Manifesto on inhaled triple therapy in asthma: an Interasma (Global Asthma Association - GAA) document.

Objective: The optimal use of drug combinations for the management of asthma is providing significant results. This has prompted Interasma (Global Asthma Association) to take a position on inhaled triple therapy in asthma.Methods: We performed an extensive literature research to clinical trials, meta-analyses, randomized controlled trials and systematic reviews.Results: Starting from an extensive literature review, Interasma executive committee discussed and approved this Manifesto, developed by Interasma scientific network (INES) members.Conclusions: The manifesto describes the evidence gathered to date and states, advocates, and proposes issues on inhaled corticosteroid (ICS) plus long-acting beta 2 agonist (LABA) and long-acting muscarinic antagonists (LAMA) with the aim of challenging assumptions, fostering commitment, and bringing about change.

Identification of an allergenic calmodulin from Amaranthus palmeri pollen.

INTRODUCTION: Pollens are an important source of allergens that trigger rhinitis or asthma. The allergenic extracts of pollens used to diagnose and treat allergies contain different allergenic antigens. Isolated allergenic proteins are employed in in vitro assays, skin tests and allergenic-specific immunotherapy. Calcium-binding allergens are clinically relevant antigens, and their allergenicity can be affected by Ca2+ binding. In this work, a calmodulin was identified as an allergen from Amaranthus palmeri pollen, an important source of pollinosis in Europe, Asia and North America. MATERIALS AND METHODS: Allergenic calmodulin from A. palmeri pollen was isolated by size-exclusion chromatography and reverse-phase chromatography and identified by mass spectrometry. Sensitization to isolated calmodulin was evaluated by skin prick tests in patients with allergy to A. palmeri pollen. RESULTS: Size-exclusion chromatography yielded two fractions that were recognized by the IgE of patients allergic to A. palmeri pollen. Mass spectrometry analysis of the fractions from reverse-phase chromatography showed peptide sequences that identified a calmodulin. Skin prick tests showed that the isolated calmodulin was recognized by 56% of patients allergic to A. palmeri pollen. CONCLUSION: A. palmeri pollen calmodulin could be a clinically relevant allergen in patients sensitized to this source.

[Allergens used in skin tests in Mexico]. / AIérgenos usados en las pruebas cutáneas en México.

BACKGROUND: Immunotherapy is the only recognized causal treatment for allergies. It is prepared on an individual basis, based on the patient's clinical history and the result of the skin prick test (SPT). An adequate composition of the allergens with which to test the patient is crucial for an optimal diagnosis. OBJECTIVE: To know allergens used in tests in allergy practices in Mexico. MATERIALS AND METHOD: A national survey among all members of the Colegio Mexicano de Inmunología Clínica y Alergia (CMICA) and of the Colegio Mexicano de Pediatras Especialistas en Inmunología Clínica y Alergia (COMPEDIA) was carried out. In a second phase respondents were asked to send in the composition of a routine SPT in their clinic. The results are presented descriptively and the frequency is calculated by which certain allergen is tested in the interviewed practices. RESULTS: A survey response rate of 61 (17%) was obtained and 54% showed their SPT content. Weeds' representation in the SPT seems adequate; Atriplex is tested in all allergy practices. Some trees that show cross-reactivity might be eliminated from the SPT, but 20% doesn't test for Cynodon nor Holcus, and 25% doesn't for important allergens as cat, dog and cockroach. House dust and tobacco are still tested with certain frequency. CONCLUSIONS: The selection of which allergens to test in a SPT is based on multiple data, that change continuously with new investigations and discoveries. Our specialty is the most indicated--and obligated--to adjust constantly to these changes to have the best diagnostic tool to detect specific allergies.

[Current and future approaches for the treatment of inflammatory diseases of inferior respiratory tract]. / Abordajes actuales y futuros para el tratamiento de las enfermedades inflamatorias de las vías aéreas inferiores.

Among the allergic disorders we emphasize the inflammatory diseases of the inferior respiratory tract by their incidence, repercussion in daily activities, and by their high cost of medical attention. For their treatment, they require more than one inhaled or systemic drug. Current medicines tend to have adverse or secondary effects, such as: osteoporosis, type 3 diabetes mellitus, tremor or tachycardia. New medicines are being developed with less adverse or secondary effects, and much more selective and specific in the molecules involved in the allergic disease's physiopathology. Among them we find pascolizumab, which inhibits the differentiation made to Th2, as well as the citokines production. Other drugs are: mepolizumab, monoclonal antibody antiCD23, and the selective inhibitor of IgE (AJP13358) Rhu-Mab-E25. Currently, they are being developed some new drugs, such as SB-207499 (SKB) and LAS 31025, which are selective inhibitors of fosfodiesterase. Within the currently studied medicines that offer high specificity to inhibit the synthesis of interleukines we emphasize the presence of humanized monoclonal antibodies antireceptor IL-4. The anti IL-5 (SB-240563) is administered in asthmatic patients to reduce eosinofilia in expectoration. Tosilate of suplatast is a selective IL-4 and IL-5 inhibitor. Ramatroban (BAY or 3405) is an antagonist of the tromboxane A2 receptor, which reduces the inflammatory process of the nasal mucose without hemodynamic effects. Immunotherapy with peptides avoids the response of IgE by the allergen, without mast cell degranulation.