Aspirin-Exacerbated Respiratory Disease (full text from NEJM)

Aspirin-exacerbated respiratory disease (AERD) is characterized by asthma, chronic rhinosinusitis with nasal polyposis, and pathognomonic respiratory reactions to aspirin (Samter’s triad). It has been estimated that this syndrome affects 7% of adults with asthma and 14% of those who have severe asthma. Pathologically, AERD is characterized by marked eosinophilic inflammation and ongoing mast-cell activation in the respiratory mucosa. The frequent recurrence of nasal polyps after surgery, as well as the requirement for high-dose glucocorticoids to manage the asthma, reflect the aggressive, persistent nature of the disease. The typical onset is in adulthood, with or without preexisting asthma, rhinitis, or atopy. An absence of familial clustering argues against a strong genetic basis, and the identification of variants of candidate genes in small studies has not been replicated.

All nonsteroidal antiinflammatory drugs (NSAIDs) that inhibit both cyclooxygenase (COX)-1 and COX-2 may provoke the pathognomonic reactions in AERD; these reactions are accompanied by idiosyncratic activation of respiratory tract mast cells. In contrast, patients with AERD can usually be treated with COX-2–selective drugs without having these reactions. The fact that structurally diverse NSAIDs that block COX-1 all provoke reactions reflects an enigmatic requirement for COX-1–derived prostaglandins to maintain a tenuous homeostasis. Curiously, the reactions also induce a refractory state in which NSAIDs can be used with diminished or no sequelae (desensitization); in fact, after desensitization, high-dose aspirin has therapeutic benefits. Insights into the mechanisms responsible for the pathogenesis of AERD or its treatment have been limited.

Read full text:

http://www.nejm.org/doi/full/10.1056/NEJMcibr1514013

Beware of Allergy on EAACI Congress 2014 in Copenhagen, Denmark

The European Academy of Allergy and Clinical Immunology (EAACI) and Asthma-Allergy Denmark are launching an outstanding campaign with a high-impact street action to increase awareness of the burden and seriousness of allergy. Allergy is a public health problem of pandemic proportions that affects more than 150 million people in Europe, where it is the most common chronic disease1. According to experts, 1 out of every 3 children have an allergy and they expect the disease to affect more than 50% of all Europeans in 10 years’ time. Furthermore, up to 1 in 5 allergic people suffer a serious debilitating disease and are in fear of death from a possible asthma attack or anaphylactic shock1. Anaphylaxis is a severe, generalised allergic reaction largely caused by food, drugs and insect bites.

2014 Guidelines on Severe Asthma

Dear friends I am happy to share with you new Guidelines on Severe Asthma which was published in European Respiratory Journal last week!

Severe or therapy-resistant asthma is increasingly recognised as a major unmet need in Respiratory medicine at the global level. A Task Force, supported by the European Respiratory Society and American Thoracic Society, reviewed the definition and provided recommendations and guidelines on the evaluation and treatment of severe asthma in children and adults. 

It is hoped that the current emerging understanding of the immunopathobiology of severe asthma, of biological agents and of emerging inflammatory and molecular phenotypes will generate and lead to safe and effective biomarker-driven approaches to the therapy of severe asthma. 

Kian Fan Chung, Sally E. Wenzel, Jan L. Brozek, Andrew Bush, Mario Castro, Peter J. Sterk, Ian M. Adcock, Eric D. Bateman, Elisabeth H. Bel, Eugene R. Bleecker, Louis-Philippe Boulet, Christopher Brightling, Pascal Chanez, Sven-Erik Dahlen, Ratko Djukanovic, Urs Frey, Mina Gaga, Peter Gibson, Qutayba Hamid, Nizar N. Jajour, Thais Mauad, Ronald L. Sorkness, and W. Gerald Teague
International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma Eur Respir J 2014 43:343-373; published ahead of print 2013, doi:10.1183/09031936.00202013

European Parliament Written Declaration on recognising the burden of allergic disease

Dear Respiratory Friends now you can sign European Parliament Written Declaration on Recognizing the Burden of Allergic Disease!

 

Allergic diseases affect over 150 million Europeans, of whom some are affected by severe, debilitating diseases, but these are neglected as a public health concern.
Members of the European Parliament now have an opportunity to call on the European Commission and EU Member States to take action by signing a Written Declaration on Recognising the Burden of Allergic Disease, which opened for signatures in October 21st and will remain open until January 21, 2014.

1. More than 150 million EU citizens suffer from chronic allergic diseases, half of whom are undiagnosed due to a lack of awareness and shortage of medical specialists;

2. More than 100 million Europeans suffer from allergic rhinitis and 70 million from asthma,the most common non-communicable diseases in children and the main cause of children’s emergency room visits and hospital admissions;

3. More than 17 million Europeans suffer from food allergies or severe allergies implying a risk of acute attacks or anaphylaxis with life-threatening potential;

4. Allergies are an underestimated cause of unhealthy ageing and have a severe impact on social, professional and educational performance, especially in children, causing socioeconomic inequalities;

5. The Commission is therefore called upon to encourage cooperation and coordinationbetween Member States to promote: national allergyprogrammes to reduce the disease burden and health inequalities; training in allergies and multidisciplinary care plans to

improve disease management; use of preventive and tolerance-inducing approaches toallergy treatment; and scientific research into direct and indirect allergy risk factors,including pollution;

6. This declaration, together with the names of the signatories, is forwarded to the Commission.