RESUMO
Weather and climate change are constant and ever-changing processes that affect allergy and asthma. The purpose of this report is to provide information since the last climate change review with a focus on asthmatic disease. PubMed and Internet searches for topics included climate and weather change, air pollution, particulates, greenhouse gasses, traffic, insect habitat, and mitigation in addition to references contributed by the individual authors. Changes in patterns of outdoor aeroallergens caused by increasing temperatures and amounts of carbon dioxide in the atmosphere are major factors linked to increased duration of pollen seasons, increased pollen production, and possibly increased allergenicity of pollen. Indoor air pollution threats anticipated from climate changes include microbial and mold growth secondary to flooding, resulting in displacement of persons and need for respiratory protection of exposed workers. Air pollution from indoor burning of mosquito repellants is a potential anticipatory result of an increase in habitat regions. Air pollution from fossil fuel burning and traffic-related emissions can alter respiratory defense mechanisms and work synergistically with specific allergens to enhance immunogenicity to worsen asthma in susceptible subjects. Community efforts can significantly reduce air pollution, thereby reducing greenhouse gas emission and improving air quality. The allergist's approach to weather pattern changes should be integrated and anticipatory to protect at-risk patients.
Assuntos
Poluição do Ar/estatística & dados numéricos , Asma/epidemiologia , Mudança Climática/estatística & dados numéricos , Exposição Ambiental/efeitos adversos , Hipersensibilidade/epidemiologia , Tempo (Meteorologia) , Poluentes Atmosféricos/imunologia , Poluição do Ar em Ambientes Fechados , Alérgenos/imunologia , Humanos , Risco , Estados Unidos/epidemiologiaRESUMO
Despite the recommendation in national asthma guidelines to target indoor environmental exposures, most insurers generally have not covered the outreach, education, environmental assessments, or durable goods integral to home environmental interventions. However, emerging payment approaches offer new potential for coverage of home-based environmental intervention costs. These opportunities are becoming available as public and private insurers shift reimbursement to reward better health outcomes, and their key characteristic is a focus on the value rather than the volume of services. These new payment models for environmental interventions can be divided into 2 categories: enhanced fee-for-service reimbursement and set payments per patient that cover asthma-related costs. Several pilot programs across the United States are underway, and as they prove their value and as payment increasingly becomes aligned with better outcomes at lower cost, these efforts should have a bright future. Physicians should be aware that these new possibilities are emerging for payment of the goods and services needed for indoor environmental interventions for their patients with asthma.
Assuntos
Asma/epidemiologia , Participação da Comunidade , Atenção à Saúde , Intervenção Médica Precoce/economia , Mecanismo de Reembolso , Alérgenos/efeitos adversos , Alérgenos/imunologia , Asma/prevenção & controle , Custos e Análise de Custo , Exposição Ambiental/efeitos adversos , Humanos , Educação de Pacientes como Assunto/economia , Abandono do Hábito de Fumar/economia , Estados Unidos/epidemiologiaRESUMO
Acquired C1 inhibitor (C1-INH) deficiency exposes patients to angioedema recurrences (acquired angioedema [AAE]) mediated by bradykinin pathway activation. C1-INH replacement and specific inhibition of plasma kallikrein with ecallantide have been successful in the treatment of hereditary angioedema (HAE), a more common related disorder. C1-INH replacement has also been used in the treatment of AAE, but because of the underlying mechanism of rapid catabolism, some patients may not respond. As part of preclinical investigation of ecallantide, a potent bradykinin pathway inhibitor, we evaluated three AAE patients treated successfully with that agent. This study was designed to assess ecallantide for treatment of attacks in AAE. Three patients with AAE were treated a total of 12 times with various dosing regimens of ecallantide based on the protocols established for the studies using ecallantide in HAE (Evaluation of DX-88's Effects in Mitigating Angioedema trials). Response to therapy was also based on outcome measures determined by these protocols. Ecallantide effectively relieved symptoms in three patients with various manifestations of AAE over 12 acute episodes. Kallikrein inhibition with ecallantide appears effective in the treatment of AAE and may be an alternative for patients with resistance to C1-INH replacement therapy.
Assuntos
Angioedema/tratamento farmacológico , Anti-Inflamatórios não Esteroides/administração & dosagem , Angioedema Hereditário Tipos I e II/tratamento farmacológico , Gamopatia Monoclonal de Significância Indeterminada/tratamento farmacológico , Peptídeos/administração & dosagem , Doença Aguda , Idoso , Angioedema/genética , Anti-Inflamatórios não Esteroides/farmacologia , Bradicinina/metabolismo , Protocolos Clínicos , Progressão da Doença , Feminino , Angioedema Hereditário Tipos I e II/genética , Humanos , Calicreínas/antagonistas & inibidores , Masculino , Pessoa de Meia-Idade , Gamopatia Monoclonal de Significância Indeterminada/genética , Peptídeos/farmacologia , Recidiva , Resultado do TratamentoRESUMO
Cannabis is the most commonly used psychoactive drug. In recent years, Cannabis access has expanded for both medicinal and non-medicinal has grown. This is also marked with an increasing number of individuals gaining employment in this emerging industry. In this article, we briefly discuss the health hazards associated with Cannabis exposure with an emphasis on the potential for allergic reactions in workers who handle and process Cannabis plant.
Assuntos
Hipersensibilidade , Exposição Ocupacional , Alérgenos , Cannabis/efeitos adversos , Humanos , IndústriasRESUMO
Within the last decade there has been a significant expansion in access to cannabis for medicinal and adult nonmedical use in the United States and abroad. This has resulted in a rapidly growing and diverse workforce that is involved with the growth, cultivation, handling, and dispensing of the cannabis plant and its products. The objective of this review was to educate physicians on the complexities associated with the health effects of cannabis exposure, the nature of these exposures, and the future practical challenges of managing these in the context of allergic disease. We will detail the biological hazards related to typical modern cannabis industry operations that may potentially drive allergic sensitization in workers. We will highlight the limitations that have hindered the development of objective diagnostic measures that are essential in separating "true" cannabis allergies from nonspecific reactions/irritations that "mimic" allergy-like symptoms. Finally, we will discuss recent advances in the basic and translational scientific research that will aid the development of diagnostic tools and therapeutic standards to serve optimal management of cannabis allergies across the occupational spectrum.
Assuntos
Cannabis , Hipersensibilidade , Exposição Ocupacional , Adulto , Analgésicos , Humanos , Estados Unidos/epidemiologiaAssuntos
Alergia e Imunologia/normas , Dessensibilização Imunológica/normas , Padrões de Prática Médica/normas , Autonomia Profissional , Unidades de Cuidados Respiratórios/normas , Alergia e Imunologia/tendências , Dessensibilização Imunológica/estatística & dados numéricos , Dessensibilização Imunológica/tendências , Humanos , Padrões de Prática Médica/tendências , Política Pública/tendências , Unidades de Cuidados Respiratórios/tendências , Estudos Retrospectivos , Estados Unidos , Recursos HumanosRESUMO
This paper provides an overview of the pathogenesis, presentation and diagnosis of clopidogrel hypersensitivity. The majority of clopidogrel hypersensitivity cases are due to a T cell mediated Gell and Coombs Type IV reaction. History, histology, and patch testing have shown consistency with a T cell mediated mechanism. Clopidogrel reactions most commonly present as a mild delayed maculopapular erythematous rash 5 to 10 days after introduction of the drug, and do not always require discontinuation of the drug. Severe cutaneous, systemic, and immediate adverse reactions to clopidogrel are rare. For the diagnosis of clopidogrel hypersensitivity, drug causality can be determined using patch testing, or for mild reactions, recurrence of symptoms after drug reintroduction, although neither are required for diagnosis.
Assuntos
Doenças Cardiovasculares/tratamento farmacológico , Clopidogrel/efeitos adversos , Hipersensibilidade a Drogas/diagnóstico , Testes do Emplastro , Inibidores da Agregação Plaquetária/efeitos adversos , Antagonistas do Receptor Purinérgico P2Y/efeitos adversos , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/diagnóstico , Hipersensibilidade a Drogas/imunologia , Hipersensibilidade a Drogas/terapia , Humanos , Agregação Plaquetária/efeitos dos fármacos , Valor Preditivo dos Testes , Fatores de Risco , Índice de Gravidade de Doença , Resultado do TratamentoAssuntos
Cateterismo Venoso Central/efeitos adversos , Corpos Estranhos/diagnóstico , Corpos Estranhos/cirurgia , Imagem por Ressonância Magnética Intervencionista , Artéria Pulmonar , Angiografia , Técnicas de Imagem de Sincronização Cardíaca , Meios de Contraste , Remoção de Dispositivo , Feminino , Humanos , Pessoa de Meia-IdadeAssuntos
Árabes , Nível de Saúde , Jornalismo Médico , Expectativa de Vida , Publicações Periódicas como Assunto , Qualidade da Assistência à Saúde , Comportamento Cooperativo , Medicina Baseada em Evidências , Humanos , Israel , Jornalismo Médico/normas , Oriente Médio , Revisão por Pares , Política , Reino UnidoAssuntos
Comportamento Cooperativo , Pesquisadores , Universidades , Guerra , Árabes , Cooperação Internacional , Israel , Pesquisa , Universidades/economiaAssuntos
Asma , Hipersensibilidade Imediata , Doença Pulmonar Obstrutiva Crônica , Idoso , Humanos , Pacientes , EspirometriaRESUMO
Angiotensin-converting enzyme inhibitors (ACEI) are commonly prescribed for blood pressure control and renal protection. ACEI angioedema is a common problem in patients who are taking ACEI, although, in most cases, the disorder is self-limited, and spontaneous episodes of apparently unprovoked angioedema stop with the discontinuation of the medication. In a subset of patients, hospitalization and even intubation are required for airway protection. The diagnosis is made clinically. There are no laboratory studies that establish the diagnosis. However, such investigations help exclude alternative diagnoses as the cause for the patient's presentation. Conventional treatment with regimens used to control allergic angioedema is ineffective in this condition. The mechanism of ACEI-induced angioedema is thought to be related to its effect on the kallikrein-kinin system. Kallikrein is a protease that converts high-molecular-weight kininogens into kinins, primarily bradykinin. Medications recently developed, primarily icatibant and ecallantide, to control hereditary angioedema, a disorder also associated with kallikrein-kinin activation, have been used to treat ACEI angioedema with some success. The efficacy of these agents and their optimal use remains to be established by randomized and placebo controlled trials.