Allergy proceedings : the official journal of regional and state allergy societies最新文献

Eosinophils are recruited to the site of IgE-mediated allergic reaction in the airway in asthma. Major eosinophil-chemotactic factors released from mast cells are platelet activating factor and Leukotriene B4. In addition, T cells and bronchial epithelial cells produce eosinophil chemotactic cytokines. Cytokines including IL-5, IL-3, and GM-CSF, which are released mainly from CD4+ T cells and possibly Th2, activates eosinophils for migration, tissue damage, and survival. Adhesion molecules on eosinophils and constituent structures of the airway participate in the process of eosinophil migration. Among a variety of adhesion molecules, VLA-4 and VCAM-1 are unique to the interaction between eosinophils and endothelial cells. A major role of recruited eosinophils in the airway in asthma is considered to be damage to the bronchial epithelium caused by eosinophil specific granules proteins, in addition to production of lipid mediators, production of cytokines, antigen-presenting cell function, and possible induction of basement membrane thickening in the airway.

Atopic dermatitis is a chronic pruritic cutaneous disease that occurs in 0.5% to 1% of the general population and affects almost 10% of all children. Since this is a disease that is associated with both a very high level of total IgE and a high incidence of allergic respiratory disease, it behooves the practicing allergist to become familiar with the diagnosis and treatment of atopic dermatitis. This following discussion will focus on the identification of major and minor clinical features of the disease and review the spectrum of immune dysregulation that is frequently seen with these patients. The primary focus of this review will be directed at the identification of treatment options available to allergists within the published practice guidelines of the American Academy of Dermatology and practice guidelines that are currently being developed by the American Academy of Allergy & Immunology. Atopic dermatitis is an "itch which rashes and not a rash which itches" and therefore, any patient treatment program should address the multiplicity of potential trigger factors that provoke this itching. These factors include heat, humidity, and perspiration, in addition to the ingestion of certain food allergens and the topical exposure to both dust mite antigen and animal dander. Recent studies suggest that the pathogenesis of allergic disease entails a complex inflammatory process in which the TH2 lymphocyte might play a major role in shifting the immune response in favor of disease. Accordingly, recent immunomodulating treatments, such as interferon gamma and cyclosporine, might offer therapeutic options to the physician beyond the standard topical forms of treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Although intravenous immunoglobulin (IVIG) has primarily been recognized as useful in patients with antibody deficiencies, it continues to be used for an ever-expanding list of conditions. In addition to antibody replacement, IVIG may act as an immune modulator in certain autoimmune and inflammatory conditions. Its use should be carefully weighed against the high cost of the product. In conditions where it appears to be useful, controlled studies are necessary to prove its efficacy and its cost benefits.

There is a growing appreciation of asthma as an inflammatory disease. Immunotherapy may play a role in modulating immunologic responses including inflammatory mediator production from cells involved in asthma. Studies of pollen-sensitive asthma have demonstrated beneficial effects of specific immunotherapy for grass, birch, and ragweed pollen-induced asthma. However, risk of systemic reactions exists, especially when specific immunotherapy is administered during the specific allergen season. House dust mite immunotherapy has benefitted asthmatic children more than adults. Patients having unstable pulmonary function may be at the highest risk of having systemic reactions to such immunotherapy. Animal dander immunotherapy and immunotherapy for molds including Clasdosporium and Alternaria may improve selected asthmatic patients. Avoidance of the offending allergen is still, however, the preferred mode of treatment of allergic asthma.