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Acupuncture for allergic disease therapy - the current state of evidence.

acupuncture_This review summarizes current evidence for acupuncture treatment of allergies. Several randomized controlled trials have demonstrated a specific effect of acupuncture for allergic rhinitis; while a few studies have shown positive effects for atopic dermatitis, asthma and itch.

Specifically for allergic rhinitis and asthma, acupuncture may be cost-effective in terms of money spent per quality-of-life gained. Acupuncture plays an increasingly important role as an evidence-based therapy for allergy relief and can be recommended as adjunct therapy for allergic rhinitis. Future randomized controlled trials need to further explore acupuncture efficacy for the treatment of itch, atopic dermatitis and asthma.

More experimental research is also needed to investigate mechanisms of action underlying acupuncture for allergy relief.

A Randomized trial of an Asthma Internet Self-management Intervention (RAISIN): study protocol for a randomized controlled trial.

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A Randomized trial of an Asthma Internet Self-management Intervention (RAISIN): study protocol for a randomized controlled trial.

Trials. 2014 May 24;15(1):185

Authors: Morrison D, Wyke S, Thomson NC, McConnachie A, Agur K, Saunderson K, Chaudhuri R, Mair FS

Abstract
BACKGROUND: The financial costs associated with asthma care continue to increase while care remains suboptimal. Promoting optimal self-management, including the use of asthma action plans, along with regular health professional review has been shown to be an effective strategy and is recommended in asthma guidelines internationally. Despite evidence of benefit, guided self-management remains underused, however the potential for online resources to promote self-management behaviors is gaining increasing recognition. The aim of this paper is to describe the protocol for a pilot evaluation of a website 'Living well with asthma' which has been developed with the aim of promoting self-management behaviors shown to improve outcomes.
METHODS: The study is a parallel randomized controlled trial, where adults with asthma are randomly assigned to either access to the website for 12 weeks, or usual asthma care for 12 weeks (followed by access to the website if desired). Individuals are included if they are over 16-years-old, have a diagnosis of asthma with an Asthma Control Questionnaire (ACQ) score of greater than, or equal to 1, and have access to the internet. Primary outcomes for this evaluation include recruitment and retention rates, changes at 12 weeks from baseline for both ACQ and Asthma Quality of Life Questionnaire (AQLQ) scores, and quantitative data describing website usage (number of times logged on, length of time logged on, number of times individual pages looked at, and for how long). Secondary outcomes include clinical outcomes (medication use, health services use, lung function) and patient reported outcomes (including adherence, patient activation measures, and health status).
DISCUSSION: Piloting of complex interventions is considered best practice and will maximise the potential of any future large-scale randomized controlled trial to successfully recruit and be able to report on necessary outcomes. Here we will provide results across a range of outcomes which will provide estimates of efficacy to inform the design of a future full-scale randomized controlled trial of the 'Living well with asthma' website.Trial registration: This trial is registered with Current Controlled Trials ISRCTN78556552 on 18/06/13. http://www.controlled-trials.com/ISRCTN78556552/raisin.

PMID: 24884722 [PubMed - as supplied by publisher]

New insights into the allergic march.

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The allergic march of childhood describes an association between atopic dermatitis, IgE-mediated food allergy, allergic asthma, and allergic rhinitis that begins with an atopic family history. This review summarizes recent insights into the nature of these conditions and their associations.

RECENT FINDINGS: In recent years, common allergic diseases have become more prevalent and increased rates of food allergies remain incompletely understood. This review explores a newly described major genetic risk factor, a mutation in the skin matrix protein filaggrin, as it relates to the allergic march of childhood. New paradigms of understanding the interrelationships between atopic dermatitis, food allergy, and asthma are described. A surge of investigative effort has been directed toward the prevention and treatment of food allergy. Risk factors for allergic asthma in young children have been used to predict patient response to treatment. A recent practice parameter on furry animal/pet avoidance updates current understanding of allergen avoidance in modifying allergic phenotypes.

SUMMARY: Understanding of the interrelationships of atopic diseases allows earlier diagnosis of allergic conditions in at-risk patient populations and may lead to novel approaches to health promotion and disease prevention.

Living on the edge of asthma: A grounded theory exploration.

Most asthma-related emergency department (ED) visits and hospitalizations for asthma are preventable. Our purpose was to develop a grounded theory to guide interventions to reduce unnecessary hospitalizations and ED visits.

DESIGN AND METHODS: Grounded theory inquiry guided interviews of 20 participants, including 13 parents and 7 children.

RESULTS: Living on the edge of asthma was the emergent theory. Categories included: balancing, losing control, seeking control, and transforming.
PRACTICE IMPLICATIONS: The theory provides the means for nurses to understand the dynamic process that families undergo in trying to prevent and then deal with and learn from an acute asthma attack requiring hospitalization or an ED visit.

Aspirin Activation of Eosinophils and Mast Cells: Implications in the Pathogenesis of Aspirin-Exacerbated Respiratory Disease.

Reactions to aspirin and nonsteroidal anti-inflammatory drugs in patients with aspirin-exacerbated respiratory disease (AERD) are triggered when constraints upon activated eosinophils, normally supplied by PGE2, are removed secondary to cyclooxygenase-1 inhibition. However, the mechanism driving the concomitant cellular activation is unknown.

We investigated the capacity of aspirin itself to provide this activation signal. Eosinophils were enriched from peripheral blood samples and activated with lysine ASA (LysASA). Parallel samples were stimulated with related nonsteroidal anti-inflammatory drugs. Activation was evaluated as Ca(2+) flux, secretion of cysteinyl leukotrienes (CysLT), and eosinophil-derived neurotoxin (EDN) release. CD34(+) progenitor-derived mast cells were also used to test the influence of aspirin on human mast cells with measurements of Ca(2+) flux and PGD2 release. LysASA induced Ca(2+) fluxes and EDN release, but not CysLT secretion from circulating eosinophils. There was no difference in the sensitivity or extent of activation between AERD and control subjects, and sodium salicylate was without effect. Like eosinophils, aspirin was able to activate human mast cells directly through Ca(2+) flux and PGD2 release. AERD is associated with eosinophils maturing locally in a high IFN-γ milieu. As such, in additional studies, eosinophil progenitors were differentiated in the presence of IFN-γ prior to activation with aspirin. Eosinophils matured in the presence of IFN-γ displayed robust secretion of both EDN and CysLTs.

These studies identify aspirin as the trigger of eosinophil and mast cell activation in AERD, acting in synergy with its ability to release cells from the anti-inflammatory constraints of PGE2.

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