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1.
J Asthma Allergy ; 11: 153-158, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29950874

RESUMO

Epinephrine is a life-saving medication used to treat systemic allergic reactions including anaphylaxis. Epinephrine autoinjectors (EAIs) are expensive and worldwide availability is limited. Epinephrine prefilled syringes and epinephrine kits are potentially lower-cost alternatives to EAIs. Advantages, disadvantages, and costs of available products are discussed. The socioeconomic factors impacting access to EAIs are described.

3.
J Allergy Clin Immunol Pract ; 5(3): 610-615, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28483314

RESUMO

Medication-induced angioedema is a bradykinin-mediated process that results from increased production or decreased degradation of bradykinin. These reactions are documented for several cardiac medications including blockers of the renin-angiotensin-aldosterone system (RAAS). Other cardiovascular and diabetes medications further increase the risk of medication-induced angioedema, particularly with concomitant use of RAAS inhibitors. Dipeptidyl peptidase IV inhibitors are a class of oral diabetic agents that affect bradykinin and substance P degradation and therefore can lead to angioedema. Neprilysin inhibitors are a separate class of cardiac medications, which includes sacubitril, and can lead to drug-induced angioedema especially when used in combination with RAAS inhibitors. This article discusses the proposed mechanisms by which these medications cause angioedema and how medication-induced angioedema differs from mast cell-mediated angioedema. It also details how to recognize medication-induced angioedema and the treatment options available.


Assuntos
Angioedema/etiologia , Antagonistas de Receptores de Angiotensina/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Antagonistas de Receptor B2 da Bradicinina/uso terapêutico , Cardiomiopatias Diabéticas/tratamento farmacológico , Inibidores da Dipeptidil Peptidase IV/uso terapêutico , Aminobutiratos , Angioedema/prevenção & controle , Animais , Bradicinina/análogos & derivados , Bradicinina/metabolismo , Humanos , Neprilisina/metabolismo , Sistema Renina-Angiotensina , Substância P/metabolismo , Tetrazóis
4.
Am J Rhinol Allergy ; 31(3): 156-160, 2017 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-28490399

RESUMO

BACKGROUND: Specific immunoglobulin E (sIgE) and sIgG4 to house-dust mite (HDM) major allergens during allergen immunotherapy (AIT) and their clinical relevance remain unclear. OBJECTIVE: To investigate the variation of sIgE and sIgG4 to HDM major allergens and the correlation with clinical responses during AIT in patients with allergic rhinitis. METHODS: Thirty-nine patients with HDM allergy were divided into the AIT group (taking immunotherapy) and the control group (medication only use). The AIT group was subdivided into negative clinical responses to AIT (nAIT) group and positive clinical responses to AIT (pAIT) group according to symptom relief and subjective evaluation. sIgE and sIgG4 to Dermatophagoides pteronyssinus (Dp) and Dermatophagoides farinae (Df), and their group 1 and group 2 major allergens (Dp1, Df1, Dp2, and Df2) were measured before AIT, at 6 months, and at 1 year after starting AIT. RESULTS: Dp2, Df, and Df2 sIgE values decreased significantly in the pAIT group versus the nAIT group after 1 year of AIT (median values of delta change were Dp2, -10.09 versus 5.89 kU/L, p = 0.001; median values of Df were -9.69 versus 17.54 kU/L, p = 0.004; median values of Df2 were -11.06 versus 20.08 kU/L, p = 0.013). There was a robust increase in the sIgG4 values to Dp, Df, and their major allergens in both the pAIT and the nAIT groups overall after 1 year of treatment. CONCLUSION: Patients with a positive response to AIT showed a significant reduction of HDM group 2 sIgEs compared with those with a negative response to AIT, which indicated that a decrease in group 2 sIgEs could be a marker that reflected AIT clinical efficacy.


Assuntos
Antígenos de Dermatophagoides/uso terapêutico , Dessensibilização Imunológica/métodos , Hipersensibilidade/terapia , Imunoglobulina E/metabolismo , Imunoglobulina G/metabolismo , Adolescente , Adulto , Animais , Antígenos de Dermatophagoides/imunologia , Criança , Feminino , Seguimentos , Humanos , Hipersensibilidade/imunologia , Masculino , Pyroglyphidae/imunologia , Adulto Jovem
5.
J Allergy Clin Immunol Pract ; 5(3): 665-668.e1, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28215605

RESUMO

Epinephrine autoinjectors provide potentially life-saving therapy for pediatric and adult subjects with systemic allergic reactions, including anaphylaxis. However, the cost of these devices, specifically the EpiPen (Mylan, Canonsburg, Pa), is increasing exponentially. Epinephrine autoinjectors are commonly prescribed in the United States but are not readily available worldwide. Alternatives for the self-administration of epinephrine exist and should be considered for patients who cannot afford or do not have access to these devices. The epinephrine prefilled syringe, stored in an eyeglass or pencil case, is a safe and viable option for the self-administration of epinephrine. Epinephrine prefilled syringes may not be as ideal as using autoinjectors but are superior to patients living without access to this medication.


Assuntos
Anafilaxia/prevenção & controle , Epinefrina/uso terapêutico , Hipersensibilidade/epidemiologia , Anafilaxia/etiologia , Honorários Farmacêuticos , Gastos em Saúde , Humanos , Hipersensibilidade/complicações , Autoadministração , Seringas , Estados Unidos/epidemiologia
6.
Aging (Albany NY) ; 8(9): 2232-2252, 2016 09 29.
Artigo em Inglês | MEDLINE | ID: mdl-27689529

RESUMO

OBJECTIVE: Recent studies implicate cardiolipin oxidation in several age-related diseases. Atp8b1 encoding Type 4 P-type ATPases is a cardiolipin transporter. Mutation in Atp8b1 gene or inflammation of the lungs impairs the capacity of Atp8b1 to clear cardiolipin from lung fluid. However, the link between Atp8b1 mutation and age-related gene alteration is unknown. Therefore, we investigated how Atp8b1 mutation alters age-related genes. METHODS: We performed Affymetrix gene profiling of lungs isolated from young (7-9 wks, n=6) and aged (14 months, 14 M, n=6) C57BL/6 and Atp8b1 mutant mice. In addition, Ingenuity Pathway Analysis (IPA) was performed. Differentially expressed genes were validated by quantitative real-time PCR (qRT-PCR). RESULTS: Global transcriptome analysis revealed 532 differentially expressed genes in Atp8b1 lungs, 157 differentially expressed genes in C57BL/6 lungs, and 37 overlapping genes. IPA of age-related genes in Atp8b1 lungs showed enrichment of Xenobiotic metabolism and Nrf2-mediated signaling pathways. The increase in Adamts2 and Mmp13 transcripts in aged Atp8b1 lungs was validated by qRT-PCR. Similarly, the decrease in Col1a1 and increase in Cxcr6 transcripts was confirmed in both Atp8b1 mutant and C57BL/6 lungs. CONCLUSION: Based on transcriptome profiling, our study indicates that Atp8b1 mutant mice may be susceptible to age-related lung diseases.


Assuntos
Adenosina Trifosfatases/genética , Envelhecimento/genética , Pulmão/metabolismo , Proteínas de Transferência de Fosfolipídeos/genética , Proteínas ADAMTS/genética , Proteínas ADAMTS/metabolismo , Adenosina Trifosfatases/metabolismo , Envelhecimento/metabolismo , Animais , Perfilação da Expressão Gênica , Metaloproteinase 13 da Matriz/genética , Metaloproteinase 13 da Matriz/metabolismo , Camundongos , Camundongos Transgênicos , Análise de Sequência com Séries de Oligonucleotídeos , Proteínas de Transferência de Fosfolipídeos/metabolismo , Transcriptoma
7.
Postgrad Med ; 127(3): 295-300, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25740573

RESUMO

PURPOSE: Patients with "allergy" to iodine and shellfish often do not obtain necessary radiologic procedures due to anxiety about potential radiocontrast media reactions. This study assesses the impact of an educational intervention to dispel these myths. METHODS: The authors surveyed 252 internal medicine, emergency medicine, pediatrics, radiology, obstetrics/gynecology, and surgery health professionals before and after an educational intervention. Pre- and posttest responses were analyzed to assess the impact of the intervention on beliefs about radiocontrast media reactions and their perceived relationship to shellfish allergy and iodine "allergy." RESULTS: The mean pre- and posttest correct response scores were 41% and 91%, respectively. The intervention had a greater impact on respondents' knowledge about iodine allergy than shellfish allergy, most likely due to the difference in baseline knowledge (P < 0.005). Emergency medicine garnered the highest pretest correct response score (54%). Internal medicine earned the lowest pretest score (30%). There was a significant difference between the highest and lowest scoring specialties on the pretest (P = 0.037). There was no statistically significant correlation with training levels. There was a considerable decrease in the percentage of respondents who would withhold radiologic studies from patients suspected of shellfish or iodine allergy. The percentage of respondents who would premedicate patients with antihistamines or steroids also decreased significantly. CONCLUSION: An educational intervention helps rectify misconceptions among health care professionals about radiocontrast media reactions and their perceived relationship to shellfish or iodine allergy.


Assuntos
Meios de Contraste/efeitos adversos , Currículo , Hipersensibilidade a Drogas , Hipersensibilidade Alimentar , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde/educação , Atitude do Pessoal de Saúde , Hipersensibilidade a Drogas/diagnóstico , Hipersensibilidade a Drogas/etiologia , Hipersensibilidade a Drogas/terapia , Hipersensibilidade Alimentar/diagnóstico , Hipersensibilidade Alimentar/etiologia , Hipersensibilidade Alimentar/terapia , Humanos , Iodo/efeitos adversos , Frutos do Mar/efeitos adversos , Oligoelementos/efeitos adversos
9.
Artigo em Inglês | MEDLINE | ID: mdl-16673678

RESUMO

OBJECTIVES: The purpose of this study was to identify the Evidence-Based Practice Center (EPC) network participants' perceptions of the characteristics of the EPC process and the relationship of the process to the success of EPC reports. METHODS: Semistructured interviews were conducted with the three groups involved in the EPC: EPC staff, Agency for Healthcare Research and Quality (AHRQ) staff, and representatives of partner organizations. RESULTS: The analysis of the coded transcripts revealed three related major themes, which form the conceptual basis for the interpretation presented here: the definition of a successful report, the determinants of a successful report, and the role of AHRQ in the process. CONCLUSIONS: A successful report is a report that is used. The ultimate success of the core health technology assessment objective, moving from research to policy, depends on balancing two values: excellence and relevance. Our findings are consistent with the "two communities thesis," which postulates the existence of two camps that confer different values to excellence and relevance, with resulting tension. A promising model for approaching this tension is integration or collaboration, which requires linking researchers and policy makers, promoting productive dialogues about the formulation and timing of analysis, and early consideration of how the resulting analysis will be used. This effort suggests that actively blurring the frontiers between these two groups will enhance their interaction. Furthermore, enhancing the role of the AHRQ as scientific broker will maximize the potential of the EPC network.


Assuntos
Diversidade Cultural , Medicina Baseada em Evidências , Avaliação da Tecnologia Biomédica , Tomada de Decisões , Entrevistas como Assunto , Pesquisa Qualitativa , Estados Unidos
10.
Ann Intern Med ; 142(12 Pt 2): 1120-5, 2005 Jun 21.
Artigo em Inglês | MEDLINE | ID: mdl-15968037

RESUMO

The Evidence-based Practice Center (EPC) program within the Agency for Healthcare Research and Quality (AHRQ) provides detailed evidence reports for partner organizations that they can translate into activities that improve patient care. A review of these dissemination activities provides a rich opportunity to understand how to create more successful linkages between best evidence and best practice. On the basis of interviews with EPC directors, AHRQ staff, and representatives of public and private users of EPC reports, we summarize the variety of efforts to disseminate the work of the EPCs. We also identify a case example of a successful dissemination of an EPC report. Experience to date reinforces the importance of creating close ties between researchers and the policymakers, clinicians, and other decision makers who use EPC evidence reports; developing a conceptual framework to guide the process; and establishing the resource foundation for the entire effort.


Assuntos
Medicina Baseada em Evidências/organização & administração , Disseminação de Informação/métodos , Doença Crônica , Humanos , Comunicação Interdisciplinar , Nefropatias/terapia , Objetivos Organizacionais , Estados Unidos , United States Agency for Healthcare Research and Quality
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