Pub Date : 2021-10-09DOI: 10.36811/ojprm.2021.110012
Nightingale Syabbalo
The atopic march refers to the natural history of allergic disorders as they develop from infancy to childhood. Classically, the atopic march begins with atopic dermatitis (AD), followed by food allergy, advancing to asthma, allergic rhinitis (AR), and finally to the fifth member eosinophilic esophagitis. The pathogenesis of the atopic march is complex, and involves genetic, immunological, and environmental factors. T helper type 2 (Th2) lymphocytes, and epithelial cells play a key role in the pathogenesis of the diseases in the atopic march. Th2 cells secrete cytokines, such as interleukin-5 (IL-5), IL-4, and IL-13, whereas, epithelial cell injury release alarmin cytokines, including IL-25, IL-33, and thymic stromal lymphopoietin (TSLP). Th2 cells and alarmin cytokines play an important role in the development of eczematous skin lesions, airway inflammation and remodeling, and oesophageal mucosal inflammation. Treatment of eosinophilic asthma and associated comorbid disorders is challenging, and requires a precision targeted approach with biologics. Dupilumab is a fully humanized IgG4 monoclonal antibody to the IL-4Rα, which mediates signaling to both IL-4 and IL-13, and blocks their immunopathological effects. Dupilumab is the only biologic that has been approved for the treatment of eosinophilic asthma, AD, and eosinophilic esophagitis. In patients with eosinophilic asthma treatment with dupilumab has been shown to improve asthma control, reduce exacerbations, and improve lung function. In patients with atopic dermatitis dupilumab has been demonstrated to improve the Eczema Area Severity Index (EASI) score, Investigator’s Global Assessment (IGA) response, SCORing Atopic Dermatitis (SCORAD) score, and the Peak Pruritus Numerical Rating (PNR) scale. Lebrikizumab and Tralokinumab (anti-IL-13) failed to show the expected results for the treatment of asthma, astoundingly, in several clinical trials they have been shown to significantly improvement EASI score, IGA response, SCORAD score, PNR scale, sleep architecture, and Dermatology Life Quality Index (DLQI). They have been granted First Tract Designation, and European Commission regulatory approval, respectively. Tezepelumab (anti-TSLP) is approved for the treatment of eosinophilic asthma, and has been shown to significantly reduce exacerbations, and improve asthma control, lung function, and HLQoL. However, tezepelumab did not meet the endpoints in phase II for the treatment of AD. Keywords: Atopic March; Atopic Dermatitis; Eosinophilic Asthma; Interleukin; Dupilumab; Tralokinumab
{"title":"Anti-Interleukin Biologics for the treatment of the Atopic March Diseases","authors":"Nightingale Syabbalo","doi":"10.36811/ojprm.2021.110012","DOIUrl":"https://doi.org/10.36811/ojprm.2021.110012","url":null,"abstract":"The atopic march refers to the natural history of allergic disorders as they develop from infancy to childhood. Classically, the atopic march begins with atopic dermatitis (AD), followed by food allergy, advancing to asthma, allergic rhinitis (AR), and finally to the fifth member eosinophilic esophagitis. The pathogenesis of the atopic march is complex, and involves genetic, immunological, and environmental factors. T helper type 2 (Th2) lymphocytes, and epithelial cells play a key role in the pathogenesis of the diseases in the atopic march. Th2 cells secrete cytokines, such as interleukin-5 (IL-5), IL-4, and IL-13, whereas, epithelial cell injury release alarmin cytokines, including IL-25, IL-33, and thymic stromal lymphopoietin (TSLP). Th2 cells and alarmin cytokines play an important role in the development of eczematous skin lesions, airway inflammation and remodeling, and oesophageal mucosal inflammation. Treatment of eosinophilic asthma and associated comorbid disorders is challenging, and requires a precision targeted approach with biologics. Dupilumab is a fully humanized IgG4 monoclonal antibody to the IL-4Rα, which mediates signaling to both IL-4 and IL-13, and blocks their immunopathological effects. Dupilumab is the only biologic that has been approved for the treatment of eosinophilic asthma, AD, and eosinophilic esophagitis. In patients with eosinophilic asthma treatment with dupilumab has been shown to improve asthma control, reduce exacerbations, and improve lung function. In patients with atopic dermatitis dupilumab has been demonstrated to improve the Eczema Area Severity Index (EASI) score, Investigator’s Global Assessment (IGA) response, SCORing Atopic Dermatitis (SCORAD) score, and the Peak Pruritus Numerical Rating (PNR) scale. Lebrikizumab and Tralokinumab (anti-IL-13) failed to show the expected results for the treatment of asthma, astoundingly, in several clinical trials they have been shown to significantly improvement EASI score, IGA response, SCORAD score, PNR scale, sleep architecture, and Dermatology Life Quality Index (DLQI). They have been granted First Tract Designation, and European Commission regulatory approval, respectively. Tezepelumab (anti-TSLP) is approved for the treatment of eosinophilic asthma, and has been shown to significantly reduce exacerbations, and improve asthma control, lung function, and HLQoL. However, tezepelumab did not meet the endpoints in phase II for the treatment of AD.\u0000\u0000Keywords: Atopic March; Atopic Dermatitis; Eosinophilic Asthma; Interleukin; Dupilumab; Tralokinumab","PeriodicalId":117491,"journal":{"name":"Open Journal of Pulmonology and Respiratory Medicine","volume":"41 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117243032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-02DOI: 10.36811/ojprm.2019.110005
M. Alim, Dina Abo Alam, Y. Sayed, Amr Abdellateef, El Sayed Al Ghareeb, Mohammad Nafee, M. Sayed, Sami Ba Baker, Mohammad Badry Eid, Suzan A. Mageed, S. E. Sayed
Pulmonary blastoma is one of the rare lung tumors and is considered to be distinct from other lung tumors by its pathological features, clinical course and prognosis [1]. Classic pulmonary blastoma is composed of both malignant mesenchymal stroma and epithelial components resembling embryonic lung tissue. Surgery is the standard treatment and the efficacy of adjuvant chemotherapy and radiotherapy has not yet been established [2]. Case Report Our patient was admitted and managed at Abassia Pulmonary Hospital, Ministry of Health, Cairo Governorate, Egypt. A 37-year-old Egyptian male presented to our hospital after repeated attacks of blood tinged sputum. The first attack dated about 6 months before admission. The patient had progressive shortness of breath over a period of two years. The patient was a smoker of one pack of cigarettes per day for more than 15 years. There was no significant past history nor family history. After admission to the Chest Medicine Department at Abbasia Pulmonary Hospital, routine basic investigations were done including complete blood picture with differential count, fasting blood sugar and 2 hours after meal, liver function tests, renal function tests, and coagulation profile. All investigations were within normal.
{"title":"Pulmonary Blastoma in an adult male","authors":"M. Alim, Dina Abo Alam, Y. Sayed, Amr Abdellateef, El Sayed Al Ghareeb, Mohammad Nafee, M. Sayed, Sami Ba Baker, Mohammad Badry Eid, Suzan A. Mageed, S. E. Sayed","doi":"10.36811/ojprm.2019.110005","DOIUrl":"https://doi.org/10.36811/ojprm.2019.110005","url":null,"abstract":"Pulmonary blastoma is one of the rare lung tumors and is considered to be distinct from other lung tumors by its pathological features, clinical course and prognosis [1]. Classic pulmonary blastoma is composed of both malignant mesenchymal stroma and epithelial components resembling embryonic lung tissue. Surgery is the standard treatment and the efficacy of adjuvant chemotherapy and radiotherapy has not yet been established [2].\u0000\u0000Case Report\u0000\u0000Our patient was admitted and managed at Abassia Pulmonary Hospital, Ministry of Health, Cairo Governorate, Egypt. A 37-year-old Egyptian male presented to our hospital after repeated attacks of blood tinged sputum. The first attack dated about 6 months before admission. The patient had progressive shortness of breath over a period of two years. The patient was a smoker of one pack of cigarettes per day for more than 15 years. There was no significant past history nor family history. After admission to the Chest Medicine Department at Abbasia Pulmonary Hospital, routine basic investigations were done including complete blood picture with differential count, fasting blood sugar and 2 hours after meal, liver function tests, renal function tests, and coagulation profile. All investigations were within normal.","PeriodicalId":117491,"journal":{"name":"Open Journal of Pulmonology and Respiratory Medicine","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128786528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-06-16DOI: 10.36811/OJPRM.2019.110003
C. Farrell, S. Coleman, B. Casserly
Lumacaftor/ivacaftor increases cystic fibrosis transmembrane conductance regulator (CFTR) activity and is an effective treatment for cystic fibrosis (CF) patients that are homozygous for the F508del mutation. We describe the case of an 18-year-old Irish man with F508del homozygous CF admitted to our centre with a rash affecting his arms and upper trunk. This occurred one day post completing a 14-day course of intravenous (IV) Piperacillin/Tazobactam and Tobramycin for an infective exacerbation of cystic fibrosis and day 9 post treatment with lumacaftor/ivacaftor. Skin punch biopsies were performed, and the features were consistent with erythema multiforme. Our patient received another dose of lumacaftor/ivacaftor 20 days after receiving the first dose. Ninety minutes after the receiving the dose, he developed a diffuse erythematous rash, similar to the initial presentation. Lumacaftor/ivacaftor was re-trailed once more 10 months later. Three hours after commencing treatment our patient developed a diffuse erythematous rash affecting his face, and upper torso along with conjunctival injection. This reaction was diagnosed as a cytokine release type reaction. There are no reported cases in the literature of a cytokine release type reaction to lumacaftor/ivacaftor resulting in its discontinuation. When assessing patients on lumacaftor/ivacaftor that have developed a rash, this should always be included in the differential as the underlying cause given its high incidence. Tezacaftor/ivacaftor is an alternative treatment for patients that have developed a severe reaction to lumacaftor/ivacaftor.
{"title":"Case report of an unexpected reaction associated with Lumacaftor/ivacaftor therapy for cystic fibrosis","authors":"C. Farrell, S. Coleman, B. Casserly","doi":"10.36811/OJPRM.2019.110003","DOIUrl":"https://doi.org/10.36811/OJPRM.2019.110003","url":null,"abstract":"Lumacaftor/ivacaftor increases cystic fibrosis transmembrane conductance regulator (CFTR) activity and is an effective treatment for cystic fibrosis (CF) patients that are homozygous for the F508del mutation. We describe the case of an 18-year-old Irish man with F508del homozygous CF admitted to our centre with a rash affecting his arms and upper trunk. This occurred one day post completing a 14-day course of intravenous (IV) Piperacillin/Tazobactam and Tobramycin for an infective exacerbation of cystic fibrosis and day 9 post treatment with lumacaftor/ivacaftor. Skin punch biopsies were performed, and the features were consistent with erythema multiforme. Our patient received another dose of lumacaftor/ivacaftor 20 days after receiving the first dose. Ninety minutes after the receiving the dose, he developed a diffuse erythematous rash, similar to the initial presentation. Lumacaftor/ivacaftor was re-trailed once more 10 months later. Three hours after commencing treatment our patient developed a diffuse erythematous rash affecting his face, and upper torso along with conjunctival injection. This reaction was diagnosed as a cytokine release type reaction. There are no reported cases in the literature of a cytokine release type reaction to lumacaftor/ivacaftor resulting in its discontinuation. When assessing patients on lumacaftor/ivacaftor that have developed a rash, this should always be included in the differential as the underlying cause given its high incidence. Tezacaftor/ivacaftor is an alternative treatment for patients that have developed a severe reaction to lumacaftor/ivacaftor.","PeriodicalId":117491,"journal":{"name":"Open Journal of Pulmonology and Respiratory Medicine","volume":"2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123862703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-04-24DOI: 10.36811/ojprm.2019.110002
Shyh-Shyong Sim, C. How, Bo-Hwi Kang
Complications from endotracheal tube introducer are rare and mostly involved mechanical trauma to airway structures. We report a rare complication while using endotracheal tube introducer during difficult airway management, which, we believed it was fragile after repeated sterilization.
{"title":"A Broken Arrow: a rare complication of Endotracheal tube introducer","authors":"Shyh-Shyong Sim, C. How, Bo-Hwi Kang","doi":"10.36811/ojprm.2019.110002","DOIUrl":"https://doi.org/10.36811/ojprm.2019.110002","url":null,"abstract":"Complications from endotracheal tube introducer are rare and mostly involved mechanical trauma to airway structures. We report a rare complication while using endotracheal tube introducer during difficult airway management, which, we believed it was fragile after repeated sterilization.","PeriodicalId":117491,"journal":{"name":"Open Journal of Pulmonology and Respiratory Medicine","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131019811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-03-27DOI: 10.36811/OJPRM.2019.110001
Chun-Chieh Yang, Chin-Ming Chen, Wen-Liang Yu
Invasive pulmonary Aspergillus infection during or after severe influenza infection in an immunocompromised patient or a previously healthy person has been reported in the literature [1-2]. In addition, coinfections of Staphylococcus aureus or Streptococcus pneumoniae with influenza are common, whereas simultaneous infections of legionellosis with aspergillosis are unusual in patients with influenza [2]. We herein report a diabetic patient who presented with a community-acquired pneumonia (CAP). The initial sputum culture yielded Aspergillus species and S. aureus, which were coinfected with influenza A, Pneumococcus and Legionella, with a deteriorated fatal course.
{"title":"Community-acquired Pneumonia with Concurrent Multi-infections of Influenza A, Staphylococcus aureus, Streptococcus pneumoniae, Legionella and Invasive Pulmonary Aspergillosis in a Diabetic Patient","authors":"Chun-Chieh Yang, Chin-Ming Chen, Wen-Liang Yu","doi":"10.36811/OJPRM.2019.110001","DOIUrl":"https://doi.org/10.36811/OJPRM.2019.110001","url":null,"abstract":"Invasive pulmonary Aspergillus infection during or after severe influenza infection in an immunocompromised patient or a previously healthy person has been reported in the literature [1-2]. In addition, coinfections of Staphylococcus aureus or Streptococcus pneumoniae with influenza are common, whereas simultaneous infections of legionellosis with aspergillosis are unusual in patients with influenza [2]. We herein report a diabetic patient who presented with a community-acquired pneumonia (CAP). The initial sputum culture yielded Aspergillus species and S. aureus, which were coinfected with influenza A, Pneumococcus and Legionella, with a deteriorated fatal course.","PeriodicalId":117491,"journal":{"name":"Open Journal of Pulmonology and Respiratory Medicine","volume":"46 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"120956520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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