Mepolizumab utility in successful aspirin desensitization in aspirin-exacerbated respiratory disease in a refractory case

Aspirin-exacerbated respiratory disease (AERD) is a severe respiratory syndrome characterized by asthma, chronic rhinosinusitis with nasal polyposis (CRSwNP), and sensitivity to nonsteroidal anti-inflammatory drugs (NSAID) including aspirin manifested by acute upper and lower respiratory symptoms with exposure to this class of medications. (1) The prevalence of AERD is reported in 5.5% to 12.4 % of adult asthmatics, and rises to 21% when NSAID hypersensitivity is determined by provocation. (2-4) The management of asthma and CRSwNP in AERD should follow international guidelines including use of combination inhaled corticosteroid and long acting beta ‐2 agonists (ICS/LABA), leukotriene‐modifying drugs (LTMD), nasal corticosteroids, nasal saline irrigations and short‐term antibiotics and oral steroids as needed.
Source: Annals of Allergy, Asthma and Immunology - Category: Allergy & Immunology Authors: Tags: Letters Source Type: research

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Asthma control changes over time and many factors contribute to this variability. Environmental exposures such as seasonal allergen fluctuations, second-hand tobacco exposure, and viral upper respiratory tract infections (RTI) are just a few of the known triggers of lability 1. In addition, host factors such as inhaler technique and co-morbid conditions including atopic diseases, obesity, and acid reflux can also contribute to this changeability. During times of lability, overzealous intervention can lead to overuse of oral corticosteroids (OCS) and healthcare visits, while delayed treatment can lead to severe exacerbation...
Source: Annals of Allergy, Asthma and Immunology - Category: Allergy & Immunology Authors: Tags: Review Source Type: research
It's not clear which inhaled corticosteroids and delivery devices have the least adverse impact on growth in children with persistent asthma, a systematic review concludes.Reuters Health Information
Source: Medscape Allergy Headlines - Category: Allergy & Immunology Tags: Pulmonary Medicine News Source Type: news
AbstractThe use of biologic agents as therapies for atopic diseases such as asthma and atopic dermatitis has increased greatly in recent years. The biological agents used to treat atopic diseases are for the most part monoclonal antibodies that suppress the immune response and reduce inflammation by targeting particular cytokines or other molecules involved in Th1, Th2, or Th17 immune reactions. Various side effects and rare complications have been reported from these agents. In this review, we discuss mechanisms of various adverse effects for the biologic agents currently in use or in development for atopic and inflammato...
Source: Clinical Reviews in Allergy and Immunology - Category: Allergy & Immunology Source Type: research
In contrast to asthma, the inflammatory response induced by human respiratory syncytial virus (RSV) infection is refractory to glucocorticoid treatment1,2 for reasons that are not clear. Reduced corticosteroid responsiveness at the cellular and clinical level is associated with reduced numbers of glucocorticoid receptor (GRs).3,4 We previously showed that RSV infection downregulated GR mRNA and protein levels in RSV-infected A549  cells and in BALB/c mice.5 Other studies showed that downregulated GR levels were associated with an increase in the microRNAs (miRNAs) miR-124-3p, miR-142-3p, and miR-29a.
Source: Journal of Allergy and Clinical Immunology - Category: Allergy & Immunology Authors: Tags: Letter to the Editor Source Type: research
We read with interest the study by Cardet et  al,1 which showed that 38% of asthmatic patients receiving an inhaled corticosteroid (ICS) and a long-acting β-agonist (LABA; ie, fluticasone/salmeterol) experienced loss of bronchoprotection. We believe that their results need to be interpreted in light of the potential interaction between the L ABA moiety and the arginine/glycine genotype at position 16 (Arg16Gly) of the β2-adrenoceptor. For example, a post hoc genotype-stratified pooled analysis of 152 patients from randomized placebo-controlled trials showed that the degree of protection after chronic dosing ...
Source: Journal of Allergy and Clinical Immunology - Category: Allergy & Immunology Authors: Tags: Correspondence Source Type: research
The European Respiratory Biologics Forum gathered participants from 21 countries in Madrid, Spain, to discuss the management and treatment of severe asthma in the era of biologics. The current insights on the pathophysiology of severe asthma were discussed, as well as the role of respiratory biologics in clinical practice and strategies for eliminating chronic use of oral corticosteroids. The participants also highlighted the key challenges in identifying patients with severe asthma based on phenotypes, biomarkers and treatable traits, and the existing problems in patient referral to specialist care. The monitoring of trea...
Source: European Respiratory Review - Category: Respiratory Medicine Authors: Tags: Asthma and allergy Review Source Type: research
Publication date: July–August 2019Source: The Journal of Allergy and Clinical Immunology: In Practice, Volume 7, Issue 6Author(s): Tianshi David Wu, Emily P. Brigham, Corinne A. Keet, Todd T. Brown, Nadia N. Hansel, Meredith C. McCormackBackgroundMetabolic dysfunction may contribute to worsened asthma in obesity. The relationship between prediabetes and diabetes, metabolic conditions more common in obesity, and asthma outcomes is not well characterized.ObjectiveWe sought to determine the association between prediabetes/diabetes and asthma exacerbations in an obese asthma cohort.MethodsA retrospective cohort of US obe...
Source: The Journal of Allergy and Clinical Immunology: In Practice - Category: Allergy & Immunology Source Type: research
Publication date: July–August 2019Source: The Journal of Allergy and Clinical Immunology: In Practice, Volume 7, Issue 6Author(s): Sarah Diver, Richard J. Russell, Christopher E. BrightlingEosinophilic airway inflammation is observed in 30% to 50% of chronic cough sufferers. It is a common feature of asthma and upper airway cough syndrome, and it is required in the diagnosis of nonasthmatic eosinophilic bronchitis. Our understanding of the mechanisms underlying allergic and nonallergic eosinophilic inflammation have evolved tremendously in the last 2 decades, but the cause of this inflammation in any individual is of...
Source: The Journal of Allergy and Clinical Immunology: In Practice - Category: Allergy & Immunology Source Type: research
AbstractPurpose of ReviewThe goal of this review is to summarize the field to date and to discuss strengths and limitations of low-level laser (light) therapy (LLLT) for the future investigation as a treatment of inflammatory disease.Recent FindingsLLLT is a promising therapeutic, particularly for those diseases of skin and joints because they are most accessible to treatment. Indeed, the known mechanisms of LLLT support its use for anti-inflammatory purposes, as well as stimulation of tissue growth and repair. Although the standard of care for the majority of inflammatory diseases is immunosuppressive agents such as corti...
Source: Current Allergy and Asthma Reports - Category: Allergy & Immunology Source Type: research
ConclusionsPoorly controlled asthma is more frequent among publicly versus privately insured pregnancies in the United States. Dispensing of long-term controller medications during pregnancy remains low, even for symptomatic patients.
Source: The Journal of Allergy and Clinical Immunology: In Practice - Category: Allergy & Immunology Source Type: research
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