1,721,005 research outputs found
GA2LEN--The Global Allergy and Asthma European Network
No full textThe European Community's Network on Allergies and Asthma was launched officially on 12 February 2004 in the presence of the European Commissioner Phillipe Bousquin. The current round of European Union funding for research includes two major new types of funding vehicle: integrated projects and networks of excellence. GA2LEN represents one of the first networks of excellence to be put into play by the European Commission, and Commissioner Bousquin was careful to point out that as well as addressing a major public health problem in Europe, the new network should serve as a standard bearer for this new form of European funding and research co-operation. So, what lies beyond the political rhetoric? Why do we need a European Network at this time and what does it hope to achieve during the 5 years of its life? Everyone agrees that allergic diseases such as asthma, allergic rhinitis (AR) and eczema have all increased over the last 30–40 years [1]. The European country with the highest prevalence of allergic disease is the UK where up to 32% of 13–14-year-olds report symptoms of asthma. While the prevalence rates vary between different European countries, the general upward trend is universal, making this a concern for all Europeans. Despite recent evidence that there has been a levelling off of the rate of asthma and related conditions in the UK [2], there remain worries that the prevalence rates could start to rise again in the UK and of course other countries have no wish to emulate the rates of asthma and allergic disease that are seen in the UK. Asthma is a major factor in children losing days from school, with potential consequences for their level of educational achievement while in adults asthma is an important cause of absence from the workplace. Besides the personal inconvenience, this represents a significant loss of productivity, and some estimates are as high as 9 billion working days lost because of asthma each year in the European Union. Asthma has direct medical costs in the form of medication and hospital care, with about 5% of the European medication budget currently being spent on caring for asthma. AR and eczema may not cause so many admissions to hospital as asthma but they also consume considerable amounts of healthcare resources in the form of medication
The role of pollutants in allergic sensitization and the development of asthma
No full textNo description supplie
Writing about emotional experiences reduces beta-agonist use in patients with asthma-3-month follow up of a randomised controlled trial
No full textRationale: as stress is known to exacerbate asthma symptoms, we examined whether written emotional disclosure (writing about traumatic experiences) could improve lung function in adults with asthma. Writing may facilitate cognitive and emotional processing of stressful events and help to reduce the physiological stress associated with inhibition of emotions.Methods: 138 adults aged between 18 and 45 with a diagnosis of asthma, requiring regular inhaled corticosteroids and able to read and understand English were invited to participate in this double blind randomised controlled trial. Participants were randomly allocated to receive either the written emotional disclosure or non-emotional writing instructions. Participants were asked to write for 20 minutes over 3 consecutive days. Spirometry readings and questionnaires measuring quality of life, asthma symptoms, subjective asthma control and medication use were conducted at baseline, 1 and 3-month follow up.Results: baseline analysis showed no significant differences between the two conditions. Controlling for baseline scores, no significant findings for lung function, quality of life or asthma symptoms were found. At 3-month follow up, participants in the intervention condition reported significantly better subjective control of their asthma (as defined by the Asthma Control Test): OR = 3.01, 95%CL (1.30, 6.94) and reported significantly better objective control of their asthma (defined as using their ?-agonist less than once a day): OR = 2.96, 95%CL (1.38, 6.33).Conclusions: written emotional disclosure may be useful in the management of asthma, improving perceived control of asthma in addition to reducing patients' use of their reliever medicatio
Usefulness of specific immunotherapy in patients with severe perennial allergic rhinitis induced by house dust mite: a double-blind, randomized, placebo-controlled trial
No full textObjectives To evaluate the effectiveness of specific immunotherapy (SIT) in patients with severe house dust mite (HDM)-induced perennial allergic rhinitis using diary cards and objective endpoints.Patients and Methods Thirty-six adult patients were selected with moderate to severe allergic rhinitis due to HDM allergy uncontrolled by regular anti-allergic drugs. Twenty-eight patients completed the study, 22 of these patients also had mild asthma. Subjects were stratified for HDM sensitivity on the basis of their 4-week diary card score and the size of their immediate and late-phase skin reaction to HDM. The groups were well matched for all relevant parameters. Patients were randomized to receive active preparation (Alutard®-SQ, ALK, Dermatophagoides pteronyssinus extract) or an identical placebo preparation. Increasing doses were administered until the maintenance dose was reached. This dose was then given once a month for 12 months.Results Clinical efficacy was evaluated by symptom medication diary cards recorded for 4 weeks after 12 months of continuous treatment and compared with pre-treatment scores. Skin test reactivity was re-measured after 12 months of treatment to HDM, cat dander and codeine phosphate. After 1 year of treatment, the actively treated group showed a 58% reduction in diary card symptom scores (P<0.002) and a 20% reduction in the use of rescue medication. The placebo group had a 32% reduction in symptom scores (P=NS), but no reduction in rescue medication requirements. The active group showed 36% reduction in skin prick test sensitivity to D. pteronyssinus (P=0.006), while the placebo group values were unchanged. Skin reactivity to codeine was unchanged in both groups. No significant adverse reactions to SIT were encountered.Conclusions One year of SIT for D. pteronyssinus in patients with poorly controlled rhinitis (±mild asthma) produced clinically useful improvement as shown by symptom–medication diary cards and reductions in immediate skin reactions compared with placebo treatment
Systemic cytokine levels in community-acquired pneumonia and their association with disease severity
No full textPro-inflammatory and anti-inflammatory cytokines are important mediators in the host response to infection. In contrast to the pro-inflammatory cytokines little is known about anti-inflammatory cytokines in community-acquired pneumonia (CAP) and their relation to disease severity. Circulating levels of three pro-inflammatory cytokines (interleukin (IL)-1ß, IL-6 and tumour necrosis factor (TNF)-) and two anti-inflammatory cytokines (IL-10, IL-1 receptor antagonist (IL-1ra)) were measured using an enzyme immunoassay on admission, day 3 and day 5 in 24 patients with CAP. The modified British Thoracic Society (BTS) prognostic rule and Acute Physiology and Chronic Health Evaluation (APACHE) II score were used to assess disease severity. IL-6, TNF-, IL-10 and IL-1ra concentrations were detected in most patients on admission and decreased significantly on day 3 and day 5 in all survivors. A significant difference between the BTS high-risk and low-risk groups was only found for IL-6 (median (range) 477 pg·mL–1 (7.6–1402 pg·mL–1) versus 81.6 pg·mL–1 (0–943 pg·mL–1); p<0.05). IL-6 also correlated with the APACHE II scores on admission. Concentrations of anti-inflammatory cytokines were elevated on admission in community-acquired pneumonia but they did not correlate with disease severity scores. <br/
TCR usage and cytokine expression in peripheral blood and BAL T cells
No full textT cells are thought to play an important regulatory role in atopic asthma. We hypothesized that human blood and BAL T cell subsets bearing various TCR-V? genes might show selective differences in their cytokine profile. Peripheral blood (PB) and bronchoalveolar lavage (BAL) T cells from seven atopic asthmatic and six non-atopic non-asthmatic subjects were stimulated with PMA and ionomycin in the presence of monensin and analysed for TCR-V? expression and production of cytokines at the single cell level. The percentage of IFN-?- and IL-2-producing BAL T cells was elevated compared with PB T cells from both the asthmatic subjects and the non-atopic, non-asthmatic controls. A small percentage of PB and BAL T cells produced IL-4 and IL-5, in asthmatic and normal subjects. In peripheral blood, the percentage of T cells expressing each cytokine was similar in the various TCR-V? subsets and in total CD3+ T cells in all normal and six of seven asthmatic subjects. However, there was a substantial degree of heterogeneity in the cytokine profile of BAL TCR-V? subsets compared with the total CD3+ T cells. This was more obvious in the asthmatic subjects with a reduction in the percentage of IFN-?- and IL-2-expressing T cells (five of seven asthmatic subjects) and an increase in the percentage of IL-4- and IL-5-expressing T cells (two of seven asthmatic subjects). These data confirm previous findings of an elevated proportion of IFN-?- and IL-2-producing BAL T cells while only a small proportion of PB and BAL T cells produce IL-4 and IL-5. Moreover, subsets of BAL T cells, defined by their TCR-V? usage, may differ in their cytokine profile compared with the total CD3+ T cells, implying that T cells expressing different V? elements may play different roles in regulating the airway inflammation in asthma
Effects of 4-week treatment with low-dose budesonide (100 ?g BID) from a novel inhaler Airmax™ and from a conventional inhaler on bronchial hyper-responsiveness, lung function and symptoms in patients with mild asthma
No full textThis study investigated the effect of low dose of budesonide 100 ?g b.d from a new multi-dose dry powder inhaler (Airmax™) and from a conventional inhaler (Turbuhaler®) on bronchial hyper-responsiveness, lung function and asthma symptoms in mild stable asthmatics. Twenty-five patients were enrolled into a double-blind double-dummy crossover study with two 4-week treatment periods separated by a 4-week washout. Patients had a mean forced expiratory volume in 1 s (FEV?) of 91±13% predicted, had previously received inhaled short-acting ??-agonists only and had a PC?? to adenosine 5? monophosphate (AMP)<40 mg/ml. PC?? AMP was assessed at baseline, and at the start and end of each treatment period. Patients recorded peak expiratory flow and symptoms throughout the study. There was a mean increase in PC??AMP from start to end of 3.49 doubling dilutions (DD) in the Airmax™ group and 2.90 DD in the Turbuhaler® group. The difference was 0.60 DD(95% CI—0.47, 1.69) favouring Airmax™ and the upper limit exceeded the equivalence limit of ±1 DD. There were similar improvements in FEV?, daily PEF and symptoms in both groups. The majority of patients preferred treatment with Airmax™ to Turbuhaler® (64 vs. 23%). Both treatments were equally well tolerated. In conclusion, 100 ?g budesonide bid during 4 weeks from AirmaxTM effectively attenuates the response to AMP in mild asthmatics. Overall Airmax™ offers equal clinical benefit to Turbuhaler® and is preferred by patients
Efficacy and safety of specific immunotherapy with SQ allergen extract in treatment-resistant seasonal allergic rhinoconjunctivitis
No full textBackground: Specific immunotherapy is widely used to treat allergic rhinitis, but few large-scale clinical trials have been performed.Objective: We sought to assess the efficacy and safety of specific immunotherapy with 2 doses of Alutard grass pollen in patients with moderately severe seasonal allergic rhinitis inadequately controlled with standard drug therapy.Methods: We performed a double-blind, randomized, placebo-controlled study of 410 subjects (203 randomized to 100,000 standardized quality units [SQ-U] maintenance, 104 to 10,000 SQ-U, and 103 to placebo). Three hundred forty-seven (85%) completed treatment. Groups were well matched for demographics and symptoms.Results: Across the whole pollen season, mean symptom and medication scores were 29% and 32% lower, respectively, in the 100,000–SQ-U group compared with those in the placebo group (both P < .001). Over the peak pollen season, mean symptom and medication scores were 32% and 41% lower, respectively, than those in the placebo group. The 10,000–SQ-U group had 22% less symptoms than the placebo group over the whole season (P < .01), but medication scores reduced by only 16% (P = .16). Quality-of-life measures confirmed the superiority of both doses to placebo. Local and delayed side effects were common but generally mild. Clinically significant early and delayed systemic side effects were confined to the 100,000–SQ-U group, but no life-threatening reactions occurred.Conclusions: One season of immunotherapy with Alutard grass pollen reduced symptoms and medication use and improved the quality of life of subjects with moderately severe hay fever. The 100,000–SQ-U regimen was more effective, but the 10,000–SQ-U regimen caused fewer side effects.Abbreviations used: AE, Adverse event; RQLQ, Rhinoconjunctivitis Quality-of-Life Questionnaire; SAR, Seasonal allergic rhinoconjunctivitis; SIT, Specific immunotherapy; SQ-U, Standardized quality unit; VAS, Visual analog scale
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