The Journal of allergy and clinical immunology
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J. Allergy Clin. Immunol. · Nov 2013
Randomized Controlled Trial Clinical TrialPredictors of response to tiotropium versus salmeterol in asthmatic adults.
Tiotropium has activity as an asthma controller. However, predictors of a positive response to tiotropium have not been described. ⋯ Although these results require confirmation, predictors of a positive clinical response to tiotropium include a positive response to albuterol and airway obstruction, factors that could help identify appropriate patients for this therapy.
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J. Allergy Clin. Immunol. · Nov 2013
Anaphylaxis: clinical patterns, mediator release, and severity.
Prospective human studies of anaphylaxis and its mechanisms have been limited, with few severe cases or examining only 1 or 2 mediators. ⋯ The results suggest that multiple inflammatory pathways drive reaction severity and support recommendations for safe observation periods after initial treatment.
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J. Allergy Clin. Immunol. · Nov 2013
Randomized Controlled Trial Multicenter StudyEffects of benralizumab on airway eosinophils in asthmatic patients with sputum eosinophilia.
Many asthmatic patients exhibit sputum eosinophilia associated with exacerbations. Benralizumab targets eosinophils by binding IL-5 receptor α, inducing apoptosis through antibody-dependent cell-mediated cytotoxicity. ⋯ Single-dose intravenous and multiple-dose subcutaneous benralizumab reduced eosinophil counts in airway mucosa/submucosa and sputum and suppressed eosinophil counts in bone marrow and peripheral blood. The safety profile supports further development. Additional studies are needed to assess the clinical benefit in asthmatic patients.
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J. Allergy Clin. Immunol. · Nov 2013
ReviewGlucocorticoid-induced osteoporosis: an update on effects and management.
Glucocorticoids remain a cornerstone of guideline-based management of persistent asthma and allergic diseases. Glucocorticoid-induced osteoporosis (GIO) is the most common iatrogenic cause of secondary osteoporosis and an issue of concern for physicians treating patients with inhaled or oral glucocorticoids either continuously or intermittently. Patients with GIO experience fragility fractures at better dual-energy x-ray absorptiometry T-scores than those with postmenopausal or age-related osteoporosis. ⋯ Effective options to detect and manage GIO exist, and a management algorithm has been published by the American College of Rheumatology to provide treatment guidance for clinicians. This review will summarize GIO epidemiology and pathophysiology and assess the role of inhaled and oral glucocorticoids in asthmatic adults and children, with particular emphasis on the effect of such therapies on bone health. Lastly, we will review the American College of Rheumatology GIO guidelines and discuss diagnostic and therapeutic strategies to mitigate the risk of GIO and fragility fractures.
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J. Allergy Clin. Immunol. · Nov 2013
Rhinovirus infection causes steroid resistance in airway epithelium through nuclear factor κB and c-Jun N-terminal kinase activation.
Although inhaled glucocorticoids are the mainstays of asthma treatment, they are poorly effective at treating and preventing virus-induced asthma exacerbations. The major viruses precipitating asthma exacerbations are rhinoviruses. ⋯ RV-16 infection of human airway epithelium induces glucocorticoid resistance. Inhibition of RV-16-induced JNK and nuclear factor κB activation fully reversed rhinovirus impairment of both GRα nuclear translocation and the transactivation/transrepression activities of glucocorticoids.