Clinical management of food allergy.

J Allergy Clin Immunol Pract. 2015 Jan-Feb;3(1):1-11

Authors: Bird JA, Lack G, Perry TT

Abstract
Food allergies are commonly seen by the practitioner, and managing these patients is often challenging. Recent epidemiologic studies report that as many as 1 in 13 children in the United States may have a food allergy, which makes this an important disease process to appropriately diagnose and manage for primary care physicians and specialists alike. Having a understanding of the basic immunologic processes that underlie varying presentations of food-induced allergic diseases will guide the clinician in the initial workup. This review will cover the basic approach to understanding the immune response of an individual with food allergy after ingestion and will guide the clinician in applying appropriate testing modalities when needed by conducting food challenges if indicated and by educating the patient and his or her guardian to minimize the risk of accidental ingestion.

PMID: 25577612 [PubMed - in process]

Pulmonary Drug Delivery: A Role For Polymeric Nanoparticles?

Curr Top Med Chem. 2015 Jan 8;

Authors: d'Angelo I, Conte C, Miro A, Quaglia F, Ungaro F

Abstract
Pulmonary drug delivery represents the best way of treating lung diseases, since it allows direct delivery of the drug to the site of action, with few systemic effects. Meanwhile, the lungs may be used as a portal of entry to the body, allowing systemic delivery of drugs via the airway surfaces into the bloodstream. In both cases, the therapeutic effect of the inhaled drug can be optimized by embedding in appropriately engineered inhalable carriers, which can protect the drug against lung defense mechanisms and promote drug transport across the extracellular and cellular barriers. To this purpose, the attention has been very recently focused on polymeric nanoparticles (NPs). The aim of this review is to offer an overview on the recent advances in NPs for pulmonary drug delivery. After a description of the main challenges encountered in developing novel inhaled products, the design rules to engineer polymeric NPs for inhalation, and in so doing to overcome barriers imposed by the lungs anatomy and physiology, are described. Then, the state-of-art on inhalable biocompatible polymeric NPs based on enzymatically-degradable natural polymers and biodegradable poly(ester)s is presented, with a special focus on NP-based dry powders for inhalation. Finally, the in vitro/in vivo models useful to address the never-ending toxicological debate related to the use of NPs for inhalation are described.

PMID: 25579350 [PubMed - as supplied by publisher]

Use of Pulmonary Arterial Hypertension-Specific Therapy in Non-WHO Group I Pulmonary Hypertension.

South Med J. 2015 Jan;108(1):51-7

Authors: Shujaat A, Bellardini J, Cury JD, Bajwa AA

Abstract
OBJECTIVES: The development of pulmonary hypertension (PH) in non-World Health Organization group I PH adversely affects exercise capacity. It is unclear whether pulmonary artery hypertension (PAH)-specific drugs improve pulmonary hemodynamics and exercise capacity in such patients.
METHODS: We performed a retrospective chart review of consecutive patients with non-World Health Organization group I PH treated with PAH-specific therapy.
RESULTS: We identified 24 patients. The mean (standard deviation) age was 48 (14.8) years. Seventeen (71%) patients were women. The 6-minute walk distance improved significantly for the whole group in an initial follow-up period of 4.6 (2.3) months; however, the improvement was seen only in patients with obstructive sleep apnea (OSA) or severe PH and it was not sustained during a longer follow-up period of 11.5 (4.1) months, except in patients with OSA. PH was treated with a variety of PAH-specific drugs, including combination therapy in five patients.
CONCLUSIONS: The use of PAH-specific therapy in selected patients with PH secondary to lung diseases, OSA, or sarcoidosis may result in significant improvement in 6-minute walk distance, particularly in patients with OSA or severe PH.

PMID: 25580759 [PubMed - in process]

A comparison of cardiopulmonary exercise test and 6 minute walking test in determination of exercise capacity in chronic obstructive pulmonary disease.

Tuberk Toraks. 2014 Dec;62(4):259-266

Authors: Çiftci F, Şen E, Akkoca Yıldız Ö, Saryal S

Abstract
Introduction: This study aimed to determine the relationship of 6 minute walking test (6MWT) and cardiopulmonary exercise test (CPET) with each other and with the measures of lung functions in patients with chronic obstructive pulmonary disease (COPD). Materials and Methods: Pulmonary function tests, 6MWT, and CPET were performed in 36 (35 males, 1 female) patients with moderate and severe COPD. Results: Maximum oxygen uptake was significantly correlated with 6 minute walking distance. Both exercise tests were correlated with pulmonary function tests. However, maximum exercise capacity was more closely correlated with measures of lung function than 6MWT. Both tests were significantly correlated with static lung volumes. Inspiratory capacity (IC) was significantly correlated with 6MWT and CPET parameters. CPET was significantly correlated with diffusion capacity and maximal inspiratory pressure. Airway conductance and resistance tests showed no correlation with the exercise tests. Conclusion: 6MWT is a simple and valuable test to determine the exercise capacity of COPD patients. Both 6MWT and CPET are correlated with ventilatory impairment determined by the lung function tests, particularly FEV1, maximum voluntary ventilation (MVV), and IC. However, CPET is an exercise test that more accurately evaluates and provides more detailed information about hyperinflation and respiratory musce strength than 6MWT does.

PMID: 25581689 [PubMed - as supplied by publisher]