July 18, 2013

Recurrence of chronic urticaria caused by reinfection by Helicobacter pylori.

Revista Paulista de Pediatria

Print version ISSN 0103-0582

Rev. paul. pediatr. vol.31 no.2 São Paulo June 2013

http://dx.doi.org/10.1590/S0103-05822013000200021 

CASE REPORT

Recurrence of chronic urticaria caused by reinfection by Helicobacter pylori

Recidiva de urticaria crónica decurrente de reinfección por Helicobacter pylori


Dayanne Melo V. BrusckyI; Luiz Alexandre R. da RochaI; Aldo José F. CostaII
IResidência em Alergia e Imunologia Clínica pelo Hospital das Clínicas da UFPE (HC-UFPE); Alergologista e Imunologista do Centro de Pesquisas em Alergia e Imunologia do HC-UFPE, Recife, PE, Brasil
IIDoutor em Nutrição pela UFPE; Alergologista e Imunologista do Centro de Pesquisas em Alergia e Imunologia do HC-UFPE, Recife, PE, Brasil


ABSTRACT
OBJECTIVE: To describe a case of chronic urticaria in a female adolescent associated with Helicobacter pyloriinfection, confirmed in two different occasions, with improvement of urticaria after the antibacterial treatment.
CASE DESCRIPTION: A 13-year-old female patient sought medical care with chronic urticaria and epigastric pain unresponsive to medical treatment. Laboratorial tests for further investigation were normal except for the upper gastrointestinal endoscopy with biopsy showing moderate chronic active gastritis associated with Helicobacter pylori. After specific and appropriate treatment, the patient had remission of the symptoms. A new upper gastrointestinal endoscopy to control the treatment after nine months was normal. After five years, the patient returned with recurrence of urticaria and epigastric pain. She was taking antihistamines, without any improvement. It was again submitted to screening protocol for chronic urticaria with normal results. She was submitted to upper gastrointestinal endoscopy, which showed positive urease test. The patient started a new treatment for Helicobacter pylori with disappearance of chronic urticaria and epigastric pain within seven days.
COMMENTS: The reported case suggests a causal relationship between the positive diagnosis of Helicobacter pylori and the occurrence of chronic urticaria, showing the remission of symptoms after the institution of effective therapy for this agent. Chronic urticaria is a disease of complex etiology, and although controversial, there is growing evidence of Helicobacter pylori involvement with extraintestinal diseases, including chronic urticaria.
Key-words: urticaria; Helicobacter pylori; adolescent.

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'Help for Hay Fever', a goal-focused intervention for people with intermittent allergic rhinitis

Open Access
Study protocol

'Help for Hay Fever', a goal-focused intervention for people with intermittent allergic rhinitis, delivered in Scottish community pharmacies: study protocol for a pilot cluster randomized controlled trial

Terry Porteous, Sally Wyke, Sarah Smith, Christine Bond, Jill Francis, Amanda J Lee, Richard Lowrie, Graham Scotland, Aziz Sheikh, Mike Thomas and Lorraine Smith
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Trials 2013, 14:217 doi:10.1186/1745-6215-14-217
Published: 15 July 2013

Abstract (provisional)

Background

Despite the availability of evidence-based guidelines for managing allergic rhinitis in primary care, management of the condition in the United Kingdom (UK) remains sub-optimal. Its high prevalence and negative effects on quality of life, school performance, productivity and co-morbid respiratory conditions (in particular, asthma), and high health and societal costs, make this a priority for developing novel models of care. Recent Australian research demonstrated the potential of a community pharmacy-based 'goal-focused' intervention to help people with intermittent allergic rhinitis to self-manage their condition better, reduce symptom severity and improve quality of life. In this pilot study we will assess the transferability of the goal-focused intervention to a UK context, the suitability of the intervention materials, procedures and outcome measures and collect data to inform a future definitive UK randomized controlled trial (RCT).

Methods

A pilot cluster RCT with associated preliminary economic analysis and embedded qualitative evaluation. The pilot trial will take place in two Scottish Health Board areas: Grampian and Greater Glasgow & Clyde. Twelve community pharmacies will be randomly assigned to intervention or usual care group. Each will recruit 12 customers seeking advice or treatment for intermittent allergic rhinitis. Pharmacy staff in intervention pharmacies will support recruited customers in developing strategies for setting and achieving goals that aim to avoid/minimize triggers for, and eliminate/minimize symptoms of allergic rhinitis. Customers recruited in non-intervention pharmacies will receive usual care. The co-primary outcome measures, selected to inform a sample size calculation for a future RCT, are: community pharmacy and customer recruitment and completion rates; and effect size of change in the validated mini-Rhinoconjunctivitis Quality of Life Questionnaire between baseline, one-week and six-weeks post-intervention. Secondary outcome measures relate to changes in symptom severity, productivity, medication adherence and self-efficacy. Quantitative data about accrual, retention and economic measures, and qualitative data about participants' experiences during the trial will be collected to inform the future RCT.

Discussion

This work will lay the foundations for a definitive RCT of a community pharmacy-based 'goal-focused' self-management intervention for people with intermittent allergic rhinitis. Results of the pilot trial are expected to be available in April 2013.
Trial registration: Current Controlled Trials ISRCTN43606442

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Cytokine and chemokine responses to helminth and protozoan parasites and to fungus and mite allergens in neonates, children, adults, and the elderly

Open Access
Research

Cytokine and chemokine responses to helminth and protozoan parasites and to fungus and mite allergens in neonates, children, adults, and the elderly

Christian J Lechner, Karl Komander, Jana Hegewald, Xiangsheng Huang, Richard G Gantin, Peter T Soboslay, Abram Agossou, Meba Banla and Carsten Köhler
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Immunity & Ageing 2013, 10:29 doi:10.1186/1742-4933-10-29
Published: 15 July 2013

Abstract (provisional)

Background

In rural sub-Saharan Africa, endemic populations are often infected concurrently with several intestinal and intravascular helminth and protozoan parasites. A specific, balanced and, to an extent, protective immunity will develop over time in response to repeated parasite encounters, with immune responses initially being poorly adapted and non-protective. The cellular production of pro-inflammatory and regulatory cytokines and chemokines in response to helminth, protozoan antigens and ubiquitous allergens were studied in neonates, children, adults and the elderly.

Results

In children schistosomiasis prevailed (33%) while hookworm and Entamoeba histolytica/E. dispar was found in up to half of adults and the elderly. Mansonella perstans filariasis was only present in adults (24%) and the elderly (25%). Two or more parasite infections were diagnosed in 41% of children, while such polyparasitism was present in 34% and 38% of adults and the elderly. Cytokine and chemokine production was distinctively inducible by parasite antigens; pro-inflammatory Th2-type cytokine IL-19 was activated by Entamoeba and Ascaris antigens, being low in neonates and children while IL-19 production enhanced "stepwise" in adults and elderly. In contrast, highest production of MIP-1delta/CCL15 was present in neonates and children and inducible by Entamoeba-specific antigens only. Adults and the elderly had enhanced regulatory IL-27 cytokine responses, with Th2-type chemokines (MCP-4/CCL13, Eotaxin-2/CCL24) and cytokines (IL-33) being notably inducible by helminth- and Entamoeba-specific antigens and fungus-derived allergens. The lower cellular responsiveness in neonates and children highlighted the development of a parasite-specific cellular response profile in response to repeated episodes of exposure and re-infection.

Conclusions

Following repeated exposure to parasites, and as a consequence of host inability to prevent or eliminate intestinal helminth or protozoa infections, a repertoire of immune responses will evolve with lessened pro-inflammatory and pronounced regulatory cytokines and chemokines; this is required for partial parasite control as well as for preventing inadequate and excessive host tissue and organ damage.

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Bronchial hyperresponsiveness testing in athletes of the Swiss Paralympic team

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BMC Sports Sci Med Rehabil. 2013; 5: 7.
Published online 2013 April 15. doi:  10.1186/2052-1847-5-7
PMCID: PMC3669034

Bronchial hyperresponsiveness testing in athletes of the Swiss Paralympic team

Mirjam Osthoff,1 Franz Michel,2 Matthias Strupler,2 David Miedinger,1 Anne B Taegtmeyer,3 Jörg D Leuppi,corresponding author4 andClaudio Perret2
Author information ► Article notes ► Copyright and License information ►

Abstract

Background

The aim of this study was to assess airway hyperresponsiveness to eucapnic voluntary hyperventilation and dry powder mannitol challenge in athletes aiming to participate at the Paralympic Games 2008 in Beijing, especially in athletes with spinal cord injury.

Methods

Forty-four athletes with a disability (27 with paraplegia (group 1), 3 with tetraplegia (group 2) and 14 with other disabilities such as blindness or single limb amputations (group 3) performed spirometry, skin prick testing, measurement of exhaled nitric oxide, eucapnic voluntary hyperventilation challenge test (EVH) and mannitol challenge test (MCT). A fall in FEV1 of ≥10% in either challenge test was deemed positive for exercise-induced bronchoconstriction.

Results

Fourteen (32%) athletes were atopic and 7 (16%) had a history of physician-diagnosed asthma. Absolute lung function values were significantly lower in patients of group 1 and 2 compared to group 3. Nine (20%) athletes were positive to EVH (8 paraplegics, 1 tetraplegic), and 8 (18%) athletes were positive to MCT (7 paraplegics, 1 tetraplegic). Fourteen (22.7%) subjects were positive to at least one challenge; only three athletes were positive to both tests. None of the athletes in group 3 had a positive test. Both challenge tests showed a significant association with physician-diagnosed asthma status (p = 0.0001). The positive and negative predictive value to diagnose physician-diagnosed asthma was 89% and 91% for EHV, and 75% and 86% for MCT, respectively.

Conclusion

EVH and MCT can be used to identify, but especially exclude asthma in Paralympic athletes.
Keywords: Disability, Eucapnic voluntary hyperventilation, Exercise-induced bronchoconstriction, Spinal cord injury, Mannitol challenge, Paraplegia

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Pulmonary embolism and 3-month outcomes in 4036 patients with venous thromboembolism and chronic obstructive pulmonary disease

Open Access
Research

Pulmonary embolism and 3-month outcomes in 4036 patients with venous thromboembolism and chronic obstructive pulmonary disease: data from the RIETE registry

Laurent Bertoletti, Sara Quenet, Silvy Laporte, Joan Carles Sahuquillo, Francisco Conget, José María Pedrajas, Mar Martin, Ignacio Casado, Antonio Riera-Mestre and Manuel Monreal
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Respiratory Research 2013, 14:75 doi:10.1186/1465-9921-14-75
Published: 18 July 2013

Abstract (provisional)

Background

Patients with chronic obstructive pulmonary disease (COPD) have a modified clinical presentation of venous thromboembolism (VTE) but also a worse prognosis than non-COPD patients with VTE. As it may induce therapeutic modifications, we evaluated the influence of the initial VTE presentation on the 3-month outcomes in COPD patients.

Methods

COPD patients included in the on-going world-wide RIETE Registry were studied. The rate of pulmonary embolism (PE), major bleeding and death during the first 3 months in COPD patients were compared according to their initial clinical presentation (acute PE or deep vein thrombosis (DVT)).

Results

Of the 4036 COPD patients included, 2452 (61%; 95% CI: 59.2-62.3) initially presented with PE. PE as the first VTE recurrence occurred in 116 patients, major bleeding in 101 patients and mortality in 443 patients (Fatal PE: first cause of death). Multivariate analysis confirmed that presenting with PE was associated with higher risk of VTE recurrence as PE (OR, 2.04; 95% CI: 1.11-3.72) and higher risk of fatal PE (OR, 7.77; 95% CI: 2.92-15.7).

Conclusions

COPD patients presenting with PE have an increased risk for PE recurrences and fatal PE compared with those presenting with DVT alone. More efficient therapy is needed in this subtype of patients.

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Update on Anticytokine Treatment for Asthma 

BioMed Research International
Volume 2013 (2013), Article ID 104315, 10 pages
http://dx.doi.org/10.1155/2013/104315
Review Article

Update on Anticytokine Treatment for Asthma

Luca Gallelli,1 Maria Teresa Busceti,2 Alessandro Vatrella,3 Rosario Maselli,2 and Girolamo Pelaia2
1Clinical Pharmacology Unit, Department of Health Science, University “Magna Græcia” of Catanzaro, Campus Universitario “S. Venuta”, Viale Europa-Località Germaneto, 88100 Catanzaro, Italy
2Department of Medical and Surgical Sciences, University “Magna Græcia” of Catanzaro, Campus Universitario “S. Venuta”, Viale Europa-Località Germaneto, 88100 Catanzaro, Italy
3Department of Respiratory Medicine, University of Salerno, 84084 Fisciano (SA), Italy
Received 29 April 2013; Accepted 7 June 2013
Academic Editor: Alexandre Paula Rogerio
Copyright © 2013 Luca Gallelli et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Current advances in the knowledge of asthma pathobiology suggest that anticytokine therapies can be potentially useful for the treatment of this complex and heterogeneous airway disease. Recent evidence is accumulating in support of the efficacy of anti-IL-4, anti-IL-5, and anti-IL-13 drugs. Therefore, these new developments are now changing the global scenario of antiasthma therapies, especially with regard to more severe disease. Current findings referring to variability of individual therapeutic responses highlight that the different asthma subtypes need to be well characterized, in order to implement phenotype-targeted treatments which in the near future will hopefully be mainly based on cytokine-directed biologics.
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Effects of an outpatient education program in patients with uncontrolled asthma

Jornal Brasileiro de Pneumologia

Print version ISSN 1806-3713

J. bras. pneumol. vol.39 no.3 São Paulo May/June 2013

http://dx.doi.org/10.1590/S1806-37132013000300003 

ORIGINAL ARTICLES
Effects of an outpatient education program in patients with uncontrolled asthma*
Carmen Denise Borba Rodrigues, Rosemary Petrik Pereira, Paulo de Tarso Roth Dalcin
Federal University of Rio Grande do Sul, School of Medicine, Porto Alegre, Brazil, Graduate Student. Graduate Program in Pulmonology, Federal University of Rio Grande do Sul School of Medicine, Porto Alegre, Brazil
Federal University of Rio Grande do Sul, School of Medicine, Porto Alegre, Brazil, Adjunct Professor. Federal University of Rio Grande do Sul School of Medicine, Porto Alegre, Brazil
Federal University of Rio Grande do Sul, School of Medicine, Porto Alegre, Brazil, Associate Professor. Federal University of Rio Grande do Sul School of Medicine, Porto Alegre, Brazil
ABSTRACT
OBJECTIVE:
To evaluate the effects of an outpatient education program in patients with uncontrolled asthma.
METHODS:
This was an uncontrolled study evaluating an educational intervention and involving patients with uncontrolled asthma ≥ 14 years of age. The participants completed a questionnaire designed to assess the level of asthma control, the inhalation technique, and quality of life. All of the patients underwent pulmonary function testing, after which they participated in an education program consisting of one 45-min face-to-face session, followed by phone interviews at two, four, and eight weeks. The participants were reevaluated after three months.
RESULTS:
Sixty-three patients completed the study. There was a significant improvement in the level of asthma control (p - 0.001). Of the 63 patients, 28 (44.4%) and 6 (9.5%) were classified as having partially controlled asthma and controlled asthma, respectively. The mean FEV1 was 63.0 ± 20.0% and 68.5 ± 21.2% of the predicted value prior to and after the educational intervention, respectively (p = 0.002), and all of the quality of life scores improved (p - 0.05 for all). The same was true for the proportion of patients prior to and after the educational intervention using the proper inhalation technique when using metered dose inhalers (15.4% vs. 46.2%; p = 0.02) and dry powder inhalers (21.3% vs. 76.6%; p < 0.001). The logistic regression analysis revealed that an incorrect inhalation technique identified during the first evaluation was independently associated with a favorable response to the educational intervention.
CONCLUSIONS:
This study suggests that an outpatient education program for asthma patients improves the level of asthma control, lung function parameters, and quality of life. An incorrect inhalation technique identified during the first evaluation was predictive of a favorable response to the educational intervention.
Keywords: Asthma/prevention and control; Quality of life; Respiratory function tests; Ambulatory care; Health education

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July 17, 2013

IL-17A and Th17 Cells in Lung Inflammation: An Update on the Role of Th17 Cell Differentiation and IL-17R Signaling in Host Defense against Infection 


Clinical and Developmental Immunology
Volume 2013 (2013), Article ID 267971, 12 pages
http://dx.doi.org/10.1155/2013/267971
Review Article

IL-17A and Th17 Cells in Lung Inflammation: An Update on the Role of Th17 Cell Differentiation and IL-17R Signaling in Host Defense against Infection

Hsing-Chuan Tsai, Sharlene Velichko, Li-Yin Hung, and Reen Wu
Center for Comparative Respiratory Biology and Medicine, University of California, Davis, CA 95616, USA
Received 16 March 2013; Accepted 27 June 2013
Academic Editor: Samuel Huber
Copyright © 2013 Hsing-Chuan Tsai et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

The significance of Th17 cells and interleukin- (IL-)17A signaling in host defense and disease development has been demonstrated in various infection and autoimmune models. Numerous studies have indicated that Th17 cells and its signature cytokine IL-17A are critical to the airway’s immune response against various bacteria and fungal infection. Cytokines such as IL-23, which are involved in Th17 differentiation, play a critical role in controlling Klebsiella pneumonia (K. pneumonia) infection. IL-17A acts on nonimmune cells in infected tissues to strengthen innate immunity by inducing the expression of antimicrobial proteins, cytokines, and chemokines. Mice deficient in IL-17 receptor (IL-17R) expression are susceptible to infection by various pathogens. In this review, we summarize the recent advances in unraveling the mechanism behind Th17 cell differentiation, IL-17A/IL-17R signaling, and also the importance of IL-17A in pulmonary infection.
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