Viral Infections and Wheezing in Preschool Children.

Wheezing is common in childhood, although only a small percentage of these children develop asthma. The child's wheezing phenotype and asthma predictive indices help predict the likelihood of a future asthma diagnosis. Viral infections are common in childhood with most wheezing episodes due to respiratory syncytial virus and rhinovirus.

Prevention and treatment of recurrent viral-induced wheezing in the preschool child.

Objective: To summarize the recent evidence in the treatment of viral-induced wheezing in the infant and preschool aged child.

Data Sources: Published literature obtained through PubMed database searches.

Study Selections: Studies relevant to phenotypes and treatment of wheezing illnesses in infants and preschool children were included.

Characterization of asthma endotypes: implications for therapy.

Objective: To describe the concept of precision medicine in treating severe asthma and the utility of relevant biomarkers.

Data Sources: PubMed was searched for published articles on human clinical trials using biologics for T-helper type 2 cell (TH2)-low and TH2-high asthma.

Study Selections: Studies were selected if they were double-masked, randomized, placebo-controlled trials published in peer-reviewed journals and relevant to the topic.

The use of anti-IgE therapy beyond allergic asthma.

Omalizumab is a monoclonal anti-IgE antibody that has been used to treat allergic asthma for over a decade. The use of omalizumab to treat other diseases has largely been limited to case reports until the recently reported large multicenter studies that have established omalizumab as an effective treatment option for chronic spontaneous urticaria. The utility of omalizumab to treat nonallergic asthma and allergic rhinitis and the added safety and therapeutic benefits in combination with allergen immunotherapy have been demonstrated in placebo-controlled trials.

Promising future therapies for asthma.

Asthma affects 300 million people worldwide and that number has been increasing especially in developed countries. The current standard of care for asthma treatment is based on 2 key pathological features of asthma, airway inflammation and airway obstruction. Improving bronchodilation can be accomplished with ultra-long acting beta2 agonists or long-acting muscarinic agonists used in combination with inhaled corticosteroids.

Immunotherapy: what lies beyond.

Allergen immunotherapy has been used to treat allergic diseases, such as asthma, allergic rhinitis, and venom allergy, since first described over a century ago. The current standard of care in the United States involves subcutaneous administration of clinically relevant allergens for several months, building up to eventual monthly injections for typically 3 to 5 years. Recent advances have improved the safety and efficacy of immunotherapy.

The effects of an H3 receptor antagonist (PF-03654746) with fexofenadine on reducing allergic rhinitis symptoms.

Background: Nasal H(3) receptors might have a role in mediating the effects of histamine in patients with allergic rhinitis.

Objective: This study explored the effect of the potent oral H(3) receptor antagonist PF-03654746 in combination with an oral H(1) receptor antagonist on the objective (acoustic rhinometry) and subjective (symptoms) responses to nasal allergen challenge.

Methods: Twenty patients with out-of-season allergic rhinitis displaying a 30% or greater decrease in minimum nasal cross-sectional area (A(min)) after bolus (ragweed) complete nasal allergen challenge at screening were studied by using a randomized, double-blind, single-dose, 4-way crossover design.

Allergic rhinitis and asthma: celebrating 100 years of immunotherapy.

Since Noon first described allergen immunotherapy a century ago the basic premise of subcutaneous injections (SCIT) of relevant aeroallergens to induce clinical tolerance has remained true [1]. Indeed, allergen immunotherapy did not change dramatically over the first 75 years, but over the past 25 years there have been a number of important advancements leading to newer approaches and novel formulations. Here we review the top 50 articles published in the past 2 years on allergens, environmental control, and immunotherapy for asthma and allergic rhinitis and the use of immunomodulators in allergic disease.

Future forms of immunotherapy and immunomodulators in allergic disease.

Future forms of immunotherapy, particularly toll-like receptor agonists, have shown promising results in animal models of allergic disease although most have failed to translate into successful human clinical trials. These results have helped to elucidate the pleotropic roles of cytokines as well as the diverse phenotypes of allergic diseases, particularly asthma. The goals of these therapies are to improve patient symptoms and quality of life, to prevent and favorably alter disease course, and to maintain a good risk/benefit ratio along with a cost-effective profile.

Future forms of immunotherapy.

Allergic respiratory diseases affect approximately 15% of the US population. Allergen immunotherapy has been a treatment option for diseases such as allergic rhinitis, allergic asthma, and venom allergy for the last 100 years. During the first 75 years, conventional subcutaneous immunotherapy did not change much.

Immunomodulators in asthma therapy.

New developments in the field of allergy and immunology have yielded a variety of novel therapeutic approaches in recent years, and more agents are at the clinical trial stage. Among the therapeutic approaches discussed in this review are Toll-like receptor agonists, immunostimulatory oligodeoxynucleotides, orally and parenterally administered cytokine blockers, and specific cytokine receptor antagonists. Transcription factor modulators targeting syk kinase, peroxisome proliferator-activated receptor-gamma, and nuclear factor-kappaB are also being evaluated in the treatment of asthma.

Time-dependent effects of inhaled corticosteroids on lung function, bronchial hyperresponsiveness, and airway inflammation in asthma.

Background: Exhaled nitric oxide (F(ENO)) and exhaled breath condensate (EBC) are noninvasive markers that directly measure airway inflammation and may potentially be useful in assessing asthma control and response to therapy.

Objective: To examine the time-dependent effects of inhaled corticosteroids on F(ENO) and EBC markers concomitantly with lung function and bronchial hyperresponsiveness.

Methods: Eleven steroid-naive adults with mild-to-moderate persistent asthma were treated with mometasone furoate dry powder inhaler, 400 microg/d, for 8 weeks, followed by a 4-week washout.

Anti-immunoglobulin e therapy.

The importance of immunoglobulin E (IgE) in atopic disorders such as asthma, allergic rhinitis, food allergies, and atopic dermatitis is well established. Elevation of total serum IgE is typically found in many atopic patients, and in predisposed individuals, allergen-specific IgE is produced. The availability of humanized monoclonal antibodies against IgE has provided a new therapeutic option and tool to explore the role IgE in allergic diseases and the effects of inhibiting IgE itself.

Immunomodulators for allergic respiratory disorders.

New knowledge about the pathogenesis of allergic and immunologic diseases has led to a variety of novel targeted therapeutic approaches. Many immunomodulators are currently under development for the therapy of asthma and allergic and immunologic diseases and are undergoing human clinical trials. The study of immunomodulators in human subjects is ultimately required to determine their therapeutic utility because several agents showing promise in in vitro and animal models have failed in human studies.

Allergy immunotherapy for primary care physicians.

Allergic diseases affect a large proportion of the population of the United States. Although there are many effective pharmacologic therapies available, only allergen-specific immunotherapy has been shown to have significant and long-lasting therapeutic and immunomodulatory effects for the management of allergic rhinitis, allergic asthma, and venom hypersensitivity. Allergen immunotherapy requires a build-up phase as the dose of the vaccine is increased until a therapeutic (maintenance) level is achieved.