Current opinion in allergy and clinical immunology
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A novel form of anaphylaxis has been described that is due to IgE antibody (Ab) directed against a mammalian oligosaccharide epitope, galactose-alpha-1,3-galactose (alpha-gal). Ongoing work regarding the cause and distribution of this IgE response is reviewed. ⋯ Large numbers of patients with IgE Ab to alpha-gal continue to be identified in the USA and globally. Clinicians should be aware of this IgE response as the reactions often appear to be idiopathic because of the significant delay between eating mammalian meat and the appearance of symptoms.
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Curr Opin Allergy Clin Immunol · Aug 2013
ReviewAngioedema induced by angiotensin-converting enzyme inhibitors.
Since angiotensin-converting enzyme inhibitors (ACEIs) were first introduced in the 1980s for treatment of hypertension and congestive heart failure, there has been progressive increase in use due to these and other new indications. This fact has led to a parallel increase in adverse effects induced by ACEIs, mainly angioedema, with different degrees of severity. ⋯ The present review will focus on current and relevant aspects of ACEI-induced angioedema. The pathological mechanism, epidemiology and risk factors, differential diagnosis, patient management and treatment will be discussed.
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Epinephrine is an important life-saving treatment in patients with anaphylaxis. However, despite the guidelines recommending the use of epinephrine in the management of all patients with anaphylaxis, many patients are either not prescribed epinephrine auto-injectors (EAIs) or remain hesitant to use them. ⋯ Epinephrine remains the cornerstone of anaphylaxis treatment and EAIs are critical because of their ability to rapidly deliver this potentially life-saving medication outside of a medical setting. Continued efforts are needed to establish evidence-based parameters for delivery of this medication and to optimize education of healthcare providers and patients on the use of EAIs.
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Curr Opin Allergy Clin Immunol · Jun 2013
ReviewAsthma exacerbations: predisposing factors and prediction rules.
Asthma is a multifaceted disease that is associated with decreased lung function, multiple symptoms, varying levels of asthma control, and risk of acute exacerbations. The ability to predict the risk of developing acute exacerbations may improve the management of asthmatics and facilitate identification of these patients for interventional studies. ⋯ This review will emphasize underlying factors associated with asthma exacerbations and clinical prediction rules that correlate with the risk of developing severe exacerbations of asthma.
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Most asthma starts early in life. Defining phenotypes of asthma at this age is difficult as many preschool children have asthma-like respiratory symptoms. This review discusses progress in defining early wheezing phenotypes and describes genetic factors associated with the age of onset of asthma. ⋯ Although most asthma starts early in life, no valid test is able to identify asthma at that age period. GWA studies have provided more insight into the unique and common genetic origins of adult-onset and childhood-onset asthma. The 17q12-21 locus is predominantly associated with childhood-onset asthma.