Global strategy for asthma management and prevention

Flavonoids are nearly ubiquitous in plants and are recognized as the pigments responsible for the colors of leaves, especially in autumn. They are rich in seeds, citrus fruits, olive oil, tea, and red wine. They are low molecular weight compounds composed of a three-ring structure with various substitutions. This basic structure is shared by tocopherols (vitamin E). Flavonoids can be subdivided according to the presence of an oxy group at position 4, a double bond between carbon atoms 2 and 3, or a hydroxyl group in position 3 of the C (middle) ring. These characteristics appear to also be required for best activity, especially antioxidant and antiproliferative, in the systems studied. The particular hydroxylation pattern of the B ring of the flavonoles increases their activities, especially in inhibition of mast cell secretion. Certain plants and spices containing flavonoids have been used for thousands of years in traditional Eastern medicine. In spite of the voluminous literature available, however, Western medicine has not yet used flavonoids therapeutically, even though their safety record is exceptional. Suggestions are made where such possibilities may be worth pursuing.

The Effects of Plant Flavonoids on Mammalian Cells:Implications for Inflammation, Heart Disease, and Cancer

Allergic rhinitis is a symptomatic disorder of the nose induced after allergen exposure by an IgE-mediated inflammation of the membranes lining the nose. It is a global health problem that causes major illness and disability worldwide. Over 600 million patients from all countries, all ethnic groups and of all ages suffer from allergic rhinitis. It affects social life, sleep, school and work and its economic impact is substantial. Risk factors for allergic rhinitis are well identified. Indoor and outdoor allergens as well as occupational agents cause rhinitis and other allergic diseases. The role of indoor and outdoor pollution is probably very important, but has yet to be fully understood both for the occurrence of the disease and its manifestations.

In 1999, during the Allergic Rhinitis and its Impact on Asthma (ARIA) WHO workshop, the expert panel proposed a new classification for allergic rhinitis which was subdivided into 'intermittent' or 'persistent' disease.

This classification is now validated. The diagnosis of allergic rhinitis is often quite easy, but in some cases it may cause problems and many patients are still under-diagnosed, often because they do not perceive the symptoms of rhinitis as a disease impairing their social life, school and work.

The management of allergic rhinitis is well established and the ARIA expert panel based its recommendations on evidence using an extensive review of the literature available up to December 1999. The statements of evidence for the development of these guidelines followed WHO rules and were based on those of Shekelle et al. A large number of papers have been published since 2000 and are extensively reviewed in the 2008 Update using the same evidence-based system. Recommendations for the management of allergic rhinitis are similar in both the ARIA workshop report and the 2008 Update. In the future, the GRADE approach will be used, but is not yet available.

Another important aspect of the ARIA guidelines was to consider co-morbidities. Both allergic rhinitis and asthma are systemic inflammatory conditions and often co-exist in the same patients. In the 2008 Update, these links have been confirmed.

The ARIA document is not intended to be a standard-of-care document for individual countries. It is provided as a basis for physicians, health care professionals and organizations involved in the treatment of allergic rhinitis and asthma in various countries to facilitate the development of relevant local standard-of-care documents for patients.

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Allergic rhinitis and its impact on asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen)

Authors Jan L. Brozek, MD, PhD – Department of Clinical Epidemiology & Biostatistics and Medicine, McMaster University, Hamilton, Canada Jean Bousquet, MD, PhD – Service des Maladies Respiratoires, Hopital Arnaud de Villeneuve, Montpellier, France, INSERM, CESP U1018, Respiratory and Environmental Epidemiology Team, France, and WHO Collaborating Center for Rhinitis and Asthma Carlos E. Baena-Cagnani, MD – Faculty of Medicine, Catholic University of Cordoba, Cordoba, Argentina Sergio Bonini, MD – Institute of Neurobiology and Molecular Medicine – CNR, Rome, Italy and Department of Medicine, Second University of Naples, Naples, Italy G. Walter Canonica, MD – Allergy & Respiratory Diseases, DIMI, Department of Internal Medicine, University of Genoa, Genoa, Italy Thomas B. Casale, MD – Division of Allergy and Immunology, Department of Medicine, Creighton University, Omaha, Nebraska, USA Roy Gerth van Wijk, MD, PhD – Section of Allergology, Department of Internal Medicine, Erasmus Medical Centre, Rotterdam, the Netherlands Ken Ohta, MD, PhD – Division of Respiratory Medicine and Allergology, Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan Torsten Zuberbier, MD – Department of Dermatology and Allergy, Charite Universitatsmedizin Berlin, Berlin, Germany Holger J. Schunemann, MD, PhD, MSc – Department of Clinical Epidemiology & Biostatistics and Medicine, McMaster University, Hamilton, Canada

/pdf/allergic-rhinitis-and-its-impact-on-asthma-20b4c7y0pr.pdf

Allergic Rhinitis and Its Impact on Asthma

Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma

Measuring peak expiratory flow (PEF) variation has been suggested as a indicator of asthma disease severity and also of nonspecific bronchial hyperreactivity. To test these assumptions, we examined the relationships between PEF variation, methacholine reactivity, symptom scores, and medication requirements in 74 children with tightly controlled allergic asthma. The level of mean diurnal variation (MDV) for the group was 7.1%, which is generally regarded as normal. We found statistically significant correlations between MDV and both methacholine reactivity (r = 0.43, p = 0.0001) and symptom scores (r = 0.28, p = 0.016). These asthma variables were analyzed longitudinally in 33 children who were followed up at 6-month intervals for at least 36 months. Visit-to-visit changes in MDV were generally not reflective of changes in other variables. However, group levels of MDV gradually decreased over time, especially in children with initial MDV of more than 8%. This reduction in group MDV coincided with similar reductions in group medication requirements and methacholine reactivity. We conclude that children with moderately severe asthma that is tightly controlled may have normal levels of PEF variation. The correlation between PEF variation and other asthma variables is statistically significant but too weak to be useful in the treatment of individual patients. In contrast, measurement of MDV may be a useful indicator of disease severity in group studies of asthma.

https://www.jacionline.org/article/0091-6749(94)90250-X/pdf

Peak flow variation in childhood asthma: A three-year analysis

BACKGROUND: Fifty percent glycerin preserves immunotherapy solution potency for at least 3 years but must be diluted before injection to reduce glycerin-induced pain and inflammation. We studied pain, erythema, induration, and bruises caused by glycerin (0% to 30%). METHODS: In 15 healthy subjects we compared, in double-blind fashion, pain scores, injection site erythema, induration, and bruising caused by subcutaneous injections in randomized order of 0.1, 0.5, and 1 ml of glycerin 0%, 10%, 20%, and 30%. RESULTS: Injection volume did not significantly influence pain scores from diluent alone (0% glycerin) ( p > 0.1). Pain scores of subjects given glycerin (0.1 to 1 ml, 10% to 30%) increased significantly as both injection volume ( p p r s = 0.67, p CONCLUSION: Injected glycerin produces pain that is proportional to total injected dose of glycerin, but individual variation in perceived discomfort is substantial. Total glycerin doses of less than 0.05 ml rarely produce clinically important pain. (J ALLERGY CLIN IMMUNOL 1996;97:1033-9.)

Pain and dermal reaction caused by injected glycerin in immunotherapy solutions

were 5- to I2-fold higher by RIP analysis while the remaining two sera were 2 and 4.3 times higher in the SPRIA. Serum-dilution curves of these six discrepant sera in the RIP assay demonstrated nonparallelism and differential plateau binding ranging from 40% to 140% of rhe reference serum plateau level. An contrast, the same six discordant sera evaluated in the SPRIA produced parallel serum-dilution curves. To assess the validity of each method, absorption experiments and Staph A solid-phase elution technique (SPET) were performed on each discrepant serum. Absorption experiments with insolubilized YJ antigen showed that all IgG anti-YJ detectable in the RIP was removed. Furthermore, results from the Staph A elution technique demonstrated the same rank order and relative potency of the six discrepant sera as shown by the SPRIA but not by the RIP analyses. These jindings suggest that for some YJ sera, the SPRIA gives more accurate estimates of IgG antibody content than does the RIP assay. In addition, the SPRIA presents several advantages over the RIP in the measurement of spec$c IgG in complex antigen mixtures: (I) The problems of radioiodination reproducibility and low immunoreactivity that are commonly seen with crude antigenic mixtures are avoided. (2) Antigen-excess conditions are employed, thereby assuring sujicient antigen to quantify all antibody specljicities. (3) IgE and IgG measurements in the same sera are more comparable since the same antigen-sorbent can be used in both the radioallergorsorbent test (RAST) for IgE and Staph A SPRIA for IgG. (4) Only one radiolabeled detection protein is required for evaluation of many antigen systems, thus alleviating the need for frequent radioiodination of multiple complex antigen mixtures. (5) Problems of nonparallelism and di#erential plateau binding that were observed in a minority of sera in the RIP assay for YJ antibody may be circumvented. We conclude, therefore, that the SPRIA has distinct advantages that may commend its use over RIP in the assessment of spec$c IgG in some complex antigen systems.

https://www.jacionline.org/article/0091-6749(81)90039-7/pdf

II. Comparison of radioimmunoprecipitation and solid-phase radioimmunoassay techniques for measurement of immunoglobulin G specific for a complex allergen mixture (yellow jacket venom)*

In this report, the radioimmunoprecipitation (RIP) assay and the Staph A (protein A from Staphylococcus aureus ) solid-phase radioimmunoassay (SPRIA) are compared for their ability to measure IgG specific for a complex antigen mixture. Sera from 32 yellow jacket venom (YJ)-allergic patients were evaluated for IgG anti-YJ using both radioassay methods. Twenty-six of the 32 sera gave concordant results in both assay systems. Four of the six discrepant sera were 5- to 12-fold higher by RIP analysis while the remaining two sera were 2 and 4.3 times higher in the SPRIA. Serum-dilution curves of these six discrepant sera in the RIP assay demonstrated nonparallelism and differential plateau binding ranging from 40% to 140% of the reference serum plateau level. In contrast, the same six discordant sera evaluated in the SPRIA produced parallel serum-dilution curves. To assess the validity of each method, absorption experiments and Staph A solid-phase elution technique (SPET) were performed on each discrepant serum. Absorption experiments with insolubilized YJ antigen showed that all IgG anti-YJ detectable in the RIP was removed. Furthermore, results from the Staph A elution technique demonstrated the same rank order and relative potency of the six discrepant sera as shown by the SPRIA but not by the RIP analyses. These findings suggest that for some YJ sera, the SPRIA gives more accurate estimates of IgG antibody content than does the RIP assay. In addition, the SPRIA presents several advantages over the RIP in the measurement of specific IgG in complex antigen mixtures: (1) The problems of radioiodination reproducibility and low immunoreactivity that are commonly seen with crude antigenic mixtures are avoided. (2) Antigen-excess conditions are employed, thereby assuring sufficient antigen to quantify all antibody specificities. (3) IgE and IgG measurements in the same sera are more comparable since the same antigen-sorbent can be used in both the radioallergorsorbent test (RAST) for IgE and Staph A SPRIA for IgG. (4) Only one radiolabeled detection protein is required for evaluation of many antigen systems, thus alleviating the need for frequent radioiodination of multiple complex antigen mixtures. (5) Problems of nonparallelism and differential plateau binding that were observed in a minority of sera in the RIP assay for YJ antibody may be circumvented. We conclude, therefore, that the SPRIA has distinct advantages that may commend its use over RIP in the assessment of specific IgG in some complex antigen systems.

Quantitation of antigen-specific immunoglobulin G in human serum. II. Comparison of radioimmunoprecipitation and solid-phase radioimmunoassay techniques for measurement of immunoglobulin G specific for a complex allergen mixture (yellow jacket venom).

https://www.jacionline.org/article/0091-6749(74)90028-1/pdf

N. Franklin Adkinson

Papers

Peak flow variation in childhood asthma: A three-year analysis

Pain and dermal reaction caused by injected glycerin in immunotherapy solutions

II. Comparison of radioimmunoprecipitation and solid-phase radioimmunoassay techniques for measurement of immunoglobulin G specific for a complex allergen mixture (yellow jacket venom)*

Quantitation of antigen-specific immunoglobulin G in human serum. II. Comparison of radioimmunoprecipitation and solid-phase radioimmunoassay techniques for measurement of immunoglobulin G specific for a complex allergen mixture (yellow jacket venom).

Aspirin intolerance in a family