Allergic Rhinitis Ebook
COPD, fibrotic lung disease, allergic rhinitis, rheumatoid arthritis, inflammatory bowel disease, and possibly psoriasis. Furthermore, concerns over the likely heterogeneity of different functions and signaling pathways of LT receptors and agonist-ligand specificities do not affect this approach. The potential disadvantages arise from the possibility that complete LT inhibition could give rise to undesirable side effects, although no indications of any essential physiological role of LTs have appeared since the discovery of these mediators. Indeed, recent work with 5-LO(- -) -deficient mice, generated by inactivation of the 5-LO gene (108,109), showed that these animals developed normally with no adverse health effects, which suggests that 5-LO blockade should not cause untoward effects. In addition, studies on Zyflo (see next section) I indicate that inhibition of whole body leuko-trienes at least to 80 would seem to be broadly safe.
In paediatric patients herbal products are used to promote health, to prevent illness and to treat acute but overall chronic, recurrent or incurable conditions such as asthma, atopic dermatitis, allergic rhinitis, cystic fibrosis, inflammatory bowel disease, rheumatoid arthritis or cancer.
Sinusitis is one of the major manifestations and may precede the diagnosis in 60 of patients. Allergic rhinitis and nasal or sinus polyps are frequent (70 ) (Fig. 9) (31). Although ENT features may be very similar to those of WG, they are usually milder and associated with less morbidity. It would be extremely unusual for CSS to cause a saddle nose deformity or SGS. Eye involvement in CSS includes episcleritis, scleritis, uveitis, retinal vasculitis, and conjunctivitis (32). Orbital pseudotumor would be very rare, and its presence should suggest WG.
Patients with RA have a decreased prevalence of allergic diseases (Verhoef et al. 1998). Moreover, those patients with RA who, for example, have hay fever have less severe disease compared with control patients with RA without hay fever (Verhoef et al. 1998). As expected, atopic RA patients have higher levels of serum IgE and peripheral blood eosinophils, but their T cells produce less IFN-Y after maximum in vitro stimulation (Verhoef et al. 1998). As allergy is the prototype Th2 disease and activated Th2 cells are able to inhibit the generation and the function of Th1 effectors, these studies support the contention that the occurrence of a Th2-mediated immune response might be beneficial in RA by inhibiting Th1-driven immunity.
From an epidemiological point of view, very interesting studies argue in favor of the important role of the bacterial environment in the first year of life in order to ensure the good orientation of immune responses preventing the short- and long-term development of atopic diseases (13,101,103,109-111). Recent comparative studies have been conducted in children living in the same allergenic environment but under different life-style conditions, urban and farming environments. Results showed that substantial protection against development of asthma, hay fever, and allergic sensitization was seen only in children exposed to stables, farm raw milk, or both in their first year of life (103). Authors also found that prenatal exposure of women had a substantial protective effect.
Quercetin (found in onions, tea, cranberries, and apples) is a powerful histamine inhibitor, not only making it a great supplement for hayfever and sinusitis, but also for leaky gut. Mast cells in the gut, which secrete histamine, promote the development of the leaky gut syndrome.
Type I reactions occur within seconds or minutes after exposure to the antigen. Antigens that provoke this type of reaction are usually small, soluble proteins capable of eliciting an immune response at low doses (examples pollen, pet dander, penicillin). After the initial exposure to the antigen, Th2 helper cells direct B cells to become IgE producing plasma cells. Monomers of IgE antibody specific to the inciting antigen then bind to FceRI on mast cells with high affinity. Upon reexposure to the antigen the IgE on the mast cell binds to the antigen causing aggregation and subsequent crosslinking of the FceRI resulting in degranulation. Mast cell degranulation releases histamine, leukotrienes, and cytokines that cause smooth muscle contraction, capillary dilatation, and increased vascular permeability. The severity of the clinical presentation is dependent on the amount of antigen innoculum, route of antigen exposure, and the amount of IgE produced. Cutaneous exposure to limited...
Other antioxidant flavonoid supplements include Ginkgo biloba, extracts of grape seeds, bilberries, cranberries, green tea, pomegranate, and many other natural plant products. Consumers use these products in the belief they will reduce the risk of heart disease, prevent breast, prostate, and other types of cancer, lessen the chance of age-related vision problems (such as cataracts or macular degeneration), minimize the symptoms of hay fever and asthma, and fight viral infections. In most cases the science to back manufacturers' advertisements claiming of efficacy is derived from very small and very short-term corporate funded studies. While the public awaits research results supported by the NIH offices, ODS, and NCCAM, they should proceed carefully and consult the ODS Web site for recommendations.
All six Prdx isoforms are expressed in the lung, but Prdx 6 is the most abundant among them 46 . It acts both as a Ca2 + -independent phospholipase A2 with maximal activity at acidic pH (with important implications regarding lung surfactant homeo-stasis) and as an antioxidant reducing phospholipid hydroperoxides, organic hydroperoxides and H2O2 46 . Prdx 6 is inducible by oxidative stress 46 , and confers increased protection against oxidant injury of the lung 47 . It can be detected in bronchoalveolar lavage fluid 48 . Strong expression of Prdx 6 in human psoriatic skin has also been described 49 . Knoops et al. 48 have proposed that Prdx 6 may play a role in hypersensitivity reactions such as asthma, hay fever and eczema. It is highly homologous to an Aspergillus fumigatus allergen and it is feasible that IgE - which is specific for the fungus antigen - crossreacts with Prdx 6 and initiates an autoimmune reaction ( 48 and references therein).
Atopic dermatitis (AD) is a type of dermatitis that occurs in patients who have an atopic state. The majority of these patients have a family history of asthma, hay fever, or dermatitis. An autoimmune mechanism may play a role in the pathogenesis of the disease, and glucocorticoste-roids are used in refractory cases. The effect of IFN on this disease may vary, depending on the age of the patient. Mackie et al. (67) reported a beneficial effect of IFN-a when used for the treatment of AD in children, but not adults. Based on this observation, Kimata et al. (68) suggested that AD is not a contraindication for the use of IFN for treating chronic viral hepatitis and other conditions, in children who have underlying AD. They studied five children who had both AD and another disease potentially treatable with IFN-a one child with chronic myelogenous leukemia, two children with hepatitis B, and two children with HCV. All four children with viral hepatitis achieved viral clearance, and there...
The link between other major groups of immune-mediated diseases, particularly cancer and allergies, has been discussed for years with a variety of supporting and disproving evidence. Theoretically, two contradictory hypotheses may be advanced either tumor immunosurveillance may operate more efficiently in those individuals who have allergies or the alterations of the immunologic system can enhance inflammatory response and favor the tumor onset (Carrozzi and Viegi 2005). Many studies suggest that the association between allergy and cancer is complex and depends on the specific allergy and the specific organ site under consideration. For instance, following the cohort of patients for 6 years, Mills et al. reported that prostate and breast cancer risk were elevated in persons who reported any type of allergic history, as was risk of lymphatic or hematopoietic cancers and sarcoma. For each of these types of cancer, risk increased with increasing numbers of allergies. However, ovarian...
11. (C) Budesonide (Rhinocort) and fluticasone propionate (Flonase) are corticosteroids that are employed clinically for the treatment of seasonal and perennial allergic rhinitis. Ne-docromil (Tilade) is an inhalational product that is used for maintenance therapy in the management of bronchial asthma. (3)
The history should also include questions regarding symptoms of other atopic diseases. This 'family' of diseases includes asthma, eczema and atopic dermatitis, and perennial and seasonal rhinitis (hayfever). Patients who have one atopic disease are known to be more at risk of IgE-mediated food allergy.3
The clinical appearance of alopecia areata varies from small patches of hair loss to total loss of scalp hair (alopecia totalis) to loss of all body hair (alopecia universalis). It is not usually associated with any symptoms, although some individuals may experience pruritus or paresthesias before or coincident with the loss of hair. A variety of other diseases may also occur in association with alopecia areata, including allergic rhinitis, asthma, atopic dermatitis, diseases of the thy- roid gland, vitiligo, systemic lupus erythematosus, discoid lupus erythematosus, rheumatoid arthritis, pernicious anemia, scleroderma, ulcerative colitis, myasthe-
Treatment of seasonal allergic rhinitis with fluticasone propionate aqueous nasal spray review of comparator studies Allergy 1995, 50, 25-29. 3. Nayak, A. A review of montelukast in the treatment of asthma and allergic rhinitis Expert Opin. Pharmaco. 2004, 5, 679-686. 4. Baena-Cagnani, C. E. Safety and tolerabiiity of treatments for allergic rhinitis in children Drug Saf. 2004, 27, 883-898, 5. Unal, M. Hafiz, G. The role of antihistamines in the management of allergic rhinitis Curr. Med. Chem Anti-Inflammatory & Anti-Allergy Agents 2005, 4, 477-480.
And is associated with allergy attacks, asthma, hay fever, and parasitic infections. Certain skin diseases, tuberculosis, Hodgkin's disease, and granulocytic leukemia result in an increase in eosinophils. A decrease in eosinophils is called eosinopenia and is associated with an increase in adrenal steroid production and acute bacterial or viral inflammation.
Lipoxygenases are present in leukocytes, tracheal cells, keratinocytes, and airway and stomach epithelium, and they catalyze the introduction of a molecule of oxygen to the 5-position of arachidonic acid to give the intermediate acid or 5-HETE, which is immediately followed by the rearrangement of 5-HETE to leukotrienes. Another potential site of action for anti-inflammatory drugs is, therefore, at the level of lipoxygenases, thus inhibiting the biogenesis of leukotriene and 5-HETE. The search for specific inhibitors of lipoxygenase activity from medicinal plants results in the characterization of anti-inflammatory agents. Lipoxygenase inhibitors might hold some potential for the treatment of asthma, psoriasis, arthritis, allergic rhinitis, cancer, osteoporosis, and atherosclerosis. The evidence currently available suggests the families Myrsinaceae, Clusiaceae, and Asteraceae have potential as sources of lipoxygenase inhibitors.
RESPIRATORY DISEASE The kinins have been implicated in the pathophysiology of allergic airway disorders such as asthma and rhinitis. Inhalation or intravenous injection of kinins causes bronchospasm in asthmatic patients but not in normal individuals. This bradykinin-induced bron-choconstriction is blocked by anticholinergic agents but not by antihistamines or cyclooxygenase inhibitors. Similarly, nasal challenge with bradykinin is followed by sneezing and serious glandular secretions in patients with allergic rhinitis.
As discussed earlier, the H4-receptor appears to be involved in the differentiation of hematopoietic cells (myeloblasts and promyelocytes) and to modulate immune function by modulating eosinophil calcium levels and chemotaxis. Several H3-agonists (R-a-methylhistamine, imetit) and antagonists (thioperamide) are also ligands for H4-receptors.84 Based on its physiological role in immune and inflammatory processes, H4-antagonists may have utility in various autoimmune (rheumatoid arthritis, asthma) and allergic disorders (allergic rhinitis, etc.).10 To date, no histamine H4-receptor ligands have been approved for marketing in the United States.
Boswellia, also known as Indian Frankincense, has been used to manage pain associated with osteoarthritis, rheumatoid arthritis (RA), rheumatism, bursitis, and tendonitis. Non-pain-related uses include ulcerative colitis, dyspepsia, asthma, allergic rhinitis, sore throat, syphilis, pimples, and cancer.
The safety of strontium salts, coupled with their ability to inhibit both sensory irritation and neurogenic inflammation, suggests that they may have therapeutic utility in the treatment of many dermatological conditions. Because the neurogenic inflammation syndrome is believed to be pathogenically important in many other conditions, including allergic contact dermatitis, psoriasis, atopic dermatitis, ocular irritation and inflammation, allergic rhinitis, asthma, rheumatoid arthritis, inflammatory bowel disease and other gastrointestinal disorders 40 , strontium salts may have additional therapeutic utility. Strontium salts represent a new class of selective inhibitors of sensory irritation and irritant contact dermatitis without local anesthetic side effects.