Pregnancy, breast-feeding and headache
Stephen D. Silberstein, Richard B. Upton, Peter J. Goadsby in Headache in Clinical Practice, 2018
Many drugs can be detected in breast milk at levels that are not of clinical significance to the infant. The concentration of drug in breast milk is a variable fraction of the maternal blood level. The infant dose is usually 1–2% of the maternal dose, which is usually trivial. Any exposure to a toxic drug or potential allergen may be inappropriate. Drug concentration in breast milk depends on the drug characteristics (pKa, lipid solubility, molecular weight, protein binding) and the breast milk characteristics (composition and volume). Breast milk derives its unique physicochemical properties from the active transport of electrolytes and the formation and excretion of lactose and proteins by glandular epithelial cells in the breast with passive diffusion of water. The volume produced depends on nutritional factors, the amount of milk removed by the suckling infant, and the increase in mammary blood flow that occurs with breast-feeding. Volume production slowly increases from an average of 600 ml/day to 800 ml/day by the time the infant is 6 months old, and undergoes a diurnal variation, with the greatest quantity occurring in the morning. For the first 10 days of production, milk composition is characterized by a gradual increase in fat and lactose from a milk that is higher in protein content (colostrum).
Asthma in Pregnancy
Jonathan A. Bernstein, Mark L. Levy in Clinical Asthma, 2014
The incidence of asthma during pregnancy ranges from 8.4% to 13.9%7,11,13,16,28 and the trend has been increasing just as the prevalence of asthma in the general population has been increasing (now being 25 million in the United States or 8.3% of the population).29 The questions raised focus on the impact that pregnancy has on the severity of asthma, the safety (and necessity) for pharmacotherapy, what dietary changes during pregnancy should be incorporated to prevent or reduce the likelihood of asthma developing in the baby (or over time), to what extent breast-feeding and/or allergen immunotherapy will prevent/delay asthma or allergic disorders such as eczema or allergic rhinitis, and whether influenza immunization is necessary.
Asthma
James M. Rippe in Lifestyle Medicine, 2019
These medication classifications are based on animal and human data and also risk-benefit. The best category is A, but there are no asthma medications in this group. Both systemic and inhaled corticosteroids can be used during pregnancy. The inhaled steroid budesonide has long been listed as category B and preferred during pregnancy because of the large amount of safety data obtained from the medical birth registry in Sweden.2 However, patients who are doing well on other inhaled corticosteroids could be continued. Inhaled beta agonist therapy with albuterol, which has the most safety data during human pregnancy, should be used for symptom breakthrough.2 During pregnancy, the leukotriene inhibitors montelukast, and zafirlukast are not preferred therapy for mild persistent asthma. The Merck Pregnancy Registry, although small and unpublished, has not shown an increase in perinatal complications. Allergy immunotherapy can be continued through pregnancy but should not be altered. Furthermore, allergen immunotherapy should not be started during pregnancy.
Metal nanomaterials: Immune effects and implications of physicochemical properties on sensitization, elicitation, and exacerbation of allergic disease
Published in Journal of Immunotoxicology, 2019
Katherine A. Roach, Aleksandr B. Stefaniak, Jenny R. Roberts
Rates of allergic disease have been on the rise for decades, and the American Academy of Allergy, Asthma, and Immunology reports that worldwide, sensitization rates to one or more common allergens are approaching 40–50% in school-aged children (AAAAI 2015). In the United States, allergic diseases are the sixth leading cause of chronic illness with an annual cost exceeding $18 billion US (Centers for Disease Control and Prevention 2017). Although the development of allergy is dependent on a multitude of genetic, behavioral, and environmental factors, exposures to immunotoxic agents are a major underlying contributor to allergic diseases (Boverhof et al. 2008). Immunotoxic agents with the capacity to impact allergic disorders generally exert one of two effects. First, the agent can act as an allergen or sensitizer. Following exposure to these agents, the resultant adaptive immune response is specific to the agent and subsequent encounters trigger allergic reactions. Contrarily, agents can augment immunological processes involved in allergic disorders specific to differing agent. These agents are often referred to as “adjuvants” or “immuno-modulators” and their effects can range from increasing host susceptibility to sensitization, decreasing the allergen dose required to induce sensitization, decreasing the dose required to elicit allergic responses, or exacerbating the severity of allergic responses (Zunft 1996).
Presentation, diagnosis, and the role of subcutaneous and sublingual immunotherapy in the management of ocular allergy
Published in Clinical and Experimental Optometry, 2021
Amruta Trivedi, Constance Katelaris
The aim of treatment in allergic eye disease is to minimise the immune‐mediated inflammatory cascade associated with the allergic response, to relieve symptoms, and to prevent complications of chronic inflammation. Initial therapies are empiric, and include allergen avoidance, intranasal corticosteroids, oral and topical second‐generation antihistamines, leukotriene receptor antagonists, topical vasoconstrictors and mast cell stabilisers. Allergic eye disease refractory to these measures can be referred for topical corticosteroids and topical immunomodulator therapies, although the former are associated with ocular adverse effects and therefore appropriate for short courses only.13 Allergen immunotherapy is well‐established as the only disease‐modifying treatment available that may provide long‐term benefit in the control of moderate–severe allergic eye disease that is refractory to initial therapies.14
Reducing the hidden burden of severe asthma: recognition and referrals from primary practice
Published in Journal of Asthma, 2021
Marc Humbert, Arnaud Bourdin, Nikolaos G. Papadopoulos, Stephen T. Holgate, Nicola A. Hanania, David M. G. Halpin, Kenneth R. Chapman, Marcela Gavornikova, David B. Price, Alan Kaplan, Liam G. Heaney
There are a number of non-corticosteroid-based therapeutic options available to patients with severe or uncontrolled disease, e.g.leukotriene receptor antagonists, long-acting β2-agonists, long-acting muscarinic antagonists, and allergen desensitization (immunotherapy). Biologic therapies have now become increasingly available for treatment of severe disease, with some only available outside of the primary care setting. The favorable safety profile of biologic therapies such as omalizumab (24–26), mepolizumab (27,28), benralizumab (29,30), reslizumab (31), and dupilumab (32), compared with the known risks of the above-mentioned steroid adverse effects, should remain an important consideration. Bronchial thermoplasty may also be a useful intervention in selected patients with severe asthma, although the selection of patient phenotypes most likely to benefit remains problematic and the procedure is not widely available (33). The known heterogeneity of asthma, including the existence of phenotypes and endotypes, underscores the need for deeper specialist-led characterization of patients with severe asthma. This supports the use of more targeted, effective therapies (5), where appropriate, whilst minimizing potential treatment-associated side effects.
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