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

Publisher Summary This chapter describes the most commonly employed immunological tests that have some usefulness in research and practice of clinical allergy. The chapter discusses the three major areas: the determination of total serum IgE levels, allergen-specific IgE determinations, and allergen-specific IgG antibody determinations. Solid-phase radioimmunoassay methods have some technique of insolubilizing a highly specific anti-IgE antibody, which is then employed in a competitive binding assay using radioiodinated IgE and the standards of known IgE content. The antibody-coated particles are incubated with a radiolabeled IgE and unlabeled IgE preparations, either standards or unknowns. After the incubation period, the immunosorbent is washed by centrifugation and then counted by gamma scintillation. This technique is called the radioimmunosorbent test (RIST). A more sensitive variant of the RIST involves a direct assay sandwich technique. Solid-phase radioimmunoassay have an advantage that they do not require the addition of a second reagent after the completion of the competitive binding assay to separate bound from free antigen.

Assessment of Allergic States: IgE Methodology and the Measurement of Allergen-Specific IgG Antibody,

Drug Allergy. Generic Protocol

SUMMARY In order to determine the effects of high-frequency ventilation on the pulmonary vascu­ lar response to hypoxia, we assessed pulmonary vascular resistance at 2 levels of inspired oxygen tension (PI02), 200 and 30 mmHg, during conventional and high-frequency ventilation in the iso­ lated, blood-perfused lungs of 10 sheep,S treated with indomethacin (40 "glml of perfusate) and 5 untreated. Resistance was assessed by measuring pulmonary artery pressure-flow curves gener­ ated over a wide range of flows (20 to 140 ml'mln-"kg body wt-'). Conventional ventilation was provided by an animal ventilator at a rate of 10 mln-' and a tidal volume of 10 mH(g body wt-' . High­ frequency ventilation was provided by a flow Interrupter at a rate of 1,200 min-' and a tidal volume less than 1.5 ml'kg body wt-'. In the 5 untreated lungs, the normoxic pressure-flow curve was un­ altered by high-frequency ventilation, but the hypoxic pulmonary vasoconstrictor response was sig­ nificantly attenuated. Furthermore, the net rate of change of 6-keto-prostaglandin F,a concentra­ tion In the perfusate during hypoxia was significantly greater with high-frequency ventilation (65.4 ± 8.9 pg'mL,'min-') than with conventional ventilation (2.8 ± 18.7 pg·ml-'·mln-'). In the 5 indomethacin-treated lungs, production of 6-keto-prostaglandin F,a was markedly depressed, and the attenuation of the hypoxic vasoconstrictor response by high·frequency ventilation was abol­ ished. These results demonstrate that in isolated sheep lungs, high-frequency ventilation attenu­ ated the pulmonary vascular response to hypoxia and suggest that this attenuation could be due to enhanced prostacyclln release by the lungs. AM REV RESPIR DIS 1985; 132:99-103 8.3 kg) were studied. The first group (n = 5) received no treatment, and the second group (n=5) was treated with indomethacin (40 ",g/m!) added to the perfusate at the initia­ tion of perfusion. The sheep were anesthe­ tized with 45 mg·kg-1 of intramuscular keta­ mine. Tracheostomy was performed, and conventional mechanical ventilation was in­ stituted with a Harvard animal ventilator (Model 613; Harvard Apparatus Co., South Natick, MA) using warmed, humidified air, a tidal volume of 10 mi. kg-I, a respiratory rate of 10 min-I, and a positive end-expiratory pressure of 4 mmHg. The animals were heparinized (10,000 units intravenously) and exsanguinated via the femoral artery. After exsanguination, the lungs were ventilated with an inspired gas mixture containing 280/0 Ol (PIOl, 200 mmHg), 5% COl, and the balance nitrogen. Midline sternotomy was performed, the ductus_arteriosus was ligated, and the pul­ monary artery and left atrium were cannu­ lated. The perfusion circuit was filled with approximately 1 L of autologous blood and 0.50 L of 3% dextran-70 in Ringer's lactate. The perfusate hematocrit was between 20 and 25%. Perfusion was begun in all animals within 30 min of exsanguination. The left

N. Franklin Adkinson

Papers

Assessment of Allergic States: IgE Methodology and the Measurement of Allergen-Specific IgG Antibody,

Drug Allergy. Generic Protocol

High-Frequency Ventilation Attenuation of Hypoxic Pulmonary Vasoconstriction

207 Effect of heat, freezing, pH and carpet additives on allergen immunoreactivity in house dust specimens

Desensitization and maintenance of clinical tolerance to penicillin in an exquisitely allergic subject