An allergy can refer to several kinds of immune reactions including Type I hypersensitivity in which a person's body is hypersensitised and develops IgE type antibodies to typical proteins. When a person is hypersensitised, these substances are known as allergens. The word allergy derives from the Greek words allos meaning "other" and ergon meaning "work". Type I hypersensitivity is characterised by excessive activation of mast cells and basophils by immunoglobulin E resulting in a systemic inflammatory response that can result in symptoms as benign as a runny nose, to life-threatening anaphylactic shock and death.

Allergy is a very common disorder and more than 50 million Americans suffer from allergic diseases. Allergies are the 6th leading cause of chronic disease in the United States, costing the health care system $18 billion annually (Allergy statistics).

History

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The term and concept of "allergy" was coined by a Viennese pediatrician named Clemens von Pirquet in 1906 ^*. He observed that the symptoms of some of his patients might have been a response to outside allergens such as dust, pollen, or certain foods. For a long time all hypersensitivities were thought to stem from the improper action of inflammatory immunoglobulin class IgE, however it soon became clear that several different mechanisms utilizing different effector molecules were responsible for the myriad of disorders previously classified as "allergies". A new four-class (now five) classification scheme was designed by P. G. H. Gell and R. R. A. Coombs. Allergy has since been kept as the name for Type I Hypersensitivity, characterised by classical IgE mediation of effects.

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International Archives of Allergy and Immunology : Last 20 articles

Decreased Sputum Mature Dendritic Cells in Healthy Smokers and Patients with Chronic Obstructive Pulmonary Disease
Tue, 30 Jun 2009 15:36:57 +0100
Int Arch Allergy Immunol 2009;150:389-397 (DOI:10.1159/000226240)
Evaluation of Receptor Expression on Immune System Cells in the Peripheral Blood of Asthmatic Children Undergoing Food Challenges
Tue, 30 Jun 2009 15:36:55 +0100
Int Arch Allergy Immunol 2009;150:377-388 (DOI:10.1159/000226239)
Three-Year Follow-Up Study of Allergen-Induced in vitro Cytokine and Signalling Lymphocytic Activation Molecule mRNA Responses in Peripheral Blood Mononuclear Cells of Allergic Rhinitis Patients Undergoing Specific Immunotherapy
Tue, 30 Jun 2009 15:36:52 +0100
Int Arch Allergy Immunol 2009;150:370-376 (DOI:10.1159/000226238)

Latest Issue of Annals of Allergy, Asthma and Immunology

Physician-patient communication as a tool that can change adherence
Bender, Bruce
The effects of corticosteroids on bone growth and bone density
Weldon, David
On the Cover
Weber, Richard W.

Surgical Endoscopy

Endoscopic closure of gastric access in perspective NOTES: an update on techniques and technologies
Tue, 30 Jun 2009 15:42:32 -0000
Abstract Background  Natural orifice transluminal endoscopic surgery (NOTES) is currently of major research interest as it may offer significant clinical potential for endoscopic procedures in the future. Nevertheless, many issues are still unresolved. The aim of this study is a systematic review of the literature to evaluate techniques and technologies to address the issue of achieving a secure gastric wall defect closure. Methods  Studies were identified by searching MEDLINE, EMBASE, Current Contents, Cochrane Library, Entrez PubMed and Clinical Trials Database until December 2008. We divided the different technologies into four groups: clipping, stitching, stapling and occluding systems. We analysed the different technologies in terms of (1) simplicity of manoeuvring for port closure, (2) security of introduction, (3) permanent implantation of the device into the organ, (4) effectiveness of port closure and (5) availability on the market. Results  Twenty-eight published studies were identified, while nine clinical trials are ongoing. Among proposed technologies, staplers and occluders have greater effectiveness but lack of security, and in the case of staplers also lack of simplicity of use. None of the stitching technologies can really be considered effective except for the Flexible Endostitch, which on the other side is difficult to handle in the current fashion. Standard clips, although easy to handle, have never been proved to be reliable, as only mucosal layer closure has been demonstrated to date. On the other side, the over-the-scope clip is likely to be effective, secure to introduce and simple to handle within the hollow organ. Conclusions  Achieving reliable closure of the hollow organ defect represents the first step towards implementation of clinical NOTES. The current data do not yet allow definitive and clear advantages or disadvantages of the different options to be determined. The introduction of the EURONOTES registry will help us to understand in which direction to proceed. Content Type Journal ArticleCategory ReviewDOI 10.1007/s00464-009-0593-1Authors Alberto Arezzo, University of Turin Centre for Minimally Invasive Surgery Corso Dogliotti 14 10126 Turin ItalyMario Morino, University of Turin Centre for Minimally Invasive Surgery Corso Dogliotti 14 10126 Turin Italy Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794
Partial amniotic carbon dioxide insufflation (PACI) during minimally invasive fetoscopic surgery: early clinical experience in humans
Tue, 30 Jun 2009 15:42:32 -0000
Abstract Background  The technical performance of minimally invasive fetoscopic surgery may be severely hindered by poor visualization of intra-amniotic contents. Partial amniotic carbon dioxide insufflation (PACI) allows the visual limitations of operating within the fluid environment to be overcome. Patients and methods  When amniotic fluid exchange failed to improve fetoscopic visualization, PACI was attempted during 37 fetoscopic procedures between 17 + 5 and 33 + 2 weeks of gestation. PACI was attempted with filtered carbon dioxide using a commercially available insufflator via one to three trocars that were percutaneously introduced into the amniotic cavity. The maximum pressure during PACI was limited by the maximum insufflation pressure (30 mmHg) generated by the insufflator. Improvement of fetoscopic visualization as well as technical, maternal, and fetal safety aspects surrounding PACI were analyzed. Results  PACI could successfully be instituted in 36 of the 37 procedures. In one case, when in the presence of increased uterine tone the opening pressure exceeded the maximum insufflation pressure of the insufflator, the strategy was abandoned. In all cases where PACI could be instituted successfully, the approach offered far superior visualization of the fetoscopic procedure than would have been possible within amniotic fluid. Acute or chronic maternal or fetal complications were observed in only one case (intraoperative membrane rupture). Conclusion  PACI greatly improves fetal visualization during fetoscopic interventions when fetoscopy within fluid meets with difficulties. Continued assessment of its benefits, risks, and safety margins at specialist centers is required. Content Type Journal ArticleDOI 10.1007/s00464-009-0579-zAuthors Thomas Kohl, University of Bonn Medical School German Center for Fetal Surgery & Minimally-Invasive Therapy (DZFT)—Department of Obstetrics & Prenatal Medicine 53105 Bonn GermanyKristina Tchatcheva, University of Bonn Medical School German Center for Fetal Surgery & Minimally-Invasive Therapy (DZFT)—Department of Obstetrics & Prenatal Medicine 53105 Bonn GermanyJulia Weinbach, University of Bonn Medical School German Center for Fetal Surgery & Minimally-Invasive Therapy (DZFT)—Department of Obstetrics & Prenatal Medicine 53105 Bonn GermanyRudolf Hering, Bonn University Hospital Department of Anesthesiology and Intensive Care Medicine Bonn GermanyPeter Kozlowski, University of Bonn Medical School German Center for Fetal Surgery & Minimally-Invasive Therapy (DZFT)—Department of Obstetrics & Prenatal Medicine 53105 Bonn GermanyRüdiger Stressig, University of Bonn Medical School German Center for Fetal Surgery & Minimally-Invasive Therapy (DZFT)—Department of Obstetrics & Prenatal Medicine 53105 Bonn GermanyUlrich Gembruch, University of Bonn Medical School German Center for Fetal Surgery & Minimally-Invasive Therapy (DZFT)—Department of Obstetrics & Prenatal Medicine 53105 Bonn Germany Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794
Telesimulation: an effective method for teaching the fundamentals of laparoscopic surgery in resource-restricted countries
Tue, 30 Jun 2009 15:42:30 -0000
Abstract Background  Several challenges exist with laparoscopic skills training in resource-restricted countries, including long travel distances required by mentors for onsite teaching. Telesimulation (TS) is a novel concept that uses the internet to link simulators between an instructor and a trainee in different locations. The purpose of this study was to determine the effectiveness of telesimulation for teaching the Fundamentals of Laparoscopic Surgery (FLS) to surgeons in Botswana, Africa. Methods  A total of 16 surgeons from two centers in Botswana participated in this 8-week study. FLS TS was set up using two simulators, computers, webcams, and Skypeâ„¢ software for eight surgeons in the TS group. A standard FLS simulator was available for the eight surgeons in the self-practice (SP) group. Participants in the TS group had one remote training session per week with an FLS proctor at the University of Toronto who provided feedback and demonstrated proper technique. Participants in the SP group had access to the FLS DVD and were instructed to train on FLS at least once per week. FLS post-test scores were obtained in Botswana by a trained FLS proctor at the conclusion of the study. Results  Participants in the TS group had significantly higher post-test FLS scores than those in the SP group (440 Â± 56 vs. 272 Â± 95, p = 0.001). All trainees in the TS group achieved an FLS simulator certification passing score, whereas only 38% in the SP group did so (p = 0.03). Conclusion  Remote telesimulation is an effective method for teaching the Fundamentals of Laparoscopic Surgery in Africa, achieving a 100% FLS skills pass rate. This training platform provides a cost-effective method of teaching in resource-restricted countries and could be used to teach laparoscopic skills anywhere in the world with internet access. Content Type Journal ArticleDOI 10.1007/s00464-009-0572-6Authors Allan Okrainec, Toronto Western Hospital – University Health Network Department of Surgery 8th Floor, Main Pavilion, Room 325 Toronto ON M5T 2S8 CanadaOscar Henao, University of Toronto Department of Surgery Toronto ON M5S 1A1 CanadaGeorges Azzie, University of Toronto Department of Surgery Toronto ON M5S 1A1 Canada Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794
News and notices
Tue, 30 Jun 2009 15:42:29 -0000
News and notices Content Type Journal ArticleCategory News and noticesDOI 10.1007/s00464-009-0603-3 Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794
Combined percutaneous–endoscopic stenting of malignant biliary obstruction: results from 106 consecutive procedures and identification of factors associated with adverse outcome
Tue, 30 Jun 2009 15:42:28 -0000
Abstract Background  In patients in whom attempted endoscopic stenting of malignant biliary obstruction fails, combined percutaneous–endoscopic stenting and percutaneous stenting using expandable metallic endoprostheses offer alternative approaches to biliary drainage. Despite the popularity of the percutaneous route, there is no available evidence to support its superiority over combined stenting in this patient group. The objective of this study was to present the short- and long-term results of a large series of combined percutaneous–endoscopic stenting procedures and identify factors associated with adverse outcome. Methods  Data were retrospectively collected on patients undergoing combined percutaneous–endoscopic biliary stenting for malignant biliary obstruction between January 2002 and December 2006. Short- and long-term outcomes were recorded, and pre-procedure variables correlated with adverse outcome. Results  Combined biliary stenting was technically successful in 102 (96.2%) of 106 patients. Procedure-associated mortality rate was 0%. In-hospital morbidity and mortality rates were 24.5% and 16.7%, respectively, with the majority of deaths resulting from biliary sepsis. Median survival was 100 days, with a 13.7% stent occlusion rate. On multivariable analysis, baseline American Society of Anaesthesiologists (ASA) grade, decreasing serum albumin and increasing leucocyte count were independently associated with in-hospital mortality following combined stenting. Conclusion  Combined biliary stenting is associated with short- and long-term outcomes equal to those reported in recent series of percutaneous transhepatic stenting. Randomised control trials, including cost-effectiveness analyses, are required to further compare these techniques. Outcomes following combined stenting may be further improved by early recognition and treatment of sepsis and scrupulous management of co-morbid disease. Content Type Journal ArticleDOI 10.1007/s00464-009-0586-0Authors C. P. Neal, Leicester General Hospital Department of Hepatobiliary and Pancreatic Surgery Gwendolen Road Leicester LE5 4PW UKS. C. Thomasset, Leicester General Hospital Department of Hepatobiliary and Pancreatic Surgery Gwendolen Road Leicester LE5 4PW UKD. Bools, Leicester General Hospital Department of Hepatobiliary and Pancreatic Surgery Gwendolen Road Leicester LE5 4PW UKC. D. Sutton, Leicester General Hospital Department of Hepatobiliary and Pancreatic Surgery Gwendolen Road Leicester LE5 4PW UKG. Garcea, Leicester General Hospital Department of Hepatobiliary and Pancreatic Surgery Gwendolen Road Leicester LE5 4PW UKC. D. Mann, Leicester General Hospital Department of Hepatobiliary and Pancreatic Surgery Gwendolen Road Leicester LE5 4PW UKY. Rees, Leicester General Hospital Department of Hepatobiliary and Pancreatic Surgery Gwendolen Road Leicester LE5 4PW UKC. Newland, Leicester General Hospital Department of Hepatobiliary and Pancreatic Surgery Gwendolen Road Leicester LE5 4PW UKR. J. Robinson, Leicester General Hospital Department of Hepatobiliary and Pancreatic Surgery Gwendolen Road Leicester LE5 4PW UKA. R. Dennison, Leicester General Hospital Department of Hepatobiliary and Pancreatic Surgery Gwendolen Road Leicester LE5 4PW UKD. P. Berry, Leicester General Hospital Department of Hepatobiliary and Pancreatic Surgery Gwendolen Road Leicester LE5 4PW UK Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794
Treatment of rectal adenomas by transanal endoscopic microsurgery: 15 years’ experience
Tue, 30 Jun 2009 15:42:28 -0000
Abstract Background  The authors present their experience with rectal adenomas managed by transanal endoscopic microsurgery (TEM). The goals of this study were to examine our institution’s experience by evaluating surgical morbidity, mortality, and local recurrence rate. Methods  This retrospective study investigated 402 patients who underwent TEM a for preoperative diagnosis of adenoma from January 1993 to October 2008. The mean age was 65 years (range = 22–92 years). All patients were regularly followed up to determine treatment efficacy in terms of local recurrence rate. Results  No 30-day perioperative mortality occurred. No conversion to laparoscopic or open procedures was reported. Minor complications occurred in 28 (7%) patients, whereas major complications were found only in 2 (0.5%) patients. Definitive histology confirmed adenomas in 366 cases (91%). At a mean follow-up of 84 months (range = 1–190 months), 16 (4%) adenomas recurred and were successfully retreated by TEM [14 cases (87.5%)] and by conventional surgery [2 patients (12.5%)]. No further recurrences were observed at subsequent follow-up. Conclusion  The findings warrant the conclusion that TEM is a safe, effective treatment for rectal adenomas where endoscopic removal is not applicable and has low morbidity and no mortality. Content Type Journal ArticleDOI 10.1007/s00464-009-0585-1Authors Mario Guerrieri, Università Politecnica delle Marche Clinica di Chirurgia Generale e Metodologia Chirurgica, Azienda Ospedaliera Umberto I 22, P. Roma 60126 Ancona ItalyMaddalena Baldarelli, Università Politecnica delle Marche Clinica di Chirurgia Generale e Metodologia Chirurgica, Azienda Ospedaliera Umberto I 22, P. Roma 60126 Ancona ItalyAngelo de Sanctis, Università Politecnica delle Marche Clinica di Chirurgia Generale e Metodologia Chirurgica, Azienda Ospedaliera Umberto I 22, P. Roma 60126 Ancona ItalyRoberto Campagnacci, Università Politecnica delle Marche Clinica di Chirurgia Generale e Metodologia Chirurgica, Azienda Ospedaliera Umberto I 22, P. Roma 60126 Ancona ItalyMassimiliano Rimini, Università Politecnica delle Marche Clinica di Chirurgia Generale e Metodologia Chirurgica, Azienda Ospedaliera Umberto I 22, P. Roma 60126 Ancona ItalyEmanuele Lezoche, Sapienza University of Rome Department of General Surgery and Organ Transplantion Piazzole Aldo Moro 5 00185 Rome Italy Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794

pubmed: 1088-5412

A case of severe refractory chronic urticaria: A novel method for evaluation and treatment.
Otto HF, Calabria CW Related Articles A case of severe refractory chronic urticaria: A novel method for evaluation and treatment. Allergy Asthma Proc. 2009 May-Jun;30(3):333-7 Authors: Otto HF, Calabria CW With cholinergic urticaria (ChU), the ultimate diagnosis often depends on the demonstration of characteristic urticaria by appropriate provocation. Several treatment options may be helpful but traditional options (antihistamines, leukotriene inhibitors, and immunosuppressives) may be exhausted by the refractory ChU patient. Here, we describe such a case. Demonstration of immediate hypersensitivity to autologous sweat skin testing (ASwST) may provide a rationale for use of omalizumab (Xolair, Genentech Novartis, South San Francisco, CA). Patients with severe ChU may have difficulty producing sufficient quantities of sweat for ASwST given that the very effort that produces the sample exacerbates ChU. Generation of sweat by iontophoresis with pilocarpine nitrate can be performed at many large medical centers. The procedure is simple, safe, and produces varying amounts of sweat depending on the individual. This sweat can then be used for ASwST. Our patient had a positive ASwST with appropriate positive and negative controls. Our testing methods were validated by negative ASwST, saline control, and positive histamine control in a nonatopic, nonurticarial control patient. By the patient's second injection of omalizumab, her quality of life score was significantly improved, as were her daily medication scores and exercise tolerance. We describe the first case of a patient with severe refractory ChU who had a positive ASwST by a novel collection method who has been successfully treated with omalizumab. We present a novel tool for the evaluation and demonstration of sweat-specific IgE in ChU patients who are unable to provide sweat by more traditional means. PMID: 19549434 [PubMed - in process]
Short-term safety of somatropin inhalation powder in adults with mild to moderate asthma.
Nelson HS, Busse WW, Sanger M, Cutler G, Ellwanger C, Chipman JJ Related Articles Short-term safety of somatropin inhalation powder in adults with mild to moderate asthma. Allergy Asthma Proc. 2009 May-Jun;30(3):325-32 Authors: Nelson HS, Busse WW, Sanger M, Cutler G, Ellwanger C, Chipman JJ Systemic therapeutic protein delivery through the lungs could potentially replace delivery by injection, but safety needs to be established in patients with known pulmonary disease. This study determined the short-term safety profile of recombinant human growth hormone (rhGH; somatropin) inhalation therapy in clinically stable adult subjects with mild to moderate asthma and methacholine sensitivity. This randomized, placebo-controlled study had two phases: (1) an escalating 3-dose, 4-day/dosage tolerance phase; and (2) a 14-day, crossover design comparability phase. Noninferiority in maintaining forced expiratory volume in 1 second (FEV(1)) was tested for somatropin inhalation powder (SIP) compared with subcutaneously injected rhGH (Hsc) and inhaled placebo. Lung hyperresponsiveness was assessed by methacholine bronchoprovocative challenge, and adverse events (AEs) were recorded. Eight and 18 subjects enrolled in the first and second phases, respectively. Noninferiority of SIP compared with Hsc and placebo was established for FEV(1) after the first and last doses, and noninferiority of SIP compared with Hsc for methacholine challenge was established after the first dose. Pulmonary uptake and systemic distribution of SIP was confirmed by increased serum insulin-like growth factor I levels. Mild, nonprogressive cough and nasal congestion occurred more commonly with SIP. All other treatment-emergent AEs were mild, similar across active treatment groups, and consistent with rhGH treatment. In clinically stable adults with mild to moderate asthma, no significant changes in pulmonary function or worsening of asthma complaints occurred during SIP treatment. Future studies of SIP may enroll subjects with mild to moderate asthma for longer-term evaluation of safety and efficacy. PMID: 19549433 [PubMed - in process]
Efficacy and safety evaluation of ciclesonide in subjects with mild-to-moderate asthma not currently using inhaled corticosteroids.
Berger WE, Kerwin E, Bernstein DI, Pedinoff A, Bensch G, Karafilidis J Related Articles Efficacy and safety evaluation of ciclesonide in subjects with mild-to-moderate asthma not currently using inhaled corticosteroids. Allergy Asthma Proc. 2009 May-Jun;30(3):304-14 Authors: Berger WE, Kerwin E, Bernstein DI, Pedinoff A, Bensch G, Karafilidis J Inhaled corticosteroids (ICSs) are a first-line treatment for persistent asthma. This study was designed to compare the efficacy and safety of ciclesonide (CIC) in subjects with mild-to-moderate persistent asthma not using an ICS. This was a multicenter, double-blind, parallel-group, placebo-controlled, 16-week study in subjects who were >/=12 years old, had a >/=6-month history of persistent asthma, a forced expiratory volume in 1 second (FEV(1)) of >/=60 to </=85% predicted, and who were not using an ICS </=30 days before study entry. Subjects were randomized to CIC, 80 mug twice daily (CIC80 b.i.d.; n = 170); CIC, 160 mug once daily in the morning (CIC160 q.d. in the A.M.; n = 173); CIC80 b.i.d. for 4 weeks followed by CIC160 q.d. for 12 weeks (CIC80 b.i.d./CIC160 q.d.; n = 171); or placebo (n = 177). Change in FEV(1) from baseline to the average of weeks 12 and 16 (primary end point) and to week 16, A.M. peak expiratory flow, rescue albuterol use, nighttime awakenings, asthma symptom scores, and safety were evaluated. FEV(1) improved from baseline to the average of weeks 12 and 16 for CIC80 b.i.d. (+0.30L; p < 0.0001), CIC160q.d. (+0.19L; p < 0.0001), CIC80 b.i.d./CIC160 q.d. (+0.19L; p < 0.0001), and placebo (+0.06L; p = 0.0251); improvement was greatest for CIC80 b.i.d. (p < 0.01). At week 16, all CIC treatments significantly improved FEV(1) and A.M. PEF from baseline (p < 0.0001) and compared with placebo (p </= 0.015). All treatments reduced albuterol use and nighttime awakenings and improved asthma symptom scores (p </= 0.05 versus baseline); these improvements were greater for CIC80 b.i.d. than for placebo (p < 0.01). The incidence of adverse events was similar among treatment groups (range, 53-58%). In this study, CIC80 b.i.d. improved disease control in subjects with mild-to-moderate persistent asthma not using an ICS and provided greater improvements than CIC160 q.d. PMID: 19549432 [PubMed - in process]

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