Improving Asthma Outcomes During Pregnancy in Underserved Communities
It is known that poor asthma control is common in pregnancy, and asthma in general disproportionally affects underserved communities. However, there is a paucity of data examining strategies to improve asthma control specifically among pregnant women from vulnerable populations. Identified barriers to optimal asthma care in other underserved groups include health literacy, financial constraints, cultural differences, and poor environmental controls. These deficiencies may also be targets for multimodal interventions geared toward improving asthma outcomes for underserved women during pregnancy. (Source: Immunology and Alle...
Source: Immunology and Allergy Clinics of North America - October 27, 2022 Category: Allergy & Immunology Authors: Alan Gandler, Edward S. Schulman, Erika J. Yoo Source Type: research

Mastocytosis in Pregnancy
Mastocytosis is a rare neoplastic disorder of the mast cell lineage resulting in unregulated proliferation and activation of mast cells. Symptoms worsen in about one-third of pregnant patients. Treatment focuses on management of symptoms with antimediator therapy (H1& H2 antihistamines, glucocorticoids, and epinephrine, if required). Medication selection requires care during labor and delivery. Although it is generally considered safe to use a medication patient tolerated before, some common medications may need to be avoided or used with caution (eg, codeine, morphine, nonsteroidal antiinflammatory drugs, vancomycin) if t...
Source: Immunology and Allergy Clinics of North America - October 27, 2022 Category: Allergy & Immunology Authors: Nonie Arora, Cem Akin, Anna Kovalszki Source Type: research

Anaphylaxis in Pregnancy
Anaphylaxis in pregnancy is a rare event, but has important implications for the pregnant patient and fetus. The epidemiology, pathophysiology, diagnosis, and treatment all carry important considerations unique to the pregnant patient. Common culprits of anaphylaxis are primarily medications, particularly antibiotics and anesthetic agents. Diagnosis can be difficult given the relative lack of cutaneous symptoms, and normal physiologic changes in pregnancy such as low blood pressure and tachycardia. Apart from patient positioning, treatment is similar to that of the general population, with a focus on prompt epinephrine adm...
Source: Immunology and Allergy Clinics of North America - October 27, 2022 Category: Allergy & Immunology Authors: Margaret M. Kuder, Rachael Baird, Maeve Hopkins, David M. Lang Source Type: research

Longitudinal Changes in Upper and Lower Airway Function in Pregnancy
Physiologic changes during pregnancy have implications for both upper and lower airway function. Upper airway resistance increases, and total lung capacity decreases. Upper airway symptoms increase; some women develop pregnancy-induced rhinitis and there is an increased prevalence of sleep-disordered breathing compared to prepregnancy. Longitudinal studies examining changes in upper and lower airway function parameters are limited, particularly in women with asthma. Some studies have observed reduced lung function with advancing gestation; however, changes are small and unlikely to be of major clinical significance. Spirom...
Source: Immunology and Allergy Clinics of North America - October 27, 2022 Category: Allergy & Immunology Authors: Vanessa E. Murphy, Megan E. Jensen Source Type: research

Maternal Macro- and Micronutrient Intake During Pregnancy
This review article explores the available literature on the association of maternal nutrient intake with development of allergies in offspring. It examines the mechanisms for maternal diet –mediated effects on offspring immunity and dissects recent human and animal studies that evaluate the role of both maternal macro- and micronutrient intake on offspring susceptibility to asthma, eczema, food allergy, and atopy. (Source: Immunology and Allergy Clinics of North America)
Source: Immunology and Allergy Clinics of North America - October 27, 2022 Category: Allergy & Immunology Authors: Katherine Stumpf, Julie Mirpuri Source Type: research

Use of Asthma Medication During Gestation and Risk of Specific Congenital Anomalies
Poorly controlled asthma can affect neonatal outcomes including congenital anomalies, which can be reduced with appropriate asthma care during pregnancy. Although there is a concern regarding the safety of asthma medication use during pregnancy and congenital anomalies, the risk of uncontrolled asthma outweighs any potential risks of controller and reliever medication use. Patient education before and during pregnancy is critical to ensure good compliance to therapy and reduce the risk of poor asthma control. (Source: Immunology and Allergy Clinics of North America)
Source: Immunology and Allergy Clinics of North America - October 27, 2022 Category: Allergy & Immunology Authors: Ruth P. Cusack, Christiane E. Whetstone, Gail M. Gauvreau Source Type: research

Advancing Exposomic Research in Prenatal Respiratory Disease Programming
Disease programming reflects interactions between genes and the environment. Unlike the genome, environmental exposures and our response to exposures change over time. Starting in utero, the respiratory system and related processes develop sequentially in a carefully timed cascade, thus effects depend on both exposure dose and timing. A multitude of environmental and microbial exposures influence respiratory disease programming. Effects result from toxin-induced shifts in a host of molecular, cellular, and physiologic states and their interacting systems. Moreover, pregnant women and the developing child are not exposed to...
Source: Immunology and Allergy Clinics of North America - October 27, 2022 Category: Allergy & Immunology Authors: Rosalind J. Wright Source Type: research

Primary Antibody Immunodeficiency and the Pregnant Patient
An overview of primary antibody immunodeficiency in pregnancy is presented. Indications for immunoglobulin replacement therapy (IGRT), dosing, and safety considerations are highlighted. Uses of immunizations and antimicrobial therapy are also discussed. In general, IGRT, both intravenous and subcutaneous, is considered safe in pregnancy. (Source: Immunology and Allergy Clinics of North America)
Source: Immunology and Allergy Clinics of North America - October 27, 2022 Category: Allergy & Immunology Authors: Shouling Zhang, Charlotte Cunningham-Rundles Source Type: research

Status Asthmaticus Gravidus
One-third of women with asthma have deterioration of their asthma during pregnancy, and one-fourth of pregnant women with asthma will experience severe exacerbations necessitating emergency department (ED) visits or hospitalizations. Early recognition of acute severe asthma, including life-threatening status asthmaticus, and aggressive medical interventions with β2-agonists, anticholinergic agents, and systemic corticosteroids are necessary to treat maternal airway bronchoconstriction, support maternal and fetal oxygenation, and avoid adverse fetal outcomes. This review describes management of acute severe asthma in pregn...
Source: Immunology and Allergy Clinics of North America - October 27, 2022 Category: Allergy & Immunology Authors: Charles B. Cairns, Monica Kraft Source Type: research

“Doctor…I’m Pregnant”!
Suddenly she turned, smiled, and said, “Dr Schulman, I’m eight weeks pregnant.” “Mazel tov.” I scurried to review her problem list, medication list, and my last note. I panicked slightly. Sound familiar? Was my patient taking potentially toxic meds during this first trimester? Is my knowledge up-to-date? Can I confidently couns el her, answering her many questions? (Source: Immunology and Allergy Clinics of North America)
Source: Immunology and Allergy Clinics of North America - October 27, 2022 Category: Allergy & Immunology Authors: Edward S. Schulman Tags: Preface Source Type: research

Immunopathology of Differing Viral Infection in Allergic Asthma Disease
The pathophysiology of asthma development is heterogenous. Although complex interactions between factors are present in any one individual, early life viral infections have been shown to play a major role through induction of epithelial damage as well as various innate and adaptive immune responses. The cytokine profile that results from epithelial damage leads to Th2 skewing of the adaptive immune response. Most asthma exacerbations in children and up to half of adults are related to viral infections that also induce epithelial damage and an acute predominately Th2 inflammatory response, leading to acute symptoms and chro...
Source: Immunology and Allergy Clinics of North America - October 18, 2022 Category: Allergy & Immunology Authors: Jenny Resiliac, Christopher D. Brooks, Mitchell H. Grayson Source Type: research

Air Pollution Effects in Allergies and Asthma
Outdoor air pollution is associated with exacerbations of allergic diseases, including asthma, allergic rhinitis, and other atopic conditions. The increased allergic disease prevalence has been linked to this urbanization, industrialization, and economic growth globally. Air pollutants are well-known to disrupt the epithelium leading to specific diseases in any organ system that has epithelial linings. This review provides an overview of the health effects of air pollution on allergic disorders and specifically addresses how it may impact the epithelial barrier in the upper and lower respiratory tracts to facilitate the he...
Source: Immunology and Allergy Clinics of North America - October 18, 2022 Category: Allergy & Immunology Authors: Anil Nanda, Syed Shahzad Mustafa, Maria Castillo, Jonathan A. Bernstein Source Type: research

Environmental Issues and Allergy
IMMUNOLOGY AND ALLERGYCLINICS OF NORTH AMERICA (Source: Immunology and Allergy Clinics of North America)
Source: Immunology and Allergy Clinics of North America - October 18, 2022 Category: Allergy & Immunology Authors: Jill A. Poole Source Type: research

Copyright
ELSEVIER (Source: Immunology and Allergy Clinics of North America)
Source: Immunology and Allergy Clinics of North America - October 18, 2022 Category: Allergy & Immunology Source Type: research

Contributors
JILL A. POOLE, MD (Source: Immunology and Allergy Clinics of North America)
Source: Immunology and Allergy Clinics of North America - October 18, 2022 Category: Allergy & Immunology Source Type: research