Atopic Dermatitis Is a Barrier Issue, Not an Allergy Issue
Atopic dermatitis (AD) is a chronic, relapsing disease that typically manifests in childhood and improves with age. Studies have demonstrated that the presence of AD increases the risk of developing food allergy, allergic rhinitis, and asthma later in life. Although children with AD are more likely to produce allergen-specific immunoglobulin E, there is conflicting evidence that allergen avoidance improves disease severity. Furthermore, food-elimination diets in patients with AD may increase the risk of developing immediate, life-threatening reactions to the removed food. The most effective treatments of AD aim to repair a...
Source: Immunology and Allergy Clinics of North America - August 31, 2019 Category: Allergy & Immunology Authors: Monica T. Kraft, Benjamin T. Prince Source Type: research

Tips and Tricks for Controlling Eczema
Eczema is a chronic, relapsing, and remitting disease that can affect patients from infancy through adulthood. Severity of eczema ranges from mild to severe and can be plagued with recurrent flares. These flares can be difficult to treat and may require use of different strategies to address the issue. In this article, the author addresses different therapeutic options that can be used in those patients with difficult-to-treat eczema. (Source: Immunology and Allergy Clinics of North America)
Source: Immunology and Allergy Clinics of North America - August 31, 2019 Category: Allergy & Immunology Authors: Rekha Raveendran Source Type: research

What to Do with an Abnormal Newborn Screen for Severe Combined Immune Deficiency
Newborn screening for severe combined immunodeficiency has been implemented in all 50 states. This screening identifies newborns with T-cell lymphopenia. After an abnormal screening, additional testing is needed to determine if the child has severe combined immunodeficiency. Because screening programs vary, it is imperative for the clinical immunologist to understand how screening is done in their state and to prepare an effective assessment protocol for the management of these patients. Part of this assessment should include training and helping to ensure the effective delivery of this news to the family, a skill neither ...
Source: Immunology and Allergy Clinics of North America - August 31, 2019 Category: Allergy & Immunology Authors: Hey J. Chong, Scott Maurer, Jennifer Heimall Source Type: research

Vocal Cord Dysfunction
Vocal cord dysfunction (VCD) is an upper airway disorder characterized by exaggerated and transient glottic constriction causing respiratory and laryngeal symptoms. Although the origin of VCD symptoms is in the upper airway, it is frequently misdiagnosed as asthma resulting in significant morbidity. VCD can coexist with asthma or mimic allergic conditions affecting the upper airway. VCD may be difficult to diagnose, because patients are intermittently symptomatic and VCD awareness in the medical community is underappreciated. Once VCD is diagnosed and treated, most patients report significant improvement in their symptoms ...
Source: Immunology and Allergy Clinics of North America - August 31, 2019 Category: Allergy & Immunology Authors: Andrej A. Petrov Source Type: research

It ’s Time to Start Phenotyping Our Patients with Asthma
Advances in the management of pediatric asthma, including biologics, offer practitioners the ability to tailor therapies to individual patients. However, asthma treatment guidelines have not kept up with current studies. This review explores the current literature incorporating the use of phenotyping in pediatric patients with asthma to provide precision therapy. Biomarkers can be used to more accurately predict the development of asthma, identify features that may be associated with difficult-to-control or severe asthma, and forecast response to therapies. Biomarkers and other phenotypic data can also be helpful in patien...
Source: Immunology and Allergy Clinics of North America - August 31, 2019 Category: Allergy & Immunology Authors: Hannah Duffey, William C. Anderson Source Type: research

Asthma Self-management
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)
Source: Immunology and Allergy Clinics of North America - August 31, 2019 Category: Allergy & Immunology Authors: Lisa Ulrich, Sabrina Palacios Source Type: research

Focusing on Children
Allergy and Immunology is a unique specialty for many reasons. Unfortunately, many allergic conditions are chronic, with initial presentation during childhood that can last through adulthood. Allergic conditions are also prevalent among the general population. As such, medical providers from across the spectrum must be versed on the recognition and management of these common conditions. This issue of Immunology and Allergy Clinics of North America addresses the spectrum of allergic diseases with a focus on the pediatric population. (Source: Immunology and Allergy Clinics of North America)
Source: Immunology and Allergy Clinics of North America - August 28, 2019 Category: Allergy & Immunology Authors: David R. Stukus Tags: Preface Source Type: research

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, b...
Source: Immunology and Allergy Clinics of North America - August 24, 2019 Category: Allergy & Immunology Authors: Stephen A. Tilles Tags: Foreword Source Type: research

It ’s Not Mom’s Fault
Thus far, the most effective strategy for the prevention of food allergy is early introduction of allergenic solids to at-risk infants. Early skin moisturization may have a role in food allergy prevention. There is insufficient evidence for hydrolyzed formula as a means of allergy prevention. Studies on vitamin D, omega 3, and probiotic supplementation; breastfeeding; early infant dietary diversity; and maternal peanut ingestion during pregnancy and breastfeeding are inconsistent. (Source: Immunology and Allergy Clinics of North America)
Source: Immunology and Allergy Clinics of North America - August 22, 2019 Category: Allergy & Immunology Authors: Elissa M. Abrams, Edmond S. Chan Source Type: research

Managing Younger Siblings of Food Allergic Children
Current guidelines state that there is insufficient evidence to recommend testing siblings of food allergic children before introduction of potential allergic foods, but the topic continues to remain controversial. Although the proportion of siblings who are sensitized to a food without clinical reactivity is high in comparison to those with a true food allergy, there is still a known increased risk amongst siblings of children with food allergies that has led to much apprehension about management. The appropriateness of testing and further steps for management of sensitization in the absence of history of clinical reactiv...
Source: Immunology and Allergy Clinics of North America - August 22, 2019 Category: Allergy & Immunology Authors: Neha T. Agnihotri, Dawn K. Lei, Ruchi S. Gupta Source Type: research

Implementation of Early Peanut Introduction Guidelines
A landmark study showed that early peanut introduction in high-risk infants, defined as infants with moderate to severe atopic dermatitis or egg allergy, reduced the risk of developing peanut allergy. Since this trial, many international societies have updated feeding guidelines to promote early introduction of peanut, usually around 6  months of age. Implementing these guidelines on a national and international level has been challenging. Furthermore, there is confusion if allergy testing is needed before peanut introduction in high-risk infants. Despite these challenges, the data are promising, that implantation of ...
Source: Immunology and Allergy Clinics of North America - August 22, 2019 Category: Allergy & Immunology Authors: Irene J. Mikhail Source Type: research

Biologics for Asthma and Risk of Infection
Monoclonal antibodies block specific inflammatory pathways involved in the pathogenesis of asthma. These pathways are important in host defense against pathogens, and in particular, against parasites. Despite theoretical concerns about infection risk, biologics seem to have a favorable safety profile. Data from large clinical trials and postmarketing surveillance for these drugs have not shown increases in severe infections, including those from parasitic organisms. This may be due to redundancy of effector cells within the immune system. Certain drugs have special considerations and precautions, and therefore, the prescri...
Source: Immunology and Allergy Clinics of North America - July 6, 2019 Category: Allergy & Immunology Authors: Joao Pedro Lopes, Mauli Desai Source Type: research

Infections and Asthma
IMMUNOLOGY AND ALLERGY CLINICS OF NORTH AMERICA (Source: Immunology and Allergy Clinics of North America)
Source: Immunology and Allergy Clinics of North America - July 6, 2019 Category: Allergy & Immunology Authors: Mitchell H. Grayson Source Type: research

Copyright
ELSEVIER (Source: Immunology and Allergy Clinics of North America)
Source: Immunology and Allergy Clinics of North America - July 6, 2019 Category: Allergy & Immunology Source Type: research

Contributors
STEPHEN A. TILLES, MD (Source: Immunology and Allergy Clinics of North America)
Source: Immunology and Allergy Clinics of North America - July 6, 2019 Category: Allergy & Immunology Source Type: research

Contents
Stephen A. Tilles (Source: Immunology and Allergy Clinics of North America)
Source: Immunology and Allergy Clinics of North America - July 6, 2019 Category: Allergy & Immunology Source Type: research

Forthcoming Issues
Pediatric Allergy (Source: Immunology and Allergy Clinics of North America)
Source: Immunology and Allergy Clinics of North America - July 6, 2019 Category: Allergy & Immunology Source Type: research

Importance of Virus Characteristics in Respiratory Syncytial Virus-Induced Disease
Severe lower respiratory tract infection in infants and young children is most frequently caused by respiratory syncytial virus (RSV). RSV infects the smallest airways, making breathing difficult and in some infants requiring medical support. Severity is affected by viral dose, infant age, virus genotype, and effectiveness of the innate/adaptive immune responses. Severe disease correlates with later wheezing and asthma in some children. The adaptive immune response is protective but wanes after each infection, likely due to the ability of the RSV NS1/NS2 proteins to inhibit the innate immune response. Several vaccine appro...
Source: Immunology and Allergy Clinics of North America - May 21, 2019 Category: Allergy & Immunology Authors: Homero San-Juan-Vergara, Mark E. Peeples Source Type: research

The Complicated Dance of Infections and Asthma
The interaction between asthma and infections is a complicated one, and that is the focus of this issue of the Immunology and Allergy Clinics of North America. Infections, both viral and bacterial, have been associated with development and exacerbation of asthma, while parasitic infections may actually help protect against asthma. Furthermore, as our drug armamentarium begins to focus on biologics, which can selectively impair components of the immune response, there is concern that treated patients with asthma will be at risk of developing opportunistic infections. (Source: Immunology and Allergy Clinics of North America)
Source: Immunology and Allergy Clinics of North America - May 21, 2019 Category: Allergy & Immunology Authors: Mitchell H. Grayson Tags: Preface Source Type: research

Beyond Respiratory Syncytial Virus and Rhinovirus in the Pathogenesis and Exacerbation of Asthma
Respiratory viruses other than rhinovirus or respiratory syncytial virus, including human metapneumovirus, influenza virus, and human bocavirus, are important pathogens in acute wheezing illness and asthma exacerbations in young children. Whether infection with these viruses in early life is associated with recurrent wheezing and/or asthma is not fully investigated, although there are data to suggest children with human metapneumovirus lower respiratory tract infection may have a higher likelihood of subsequent and recurrent wheezing several years after initial infection. (Source: Immunology and Allergy Clinics of North America)
Source: Immunology and Allergy Clinics of North America - May 16, 2019 Category: Allergy & Immunology Authors: Andrea M. Coverstone, Leyao Wang, Kaharu Sumino Source Type: research

Sinus Infections, Inflammation, and Asthma
There is an important link between the upper and lower respiratory tracts whereby inflammation in one environment can influence the other. In acute rhinosinusitis, pathogen exposures are the primary driver for inflammation in the nose, which can exacerbate asthma. In chronic rhinosinusitis, a disease clinically associated with asthma, the inflammation observed is likely from a combination of an impaired epithelial barrier, dysregulated immune response, and potentially infection (or colonization) by specific pathogens. This review explores the associations between rhinosinusitis and asthma, with particular emphasis placed o...
Source: Immunology and Allergy Clinics of North America - May 16, 2019 Category: Allergy & Immunology Authors: Anna G. Staudacher, Whitney W. Stevens Source Type: research

Rhinovirus and Asthma Exacerbations
Rhinovirus (RV) is ubiquitous and typically causes only minor upper respiratory symptoms. However, especially in children and adolescent asthmatics, RV is responsible for most exacerbations. This ability of RV to drive exacerbations typically requires the concomitant presence of exposure to a bystander allergen. Susceptibility to RV-mediated exacerbations is also related to the genetic background of the host, which contributes to greater infectivity, more severe infections, altered immune responses, and to greater inflammation and loss of asthma control. Given these responses, there are several treatments available or bein...
Source: Immunology and Allergy Clinics of North America - May 15, 2019 Category: Allergy & Immunology Authors: Joshua L. Kennedy, Sarah Pham, Larry Borish Source Type: research

Infant Immune Response to Respiratory Viral Infections
Of all respiratory viruses that affect infants, respiratory syncytial virus (RSV) and rhinovirus (RV) represent the leading pathogens causing acute disease (bronchiolitis) and are associated with the development of recurrent wheezing and asthma. The immune system in infants is still developing, and several factors contribute to their increased susceptibility to viral infections. These factors include differences in pathogen detection, weaker interferon responses, lack of immunologic memory toward the invading pathogen, and T-cell responses that are balanced to promote tolerance and restrain inflammation. These aspects are ...
Source: Immunology and Allergy Clinics of North America - May 15, 2019 Category: Allergy & Immunology Authors: Santtu Heinonen, Rosa Rodriguez-Fernandez, Alejandro Diaz, Silvia Oliva Rodriguez-Pastor, Octavio Ramilo, Asuncion Mejias Source Type: research

Microbes, Infections, and Their Relationship to Asthma
Examining the impact of bacteria, viruses, fungi, and parasites on human disease has been a complicated undertaking that began centuries ago and has led to profound effects on human history, including the development of interventions such as sanitation technologies, antibiotics, and vaccinations. In recent decades, we have also begun to appreciate the potential detrimental effects of altering natural patterns of microbial species that coexist with us, including the importance of changes in the early-life microbiome on the development of asthma and other allergic diseases. (Source: Immunology and Allergy Clinics of North America)
Source: Immunology and Allergy Clinics of North America - May 11, 2019 Category: Allergy & Immunology Authors: Stephen A. Tilles Tags: Foreword Source Type: research

Rhinovirus Attributes that Contribute to Asthma Development
Early-life wheezing-associated infections with human rhinovirus (HRV) are strongly associated with the inception of asthma. The immune system of immature mice and humans is skewed toward a type 2 cytokine response. Thus, HRV-infected 6-day-old mice but not adult mice develop augmented type 2 cytokine expression, eosinophilic inflammation, mucous metaplasia, and airway hyperresponsiveness. This asthma phenotype depends on interleukin (IL)-13 –producing type 2 innate lymphoid cells, the expansion of which in turn depends on release of the innate cytokines IL-25, IL-33, and thymic stromal lymphopoietin from the airway e...
Source: Immunology and Allergy Clinics of North America - May 7, 2019 Category: Allergy & Immunology Authors: Mingyuan Han, Charu Rajput, Marc B. Hershenson Source Type: research

Bacteria in Asthma Pathogenesis
The airways are under continuous assault from aerosolized bacteria and oral flora. The bacteria present in the airways and gastrointestinal tract of neonates promote immune maturation and protect against asthma pathogenesis. Later bacterial infections and perturbations to the microbiome can contribute to asthma pathogenesis, persistence, and severity. (Source: Immunology and Allergy Clinics of North America)
Source: Immunology and Allergy Clinics of North America - May 7, 2019 Category: Allergy & Immunology Authors: Michael Insel, Monica Kraft Source Type: research

Helminths and Asthma
This article discusses the impact of helminth infections on asthma as well as the potencial of helminth-derived molecules with regulatory characteristics in the prevention or treatment of this disease. The ability to induce regulation has been observed in animal models of asthma or cells of asthmatic individuals in vitro. Potential future clinical applications of helminth antigens or infection for prevention of asthma merit further translational research. (Source: Immunology and Allergy Clinics of North America)
Source: Immunology and Allergy Clinics of North America - May 7, 2019 Category: Allergy & Immunology Authors: Jamille Souza Fernandes, Luciana Santos Cardoso, Paulo M. Pitrez, Álvaro A. Cruz Source Type: research

Early Life Respiratory Syncytial Virus Infection and Asthmatic Responses
The infant ’s developing immune response is central to establishing a balanced system that reacts appropriately to infectious stimuli, but does not induce altered disease states with potential long-term sequelae. Respiratory syncytial virus may alter the immune system, affecting future responses. Early infec tion may have direct effects on the lung itself. Other early life processes contribute to the development of immune responses including assembly of the microbiome, which seems to have a particularly important role for establishing the immune environment. This review covers studies that have set up i mportant para...
Source: Immunology and Allergy Clinics of North America - April 30, 2019 Category: Allergy & Immunology Authors: Catherine Ptaschinski, Nicholas W. Lukacs Source Type: research

Epidemiology of Infections and Development of Asthma
Asthma and allergic diseases have become more prevalent, although the reasons for this increase in disease burden are not known. Understanding why these diseases have become more common requires knowledge of the disease pathogenesis. Multiple studies have identified respiratory viral infections and atypical bacteria as potential etiologic agents underlying the development of asthma (and possibly allergies). This review discusses the epidemiology and potential mechanistic studies that provide links between these infectious agents and the development (and exacerbation) of asthma. These studies provide insight into the increa...
Source: Immunology and Allergy Clinics of North America - April 29, 2019 Category: Allergy & Immunology Authors: Jenny Resiliac, Mitchell H. Grayson Source Type: research

Childhood Asthma Inception and Progression
Inappropriate responses to respiratory viruses, especially rhinovirus, and early allergic sensitization are the strongest contributors to the inception and persistence of early onset asthma. The ORMDL3 asthma locus in chromosome 17q seems to exert its effects by increasing susceptibility to human rhinovirus in early life. Being raised on animal farms is highly protective against the development of asthma, and this protective effect is mediated by exposure to microbes. Two trials in high-risk young children, one to prevent wheezing lower respiratory tract illness using bacterial lyophilizates and another using anti-immunogl...
Source: Immunology and Allergy Clinics of North America - April 4, 2019 Category: Allergy & Immunology Authors: Fernando D. Martinez Source Type: research

Recent Diagnosis Techniques in Pediatric Asthma
Objective measures of lung function are important in the diagnosis and management of asthma. Spirometry, the pulmonary function test most widely used in asthma, requires respiratory maneuvers that may be difficult for preschoolers. Impulse oscillometry (IOS) is a noninvasive method of measuring lung function during tidal breathing; hence, IOS is an ideal test for use in preschool asthma. Fractional exhaled nitric oxide (FeNO) levels correspond to eosinophilic inflammation and predict responsiveness to corticosteroids. Basic concepts of IOS, methodology, and interpretation, including available normative values, and recent f...
Source: Immunology and Allergy Clinics of North America - April 4, 2019 Category: Allergy & Immunology Authors: Karen M. McDowell Source Type: research

Management of Asthma in the Preschool Child
This article reviews an approach using patient characteristics for selecting initial treatment approaches based on disease phenotype, such as symptom patterns or evidence of atopic markers. Evidence for and against the use of oral corticosteroids during acute episodes and barriers to adherence and effective treatment are discussed. (Source: Immunology and Allergy Clinics of North America)
Source: Immunology and Allergy Clinics of North America - April 4, 2019 Category: Allergy & Immunology Authors: Christina G. Kwong, Leonard B. Bacharier Source Type: research

Management/Comorbidities of School-Aged Children with Asthma
Asthma is a complex heterogeneous disease characterized by reversible airflow obstruction. After appropriate diagnosis, the management in school-aged children centers on 3 broad domains: pharmacologic treatment, treatment of underlying comorbidities, and education of the patient and caregivers. It is important to understand that the phenotypic differences that exist in the school-aged child with asthma may impact underlying comorbid conditions as well as pharmacologic treatment choices. Following initiation of therapy, asthma control must be continually evaluated in order to optimize management. (Source: Immunology and All...
Source: Immunology and Allergy Clinics of North America - April 4, 2019 Category: Allergy & Immunology Authors: Carolyn M. Kercsmar, Cassie Shipp Source Type: research

The Effects of the Environment on Asthma Disease Activity
Asthma is highly prevalent and causes significant morbidity in children. The development of asthma depends on complex relationships between genetic predisposition and environmental modifiers of immune function. The biological and physical environmental factors include aeroallergens, microbiome, endotoxin, genetics, and pollutants. The psychosocial environment encompasses stress, neighborhood safety, housing, and discrimination. They all have been speculated to influence asthma control and the risk of developing asthma. Control of the factors that contribute to or aggravate symptoms, interventions to eliminate allergen expo...
Source: Immunology and Allergy Clinics of North America - April 4, 2019 Category: Allergy & Immunology Authors: Margee Louisias, Amira Ramadan, Ahmad Salaheddine Naja, Wanda Phipatanakul Source Type: research

Treatment Adherence in Young Children with Asthma
Treatment nonadherence in young children with asthma involves multiple factors and should be viewed within an ecological framework. Few interventions have targeted multiple bidirectional factors, however, and little research has examined which interventions may be most appropriate for young children. Additional research is needed to identify essential intervention components, and to determine how to sustain such interventions in at-risk communities. Pediatric psychologists, with training in psychosocial intervention, screening, and primary prevention models, may be uniquely equipped to partner with communities and medical ...
Source: Immunology and Allergy Clinics of North America - April 4, 2019 Category: Allergy & Immunology Authors: Genery D. Booster, Alyssa A. Oland, Bruce G. Bender Source Type: research

Severe Asthma in Childhood
Severe asthma is broadly defined as asthma requiring a high level of therapy, usually high doses of inhaled corticosteroids, to bring under control. Children who remain symptomatic despite such treatment are a heterogeneous population, and bear a high burden of disease and require high resource utilization. Children with severe asthma require a comprehensive evaluation, careful consideration of alternative diagnoses and comorbid conditions, assessment of medication adherence and environmental conditions, and frequent disease monitoring. (Source: Immunology and Allergy Clinics of North America)
Source: Immunology and Allergy Clinics of North America - April 4, 2019 Category: Allergy & Immunology Authors: Angela Marko, Kristie R. Ross Source Type: research

Inner-City Asthma in Childhood
The inner-city is a well-established and well-studied location that includes children at high risk for high asthma prevalence and morbidity. A number of intrinsic and extrinsic risk factors contribute to asthma in inner-city populations. This review seeks to explore these risk factors and evaluate how they contribute to increased asthma morbidity. Previous literature has identified risk factors such as race and ethnicity, prematurity, obesity, and exposure to aeroallergens and pollutants. Environmental and medical interventions aimed at individual risk factors and specific asthma phenotypes have contributed to improved out...
Source: Immunology and Allergy Clinics of North America - April 4, 2019 Category: Allergy & Immunology Authors: Amaziah T. Coleman, Stephen J. Teach, William J. Sheehan Source Type: research

Personalized Medicine and Pediatric Asthma
Asthma is a heterogeneous disorder described by a large number of clinical features. A growing body of literature on more specific asthma phenotypes provides evidence for a phenotype-based approach to management in which specific therapies are recommended based on patient and disease characteristics. This understanding, coupled with an increase in the number of available therapies for children with asthma, as well as emerging therapies and phenotypic markers, will allow for improved asthma management in the future. (Source: Immunology and Allergy Clinics of North America)
Source: Immunology and Allergy Clinics of North America - April 4, 2019 Category: Allergy & Immunology Authors: Nathan M. Pajor, Theresa W. Guilbert Source Type: research

Potential Strategies and Targets for the Prevention of Pediatric Asthma
This article reviews potential asthma prevention strategies and identifies future areas of research. (Source: Immunology and Allergy Clinics of North America)
Source: Immunology and Allergy Clinics of North America - April 4, 2019 Category: Allergy & Immunology Authors: Brooke I. Polk, Leonard B. Bacharier Source Type: research

Asthma in Schools
Children with asthma experience frequent exacerbations that require careful care coordination among families, clinicians, and schools. Prior studies have shown that children with asthma miss more school each year compared with their healthy peers due to uncontrolled asthma symptoms. Successful school-based asthma programs have built strong partnerships among patients, their families, and clinicians to improve communication and the dissemination of asthma action plans and medications to schools. The widely endorsed School-based Asthma Management Program, consisting of 4 components, provides a comprehensive and expert-suppor...
Source: Immunology and Allergy Clinics of North America - April 4, 2019 Category: Allergy & Immunology Authors: Sujani Kakumanu, Robert F. Lemanske Source Type: research

New Directions in Pediatric Asthma
Childhood asthma affects many children placing them at significant risk for health care utilization and school absences. Several new developments relevant to the field of pediatric asthma have occurred over the last 5  years; yet, there is much more to learn. It is poorly understood how to prevent the disease, optimally address environmental challenges, or effectively manage poor adherence. Moreover, it is not clear how to customize therapy by asthma phenotype, age group, high risk groups, or severity of disease . Highlights of advances in pediatric asthma are reviewed and multiple essential areas for further explorat...
Source: Immunology and Allergy Clinics of North America - April 4, 2019 Category: Allergy & Immunology Authors: Leonard B. Bacharier, Theresa W. Guilbert Source Type: research

Key Issues in Pediatric Asthma
Childhood asthma is characterized by airway inflammation, hyperresponsiveness, and variable airflow obstruction. It is a common disease that affects an estimated 6.8 million children in the United States,1 which places them at significant risk for hospitalizations, emergency room visits, and school absences.2-4 Asthma accounts for 13.8 million days of school missed annually and results in a significant social and economic burden for both families and the health care system.1,2 Asthma also exerts a particularly heavy burden on children from racial and ethnic minorities, particularly those living in inner cities. (Source: Im...
Source: Immunology and Allergy Clinics of North America - April 4, 2019 Category: Allergy & Immunology Authors: Leonard B. Bacharier, Theresa W. Guilbert Tags: Preface Source Type: research

Childhood Asthma
We began appreciating the existence of a pediatric asthma epidemic more than 2 decades ago, and in the years since then, the available treatment alternatives and paradigms have changed dramatically, including impressive improvements in symptom and objective testing outcomes in clinical studies, and an overall stabilization of prevalence and exacerbation rates.1 However, pediatric asthma continues to be an important public health problem, and the overall disease burden shows no objective signs of shrinking in the near term. (Source: Immunology and Allergy Clinics of North America)
Source: Immunology and Allergy Clinics of North America - April 4, 2019 Category: Allergy & Immunology Authors: Stephen A. Tilles Tags: Foreword Source Type: research

Asthma in Childhood
IMMUNOLOGY AND ALLERGY CLINICS OF NORTH AMERICA (Source: Immunology and Allergy Clinics of North America)
Source: Immunology and Allergy Clinics of North America - April 4, 2019 Category: Allergy & Immunology Authors: Leonard B. Bacharier, Theresa W. Guilbert Source Type: research

Copyright
ELSEVIER (Source: Immunology and Allergy Clinics of North America)
Source: Immunology and Allergy Clinics of North America - April 4, 2019 Category: Allergy & Immunology Source Type: research

Contributors
STEPHEN A. TILLES, MD (Source: Immunology and Allergy Clinics of North America)
Source: Immunology and Allergy Clinics of North America - April 4, 2019 Category: Allergy & Immunology Source Type: research

Contents
Stephen A. Tilles (Source: Immunology and Allergy Clinics of North America)
Source: Immunology and Allergy Clinics of North America - April 4, 2019 Category: Allergy & Immunology Source Type: research

Forthcoming Issues
Infections and Asthma (Source: Immunology and Allergy Clinics of North America)
Source: Immunology and Allergy Clinics of North America - April 4, 2019 Category: Allergy & Immunology Source Type: research

Personalized Therapy
Immunoglobulin replacement therapy is the cornerstone of management for most primary immunodeficiency disease patients. The selection of a particular product, dose, and route of administration requires an understanding of the features of therapeutic immunoglobulin as well as patient-specific risk factors in order to maximize efficacy and tolerability and minimize risk. Individualizing therapy, taking into consideration the burdens of care, is necessary in order to optimize patient outcomes. (Source: Immunology and Allergy Clinics of North America)
Source: Immunology and Allergy Clinics of North America - November 20, 2018 Category: Allergy & Immunology Authors: Richard L. Wasserman Source Type: research

Secondary Hypogammaglobulinemia
This article reviews immunosuppressive medications, including biological treatments that cause secondary hypogammaglobulinemia. It summarizes risk factors for rituximab-induced hypogammaglobulinemia, such as preexisting low immunoglobulin G levels, CD19 levels, host factors, and additive effect of all immunomodulatory drugs used. The evaluation and management of secondary hypogammaglobulinemia are discussed. (Source: Immunology and Allergy Clinics of North America)
Source: Immunology and Allergy Clinics of North America - November 20, 2018 Category: Allergy & Immunology Authors: Blanka Kaplan, Vincent R. Bonagura Source Type: research