Current opinion in allergy and clinical immunology
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Curr Opin Allergy Clin Immunol · Jun 2008
ReviewWhen should self-injectible epinephrine be prescribed for food allergy and when should it be used?
To explore why epinephrine autoinjectors have failed to prevent fatal food anaphylaxis and how this problem might be solved. ⋯ The fallibility of autoinjectors means that in the management of food allergy, their provision must take second place to accurate identification of the trigger foods, optimal avoidance, and optimal treatment of other medical conditions that make reactions more dangerous.
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Curr Opin Allergy Clin Immunol · Apr 2008
ReviewThe role of written action plans in childhood asthma.
The aim of this article is to examine the evidence for the effectiveness of a written action plan as an important element of guided self-management and to identify key features associated with its effectiveness in children and adolescents. ⋯ Written action plans are effective tools to facilitate self-management. While step-up therapy is not superior to daily controller medication, symptom-based are superior to peak-flow based action plans for preventing exacerbations, other keys features associated with effectiveness have yet to be identified.
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Curr Opin Allergy Clin Immunol · Apr 2008
ReviewPediatric biomarkers in asthma: exhaled nitric oxide, sputum eosinophils and leukotriene E4.
Markers of disease status that provide a numerical measure of disease activity, biomarkers, have come into more routine use in medicine. This is evidenced by troponin and brain natriuretic peptide when measuring cardiac function or glomerular filtration rate in relation to kidney function. Similar markers to assess inflammation in the asthmatic lung have emerged as possible tools to guide treatment. Three biomarkers, fractional exhaled nitric oxide, sputum eosinophils and leukotriene E4 in the urine and exhaled breath condensate, have been heavily investigated. ⋯ Exhaled nitric oxide and urinary leukotriene E4 are relatively easy to attain in the clinical setting. Sputum eosinophils are an excellent tool for assessing inflammation, however sputum induction can be challenging for a young child. Despite small limitations, all three biomarkers are potentially valuable when used in conjunction with conventional methods for airway control.
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Curr Opin Allergy Clin Immunol · Apr 2008
ReviewRole of respiratory viral infections in the development of atopic conditions.
Respiratory viral infections are implicated in both protection from, and inception of, allergic airway disease. Severe lower respiratory tract viral infections are associated with recurrent wheeze, asthma and atopy. It is unclear if this association is causal and the underlying mechanisms governing this are unknown. Whilst respiratory viral infections are the major precipitants of acute exacerbations of wheezing illness, early life infections are also clearly associated with protection from allergic diseases. This article aims to review the current understanding of the complex relationship between lower respiratory tract viral infections and their impact upon development of atopy in the airway. ⋯ Progress into understanding the relationship between respiratory viral infections and allergic airway disease is essential for development of treatments aimed at treating common risk factors mediating association but not cause. Recent findings may have begun to identify key pathways open to therapeutic intervention.