The Journal of allergy and clinical immunology
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J. Allergy Clin. Immunol. · Oct 2007
Pay for performance for the allergist-immunologist: potential promise and problems.
Pay for performance is one component of a growing movement in this country to better align incentives so as to increase the quality of medical care and reduce unnecessary costs. The Physician Consortium for Quality Improvement is a national multistakeholder organization that is developing performance measures. ⋯ The Institute of Medicine 2006 report supports pay for performance "as a stimulus to foster comprehensive and system-wide improvements in the quality of healthcare." This report also recommends that implementation of pay-for-performance programs should be carefully monitored to be sure that the stated goals are being achieved and that unintended consequences are recognized as early as possible. It is important for the allergist-immunologist to be an active participant in the evolving paradigm of pay for performance, advocating for the best interests of patients and providers alike.
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J. Allergy Clin. Immunol. · Oct 2007
Trends in hospitalizations for anaphylaxis, angioedema, and urticaria in Australia, 1993-1994 to 2004-2005.
Recent investigations in developed countries have found marked increases in the prevalence of allergic conditions. ⋯ Among older persons, angioedema is becoming an increasing problem. Among children, hospitalization because of food-induced anaphylaxis is a growing concern.
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J. Allergy Clin. Immunol. · Aug 2007
Randomized Controlled Trial Multicenter StudyCritical role of kallikrein in hereditary angioedema pathogenesis: a clinical trial of ecallantide, a novel kallikrein inhibitor.
Hereditary angioedema (HAE) is a rare, autosomal-dominant disorder caused by C1 inhibitor gene mutation. Patients with HAE experience intermittent attacks of edema affecting the oropharynx, abdomen, gastrointestinal tract, and limbs. C1 inhibitor is the primary endogenous inhibitor of the kallikrein-kinin (contact) cascade. Unregulated kallikrein activation generates bradykinin, the likely mediator of the swelling and pain characterizing HAE attacks. Ecallantide, a novel, recombinant protein, potently inhibits kallikrein. This is the first placebo-controlled assessment in human beings of a therapeutic intervention to improve symptoms of HAE attacks under the hypothesis that the contact cascade is the putative pathway responsible for HAE pathology. ⋯ Ecallantide is a promising new therapy for HAE attacks.