August 19, 2013

Statin use and asthma control in patients with severe asthma

Volume 3, Issue 8
> Article

BMJ Open

2013;3:e003314 doi:10.1136/bmjopen-2013-003314

Respiratory medicine

Statin use and asthma control in patients with severe asthma

+Author Affiliations

¹Department of Internal Medicine, University of California, Davis School of Medicine, Sacramento, California, USA
²Division of Pulmonary, Critical Care Medicine, and Sleep Medicine, University of California, Davis School of Medicine, Sacramento, California, USA
³Clinical and Translational Science Center, University of California, Davis School of Medicine, Sacramento, California, USA
⁴Center for Comparative Respiratory Biology & Medicine, University of California, Davis School of Medicine, Sacramento, California, USA
⁵Department of Public Health Sciences, Division of Biostatistics, University of California, Davis School of Medicine, Sacramento, California, USA
⁶Department of Obstetrics & Gynecology, University of California, Davis School of Medicine, Sacramento, California, USA

Correspondence toDr Amir A Zeki; amir.zeki@ucdmc.ucdavis.edu

Received 29 May 2013
Revised 4 July 2013
Accepted 5 July 2013
Published 13 August 2013

Abstract

Objectives We hypothesised that severe asthmatics taking a statin drug, in addition to inhaled corticosteroids/long-acting β-agonist inhaler therapy, would have better asthma symptom control and improved lung function compared to their controls.

Study design A retrospective, cross-sectional study of 165 patients with severe asthma seen from 2001–2008. Hierarchical linear and logistic regression models were used for modelling fitting.

Setting University of California, Davis Medical Center (Sacramento, California, USA). Academic, single-centre, severe asthma subspecialty clinic.

Participants 612 screened, 223 eligible and 165 adult patients were included in the final study (N=165; 31 statin users and 134 non-users).

Primary and secondary outcome measures The primary endpoint was asthma control as measured by the Asthma Control Test (ACT). The secondary endpoints included lung function, symptoms and the need for corticosteroid burst and peripheral eosinophil count.

Results At baseline, statin users compared to non-users were older, had lower lung function (FEV₁% predicted, FEV₁, forced vital capacity and FEF_25–75%) and had a higher prevalence of comorbid conditions. Statin use was associated with more aspirin and ipratropium inhaler use than in non-users. Patients in both groups were obese (body mass index + 30). Statin users had better asthma symptom control compared to non-users (higher adjusted mean ACT score by 2.2±0.94 points, p-0.02). Median statin use was for 1 year. There were no statistically significant differences in lung function, corticosteroid or rescue bronchodilator use or peripheral eosinophilia between the two groups.

Conclusions In our severe asthma referral population, statin users already taking inhaled controller therapy achieved better asthma control compared to non-users. The implications of this study is that patients with severe asthma could potentially benefit from added statin treatment. Because our study population was on average obese, the obese severe asthmatic may be a viable asthma subphenotype for further studies. Prospective randomised clinical trials evaluating the safety and efficacy of statins in severe asthma are warranted.

This Article

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August 17, 2013

Evidence of a novel allergenic protein Narcin in the bulbs of Narcissus tazetta

Int J Biochem Mol Biol. 2013; 4(2): 95–101.

Published online 2013 July 29.

PMCID: PMC3729256

Evidence of a novel allergenic protein Narcin in the bulbs of Narcissus tazetta

Mau Sinha,1 Amar Singh,2 Akshita Shokeen,1 Pradeep Sharma,1 Sanket Kaushik,1 Dipendra K Mitra,2 Punit Kaur,1Sujata Sharma,1 and Tej P Singh1

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Abstract

Several plant-derived allergens have been identified which result in the formation of immunoglobulin E antibodies. Primarily, these allergens belong to the protein families including seed storage proteins, structural proteins and pathogenesis-related proteins. Several allergens are also reported from flower bulbs which cause contact dermatitis. Such symptoms are highly common with the bulb growers handling different species of Narcissus. Narcissus toxicity is also reported if the bulbs are consumed accidentally. The present study aimed to characterize the protein from the bulbs of Narcissus tazettaresponsible for its allergenic response. A 13 kDa novel allergenic protein, Narcin was isolated from the bulbs of Narcissus tazetta. The protein was extracted using ammonium sulfate fractionation. The protein was further purified by anion exchange chromatography followed by gel filtration chromatography. The N-terminal sequence of the first 15 amino-acid residues was determined using Edman degradation. The allergenicity of the protein was measured by cytokine production using flow cytometry in peripheral blood mononuclear cells. Further estimation of total IgE was performed by ELISA method. This novel protein was found to induce pro-inflammatory cytokines and thus induce allergy by elevating total IgE level. The novel protein, Narcin isolated from Narcissus tazetta was found to exhibit allergenic properties.

Keywords: Allergen, Narcissus tazetta, cytokines, IgE, ELISA, flow cytometry

A New Case of DRESS Syndrome Induced by Sulfasalazine and Triggered by Amoxicillin

Case Rep Rheumatol. 2013; 2013: 409152.

Published online 2013 July 10. doi: 10.1155/2013/409152

PMCID: PMC3723001

A New Case of DRESS Syndrome Induced by Sulfasalazine and Triggered by Amoxicillin

Francesco Girelli, 1 ,* Simone Bernardi, 1 Lucia Gardelli, 1 Bruna Bassi, 1 Gianluca Parente, 2 Alessandra Dubini, 3 Luigi Serra, 3 and Maurizio Nizzoli 1

Author information ► Article notes ► Copyright and License information ►

Abstract

Drug Rash Eosinophilia Systemic Symptoms (DRESS) syndrome is a systemic hypersensitivity reaction characterized by exfoliative dermatitis and maculopapular rash, lymphadenopathy, fever, eosinophilia, leukocytosis, and involvement of internal organs as liver, lung, heart, and kidney; the disorder starts within 2–6 weeks after taking a drug with an incidence that ranges from 1/1000 to 1/10000 exposures. Fatal cases are reported. The exact pathogenesis of DRESS syndrome is not completely understood, while it is reported that amoxicillin could trigger it in patients who are taking allopurinol, sulfasalazine, NSAIDs, carbamazepine, strontium ranelate, lisinopril, lansoprazole, and minocycline. Amoxicillin could act directly, inducing the reactivation of a viral infection (HHV 6 and EBV) with symptoms similar to DRESS syndrome or by reducing the patients' ability to detoxify the body from substances chronically taken. We describe a case of a patient admitted to our hospital for a DRESS syndrome flared after amoxicilline intake during treatment with sulfasalazine; this combination can activate severe reactions often with an insidious onset that can mimic an infectious disease.

Detailed analysis of allergic cutaneous reactions to spinal cord stimulator devices

Case Series

(364) Total Article Views

Authors: Chaudhry ZA, Najib U, Bajwa ZH, Jacobs WC, Sheikh J, Simopoulos TT

Published Date August 2013 Volume 2013:6 Pages 617 - 623
DOI: http://dx.doi.org/10.2147/JPR.S44676

Received:	02 March 2013
Accepted:	30 May 2013
Published:	01 August 2013

Zeshan Ahmed Chaudhry,¹ Umer Najib,² Zahid H Bajwa,³ W Carl Jacobs,⁴ Javed Sheikh,⁵ Thomas T Simopoulos⁶
¹Department of Diagnostic and Interventional Neuroradiology, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA; ²Department of Neurology, Robert C Byrd Health Sciences Center of West Virginia University, Morgantown, WV, USA; ³Boston Headache Institute, Waltham, MA, USA; ⁴Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; ⁵Department of Medicine, Allergy and Immunology,⁶Department of Anesthesia, Beth Israel Deaconess Medical Center, Brookline, MA, USA

Abstract: The use of spinal cord stimulation (SCS) devices to treat chronic, refractory neuropathic pain continues to expand in application. While device-related complications have been well described, inflammatory reactions to the components of these devices remain underreported. In contrast, hypersensitivity reactions associated with other implanted therapies, such as endovascular and cardiac rhythm devices, have been detailed. The purpose of this case series is to describe the clinical presentation and course of inflammatory reactions as well as the histology of these reactions. All patients required removal of the entire device after developing inflammatory reactions over a time course of 1–3 months. Two patients developed a foreign body reaction in the lead insertion wound as well as at the implantable pulse generator site, with histology positive for giant cells. One patient developed an inflammatory dermatitis on the flank and abdomen that resolved with topical hydrocortisone. “In vivo” testing with a lead extension fragment placed in the buttock resulted in a negative reaction followed by successful reimplantation of an SCS device. Inflammatory reactions to SCS devices can manifest as contact dermatitis, granuloma formation, or foreign body reactions with giant cell formation. Tissue diagnosis is essential, and is helpful to differentiate an inflammatory reaction from infection. The role of skin patch testing for 96 hours may not be suited to detect inflammatory giant cell reactions that manifest several weeks post implantation.

Keywords: spinal cord stimulation, delayed inflammatory responses, foreign body giant cell reactions, contact dermatitis

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Clinical evidence for allergy in orofacial granulomatosis and inflammatory bowel disease

Research

Clinical evidence for allergy in orofacial granulomatosis and inflammatory bowel disease

Pritash Patel, Jonathan Brostoff, Helen Campbell, Rishi M Goel, Kirstin Taylor, Shuvra Ray,Miranda Lomer, Michael Escudier, Stephen Challacombe, Jo Spencer and Jeremy Sanderson

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Clinical and Translational Allergy 2013, 3:26 doi:10.1186/2045-7022-3-26

Published: 15 August 2013

Abstract (provisional)

Background

Orofacial granulomatosis (OFG) causes chronic, disfiguring, granulomatous inflammation of the lips and oral mucosa. A proportion of cases have co-existing intestinal Crohn's disease (CD). The pathogenesis is unknown but has recently been linked to dietary sensitivity. Although allergy has been suggested as an aetiological factor in OFG there are few published data to support this link. In this study, we sought clinical evidence of allergy in a series of patients with OFG and compared this to a series of patients with inflammatory bowel disease (IBD) without oral involvement and to population control estimates.

Methods

Prevalence rates of allergy and oral allergy syndrome (OAS) were determined in 88 patients with OFG using questionnaires, skin prick tests, total and specific serum IgE levels. Allergy was also determined in 117 patients with IBD without evidence of oral involvement (79 with CD and 38 with ulcerative colitis (UC)).

Results

Prevalence rates of allergy in patients with OFG were significantly greater than general population estimates (82% versus 22% respectively p = <0 .0005="" 44="" allergic="" allergy="" also="" amongst="" and="" associated="" but="" cd="" colonic="" common="" comparable="" concomitant="" concurrent="" conversely="" disease="" estimates.="" greater="" highest="" ileal="" ileocolonic="" in="" interestingly="" less="" location.="" not="" oas="" of="" ofg="" or="" p="" patients="" perianal="" population="" rates="" respectively="" significantly="" those="" to="" uc="" vs="" was="" were="" whist="" with="" without="">

Conclusion

We provide compelling clinical evidence for the association of allergy with OFG whether occurring alone or in association with CD. The presence of gut CD increases this association but, conversely, reduces the expression of OAS in those with atopy. Interestingly, there is no evidence of increased allergy in UC.

The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.

Treatments for Seasonal Allergic Rhinitis

Comparative Effectiveness Reviews, No. 120

Investigators: Joan Glacy, MD, Kathleen Putnam, SM, Sarah Godfrey, MPH, Louise Falzon, PGDipInf, Barbara Mauger, PhD, David Samson, MS, and Naomi Aronson, PhD.

Blue Cross and Blue Shield Association Technology Evaluation Center, Evidence-based Practice Center

Rockville (MD): Agency for Healthcare Research and Quality (US); July 2013.

Report No.: 13-EHC098-EF

Structured Abstract

Objectives:

This review compared the effectiveness and common adverse events of medication classes used to treat seasonal allergic rhinitis (SAR) in adolescents and adults, in pregnant women, and in children. We sought to compare the following classes of drugs: oral and nasal antihistamines and decongestants; intranasal corticosteroids, mast cell stabilizers (cromolyn), and anticholinergics (ipratropium); oral leukotriene receptor antagonists (montelukast); and nasal saline.

Data sources:

We identified English-language studies using a peer-reviewed search strategy. The following databases were searched on July 18, 2012, with no date restrictions: MEDLINE® (PubMed® and Ovid), Embase® (Ovid), Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Database of Systematic Reviews, and DARE (Database of Abstracts of Reviews of Effects).

Review methods:

We consulted a Technical Expert Panel to identify the treatment comparisons most relevant to patients and providers. Subpopulations of interest were individuals with asthma or eye symptoms. Outcomes of interest were patient-reported symptom scores, quality of life, and adverse events. Inclusion was limited to studies that reported an outcome of interest and directly compared drugs of interest that were approved by the U.S. Food and Drug Administration (FDA). Two independent reviewers performed study selection and data abstraction. Disagreements were resolved by consensus or a third reviewer.

Results:

We identified 59 trials that addressed 13 of 22 treatment comparisons of interest for adolescents and adults, 0 of 17 comparisons of interest for pregnant women, and 1 of 21 comparisons of interest for children. Across all comparisons, 20 of 39 drugs FDA approved for the treatment of SAR were studied. For adolescents and adults with SAR, evidence was sufficient to form the following conclusions. For the treatment of nasal symptoms, montelukast (oral leukotriene receptor antagonist) and intranasal corticosteroid were similarly effective (high strength of evidence [SOE]). For the treatment of nasal symptoms and eye symptoms, intranasal corticosteroid, nasal antihistamine, and combination intranasal corticosteroid plus nasal antihistamine were similarly effective (high SOE), and montelukast and oral selective antihistamine were similarly effective (moderate SOE). For improved quality of life, montelukast and oral selective antihistamine were similarly effective (moderate SOE), and combination oral selective antihistamine plus intranasal corticosteroid was superior to oral selective antihistamine alone (low SOE). To avoid insomnia, oral selective antihistamine was superior to oral decongestant and to combination oral selective antihistamine plus oral decongestant (moderate SOE). In patients codiagnosed with SAR and asthma, montelukast was superior to oral selective antihistamine for reduced asthma rescue medication use (moderate SOE). In sensitivity analyses using a lower threshold for minimum clinical effectiveness, combination oral selective antihistamine plus oral decongestant was superior to oral selective antihistamine alone for the treatment of nasal symptoms in adolescents and adults with SAR (moderate SOE). In this population, we did not find evidence that any single treatment was both more effective and had lower risk of harms. Evidence for both effectiveness and harms was insufficient regarding the comparison between oral selective and oral nonselective antihistamine in children. All effectiveness and harms outcomes were limited by short trial durations.

Conclusions:

Several effectiveness comparisons demonstrated similarity of treatments for selected outcomes. For most harms comparisons, the evidence was insufficient. Conclusions were limited by (1) lack of comparative evidence for all drugs within each class and (2) lack of evidence on the magnitude of symptom change that constitutes a minimal clinically important difference.

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Contents

Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services1, Contract No. 290-2007-10058-I. Prepared by: Blue Cross and Blue Shield Association Technology Evaluation Center, Evidence-based Practice Center, Chicago, IL

Suggested citation:

Glacy J, Putnam K, Godfrey S, Falzon L, Mauger B, Samson D, Aronson N. Treatments for Seasonal Allergic Rhinitis. Comparative Effectiveness Review No. 120. (Prepared by the Blue Cross and Blue Shield Association Technology Evaluation Center Evidence-based Practice Center under Contract No. 290-2007-10058-I.) AHRQ Publication No. 13-EHC098-EF. Rockville, MD: Agency for Healthcare Research and Quality; July 2013.www.effectivehealthcare.ahrq.gov/reports/final.cfm.

This report is based on research conducted by the Blue Cross and Blue Shield Association Technology Evaluation Center Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-2007-10058-I). The findings and conclusions in this document are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.

The information in this report is intended to help health care decisionmakers—patients and clinicians, health system leaders, and policymakers, among others—make well-informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances presented by individual patients.

This report may be used, in whole or in part, as the basis for development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.

None of the investigators have any affiliations or financial involvement that conflicts with the material presented in this report.

1: 540 Gaither Road, Rockville, MD 20850; www.ahrq.gov

Bookshelf ID: NBK153714PMID: 23946962

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August 19, 2013