Allergy News

Stomach Bacterium May Thwart Asthma

2007-04-24T13:27:51Z

April 23, 2007 -- A stomach bacterium that causes ulcers and is linked to stomach cancer may make asthma less likely.

That news appears in the Archives of Internal Medicine.

The bacterium is called Helicobacter pylori (H. pylori). It is associated with ulcers and increased risk of stomach cancer.

H. pylori is found worldwide, but it's more common in developing countries, note Yu Chen, PhD, MPH, and Martin Blaser, MD.

]]> Chen and Blaser work at the New York University Cancer Institute; Blaser also works with the Department of Veterans Affairs New York Harbor Healthcare System.

They studied data on 7,663 U.S. adults who took part in a national health study conducted from 1988-1994.

Participants were asked if they had ever had asthma. They also took a blood test to see if they had ever been infected with H. pylori. A subgroup of nearly 2,400 participants also took skin tests to check their skin's sensitivity to pollen and molds.

H. Pylori and Asthma

Overall H. pylori infection didn't affect participants' odds of currently having asthma. But it apparently reduced their risk of having had asthma in the past, especially in childhood.

H. pylori infection was also linked to never having had hay fever (allergic rhinitis), allergy symptoms, or skin sensitivity to pollen or molds.

"The present observations are consistent with the 'hygiene hypothesis' that microbial infections during early childhood may prevent or diminish [skin] sensitization and asthma," write the researchers.

H. pylori may have "costs and benefits," Blaser says in a New York University news release. "The relative costs and benefits clearly differ among individuals," he adds.

The study doesn't show how H. pylori makes asthma less likely.

"One hypothesis is if you have H. pylori in your stomach, you have an inflammatory process that is ongoing for decades, and this is skewing the immune system in a particular direction," Blaser says.

SOURCES: Chen, Y. Archives of Internal Medicine, April 23, 2007; vol 167: pp 821-827. News release, New York University Medical Center and School of Medicine.

via WebMD

Inflammation, Asthma, and Tumor Necrosis Factor-alpha

2007-04-24T13:18:47Z

by Erwin W. Gelfand, MD

Patients with severe and refractory asthma suffer from numerous complications, fatal disease, and utilize a large proportion of healthcare resources. Treatment options are certainly limited, and it is unclear what underlies their refractoriness to conventional therapy. Whether they are "resistant" to therapy with glucocorticoids or the pathophysiologic pathways involved in their disease are not sensitive to glucocorticoids is unclear at present.

Some phenotypic differences in patients with refractory asthma have emerged, such as a greater involvement of neutrophils, but the relevance of these data are not clear. Among the candidates identified as perhaps playing a role in refractory asthma is tumor necrosis factor-alpha (TNF-alpha), a pleiotropic inflammatory cytokine that is expressed in mast cells^[1] and is present in higher concentrations in bronchoalveolar fluid from patients with asthma, particularly in bronchoalveolar lavage (BAL) fluid from patients with more severe asthma.^[2]

]]> TNF-alpha and Asthma

TNF-alpha has served as a major therapeutic target in a number of chronic inflammatory conditions, generally involving neutrophils, and include rheumatoid arthritis, juvenile arthritis, ankylosing spondylitis, Crohn's disease, psoriasis, glomerulonephritis, sarcoidosis, and Behcet's disease.^[1] All of these diseases have a tendency toward a predominant Th1 response and all with a link to high levels of production of TNF-alpha.

It therefore seems incongruous that asthma and airway eosinophilia, thought of as a Th2 disease, may also have some link with asthma. At least in mouse models of asthma deficiencies in TNF-alpha, deficiencies in expression of TNF-alpha receptors, treatment with anti- TNF-alpha antibody, or induction of TNF-alpha autoantibody result in attenuation of antigen-induced airway hyperresponsiveness and eosinophilic airway inflammation.^[2,3] Inhalation of TNF-alpha in rodents^[4] and humans, normals, or asthmatics^[5,6] did trigger altered airway function (bronchial hyperresponsiveness) together with airway neutrophilia. Genetic associations have linked TNF-alpha gene polymorphisms and bronchial hyperresponsiveness and asthma.^[7,8]

Many different cell types release TNF-alpha, including T cells, monocytes/macrophages, mast cells, eosinophils, and epithelial cells. Beyond the recruitment of neutrophils, TNF-alpha sustains lung inflammatory responses by increasing the expression of adhesion molecules, accounting for the increased accumulation of neutrophils and eosinophils in the airways. Their activation by TNF-alpha triggers the release of cytotoxic mediators and toxic products of reactive oxygen and nitrogen, further damaging the airways.^[9] TNF-alpha also contributes to airway remodeling by inducing activation and proliferation of fibroblasts, subepithelial fibrosis, production of extracellular matrix glycoproteins, and goblet cell metaplasia.^[10] TNF-alpha also has direct effects on airway reactivity to methacholine or allergen, as shown in isolated tracheal ring experiments.^[11]

Given these effects of TNF-alpha on airway inflammation and reactivity, selective inhibition of TNF-alpha would provide important information about its role in asthma in general and severe, refractory asthma in particular. There are currently a number of inhibitors available with extensive clinical experience in inflammatory disorders. The inhibitors include the monoclonal antibodies against TNF-alpha (infliximab and adalimumab) as well as the soluble TNF-alpha receptor fused to human immunoglobulin (Ig)G (etanercept).^[1,12] These agents were shown to suppress inflammation, slow progression of disease, and strikingly induce remission in certain patients with rheumatoid arthritis, ankylosing spondylitis, Crohn's disease, and psoriasis.^[1]

Targeting TNF-alpha

Because of the unmet need in patients with severe, persistent asthma, the potential of targeting TNF-alpha has been explored in 3 recent studies. In the first study, Howarth and colleagues^[13] demonstrated that TNF-alpha levels in the airways were related to the severity of asthma. Despite the use of high-dose corticosteroid therapy, the levels of expression of the TNF-alpha gene and protein in BAL fluid, and numbers of TNF-alpha immunoreactive cells, were higher in the airways of asthmatics with refractory disease than in the airways of control subjects or patients with milder disease. In an open-label trial of etanercept (soluble TNF-alpha receptor) for 3 months, treated patients had some improvement in measures of airflow, symptom scores, and bronchial hyperresponsiveness. Seventeen patients were recruited, and 15 completed the 12-week study. Paired sputum samples from 8 of 11 subjects showed reductions in eosinophil and neutrophil numbers, but failed to achieve statistical significance. The mean increase from baseline forced expiratory volume in 1 second (FEV₁) values was 240 mL with morning and evening peak expiratory flow (PEF) percentage predicted) increasing 6% and 8%, respectively.

In a similar study, Berry and colleagues^[14] measured markers of TNF-alpha activation in 10 patients with mild-to-moderate asthma and 10 control subjects. In addition, the effects of treatment with etanercept were evaluated in 10 patients with refractory asthma for 10 weeks in a randomized, double-blind, crossover study. The results showed that in patients with refractory asthma, there was increased expression of membrane-bound TNF-alpha, TNF receptor 1, and TNF-alpha-converting enzyme by peripheral blood monocytes. In the patients who completed the 10-week trial, treatment with etanercept reduced the expression of membrane-bound TNF-alpha in peripheral blood monocytes as well as demonstrated improvement in PC₂₀, asthma-related quality-of-life scores, FEV₁, and symptom scores. Of note, the baseline expression of membrane-bound TNF-alpha by peripheral blood monocytes and the extent to which it was reduced by etanercept treatment were independently associated with the net improvement in the primary outcome measures (PC₂₀ and asthma quality-of-life scores).

In a third study,^[15] infliximab was used in a double-blind, placebo-controlled, parallel group design. Thirty-eight patients with moderate asthma and treated with inhaled corticosteroids were enrolled and were symptomatic during the run-in phase. Infliximab was administered at weeks 0, 2, and 6 with evaluation at week 8. The primary endpoint, change in morning PEF at days 50-56 compared with the last 7 days of the run-in, was not significantly different on treatment. There were also no treatment differences in FEV₁, rescue beta2-agonist use, or in asthma symptom scores. In addition, there were no differences in markers of inflammation, including exhaled nitric oxide, blood eosinophil counts, or sputum cell composition. Infliximab treatment did reduce levels or TNF-alpha, interleukin (IL)-1alpha, IL-6, human interferon inducible protein (IP)-10, and IL-8 but not eotaxin in sputum supernates. Treatment with infliximab was associated with some reduction in asthma exacerbations and diurnal variation of the peak expiratory flow (PEF) rate. The study authors concluded that infliximab did not demonstrate significant clinical efficacy in primary endpoint lung function in these patients with symptomatic moderate asthma. Whether the apparent lack of benefit in this study compared to the 2 earlier studies represents differences in the pharmacology of targeting TNF-alpha with a monoclonal antibody (infliximab) or soluble receptors (etanercept) remains to be determined.

These studies suffer from the very short duration of the trials and the small numbers of patients who completed the full course of therapy. It is therefore important to await the results of much larger, multicenter, and well-designed trials before embarking on this expensive therapy in individual patients with refractory asthma. Patients with refractory asthma require novel therapeutic approaches to control their disease, especially when conventional therapy, including corticosteroids, fails. Whether targeting TNF-alpha will provide one such avenue awaits further study.

References

Feldmann M, Maini RN. Lasker Clinical Medical Research Award. TNF defined as a therapeutic target for rheumatoid target for rheumatoid arthritis and other autoimmune diseases. Nat Med. 2003;9:1245-1250. Abstract
Rudmann DG, Moore MW, Tepper JS, et al. Modulation of allergic inflammation in mice deficient in TNF receptors. Am J Physiol Lung Cell Mol Physiol. 2000;279:L1047-L1057. Abstract
Zuany-Amorim C, Manlius C, Dalum I, et al. Induction of TNF-alpha autoantibody production by AutoVac TNF106: a novel therapeutic approach for the treatment of allergic diseases. Int Arch Allergy Immunol. 2004;133:154-163. Abstract
Kips JC, Tavernier J, Pauwels RA. Tumor necrosis factor causes bronchial hyperresponsiveness in rats. Am Rev Respir Dis. 1992;145:332-336. Abstract
Thomas PS, Yates DH, Barnes PJ. Tumor necrosis factor-alpha increases airway responsiveness and sputum neutrophilia in normal human subjects. Am J Respir Crit Care Med. 1995;152:76-80. Abstract
Thomas PS, Heywood G. Effects of inhaled tumour necrosis factor alpha in subjects with mild asthma. Thorax. 2002;57:774-778. Abstract
Li Kam Wa TC, Mansur AH, Britton J, et al. Association between -308 tumour necrosis factor promoter polymorphism and bronchial hyperreactivity in asthma. Clin Exp Allergy. 1999;29:1204-1208. Abstract
Noguchi E, Yokouchi Y, Shibasaki M, et al. Association between TNF{alpha} polymorphism and the development of asthma in the Japanese population. Am J Respir Crit Care Med. 2002;166:43-46. Abstract
Proceedings of the ATS workshop on refractory asthma: current understanding, recommendations, and unanswered questions. Am J Respir Crit Care Med. 2000;162:2341-2351. Abstract
Thomas PS. Tumour necrosis factor-alpha: the role of this multifunctional cytokine in asthma. Immunol Cell Biol. 2001;79:132-140. Abstract
Pennings HJ, Kramer K, Bast A, Buurman WA, Wouters EF. Tumour necrosis factor-alpha induces hyperreactivity in tracheal smooth muscle of the guinea-pig in vitro. Eur Respir J. 1998;12:45-49. Abstract
Aggarwal BB. Signalling pathways of the TNF superfamily: a double-edged sword. Nat Rev Immunol. 2003;3:745-756. Abstract
Howarth PH, Babu KS, Arshad HS, et al. Tumour necrosis factor (TNFa) as a novel therapeutic target in symptomatic corticosteroid dependent asthma. Thorax. 2005;60:1012-1018. Abstract
Berry MA, Hargadon B, Shelley M, et al. Evidence of a role of tumor necrosis factor alpha in refractory asthma. N Engl J Med. 2006;354:697-708. Abstract
Erin EM, Leaker BR, Nicholson GC, et al. The effects of a monoclonal antibody directed against tumor necrosis factor-alpha in asthma. Am J Respir Crit Care Med. 2006;174:753-762. Abstract

source Medscape

Revolutionary new medical device offers hope for hayfever and allergy sufferers

2007-03-16T19:02:27Z

Medinose heralds a breakthrough in the way hayfever and allergies are treated. Using photo therapy (light therapy) Medinose can practically eliminate allergic symptoms such as congestion, runny nose, watery eyes, and headaches within a couple of weeks of use.

Using photo therapy, Medinose inhibits the release of histamine, relieving or even completely eliminating allergic reactions and complaints in a natural way. The body is not burdened by drugs and Medinose has no side effects. Medinose consists of a small power pack (about the size of an IPOD) and two probes which are inserted into the nostrils.

Each treatment session with the Medinose takes just approx. 4.5 minutes 2-3 times a day. The Medinose can be used anywhere: at home, on the move or at work. With severe symptoms, treatment can be repeated several times without any side effects. As soon as the symptoms subside, the number of treatments can be reduced. The Medinose is, however, also suitable for prevention. ]]> Phototherapy is a method developed in hospitals for treating allergic reactions. It uses visible red light that acts on the cellular metabolism, slowing down the immune reaction and reducing inflammation of the nasal mucous membranes. The light causes an overall reduction in allergic reactions and symptoms. The manufacturers of Medinose have taken this technology and developed a hand held, consumer friendly device.

A double blind, placebo controlled trial was conducted to assess the effectiveness of Medinose. Following treatment, 72% of allergic rhinitis patients reported a reduction in symptoms and an improvement in their overall condition, compared to only 24% in the placebo group. Patients also received a nasaloscopy (examination of nasal tissue using an endoscope), which further supports the results by showing a significant reduction in nasal tissue inflammation after treatment. This is the ‘gold standard’ diagnostic evaluation for nasal conditions.

NB: Medinose is suitable for use by children. Particularly effective at reducing symptoms associated with hayfever, dust and animal allergies. Full 30 day money back guarantee if not satisfied.

More information:

Valeo Public Relations
Email: jon@valeo-pr.com
Tel: 020 8392 3908

Medinose costs £79.95 and is available by calling:

Tel: 0870 350 1264
www.anhealth.co.uk

Baking Soda Helps Kids During Severe Asthma Attack

2007-03-08T19:50:31Z

An intravenous infusion of a solution of sodium bicarbonate -- better known as baking soda -- reduces respiratory distress and excessive acidity of body fluids in children with a life-threatening asthma flare-up, according to a report from the Netherlands.

High blood acidity, or acidosis, causes the heart to contract less strongly, reduces the effectiveness of beta-agonist bronchodilators used to treat asthma, and may stimulate rapid, shallow breathing, Dr. Corinne M. P. Buysse and her colleagues point out in the medical journal Chest.

They explain that treatment with sodium bicarbonate has been shown to relieve bronchial spasm and restore the response to bronchodilators. However, doctors have avoided the use of intravenous sodium bicarbonate for fear of increasing levels of carbon dioxide in the blood.

]]> Buysse’s team analyzed data on 73 children with life-threatening asthma admitted to the pediatric intensive care unit of the Erasmus MC-Sophia Children’s Hospital in Rotterdam. Sodium bicarbonate was administered intravenously to patients along with usual care if acidosis set in and the patient remained in respiratory distress.

Seventeen patients were given infusions of sodium bicarbonate, which resulted in a significant decrease in acidity, and 16 patients experienced "prompt" improvements in respiratory disease and level of consciousness.

Blood levels of carbon dioxide actually decreased significantly.

The researchers note that sodium bicarbonate was given to 14 patients in a last-ditch attempt to avoid putting them on a respirator, and only one of these subsequently required ventilation. All the patients survived.

"We believe that sodium bicarbonate might be useful as an adjunctive treatment in patients with life-threatening asthma and acidosis in whom mechanical ventilation is considered," Buysse and her associates conclude.

source Pakistan News online

Survey Shows Discomfort With Existing Nasal Sprays Causes Allergic Rhinitis Patients to Discontinue Treatment

2007-03-08T18:31:18Z

SAN DIEGO, Feb. 26 /PRNewswire/ -- A survey of more than 1,500 allergic rhinitis sufferers who have used a prescription nasal spray to treat their symptoms revealed that device and formulation-related attributes were the major causes of discontinuing their treatment. The survey data (poster #896) were presented today at the annual meeting of the American Academy of Allergy, Asthma & Immunology (AAAAI).

"These results suggest compliance among nasal spray users could improve if new technology overcomes the key barriers to continued use identified by these patients," said Eli Meltzer, M.D., co-director of the Allergy & Asthma Medical Group and Research Center in San Diego, Calif., who led the survey. "This is important because nasal sprays, specifically intranasal corticosteroids, are considered by medical experts as first-line therapy when congestion is a major component of the patient's nasal allergy symptoms."

]]> Survey respondents indicated that medication running down their throats or out of their noses was the primary reason for stopping treatment (62 percent). Other reasons for stopping treatment cited by nasal spray users included the bitter taste left by nasal sprays (44 percent), failure to provide 24-hour relief (35 percent), uncertainty about the amount of medication received in each spray (32 percent) and lack of clarity regarding when to refill their prescriptions (31 percent).

When asked which features of a nasal spray were most important to them, survey respondents selected ease-of-use as the most important (47 percent). Other attributes survey responders rated as important when considering nasal spray features included minimal side effects (46 percent) and medication that does not run down the throat or out of the nose (43 percent) or cause throat or nose irritation (43 percent).

INS

Allergic rhinitis (AR), known as nasal allergies, is an inflammatory reaction of the nasal passages to allergens, such as dust mites, animal dander, mold spores, and pollens. One of the most prevalent and chronic diseases in the U.S., nasal allergies affect up to 40 million people annually, including 10 to 30 percent of adults and up to 40 percent of children. Within minutes of exposure to an allergen, immune response cells release inflammatory mediators -- such as histamines and leukotrienes -- that lead to inflammation and produce symptoms including nasal congestion, sneezing and runny or itchy nose. Seasonal allergic rhinitis, triggered by pollens, occurs during certain seasons and lasts a few weeks to a few months. Perennial allergic rhinitis, triggered by dust mites, animal dander, and mold, occurs year-round.

About GlaxoSmithKline

GlaxoSmithKline is one of the world's leading research-based pharmaceutical and healthcare companies. GlaxoSmithKline is committed to improving the quality of human life by enabling people to do more, feel better, and live longer. For company information visit www.gsk.com.

Source: GlaxoSmithKline

Progress Against Peanut Allergies

2007-03-07T10:12:45Z

Small doses of peanut protein, given for months under medical supervision, can desensitize children with peanut allergy, reducing the risk of a reaction if they accidentally eat peanuts, according to a new study.

In other new research, scientists say they have found a way to predict which children are likely to outgrow their allergy to peanuts.

Both studies were presented Saturday at the 2007 Annual Meeting of the American Academy of Allergy, Asthma and Immunology in San Diego.

]]> About Peanut Allergies

Peanut allergies affect about 1% of the U.S. population, according to the Academy.

Reactions can range from mild to severe, even leading to anaphylaxis, a potentially fatal response that can cause breathing problems and loss of consciousness.

Traditional advice for food allergies was to simply avoid the food.

But avoiding all peanut-containing foods can be difficult and accidental ingestion often occurs, says Scott David Nash, MD, allergy fellow at Duke University and an author of the desensitization study.

About Immunotherapy

For years, allergists have used immunotherapy, or allergy shots, to help children with allergies to insect stings and nasal allergies to non-food substances, for example.

With immunotherapy, tiny amounts of the allergens are injected until tolerance develops.

Oral Peanut Immunotherapy

So Nash's team decided to try oral immunotherapy for peanut allergy problems, giving eight children with known peanut allergy escalating doses of peanut protein in the form of a flour mixed into applesauce or other food.

"We are the first to do a trial of oral immunotherapy for peanut allergy," he tells WebMD.

The treatment included three phases: one day in the medical center, with increasing doses given throughout the day; a home phase lasting three or four months that involved daily, escalating doses; and a home maintenance phase in which the daily dose was 300 milligrams, about the equivalent of one peanut.

The maintenance phase lasted up to 18 months, depending on how much peanut protein the child tolerated.

At the end of the study, which seven children completed, Nash's team gave the children a "food challenge" to peanut flour, exposing them to up to nearly 8 grams, or the equivalent of more than 13 peanuts.

"Most [five of seven] tolerated the equivalent of 13 peanuts at the food challenge at the end of the study," Nash says.

Immune system changes from the start to the end of the study showed growing tolerance to the peanut protein, he says.

Goals of Immunotherapy

"What we would like to have happen is for their food allergy to go away," Nash says.

For now, however, he says, "We have essentially proven they can tolerate an accidental ingestion. We think our patients now are at reduced risk for anaphylaxis."

Egg Allergies Studied

"No one should try this at home," Nash cautions. The concept is still in the research phases, and Nash says it's difficult to say when allergists might begin adopting the practice.

Parents in the study were told to contact the center if they suspected reactions; most reactions occurred in the clinic, not at home, Nash says.

More research is needed, he says, to prove the concept safe and effective.

Similar research is being done with egg immunotherapy. Wesley Burks, MD, another author of the peanut immunotherapy study, has done a similar study on egg allergies, Nash says.

The Remission Question

When parents find out their child is allergic to peanuts, they always ask the same question, says Katie Allen, MD, PhD: "Are they going to be one of the 20% who grow out of it?"

Allen is a pediatric gastroenterologist and allergist at the Murdoch Children's Research Institute at the Royal Children's Hospital in Melbourne, Australia.

Until recently, doctors could only guess.

Now, Allen has found some good predictors by looking at skin prick test results.

The Skin Prick Test

In this test, commonly used by allergists, the skin is pricked and a tiny amount of the allergen is dropped onto the skin.

If the person is allergic to the substance, the body's allergic antibody, immunoglobulin E (IgE), is triggered and a chain reaction is set off, resulting in the patch of pricked skin becoming red and swollen.

This raised bump or small hive is called a wheal, and its size is known to give clues about allergies, Allen tells WebMD.

It's well-known by allergists, she says, that "kids who are 12 months old and have a skin prick with a wheal that is more than 4 millimeters means they are more than likely to have a reaction [if they eat the food they're suspected of being allergic to]."

The Remission Study

Allen and her colleagues followed 267 children with peanut allergies, some for years, to see if the size of the wheal over time could predict remission.

The children entered the study at an average age of 14 months -- the time when most infants first show peanut sensitivity, Allen says.

"We looked at the size of the skin prick wheal and followed them," Allen says. Once the size of the wheal that came after a prick fell sufficiently, the scientists would give a food challenge to see if the child had outgrown the allergy.

"We found that 20% of them outgrew it by 5 years of age,'' Allen says.

"We found the best predictor of remission was a falling skin prick test ... every year the reaction got a little smaller," she says.

The size of the wheal when children are younger can predict remission, too, Allen says.

"If the skin prick wheal is greater than 6 millimeters before 2 years of age, they are 1.5 times less likely to become tolerant," she tells WebMD.

The severity of the initial reaction, however, did not predict tolerance. "Kids with severe initial reactions are as likely to outgrow it," she says, as those whose first reaction was milder.

The results offer valuable information not just for parents whose children do outgrow it, she says, but also for those whose children are not likely to and therefore may need closer follow-up.

source WebMD

Gene find could be end of the asthma inhaler

2007-03-01T12:10:59Z

Scientists have identified a gene that could lead to a breakthrough in the treatment of asthma, with tablets replacing steroid inhalers.

As a result of work carried out at Dundee University, researchers believe that drugs currently used to treat diabetes could be adapted to control acute asthma attacks.

Until now asthma treatments have been dominated by steroid therapies which can often have serious side effects.

]]>

There are around 400,000 asthma sufferers in Scotland, more than one-quarter of them children.

Research has revealed that a particular form of the PPAR gamma gene makes young asthmatics two to three times more likely to suffer acute attacks. The gene has been studied by teams working on diabetes, cancer and heart disease. Now scientists say the cross-over to asthma has produced "exciting results".

Somnath Mukhopadhyay, consultant paediatrician at Tayside Children's Hospital, who has led the research with Colin Palmer from the Biomedical Research Centre in Dundee, said: "The exciting thing is that drugs which target PPAR gamma are already available and used to treat type 2 diabetes. If these drugs also correct the problems . . . in terms of increased proneness to asthma attacks, then this is potentially a major boost in how we treat asthma.

"The next step for us is to investigate whether these drugs, which do not carry any of the side-effects of steroids, have the effect of protecting asthmatics from acute asthma attacks."

Dr Palmer said: "Our hope is that by identifying the gene we will be able to personalise asthma treatment for each individual patient, thereby making it more effective.

"The next stage will be to carry out clinical trials with these diabetes drugs to see if they are equally effective in preventing asthma attacks.

"If the trials are successful it could be that the tablets would be used to completely replace steroid inhalers for some asthmatic children, avoiding all of the side effects often associated with steroids."

Asthma attacks are one of the commonest causes of school absences, hospital admissions and GP visits. They cost the NHS over £100m a year and nearly 13 million UK working days are lost to the condition every year.

Dr Mukhopadhyay said that using inhaled steroids in high doses could results in the suppression of the patients' adrenal glands and this leads to the body having low resistance to infections and other problems.

The research is published in the journal Clinical Pharmacology and Therapeutics.

source - The Herald UK

What Is Known About Asthma In Africa?

2007-03-01T12:07:22Z

A study led by Adnan Custovic from the University of Manchester analyzing two surveys ten years apart (1993 and 2003) among 9-16 yr old schoolchildren attending urban and rural schools in Ghana showed that the prevalence of both exercise-induced bronchospasm and atopy had approximately doubled over the period.

A related essay puts this survey into context through a discussion of the epidemiology of asthma in Africa.

Citation: Addo-Yobo EOD, Woodcock A, Allotey A, Baffoe-Bonnie B, Strachan D, et al. (2007) Exercise-induced bronchospasm and atopy in Ghana: Two surveys ten years apart. PLoS Med 4(2): e70. ]]> Related PLoS Medicine Essay:

What do we know about asthma in Africa?

A recent study published in PLoS Medicine found an increase in the prevalence of asthma and allergic diseases in children in Ghana between 1993 and 2003. In an essay in this week's PLoS Medicine, two asthma researchers discuss how asthma in Africa differs from asthma in industrialized countries.

Matthias Wjst (Institut für Epidemiologie, GSF-Forschungszentrum für Umwelt und Gesundheit, Germany) and Daniel Boakye (University of Ghana) say that while asthma symptoms are the same in Africa and the West, there are differences in risk factors and prevalence, and the disease may be caused in different ways.

Citation: Wjst M, Boakye D (2007) Asthma in Africa. PLoS Med 4(2): e72.

source Medical News Today

AAAAI: Oral Immunotherapy Dampens But May Not Cure Peanut Allergy

2007-02-27T12:36:56Z

SAN DIEGO -- An oral immunotherapy regimen can help take the sting out of severe peanut allergies, reported investigators here.

Five of seven children with severe peanut allergy were able, after two years of immunotherapy, to tolerate a dose of 7.8 grams of peanut flour, equivalent to eating more than 13 peanuts, reported Scott David Nash, M.D., of Duke in Durham, N.C., and colleagues.

Yet while oral immunotherapy can desensitize patients to peanuts, children who undergo it may not be in the clear, cautioned the authors in a featured poster session at the annual meeting of the American Academy of Allergy, Asthma & Immunology here.

]]> "We think that our patients are now at decreased risk for anaphylaxis if they have accidental ingestion [of peanuts], but we're not recommending that our patients reintroduce peanuts into their diets, and all patients were on peanut-elimination diets during the study," said Dr. Nash.

The investigators enrolled children with a convincing clinical history of peanut allergy who had peanut-specific immunglobulin E (IgE) of 7kU/L or greater.

The children were started on a modified rush immunotherapy protocol, performed in the research unit, in which they would receive over one day increasing multiple doses of peanut flour (mixed in a food of choice, such as applesauce), with dose escalating from 0.1 mg to 25 mg, or, if tolerated, to 50 mg. About half of the patients were able to tolerate the 50 mg dose by the end of the day; the remainder were able to tolerate either 12.5 or 25 mg, said Dr. Nash.

The children then went home and remained on their current dose daily, returning to the center every two weeks for a dose increase until they reached a dose of 300 mg, equivalent to about one peanut. Parents were asked to keep a daily diary of symptoms.

After patients had been maintained on 300 mg of peanut flour daily for two years, they returned to the center for an open food challenge of up to 7.8 g of peanut flour, equal to a good adult-sized handful of nuts. The challenge was delivered as escalating doses beginning at 600 mg every 30 minutes up to the maximum.

In all, five of seven patients had no reaction on the food challenge. One patient took the full dose, but 90 minutes later had a reaction, including stridor, that required epinephrine. The remaining patient made it to 4,200 mg, and then required epinephrine for cough and diffuse hives.

They also looked at immunologic characteristics of food allergy, and found that peanut-specific IgE and IgG both rose initially and the fell during the study, while peanut-specific IgG4 increased throughout the study.

"Peanut oral immunotherapy, we feel, is safe and effective for peanut-allergic patients, and we feel that our immunologic findings for peanut oral immunotherapy are similar to what we find for other forms of oral immunotherapy," Dr. Nash said.

Primary source:

American Academy of Allergy, Asthma & Immunology

Source reference:

Nash SD et al. "Oral Peanut Immunotherapy For Peanut Allergic Patients." Abstract 622 presented Feb. 25

via MedPageToday

Cows' milk can protect against asthma

2007-02-27T12:33:04Z

Children who start drinking fresh milk from the farm early on are less likely to develop allergies when they are of school age, according to Swiss scientists.

But why more people are suffering allergies remains unclear, say researchers at Basel University, who have begun a study involving more than 14,000 children.

Cows' milk as food for infants has a bad reputation. From a nutritional perspective it does not fulfil the dietary requirements of babies, and children who are fed only cows' milk for too long often suffer an iron deficiency.

]]> But there is now positive news concerning cows' milk. Marco Waser and fellow epidemiologists at the Institute of Social and Preventive Medicine of Basel University have shown that children, even from the age of one, who consume fresh milk straight from the farm? whether untreated or boiled? are less likely to develop asthma and hay fever.

Roughly 30 per cent fewer children had asthma and about 40 per cent fewer children developed hay fever.

"[The study] showed that the protective effect was greatest for children who until now had regularly drunk milk that came from a farmyard," Waser said.

The data was taken from the "Parsifal" study, which involved 14,000 children.

"What is astonishing is that the milk's protective effect was no longer dependent on whether the children actually lived on a farm. This obviously opens new perspectives for more widely applied preventive measures," he added.

Hypothesis

Asthma is today one of the most common illnesses, in particular in industrialised countries, and its frequency is increasing. The number of new hay fever cases also continues to rise.

Why this should be remains a mystery: air pollution, lifestyle and different nutritional habits have all been suggested.

There are also many supporters of the "hygiene hypothesis", which contests that our modern environment is too sterile, with the result that the stimulation of the immune system in early ages is absent.

"The hygiene hypothesis has solid foundations," said Roger Lauener, a paediatrician and allergy expert at Zurich Children's Hospital.

The hypothesis is also believed to be behind the secrets of the healthier farm children. Thus Lauener was able to demonstrate how harmless microbes in the immune systems of farm children triggered certain changes.

But what exactly lies behind the proven protective effects remains unclear. It is also possible the microbes play a role here as well, yet the researchers say it is astonishing that it made no difference whether the milk was boiled or not.

What's more, other products that are eaten straight from the farm, such as fruit or vegetables, had no protective effect whatsoever.

Therefore scientists are looking at other components of milk, for example omega:3 fatty acids.

Early effect

The Swiss researchers are hoping to get more solid insights from the "Pasture" study, in which the allergy development of 500 children who have grown up on farms and 500 who haven't has been specifically monitored over four years.

The Pasture study includes the effects of mothers' milk and cows' milk among other factors.

The advice of Swiss paediatricians remains that children should not be given cows' milk before their second year. By that time it cannot do much harm ? but it has probably also lost a lot of its preventive power.

"These effects on the immune system are a factor above all in one's earliest childhood," said Lauener.

source Swissinfo

Finnish study links child asthma with structural dampness in buildings

2007-02-27T12:26:49Z

A fresh study by the Environmental Health section of the National Public Health Institute shows a strong link between asthma in children and dampness in the building structures of the home.

According to an article in the upcoming edition of the European Respiratory Journal, at least one in ten, and possibly as many as one in five cases of asthma among children are linked with water damage in the building.

The onset of asthma is the result of the cumulative effect of many factors. Nevertheless, in the 1990s there was a rapid increase in cases of asthma in Finland, as well as an increase in damage caused by dampness in buildings.

]]> More recently, cases of asthma have declined.

The prognosis for young children being treated for asthma is quite good; many are completely cured.

When the small children involved in the study were diagnosed with asthma, two building engineers were sent to the home to look for signs of dampness: leaks of water and stains they may have left behind, discolouration in building materials, flaking paint on walls, fungal odour, or visible fungus.

The engineers also visited the homes of children in a control group. These children, who did not have asthma, were of the same age as the ones who did, living in the same kinds of buildings and in the same area.

It was found that the homes of children with asthma were more likely to have windows that fogged up in cold weather, as well as humidifiers and supplementary heaters.

Dampness and visible fungus in living areas had a significant correlation with the frequency of asthma; fungus in cellars and saunas, where children spend less time than in their bedrooms, were less significant.

The researchers recommended that closer attention be paid to the planning, implementation, and maintenance of buildings.

The degree of the damage also affected the risk of illness. The more serious the damage, the greater the danger that a child might come down with asthma.

mechanism that leads to the onset of the disease is not known, but materials damaged by dampness and fungus put out particles similar to microbes and spores, as well as even smaller fragments.

It has been estimated that between 84 and 95 per cent of fungus spores and 27 to 46 per cent of fragments can end up in the lungs, and it is believed that the fragments can get into the lower respiratory tracts of small children more easily than that of others, according to laboratory nurse Aino Nevalainen and researcher Anne Hyvärinen in an article in the Finnish medical journal Lääkärilehti. Nevalainen and Hyvärinen conducted the new study along with research professor Juha Pekkarinen.

Dust mites are not seen to be major culprits. Researchers note that there are few dust mites in Finnish homes and that they emerge irregularly, because indoor air tends to be dry most of the year.

Dust mites were as common in the beds of children without asthma as in those of children who have the disease.

source Helsingin Sanomat

Dynavax drops allergy drug trials

2007-02-26T14:56:39Z

BERKELEY — Biopharmaceutical company Dynavax Technologies Corp. announced Friday it is discontinuing two clinical trials for its ragweed allergy treatment.

The Berkeley-based company said it will explore developing a different path for trials for the treatment, called Tolamba.

It announced Jan. 8 that trials for the drug were inconclusive, sending shares of the company's stock that day down 30 percent to just below $6.

"It's not the death knell for the allergy program," said Shari Annes, a Dynavax spokeswoman. "It was an inconclusive trial, not a failed drug."

]]> The company said it wants to find a partner and create a trial that's different from the traditional allergy trial that was inconclusive.

Dynavax also said it will reduce by $25 million its expenditures for clinical development this year.

The company's stock fell 4 cents Friday to $5.50 on the Nasdaq stock market. It peaked at $10.66 per share in November, and was a fast-rising stock for 2006. But the stock reversed directions after the January announcement.

Dynavax will continue focusing on its hepatitis B vaccine that is in pivotal Phase 3 clinical trials, Annes said.

Earlier this month, Dynavax announced a loss of $52 million for 2006.

It now expects 2007 revenue in the range of $24 million to $28 million.

The company has $86 million in cash and expects an influx of $30 million in April.

source - Insde Bay Area

Steroid-Free Astelin Nasal Spray Demonstrated Seasonal Allergy Symptom Improvement Within 15 Minutes in Clinical Study

2007-02-26T14:51:04Z

The prescription antihistamine Astelin(R) (azelastine HCl) Nasal Spray(R) relieved the major symptoms of pollen allergy, including sneezing, runny nose and congestion, within 15 minutes of application compared to placebo and maintained efficacy at all time points for 8 hours in a randomized, single dose, double-blind, placebo- controlled study, MedPointe Pharmaceuticals announced today.

In addition, a group of patients treated with intranasal Nasonex(R) (mometasone furoate monohydrate) did not show symptom improvement compared to placebo during the eight hour study period. Data from the 450-patient study, conducted in a controlled environmental exposure unit (EEU), were presented at the 2007 American Academy of Allergy, Asthma and Immunology (AAAAI) Annual Meeting in San Diego, California.

]]> "Patients suffering from seasonal allergies want rapid relief from their symptoms. These new data confirm that the second-generation antihistamine nasal spray ASTELIN is fast-acting and maintains significant control of moderate to severe allergy symptoms," said William E. Berger, MD, Clinical Professor, Department of Pediatrics, Division of Allergy and Immunology, University of California, Irvine, and Medical Director of Allergy and Asthma Associates of Southern California. "Because ASTELIN rapidly relieves the full range of rhinitis symptoms, including congestion, caused by both seasonal allergens and environmental irritants, and is well-tolerated, it is a particularly effective first-line therapy for most patients."

About the Study

The study was designed to compare the onset of action of ASTELIN and the intranasal steroid Nasonex to placebo in patients symptomatic for seasonal allergic rhinitis (SAR) after controlled exposure to ragweed pollen in an EEU.

Treatment activity was evaluated on the basis of total nasal symptom scores (TNSS), combining patient-assessed severity of sneezing, nasal itching (pruritis), runny nose (rhinorrhea), and congestion on a 4-point scale (0 for no symptoms to 3 for severe symptoms). Patients who demonstrated moderate to severe rhinitis symptoms upon exposure to ragweed were admitted to the study. A total of 450 patients, 150 in each study arm, were randomized to receive two metered sprays per nostril of either ASTELIN, Nasonex or placebo spray and then asked to record their symptoms at specified intervals over 8 hours of pollen exposure in the EEU.

By the first post-dose observation at 15 minutes, ASTELIN(R) (azelastine HCl) Nasal Spray(R) produced a significant reduction from baseline TNSS of 3.12 units, compared to 1.28 units in the placebo arm (p < .001). This significant difference in symptom reduction for ASTELIN persisted at each time point during the 8-hour allergen exposure versus placebo.

Nasonex(R) (mometasone furoate monohydrate) did not produce a significant reduction from baseline TNSS compared to placebo at any time point (p . .09). ASTELIN demonstrated a significant reduction from baseline TNSS compared to Nasonex at each time point during the 8-hour study period (p . .001).

"This study contributes to the robust body of data we've been assembling on the broad utility of ASTELIN in the treatment of seasonal allergies and nonallergic vasomotor rhinitis," said Paul R. Edick, President and CEO of MedPointe Pharmaceuticals. "This single-dose study demonstrated that ASTELIN provided significant, rapid relief of nasal symptoms as early as 15 minutes and maintained efficacy over the entire 8 hour study period, while Nasonex did not separate from placebo at any time point in the study. Because ASTELIN is a product in a highly competitive therapeutic category where fast relief is important, an established rapid onset of action gives ASTELIN the hallmark of a potential market leader."

Safety

Both ASTELIN and Nasonex were well tolerated in the study. The only adverse event that occurred in more than 2 percent of patients in any treatment group was headache in 3 (2.0 percent) patients receiving Nasonex, 4 (2.7 percent) receiving placebo, and 0 receiving ASTELIN. There were no severe or serious adverse events in any treatment group and all 450 randomized patients completed the study.

Impact of Allergies

As many as 58 million people, approximately 20 percent of the U.S. population, suffer from seasonal allergies, caused by pollen, spores, and other plant allergens, and associated with familiar nasal symptoms (seasonal allergic rhinitis) including sneezing, runny nose and congestion. Millions of Americans affected by seasonal allergies also may be sensitive to environmental triggers, including such irritants as air pollution, cigarette smoke, cold or dry air, and cleaning solutions, which cause similar nasal symptoms (nonallergic vasomotor rhinitis). In addition to its impact on quality of life and lost productivity, allergic rhinitis results in more than 20 million physician visits each year and up to $6 billion in healthcare costs. Accurate diagnosis, specifically the identification of symptom triggers, and the evaluation of symptom severity and duration are critical to the selection of appropriate therapy.

Additional Information About ASTELIN(R)

ASTELIN(R) (azelastine HCl) Nasal Spray(R) is a steroid-free antihistamine nasal spray, available by prescription only, that provides rapid relief from symptoms, including congestion, runny nose, postnasal drip, itchy eyes/nose, and sneezing, associated with seasonal allergies or environmental irritants. ASTELIN is the only prescription antihistamine nasal spray approved by the U.S. Food and Drug Administration (FDA) to treat symptoms of both seasonal allergic rhinitis and nonallergic vasomotor rhinitis.

ASTELIN is indicated for the treatment of the symptoms of seasonal allergic rhinitis in patients 5 years of age and older and nonallergic vasomotor rhinitis in patients 12 years of age and older.

The most commonly reported adverse events in seasonal allergic rhinitis and nonallergic vasomotor rhinitis patients 12 years and older were bitter taste, headache, somnolence, and nasal burning. The adverse event profile in seasonal allergic rhinitis patients 5 to 11 years was similar to that in the adult population.

Additional information and/or full Prescribing Information on ASTELIN is available by calling 1-800-598-4856 or by visiting www.astelin.com.

About MedPointe Pharmaceuticals

MedPointe Pharmaceuticals is a privately held, specialty pharmaceutical company located in Somerset, New Jersey. MedPointe specializes in respiratory, allergy, central nervous system, and cough-cold products. The company maintains a manufacturing facility in Decatur, Illinois. For more information on MedPointe, visit http:// www.astelin.com.

source PRNewsWire

FDA Warns On Genentech's Asthma Drug Xolair

2007-02-22T21:10:07Z

WASHINGTON -(Dow Jones)- The U.S. Food and Drug Administration warned Wednesday a Genentech Inc. (DNA) asthma drug can cause a life-threatening allergic reaction known as anaphylaxis.

The agency said it's asked the company to put a black-box warning label on the drug, which is sold under the brand name Xolair. A black box warning is the FDA's strongest warning.

Xolair was approved in 2003 to treat adults and adolescents with moderate to severe persistent asthma related to allergies whose symptoms are inadequately controlled with inhaled steroids.

A company spokesman couldn't immediately be reached.

Genentech shares recently rose 8 cents to $87.02.

Race May Play a Role in Children’s Asthma Care

2007-02-21T13:47:28Z

Newswise — Children in this country suffer from asthma more than any other chronic illness, and new research finds African-American children with the condition have a greater risk than others of experiencing severe symptoms that escalate into an emergency.

Previous research has shown that in comparison with white and Hispanic children, African-Americans have a higher rate of asthma, are hospitalized more and face more disability due to the condition. Because of this, “we suspected they might also exhibit relatively more severe asthma symptoms at the time of hospitalization,” said Yu Bai, a doctoral candidate at Pennsylvania State University.

Bai and his colleagues analyzed the records of 7,726 white, African-American and Hispanic children up to age 19 who were admitted to Pennsylvania hospitals in 2001 for asthma symptoms. The researchers then examined how the physician reported the severity of the children’s condition and ranked them either as “emergency” or “non-emergency” admissions.

]]> Ninety percent of the African-American children had an emergency asthma condition compared with 60 percent of white and 64 percent of Hispanic children. In all, African-American children were more than twice as likely to have severe asthma symptoms as whites.

The study appears in the February issue of the Journal of Health Care for the Poor and Underserved.

Bai and colleagues found that children on Medicaid had the most severe symptoms at admission compared with those who had private insurance — and two-thirds of African-American children had Medicaid or other public insurance.

Other studies have shown that children on Medicaid have less access to primary care for asthma and are less likely to be prescribed the proper medication, according to the authors.

Bai said there’s a need for improvement: “Providing greater resources to the Medicaid program would allow for more comprehensive provision of services that would help children and their families manage asthma including case management services, provision of medically necessary equipment and supplies and referrals to asthma specialists when needed.”

Barbara Tilley, Ph.D., chair of the department of biometry and epidemiology at the Medical University of South Carolina in Charleston, said the authors’ results were “consistent with other studies that indicate an increased burden of asthma for African-American children whether or not they are on Medicaid.” She agreed there is a need for improvement in delivery of care for all children on Medicaid with asthma.

Journal of Health Care for the Poor and Underserved: Contact Editor Virginia M. Brennan at (615) 327-6819 or vbrennan@mmc.edu. Online, visit http://www.press.jhu.edu/journals/journal_of_health_care_for_the_poor_and_underserved/

source Newswise

Cracked skin could be path to asthma

2007-02-21T13:43:37Z

Researchers have long noted that many asthma sufferers also have atopic dermatitis -- often called eczema -- a chronic disease of the skin that can leave it red, raw, scaly, tender, oozy and excruciatingly itchy. But scientists are looking at whether such ravaging of the skin creates the conditions that can trigger asthma.

British scientists reported last spring in the journal Nature Genetics that people who suffer from both eczema and asthma carry the same gene mutation and concluded that in some cases eczema may actually lead to asthma.

]]> Until now, it had largely been assumed that dander, dust mites, pollen and other allergens that can cause asthma enter the body through the respiratory system. But the researchers said they now believe that they also can enter the body through tiny breaks in the skin's surface -- something that occurs in patients with eczema.

"Allergens from our environment can actually enter the skin through these cracks and the immune cells under the skin cells appear to be reacting and forming an allergic reaction" to them, said Dr. Thomas J. Hudson, an immunologist and the president and scientific director of the Ontario Institute for Cancer Research. He was not affiliated with the study but wrote a commentary on it in Nature Genetics.

That allergic reaction "can prime the immune system so that subsequent inhalation of the same allergens leads to a reaction in the lungs and contributes to the development of asthma," Dr. Julie Schaffer, an assistant professor of dermatology at New York University School of Medicine, wrote in an e-mail message.

The researchers also found that two gene mutations, known to diminish the skin's ability to form its protective outer barrier, were present in people with both asthma and eczema, confirming that the two can be genetically linked. But individuals who had asthma but no eczema did not have the mutations.

The lack of a direct link between asthma and the mutations -- when eczema was not present -- suggests that sensitization may arise after eczema sets in, as a result of a weakened skin barrier, Hudson concluded.

Doctors said their strongest hope is that the discovery could lead to new ways to prevent asthma in people who are genetically susceptible. The measures could be as simple as using moisturizer and gentle cleansers on babies and children to improve the health of their skin, said Dr. Jon M. Hanifin, a professor of dermatology at Oregon Health and Science University and a consultant to drug companies.

Asthma, the Most Common Chronic Childhood Illness, Affects about 10% of Children

2007-02-20T13:38:50Z

DUBLIN, Ireland--(BUSINESS WIRE)--Research and Markets has announced the addition of Asthma – Evaluation and Management 2007 Update to their offering.

Patients with asthma require a continuum of preventive, acute, psychological, rehabilitative, education, and self-management interventions to meet their complex health and psychosocial needs. Deaths usually occur in asthma as a result of the lack of appreciation for the severity of an exacerbation, and inadequate prompt home emergency treatment.

Care by a pulmonary or allergy specialist for patients with mild to moderate as well as severe asthma has demonstrated improved outcomes. Improved outcomes related to specialist management (as measured by reduced hospitalizations and ER visits) appear due to the greater use of prophylactic medication and other strategies such as case management.

]]> This Report Provides:

Diagnosis, non-pharmaceutical and pharmaceutical management to improve the quality of care while reducing cost.
References.
Example handouts.
Web links/other resources.

These ‘single topics’ provide the tools needed for a cost-effective, evidence-based strategy to increase the efficiency and quality of care management. Each is supported by current references from the peer-reviewed medical literature and other authoritative resources.

Topics Covered:

Preface

Disclaimers, Copyright and proprietary protection notice

Introduction

Action Plans

AAHP/HIAA study findings

JCAHO proposed standards for clinical guideline use in hospitals

Introduction - Asthma

Diagnostic criteria for asthma

Prevention of asthmatic symptoms and asthma

Exercise-induced asthma

Exercise recommendations for the asthmatic individual

Office education

Quality of care measures

Patient and family education – ‘self-management’

Assessment of asthma severity

Home Peak Expiratory Flow Rate Measurements

Medications for different levels of asthma severity

Treatment goals

Findings suggesting the need for acute hospitalization for management

Special ER observation units for asthma care

Therapy

Complications of therapy

Combination therapy

Antibiotics

“Quick relief” vs “Controller” Medications

Drug therapy options for asthma management (table)

NHLBI Expert Panel 2002 update: Stepwise approach for managing asthma in adults and children older than 5 years of age

NHLBI Expert Panel 2002 update: Stepwise approach for managing acute or chronic asthma in infants and young children (5 years of age and younger)

Asthma Home Treatment Plan – Adults

References

Resources: Patient education resources, web sites, and materials

Asthma Care Flowsheet

Asthma Program for Children

Instruction sheets for parents following acute care

Asthma, childhood – education plan and materials

Asthma Performance Profile

Bed and Pillow Covers for Patients with Asthma (added 01-04)

Web Resources related to Asthma

Summary

Asthma has proven to be one of the most expensive, increasingly common, and burdensome chronic diseases affecting individuals of all ages - financially, physically and psychologically. It is characterized by variable airflow obstruction and airway hyper-responsiveness. The incidence of asthma has increased about 150% over the past 20 years. It now afflicts about 20 million Americans, (more than 5 million are under age 17 years), and accounts for more than 450,000 primary admissions each year with an average length of stay of 3 days. Asthma is the most common chronic childhood illness, affecting about 10% of children. It is a leading cause of school absenteeism. Asthma affects about 8% of U.S. adults - 43% of adult cases occur in males – many have had asthma since childhood. 16% of all asthmatics have severe-persistent asthma, 31% have moderate-persistent asthma, 25% have mild-persistent asthma, while 28% have mild-intermittent asthma. Asthma accounts for 5,000 deaths annually.

For more information visit http://www.researchandmarkets.com/reports/c50702

source Business NewsWire

Short-Course Montelukast Improves Outcomes for Intermittent Asthma in Children

2007-02-19T12:26:46Z

February 16, 2007 — In children with intermittent asthma, a short course of montelukast resulted in reduction in acute healthcare resources, asthma symptoms, and days lost from school and from work for parents, according to the results of a multicenter, randomized, double-blind, controlled trial reported in the February 15 issue of the American Journal of Respiratory & Critical Care Medicine.

"In children, intermittent asthma is the most common pattern and is responsible for the majority of exacerbations," write Colin F. Robertson, MD, of the Royal Children's Hospital in Melbourne, Australia, and colleagues. "Montelukast has a rapid onset of action and may be effective if used intermittently."

]]> During a 12-month period, 220 children, aged 2 to 14 years with intermittent asthma, were randomized to receive montelukast (n = 107) or placebo (n = 113). Treatment with study medication was initiated by parents at the onset of each upper respiratory tract infection or asthma symptoms and continued for at least 7 days or until symptoms had resolved for 48 hours.

Of 681 treated episodes in 202 children, 345 were treated with montelukast and 336 with placebo. There were 163 unscheduled healthcare resource utilizations for asthma in the montelukast group and 228 in the placebo group (odds ratio [OR], 0.65; 95% confidence interval [CI], 0.47 - 0.89), and there was a nonsignificant trend toward reduction in specialist attendances and hospitalizations, duration of episode, and beta-agonist and prednisolone use.

With montelukast, symptoms were reduced by 14%, nights of disturbed sleep by 8.6% (P = .043), days off from school or childcare by 37%, and parent time off from work by 33% (P < .0001 for both).

"A short course of montelukast, introduced at the first signs of an asthma episode, results in a modest reduction in acute health care resource utilization, symptoms, time off from school, and parental time off from work in children with intermittent asthma," the authors write. "Although there was no significant effect on beta-agonist or oral prednisolone use, there was a significant reduction in asthma symptoms.... Although the difference in the number of days lost from work between treatment groups was relatively small, the days absent per year is a conservative estimate based on the presumption of a 365-day working year."

Merck, Sharp, & Dohme Australia, the maker of montelukast, funded this study. Some of the authors have disclosed relevant financial relationships with Merck, Sharp, & Dohme; AstraZeneca; Altana; GlaxoSmithKline; Novartis; Boehringer-Ingelheim; IVAX Corp; Thorpe Respiratory Research; Pharmaxis, Ltd; Australian Singulair Advisory Board; MSD Australia; and/or Schering Plough.

Am J Respir Crit Care Med. 2007;175:323-329.

source Medscape

Astrazeneca Launches A Smarter Approach To Asthma Management In Europe

2007-02-15T10:34:32Z

AstraZeneca today announced that 37 countries to date have received approval of Symbicort® Maintenance And Reliever Therapy (Symbicort SMART®), and that a period of world wide launches will now be initiated. This new, smarter approach to asthma is the first to provide patients with both asthma maintenance and reliever therapy together in just one inhaler.

With the Symbicort SMART management approach, patients receive inhaled corticosteroid (ICS) and long acting bronchodilator (LABA) with every inhalation. Thus, with Symbicort SMART it is possible to treat the underlying inflammation with every inhalation, even when used for rapid symptom relief, making it a more effective way to manage asthma. A separate SABA (short acting bronchodilator) inhaler is therefore no longer needed. Symbicort SMART has been proven to reduce exacerbations by 39% compared with salmeterol / fluticasone combination and a separate reliever medication.1]]> The Symbicort SMART treatment approach is possible only because Symbicort combines two components in one inhaler: budesonide, an ICS to provide an anti-inflammatory effect in the airways, and formoterol, a unique bronchodilator that is both rapid in effect and long lasting (LABA). The other LABA available for maintenance treatment of asthma, salmeterol, does not have the properties that enables it to be used in this way. Consequently, Seretide™ (salmeterol/fluticasone) can not be used in the same way as Symbicort SMART. Patients on Symbicort SMART receive a maintenance dose in line with normal practice to establish asthma control and can then take additional inhalations 'as needed' if symptoms occur, to provide both rapid symptom relief and increased asthma control in the longer term.

"We know that patients tend to over-rely on their symptom relief inhaler when experiencing a worsening of their symptoms," comments Professor Claus Vogelmeier, Professor of Medicine and Head of Pulmonary Division, Marburg University Hospital Germany, and speaker at the official Symbicort SMART launch event in Lund. "Although patients consistently adjust their medication in response to asthma variations, often the adjustment in maintenance therapy is delayed in response to an exacerbation. With Symbicort SMART, physicians can be sure that patients are receiving their anti-inflammatory treatment with every inhalation, ensuring their asthma is better controlled."

The Symbicort SMART approach is recognised by the Global Initiative for Asthma (GINA) who recently announced revised international treatment guidelines on best practice in the prevention and treatment of asthma. The guidelines support the need for a new management approach - Symbicort SMART.2

"Previous editions of the GINA Guidelines have perhaps led to an impression that mild asthma could be equated to mild symptoms and severe asthma to severe symptoms, which we know is not the case," comments Dr Paul O'Byrne, McMaster University, Ontario, Canada and Chair of the GINA Executive Committee. "Asthma is a variable disease and the GINA Committee felt that a treatment approach based upon effective control of symptoms and exacerbations would better reflect the natural course of the disease. The result will be improved outcomes by allowing treatment to be rapidly increased when symptoms first appear and then brought back down again when control is achieved, and thus let the dosing respond quickly to the patients' asthma control status."

Symbicort SMART has been tested extensively in a wide clinical trial program involving over 14,000 patients with persistent asthma. These studies consistently show that Symbicort SMART, irrespective of asthma severity, reduces the risk of patients developing potentially life-threatening asthma attacks compared with traditional treatment approaches such as fixed dosing with either higher doses of ICS plus a short-acting bronchodilator (SABA) or with an ICS/LABA combination therapy plus a SABA. 1, 3-7

In the EU, Symbicort SMART is licensed for use in adults with a need for ICS / LABA combination treatment. National launches are expected throughout the EU over the coming months.

"We are delighted to announce the launch of Symbicort SMART in Europe," said Dr John Patterson, Executive Director, Development for AstraZeneca. "This new treatment approach will simplify asthma management and has the potential to improve the lives of a great many asthma patients. We now have a management approach that provides the reassurance of instant relief when needed and in the same breath treats the underlying disease for the long term. This is a significant step forward for asthma patients."

To date, Symbicort has been effectively and widely used as a traditional maintenance treatment for asthmatics across the world. With the advent of today's launch of Symbicort SMART, Symbicort is the first maintenance therapy to als

o be proven effective and licensed for maintenance and reliever therapy in one inhaler. AstraZeneca is a major international healthcare business engaged in the research, development, manufacture and marketing of prescription pharmaceuticals and the supply of healthcare services. It is one of the world's leading pharmaceutical companies with healthcare sales of $26.47 billion and leading positions in sales of gastrointestinal, cardiovascular, neuroscience, respiratory, oncology and infection products. AstraZeneca is listed in the Dow Jones Sustainability Index (Global) as well as the FTSE4Good Index.

For further updates, news and information on Symbicort, please visit
http://www.astrazenecapressoffice.com

References

1. Kuna P, Peters MJ, Buhl R. Budesonide/formoterol as maintenance and reliever therapy reduces asthma exacerbations versus a higher maintenance dose of budesonide/formoterol or salmeterol/fluticasone. Abstract presented at the ERS Congress 2006.

2. The Global Initiative for Asthma (GINA). GINA Report, Global Strategy for Asthma Management and Prevention, published November 2006. www.ginasthma.com

3. Rabe K, Atienza T, Magyar P et al. Reduction in asthma exacerbations with budesonide in combination with formoterol for reliever therapy: a randomised, controlled, double-blind study. Lancet 2006;368: 744-53.

4. Vogelmeier C, D'Urzo A, Pauwels R, Merino JM, Jaspal M, Boutet S, Naya I, Price D. Budesonide/formoterol maintenance and reliever therapy: an effective asthma treatment option? Eur Respir J 2005; 26(5): 819-828.

5. O'Byrne P, Bisgaard H, Godard P, Pistolesi M, Palmqvist M, Zhu Y, Ekström T, Bateman E. Budesonide/Formoterol Combination Therapy as Both Maintenance and Reliever Medication in Asthma. American Journal of Respiratory and Critical Care Medicine 2005; 171(2): 129-136.

6. Scicchitano R, Aalbers R, Ukena D, Manjra A, Fouquert L, Centanni S, Boulet L-P, Naya IP, Hultquist C. Efficacy and safety of budesonide/formoterol single inhaler therapy versus a higher dose of budesonide in moderate to severe asthma. Current Medical Research and Opinion 2004;20(9):1403-18.

7. Klaus F. Rabe, Emilio Pizzichini, Björn Ställberg, Santiago Romero, Ana M. Balanzat, Tito Atienza, Per Arve Lier, and Carin Jorup, Budesonide/Formoterol in a Single Inhaler for Maintenance and Relief in Mild-to-Moderate Asthma: A Randomized, Double-Blind Trial, Chest, Feb 2006; 129: 246 - 256

Symbicort SMART -- Symbicort SMART improves daily symptom control and reduces asthma attacks while patients only need one inhaler*. A separate short-acting bronchodilator is no longer needed. Patients prescribed Symbicort SMART, take a maintenance dose of Symbicort every day in line with normal practice to establish asthma control and take additional inhalations 'as needed' of Symbicort if symptoms occur, to provide both rapid symptom relief and improved asthma control. *not indicated for prophylactic use before exercise

-- Symbicort SMART successfully completed the European Union Mutual Recognition Procedure (MRP) in October 2006

-- Symbicort SMART is currently approved in 37 countries worldwide

-- Symbicort is currently approved in more than 90 countries; sales were $585 million in the first half 2006 (up 24 percent on 2005 figures) and have now reached more than five million treatment years

-- Symbicort received FDA approval in the US in July 2006 for maintenance treatment of asthma (in patients from 12 years of age)

Asthma -- Asthma is a chronic inflammatory condition of the airways characterised by reversible airway obstruction. It is a variable condition that can change both daily and seasonally

-- Most asthma patients require maintenance treatment with an inhaled corticosteroid (ICS), which suppresses the underlying airway inflammation, and a bronchodilator, which relaxes the smooth muscle of the airways.

source Medical News Today

FDA: New Limits to Ketek Use

2007-02-15T10:27:36Z

February 13, 2007 — Multiple label revisions for telithromycin (Ketek tablets, made by Sanofi-Aventis) include removal of its approval for 2 of its 3 indications, according to the US Food and Drug Administration (FDA).

The risks of telithromycin for the treatment of acute bacterial sinusitis and acute bacterial exacerbations of chronic bronchitis have been found to outweigh the benefits, the FDA said in an alert sent yesterday from MedWatch, the FDA's safety information and adverse event reporting program.

Other label changes include a boxed warning stating that use of telithromycin is contraindicated in patients with myasthenia gravis, and a strengthened warning section regarding the risk for adverse events such as visual disturbances and loss of consciousness; the risk for hepatotoxicity was previously emphasized in June 2006.
]]> In addition, a patient medication guide has been developed to inform patients regarding the risks and safe use of telithromycin. The information sheet will be dispensed with each prescription.

According to an FDA news release, the revisions were based on comprehensive scientific analysis and thoughtful public discussion of available data and are consistent with December 2006 recommendations from a joint panel of the FDA's Anti-Infective Drugs and Drug Safety and Risk Management Advisory committees.

Telithromycin remains approved only for the treatment of mild to moderate cases of community-acquired pneumonia.

Healthcare professionals are encourage to report telithromycin-related adverse events to the FDA's MedWatch reporting program by phone at 1-800-FDA-1088, by fax at 1-800-FDA-0178, online at http://www.fda.gov/medwatch, or by mail to 5600 Fishers Lane, Rockville, MD 20852-9787.

source Medscape

Allergy hope over wine preserver

2007-02-12T09:29:40Z

A new technique for preserving grapes for mass-market wine may prevent the drink causing allergies, a study says.

Spanish researchers found using ozone to keep grapes fresh for wine was 90% as effective as sulphur dioxide, which is currently used by producers.

Sulphur dioxide is often linked to allergies such as asthma and migraines, the journal Chemical and Industry said.

But experts said there were other properties in wine that could trigger allergic reactions.

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Histamines and tannins, both of which occur naturally in wine - especially red wine - are also thought to cause conditions such as itchiness, rashes, diarrhoea and asthma.

A spokeswoman for Allergy UK said: "Sulphur dioxide is a common cause of these reactions, but it is not the only one.

"So this method might not solve problems for everyone."

The researchers compared grape storage using sulphur dioxide and ozone treatment.

They found ozone treatment was 90% as effective but, as it is a water-based gas, it carries none of the side-effects of sulphur dioxide.

Antioxidants

They also found that ozone-treated grapes had up to four times more antioxidants than untreated grapes. Researchers could not say why this happened.

Lead researcher Francisco Artes-Hernandez, from the University of Cartagena, said the finding offered real hope.

"This is a new technique which could be used to preserve grapes and help prevent allergies and boost healthy compounds at the same time."

Andrew Waterhouse, an expert on the wine-making industry from California University, said not all wine growers used sulphur dioxide as grapes were no longer kept for long periods of time.

Instead, he suggested ozone may be better used in place of another preservative, sulphites, which has also been linked to allergies.

He said: "The ozone process could be tweaked to replace problematic sulphites during the liquidation process, presenting the possibility of healthier more hypoallergenic wines."

source BBC UK

Link found between asthma and obesity

2007-02-09T12:11:32Z

Asthmatics are more likely than other Australians to be obese and suffer other long-term health conditions, a new study says.

Australian researchers have found more than one in five asthma patients are obese, and fewer than half had a normal body mass index.

Only about 38 per cent of middle aged asthmatics had a normal body mass index.

The Australian Institute of Health and Welfare (AIHW) report concluded people with asthma aged 18 to 64 were more likely to be obese than those who had never had asthma, but could not identify the reason.

]]> "Although there is some evidence from longitudinal studies that being overweight or obese raises the risk of the onset of asthma in children, especially among boys, it is not clear whether the link ... is physiological or due to subsequent changes in lifestyle," the report said.

"For example, it may be argued that asthma leads to obesity due to an associated reduction in physical activity, or that it affects the quality of asthma management, thereby aggravating the condition."

Asthma, a chronic inflammatory disease of the airways, affects about two million Australians.

The report also found asthmatics were more likely to suffer other health woes and to seek medical care.

About two-thirds of asthmatics surveyed had seen a doctor in the three months before the survey, and about one-third had visited a doctor in the previous two weeks.

About one in 10 had seen the doctor specifically for their asthma in the past two weeks.

Report author Perri Timmins, of the AIHW's Asthma, Arthritis and Environmental Health Unit, found 16 long-term health conditions that asthma patients were more likely than others to suffer.

"Allergic and inflammatory conditions such as hay fever, allergy, chronic sinusitis, bronchitis and emphysema are consistently more common among people with asthma," he said.

Migraine, back pain, depression and anxiety-related conditions also were more frequent, he said.

"It should be stressed, however, that ... the majority of people with asthma consider themselves in, generally, good health," Dr Timmins said.

The report also confirmed previous studies that found asthma was more common in boys before adolescence and females after adolescence.

Cracked Skin Could Be Path to Asthma

2007-02-08T12:56:22Z

Researchers have long noted that many asthma sufferers also have atopic dermatitis — often called eczema — a chronic disease of the skin that can leave it red, raw, scaly, tender, oozy and excruciatingly itchy. But scientists are looking at whether such ravaging of the skin creates the conditions that can trigger asthma.

Last spring in the journal Nature Genetics, British scientists reported that people who suffer from both eczema and asthma carry the same gene mutation and concluded that eczema may actually lead to asthma in some cases.

Until now, it had largely been assumed that dander, dust mites, pollen and other allergens that can cause asthma enter the body through the respiratory system. But the researchers said they now believe that they can also enter the body through tiny breaks in the skin’s surface — something that occurs in patients with eczema.

]]> “Allergens from our environment can actually enter the skin through these cracks,” said Dr. Thomas J. Hudson, an immunologist and the president and scientific director of the Ontario Institute for Cancer Research, who was not affiliated with the study but wrote a commentary on it in Nature Genetics, “and the immune cells under the skin cells appear to be reacting and forming an allergic reaction” to them.

That allergic reaction “can prime the immune system so that subsequent inhalation of the same allergens leads to a reaction in the lungs and contributes to the development of asthma,” Dr. Julie Schaffer, an assistant professor of dermatology at New York University School of Medicine, wrote in an e-mail message.

The researchers also found that two gene mutations, known to diminish the skin’s ability to form its protective outer barrier, were present in people with both asthma and eczema, confirming that the two can be genetically linked. But individuals who had asthma but no eczema did not have the mutations.

The lack of a direct link between asthma and the mutations — when eczema was not present — suggests that sensitization may arise after eczema sets in, as a result of a weakened skin barrier, Dr. Hudson concluded.

Dr. Hudson said: “When we find here a direct link between the skin barrier and asthma, it makes you think, ‘Could we be doing something different? Could we be affecting the skin of our kids?’ But if there were ways we could improve the maintenance of this epithelial barrier, we would prevent subsequent asthma.”

by Laurel Naversen Geraghty, The NY Times

Maternal diet during pregnancy in relation to eczema and allergic sensitization in the offspring at 2 y of age

2007-02-07T12:42:31Z

Background: Maternal diet during pregnancy might be one of the factors that influences fetal immune responses associated with childhood allergy.

Objective: We analyzed the association between maternal diet during the last 4 wk of pregnancy and allergic sensitization and eczema in the offspring at 2 y of age.

Design: Data from 2641 children at 2 y of age were analyzed within a German prospective birth cohort study (LISA). Maternal diet during the last 4 wk of pregnancy was assessed with a semiquantitative food-frequency questionnaire, which was administered shortly after childbirth.]]> Results: High maternal intake of margarine [adjusted odds ratio (aOR): 1. 49; 95% CI: 1.08, 2.04] and vegetable oils (aOR: 1.48; 95% CI: 1.14, 1.91) during the last 4 wk of pregnancy was positivelyassociated and high maternal fish intake (aOR: 0.75; 95% CI: 0.57, 0.98) was inversely associated with eczema during the first 2 y in the offspring. High celery (aOR: 1.85; 95% CI: 1.18, 2.89) and citrus fruit (aOR: 1.73; 95% CI: 1.18, 2.53) intakes increased the risk of sensitization against food allergens. In turn, sensitization against inhalant allergens was positively related to a high maternal intake of deep-frying vegetable fat (aOR: 1.61; 95% CI: 1.02, 2.54), raw sweet pepper (aOR: 2.16;95% CI: 1.20, 3.90), and citrus fruit (aOR: 1.72; 95% CI: 1.02, 2.92).

Conclusions: We suggest that the intake of allergenic foods and foods rich in n–6 polyunsaturated fatty acids during pregnancy may increase and foods rich in n–3 polyunsaturated fatty acids may decrease the risk of allergic diseases in the offspring.

Stefanie Sausenthaler, Sibylle Koletzko, Beate Schaaf, Irina Lehmann, Michael Borte, Olf Herbarth, Andrea von Berg, H-Erich Wichmann, Joachim Heinrich for the LISA Study Group

1 From the GSF–National Research Center for Environment and Health, Institute of Epidemiology, Neuherberg, Germany (SS, HEW, and JH); Dr von Hauner Children's Hospital (SK) and the Institute of Medical Data Management, Biometrics and Epidemiology (HEW), Ludwig-Maximilians–University of Munich, Munich, Germany; the Department of Pediatrics, Marien-Hospital Wesel, Wesel, Germany (BS and AvB); the Department of Environmental Immunology, UFZ–Center for Environmental Research, Leipzig, Germany (IL); the Departments of Pediatrics (MB) and Faculty of Medicine, Environmental Hygiene and Environmental Medicine (OH), University of Leipzig, Leipzig, Germany; the Municipal Hospital "St Georg" Leipzig, Children's Hospital, Leipzig, Germany (MB); and the Department of Human Exposure Research and Epidemiology, UFZ–Center for Environmental Research, Leipzig, Germany (OH)

source American Journal of Clinical Nutrition