Management of Inflammation in Allergic Asthma (IRINE Symposium)
Allergic inflammation as a cause of asthma is now well recognized. New methods of identification of allergen-specific IgE including improved in vitro technologies will require optimization of the lowest threshold for the detection of allergen-specific IgE in order to maximize sensitivity without loss of specificity, thus allowing for significant enhancement in a clinical setting for determination of allergen-specific IgE levels. New concepts of allergic inflammation include the recognition that significant histologic changes may occur even in the mildest allergic patients. Thus, early intervention with anti-inflammatory therapies including corticosteroids or inhaled nedrocromil sodium appears clearly warranted based on these early pathological changes occurring in asthmatic individuals. Inhaled corticosteroids have been demonstrated to prevent pathological changes that otherwise occur in asthmatic patients whose sole therapy is use of inhaled B2 agonist. Corticosteroids have also been noted to be successful in the prevention of progression of pathological changes including the development of bronchiectasis in asthmatic patients with allergic bronchopulmonary fungoses. Allergen-specific immunotherapy may be successfully used in selective asthmatic patients allergic to pollen, dust mite, or certain mold allergens including Alternaria. Immunotherapy appears to be most useful in those patients who are allergic to one rather than many allergens and whose asthma is not associated with other significant precipitating factors such as chronic rhinosinusitis or aspirin sensitivity. The risk of systemic reactions to allergen immunotherapy in the asthmatic patient is significant. Although benefits may accrue from allergen-specific immunotherapy, those patients with unstable asthma, including those whose FEV1 is less than or equal to 70% predicted, appear at greatest risk for having disease exacerbation induced by such immunotherapy. Management of asthmatic inflammation thus requires identification and avoidance of those allergens responsible for initiation of the allergic asthmatic response and the use of appropriate anti-inflammatory therapy, including inhaled nedocromil sodium, an agent having a high risk-to-benefit ratio because of its low degree of toxicity and inhaled corticosteroids, agents which have been most clearly proven to prevent pathological changes in the asthmatic lung. Those patients presenting with early mild to moderate asthma may potentially be protected from the development of irreversible pathological changes through early intervention employing anti-inflammatory therapy.
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Document Type: Research Article
Publication date: 1994-11-01
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- Allergy and Asthma Proceedings is a peer reviewed publication dedicated to distributing timely scientific research regarding advancements in the knowledge and practice of allergy, asthma and immunology. Its primary readership consists of allergists and pulmonologists.
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