The management of allergic patients; the role of the internist

There has been an increasing trend in the United States toward intensive specialization in allergic diseases. Whereas the tendency toward specialization has led to greater knowledge of the scientific aspects of allergic phenomena, it has somewhat diverted the specialists' attention from the many clinical problems that await solution. Effective treatment of the allergic patient depends in no small measure on the broad viewpoint and clinical experience of the internist. This fact has been reemphasized by the growing awareness of the significance of the secondary or precipitating causes, such as climatic, nutritional, hormonal and psychogenic factors which influence allergic manifestations. Overemphasis on specialization in allergic diseases with their wide ramifications may defeat the main objective-a successful therapeutic result. To meet this challenge, the internist should be trained in allergy and yet retain a broad approach to the more basic problems of internal medicine. This objective may be attained by certain modifications in undergraduate medical instruction in allergy. Postgraduate training sponsored by our national allergy societies affords internists an excellent opportunity to advance their knowledge of clinical allergy.     

THE MANAGEMENT OF ALLERGIC PATIENTS—The Role of the Internist

There has been an increasing trend in the United States toward intensive specialization in allergic diseases. Whereas the tendency toward specialization has led to greater knowledge of the scientific aspects of allergic phenomena, it has somewhat diverted the specialists'' attention from the many clinical problems that await solution.Effective treatment of the allergic patient depends in no small measure on the broad viewpoint and clinical experience of the internist. This fact has been reemphasized by the growing awareness of the significance of the secondary or precipitating causes, such as climatic, nutritional, hormonal and psychogenic factors which influence allergic manifestations. Overemphasis on specialization in allergic diseases with their wide ramifications may defeat the main objective—a successful therapeutic result.To meet this challenge, the internist should be trained in allergy and yet retain a broad approach to the more basic problems of internal medicine. This objective may be attained by certain modifications in undergraduate medical instruction in allergy. Postgraduate training sponsored by our national allergy societies affords internists an excellent opportunity to advance their knowledge of clinical allergy.     

Mechanisms underlying eosinophil trafficking and their relevance in vivo

After their formation in the bone marrow, eosinophils circulate with a short half-life and are distributed throughout the body, especially in mucosal and sub-mucosal regions. Although a small amount of these cells are normally seen in healthy tissue, blood and tissue eosinophilia is a hallmark of helminthic and allergic diseases. The role of eosinophils in the normal physiology of mucosal tissues is not understood, but there is good evidence to demonstrate that these cells protect the host at least against some intestinal helminths, specially those with a lung cycle. In addition, there are now many data that support a role for eosinophils in the pathophysiology of allergic diseases, such as asthma. Because helminthic diseases have been largely controlled in developed countries, there has been much interest in the development of drugs which affect eosinophil migration and/or activation in the tissue and which may, thus, be useful in the treatment of allergic conditions. The understanding of the mechanisms controlling eosinophil trafficking and/or activation are essential in the development of anti-eosinophil-based therapeutic strategies. The present paper reviews aspects of eosinophil biology with emphasis on the role of eosinophils in parasitic infections and allergy, the basic mechanisms underlying the trafficking of eosinophils into tissue and how these can be modulated pharmacologically.     

Current Concepts in Dermatology: III. The Use of Radiotherapy and Corticosteroids

The use of ionizing radiation and corticosteroids is discussed, in this third and final part of a review of diseases of the skin. Radiation is being used less extensively because superior methods of treatment are available for many conditions which formerly were frequently treated by this modality. The concept of applying the radiation at the level of the basic pathologic process has been developed into clinical practice by the use of generators which can produce very soft (or superficial) ionizing radiation. Topical or systemic corticosteroids do not cure skin diseases but produce dramatic suppression of signs and symptoms. For best results consideration must be given to the diagnosis, the natural history of the disease to be treated, the method of administration and a search for possible contraindications to the use of these steroids. Basic dermatological principles (removal of offending agents, bland soothing applications, sedation, etc.) must be adhered to. The corticosteroids are not a panacea in the treatment of skin disease.     

儿童慢性腹泻病因分析

目的探讨儿童慢性腹泻的病因,以提高临床诊治水平。方法选择2005年12月至2010年12月在重庆医科大学附属儿童医院住院的141例慢性腹泻患儿为研究对象,对患儿的临床资料进行回顾性分析。结果本组病例中常见致病因素依次为过敏因素46.2%(24/52)、肠道内感染28.4%(40/141)、乳糖不耐受28.3%(26/92)。共109例明确病因诊断,55.1%(60/109)为多因素共同致病,以肠道内感染合并继发乳糖不耐受,过敏合并继发乳糖不耐受,免疫缺陷合并肠道内感染多见。前4位主要病因诊断为感染性腹泻(24.1%)、过敏性腹泻(17.0%)、乳糖不耐受(7.1%)、炎症性肠病(6.4%)。结论除肠道内感染外,过敏因素、乳糖不耐受等也是儿童慢性腹泻常见致病因素。儿童慢性腹泻常由多因素共同致病,主要病因除感染性腹泻外,过敏性腹泻、乳糖不耐受、炎症性肠病等也是常见病因。儿童慢性腹泻重在病因诊断,针对病因治疗。     

Marine algae as a potential pharmaceutical source for anti-allergic therapeutics

The prevalence of allergic diseases such as asthma, atopic dermatitis, and allergic rhinitis has increased during the last two decades and contributed a great deal to morbidity and an appreciable mortality in the world. Until now, few novel efficacious drugs have been discovered to treat, control or even cure these diseases with a low adverse-effect profile. Meanwhile, glucocorticoids are still the mainstay for the treatment of allergic disease. Therefore, it is necessary to isolate novel anti-allergic agents from natural resources. Recently, marine algae have received much attention as they are a valuable source of chemically diverse bioactive compounds with numerous health benefit effects. This review focuses on anti-allergic agents derived from marine algae and presents an overview of their pharmaceutical potential in the treatment of allergic disorders.     

肠道微生物与过敏性疾病关系研究进展

目前,过敏性疾病的防治主要依赖于使用抗生素,然而抗生素的滥用已造成了严重的危害。近年来随着肠道微生物相关研究的不断深入以及人们对过敏性疾病的日益关注与重视,肠道微生物与过敏性疾病间的关系逐渐受到科学家们的关注。调整肠道菌群结构可能为过敏性疾病的防治提供新的思路。目前对肠道微生物与过敏性疾病间的相关性报道相对较少且未有深层次的剖析。本文总结了关于肠道微生物与过敏性疾病关系的研究起源、发展与现状,旨在为过敏性疾病的防治提供新策略。     

家庭致敏螨类概述

近年来,随着人们生活水平日益提高,变态反应性疾病的发病率在全世界范围内呈不断上升趋势,受到人们的日益重视,其中家庭螨类是最主要的过敏原之一。本文对蜱螨、家庭螨类的组成及可导致人体过敏性疾病的种类作了简要介绍,并编制了家庭螨类常见目、亚目和科及麦食螨科Pyroglyphidae物种成螨检索表。此外,本文结合变态反应性疾病的相关医学知识及对未来主要研究方向的展望,为螨过敏性疾病的流行病学调查及防治提供了一定的参考价值。     

THE ROLE OF THE CONNECTIVE TISSUE GROUND SUBSTANCES (MUCOPOLYSACCHARIDES) IN ALLERGIC INJURY

The basic histologic reactions of the classic allergic diseases and of several systemic diseases in which allergic mechanisms appear to operate are described and illustrated. Particular attention is drawn to the ground substances—mucopolysaccharides—which constitute important elements of connective tissue and vascular structure. The intimate locus of the allergic reaction appears to be in and to involve a swelling of such substances. It is suggested that antibodies (and possibly antigens) may be attached to these mucinous ground substances of the connective tissues.     

基于HIS模型建立肝病知识库对军队医院的作用及意义

目的:通过整合302医院丰富的肝病病例、肝病专家诊疗经验和临床科研数据,建立肝病知识库,提高基础资源辅助临床诊疗和科研的能力。方法:对肝病智能知识模型进行分析,获取知识库中结构化知识,并以知识库模型的形式建立知识库,形成一套独立、可重复的智能化的辅助诊疗和科研信息系统,实现知识库辅助临床诊疗、知识科学研究,最大程度发挥知识库的意义,真正为临床服务。结果:建立的基于HIS的肝病知识库主要编配于医疗单位,适用于临床医护人员、临床科研人员以及所有从事医疗行业的工作人员。医护工作者可通过程序访问知识库,对知识库中的肝病知识进行检索、分析、推理,辅助临床医护工作者提高临床诊疗能力,提升临床科研水平。结论:建立的肝病知识库系统为用户提供横向及纵向医疗基础信息的检索、分析及推理方法。推理出的合适的知识模型,为肝病的临床诊疗和临床科研提供前沿、实用、高效的智能辅助信息支持。     

Current directions of studies for development of methods for specific diagnostics of allergic diseases in vitro

Results of studies as well as perspectives for development and use of modern in vitro methods of allergic diseases diagnostics are presented. High prevalence of allergic diseases dictates the need of high-quality etiologic diagnosis for conducting relevant etiopathogenetic treatment - allergen-specific immunotherapy and prophylactic measures. Interest to in vitro diagnostic methods due to their high specificity and commonality is rising. They are directed to identification of various elements of "material substrate" of allergic reaction - specific antibodies, cell elements, cytokines as well as genes, which encode them. Intensively developing methods based on immunoenzyme, immunofluorescent, and immunochemiluminescent reactions are widely used now. Methods based on the use of various monoclonal antibodies for identification of lymphocytic markers, cytokines, antigen-presenting cells by laser flowcytometry are also very promising. ELISPOT technology is also intensively used for diagnostics of allergic diseases. From immunogenetic methods great potential belongs to molecular biologic methods of assessment of genome specificity characterizing sensitization to given antigen.     

Present status and future prospects for the hybridoma technology

Summary A somatic cell genetic technique has recently been developed that makes it possible to obtain very large amounts of homogeneous antibodies and to replenish the supply of the exact same antibodies whenever they are needed. This hybridoma technology has already contributed to major scientific advances and will surely improve the diagnosis and treatment of many diseases. Because the technology itself is relatively simple and inexpensive, it has captured the attention of basic scientists, clinicians, and industrial managers and investors. This work was supported by National Institutes of Health Grants AI 10702 and AI 5231, National Science Foundation Grant PCM77-25635, and American Cancer Society Grant NP-317.     

New approaches for allergen-specific immunotherapy

Rates of allergic diseases such as asthma and rhinitis are on the rise as important health problems in every country of the world. Allergen specific immunotherapy with natural allergenic extracts is a treatment directed to changing the natural course of these diseases, and is a treatment that has reported beneficial effects in a majority of allergic patients. However, this treatment is difficult because of the complex composition of the extracts. The composition is difficult to standardize and, consequently, the risk of anaphylactic shock is increased; furthermore, sensitization can occur to other antigens present in the extract. Therefore, new allergen specific immunotherapy approaches are needed. Chemically defined and standardized antigens are more easily managed and provide a safer and more efficient treatment. Vaccines for immunotherapy have already been designed, based on recombinant allergens, variants (or peptides derived from them), that can be administrated alone or in combination with adjutants. Some of these preparations are indicated for facilitating the uptake and antigenic presentation by dendritic cells, or by targeting the mast cells and basophiles. Studies in vitro, in animal models and clinical trials in allergic patients, indicate that these preparations may provide protection against the allergen exposure and improve the symptoms by inducing the production of blocking antibodies of the IgE mediated response, production of regulator T cells and cytokines of Th1 profile.     

Allergy and autoimmunity: Molecular diagnostics,therapy, and presumable pathogenesis

Allergic and autoimmune diseases represent immunopathological reactions of an organism to antigens. Despite that the allergy is a result of exaggerated immune response to foreign antigens (allergens) and autoimmune diseases are characterized by the pathological response to internal antigens (autoantigens), the underlying mechanisms of these diseases are probably common. Thus, both types of diseases represent variations in the hypersensitivity reaction. A large percentage of both the adult and pediatric population is in need of early diagnostics of these pathologies of the immune system. Considering the diversity of antibodies produced in allergic and autoimmune disease and the difficulties accompanying clinical diagnosing, molecular diagnostics of these pathological processes should be carried out in several stages, including screening and confirmatory studies. In this review, we summarize the available data on the molecular diagnostics and therapy of allergic and autoimmune diseases and discuss the basic similarities and differences in the mechanisms of their development.     

基于机器学习的肠道菌群数据建模与分析研究综述

人体肠道菌群与人类的健康和疾病存在密切关系,对肠道菌群的宏基因组数据进行建模和分析,在疾病预测及诊断相关领域科学研究和社会应用方面均具有重要意义。本文从大数据分析和机器学习的角度,对人体肠道菌群数据的建模、分析和预测算法的原理、过程以及典型研究应用实例进行综述,以期推动肠道菌群分析相关研究发展以及探索结合机器学习算法进行肠道菌群分析的有效方式,同时也为开发基于肠道菌群数据的新型诊疗手段提供借鉴,推动我国精准医疗事业发展。     

The diagnostic problem of cephalalgia

Cephalalgia, a common complaint, often presents both a diagnostic and a therapeutic problem. In a significant number of cases the cause may be traced to allergic sensitivity. "Allergic headache" is no different from other allergic diseases either as to the factors that produce the head pain or as to the specific treatment required. Taking a careful history and carrying out definitive skin testing may lead to diagnosis in cases that otherwise might be considered functional.     

The regulatory framework for similar biotherapeutic products in Cuba

Biopharmaceuticals make up a significant proportion of medicinal products used for the treatment of diseases such as cancer, arthritis, cardiac dysfunctions and AIDS. Access to therapies based on the use of these products has been limited as a result of the high marketing costs. Cuba has a biopharmaceutical industry with great potential for innovation, capable of developing new products and to produce others, like the biosimilars destined to fulfill the needs of its National Health System. The Center for State Control on the Quality of Drugs (CECMED) the Cuban NRA, is facing the challenge of regulating the approval of biosimilar products manufactured locally. Consequently, CECMED has issued a position paper establishing the basic principles for regulation of these products and a specific guideline on this was elaborated.     

Mechanisms of IgE-mediated allergy

Allergic diseases are a global health problem today. Knowledge is still lacking about what causes some people to develop allergies while others remain tolerant to environmental antigens. The recent increase in prevalence suggests an involvement of gene-environment interactions and epigenetic mechanisms. Since allergies often develop early in life, the intrauterine environment has been proposed to play a role in predisposing some individuals to become allergic. The development of techniques to produce allergens as highly pure recombinant proteins has improved the tools for allergy diagnosis and treatment. Novel strategies for allergen-specific immunotherapy include tailor-made vaccines and alternative routes for administration.     

Arachidonic acid metabolites, leukotrienes--mediators of hypersensitivity and inflammation

A problem of leukotrienes--metabolites of arachidonic acid is reviewed in immunological aspects. Their nomenclature is given; basic pathways of biosynthesis, transformation and mode of leukotriens participation in hypersensitivity and inflammatory reactions are considered. The possibility of application of leukotrienes antagonists and inhibitors of their formation for allergic diseases treatment is discussed.     

Novel vaccination for allergy through gene silencing of CD40 using small interfering RNA

Small interfering RNA (siRNA) is a potent means of inducing gene-specific silencing. Gene silencing strategies using siRNA have demonstrated therapeutic benefits in animal models of various diseases, and are currently in clinical trials. However, the utility of gene silencing as a treatment for allergic diseases has not yet been reported. In this study, we report a novel therapy for allergy through gene silencing of CD40, a critical costimulatory molecule and a key factor in allergic immune responses. Silencing CD40 resulted in generation of immunoregulatory dendritic cells (DCs). Administration of CD40 siRNA remarkably reduced nasal allergic symptoms and local eosinophil accumulation in the OVA-induced allergic mice. The OVA-specific T cell response was inhibited after the CD40 siRNA treatment. Additionally, anti-OVA specific IgE and production of IL-4 and IL-5 of T cells stimulated by OVA were significantly decreased in CD40 siRNA-treated mice. Furthermore, we demonstrated that the therapeutic effects by CD40 siRNA were associated with impaired Ag-presenting functions of DCs and B cells, and generation of regulatory T cells. The present study highlights a therapeutic potential of siRNA-based treatment for allergic diseases.