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Pulmonary – Treatable traits
Published in Vibeke Backer, Peter G. Gibson, Ian D. Pavord, The Asthmas, 2023
Vibeke Backer, Peter G. Gibson, Ian D. Pavord
The pathogenesis of early-onset allergic eosinophilic asthma has been extensively studied. In susceptible individuals, exposure to aero-allergens such as house dust mite leads to induction of Th2 CD4+ T-lymphocytes by antigen-presenting dendritic cells (Figure 2.7). These Th2 cells produce the type-2 cytokines IL-4, IL-5 and IL-13: IL-4 induces switching of B lymphocytes to IgE; IL-5 stimulates eosinophil development in the bone marrow and eosinophil survival in the bronchial mucosa, leading to blood and airway eosinophilia; and IL-13 stimulates goblet cell metaplasia and bronchial hyperreactivity.
Allergy–Asthma Practice
Published in Pudupakkam K Vedanthan, Harold S Nelson, Shripad N Agashe, PA Mahesh, Rohit Katial, Textbook of Allergy for the Clinician, 2021
Mark Holbreich, Pudupakkam K Vedanthan, PA Mahesh, Sitesh Roy
Eosinophilic esophagitis is a disease characterized most commonly by dysphagia in adults and chronic abdominal complaints in children. It was first recognized in 1986 and over the past 10 years the disease has been better defined. Although found throughout the world it is most prevalent in caucasian males living in developed countries. The treatment may consist of a diet or swallowed corticosteroids. It is a chronic and progressive disease.
Multidisciplinary team approach and the role of psychologists in gastroenterology services
Published in Clarissa Martin, Terence Dovey, Angela Southall, Clarissa Martin, Paediatric Gastrointestinal Disorders, 2019
Alan Silverman, Sara E Williams
The interdisciplinary centre included gastroenterology, dietetics, speech– language pathology and psychology. The centre’s first step was to identify other health concerns warranting further attention. At that time, Aviva had persistent feeding intolerance and eczema, so the feeding centre went on to refer Aviva to an asthma and allergy centre for further evaluation, where she was diagnosed with multiple food allergies, including allergies to peanuts, tree nuts, dairy, eggs, fish and soy. In further gastrointestinal investigation through the interdisciplinary feeding team, she was also diagnosed with eosinophilic esophagitis, a condition of inflammation of the oesophagus that leads to dysmotility of the oesophagus, pain, and feeding and swallowing difficulties. This case illustrates the complexity of patient care when a child has multiple medical conditions.
Metabolomics of asthma, COPD, and asthma-COPD overlap: an overview
Published in Critical Reviews in Clinical Laboratory Sciences, 2023
Sanjukta Dasgupta, Nilanjana Ghosh, Parthasarathi Bhattacharyya, Sushmita Roy Chowdhury, Koel Chaudhury
In contrast to childhood asthma, which is largely allergic in nature, the symptoms in adult-onset asthma tend to be more persistent and less well controlled. Eosinophilic asthma is a severe type of asthma that arises due to a considerable increase in eosinophils in the airway lining and/or blood [140]. Most studies reported with this subtype suggest an alteration of lipid metabolism in these patients as compared to the non-eosinophilic group [70,75]. Eosinophilic asthma can occur in patients who have a tendency toward allergies (allergic or atopic) and also in those without an allergic predisposition. Allergic asthma is the most prevalent type of asthma and occurs in ∼7.3% of the population [141]. In only one study to date have the metabolites in allergic and non-allergic asthmatics been compared with healthy controls. Pathways associated with various amino acids and lipids were found to be significantly dysregulated in both the groups as compared to the controls [42]. Obesity is the most common co-morbidity of asthma and is associated with a higher risk of poor prognosis and exacerbations [142]. Several metabolomics studies have shown that energy metabolism was altered in obese asthmatics [52,53]. Interestingly, gender disparity in the prevalence of asthma has been demonstrated; in adult asthmatics, disease prevalence, and severity were reported to be higher in women than in men [143]. In only one study was an MS platform used to identify metabolites that differentiated male and female asthma patients; dysregulated lipid metabolism was found to be a major discriminant between the two groups [72].
Systemic eosinophilic disease presenting as dacryoadenitis
Published in Orbit, 2023
Kayla Danesh, Liza M. Cohen, Yan Liu, Justin N. Karlin, Daniel B. Rootman
Eosinophilic asthma is a subtype of asthma distinguished by increased severity, association with atopy, late onset and eosinophilic cellular infiltrate in the airway.2 Patients typically respond to corticosteroids and T-helper type 2 (Th2) targeted treatments, such as anti-IL-5 therapy.2 Very little evidence is available regarding the association between this disorder and orbital inflammation, which is more typical of EGPA. However, our two patients’ presentations with obstructive airway symptoms, respiratory distress, eosinophilia and response to corticosteroids in both and anti-IL-5 therapy in one, make this a potential diagnosis. Eosinophilic infiltration of the lacrimal gland may be a manifestation of this systemic disease, similar to the eosinophilic infiltration of the respiratory system found in this condition. The lacrimal gland contains a high density of lymphatic tissue,3 and dacryoadenitis is not infrequently a sign of systemic inflammation. Lacrimal gland involvement in eosinophilic asthma could be attributable to this same mechanism.
Effectiveness of esophagogastroduodenoscopy in changing treatment outcome in refractory gastro-esophageal reflux disease
Published in Scandinavian Journal of Gastroenterology, 2022
Ye Eun Kwak, Ahmed Saleh, Ahmed Abdelwahed, Mayra Sanchez, Amir Masoud
Esophageal biopsies were taken in 44.5% (134/301) of the patients who underwent EGD as a part of the evaluation of abnormal endoscopic lesions or sampling of normal or benign appearing mucosa. 91.0% (122/134) had normal or benign biopsy results. Benign findings included cardia-type mucosa (36/301, 12.0%), inflammatory or reactive changes (38/301, 12.6%), reflux esophagitis (26/301, 8.6%), ulcerative esophagitis (5/301, 1.7%), erosion (2/301, 0.7%), hyperkeratosis (2/134, 0.7%) or eosinophilic esophagitis (1/301, 0.3%). Three patients had eosinophilic infiltrate more than 15/HPF in the distal esophagus but the proximal esophageal biopsy was unavailable to diagnose eosinophilic esophagitis. Biopsy-proven intestinal metaplasia was found in 4.0% of the patients (12/301) which correlates with endoscopic findings of irregular z-line (5 patients) or salmon-colored mucosa (7 patients). Among endoscopic intestinal metaplasia suspected lesions, 14.3% (5/35) of irregular z-line and 33.3% (7/21) of salmon-colored mucosa were proven to be actual intestinal metaplasia on the biopsies. None of the patients had dysplasia or malignancy. A small number of patients (15/301, 5.0%) had incidental findings of H. pylori infection. Proportions of all microscopic esophageal findings were not significantly different in PPI and non-PPI groups except for people who were not on PPI had more ulcerative esophagitis compared to people who were on PPI (5.4% (3/56) vs. 0.8% (2/245), p = 0.046, Table 3).