Suchen und Finden
Foreword
5
Preface
11
Contents
13
Contributors
17
Part I: Therapy and Prevention of Allergies
24
Chapter 1
25
Allergen Avoidance and Prevention of Allergy
25
Introduction
25
Definitions
25
Risk Factors
26
At Risk Population
26
Early Critical Period
26
Allergen Exposure
27
Exposure and Disease
27
Primary Prevention
28
Food Allergen Avoidance
28
Breast Feeding
28
During Pregnancy
29
Late Introduction of Solid Foods
30
Hydrolyzed Milk Formulae
30
Aeroallergens
31
House Dust Mite Allergen Avoidance
31
Other Aeroallergens
33
Combined Approach
34
Secondary Prevention
34
Occupational Allergens
35
Food Allergens
35
Aeroallergens
35
Summary
36
References
37
Chapter 2
41
Pharmacotherapy of Allergic Rhinitis
41
Introduction
41
Oral H1 -Antihistamines
41
First Generation H1 -Antihistamines
42
Second Generation H1 -Antihistamines
42
Cetirizine
43
Levocetirizine
44
Loratadine
44
Desloratadine
44
Fexofenadine
45
Intranasal H1 -Antihistamines
45
Azelastine
45
Olopatadine
46
Intranasal Corticosteroids
46
INS Compared with Placebo
47
Comparison of Individual INS
47
INS Compared with Oral H1 Antihistamines
48
Adverse Effects of INS
48
Leukotriene Modifying Agents
50
Local Chromones
51
Local Anticholinergics
51
Decongestants
51
Summary
52
References
53
Chapter 3
59
Antihistamines in Rhinitis and Asthma
59
Histamine: Role in Health and Disease
59
Histamine Receptors and Agonists: Diversity of Action
60
Classifications of Allergic Rhinitis and Implications for Treatment
63
Antihistamines in the Treatment of Allergic Rhinitis: Beyond the Histamine Effects
64
Antihistamines in Asthma: Same Airway Disease, but Dramatically Different
67
Antihistamines in Children, Elderly and Pregnant Women with Rhinitis
68
The Ideal Antihistamine: Basis for Comparison of all Existing Preparations
69
References
70
Chapter 4
73
Antiallergic and Vasoactive Drugs for Allergic Rhinitis
73
Introduction
73
Guidelines for the Treatment of AR
74
Cornerstones of Rhinitis Treatment
74
Oral H1 -Receptor Antagonists
75
Topical Nasal H1 -Receptor Antagonists
76
Topical Nasal Corticosteroids
76
Systemic Corticosteroids
77
Antileukotrienes
77
Sodium Cromoglicate
78
Anti-IgE
78
Intranasal Decongestants
78
Oral Decongestants
79
Conclusion
79
References
79
Chapter 5
84
Antileukotrienes in Asthma and Rhinitis
84
Introduction
84
The Leukotriene Biosynthetic Pathway
84
Cellular Sources of Leukotrienes
86
Cysteinyl-Leukotriene Receptors
86
Actions of cys-LTS in Asthma and Rhinitis
88
Bronchoconstriction
88
Vascular Effects
88
Leukocyte Recruitment
89
Other Inflammatory Actions
90
Airway Remodeling
90
Leukotrienes in Biological Fluids
91
Classes of Oral Antileukotriene Drug
91
Antileukotriene Drugs in Provocation Studies
93
Allergen Bronchoprovocation
93
Exercise and Cold Air Challenges
93
Aspirin Challenge
94
Efficacy of Antileukotriene Drugs in Asthma
94
Acute Asthma
94
Chronic Asthma
95
Anti-Inflammatory and Remodeling Effects
95
Comparison with Other Asthma Therapies
96
Add-on Therapy and Steroid-Tapering Trials
98
Efficacy of Antileukotriene Drugs in Allergic Rhinitis
100
Monotherapy
100
Combination Therapy
100
Safety, Compliance, and Adherence
101
Variability in Clinical Response
102
Summary
102
References
103
Chapter 6
112
Mechanisms of Action of beta2 Adrenoceptor Agonists
112
Introduction
112
Adrenoceptor Populations in the Airways
112
Molecular Genetics of the Human beta2 Adrenoceptor
113
Structure–Function Relationships of the beta2 Adrenoceptor
113
Distribution of beta2 Adrenoceptor Expression
115
Regulation of beta2 Adrenoceptor Expression
116
Pharmacology of beta Adrenoceptor Agonists
117
Clinical Pharmacology of SABAs and LABAs
118
Clinical Effects
118
Safety of SABAs and LABAs
119
Summary
121
References
121
Chapter 7
125
Alkylxanthines and Phosphodiesterase 4 Inhibitors for Allergic Diseases
125
Introduction
125
Generic Properties and Characteristics of Cyclic Nucleotide PDEs
126
Phosphodiesterase 4
131
Therapeutic Indications of PDE4 Inhibitors
131
Anti-inflammatory Effects of PDE Inhibitors In Vivo
132
IgE-Mediated Processes
133
Proinflammatory Cell Infiltration
133
Microvascular Leakage and Edema
134
Clinical Trials of Theophylline in Asthma
135
Clinical Trials of PDE4 Inhibitors in Asthma and Rhinitis
135
Asthma
135
Clinical Trials of PDE4 Inhibitors in Psoriasis and Atopic/Contact Dermatitis
137
Rolipram and Rolipram Analogues
137
Xanthines
138
Thalidomide Derivatives
139
Safety, Tolerability, Drug Metabolism and Pharmacokinetics of Theophylline and PDE4 Inhibitors: A Comparison
139
Adverse Events of Theophylline and PDE4 Inhibitors
140
Theophylline
140
PDE4 Inhibitors
142
Concluding Remarks
143
References
144
Chapter 8
153
Glucocorticoid Insensitive Asthma
153
Definition of GC Insensitive Asthma
154
Abnormal Activation of the GC Receptor and its Nuclear Inhibitory Effects
154
GC Insensitivity Due to the Presence of a “Different” Inflammatory Process
158
GC Insensitivity Due to the Lack of Any Inflammatory Process
158
GC Insensitivity Due to the Presence of an Inflammatory Process in a Region of the Lung Poorly Accessible to Inhaled CS Therapy
159
Approaches to Therapy in GC Insensitive Patients
160
Conclusions
161
References
161
Chapter 9
165
Recalcitrant Asthma
165
Introduction
165
Definitions of Severe Asthma
165
Risk Factors for Severe Asthma
169
Genetic Risk Factors
171
Environmental Risk Factors
173
Infections
173
Smoking
177
Obesity
177
Gastroesophageal Reflux Disease (GERD)
178
Adherence
178
Histological Features of Severe Asthma
179
Management of Severe Asthma
182
New Approaches to Treatment of Severe Asthma
185
Conclusion
186
References
187
Chapter 10
191
Mechanisms and Management of Exercise-Induced Bronchoconstriction
191
Introduction
191
Epidemiology
191
Pathogenesis
192
Clinical Manifestations
194
Diagnosis
194
Differential Diagnosis
195
Management
196
Pharmacological
196
Beta 2 Agonists
196
Cromoglycates
197
Inhaled Corticosteroids
198
Leukotriene-Modifying Agents
199
Histamine (H 1 ) Antagonists
200
Dietary Modification
200
Other Therapies
201
Nonpharmacological
201
Conclusion
201
References
202
Chapter 11
207
Use of Theophylline and Sodium Cromoglycate in Adult Asthma
207
Introduction
207
Properties of Sustained-Release Theophylline
208
Pharmacological Properties of Theophylline
208
Anti-Inflammatory Effects of Theophylline
209
Safety of Theophylline
210
Evidence Supporting the Effectiveness of Theophylline for the Long-Term Management of Asthma
211
Evidence Supporting the Concurrent Use of Theophylline and Inhaled Corticosteroids
211
Evidence Supporting the Effectiveness of Theophylline for Severe Asthma
212
References
213
Chapter 12
215
New Insights into Allergen-Specific Immunotherapy in Rhinitis and Asthma
215
Historical Context
215
Injection Immunotherapy
216
Efficacy and Safety
216
Mechanisms
217
Long-Lasting Effect and Prevention
218
Sublingual Immunotherapy
219
Efficacy and Safety
219
Mechanisms
221
Aspects Currently Under Investigation
222
Future Developments
223
Novel Formulations and Routes of Administration
223
Immunotherapy with Adjuvants
224
Immunotherapy with Bacterial Adjuvants
225
DNA-Adjuvanted Immunotherapy
225
Immunotherapy with Peptides
226
Recombinant and Engineered Allergens
226
Concluding Remarks
227
References
227
Chapter 13
236
Sublingual Immunotherapy in Allergic Rhinitis and Asthma
236
Introduction
236
Mechanisms
237
Clinical Evidence of Efficacy
240
New Dosing Regimes
241
Economic Evaluation
241
Safety
242
Psychological Stress and Response to SLIT
242
Future Directions
242
References
243
Chapter 14
246
Anti-IgE in Allergic Airway Diseases: Indications and Applications
246
Introduction: Role of IgE and Anti-IgE Molecules
246
Proof of Concept of Omalizumab Actions in Asthma
249
Clinical Efficacy in Allergic Asthma
249
Design of Studies
250
Asthma Exacerbations
250
Inhaled Corticosteroids
250
The Effect of Omalizumab on Other Medication Use, Including Beta-2 Agonists and Oral Corticosteroids
251
Lung Function
251
Quality of Life
251
Severe Asthma
252
Children
252
Predictors of Response to Omalizumab
252
Asthma Guidelines
253
Allergic Rhinitis
253
Mechanism of Action of Anti-IgE
255
Pharmacokinetics of Omalizumab
256
Safety of Omalizumab
257
Neoplasms
258
Immune Complex and Antibodies
259
Helminth Infection
259
Thrombocytopenia
259
Summary
260
References
260
Chapter 15
263
Drug Delivery Devices and Propellants
263
Introduction
263
Aerosol Characteristics
263
Aerosol Devices
265
Inhalers
265
Dry Powder Inhalers (DPI)
265
Pressurized Metered Dose Inhalers (pMDI)
266
Breath Activated pMDI
267
Venturi Type Jet Nebulizers (JN)
268
Breath Activated Nebulizers
268
Large Volume Nebulizers (LVN)
268
Ultrasonic Nebulization
269
Vibrating Mesh Nebulizers (VM)
269
Other New Nebulizer Technologies
269
Accessory Devices
270
Spacers
270
Valved Holding Chambers (VHC)
270
Masks
271
Activation Enablers
271
Special Uses
271
Neonatal and Pediatric Aerosol Therapy
271
Emergency Department Aerosol Delivery for Acute Asthma
272
Care of Devices
273
Jet Nebulizer Maintenance
273
VHC Maintenance
273
DPI and pMDI Maintenance
274
Patient Education
274
References
274
Chapter 16
277
Update on the Management of AtopicDermatitis/Eczema
277
Introduction
277
Basic Approach to Therapy
278
Avoidance of Exacerbating Factors
278
Topical Treatments
280
Emollients
280
Topical Steroids
282
Topical Calcineurin Inhibitors
283
Infection and Antimicrobial Treatments
284
Bacterial Infections
284
Viral Infections
285
Fungal Infections
286
Antimicrobial Peptides
286
Anti-Itch Treatment
287
Systemic Immunosuppressive Therapy
288
Systemic Steroids
289
Methotrexate
289
Oral Calcineurin Inhibitors
290
Mycophenolate Mofetil
291
Azathioprine
292
Biologics
292
Interferon- gamma (rIFN- gamma)
293
Intravenous Immunoglobulin (IVIg)
293
Tumor Necrosis Factor (TNF) alpha inhibitors (Etanercept – Enbrel®,Amgen; Infliximab – Remicade®, Centocor; Adalimumab –Humira®, Abbott)
294
Anti-LFA agents (Efalizumab – Raptiva®, Genentech-Xoma)
295
Anti IgE Agents (Omalizumab – Xolair®, Genentech)
295
Alternative Approaches
296
Probiotics
296
Gamma linoleic Acid (GLA)
297
Psychological Interventions
297
Conclusions
297
References
298
Chapter 17
309
Immunosuppressants as Treatment for Atopic Dermatitis
309
Introduction
309
Glucocorticosteroids
309
GCS Signaling
310
GCS and the Th1/Th2 Balance
310
GCS and Antigen Presentation
311
GCS and Leucocyte Migration
312
GSC and Cell Viability/Skin Barrier
312
GSC and Mast Cells/Eosinophils
313
Cyclosporine
314
CsA and Keratinocytes
314
CSA and Leukocyte Migration
315
CsA and IgE Autoreactivity
315
Calcineurine Inhibitors
316
CNI and T cells
316
CNI and Antigen Presentation
317
CNI and Eosinophils
318
CNI and Effector Cells
318
CNI and Keratinocytes
318
Mycophenolate Mofetil
319
Methotrexate
319
Intravenous Immunoglobulines
320
Biologicals
320
Conclusion
321
References
321
Chapter 18
329
Management of Anaphylaxis
329
The Prevention of Anaphylactic Episodes
329
General Preventive Measures
329
Preventive Measures for Patients at Risk
330
Management of the Acute Event
331
Treatment Administered in a Medical Facility
331
Immediate Measures
334
Measures Initiated After Further Evaluation
335
Treatment in the Field by the Patient
337
The Observation Period After Resolution of Symptoms
338
Fatalities
339
References
340
Chapter 19
342
Anaphylaxis: Are Regulatory T Cells the Targetof Venom Immunotherapy?
342
Abbreviations
342
Introduction
342
Types of TReg Cells and Allergic Responses to Insect Venoms
344
Role of T Reg Cells During Natural Tolerance and Venom SIT
345
Conclusion
348
References
348
Chapter 20
352
Food Allergy: Opportunities and Challenges in the Clinical Practice of Allergy and Immunology
352
Introduction
352
Allergen-Specific Immunotherapy
353
Allergen Immunotherapy
353
Subcutaneous Immunotherapy (SCIT)
353
Oral Immunotherapy (Specific Oral Tolerance Induction, SOTI)
354
Sublingual Immunotherapy (SLIT)
356
Modified Recombinant Vaccines
357
Peptide Immunotherapy
358
Immunostimulatory Sequence-Conjugated Protein Immunotherapy
358
Plasmid DNA Immunotherapy
359
Allergen Non-Specific Immunotherapy
359
Anti-IgE
359
Herbal Medicine
359
Summary and Conclusions
360
References
360
Chapter 21
364
Early Immunological Influences on Asthma Development: Opportunities for Early Intervention
364
Introduction
364
Postnatal Development of Immune Competence
365
Recent Thymic Emigrants (RTE) and the Conundrum of Intrauterine Sensitisation to Allergens
367
Immune Maturation and Genetic Risk for Atopic Disease
367
Pathways Leading to Development of Wheeze in Childhood: Towards a Rational Basis for Development of Effective Prevention Strategies
368
Strategies for Primary and Secondary Prevention of Persistent Atopic Asthma: Current and Future Options
370
Rational for Early Intervention Strategies for Asthma Prevention
370
Targeting Postnatal Maturation of Immune Competence
371
Protection against the Induction and Persistence of Allergic Sensitization
372
Early Treatment with Anti-Inflammatory Drugs to Blunt the Asthma-Promoting Effects of Airway Inflammation in Children
373
Protection Against Early Respiratory Viral Infections: The Ultimate Challenge
373
Conclusions
374
References
375
Chapter 22
381
Asthma and Allergy in Childhood: Predictionand Early Diagnosis
381
Why Should We Predict Disease?
381
Some Definitions and Considerations
382
Prediction Versus Risk Factors
383
Tools for Prediction
385
Early Diagnosis
389
References
390
Chapter 23
394
Early Interventions in Allergic Diseases
394
Introduction
394
Risk Factors for Allergies and Asthma
395
Respiratory Viruses, Wheezing, Allergen Sensitization and Asthma
395
Breast Feeding
398
Endotoxin
398
Pet Ownership
399
Tobacco Smoke
400
Therapeutic and Preventive Strategies
401
Perspectives of Treatment and Prevention of Respiratory Viral Infections
401
Environmental Interventions in Genetically Predisposed Infants
402
Pharmacological Treatment
403
Allergen-Specific Immunotherapy
404
Conclusions
404
References
406
Chapter 24
411
Birth Cohort Studies for the Prevention of Allergy: New Perspectives—Where Do We Go from Now?
411
Introduction
411
Study Design
411
Cross-Sectional Studies
412
Cohort Studies
412
Observational Birth Cohort Studies
412
Interventional Birth Cohort Studies
413
Defining Allergies
413
Natural Course of Allergic Illnesses
414
Risk Factors and Protective Exposures
415
Nutrition
415
Maternal Diet
415
Breastfeeding
415
Hypoallergenic Infant Formula
416
Infantile Diet
416
Probiotics
417
Environmental Factors
418
Environmental Tobacco Smoke
418
Traffic Related Pollution
418
Inhaled Allergens
418
Pets
419
Family Size/Day Care
420
Infections
421
Microbial Exposures in the Environment
421
Antibiotics/Vaccinations/Paracetamol
421
Multifaceted Interventional Studies
422
Secondary and Tertiary Prevention in Cohort Studies
423
Conclusion
423
Where do we go from now?
424
References
424
Chapter 25
430
Novel Immunomodulatory Strategies for the Prevention of Atopy and Asthma
430
Introduction
430
The Need for Early Interventions for Allergy Prevention
431
Limitations of Current Strategies
432
Identifying Target Populations for PreventionStrategies - the Need for Better Allergy Predictors
432
Novel Non-Invasive Strategies Using Dietary Nutrients to Prevent Disease
434
Novel Strategies using other Microbial Products
438
The Role of Allergen Immunotherapy
440
Future Directions
440
References
441
Chapter 26
446
Recombinant Allergens for Therapy and Prevention: Molecular Design and Delivery of Allergy Vaccines
446
Introduction
446
Recombinant Allergens
447
Recombinant Allergy Vaccines
448
Molecular Design of Allergy Vaccines
449
Delivery of Allergy Vaccines
451
Cytokines
452
CpG DNA
453
Live Bacillus Calmette-Guerin BCG
453
Live Vectors
454
Nanoparticles
454
Future of Immunotherapy
455
Concluding Remarks
455
References
456
Chapter 27
460
Prevention of Allergic Diseases
460
Introduction
460
Factors in the Environment that May Confer Protection
461
Farm Milk Consumption
461
Raw Vegetable and Fresh Fruit Consumption
462
Natural Water Consumption
462
Tolerance
463
Definition of Tolerance
463
Mechanisms Involved in the Development of Tolerance
464
Bell-Shaped Curve
464
Toll-Like Receptors in the Development of Tolerance
465
Healthy Immune Response vs. Allergic Immune Response
467
Can Tolerance Be Restored in Atopic Individuals?
468
Primary Prevention
468
The Finnish Allergy Programme 2008–2018 Launched
470
Goals and Focus
471
Conclusion
471
References
472
Chapter 28
478
Emerging Nonsteroidal Anti-Inflammatory Therapies Targeting Specific Mechanisms in Asthma and Allergy
478
Introduction
478
Anti-Leukotrienes
478
Anti-Prostanoids
479
Nonsteroidal Therapy in Asthma & Allergy 467act also as a CRTH2 receptor antagonist. Modest, though beneficial effects havebeen reported when applied in allergic rhinitis and asthma, the drug has been registeredin Japan as a controller of allergy [18]. Pres
480
Anti-IgE
480
Allergen Specific Immunotherapy
481
Anti-Cytokine Therapy
481
Anti-TNF- alpha
483
Anti-IL-5
483
Anti-IL-4 and Anti-IL-13
484
Anti-IL-13
485
Anti-IL-9
485
IL-10
485
Recombinant IL-12
486
Conclusion Anti-Cytokine Therapy
486
Probiotics
487
Heparins
487
Other Potential Anti-Asthma Targets
488
Conclusion
489
References
489
Part II: Special Consideration in Children, Elderly and Pregnancy
496
Chapter 29
497
Asthma and Rhinitis in Pregnancy
497
Introduction
497
Asthma During Pregnancy
497
Asthma Control
497
Asthma Exacerbations
498
Lung Function During Pregnancy
499
Rhinitis During Pregnancy
499
Allergic Rhinitis
500
Pregnancy Rhinitis
500
Snoring and Rhinitis in Pregnancy
501
Maternal and Fetal Complications of Asthma in Pregnancy
501
Low Birth Weight
501
Preterm Birth
502
Pre-eclampsia and Pregnancy induced hypertension
502
Congenital Malformations
502
Perinatal Mortality
502
Management of Asthma and Rhinitis During Pregnancy
503
Managing Asthma and Rhinitis
503
Treatment of Asthma Exacerbations During Pregnancy
503
Safety of Drug Treatments for Asthma and Rhinitis
504
beta2 -Agonists
504
Inhaled Corticosteroids
505
Intranasal Corticosteroids
505
Oral Corticosteroids
505
Leukotriene Receptor Antagonists
506
Antihistamines
506
Nasal Decongestants
506
Conclusions
506
References
507
Chapter 30
510
Asthma in the Elderly
510
Introduction
510
Diagnosis
510
Onset and Prevalence
512
Course
512
Death
513
Management and Treatment
513
Irreversibility
515
Summary and Conclusions
518
References
519
Chapter 31
522
The Natural History of Childhood Asthma
522
Introduction
522
Definition of Asthma
522
When does Asthma begin?
524
Who gets Asthma?
525
Natural History of Early Childhood Asthma
527
Can the Natural History of Asthma be Altered?
535
Other Asthma Phenotypes in Childhood
535
Summary
537
References
537
Chapter 32
542
The Wheezing Infant and Young Child
542
Interpretation of Wheeze
543
Infant Wheeze
543
Early Wheezing and Prematurity
544
Wheezing after RSV Bronchiolitis
544
Recurrent Symptoms Beyond Infancy
545
Atopic Asthma
545
Viral Associated Wheeze
545
Cough
546
Major Environmental Factors
547
Airway Inflammation and Remodelling
547
Persistence and Resolution
548
Implications for Therapy
549
Conclusions
549
References
550
Chapter 33
554
Acute Severe Asthma in Children
554
Definition
554
Epidemiology of Severe Acute Asthma in Children
555
Recognition and Treatment of Severe Acute Asthma
556
Assessment in the Emergency Department or Acute Care Facility
557
First Line Care in the ED
558
The History and Physical Examination
560
Ongoing ED Care
561
Monitoring Response to Therapy
563
Consideration of Hospital Based Therapy
563
Respiratory Failure
563
Prevention and Discharge Planning
564
Summary
567
References
567
Chapter 34
575
Best Estimates of Asthma Control in Children
575
Asthma Severity Versus Asthma Control
575
Assessment of Asthma Control Using Subjective Measures
577
Symptom Assessments
577
Quality of Life Measures
578
Healthcare Utilization
579
Assessment of Asthma Control Using Objective Measures
580
Monitoring the Peak Expiratory Flow Rate
580
Forced Expiratory Spirometry
581
Sputum Eosinophil Counts
581
Measurement of Exhaled Nitric Oxide
582
Is Asthma Control Possible?
582
Achieving Asthma Control
583
Improving Asthma Control
583
References
584
Chapter 35
587
Risk-Benefit of Asthma Therapy in Children: Topical Corticosteroids
587
Characteristics of Inhaled Corticosteroids
588
Effects of Inhaled Corticosteroids
588
Similarities and Differences in Inhaled Corticosteroids
588
Benefits of Inhaled Corticosteroids in Children
590
Overview of Efficacy of Inhaled Corticosteroids
590
Early Intervention with Inhaled Corticosteroids
590
Failure to Respond to Inhaled Corticosteroids
591
Risks of Inhaled Corticosteroids in Children
591
Effect of ICS on Linear Growth and Bone Metabolism
591
Effect of ICS on the HPA Axis
593
Other Potential Adverse Effects of ICS
593
Maximizing the Benefits and Minimizing the Risks
594
Inhaled Corticosteroids in Infants
594
Combining Inhaled Corticosteroids with Long-Acting Beta-Agonists in Children
595
Conclusion: Treatment with ICS in Asthmatic Children: Risk or Benefit?
595
References
596
Chapter 36
602
Risk-Benefit of Asthma Therapy in Children: Nonsteroidal Anti-Inflammatory Drugs
602
Introduction
602
General Principles
602
Cromolyn Sodium and Nedocromil
604
Mechanism of Action
604
Benefits and Place in Therapy
606
Risks and Drawbacks
607
Ketotifen
607
Mechanism of Action
607
Benefits and Place in Therapy
607
Risks and Drawbacks
608
Theophylline
608
Mechanism of Action
608
Benefits and Place in Therapy
608
Risks and Drawbacks
609
Leukotriene Modifiers
609
Mechanism of Action
609
Benefits and Place in Therapy
610
Risks and Drawbacks
612
Omalizumab
613
Mechanism of Action
613
Benefits and Place in Therapy
613
Risks and Drawbacks
613
Conclusions
614
References
614
Chapter 37
619
The Role of Influenza Vaccination in Asthmatic Children
619
Introduction
619
Influenza: Incidence and Clinical Impact
620
Availability and Immunogenicity of Vaccines
621
Adverse Effects of Influenza Vaccination
622
Effectiveness
622
Vaccine Uptake in Children with Asthma
624
Cost Effectiveness of Influenza Vaccination
624
Conclusion
625
References
625
Chapter 38
628
Treatment of Infants with Atopic Dermatitis
628
Genetic and Other Risk Factors for AD
628
Pathophysiology
629
Triggers of AD
630
Allergens
630
Microorganisms
630
Irritant Factors
631
Diagnostic Work-Up
631
Food
631
Treatment
632
Basic Treatment
632
Topical Treatment
633
Emollients
633
Topical Glucocorticosteroids
633
Topical Calcineurin Inhibitors (TCIs)
634
Wet-Wrap Therapy
634
Topical Antimicrobial Therapy
635
Systemic Treatment
635
Antimicrobial Treatment
635
Systemic Corticosteroids
636
Cyclosporin A
636
Antihistamines
637
Diet
637
Education
637
References
638
Chapter 39
642
Diagnosing Food Allergy in Children
642
Introduction
642
Features of IgE-Mediated Food Allergy
642
Features of NonIgE-Mediated Food Allergy
644
Evaluation of the Food Allergic Child
645
History
645
Physical Examination
647
Skin Testing
648
Atopy Patch Testing
649
Laboratory Testing
650
Elimination Diets
651
Food Challenges
651
Management of the Food Allergic Child
653
Future Directions
655
References
656
Chapter 40
660
Diagnosis and Treatment of Latex Allergy
660
Introduction
660
Latex Allergens
661
Functional Properties of Latex Allergens
663
Biological Properties
663
Polyisoprene Elongation
664
Plant Defense Functions
664
Common Enzymes and Structural Proteins
665
Immunologic Properties
665
Immune Responses to Rubber Biosynthesis Proteins
665
Immune Responses to Defense-Related proteins
666
Hev b 8 (Profilin)
668
Hev b 9 (Enolase)
668
Hev b 10 (Manganese Superoxide Dismutase )
668
Hev b 11 (Endochitinase)
669
Hev b 12 (Lipid Transfer Protein)
669
Hev b 13 (Latex Esterase)
669
Diagnosis of Latex Allergy
669
In Vitro Testing for Latex Allergy
671
In Vivo Provocation Testing
672
Prevention and Treatment of the Patient with Latex Allergy
673
Summary
675
References
675
Chapter 41
682
New Aspects of Peanut and Tree Nut Allergy
682
Introduction
682
Environmental and Genetic Factors
683
Genetics
684
Linkage Analyses
684
HLA
685
SPINK5
686
Peanut and Tree Nut Allergens
686
Peanut
687
Hazelnut
687
Walnut
688
Almond, Cashew and Brazil Nut
688
Cross-Reactivity
689
Tree Nut Allergy
690
Diagnosis
690
Skin Testing
690
IgE Levels
691
Possibilities for Remission
691
Avoidance
692
Treatments
692
Immunotherapy
692
Anti-IgE
694
Herbal Treatments
694
Conclusions
695
References
695
Chapter 42
701
Allergic Fungal Sinusitis: Controversy and Evolution of Understanding with Therapeutic Implications
701
Introduction
701
Historical Aspects
703
Confusion and Controversy over the Diagnosis of AFS Categorization
703
Epidemiology and Geography
704
Pathophysiology Similarities and Differences of AFS to ABPFD
705
Proteases and Fungal Sinus Disease
706
Superantigen and Genetic Predisposition
707
IgE Levels and Associated Fungal Findings
708
Fungal Culture
709
Clinical Presentation
709
Radiological Findings
710
Treatment
711
Surgical Management
711
Medical Management
712
Antifungal Therapy
712
Immunotherapy
714
Anti-IgE
714
Other Modalities
714
Discussion
715
References
715
Chapter 43
718
Immunomodulatory Role of Bacillus Calmette-Guérin in the Prevention and Therapy of Allergy and Asthma
718
Abbreviations
718
Introduction
718
Hygiene Hypothesis
719
Bacillus Calmette-Guérin
719
Therapeutic Effects of BCG
719
BCG in Allergy and Asthma
720
Factors Regulating Efficacy of BCG as an Anti-Asthma Therapy
720
BCG-Induced Immunoregulation and Airway Remodeling
721
T H 1/T H 2 Concept
721
Growing Skepticism on the T H 1/T H 2 Concept
722
Role of Other Immunoregulatory Cells
722
T reg Cells
722
CD8 + T-Cells
723
gamma delta -T Cells
724
NKT Cells
725
Antigen Presenting Cells
725
Role of NRAMP and TLRs
725
NRAMP1
725
Toll-Like Receptors
726
Conclusion
726
References
727
Chapter 44
732
Use of Theophylline and Sodium Cromoglycate in Pediatric Asthma
732
Introduction
732
Theophylline
732
Pharmacological Properties
732
Physiological Effects
732
Anti-Inflammatory Effects
733
Molecular Mechanisms of Theophylline Effects
733
PDE Inhibition
733
Adenosine Receptor Antagonism
733
Other Effects
734
Therapeutic Use
734
Epigenetics
735
Sodium Cromoglycate
735
Introduction
735
Pharmacological Properties
736
Pharmacologic Effects
737
Absorption, Fate and Excretion
737
Toxicity
737
Therapeutic Use
738
References
738
Chapter 45
741
Antibody Deficiency Syndromes (Including Diagnosis and Treatment)
741
Introduction
741
Antibody-Mediated Immunity
741
Clinical Aspects of Antibody Deficiency
743
General Evaluation of Antibody-Mediated Immunity
744
Antibody Deficiency Syndromes
746
Agammaglobulinemia
746
Hyper-IgM Syndrome
747
Common Variable Immunodeficiency Disease (CVID)
747
Transient Hypogammaglobulinemia of Infancy
749
Selective IgA Deficiency
749
IgG Subclass Deficiencies
750
IgG1 Subclass Deficiency
751
IgG2 Subclass Deficiency
751
IgG3 Subclass Deficiency
751
IgG4 Subclass Deficiency
751
Specific Antibody Deficiency with Normal Immunoglobulins
751
Selective Anti-Pure (Non-Conjugated) Polysaccharide Antibody Deficiency
752
Treatment of Antibody Deficiencies
753
Clinical Staging of Complications
754
Summary
754
References
754
Index
758
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