The Journal of allergy and clinical immunology
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J. Allergy Clin. Immunol. · Sep 2012
Allergic airway disease is unaffected by the absence of IL-4Rα-dependent alternatively activated macrophages.
Markers of alternatively activated macrophages (AAMs) are upregulated in the lungs of asthmatic patients and in mice with allergic airway disease. AAMs are thought to contribute to the pathogenesis of allergic airway disease by virtue of their decreased NO production and increased production of proline and polyamines, which are important in the synthesis of connective tissues such as collagen. ⋯ Our results suggest that the presence of AAMs in allergic airway disease may be only an association, as a result of the increased T(H)2 responses present during disease, and that IL-4Rα-dependent AAMs do not play an important role in the pathology of disease.
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J. Allergy Clin. Immunol. · Aug 2012
Randomized Controlled Trial Multicenter StudyLong-term safety and asthma control measures with a budesonide/formoterol pressurized metered-dose inhaler in African American asthmatic patients: a randomized controlled trial.
Information surrounding the long-term safety of combination inhaled corticosteroid/long-acting β(2)-adrenergic agonist medications in African American asthmatic patients is limited. ⋯ In this population budesonide/formoterol pMDI was well tolerated over 12 months, with a safety profile similar to that of budesonide; the asthma exacerbation rate was reduced by 38.5% versus budesonide.
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J. Allergy Clin. Immunol. · Aug 2012
Randomized Controlled TrialIL-4 receptor polymorphisms predict reduction in asthma exacerbations during response to an anti-IL-4 receptor α antagonist.
This is the first large pharmacogenetic investigation of the inflammatory IL-4/IL-13 pathway in patients with moderate-to-severe asthma. We analyzed genomic DNA from participants in a 12-week placebo-controlled efficacy trial of pitrakinra (1, 3, or 10 mg twice daily), a novel IL-4/IL-13 pathway antagonist (Clinicaltrials.govNCT00801853). ⋯ This study demonstrates a significant pharmacogenetic interaction between anti-IL-4 receptor α therapy and IL4RA gene variation, identifying an asthma subgroup that is more responsive to therapy with this antagonist.
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J. Allergy Clin. Immunol. · Aug 2012
ReviewDiagnosis and management of early asthma in preschool-aged children.
Asthma is a common disease in young children and is associated with significant morbidity and an increasing prevalence over time. Early childhood wheezing and asthma are heterogeneous disorders; thus identifying phenotypes of asthma remains a goal to identify high-risk children who might benefit from specific therapies or secondary prevention interventions. The typical pattern of illness in preschool-aged children consists of short but recurrent exacerbations of cough and wheeze usually triggered by viral respiratory tract infections. ⋯ Strategies used to manage intermittent disease include daily and intermittent controller therapy. Management strategies for persistent asthma include daily inhaled corticosteroids, daily leukotriene receptor antagonists, and combination therapies. Finally, regular monitoring of symptom control and medication side effects is important along with titrating controllers to the minimally effective dose.
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J. Allergy Clin. Immunol. · Aug 2012
Risk factors and characteristics of respiratory and allergic phenotypes in early childhood.
Unsupervised approaches can be used to analyze complex respiratory and allergic disorders. ⋯ Atopy should be taken into account when assessing the risk of severe exacerbations (that require hospital-based care) in wheezing infants; precautions should be taken against respiratory irritants and molds and to prevent children from becoming overweight.