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Risk factors – Treatable traits
Published in Vibeke Backer, Peter G. Gibson, Ian D. Pavord, The Asthmas, 2023
Vibeke Backer, Peter G. Gibson, Ian D. Pavord
Patients with allergic asthma often have airway hyperresponsiveness towards indirect agents, such as mannitol. A detailed history illustrating periodicity of the respiratory symptoms should be documented. Often, patients with allergic asthma have seasonal variations or specific items that can induce asthma development, such as pet dander or house dust mites. Patients with allergic asthma can also experience asymptomatic periods, and, at least in patients with milder asthma, allergen-driven asthma should be suspected.
Immunologically Mediated Diseases and Allergic Reactions
Published in Julius P. Kreier, Infection, Resistance, and Immunity, 2022
Kim A. Campbell, Caroline C. Whitacre
Allergies to certain foods, dust, or animal dander can be controlled by avoidance of the allergen. However, ubiquitous allergens such as ragweed, grasses, or certain tree pollens are difficult to avoid. Many allergy patients undergo allergen immunotherapy, which is a technique that involves subcutaneous injection of increasing doses of an allergen over a period of weeks or months in hopes of reducing allergen-specific IgE levels. Allergen immunotherapy has proven successful for treatment of allergic asthma and rhinitis, but the mechanism by which this treatment improves clinical symptoms is not entirely clear. Following repeated injections of allergen, there is an increase in antigen-specific IgG antibodies, which are postulated to function by neutralizing antigen, by blocking the interaction of antigen and IgE, and by negatively regulating IgE production through antibody feedback mechanisms. Desensi tiza ti on through continued allergen injection could also downregulate IgE production by shifting the predominance of antigen-specific TH2 T lymphocytes to TH1 cells or by inducing specific T cell tolerance.
Fenugreek in Management of Immunological, Infectious, and Malignant Disorders
Published in Dilip Ghosh, Prasad Thakurdesai, Fenugreek, 2022
Rohini Pujari, Prasad Thakurdesai
Allergy is an immunity-associated disease resulting from sensitization and hypersensitive immune response to harmless substances in the environment called allergens. Asthma is one of the allergic, severe, chronic, progressive, and inflammatory bronchial diseases. Allergic asthma involves the symptoms such as dyspnea (shortness of breath) and wheezing (high-pitched whistling sound), resulting from increased bronchial hyperreactivity to a variety of allergenic and non-allergenic stimuli (Bosnjak et al. 2011). Many patients with chronic allergic conditions, such as allergic rhinitis and asthma seek complementary alternative medicine to attain better control of symptoms due to limitations of existing options (Amaral-Machado et al. 2020; Hussain et al. 2017; Koshak 2019).
2016 Thunderstorm-asthma epidemic in Melbourne, Australia: An analysis of patient characteristics associated with hospitalization
Published in Canadian Journal of Respiratory, Critical Care, and Sleep Medicine, 2021
Nur-Shirin Harun, Philippe Lachapelle, Gayan Bowatte, Caroline Lodge, George Braitberg, Louis Irving, Timothy Hinks, Shyamali Dharmage, Jo Douglass
Since future episodes of the weather events leading to thunderstorm asthma are highly likely, patients and healthcare providers need to be aware of the risk of asthma symptoms in individuals with allergic rhinitis. Our study suggests that asthma symptoms in those with seasonal allergic rhinitis are a likely indicator of risk in the setting of a TA event and so should be identified and treated. Treatment options for allergic rhinitis for which some evidence of efficacy in asthma exists includes intranasal corticosteroids and montelukast, although there has been some debate about the former and neither of these agents have been studied in a prospective manner in seasonal allergic asthma due to grass pollen sensitization.25–27 Recommended treatments for episodic asthma include seasonal inhaled asthma preventive inhaled corticosteroids with as needed short-acting beta 2 agonist, or as needed ICS/LABA (long-acting beta2-agonist) combination therapy, particularly in those likely to have poor adherence to regular preventer use.28,29 Allergen immunotherapy has efficacy in allergic rhinoconjunctivitis due to grass pollens, and a recently published retrospective analysis provides evidence that sensitized individuals were protected from TA by grass pollen sublingual tablet immunotherapy, reinforcing the potential role of immunotherapy in TA.30–32
Clinical and daily respiratory care and clinical trials within the COVID-19 era
Published in European Clinical Respiratory Journal, 2020
Zuzana Diamant, Vibeke Backer, Leif Bjermer
These initial observations raised many questions regarding the use of immunosuppressants such as corticosteroid-containing controllers. However, optimal disease control is the cornerstone of defense against respiratory triggers, including infections and allergens, in patients with chronic airway disease including allergic rhinosinusitis and (allergic) asthma. Given the fact that there is currently no evidence that topical corticosteroids negatively affect the COVID-19 outcome and in line with other professional societies within the respiratory and allergy field, e.g. AAAAI, ERS, GINA, NAEPP and NICE, NORA underscores the importance of adequate disease control – especially since spring pollen season has started in Northern Hemisphere. Apart from the general avoidance and hygiene measures issued by health authorities, respiratory societies recommend that patients continue taking their controller medications including corticosteroid-containing controllers and biologicals, according to their personal treatment plan and to seek medical help if disease control deteriorates [8–10]. These recommendations are in place for both adults and children with chronic inflammatory airway disease even if infected by SARS-CoV-2 or suspected of having the infection. In line with the general recommendations, interactions with HPCs should take place remotely, whenever possible.
Advances in allergen immunotherapy as a treatment of asthma
Published in Expert Review of Respiratory Medicine, 2019
Cristoforo Incorvaia, Eleni Makri, Erminia Ridolo, Irene Pellicelli, Lorenzo Panella
Allergic asthma has a high prevalence worldwide and may be treated with very effective drugs, bur their therapeutic action cannot continue beyond treatment withdrawal. By contrast, AIT has its most remarkable outcome in the persistence of clinical effect also following treatment end. This exclusive effect is due to the mechanism of action of immunotherapy, which induces (similarly in SCIT and SLIT) tolerance to the administered allergy by modifying the immunological response, particularly the pattern of T cell response from the Th2 dominance (typical of the allergic pattern) to the Th1 dominance with the related cytokine production, and by inducing the generation of T regulatory cells as well [66]. Moreover, a study on pediatric population has shown that AIT has a prolonged efficacy, even after the treatment discontinuation, in reducing the ICS dose needed to control asthma [67]. Clinically, the effectiveness of SCIT was clearly showed by Abramson et al. in three Cochrane meta-analysis from 2000 to 2010 [15–17]. The latest analyzed 88 RPCTs and concluded as to efficacy that ‘Immunotherapy reduces asthma symptoms and use of asthma medications and improves bronchial hyper-reactivity’, and as to safety that ‘The possibility of local or systemic adverse effects (such as anaphylaxis) must be considered’ [17]. Concerning SLIT, there is evidence for a better safety, while for efficacy the results of meta-analyses are less solid, mainly because of a significant heterogeneity of the used methods, doses, and assessment parameters [32].