The Correlation of Allergic Rhinitis with ABO Phenotype

Abstract

The aim of study the correlation of ABO phenotypes in patients of allergic rhinitis and controls and to compare our study with the previous studies to analyse the association of above. 100 patients with symptoms of allergic rhinitis and 100 controls individual were selected from same geographical region and paired by gender and age were enrolled in the study. Detailed history, examination and relevant radiological and hematological investigations were done. ABO phenotypes were identified in red blood cells using hemagglutination technique. This clinic-based observational study was conducted among the patients presenting with signs and symptoms of allergic rhinitis. Maximum no. of cases were seen in ABO phenotype O (52%), followed by A, B and AB (33, 12 and 3% respectively) and it was found to be statistically significant (p = 0.001). Also more number of male patients were found in B and O blood group which was statistically significant (OR 5.33, p = 0.017 and OR 3.63, p = 0.006 respectively). Controls showed marginalized difference in distribution among the basis of different ABO phenotypes. The O blood group phenotype of ABO histo-blood group system is associated with AR. This study contributes to the better understanding of the pathophysiology and clinical variability of this disease and may help to improve strategies towards its prevention and diagnosis. Additionally, ABO histo-blood group phenotyping, an inexpensive and easy to perform assay could be used to identify individuals at risk of developing allergic rhinitis.

http://ift.tt/2xjfO5r

Effectiveness of tip rotation in fibreoptic bronchoscopy under different experimental conditions: an in vitro crossover study

Abstract

Background

Proper manipulation of fibreoptic bronchoscopes is essential for successful tracheal intubation or diagnostic bronchoscopy. Failure of proper navigation and rotation of the fibrescope may lead to difficulties in advancing the fibrescope and might also be responsible for (unnecessary) difficulties and delays in fibreoptic tracheal intubation, with subsequent hypoxaemia. The present study, therefore, aimed to assess the effectiveness of tip rotation in flexible bronchoscopes in different experimental conditions.

Methods

Five differently sized pairs of fibrescopes (outer diameters of 2.2, 2.4, 3.5, 4.2, and 5.2 mm) were inserted into paediatric airway manikins via an appropriately sized laryngeal mask and were turned clockwise or anticlockwise at the fibrescope body or cord to 45, 90, and 180°, with the cord held either straight or bent. The primary outcome measure was the ratio of rotation measured at the tip over the rotation performed with the fibrescope body or cord.

Results

Overall, the 'body' turn was significantly less effective when a bent cord was present (mean difference ranging from 29.8% (95% confidence interval 8.8–50.9) to 117.4% (93.6–141.2). This difference was diminished when the 'cord' turn was performed. Smaller fibrescopes, with outer diameters of 2.2 and 2.4 mm, were inferior with respect to the transmission of 'body' rotation to the tip.

Conclusions

'Cord' turning of the fibrescope appears to be more effective in rotating the tip than a turn of the fibrescope 'body' only. Straightening the fibrescope cord and combined 'body' and 'cord' turning are recommended.

http://ift.tt/2fSsAWc

Evidence-based medicine: the clue is in the name

Keane and Berg¹ have taken issue with the scientific basis of medicine. Their premise is built on the following three challenges: that 'science' (in particular, the randomized controlled trial) is fundamentally unsuited to complex health care; that the evolutionary processes described in economics are a better fit to health care; and that attempts to grade recommendations are unnecessary and unhelpful. Their editorial raises genuine concerns and merits careful reading. But this perhaps presents a Utopian fallacy; evidence-based medicine isn't perfect so it must be replaced. The term 'evidence-based medicine' is frequently misused, misapplied, and misunderstood. Evidence-based medicine (if it is to live up to its name) should be open to scrutiny and challenge. It is certainly not a religious creed that cannot be questioned. Unthinking misapplication of 'evidence' leads both directly and indirectly to poor patient outcomes. Evidence-based medicine has many definitions, but Masic and colleagues² described it well: 'Evidence based medicine is the conscientious, explicit, judicious and reasonable use of modern, best evidence in making decisions about the care of individual patients. Evidence based medicine integrates clinical experience and patient values with the best available research information.'

http://ift.tt/2y0CTNX

An experimental study comparing the respiratory effects of tapentadol and oxycodone in healthy volunteers

Abstract

Background

There is a clinical need for potent opioids that produce little or no respiratory depression. In the current study we compared the respiratory effects of tapentadol, a mu-opioid receptor agonist and noradrenaline reuptake inhibitor, and oxycodone, a selective mu-opioid receptor agonist. We hypothesize that tapentadol 100 mg has a lesser effect on the control of breathing than oxycodone 20 mg.

Methods

Fifteen healthy volunteers were randomized to receive oral tapentadol (100 and 150 mg), oxycodone 20 mg or placebo immediate release tablets in a crossover double-blind randomized design. The main end-point of the study was the effect of treatment on the ventilatory response to hypercapnia and ventilation at an extrapolated end-tidal P_CO2 of 7.3 kPa (55 mmHg, VE55); VE55 was assessed prior and for 6-h following drug intake.

Results

All three treatments had typical opioid effects on the hypercapnic ventilatory response: a shift to the right coupled to a decrease of the response slope. Oxycodone 20 mg had a significantly larger respiratory depressant effect than tapentadol 100 mg (mean difference −5.0 L min⁻¹, 95% confidence interval: −7.1 to −2.9 L min⁻¹, P<0.01), but not larger than tapentadol 150 mg (oxycodone vs. tapentadol 150 mg: P>0.05).

Conclusions

In this exploratory study we observed that both tapentadol and oxycodone produce respiratory depression. Tapentadol 100 mg but not 150 mg had a modest respiratory advantage over oxycodone 20 mg. Further studies are needed to explore how these results translate to the clinical setting.

http://ift.tt/2fRf590

Guidelines on informed consent in anaesthesia: unrealistic, unethical, untenable….

'Informed consent' has become the primary paradigm for protecting the legal rights of patients and guiding the ethical practice of medicine.¹ The Association of Anaesthetists of Great Britain and Ireland (AAGBI) 'informed consent' guidelines have recently been updated in response to 'the changing ethical and legal background against which anaesthetists, intensivists and pain specialists, currently work'.² This guidance aims to advise its members (and others) how to provide information about anaesthesia that respects patient autonomy and stays within the law.³ This raises the question, are we really achieving the key principles of primum non nocere,⁴ respect for patient autonomy,⁵ and the need to provide adequate information?⁶ Current guidance has been almost solely based on medicolegal determinations around inadequate informed consent, focusing on the failure to disclose a 'material risk'.⁷⁸ This has led health authorities and many clinicians to interpret the guidelines as a directive, informing patients of an ever-increasing list of potential anaesthesia-related adverse events. Misguided attempts to include every possible 'material risk' are leaving patients bombarded with excessive amounts of largely irrelevant and incomprehensible information.⁹¹⁰ This practice is also leading to unnecessary alarm and confusion, not to mention exposure of patients to the adverse effects of nocebo communications (negative suggestion).¹¹

http://ift.tt/2y13ri2

Big data, small airways, big problems

Some of the earliest airway management interventions in humans occurred in neonates in the 18^th century. Small tubes were passed into the oropharynx of newborn children to support ventilation. Later in that century, the Royal Humane Society was developed in the United Kingdom to address adult drowning, and the first approaches to tracheal intubation were described. Airway management expanded from life-saving interventions such as these to the operating theatre to support surgical procedures with required ventilation. In the operating theatre, the focus of new approaches to airway management has been on adults. Unfortunately, this has left the paediatric provider with adult tools and techniques that have simply been downsized for paediatric airway management. Advancing our knowledge regarding the optimal airway management techniques in children is challenging because of the rare occurrence of difficult events and challenges surrounding enrolling children in clinical trials.

http://ift.tt/2y0u5Yo

Does pharmacokinetic/pharmacodynamic model-guided anaesthesia improve outcome after hip fracture surgery?

Hip fracture affects ∼628 000 patients annually and accounts for ∼200 000 deaths in Europe.¹ The EuroHOPE database, which includes seven European countries, revealed that the 30 day mortality rate after hip fracture surgery ranges from 4 to 12% and reaches up to 35% after 1 yr.² Postoperative complications, such as serious cardiac and pulmonary events, appear most frequently.¹³ Postoperative delirium occurs often and is associated with increased mortality.⁴ Improving outcomes for vulnerable elderly hip-fractured patients is a key goal for perioperative care.¹

http://ift.tt/2fRepjY

Is science the answer?

Nearly ten years ago, Tobin described the irony that evidence-based medicine (EBM) lacks a sound scientific basis.¹ A sentinel paper concluded that most results of medical research were false,² and now the same author, a well-lauded EBM proponent, argues that even if true, most clinical research is not useful³ and now concedes that EBM has been 'hijacked' by 'vested interests' including industry and researchers.⁴ The community expends vast resources on research, yet it has been estimated that there is an 85% 'waste in the production and reporting of research evidence'.⁵

http://ift.tt/2y0QODL

Surgical pleth index: prediction of postoperative pain in children?

Abstract

Background

. Surgical Pleth Index (SPI) is a non-invasive, dimensionless score (0–100) aimed to allow an estimate of intraoperative nociception. Thus, it may be a useful tool to guide intraoperative analgesia. However, no optimum SPI target range for the use in children has yet been defined. It was the aim of this study to define a clinically appropriate SPI target to predict moderate-severe postoperative pain in children.

Methods

. After ethics approval 105 children (2–16 yr) undergoing elective sevoflurane/opioid-based anaesthesia were included. SPI was recorded directly before the end of surgery and compared with acute postoperative pain (age appropriately assessed on different pain scales in the age groups two to three yr, four to eight yr and nine to16 yr) in the postoperative acute care unit (PACU).

Results

Data of 93 children were analysed. A significant negative correlation was found between age and SPI (r=−0.43; P=0.03). The SPI cut-off value with the highest sensitivity (76%) and specificity (62%) in all children combined was 40. The negative predictive value for SPI ≤ 40 to predict the absence of moderate-severe pain in PACU was 87.5%. The commonly used SPI cut-off (50) published in all related studies had neither any clinically relevant sensitivity nor specificity to predict the presence or absence of acute pain in PACU.

Conclusions

. The results suggest that a lower (≤ 40) than previously published (50) target for SPI may be more appropriate in studies investigating SPI guided anaesthesia in children, if the avoidance of moderate-severe postoperative pain is the main goal.

Clinical trial registration

ACTRN12616001139460.

http://ift.tt/2y0i59k

Frequent immunoglobulin G4 expression in a common variant of primary cutaneous marginal zone B-cell lymphoma

Abstract

Immunoglobulin (Ig)G4 expression was recently observed in a proportion of primary cutaneous marginal zone B-cell lymphoma (PCMZL) with plasmacytic differentiation. IgG4-related disease is characterised by polyclonal lymphoplasmacytic infiltration with IgG4 expression, storiform fibrosis and obliterative phlebitis in histopathology. Here we report three cases of common variants of PCMZL with predominant and varied IgG4 expression, suggesting there is an underlying clonal progression between these two entities.

http://ift.tt/2xgyLuN

MDs and Industry Must Collaborate for Research and Education

Dr Frank Veith explains the advantage of MDs and industry working together to create innovative products and improve education while criticizing regulations that restrict the MD/industry relationship.
Medscape General Surgery

http://ift.tt/2y21iDf

Adrenal Insufficiency in Pediatric Eosinophilic Esophagitis Patients Treated with Swallowed Topical Steroids

Pediatric Allergy, Immunology, and Pulmonology Sep 2017, Vol. 30, No. 3: 135-140.


http://ift.tt/2y0Si17

Outcomes for Umbilical Cord Blood Transplantation in Severe Combined Immunodeficiency Disorders: Ten-Year Experience

Pediatric Allergy, Immunology, and Pulmonology Sep 2017, Vol. 30, No. 3: 171-180.


http://ift.tt/2xizGpu

Inhaling Essential Oils: Purported Benefits and Harms

Pediatric Allergy, Immunology, and Pulmonology Sep 2017, Vol. 30, No. 3: 186-188.


http://ift.tt/2ximT6B

Expression of FK506-binding protein 51 (FKBP51) in Mycosis Fungoides

Summary

Background

Mycosis fungoides (MF) is the major subtype of cutaneous T-cell lymphomas (CTCL). It usually has a prolonged indolent clinical course with a minority of cases acquiring a more aggressive biological profile and resistance to conventional therapies, partially attributed to the persistent activation of Nuclear Factor-kappa B (NF-κB) pathway. In the last decade, several papers suggested an important role for the FK506-binding protein 51 (FKBP51), an immunophilin initially cloned in lymphocytes, in the control of NF-κB pathway in different types of human malignancies.

Objectives

We aimed to investigate the possible value of FKBP51 expression as a new reliable marker of outcome in MF patients.

Methods

We assessed by immunohistochemistry (IHC) FKBP51 expression in 44 patients with MF, representative of different stages of the disease. Immunohistochemical results were subsequently confirmed at mRNA level with quantitative PCR (qPCR) in a subset of enrolled patients. In addition, IHC and qPCR served to study the expression of some NF-κB target genes, including the tumour necrosis factor receptor-associated factor 2 (TRAF2).

Results

Our results show that FKBP51 was expressed in all evaluated cases, with the highest level of expression characterizing MFs with the worst prognosis. Moreover, a significant correlation subsisted between FKBP51 and TRAF2 IHC expression scores.

Conclusions

we hypothesize a role for FKBP51 as a prognostic marker for MF and suggest an involvement of this immunophilin in deregulated NF-κB pathway of this CTCL.

This article is protected by copyright. All rights reserved.

http://ift.tt/2fM9v4k

Reduction in harm from tracheostomy related incidents after implementation of the paediatric National Tracheostomy Safety Project resources: a retrospective analysis from a tertiary paediatric centre

Abstract

In the UK, patient safety issues related to adult tracheostomies are well recognised. A number of reports from the National Patient Safety Agency and National Confidential Enquiry into Patient Outcome and Death highlighted recurrent themes with deficiencies in staff education, resources, equipment provision and emergency guidance.^1,2. Similar patient safety concerns exist in the paediatric population. Studies report overall mortality rates in paediatric patients with tracheostomies varying from 2.2%³ to 58.8%,⁴ whilst tracheostomy-specific mortality is lower at 0.9%⁵ to 5.9%.⁴ Within our institution, concerns were noted regarding the risk of serious avoidable tracheostomy morbidity after merging three paediatric hospitals onto a single site in 2009.

This article is protected by copyright. All rights reserved.

http://ift.tt/2fSoXj3

Dust mite induces multiple polar T-cell axes in human skin

Abstract

Background

House dust mite/HDM atopy patch test/APT elicits positive reactions in a high fraction of atopic dermatitis/AD and healthy individuals. Experimental systems for new-onset/chronic AD are needed to support rapid therapeutic development, particularly since animal models representing human AD are lacking. While HDM APT has been considered to simulate AD, its suitability to model AD's emerging Th2/Th22 phenotype with Th1 and Th17 components is unknown.

Objective

To assess whether HDM APT reproduces AD.

Methods

Positive HDM APTs (n=15) from patients with and without AD were evaluated, using genomic and immunohistochemistry studies, against intrapersonal control skin.

Results

APT lesions showed higher T-cell and dendritic cell infiltrates vs. controls. 743 up- and 326 downregulated genes were differentially expressed in HDM APT (fold-change>2 and false-discovery rate<0.05), with increased expression of Th2, Th9, Th17/Th22 polar cytokines (i.e. IL-5, IL-13, IL-9, IL-17, IL-22).

Conclusion

While HDM caused significant Th2 skewing, it also illustrated differences in Th2 induction and barrier defects, thus HDM APT does not fully simulate AD. Given its widespread availability and sensitization rates, HDM may potentially be a useful tool that represents select aspects of AD, psoriasis, or contact dermatitis.

This article is protected by copyright. All rights reserved.

http://ift.tt/2gbCu1N

Inflammatory proteins in nasal lavage of workers exposed to occupational agents

Abstract

Background

Low-molecular-weight (LMW) and high-molecular-weight (HMW) agents have been recognized as causes of occupational rhinitis (OR). Immunological mechanisms underlying OR differ according to the type of exposure. While HMW agents act mainly through IgE-mediated mechanisms, LMW agents appear to act through both immunologic and non-immunologic mechanisms.

Objective

The objective of this study was to identify potential differences in the upper airways inflammatory response after exposure to LMW and HMW agents by specific inhalation challenge test (SIC).

Methods

Nasal lavage (NL) samples from 20 subjects who were exposed to HMW (n=10, Group I) and LMW (n=10, Group II) at their workplaces were collected after SIC with control and specific occupational agents. These samples were analyzed for 47 inflammatory markers using multiplex bead technology.

Results

After exposure to specific agent, Group I exhibited higher concentrations of the following proteins compared to Group II: fibrinogen (median (interquartile range) Group I: 0.09 (0.00) μg/ml, Group II: 0.04 (0.05) μg/ml, p=0.05); haptoglobin (Group I: 0.86 (0.01) μg/ml, Group II: 0.14 (0.20) μg /ml, p=0.02); vascular cell adhesion molecule-1 (VCAM-1) (Group I: 0.34 (0.67) ng/ml, Group II: 0.11(0.11) ng/ml, p=0.01); vascular endothelial growth factor (VEGF) (Group I: 157.0 (154.0) pg/ml, Group II: 98.0 (20.25) pg/ml, p=0.01) and vitamin D (VDBP) (Group I: 0.06 (0.13) μg /ml, Group II: 0.03 (0.03) μg /ml, p=0.04). No statistically significant differences in proteins profiles were observed between the groups after exposure to control agent. Also, subjects exposed to HMW agents showed a significant increase in NL levels of C-reactive protein compared to control day exposure.

Conclusions and clinical relevance

Exposure to HMW and LMW agents by SIC induced a differential nasal airway response including acute-phase reactants proteins (fibrinogen, haptoblobin and CRP), cell adhesion molecules (VCAM-1), endothelial growth factors (VEGF) and VDBP.

This article is protected by copyright. All rights reserved.

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Response to ‘Serological diagnostics in the detection of IgG autoantibodies against human collagen VII in epidermolysis bullosa acquisita – a multicenter analysis’

Abstract

In a recent retrospective serological study in 95 sera from epidermolysis bullosa acquisita (EBA) patients Schmidt et al. conclude that Col7A-NC1/NC2 ELISA (MBL, Japan) is superior to NC1 ELISA, Western blot and indirect immunofluorescence (IIF) on salt-split skin (SSS) with the highest sensitivity of 97.9%.¹ This sensitivity is an overestimation from a biased sample, since the sera had been preselected from patients with IgG reactivity fitting EBA by at least one of the immune serological assays indirect immunofluorescence, ELISA, and Western blot. The deficiency in study design with an incorrect reference standard creates a bias in estimated test accuracy.

This article is protected by copyright. All rights reserved.

http://ift.tt/2fL8jOz

HLA class II alleles of susceptibility and protection in Brazilian and Dutch pemphigus foliaceus

Abstract

Pemphigus foliaceus (PF) is a worldwide chronic autoimmune bullous disease targeting desmoglein 1 (Dsg 1) on epithelial cell surface of skin and mucous membranes, causing lesions in skin but sparing mucosa, since the latter contain compensating desmoglein 3¹. Several environmental triggers for the autoimmune reaction have been imputed, such as drugs, ultraviolet radiation and mercurium. Human leucocyte antigens class II (HLA-DR4) alleles were linked to the disease in Ashkenazi Jews and other populations². For endemic pemphigus foliaceus in Brazil, named fogo selvagem (FS), HLA-DRB1*04 was shown to have a relative risk >14 for the disease³.

This article is protected by copyright. All rights reserved.

http://ift.tt/2ypkSKJ

Phase I/Ib Study of LHC165 Single Agent and in Combination With PDR001 in Patients With Advanced Malignancies

Condition:   Solid Tumors
Interventions:   Drug: LHC165;   Biological: PDR001
Sponsor:   Novartis Pharmaceuticals
Not yet recruiting

http://ift.tt/2xVE7bJ

Study of the Interest of Pursuing or Not the Chemotherapy for Patients With Metastatic Esophageal Cancer

Condition:   Esophageal Cancer, Squamous Cell
Intervention:   Drug: pursuit of chemotherapy
Sponsor:   Centre Oscar Lambret
Not yet recruiting

http://ift.tt/2yq0ZTQ

Genomic Testing and Resulting Medical Decisions

Conditions:   Cancer of Unknown Origin;   Cancer Refractory;   Cancer of Stomach;   Cancer Head Neck;   Cancer of Skin;   Cancer, Lung;   Cancer Colorectal;   Cancer of Esophagus;   Cancer, Bladder;   Cancer, Uterus;   Cancer Cervix;   Cancer Liver;   Cancer, Kidney;   Cancer, Breast;   Hematologic Neoplasms
Intervention:   Other: Genomic testing
Sponsors:   Arbeitsgemeinschaft medikamentoese Tumortherapie;   Roche Pharma AG
Recruiting

http://ift.tt/2xUvjmu

Pansclerotic morphea associated with hypohidrosis and anti-M3 muscarinic acetylcholine receptor antibodies

Abstract

A man in his 50s was referred to our hospital due to a 3-month history of extensive hypohidrosis that he first realized in his upper trunk. He subsequently noticed tenseness of the skin on the hypohidrotic areas. He had a medical history of hyperlipidemia, duodenum ulcer and obsessive-compulsive disorder, but had not received drugs known to induce sclerosis or hypohidrosis. Physical examination showed diffuse, shiny, mildly sclerotic skin with a symmetrical distribution in the upper extremities and the trunk; however, the hands, axillae and lateral chest were spared (Figure 1a).

This article is protected by copyright. All rights reserved.

http://ift.tt/2yZ4u0L

A pleiotropic effect of the APOE gene: association of APOE polymorphisms with multibacillary leprosy in Han Chinese from Southwest China

Summary

Background

Leprosy patients had a very low risk of Alzheimer's disease (AD), and the β-amyloid (Aβ) deposition was significantly lower in the brain tissues of elderly leprosy patients than those of age-matched controls. The APOE played critical roles in lipid metabolic pathways and in brain to facilitate the proteolytic clearance of Aβ. We hypothesized that APOE would confer risk to leprosy as lipid metabolism was involved in Mycobacterium leprae infection.

Objective

To investigate the potential genetic associations between APOE and leprosy in two independent Chinese case-control cohorts from the Yuxi and Wenshan Prefectures, Yunnan Province of Southwest China.

Methods

Five APOE SNPs were analyzed in 1110 individuals (527 patients and 583 controls) from the Yuxi Prefecture by using SNaPshot assay. Genetic variations in the entire APOE exons of were screened in 1788 individuals (798 patients and 990 controls) from the Wenshan Prefecture by using the next generation sequencing technology.

Results

The AD-associated SNPs rs405509 and rs439401 increased risk to leprosy per se and multibacillary leprosy (MB, P < 0.005), but APOE-ε4 allele did not affect leprosy. SNPs rs405509 and rs439401 were cis eQTLs for APOE expression in human skin. Differential APOE mRNA expression was observed in skin lesions of type I reaction leprosy and MB patients. The APOE and related lipid genes were participated in a highly interacted network with leprosy susceptibility genes.

Conclusions

The APOE gene was associated with leprosy, most likely by regulating lipid metabolism related genes.

This article is protected by copyright. All rights reserved.

http://ift.tt/2y0aGHr

HPV-Induced Atypical Pigmented High-grade Dysplasia of the Scrotum

This case report describes a patient with HPV-induced atypical pigmented high-grade dysplasia of the scrotum.

http://ift.tt/2xgWIx6

Delay and Disparity in Time to Surgical Treatment for Melanoma

The relationship between patient health insurance status, health care use, and outcomes has been explored in great depth and detail over decades for myriad diseases in the United States. Likewise, health services research has become increasingly relevant within the specialty of dermatology, especially as the emergence of "big data" and advanced analytics continue to transform overall health care delivery.

http://ift.tt/2y18teV

Treatment of Psychiatric Disorders and Skin-Restricted Lupus Remission

This observational cohort study investigates the association between treatment of psychiatric disorders and skin-restricted lupus remission in a patient cohort over 2.5 years.

http://ift.tt/2xhero1

Association of Delays in Surgery for Melanoma With Insurance Type

This cohort study investigates whether patients with Medicaid are more likely than patients with Medicare or private insurance to experience delays in surgery for melanoma.

http://ift.tt/2kohWYr

Brentuximab Vedotin for Patients With Refractory Lymphomatoid Papulosis

This phase 2 trial of 12 patients assesses the efficacy and safety of brentuximab vedotin for lymphomatoid papulosis.

http://ift.tt/2yI4CR3

Is Age a Risk Factor for Lymph Node Positivity in Melanoma?

Certain patients with thin melanomas aren't recommended for sentinel lymph node biopsy, but a study suggests that they should be.
Medscape Dermatology

http://ift.tt/2kmIut7

Need Surgery for Melanoma? Which Insurance Causes Delays?

When categorized by insurance type, Medicaid patients had longer delays for melanoma surgery than patients with Medicare and private insurance.
Medscape Medical News

http://ift.tt/2fQK4SD

Topical propranolol improves epistaxis in patients with hereditary hemorrhagic telangiectasia - a preliminary report

Abstract

Background

Severe epistaxis is often difficult to control in patients with hereditary hemorrhagic telangiectasia (HHT). Propranolol has been shown to have antiangiogenic properties in vitro and in vivo and is commonly used to treat hemangiomas. We present our experience with topical nasal propranolol for the treatment of moderate to severe epistaxis in patients with HHT.

Methods

Retrospective case series. Six patients with HHT were treated with 0.5 cm³ of 1.5% propranolol gel, applied to each nostril twice daily for at least 12 weeks. Outcome measures were epistaxis severity score (ESS), hemoglobin level, and number of blood transfusions prior to and while on treatment. Local and systemic side effects were recorded.

Results

The mean duration of treatment was 30 ± 5.6 weeks. A significant improvement in the ESS was found in all patients, with a mean decrease from 6.4 ± 2.1 at treatment onset to 3.5 ± 1.7 at 12 weeks (p = 0.028). Hemoglobin level increased significantly from 8.4 ± 3.1 to 11.0 ± 1.8 g/dL at 12 weeks (p = 0.043). The mean number of blood transfusions decreased from 4.5 ± 4.9 before treatment to 2.5 ± 2.9 at 12 weeks and 0.3 ± 0.8 at 24 weeks, but the difference did not reach statistical significance (p = 0.109 for both). No significant side effects of treatment were recorded.

Conclusions

These preliminary results suggest that topical propranolol may be effective for the treatment of epistaxis in patients with HHT. A prospective controlled trial is required to confirm our findings.

http://ift.tt/2yIEKED

Erythrodermic psoriasis peculiarly sparing anti-TNF injection sites in a patient with secondary loss of efficacy

http://ift.tt/2xgy7gL

Infliximab-induced acne and acute localized exanthematous pustulosis: Case report

http://ift.tt/2fLqvYj

Vismodegib persistence and discontinuation patterns in Greek patients from a real world setting

Abstract

Hedghehog pathway inhibitors have been successfully used for patients with locally advanced basal cell carcinomas. However, these treatments have been associated with various adverse events that may limit patient compliance. In this study, an association of patient and disease characteristics with drug compliance in a real clinical setting was made. 18 patients were included in the study. The average patient age was 78.39 years. The time that patients remained to treatment was, on average, 8.73 months. 72.2% of patients experienced at least one adverse event. At study cut-off, 11 out of 18 patients had discontinued treatment. The most common reason for discontinuation was reported "fatigue" from the treatment due to the type of AEs experienced (37.4%) and patient's choice after complete response achievement (30.8%). Factors that were associated with treatment discontinuation was: number of previous treatments, severity of AEs and patient age.

http://ift.tt/2xhX1MK

Amelanotic melanoma arising within a lesion of disseminated superficial actinic porokeratosis: An unusual presentation leading to a novel therapeutic approach

Abstract

Disseminated superficial actinic porokeratosis (DSAP) is the most common variant of porokeratosis with a potential for malignant transformation. Its association with malignant melanoma, however, is exceedingly rare. Treatment of DSAP is often ineffective. We report a unique case of amelanotic melanoma arising within a lesion of DSAP. The melanoma was managed surgically, and her DSAP were treated successfully with a novel approach utilizing 5-fluorouracil chemowraps.

http://ift.tt/2fJBBgt

Role of viral infections in the development and exacerbation of asthma in children

Publication date: October 2017
Source:Journal of Allergy and Clinical Immunology, Volume 140, Issue 4
Author(s): Tuomas Jartti, James E. Gern
Viral infections are closely linked to wheezing illnesses in children of all ages. Respiratory syncytial virus (RSV) is the main causative agent of bronchiolitis, whereas rhinovirus (RV) is most commonly detected in wheezing children thereafter. Severe respiratory illness induced by either of these viruses is associated with subsequent development of asthma, and the risk is greatest for young children who wheeze with RV infections. Whether viral illnesses actually cause asthma is the subject of intense debate. RSV-induced wheezing illnesses during infancy influence respiratory health for years. There is definitive evidence that RSV-induced bronchiolitis can damage the airways to promote airway obstruction and recurrent wheezing. RV likely causes less structural damage and yet is a significant contributor to wheezing illnesses in young children and in the context of asthma. For both viruses, interactions between viral virulence factors, personal risk factors (eg, genetics), and environmental exposures (eg, airway microbiome) promote more severe wheezing illnesses and the risk for progression to asthma. In addition, allergy and asthma are major risk factors for more frequent and severe RV-related illnesses. Treatments that inhibit inflammation have efficacy for RV-induced wheezing, whereas the anti-RSV mAb palivizumab decreases the risk of severe RSV-induced illness and subsequent recurrent wheeze. Developing a greater understanding of personal and environmental factors that promote more severe viral illnesses might lead to new strategies for the prevention of viral wheezing illnesses and perhaps reduce the subsequent risk for asthma.



http://ift.tt/2y1iIQz

Role of viral infections in the development and exacerbation of asthma in children

Publication date: October 2017
Source:Journal of Allergy and Clinical Immunology, Volume 140, Issue 4





http://ift.tt/2fRohue

Viral infections in allergy and immunology: How allergic inflammation influences viral infections and illness

Publication date: October 2017
Source:Journal of Allergy and Clinical Immunology, Volume 140, Issue 4
Author(s): Michael R. Edwards, Katherine Strong, Aoife Cameron, Ross P. Walton, David J. Jackson, Sebastian L. Johnston
Viral respiratory tract infections are associated with asthma inception in early life and asthma exacerbations in older children and adults. Although how viruses influence asthma inception is poorly understood, much research has focused on the host response to respiratory viruses and how viruses can promote; or how the host response is affected by subsequent allergen sensitization and exposure. This review focuses on the innate interferon-mediated host response to respiratory viruses and discusses and summarizes the available evidence that this response is impaired or suboptimal. In addition, the ability of respiratory viruses to act in a synergistic or additive manner with TH2 pathways will be discussed. In this review we argue that these 2 outcomes are likely linked and discuss the available evidence that shows reciprocal negative regulation between innate interferons and TH2 mediators. With the renewed interest in anti-TH2 biologics, we propose a rationale for why they are particularly successful in controlling asthma exacerbations and suggest ways in which future clinical studies could be used to find direct evidence for this hypothesis.



http://ift.tt/2y0U5mO

The Editors' Choice

Publication date: October 2017
Source:Journal of Allergy and Clinical Immunology, Volume 140, Issue 4
Author(s): Cezmi A. Akdis, Zuhair K. Ballas




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News Beyond Our Pages

Publication date: October 2017
Source:Journal of Allergy and Clinical Immunology, Volume 140, Issue 4
Author(s): Marc E. Rothenberg, Jean Bousquet




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A pilot study of Merkel cell polyomavirus in squamous cell carcinoma of the tongue

Publication date: November 2017
Source:Oral Oncology, Volume 74
Author(s): Mickie Hamiter, Ameya Asarkar, Donna Rogers, Tara Moore-Medlin, Gloria McClure, Xiaohui Ma, John Vanchiere, Cherie-Ann O. Nathan




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Evaluation of interleukin-10 producing CD19+ B cells in human gingival tissue

Publication date: December 2017
Source:Archives of Oral Biology, Volume 84
Author(s): Jiayin Dai, Liangjia Bi, Jiang Lin, Feng Qi
ObjectiveThis study aimed to evaluate IL-10 producing CD19⁺ B cells and to examine the correlation between these cells and the expression levels of IL-1β, TNF-α, RANKL, and IL-10 cytokines in the gingival tissues of individuals with and without chronic periodontitis.DesignData were obtained from 20 patients with chronic periodontitis and 10 healthy controls. The gingival samples were analyzed by immunofluorescence, while real-time PCR and enzyme-linked immunosorbent assays were performed to determine cytokine levels.ResultsThe number of IL-10 producing CD19⁺ B cells and the expression levels of IL-10 were significantly higher in the inflamed gingival tissues than in the healthy tissues. A positive correlation between the expression levels of IL-10 and the number of IL-10 producing CD19⁺ B cells were observed. IL-1β, TNF-α, and RANKL expression levels were significantly elevated in diseased gingivae compared to healthy tissues, and there was a positive correlation between the expression levels of these pro-inflammatory cytokines and the number of IL-10 producing CD19⁺ B cells.ConclusionWhile IL-10 producing CD19⁺ B cells are present in the gingival tissues of patients with periodontal disease and of those with a healthy periodontium, the diseased gingival tissues had a much greater number of these cells than the healthy. The mRNA and protein levels of IL-10, IL-1β, and RANKL, as well as mRNA levels of TNF-α, were positively correlated with the number of IL-10 producing CD19⁺ B cells, which highlights the importance of these factors in the development and progression of periodontitis.



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Effect of Proanthocyanidin-enriched extracts on the inhibition of wear and degradation of dentin demineralized organic matrix

Publication date: December 2017
Source:Archives of Oral Biology, Volume 84
Author(s): Ana Paula Boteon, Melissa Thiemi Kato, Marília Afonso Rabelo Buzalaf, Anuradha Prakki, Linda Wang, Daniela Rios, Heitor Marques Honório
ObjectivesThe aim of this study was to evaluate the effect of Cranberry and Grape seed-enriched extract gels in inhibiting wear and degradation of demineralized organic matrix (DOM).Design225 dentin specimens obtained from bovine incisors were randomly allocated into 5 groups (n=45): 10% Grape seed extract gel (GSE), 10% Cranberry extract gel (CE), 0.012% Chlorhexidine gel (CX), 1.23% NaF gel (F), and no active compound gel (P, placebo). Before the treatments, samples were demineralized by immersion in 0.87M citric acid, pH 2.3 (36h). Then, the studied gels were applied once over dentin for 1min. Next, the samples were immersed in artificial saliva containing collagenase obtained from Clostridium histolyticum for 5days. The response variable for dentin wear was depth of dentin loss measured by profilometry and for collagen degradation was hydroxyproline determination. Data were analyzed by ANOVA followed by Tukey's test and Pearson Correlation Test (p<0.05).ResultsGrape seed extract significantly reduced dentin wear compared to the other groups (p<0.05). Cranberry extract and Chlorhexidine did not differ statistically and were able to reduce wear when compared to NaF and placebo treatments. The hydroxyproline analysis showed that there was no significant difference among groups for all treatments (p<0.05). Correlation analysis showed a significant correlation between the amount of degraded DOM evaluated by profilometry and the determination of hydroxyproline.ConclusionCranberry extract was able to reduce the dentin wear and collagen degradation, likely due to the proanthocyanidin content and its action. Therefore, Cranberry could be suggested as an interesting natural-based agent to prevent dentin erosion.



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Reaction to 'Old' Tattoo Ink Mimics Lymphoma

An unusual case of tattoo pigment hypersensitivity caused widespread lymphadenopathy 15 years later, but without a skin reaction.
Medscape Medical News

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Acute kidney injury after pediatric liver transplantation

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Combined intraoperative paracetamol and preoperative dexamethasone reduces postoperative sore throat: a prospective randomized study

Abstract

Purpose

Postoperative sore throat (POST) after general anesthesia with endotracheal intubation is a common and undesirable complication. In this study, we evaluated the combined effects of paracetamol and dexamethasone on the prevention of POST in patients after general anesthesia.

Methods

A total of 226 patients scheduled for urologic surgery under general anesthesia were randomly assigned to one of two groups. In the DexaPara group (n = 113), dexamethasone (10 mg) and paracetamol (1000 mg) was infused. In the Dexa group (n = 113), dexamethasone (10 mg) alone was given. POST, hoarseness, and dysphagia were monitored. The postoperative wound pain score and perioperative opioid requirements were compared. In addition, complications related to opioids were compared between the groups.

Results

The overall incidence of POST was lower in the DexaPara group than in the Dexa group [42 (37%) vs. 72 (64%), p < 0.001]. The incidence of POST while resting at postoperative 1 and 6 h was lower in the DexaPara group than in the Dexa group (p = 0.008 and p = 0.004, respectively). The incidence of postoperative nausea, vomiting, drowsiness, shivering, and headache was comparable between the groups.

Conclusions

Paracetamol and dexamethasone infusion reduced the incidence of POST without serious complications in patients for urologic surgery under general anesthesia.

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Brooke–Spiegler syndrome: focus on reflectance confocal microscopy findings of trichoepithelioma and flat cylindroma

Summary

Brooke–Spiegler syndrome (BSS) is a rare, autosomal dominant disorder characterized by multiple adnexal tumours, especially trichoepitheliomas, cylindromas and occasionally spiradenomas. These lesions usually begin to appear in the second or third decade of life. Malignant transformation of pre-existing tumours may occur. In vivo reflectance-mode confocal microscopy (RCM) is a noninvasive method that can be used to visualize the epidermis and the upper dermis at almost histological resolution. It has been used to evaluate several skin conditions, especially malignant lesions, and has been reported to be useful for differentiating between malignant and benign skin tumours. Only a few studies have reported on the use of confocal microscopy to characterize the features of benign adnexal neoplasms. We present a patient with BSS who presented to our clinic with multiple skin tumours. The possible utility of RCM for identifying adnexal neoplasms is emphasized in this report, which also describes the observed microscopic features.

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Periodic facial erythema in a patient with postural orthostatic tachycardia syndrome

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Migraine Treatment in Pregnancy and Lactation

Abstract

Purpose of Review

Since up to 40.9% of reproductive aged women have migraine—and reproductive-aged women often reproduce—it is essential that we have good information and guidelines regarding proper treatment of migraine during pregnancy and lactation.

Recent Findings

A review of articles published in the last year on the treatment of migraine during pregnancy and lactation found dishearteningly little. Nevertheless, this article will review the risk/safety information related to migraine treatment in both pregnancy and lactation, citing both new and less recent publications.

Summary

There is little if any formal research is being carried out on pharmacotherapy for migraine that occurs during pregnancy or lactation. This is likely due to two issues: (1) neurology offers little training in female sex hormones, while gynecology is a surgical field; (2) there is the ever-present concern of litigation if any bad outcome occurs, yet there is no designation of "legally safe" that can be applied to a drug's use in pregnancy and lactation.

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Real-world health care utilization and effectiveness of omalizumab for the treatment of severe asthma

Publication date: Available online 3 October 2017
Source:Annals of Allergy, Asthma & Immunology
Author(s): Mina Tadrous, Wayne Khuu, Gerald Lebovic, Matthew B. Stanbrook, Diana Martins, J. Michael Paterson, Muhammad M. Mamdani, David N. Juurlink, Tara Gomes
BackgroundOmalizumab is indicated for the treatment of moderate to severe asthma. There is limited observational evidence on the costs and effectiveness of omalizumab.ObjectiveTo examine the costs and effectiveness of omalizumab for treatment of severe asthma relative to nonusers.MethodsWe conducted a within-person repeated-measures matched cohort study in Ontario, Canada from April 1, 2012 to March 31, 2014. Continuous users of omalizumab were matched with up to 4 nonusers according to age, sex, recent specialist visits, oral corticosteroid use, asthma severity, and Charlson comorbidity score. The primary outcome was direct health care costs. Secondary outcomes were asthma-related hospitalizations or emergency department visits and oral corticosteroid use. The association between omalizumab use and each outcome was assessed using mixed-effects models adjusting for confounders.ResultsNinety-five omalizumab users and 352 nonusers were matched. Among users, there was a significant increase in health care costs of $1,796 per person owing to the cost of the medication at treatment initiation (P < .0001). Costs did not change significantly among nonusers ($85 increase in average monthly costs per person; P = .59). We found no significant changes in the rates of asthma-related hospitalizations or emergency department visits among omalizumab users (P = .44) or nonusers (P = .99) between pre- and postintervention periods.ConclusionThe use of omalizumab was associated with increased costs but no evidence of lower rates of clinically important outcomes. These results suggest omalizumab had limited effectiveness in our study population. Future studies should further explore subsets of patients most likely to benefit from omalizumab therapy.



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Real-world health care utilization and effectiveness of omalizumab for the treatment of severe asthma

Omalizumab is indicated for the treatment of moderate to severe asthma. There is limited observational evidence on the costs and effectiveness of omalizumab.

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Psychiatric adverse events during treatment with brodalumab: Analysis of psoriasis clinical trials

Individuals with psoriasis are at increased risk for psychiatric comorbidities, including suicidal ideation and behavior (SIB).

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Paraprotein deposits in the skin

Cutaneous manifestations secondary to paraprotein deposits in the skin include a group of different disorders that although rare, may be the first clinical manifestation of the underlying hematologic dyscrasia. In this article we review the clinical manifestations and histopathologic findings of the processes that result from specific deposition of the paraprotein in different structures of the skin. Paraneoplastic processes frequently associated with hematologic malignancies will not be covered in this review.

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Issue Information

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In response to the commentary of Dr. Lou on treatment of laryngopharyngeal reflux using a sleep positioning device: A prospective cohort study

Publication date: Available online 3 October 2017
Source:American Journal of Otolaryngology
Author(s): William S. Tierney, Scott L. Gabbard, Paul C. Bryson




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Check-list for the assessment of functional impairment in children with congenital aural atresia

Publication date: November 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 102
Author(s): Silvia Montino, Anna Agostinelli, Patrizia Trevisi, Alessandro Martini, Sara Ghiselli
ObjectivesCongenital Aural Atresia (CAA) is a deformity of the external ear and it is commonly associated with malformations of middle and inner ear and, in some cases, with other facial deformities.Very few assessment measures exist for evaluating the functional impairment in children with CAA. Purpose of this study is to introduce and describe an assessment Checklist, (nominated FOS Checklist) that covers feeding abilities (F), oralmotor skills (O), communication/language development (S) in children with CAA.FOS wants to offer a range of assessment providing a profile of the child in comparison to hearing peers and it aims to make clinicians able to identify additional problems and areas of difficulties as well as specific abilities and skills.Secondary, we want to investigate the presence of correlations between disorders and side of CAA.Methodsa new Checklist (FOS Checklist) was administered to 68 children with CAA.ResultsFeeding abilities are age-adequate in 94,3% of all patients.54,4% of all patients are in need for further assessment of their oral-motor skills; delays in language development were found in 44,1% of cases. Orofacial development delays have been observed in 57.2% of subjects among the bilateral CAA group, in 53.9% among the right CAA group and in 53.4% among the left CAA group.Patients referred for further language evaluation were 42,9% in the bilateral CAA group, 33.3% in the right CAA group and 33.3% in the left CAA group.According to the χ² analysis, referral for further assessment is independent from side of aural atresia.ConclusionsSubjects with bilateral CAA are more likely to be referred for further assessment, both for oral motor aspects and for speech perception and language development. However, there is not a significant statistical difference between the performances of children with bilateral or unilateral CAA.FOS Checklist is simple, reliable and time effective and can be used in everyday clinical practice. FOS enable clinicians to identify additional problems and areas of difficulties as well as specific abilities and skills; moreover, FOS allows to determine appropriate referrals and intervention strategies.



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Scalp hypothermia as a preventative measure for chemotherapy-induced alopecia: A review of controlled clinical trials

Abstract

Chemotherapy-induced alopecia (CIA) is a temporary, yet psychologically devastating form of hair loss that affects 65% of patients receiving cancer chemotherapy. In the 1970s, scalp hypothermia was introduced as a preventative measure against the development of CIA. Numerous studies provide evidence for the effectiveness of scalp cooling to prevent CIA, although results varied because of differences in chemotherapy regimen, cooling technique, mode of administration, and patient factors. However, many of the existing studies are uncontrolled or consist of small sample sizes, and data from randomized, randomized studies are limited. To date, no clear guidelines have been established for optimum scalp cooling use as a treatment modality and its efficacy remains unknown. Nonetheless, scalp cooling remains the most widely utilized method for the prevention of CIA, and in December 2015, the United States Food and Drug Administration (FDA) cleared the DigniCap^® scalp cooling system (Dignitana AB, Sweden) for marketing and the Orbis from Paxman^® Coolers Ltd. received clearance in 2017. This literature review is one of the first to provide up-to-date review and side-by-side comparisons of controlled and randomized clinical trials (CCTs and RCTs) evaluating scalp hypothermia for the prevention of CIA. Our analyses of CCTs and RCTs to date show that scalp hypothermia is effective in reducing the occurrence rate of CIA, by 2.7 fold in the CCTs and 3.9 fold in the RCTs. These results suggest that scalp hypothermia represents an effective preventative measure for CIA, and provide guidance for management of anticipated alopecia following chemotherapy and for future investigations.

This article is protected by copyright. All rights reserved.

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A Case of Polyarteritis Nodosa Presenting as Rapidly Progressing Intermittent Claudication of Right Leg

Background. Polyarteritis nodosa (PAN) is a medium vessel vasculitis which causes significant morbidity and mortality. Usually, it presents with constitutional symptoms with angiographic evidence of aneurysms or segmental stenosis of arteries of mesenteric or renal vasculature. It is exceedingly uncommon for PAN to present with symptomatic progressive intermittent claudication. Case Presentation. We describe a 60-year-old male who presented with rapidly progressive intermittent claudication of his right leg. He did not have any significant atherosclerotic risk factors. He had recent onset hypertension and loss of weight. He also had mononeuropathy of right common peroneal nerve and livedo reticularis rash. With negative autoimmune markers and suggestive histology in deep punch skin biopsy and angiographic evidence of segmental stenosis of femoral and renal arteries, we diagnosed PAN. We treated him with aggressive immunosuppressants and vascular bypass surgery of right femoral vessels; he showed a good response. Conclusion. Rapidly progressive unilateral intermittent claudication could be a very rare, but noteworthy presentation of PAN. With suggestive histology and exclusion of other comorbidities aggressive immunosuppressants should be instituted. Vascular bypass surgery for critical ischaemia of the limbs is an option that could be considered for limb-threatening disease.

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Merkel Cell Carcinoma of the Buccal Mucosa and Lower Lip

Abstract

Merkel cell carcinoma (MCC) is an uncommon relatively aggressive neuroendocrine dermal neoplasm first described in 1972 as a tumor of the sun exposed skin. Although most MCC affect the skin of the head and neck, rare primarily oral mucosal cases have been documented. Merkel cells are nondendritic neuroendocrine cells that are found not only in the skin but also the oral mucosa and give rise to MCC. Neuroendocrine cells may be found as aggregates in organs or as diffuse or isolated cells within organs and their epithelial lining. They contain peptide hormones and biogenic amines and occur in two forms: dendritic, which are not associated with nerve fibers and non-dendritic, which are associated with nerve fibers. Merkel cells as well as MCC express simple epithelium-type Cytokeratins (8, 18, 19, 20), neurosecretory substances; chromogranin A, synaptophysin, neuron-specific enolase (NSE), adhesion molecules, and villin (intermediate filament). Though weakly, they also express neural markers such as S-100 protein. Cytokeratin 20, and Cluster of differentiation 56, are the two key diagnostic markers for Merkel cells and MCC. Etiology includes UV radiation, the recently described Merkel cell polyomavirus, and long term systemic immunosuppression. The cutaneous and mucosal variants of MCC are considered aggressive tumors with a high risk for local recurrence and metastasis and should be considered in the differential diagnosis of head and neck mucosal lesions. We present two cases of primary Merkel cell carcinoma, one on the buccal mucosa and the other on the lower lip, and discuss the salient histologic, immunohistochemical and clinical features.

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Sinonasal Secretory Carcinoma of Salivary Gland with High Grade Transformation: A Case Report of this Under-Recognized Diagnostic Entity with Prognostic and Therapeutic Implications

Abstract

Secretory carcinoma (SC) is a recently described salivary gland carcinoma with characteristic ETV6-NTRK3 fusion. In this case report, we described a SC of the maxillary sinus that underwent high grade transformation in a 61-year-old patient. The diagnosis was confirmed by the presence of ETV6 translocation. Within the sinonasal tract, SC is an important differential diagnosis especially of sinonasal adenocarcinoma, non-intestinal type (non-ITAC), as these two entities bears histologic and immunophenotypic similarity. Distinction between these two tumors can be challenging based on the morphology alone and may require additional immunohistochemical and molecular studies. It is important to recognize that SC can occur in the sinonasal tract as correctly diagnosing SC may be prognostic relevant and may provide new targeted therapeutic avenues for these patients.

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Chordoma of the Head and Neck: A Review

Abstract

Chordoma is a rare malignant bone tumor that can arise anywhere along the central neural axis and many involve head and neck sites, most commonly the skull base. The relative rarity of these tumors, combined with the complex anatomy of the head and neck, pose diagnostic challenges to pathologists. This article describes the pertinent clinical, pathologic, and molecular features of chordomas and describes how these features can be used to aid in formulating a differential diagnosis. Emphasis is placed on key diagnostic pitfalls and the importance of incorporating immunohistochemical information into the diagnosis.

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Response to Ebo et al., Letter to the Editor Regarding Update on Quinolone Allergy

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Increased attention-deficit/hyperactivity symptoms in atopic dermatitis are associated with history of antihistamine use

Abstract

Background

Epidemiologic evidence indicates a relevant association between atopic dermatitis (AD) and attention-deficit/hyperactivity disorder (ADHD). Underlying mechanisms and ways to best identify subgroups of AD patients at risk for ADHD are poorly understood.

Aims of the study

To compare sociodemographic, clinical, and psychosocial characteristics of children with AD, ADHD, comorbid AD/ADHD, and age-matched healthy controls. To investigate aspects of AD related to ADHD symptoms.

Methods

Applying a factorial design we investigated 4 groups of children age 6 to 12 years: AD-only (i.e. without ADHD), ADHD-only (i.e. without AD), AD+ADHD, healthy controls (HC; i.e. no AD/no ADHD). Using validated instruments, ADHD symptoms and other behavioural problems, quality of life, parenting stress, and sleeping problems were compared between groups. In children with AD-only, clinical signs (objective SCORAD), symptoms (POEM, VAS pruritus, VAS sleeping problems), and previous treatment of AD were assessed to investigate disease patterns related to ADHD symptoms.

Results

Compared to HC (n=47), children with AD-only (n=42), ADHD-only (n=34) and comorbid AD+ADHD (n=31) had significantly increased behavioural problems and decreased quality of life. Children with AD-only had significantly higher levels of ADHD symptoms than HC. In children with AD-only, previous use of antihistamines was significantly associated with increased ADHD symptoms (OR 1.88; 95%-CI 1.04-3.39). Current clinical signs and AD-symptoms were unrelated to the level of ADHD symptoms.

Conclusions

Even if the clinical diagnosis of ADHD is excluded, children with AD show increased levels of ADHD symptoms. Further investigations need to determine whether early antihistamine exposure is a major risk factor for ADHD or a surrogate for previous AD severity and/or associated sleeping problems.

This article is protected by copyright. All rights reserved.

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