Current opinion in allergy and clinical immunology
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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.
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Curr Opin Allergy Clin Immunol · Apr 2013
ReviewThe use of specific inhalation challenge in hypersensitivity pneumonitis.
The diagnosis of hypersensitivity pneumonitis remains a dilemma because of the absence of any characteristic features able to distinguish it from other interstitial lung diseases. We analyze the current role of the specific inhalation challenge (SIC) in the diagnosis of this entity. ⋯ Hypersensitivity pneumonitis remains a diagnostic challenge. Given that the main cause of the disease is sensitization and hyper-responsiveness to specific antigens in susceptible individuals, SIC is an obvious candidate as the gold standard for diagnosis of this entity. The present review analyzes the reasons for the test's limited use, assesses its diagnostic utility, and proposes a basis for its standardization.
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Curr Opin Allergy Clin Immunol · Apr 2013
ReviewRemodeling, inflammation and airway responsiveness in early childhood asthma.
Remodeling and inflammation together with airway hyperresponsiveness are essential components of asthma but their role in development of the disease is still obscure. ⋯ Even young children with chronic asthma have detectable elements of airway remodeling, inflammation and increased airway responsiveness, which all contribute to impaired lung function.
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Both atopy and diseases from the spectrum of dermatitis and eczema are among the most frequent clinical problems worldwide; nevertheless, they are still poorly defined and too frequently misdiagnosed. In the present review, studies pertinent to this topic were systematized and critically assessed with particular attention to definitions of relevant diseases. ⋯ The interplay between atopy and diseases from the spectrum of dermatitis and eczema is not fully understood; nevertheless, their coexistence and overlapping are not rare. Therefore, every patient with eczema - regardless of age, sex or atopic status - should undergo an extensive diagnostic programme including each atopic eczema, irritant contact dermatitis, allergic contact dermatitis, and protein contact dermatitis. Better definitions and well designed studies are necessary to achieve detailed information on the complex relationships between each atopy, atopic eczema, and the three contact dermatitides.