Current opinion in allergy and clinical immunology
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Curr Opin Allergy Clin Immunol · Feb 2007
ReviewUse of diagnostic algorithms and new technologies to study the incidence and prevalence of viral upper respiratory tract infections and their complications in high risk populations.
Most studies on the natural history of viral upper respiratory tract infections and their complications rely for ascertainment on self-assessed cold/flu illness or the identification of presumed complications. The criteria for cold/flu definition, however, are variable within and between individuals and illness is not prerequisite for a viral upper respiratory tract infection. These factors bias estimates of the incidence and prevalence of viral upper respiratory tract infections and their complications. Here we review new methodologies that can be adapted for use in future studies to refine those estimates. ⋯ The methodologies and sampling strategies that we describe hold promise for better characterizing the incidence of complications for symptomatic and asymptomatic expressions of a viral upper respiratory tract infection caused by specific viruses. These data can then be used to estimate the efficacy and efficiency in a specified target population of prophylactic or intercurrent treatments to prevent the complications.
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Curr Opin Allergy Clin Immunol · Dec 2006
ReviewHemophagocytic lymphohistiocytosis and related disorders.
The rate of diagnosis of hemophagocytic lymphohistiocytosis, a genetically heterogeneous and, frequently, rapidly fatal autosomal recessive disorder of immune regulation, is increasing worldwide. Awareness has grown through the Histiocyte Society and the publication of newly-recognized genetic causes. I summarize current knowledge regarding the pathophysiology, diagnosis and treatment of hemophagocytic lymphohistiocytosis. ⋯ Bench and clinical research have advanced understanding of the pathophysiology of hemophagocytic lymphohistiocytosis and related disorders, and significantly improved clinical outcomes during the past decade.
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Curr Opin Allergy Clin Immunol · Aug 2006
ReviewRapid desensitization for hypersensitivity reactions to chemotherapy agents.
Hypersensitivity reactions (HSRs) to chemotherapy agents have limited their use for fear of inducing severe reactions or death. Alternative regimens may be limited by tumor sensitivity and the need to provide first-line therapy. Rapid desensitizations allow patients to be treated with medications to which they have presented a HSR. The purpose of this review is to highlight the indications and recent developments in chemotherapy rapid desensitization protocols. ⋯ The use of rapid desensitization protocols for cancer patients with HSRs to chemotherapy depends on their demonstrated tolerability and efficacy in selected populations. Education of nurses, pharmacists, and oncology and allergy specialists is needed to improve their universal application as standard of care.
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Curr Opin Allergy Clin Immunol · Aug 2006
ReviewEmergency treatment and prevention of insect-sting anaphylaxis.
Hymenoptera stings are thought to cause systemic allergic reactions in 0.4-5% of individuals, and to account for 40-100 deaths annually in the USA. This review examines current research on insect-sting anaphylaxis in the emergency department (ED), and provides suggestions on how to improve ED treatment and prevention. ⋯ Concordance with national guidelines for the treatment of anaphylaxis remains poor among insect-sting allergy patients. The development of a simple, clinical definition of anaphylaxis is urgently needed to facilitate identification of cases. Such a definition would help tremendously with dissemination of emergency management guidelines and the creation of systems for their implementation. All of these steps are essential for the improved treatment and prevention of insect-sting anaphylaxis in the ED.
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Curr Opin Allergy Clin Immunol · Jun 2006
ReviewOutcome evaluation of early discharge after hospitalization for asthma.
This review is designed to assess the evidence around the criteria used to decide when it is appropriate for an individual with asthma to be discharged from hospital. ⋯ The available data for adults with acute asthma on the appropriate end points for discharge from hospital are inadequate to provide firm conclusions. Children with acute asthma should be considered ready for discharge when clinically stable on 3-hourly bronchodilator.