RESUMEN
There is comparatively little information on health-related quality of life (HRQoL) in subjects with allergic rhinitis (AR) or allergic rhinoconjunctivitis (AR/C) in countries beyond western Europe and North America. The primary aim of this investigation was therefore to review and assess the information in the public domain on HRQoL in AR/C patients from diverse regions of the world, represented by different countries, including Argentina, Australia, Brazil, Russia, Singapore, South Africa and Turkey. Second, in view of the absence of a standardized definition for 'AR control', the review aimed to determine whether a working definition of AR/C can be inferred from validated tests or other instruments documented to date. Despite the comparatively low number of studies, this review demonstrated that overall the symptoms of AR/C impair the HRQoL of patients in these regions by adversely impacting sleep, daily activities, physical and mental status and social functioning, similar to that demonstrated in much larger numbers of studies of AR/C patients in Europe and the United States. Furthermore, the findings of the review suggest that 'overall' control of the disease should encompass reduction of nasal and ocular symptoms, as well as improvements in HRQoL, comorbid conditions and cognition. Although some instruments are currently available for measuring control of AR, none are capable of assessing all these aspects, emphasizing the need to develop appropriate new instruments.
Asunto(s)
Conjuntivitis Alérgica/fisiopatología , Calidad de Vida , Rinitis Alérgica Perenne/fisiopatología , Argentina , Australia , Brasil , Conjuntivitis Alérgica/epidemiología , Conjuntivitis Alérgica/prevención & control , Humanos , Rinitis Alérgica , Rinitis Alérgica Perenne/epidemiología , Rinitis Alérgica Perenne/prevención & control , Federación de Rusia , Singapur , Sudáfrica , TurquíaRESUMEN
BACKGROUND: Differences in the IgE response to isoallergens could have clinical implications; therefore, its analysis will contribute to the design of better strategies for the diagnosis and treatment of allergic respiratory diseases. Several isoforms have been described from mites but there is no information about the clinical impact of Blomia tropicalis isoallergens. OBJECTIVE: To evaluate the differences in the IgE response against two Blo t 12 isoallergens. METHODS: The IgE-binding properties of Blo t 12 isoallergens were analysed by ELISA, a skin prick test and ELISA cross-inhibition. Epitope mapping was performed using synthetic overlapping peptides. Fold recognition methods were used to model the chitin-binding domain of the two isoallergens. RESULTS: The frequency and strength of the IgE response were greater for Blo t 12.0101 than for Blo t 12.0102. Three IgE-binding areas were identified in Blo t 12.0101; one of them included two residues that are different in Blo t 12.0102. Modelling of the chitin-binding domains of these allergens predicted that they have structural differences that could influence antibody recognition of one of these epitopes. CONCLUSION: In silico structural analysis and immunological characterization of Blo t 12 reveals that allergen polymorphism influences IgE reactivity. Blo t 12.0101 is the most IgE-reactive isoform in Cartagena. The identified IgE epitopes could be mutated to obtain hypoallergenic molecules of potential use for immunotherapy.
Asunto(s)
Alérgenos/inmunología , Asma/inmunología , Inmunoglobulina E/sangre , Pyroglyphidae/inmunología , Adolescente , Alérgenos/química , Secuencia de Aminoácidos , Animales , Niño , Clonación Molecular , Reacciones Cruzadas/inmunología , Mapeo Epitopo , Humanos , Datos de Secuencia Molecular , Péptidos/inmunología , Isoformas de Proteínas/química , Isoformas de Proteínas/inmunología , Pyroglyphidae/química , Alineación de Secuencia , Pruebas CutáneasRESUMEN
OBJECTIVE: We tested the hypothesis that adding montelukast to budesonide would improve asthma control in children with inhaled glucocorticoid-dependent persistent asthma. STUDY DESIGN: In a multicenter, randomized, double-blind, crossover study, we compared the benefit of adding montelukast, 5 mg, or placebo once daily to budesonide, 200 microg, twice daily. RESULTS: After a 1-month run-in with budesonide, 200 microg, twice daily, 279 children were randomized to montelukast or placebo. The mean +/- SD age was 10.4 +/- 2.2 years, the mean forced expiratory volume in 1 second (FEV(1)) was 77.7% +/- 10.6% predicted, and reversibility was 18.1% +/- 12.9%. Compared with adding placebo to budesonide, adding montelukast produced significant improvements in mean percent change from baseline FEV(1) (P =.062 [P =.010 for per-protocol analysis]), mean absolute change from baseline FEV(1) (P =.040), mean increase from baseline in morning (P =.023) and evening (P =.012) peak expiratory flows, decrease in exacerbation days by approximately 23% (P <.001), decreased beta2-agonist use (P =.013), and reduced blood eosinophil counts (P <.001). The treatments did not differ significantly with regard to safety. CONCLUSIONS: Montelukast, 5 mg, added to budesonide improved asthma control significantly, indicated by a small additive effect on lung function and a clinically relevant decrease in asthma exacerbation days.
Asunto(s)
Acetatos/uso terapéutico , Antiasmáticos/uso terapéutico , Asma/tratamiento farmacológico , Quinolinas/uso terapéutico , Acetatos/administración & dosificación , Acetatos/efectos adversos , Antiasmáticos/administración & dosificación , Antiasmáticos/efectos adversos , Asma/fisiopatología , Budesonida/administración & dosificación , Budesonida/efectos adversos , Budesonida/uso terapéutico , Ciclopropanos , Método Doble Ciego , Quimioterapia Combinada , Volumen Espiratorio Forzado/fisiología , Humanos , Valor Predictivo de las Pruebas , Calidad de Vida , Quinolinas/administración & dosificación , Quinolinas/efectos adversos , Sulfuros , Resultado del TratamientoRESUMEN
The Chinese delicacy "bird's nest" is the most common cause of food-induced anaphylaxis requiring hospitalization among Chinese children in Singapore. This investigation has established an immunoglobulin E-mediated cause and has characterized the major putative allergens.