Immunology and allergy clinics of North America
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Immunol Allergy Clin North Am · Nov 2012
ReviewUpdate on diffuse alveolar hemorrhage and pulmonary vasculitis.
Diffuse alveolar hemorrhage is a clinical syndrome that can be a manifestation of multiple different causes. Identification of the underlying etiology is of utmost importance and dictates treatment. ⋯ For AAV, treatment includes induction followed by maintenance therapy. Rituximab has an increasing role in the treatment of AAV.
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This article provides a broad overview of the complex intersection between the connective tissue diseases (CTDs) and their pulmonary manifestations. Indirect pulmonary complications - such as respiratory infection and medication-induced lung toxicity - are briefly discussed, and the importance of a comprehensive assessment of the patient with CTD with respiratory symptoms is emphasized. A concise review of the many pulmonary manifestations of each specific CTD is provided, and particular emphasis is placed on CTD-associated interstitial lung disease.
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Idiopathic pulmonary fibrosis (IPF) is a chronic lung disease of unknown cause characterized by progressive scarring of the lung parenchyma and relentless loss of lung function. The diagnosis depends on close collaboration between clinicians, radiologists, and pathologists. No therapies approved by the Food and Drug Administration are available for IPF, and an analysis of completed clinical trials has demonstrated that the clinical course of IPF is largely unpredictable. Until therapies that improve survival become available, measures to preserve function and quality of life should be considered, and gastroesophageal reflux should be treated aggressively.
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Exhaled breath condensate (EBC) is a promising source of biomarkers of lung disease. EBC may be thought of either as a body fluid or as a condensate of exhaled gas. ⋯ The nonvolatile constituents and the water-soluble volatile constituents are of particular interest. Several key issues are discussed in this article.
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Immunol Allergy Clin North Am · May 2012
ReviewThe use of intravenous immunoglobulin in autoimmune bullous diseases.
Intravenous immunoglobulin (IVIG) has been shown to be effective in the treatment of autoimmune blistering diseases and may be an option if disease is refractory to conventional treatment. IVIG effectiveness appears to increase when administered concurrently with a cytotoxic drug and used in multiple treatment cycles (though a single cycle may give benefit). Tapering administration may improve the duration of remission and subcutaneous injections may be an option. This article provides an introduction to the make-up and use of IVIG, and reviews previous studies.