Immunology and allergy clinics of North America
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The epidemiology of asthma and outdoor air pollution has shown that respiratory health effects can vary in relation to different emission sources, types of pollutants, underlying nutritional status, medication use, and genetic polymorphisms. Using sophisticated exposure assessment methods in conjunction with clinical tests and biomarkers that provide mechanistic information, the study of outdoor epidemiology and asthma has evolved into a complex multidisciplinary field. This article presents an overview of the mechanisms by which outdoor air pollution and traffic-related emissions lead to changes in respiratory health and lung function in subjects with asthma.
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Exhaled nitric oxide (FENO) is a noninvasive easily measurable biomarker that is proving to be an excellent surrogate for eosinophilic inflammation in the lungs of patients who have asthma. Although large-scale normative data are still awaited, preliminary studies have shown FENO to be helpful in diagnosing and assessing severity and control for asthma. FENO levels have also proven helpful in diagnosing and managing several other inflammatory lung diseases.
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Acute eosinophilic pneumonia, chronic eosinophilia, Churg-Strauss syndrome, and the hypereosinophilic syndrome are pulmonary eosinophilic syndromes characterized by an increased number of eosinophils in peripheral blood, in lung tissue, in sputum, in bronchoalveolar lavage fluid, or in all of these. These pulmonary eosinophilic syndromes generally are characterized by increased respiratory symptoms, abnormal radiographic appearance, and the potential for systemic manifestations. It is critical to exclude other causes of eosinophilia in patients who have lung disease, to make a quick diagnosis, and to treat aggressively with corticosteroids and other therapies to prevent long-term sequelae.
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Food allergy is a common cause of anaphylaxis, and its incidence is rising. The development of allergy is multifactorial, and the mechanisms of tolerance are complex. The natural history of food allergy varies by causative food; some allergies are mostly outgrown, while others are usually life-long. ⋯ Death is usually caused by respiratory failure, and patients who have asthma are at greatest risk for severe reactions. At this time, avoiding allergenic triggers, and when that fails, timely administration of epinephrine, are the main approaches to food allergy. Although several experimental medications promise to dramatically change the field of food allergy, none of these treatments are currently available outside of research settings.
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Immunol Allergy Clin North Am · Aug 2006
ReviewDiagnostic value of tryptase in anaphylaxis and mastocytosis.
Serum (or plasma) levels of total and mature tryptase measurements are recommended in the diagnostic evaluation of systemic anaphylaxis and systemic mastocytosis, but their interpretation must be considered in the context of a complete workup of each patient. Total tryptase levels generally reflect the increased burden of mast cells in patients with all forms of systemic mastocytosis (indolent systemic mastocytosis, smoldering systemic mastocytosis, systemic mastocytosis associated with a hematologic clonal non-mast cell disorder, aggressive systemic mastocytosis, and mast cell leukemia) and the decreased burden of mast cells associated with cytoreductive therapies in these disorders. Causes of an elevated total tryptase level other than systemic mastocytosis must be considered, however, and include systemic anaphylaxis, acute myelocytic leukemia, various myelodysplastic syndromes, hypereosinophilic syndrome associated with the FLP1L1-PDGFRA mutation, end-stage renal failure, and treatment of onchocerciasis. Mature (beta) tryptase levels generally reflect the magnitude of mast cell activation and are elevated during most cases of systemic anaphylaxis, particularly with parenteral exposure to the inciting agent.