Pediatric Allergy: The Key to an Evolving Renaissance in Our Specialty

Historically, pediatric allergic diseases have been understudied, and their treatments were missing their mark. For example, not very many decades ago “parentectomy” was a viable therapeutic option when treating severe pediatric asthma. Subsequently, the concept of asthma as an inflammatory disease emerged, and we began using inhaled corticosteroids (ICS) with the thought that using them regularly would interrupt disease progression and even r everse underlying asthma. To prove this, in the early 1990s, the National Institutes of Health initiated the CAMP (“Child Asthma Management Program”) study, boldly randomizing children as young as 5 years old to long-term continuous ICS therapy.
Source: Immunology and Allergy Clinics of North America - Category: Allergy & Immunology Authors: Tags: Foreword Source Type: research

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ConclusionThere is moderate evidence that high doses of ICS, in addition to SCS, reduces the risk of hospital admission in ED treatment of moderate to severe asthma exacerbations. Further research is required to determine their optimal role in both ED and outpatient settings.
Source: The Journal of Allergy and Clinical Immunology: In Practice - Category: Allergy & Immunology Source Type: research
Combination of IL-6 (non-Type 2 asthma) and FeNO or blood eosinophil count (Type 2 asthma) identified asthma endotypes related to asthma severity, exacerbations, and responsiveness to corticosteroids and potential for response to anti-Type 2 and anti-IL-6 treatment.
Source: Journal of Allergy and Clinical Immunology - Category: Allergy & Immunology Authors: Source Type: research
AbstractPurpose of reviewTreatment of acute asthma exacerbations involves using systemic corticosteroids and short-acting β2-agonists (SABA). In an effort to limit the burden of systemic steroids, recent studies suggest benefit with the use of inhaled corticosteroids in an acute asthma exacerbation.Recent findingsRecent data has demonstrated benefit from the addition of inhaled corticosteroids to systemic steroids, increasing inhaled corticosteroid dose, and adding a separate inhaled corticosteroid inhaler during an exacerbation. Additionally, inhaled corticosteroid and fast-acting long-acting β-agonist (LABA) ca...
Source: Current Treatment Options in Allergy - Category: Allergy & Immunology Source Type: research
AbstractPurpose of reviewTo summarize the recent evidence on the various wheezing patterns in early life and provide a case-based review with insights into clinical application of individualized therapy in preschool children with recurrent wheezing.Recent findingsPreschool wheezing is often characterized predominantly by the risk domain with exacerbations and relatively limited impairment. In children with intermittent disease and a positive Modified Asthma Predictive Index, intermittent therapy with inhaled corticosteroids (ICSs) should be considered as an initial therapy to prevent exacerbations. Early administration of ...
Source: Current Treatment Options in Allergy - Category: Allergy & Immunology Source Type: research
ConclusionsThis exploratory analysis suggests that improvements with tiotropium as add-on to ICSs, with or without additional controllers, in 6- to 17-year-olds with symptomatic asthma do not vary according to systemic markers of T2 inflammation, namely, total IgE and blood eosinophil counts.
Source: The Journal of Allergy and Clinical Immunology: In Practice - Category: Allergy & Immunology Source Type: research
ConclusionReslizumab is an effective and safe option for patients with severe eosinophilic asthma and a history of omalizumab failure.
Source: The Journal of Allergy and Clinical Immunology: In Practice - Category: Allergy & Immunology Source Type: research
Abstract BACKGROUND: Despite the low prevalence for all asthma patients, those with severe disease account for a disproportionately large economic burden. OBJECTIVE: To evaluate current direct health care and productivity loss costs associated with asthma patients receiving Global Initiative for Asthma Step 4/5 therapy ("G4/5 asthma") in the United States (U.S.). METHODS: Asthma patients aged ≥12 years were identified in the IBM MarketScan® Research Databases between 1/1/2012‒12/31/2015. Patients were indexed on their earliest medical claim for asthma and were required to have ≥2 ye...
Source: Annals of Allergy, Asthma and Immunology - Category: Allergy & Immunology Authors: Tags: Ann Allergy Asthma Immunol Source Type: research
This article focuses on the variety of options available to patients and providers to choose from as they customize an asthma self-management plan. Literature regarding short-acting bronchodilators is reviewed along with studies on more controversial therapies, such as use of home oral steroids, inhaled corticosteroid and beta agonist combination therapy, and macrolides in acute asthma exacerbations.
Source: Immunology and Allergy Clinics of North America - Category: Allergy & Immunology Authors: Source Type: research
Children with severe therapy-resistant asthma (STRA) have poor control despite maximal treatment, while those with difficult asthma (DA) have poor control from failure to implement basic management, including adherence to therapy. Although recognised as clinically distinct, the airway molecular phenotype, including the role of innate lymphoid cells (ILCs) and their response to steroids in DA and STRA is unknown. Immunophenotyping of sputum and blood ILCs and T-cells from STRA, DA and non-asthmatic controls was undertaken. Leukocytes were analysed longitudinally pre- and post-intramuscular triamcinolone in children with STR...
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Lung biology and experimental studies, Asthma and allergy, Paediatric pulmonology Original Articles: Basic science and asthma Source Type: research
Study in African - American children shows symptom - based adjustment of inhaled corticosteroids is feasible
Source: Pulmonary Medicine News - Doctors Lounge - Category: Respiratory Medicine Tags: Family Medicine, Pediatrics, Pharmacy, Pulmonology, Allergy, Emergency Medicine, Journal, Source Type: news
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