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Saudi Arabia says has 113 more MERS cases than previously thought

Saudi_MERSSaudi Arabia announced a jump of nearly 50 percent in deaths from a new virus on Tuesday after re-examining old data that also showed the number of infections since 2012 was a fifth higher than previously reported.

The increase in total confirmed cases of Middle East Respiratory Syndrome (MERS) to 688 from 575, and the rise in deaths from the virus to 282 from 190, came in a review of data ordered by the Health Ministry last month.

The sharp increase in deaths now attributed to MERS, which causes coughing, fever and pneumonia in some, means the mortality rate from the virus in Saudi Arabia is now 41 percent, instead of the 33 percent previously thought.

However, the ministry said that although the total number of historical cases had risen, the rate of infection in the most recent outbreak appeared to be slowing.
Of the total, 53 patients were still being treated, while 353 had recovered, the statement said. ...

Aspirin desensitization: useful treatment for chronic rhinosinusitis with nasal polyps (CRSwNP) in aspirin-exacerbated respiratory disease (AERD)?

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AspirinAspirin intolerance syndrome is due to disturbances in the arachidonic acid metabolism implicating both the lipoxygenase and cyclooxygenase pathways. This results in imbalances of eicosanoid, leukotriene and prostaglandin synthesis. Thus, preinflammatory cysteinyl leukotrienes increase and antiinflammatory prostaglandins (PG) such as PGE2 decrease.

Clinically, intolerance reactions to nonsteroidal antiinflammatory drugs (NSAIDs) can lead to different clinical manifestations; five phenotypes of the aspirin intolerance syndrome are listed in the ENDA classification.

Aspirin-exacerbated respiratory disease (AERD) is the most common phenotype characterized by an eosinophil-dominated inflammatory disease of the airways that presents clinically with nasal polyps, chronic sinusitis and bronchial asthma. About 34 % of patients with aspirin-induced asthma and rhinosinusitis are thought to have AERD. Important biochemical findings in many AERD patients are increased basal leukotriene levels (at least in cell cultures) that excessively increase after intake of COX-1 inhibitors. Aspirin desensitization uses the repetitive application of aspirin to induce a tolerance to NSAIDs, especially COX-1 inhibitors. After a dose-increase phase reaching a threshold dose, a dose-continuation phase is performed.

For application, the nasal, bronchial, oral and intravenous routes have been described.
Aspirin desensitization has been proven to be efficacious and safe and was able to reduce the need for other medications in AERD patients.

Determinants of Allergic Rhinitis in Young Children with Asthma.

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rhinitisIn the preschool period, allergic rhinitis (AR) is infrequent and thus under-diagnosed. However, recent works have highlighted the occurrence of AR in toddlers although the causes of AR in this young population remain unknown. The objective of this study was to identify determinants of AR in young children with asthma.

METHODS: We carried out a case-control study of 227 children with active asthma and enrolled in the Trousseau Asthma Program. AR and other allergic diseases (asthma, food allergy and eczema) were diagnosed by medical doctors using standardized questionnaires. Parental history of AR and asthma, biological markers of atopy (total IgE, blood eosinophilia, allergic sensitization towards food and aeroallergens) and environmental parameters were also collected.

RESULTS: Forty one of the children (18.1%) had AR. By univariate logistic regression analysis, AR was mainly associated with peanut sensitization (OR = 6.75; p = 0.002); food allergy (OR = 4.31; p = 0.026); mold exposure (OR = 3.81 p<0.01) and parental history of AR (OR = 1.42; p = 0.046). Due to the strong link between food allergy and peanut sensitization three models of multivariate logistic regression were performed and confirmed that AR is associated with peanut sensitization but also food allergy and mold exposure. A random forest analysis was also performed to explain AR. The results reinforced the logistic analysis that peanut sensitization and mold exposure were the principal determinants of AR.

CONCLUSIONS & CLINICAL RELEVANCE: These results stress the importance of investigating AR in young children with asthma to potentially diagnose a particularly severe allergic asthmatic phenotype. Moreover, these data evoke the hypothesis that peanut could be an aeroallergen.

Anaphylaxis as occupational risk.

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anaphylaxisAnaphylaxis is a severe form of allergic reaction that may cause death. Main triggers of anaphylaxis have been reported to also cause occupational anaphylaxis (OcAn). The purpose of this article was to summarize the current scientific evidence on OcAn and review the specific literature published in 2012 and 2013.

RECENT FINDINGS: Allergens derived from Hymenoptera and natural rubber latex are the most frequently reported triggers of OcAn, but other high and low-molecular weight agents have been described. Among the latter, foods, insects, snakes, chemicals, and medications have been described in the last 2 years. Furthermore, reviews on the clinical significance of immunological contact urticaria as a risk factor for systemic allergic reaction and on Hymenoptera venom immunotherapy have been published.

SUMMARY: OcAn is a serious event, and several agents and occupations have been identified as responsible. In any occupational setting, where there is a worker with a history of previous anaphylactic reactions, and in occupations at greater risk, a written emergency management plan of anaphylaxis episodes, along with the availability of adrenaline and trained personnel, are mandatory. Venom immunotherapy should be considered for patients with Hymenoptera venom allergy.

Management of idiopathic pulmonary fibrosis: selected case reports.

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In 2011, revised international guidelines were issued jointly by the American Thoracic Society, the European Respiratory Society, the Japanese Respiratory Society and the Latin American Thoracic Association, which provide a valuable framework for the diagnosis and management of idiopathic pulmonary fibrosis (IPF). However, due to the complexity of IPF, these guidelines may not comprehensively account for the management of individual IPF patients in clinical practice.

We describe three patient cases that were presented and discussed during the 2013 AIR: Advancing IPF Research meeting in Nice, France. These cases highlight the heterogeneity in the presentation, history and clinical course of IPF, together with expert insights regarding the diagnosis and management of IPF in the real-life setting.

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