alternative traditions.[1] Complementary and alternative medicine (CAM) has become more popular in the United States over the past few decades. With this increasing popularity of CAM, it is important that practitioners become familiar with this area of medical practice for all diagnoses.

According to the National Center for Complementary and Alternative Medicine (NCCAM), CAM is defined as "a group of diverse medical and healthcare systems, practices, and products that are not presently considered to be part of conventional medicine.[2]" The list of modalities included in this definition continually changes as practices are integrated into Western conventional medicine. They also identify 5 concepts, or domains, of CAM:

Novel Therapies for Asthma

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asthmaBy David H. Broide, MD, ChB

Asthma is a very common airway disease affecting approximately 20 million individuals in the United States. For many patients with persistent asthma, asthma is well controlled with a regular controller medication, such as an inhaled corticosteroid, and an as-needed beta2-agonist inhaler for symptom relief.[1] Nevertheless, each year in the United States, there are still approximately 10 million acute attacks of asthma, 2 million asthma urgent care visits, 400,000 asthma hospitalizations, and 4000-5000 asthma deaths, underscoring the fact that asthma is still not well controlled in a large number of asthmatics.[2] Patients with severe asthma use a significant fraction of the $6.2 billion in annual direct cost expenditure on asthma in the United States.[3] The development of novel therapeutic options for these asthmatics would be a significant advance.

Maximizing Asthma Control

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patient with doctorBy Mark T. O'Hollaren, MD Oregon Health and Science University

In the last several years, the concept of "asthma control" has received significant attention. National and international asthma treatment guidelines increasingly stress the fact that those caring for patients with asthma need to be aware of the impact that asthma has on the daily lives of their patients. Asthma care is moving away from focusing primarily on a number, such as pulmonary function tests or peak expiratory flow measurements, to one in which these numbers are combined with other assessments, such as quality of sleep, limitation of activity and exercise, and requirement for rescue medications.

T Cells in the Pathogenesis and Prevention of Asthma

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asthmaBy Dale T. Umetsu, MD, PhD

Allergic asthma is an immunologic disease that is caused by adaptive immune responses to environmental allergens. Asthma is thus characterized by the presence of allergen-specific immunoglobulin (Ig)E, which is produced during adaptive immune response and by the presence of allergen-specific CD4+ Th2 cells producing interleukin (IL)-4, IL-5, and IL-13.[1] Th2 cells are also generated during adaptive immune responses, and are thought to play a central role in orchestrating the inflammation in asthma, because IL-4 causes isotype switch to IgE; IL-5 enhances the growth and differentiation of eosinophils; and IL-13 causes airway hyperresponsiveness (AHR) -- a cardinal feature of asthma.[2] The development of these adaptive immune responses with IgE and Th2 cells reflects allergen sensitization, which is a significant risk factor for the development of asthma.