Is Your Past Too Heavy to Haul Around?
Imagine a cloth bag containing 10 pounds of river rocks, their surface smoothed by years of water washing over them, tumbling them, moving them downstream. You are asked how long you could possibly hold the bag draped over your shoulder or held extended out from one arm. What might your answer be? When I offered this exercise at a substance addiction out-patient rehab where I worked from 2012-2014, the teens would laugh and say that they could do it for an extended period of time. I nodded and they took on the challenge. Within moments, their resolve faded as they realized how heavy 10 pounds could be and try as they might, a minute or so was all they could handle. I gave them a few options. They could either put the whole thing down or take the rocks out a few at a time and see if that made it easier to hold. The rocks represented the choices they had made, the drugs they ingested, the ill-advised friendships they had attracted and maintained, and even more powerful; the beliefs they held that enabled all of this to occur. I asked what it might feel like, in either case, to unburden themselves and stand up straight. Several had been bent by childhood events, losses, parental substance addictions, family dysfunction and the concomitant choices they had made and thought they still had to. I reminded them that their history need not be their destiny. That line remains with me each day as well. My history is not my destiny, regardless of how deeply entrenched my beliefs might ...
A long-term goal of clinical care has always been to fit the specific treatment to the individual patient —what we would now call personalized medicine. However, the ability to predict which patient will best respond to which treatment has historically been nearly impossible. Accordingly, personalized medicine has typically involved significant trial and error with different therapies until desired cl inical results are achieved. Fortunately for both patients and physicians, this paradigm has begun to change.
Environmental nonallergenic exposures, such as microbes and air pollutants, are thought to influence the clinical manifestations of allergic and atopic disease. However, as patterns of urbanization, climate change, and socioeconomic health disparities persist, the health effects of the envirome are increasingly relevant to practitioners and policymakers. In this issue of Annals, Peden1 outlines the influence of pollutant, infectious, and psychosocial conditions on the incidence and severity of allergic disease.
The goal of personalized medicine is arguably as old as medicine itself,1 and the promise of using simultaneously broad (all genes and all exposures), precise (single molecules or cells), and unbiased (not dependent on prior knowledge) data sets to tailor clinical care is the compelling objective of systems biology as applied to medicine. In this issue, Virkud et al2 present a useful and informative overview of the “big data” domains, including genomics, epigenomics, transcriptomics, and proteomics along with the microbiome and exposome and their integrated effects on the metabolome, which are the grist f...
Urticaria is characterized by the appearance of hives or angioedema.1 Chronic urticaria is defined by urticarial episodes that last more than 6 weeks, occurring daily or several times per week.2 Although acute urticaria is commonly associated with infections,3 most cases of chronic urticaria have no identifiable cause. Nevertheless, several reports documented chronic urticaria from infectious causes including Helicobacter pylori.4 Studies show association of upper respiratory infections, including sinusitis, with chronic urticaria with remission after antibiotic therapy.
Linda S. Cox