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Asthma, Allergy and Clinical Immunology of Chester County

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TIme for a Hike …. and a smoke???

April 14, 2013 No comments

It is a beautiful spring Sunday afternoon. I got the “honey-do” list mostly done — as we all know it is never completely done — and began to work on an allergy advocacy project. As I sit at my desk, editing slide after slide I realized it is too nice to sit inside and be stuck at a computer. So off to the woods I go with my dog, Zeus.

 

Zeus is still a pup, 10 months old now, and has not really been on any major hikes. For those of you that don’t know I like to hike. Once the weather breaks, there is nothing like spending a few hours hiking the Appalachian Trail (AT) — peace and quiet and lots of time to recharge the batteries. Anyway, back to the point, Zeus is still a pup and needs to be conditioned more for hiking in the woods and for long distance hiking. Fortunately, I live close to a local national park that has some good hikes for training. So off we went.

 

It was a nice day for a hike. Not too cold nor too hot and lots of folks had the same idea today — get outside and go for a hike. So off we went to go up and over and then back up and over Mt Misery — sounds terrible but it is really not that bad a hike. Saw lots of folks on the trail, even some trails runners and bikers. All in all not a bad hike. Zeus did pretty good to. This was his second time out in the woods so he spent a little too much time sniffing everything and needed to be coaxed along a bit – but other than that he did pretty good.

 

So we get back to the trail head and we were hanging out in a field. Zeus needed to cool down and get a drink. Then it hits me, cigarette smoke. A couple that was in front of us on the hike were hanging out in the same field and then decide to “light em up”. Seriously! You just spent the past hour or so out for a nice hike and you reward yourself by having a cigarette. Dang, that is just not a good choice.

 

Lesson for the day: get outside, be mobile, walk your dog, go for a hike, a run or a bike ride. BUT on a nice day don’t go outside for a hike and a smoke. See you on the trails.

Allergy Conjunctivitis, Allergy Rhinitis, Asthma, Food Allergy, Hives / Urticaria none

Spring is Springing

March 20, 2013 No comments

Well today is the Spring equinox and the official first day of spring — and a balmy 45 degrees it is. One could also say this is the first official day of the spring allergy season — early trees are pollinating and folks are getting symptomatic. I thought now might be a good time to go over some spring allergy tips.

The Do’s

-keep window closed to keep pollens from drifting inside; if need be consider using your A/C

-minimize early morning activity — pollen levels are usually higher in the early morning

-keep car windows close when traveling

-stay inside when the pollen count or humidity is high and on windy days when dust and pollen are getting blown around

-take your medication as perscribed by your Allergist/Immunologist

-if your symptoms are not being controlled called your Allergist/Immunologist and discuss the role of allergy vaccine therapy

 

The Don’t s

-Don’t take more medication than is prescribed

-Don’t mow lawns or be around freshly cut grass

-Don’t rake the leaves

-Don’t hang your clothes outside to dry

 

 

 

Allergy Conjunctivitis, Allergy Medications, Allergy Rhinitis, Allergy Shots, Asthma, Atopic Dermatitis, Pollen, Pruritis, Sinusitis, Skin testing none

Hand Washing

December 3, 2012 4 comments

Over the past several years there has been great attention focused on health care practitioners and their hand washing – or lack there of. Recently, one institution has gone so far as to install cameras in their ICU and in real time monitor handwashing behavior. A little extreme but, I guess, if the staff is to lazy to wash their hands so be it. Clearly, hand washing is very important and simple infection control measure.

The other week I walked into a patient room. I put all my stuff (computer, pen, otoscope and ophthalmoscope) down and washed my hands. In this case, using a hand gel. I then introduced myself and shook hands with my patient. Then the patient then said the craziest thing — “Why don’t you make patients wash their hands?”.  I was at a loss for words. The patient expounded, that if we as patients expect you as Doctors to wash your hands, why don’t you expect us to wash our hands. We are just as “dirty” as you are and we’re the reason that you will get sick and others will get sick. Wow! I didn’t really know what to say except “Good point” and I passed the patient the hand gel. We had a good laugh and then went to work.

This anecdote brings up a very good point and a very difficult point. Physician hands certainly can spread alot of germs and appropriate hand washing will certainly reduce that spread. This is just good ole common sense — grandma was pretty darn smart ID Doc. But we are only addressing half the vectors. Patients don’t wash their hands when they come into the office. How many germs are they bringing in and leaving behind? What kind of pathogens are they leaving behind on my hands after I shake their hand? Are we missing an opportunity to reduce the spread of MRSA, C diff and other pathogens that are floating around in the community.

Asking patients to wash their hands would be very tricky. I remember years ago, in Med School or residency, when a patient complained that another colleague didn’t want to touch them because of the rash they had. The patient was very offended that the staff (and I can’t remember if this was a med student, nurse, resident or who it was) implied that they sick and potentially infectious. They felt like they were not being treated like a human being. These are very good and valid points. Healthcare is about relationships and touch is a very important part of establishing a human relationship. Touch is a powerful healer. But what is that patient was carrying MRSA, Cdiff or other highly infectious agent on their skin? Is it right for patients to assume that physicians must risk their health in order to care for the patient? Is it acceptable for a uninfected physician to now become colonized with a pathogen and then become the vector that infects others ?

Difficult questions and scenarios. But it is interesting to think about. Why is it assumed that Doctors have dirty hands and not patients? Think about that the next time you shake a patients hand.

 

Allergy Conjunctivitis, Allergy Rhinitis, Anaphylaxis, Asthma, Atopic Dermatitis, Drug Allergy, Food Allergy, hand washing, Hives / Urticaria, Immunodeficiency, Infectious Disease, Sinusitis none

Sport Physicals

August 27, 2012 No comments

Over the past several weeks I have been seeing signs posted around town for what I would call “drive by sports physicals”. School is starting and so is the fall sports season. Most schools / community athletic programs requires the athlete to have had a complete physical and the “OK” to play that sport. This is a very good thing, sports, especially competitive sports are very demanding and if the athlete is not prepared or has an underlying medical condition there can be bad outcomes — i.e. death.

What I find very disturbing, is that many organizations, treat these sports physicals as money making ventures. Come on in, no appointment necessary, we can have you in and out in 5 minutes and we will only charge you $25. No need to see you regular Doctor. Over the past several months I have be prviy to high level discussion about sports physicals. What is clear is that only those who are thoroughly trained and committed to keeping up on the latest standards are qualified to perform these exams. Witness this recent article (http://www.amjmed.com/article/PIIS0002934312002823/abstract?rss=yes) about the potential liability surrounding these activities.

So the next time your son or daughter needs a sports physical, ask yourself this question, ” Is the life of my child really worth the risk of a corner store sports physical? ” Just a thought.

Uncategorized none

Newer is not necessarily better.

August 1, 2012 No comments

I came across this article (http://opinionator.blogs.nytimes.com/2012/05/27/in-medicine-falling-for-fake-innovation/?ref=health ) written by one of the faculty at UPenn. In this article he discusses how a new technology, the daVinci Surgical Robot system, while an innovative and cutting edge technology, has increased heatlhcare costs but does not seem to have a corresponding significant improvement in patient care or reduction in health care costs. In fact, there seems to be some evidence that for certain procedures, prostate cancer surgery, this new technology may increase complications.  This commentary raises a very interesting point about healthcare: Why do Doctors always have to do something to a patient?

 

Why do Doctor’s always have to do something to a patient? What does that mean? Aren’t Doctors suppose to “treat” patients? Aren’t Doctors suppose to do something? Prescribe a pill?, Order a CT scan?, Draw lab work?  There seems to be have developed, an expectation over the past few years, that physicians must do something: order the newest test, use the newest medication, utilize the latest high tech surgical tool. Obviously newer is better. Or is it?  Part of this belief that newer is better is ingrained in physician training and what the expectation of treatment is:  we see a patient, make a diagnosis and then we must order a test, prescribe a medication, do a procedure.  We must do something or we are a bad Doctor. Compounding this issue is that throughout training physicians are taught all the latest innovations. One becomes a “superstar” in training by quoting the latest research paper, utilizing the latest lab test or newest medication to treat a patient. The perception is the doing something is always better and the best physicians are always adopting the latest medication or technology first. But is this the best approach to medical care?

 

Healthcare organizations are just are culpable for perpetuating this myth. How many times have you seen ads that tout we are the first to offer fill in the blank technology? We are the only organization in the area that has fill in the blank technology? These ads are very effective. The goal is to “get” more patients to come to the sponsor of the advertisement. The problem as highlighted above is that all this new technology may not improve healthcare. The sad fact is that advertising that “Our Doctors and our organization will do less to improve your health and reduce your healthcare costs” does not advertise well.

 

Patients also have a role to play.  Patients will often say to their physicians something to the effect of “are there any new medications or procedures out there for treatment”.  Or patients will have the expectation, that a physician who offers the “newest cutting edge treatment” or the institution that offer the “latest surgical approach” are the “best” and have the best outcomes.  Using a generic pill that costs pennies to treat hypertension must not be as good as the latest blood pressure pill that the insurance company will not cover. No longer does it seem acceptable to adopt a “watch and wait” approach.  Nor does it seem acceptable not to perform any testing or procedure if they are not warranted. Patients want more testing, more medications more more more. But there is very little thought given to the concept that less is better, older cheap medications may work just as well and the newer and more expensive medicine or technologic breakthrough does not necessarily mean better health or cheaper costs. Given the current state of healthcare in the US, this is a very troubling development.

 

This problem is not something new. It has been around for years. But given the limited resources that are available for healthcare and the economic realities of today it has become more pointed. The question that needs to be asked, is what is going to improve a patients health, societies health and reduce healthcare costs. Physicians need to understand and adopt not what is the latest and greatest but what is the most effective and most cost effective treatment for their patients. Healthcare organizations need to ask what is going to improve the healthcare of their community not what is the slickest ad, about the latest technology, that can be run to improve the bottom line. Patients need to understand that doing nothing is sometimes better than doing something, newer is not always better and more expensive does not mean better outcomes or better care.

 

(As a footnote, this article was published just as I finished this blog http://www.ama-assn.org/amednews/2012/07/30/prse0801.htm )

 

 

Allergy Conjunctivitis, Allergy Medications, Allergy Rhinitis, Allergy Shots, Anaphylaxis, Asthma, Atopic Dermatitis, Drug Allergy, Food Allergy, Hives / Urticaria, Immunodeficiency, Peak Flow meter none

The Power of One

July 24, 2012 1 comment

The past few months and years has not been a good time to be a Penn Stater. The monumental failures in leadership that this organization demonstrated then and and now are well ….. sad. I don’t want to rehash was has already occurred and is occurring now. Those issues are documented and being discussed in many different forums.  What I want to think about about is the power of the One.

 

What if One individual would have stood up and yelled from the tree tops that children were being abused in the showers at Penn State?  What if one individual at Penn State would have had the courage and the leadership to step up and fight for those who were being abused? Would dozens of other children have been sexually abused? Would Penn State being dealing with the issues they are dealing with today? What if one person stood up and called the world’s attention to the predator that existed in this organization, this organization could have stopped horrific crimes from occurring and at the same time been a leader in protecting children from abuse.  The inability of just One, just One individual to stand up and do the right thing would have made a world of difference.

 

Being that One is very difficult. The One who stands up and fights for injustice or others is often ridiculed, defamed or worse. But where we would be without the One’s who are willing to stand up and fight the good fight. Where would we be with the Abraham Lincoln’s, the Rosa Park’s, the Dali Lama’s, the local cop or firefighters of the world? Where would we be without those individuals who take it upon themselves to fight for what is right and good and against evil? Where would we be?

 

Think about Penn State scandal the next time you see an injustice or just simply what to make the world a better place. Think about the impact One individual could have if they simply stood up and made the world take notice. Think about it. Are you willing to be that one?

Uncategorized none

What my dog taught me about living.

July 9, 2012 8 comments

A week or so ago, my chocolate lab died after a very brief illness. Brownie, that was his name, was a great dog. Always friendly. Always looking to play. Always looking to go for a walk. Always willing to steal your food if you weren’t paying attention. Always there to greet you barking, tail waging and ready to lick your face off. Just a great dog.

 

So I knew something was wrong a couple of weeks ago when he well,  just wasn’t his ole self. You have to understand Brownie, given the choice between hanging out and doing something, Brownie is ready to go. Say the word walk and he’s up and ready to go. Say the word hike, and he’s ready for a 5 hour hike in the woods. Brownie has hiked with me up and down the east coast — even had a nice swim in an sub alpine lake in New Hampshire one year.  So a couple of weeks ago, I noticed that Brownie just did not want to walk as far as we normally do. As most dogs go, Brownie had his territory in the neighborhood that we walked and he marked — if you know what I mean.  Usually there was no stopping him from his rounds. But recently, he did not want to make the rounds. And he was puffing a lot more than usual. So I knew something was up. Off to the vet.

 

Cari, our vet, is our neighbors daughter and has taken care of Brownie since we got him. She knew him from being a patient and from the neighborhood. So when we brought the Brown Dog in — actually we had to carry him into the office in a doggie stretcher– she knew something was wrong. She took the history, did a physical, got some lab work and xrays. Not good. Brownie was profoundly anemic and had a very large spleen. We had to take Brownie for an ultrasound of his abdomen to further evaluate his spleen. Got that done and it look like he had auto immune hemolytic anemia. Although with a large spleen the potential for badness was still around.

 

We got a prescription for prednisone and well as prilosec and sucralfate to treat the anemia and protect his stomach. A couple of days went by and Browne started to perk up. He was still panting a lot and not walking as far but he was back to chasing the squirrels out of the yard and barking at cars as they drove by. His check up a week later was ok. He was still anemic and cranking out the nucleated RBC’s. So we continued on the same course. He was perking up. Back to stealing food and looking at you afterward like — “hey you left the cookie so I could reach it so it’s mine”. Then the next day came.

 

My wife and son just got back from a college trip the night before. That’s when the cookie stealing event occurred. That night Brown was all revved up. His people are home — running around like a maniac, barking like a fool, being a nudge, just being the Brown dog. Then the next morning came. Not the same dog. Just not looking right. He spent most of the day outside just laying around – not unusual – except he did not really move from the same spot all day. I got home from work, and got the “Brownie does look good” report from the family.

 

One look at Brown and I knew something bad was going on. He barely picked his head up to say “hello”. Normally he is running around the car barking when I come home. His belly was bigger than normal, his tongue and gums were pale – something catastrophic was happening. My clinical radar was telling me, whatever was going on, was a terminal event. My dog was dying right before my eyes. But that didn’t stop Brownie from being Brownie. As we sat next to Brownie and petted and comforted him he just kept being Brownie. He would move his head to the spot he wanted rubbed. Is we stopped petting him, he turn and look at you, as if to say:” Really, I didn’t say you could stop petting me. Rub my back now”. Over the next hour or so, Brown got significantly worse, his panting was getting heavier, his gums were paler and most concerning his belly was getting bigger — he was bleeding out probably from a tumor in his spleen that ruptured or eroded into a blood vessel.

 

Still, this was not enough to stop Brownie from being Brownie. One of my sons friends had come over. They came outside to see Brownie and sure enough, Brownie seeing someone new in his yard tries to get up and greet his visitor. Even as he was dying, his doggie brain is saying “Hey visitor, get up and sniff him and lick him. Maybe he can pet me as well.” Not too longer after that, Brownie put his head in my lap and passed away.

 

So what did Brownie teach me about living:

 

-always wag your tail when you see friends and family

-chase squirrels — it’s king of fun

-even if you are having a bad day — say hello

-steal a cookie once in a while — they taste pretty good

-go for a walk or a hike — if more fun to sniff the ground that to sleep the day away

-just because your sick doesn’t mean you have to be mean or nasty

-bark more when the people you love and care about come home

-if you want to get petted — just ask

 

Thanks Brown

Uncategorized none

Using fruit to improving anaphylaxis care

April 29, 2012 No comments

I was talking with a colleague the other day about developing an allergy/anaphylaxis education program for a local school district. As these conversations go,we talked about the various aspects of allergy care and how the goal of such a program would be to try and make everyone in a school as comfortable as possible in recognizing and then, providing assistance to a student who may need help. We talked for few more minutes and then she said to me that her daughter, who is not an patient of mine so HIPPA police calm down, has anaphylaxis and for a long time never felt comfortable if she had to use her epinephrine. Before everyone starts screaming, “she needs more education” she did not. She saw a very good Allergist and was instructed in the proper use, storage and indication for epinephrine use. Her mother, the colleague I was speaking with, is a nurse and very comfortable around injectable epinephrine. So I asked how did she, meaning her daughter, get comfortable about having to use her epinephrine. Her response: “An orange”.

“Excuse me”.

She repeated ” An orange.”

“Yeah, that’s pretty funny.  Seriously how did she get more comfortable with her epi”, I replied.

After a few minutes of staring and smiling at me — I think she enjoyed having stumped me — she relayed her story. Her daughter, a teenager, never felt comfortable if she had to ever use her epi. She had been taught the right things by her Doctor. She had an epinephrine trainer. She knew how to remove the cap, inject herself in her outer thigh, count to ten and then call 911. She knew when to use her epinephrine as well. But she was still afraid if it ever came time to use her injectable epinephrine she would not be able to inject herself.

Then one day, my colleagues daughter decided to use her injectable epinephrine — despite not have any symptoms of food allergy and anaphylaxis.

“Tell me she didn’t just inject herself for kicks”, I chimed in.

Well, I must have had an interesting look on my face as, my colleague, just starred at me. Now I have known her for a long time and I thought she was just messing with me and having some fun — at my expense. But I also knew she, from past experience, she usually has some good ideas and comments.

“She used an orange” my colleague casually throws out there.

“Really”.

“Yup, she used her expired injectable epinephrine on an orange”. She explained, her daughter was always afraid that the real epinephrine would be more difficult to use than the trainer. Once she used her expired injectable epinephrine on a orange she realized that the it really was not that difficult and now she has no fear or worries about using her injectable epinephrine.

Well this idea, use your expired injectable epinephrine on an orange,  just became apart of my injectable epinephrine education program.

Don’t you hate it when teenagers teach us lessons!

Allergy Medications, Anaphylaxis, Anaphylaxis treatment plan, Bee Sting Allergy, Epinephrine, Food Allergy, Hives / Urticaria , , , ,

Management of Food Allergy

April 18, 2012 1 comment

I recently became aware of some information that may provide improper advice for those with food allergies. This information suggests that food allergic individuals need not be as vigilant as they should be as long as they have their injectable epinephrine with them. Well, this is just plain wrong!

 

Let’s review some basics about food allergy management. Now this all assumes that one has been properly evaluated and diagnosed as having a food allergy.

 

1.Know what you are allergic to.

2.Read labels and understand what you are eating.

3.Make sure others know what you are allergic to. Don’t accept or eat any food if you are not 100% sure of the                                                           ingredients. 99.999% is not good enough — if you are not sure don’t eat it. Remember food allergy can kill!

4. If you are going to a party or some other function and you are not sure of the foods that will be there, bring your own food.

5.Have an Anaphylaxis Treatment Plan. Know what do in the event of an exposure to your food allergen or if you develop allergy symptoms even if you don’t think there was an exposure to your food allergen. Treat yourself first then figure out what the exposure was later.

6.Always have your injectable epinephrine with you. Remember, if you have an exposure to your food allergen and develop allergy symptoms the treatment of anaphylaxis is use your epinephrine. Benadryl, albuterol and  other medicines can be helpful to treat your symptoms after you use epinephrine.

7.If you use your epinephrine, call 911. Food allergy reactions and anaphylaxis are life threatening reactions and require emergent care, evaluation and treatment. Epinephrine can be life saving but even with the prompt administration of epinephrine and calling 911 there can still be bad outcomes.

 

If you have questions about your medical condition or the medication(s) you are taking speak with your physician.  Always remember, your physicians ethical and professional responsibility is to take care of you!

Anaphylaxis, Anaphylaxis treatment plan, Epinephrine, Food Allergy , ,

Chronic Urticaria

April 17, 2012 No comments

Sarbjit Saini, MD – Associate Professor at JHU. CIU and  response to Anti – IgE therapy. Notes from presentation at 51st Swineford Conference at UVa

 

General Overview about CU:

CU > 6weeks of hives; 80% are idiopathic; 1% prevalence in US; 2F>M

50% better at one year; >20% will have disease >5yr

angioedema predicts more severe disease.

 

Coexpression of angioedema in CIU:

50% Urticaria; 40% have Urticaria and Angio;  10% just angioedema

 

Evaluation of CIU:

exclusion of drug/food (rare);

1/3 with NSAID intolerance;

exclude secondary causes (25% have abnormal thyroid test; thyroid ds is 2 times nl frequency);

consider rare disease (chronic hepatitis, cryoglubulinemia, systemic vasculitis, chronic infections – sinus, dental, H pylori etc)

JACI Feb 2012:hypothyroid 10% CU vs 0.6% in NL

hyperthyroid 2% CU  vs 1%   in NL

20% of thyroid ds before dx with CU

3-4% dx with thyroid disease with 6 months of Cu

 

Systemic W/U of 6000 cases of CU: 

1.6% of cases had other disease with extensive lab w/u

? do we need to do lab w/u in CIU if only rarely find other diseases?

 

Approach to CU:

Non sedating  anti histamine at normal dosing, if not controlled then updose to 4x nl dosing. If not helpful then add H2 blkr, LTRA, and / or change anti histamines. If still not  controlled then consider prednisone burst for 3 – 7 days.

If hives then still persist then into refractory CIU and consider skin biopsy to confirm what is going on and then possibly alternative agents

 

Why Biopsy?

1) confirm histology ( should see edema, vascular dilation, perivascular infiltrate to include lymphocytes, eosinophils and basophils)

2)Characterize infiltrate:

lymphocytre predominant urticaria +/- eosinophils ( ? use sulfasalazine)

neutrophil predominant  (? dapsone or colchicine)

if use alternative agents will need to monitor CBC, LFT’s

  1. Exclude other disorders ( leuokocytoclastic vasculitis, mastocytosis )

 

CYA for CIU:

lymph predominant disease; CYA will inhib T Cells as well as MC and basophils

monitor BP, Cr

 

CIU Proposed Pathophysiology:

trigger of some sort to MC (allergen autoab unkn)

histamine release and other med recruits leukocytes

Basophils are depleted in those with more severe CIU – see basopenia

Suppressed Basophil Histamine Release

Auto ab mechanism:

trigger IgE receptor on MC/Baso; 40% of pts have autoab

looking for autoab assay:

autologous ST, sera for auto ab, HRA with pt sera and donor basophils

these assays don’t cross compare

 

CIU index:

if some possible HRF with see Baso release

or see expression of new markers

25% of nl have positive CIU index – problem

even pt who go into remission still have positive CIU index – problem

no assay is superior; problems with specificity

 

Skin MC in CIU:

release to 48/40 in increased in active CIU vs in CIU remission which suggests reversible skin MC hyper- responsiveness.

MC numbers are not increased in CIU biopsy sites. Nor is tryptase elevated in CIU patients. However, tryptase is slightly higher in CIU vs atopic patients. The skin MC in CIU patients have increased spontaneous histamine releasability.

CD34+ MC have increased spontaneous histamine release

Basophils in CIU:

decreased in blood and are recruited to lesional and non lesional tissue

Basophil Histamine Release via FcER1 is reduced during disease and rises in remission

 

Two functional phenotypes of basophils seen on CIU

Responders (R) and Non responders (NR) – based upon histamine release to polyclonal anti IgE: CIU – R and CIU – NR

Longitudinal follow up of these pt – those with active disease stay in the same phenotype but with remission: baso fxn changed from suppressed to non suppressed state as get better

Also will see # of blood basophils increase with remission – ** blood basophils counts are based upon 120cc of blood. This amount was needed to be drawn and basophils counts done to see difference. Typical CBC basophil count probably not enough volume.

 

Why Xolair in CIU?:

Xolair impairs ability of IgE to bind to receptor; dec # of FcERI, decrease meds and decreased symptoms. We know this from asthma, AR.

 

Xolair decrease IgE within a few days then decreases basophil surface IgE and FcERI and function. Then see MC change with tissue MC taking months to drop b/c so longed lived take a long time to drop receptors

 

Reasons why Xolair might be helpful in CIU:

We know that there is MC activation with late phase infiltrate. This is accompanied by altered basophil FcERI HR, basophils being recruited to skin lesion and basopenia.

 

Therefore, omalizumab could cause shifts in MC and Baso FcERI function. Be able to distinguish the roles of MC and Baso in CIU based upon onset of action and possibly reduce targets for autoantibodies ( IgE and FcERI)

 

Random DBPC trial: (Goober AAAAI 2008)

20pt; 18-80yo; symptoms >12 wks; can have angioedema; daily H1 blocker; no steroids or other immunosuppresants < 1 month prior to study

Results:

decreased MD urticaria severity score, within first weeks – with rebound as tapered off

pt reported increased symptom free days

basophil # rise with tx within a month and decrease after stopping drug

 

Kaplan Xolair in auto immune urticaria: JACI 2008

pt with posit Baso histamine releasing activity

Phase 2 study of Xoalir in resistant CIU:

within one week see decreased symptom score; can see a dose effect as well ( to some degree)

Some conclusions:

This brisk effect of xolair is much faster than would be expected if due to MC alteration

Xolair helps in both CIU and autoimmune CIU

? long term disease benefit – what happens when they stop

risk of anaphylaxis. malignancy, carry epi, high rate of local rxn

Novel role of IgE as opposed to IgE that sits on cells and binds allergen(s)

Basopenia and basophil FceRI mediated response improve

basophil shifts like natural remission

 

 

Hives / Urticaria, Urticaria , ,
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