CORD-19_Custom_license_subset  

CORD-19:775b90287b44353bee979abb0970a4666022f86d JSONTXT 8 Projects

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Id Subject Object Predicate Lexical cue
T1 0-102 Sentence denotes ABSTRACTS PRESENTED AT CONCURRENT SESSIONS ATYPICAL PRESENTATION OF HONEY BEE STING HYPER- SENSITIVITY
T2 104-112 Sentence denotes Abstract
T3 113-126 Sentence denotes Introduction:
T4 127-257 Sentence denotes A bee sting can result in a myriad of manifestations ranging from acute localized cutaneous response to unusual delayed reactions.
T5 258-362 Sentence denotes Here we report a case of a 15 year old boy who developed bloody diarrhea 72 hours following a bee sting.
T6 363-464 Sentence denotes To the best of our knowledge this is the first such report of delayed gastrointestinal manifestation.
T7 465-477 Sentence denotes Case Report:
T8 478-546 Sentence denotes A 15 year old male presented for evaluation of allergy to honey bee.
T9 547-752 Sentence denotes He stated that on 2 occasions he was stung by a bee resulting in localized swelling of affected area, nausea, vomiting and abdominal pain after the sting, then bloody diarrhea approximately 72 hours after.
T10 753-898 Sentence denotes The most recent episode was 1 week prior to clinic visit when the patient was stung by a bee on his toe, following which he had a local reaction.
T11 899-967 Sentence denotes Then 3 days later he had abdominal pain and loose stools with blood.
T12 968-1028 Sentence denotes Examination revealed a well healed puncture mark on his toe.
T13 1029-1108 Sentence denotes His vitals were normal and CBC, ESR, CMP and a stool culture were unremarkable.
T14 1109-1156 Sentence denotes Skin prick testing was positive for honey bees.
T15 1157-1302 Sentence denotes Intradermal testing at lowest concentration (1/100000) was positive for all other Hymenoptera (wasp, yellow jacket, hornet) with negative saline.
T16 1303-1358 Sentence denotes Immunocap showed positivity to all Hymenoptera species.
T17 1359-1370 Sentence denotes Discussion:
T18 1371-1514 Sentence denotes Delayed gastrointestinal hemorrhage is an unusual manifestation after sting by a honey bee that cannot be explained by IgE-mediated mechanisms.
T19 1515-1704 Sentence denotes We postulate that this response could be due to a delayed type hypersensitivity leading to deposition of immune complexes in the basement membrane of small blood vessels causing vasculitis.
T20 1705-1792 Sentence denotes This may explain the delayed manifestation of bloody diarrhea 72 hours after the sting.
T21 1793-2006 Sentence denotes It is also possible that the etiology of this unusual reaction may not be immunologically mediated and may be due to a direct cytotoxic effect of honey bee venom component like Melittin on gastrointestinal tissue.
T22 2007-2125 Sentence denotes Melittin is known to cause complement cleavage and the release of Bradykinin which are both associated with hemolysis.
T23 2126-2260 Sentence denotes Studies indicate that Melittin and Phospholipase A2 can decrease smooth muscular contractility and thus potentially induce hemorrhage.
T24 2261-2272 Sentence denotes Conclusion:
T25 2273-2412 Sentence denotes We report an unusual and rare case of bee sting induced bloody diarrhea in an adolescent which was reproducible on two different occasions.
T26 2413-2532 Sentence denotes We hypothesize that this could be due to a delayed hypersensitivity reaction or a direct cytotoxic effect of bee venom.
T27 2534-2536 Sentence denotes S.
T28 2537-2552 Sentence denotes Melethil * , S.
T29 2553-2561 Sentence denotes Ho, R.S.
T30 2562-2583 Sentence denotes Mehta, Galveston, TX.
T31 2584-2597 Sentence denotes Introduction:
T32 2598-2728 Sentence denotes A bee sting can result in a myriad of manifestations ranging from acute localized cutaneous response to unusual delayed reactions.
T33 2729-2833 Sentence denotes Here we report a case of a 15 year old boy who developed bloody diarrhea 72 hours following a bee sting.
T34 2834-2935 Sentence denotes To the best of our knowledge this is the first such report of delayed gastrointestinal manifestation.
T35 2936-2948 Sentence denotes Case Report:
T36 2949-3017 Sentence denotes A 15 year old male presented for evaluation of allergy to honey bee.
T37 3018-3223 Sentence denotes He stated that on 2 occasions he was stung by a bee resulting in localized swelling of affected area, nausea, vomiting and abdominal pain after the sting, then bloody diarrhea approximately 72 hours after.
T38 3224-3369 Sentence denotes The most recent episode was 1 week prior to clinic visit when the patient was stung by a bee on his toe, following which he had a local reaction.
T39 3370-3438 Sentence denotes Then 3 days later he had abdominal pain and loose stools with blood.
T40 3439-3499 Sentence denotes Examination revealed a well healed puncture mark on his toe.
T41 3500-3579 Sentence denotes His vitals were normal and CBC, ESR, CMP and a stool culture were unremarkable.
T42 3580-3627 Sentence denotes Skin prick testing was positive for honey bees.
T43 3628-3773 Sentence denotes Intradermal testing at lowest concentration (1/100000) was positive for all other Hymenoptera (wasp, yellow jacket, hornet) with negative saline.
T44 3774-3829 Sentence denotes Immunocap showed positivity to all Hymenoptera species.
T45 3830-3841 Sentence denotes Discussion:
T46 3842-3985 Sentence denotes Delayed gastrointestinal hemorrhage is an unusual manifestation after sting by a honey bee that cannot be explained by IgE-mediated mechanisms.
T47 3986-4175 Sentence denotes We postulate that this response could be due to a delayed type hypersensitivity leading to deposition of immune complexes in the basement membrane of small blood vessels causing vasculitis.
T48 4176-4263 Sentence denotes This may explain the delayed manifestation of bloody diarrhea 72 hours after the sting.
T49 4264-4477 Sentence denotes It is also possible that the etiology of this unusual reaction may not be immunologically mediated and may be due to a direct cytotoxic effect of honey bee venom component like Melittin on gastrointestinal tissue.
T50 4478-4596 Sentence denotes Melittin is known to cause complement cleavage and the release of Bradykinin which are both associated with hemolysis.
T51 4597-4731 Sentence denotes Studies indicate that Melittin and Phospholipase A2 can decrease smooth muscular contractility and thus potentially induce hemorrhage.
T52 4732-4743 Sentence denotes Conclusion:
T53 4744-4883 Sentence denotes We report an unusual and rare case of bee sting induced bloody diarrhea in an adolescent which was reproducible on two different occasions.
T54 4884-5003 Sentence denotes We hypothesize that this could be due to a delayed hypersensitivity reaction or a direct cytotoxic effect of bee venom.
T55 5004-5015 Sentence denotes Background:
T56 5016-5130 Sentence denotes Early, massive exposure to milk allergens is traditionally considered a risk factor for cow's milk allergy (CMA) .
T57 5131-5305 Sentence denotes Epidemiological studies, however, beg the question whether it can be protective; high milk allergen exposure has also been hypothesized as policy for food allergy prevention.
T58 5306-5440 Sentence denotes In this context, short bowel syndrome has been anecdotally associated with CMA, and no studies have used confirmatory milk challenges.
T59 5441-5449 Sentence denotes Methods:
T60 5450-5577 Sentence denotes A review of consecutive patients followed with short bowel syndrome over a ten-year period at a tertiary pediatric institution.
T61 5578-5925 Sentence denotes Patients included only the patients who fulfilled the following criteria: -Intestinal failure following SBS, defined as dependency on parenteral nutrition providing at least 50% of the total required intake for at least three months -Clinical follow-up from surgery to the complete introduction of a diversified diet including cow's milk proteins.
T62 5926-6043 Sentence denotes Infants with symptoms of CMA underwent a milk-specific IgE sensitization test and a confirmatory oral milk challenge.
T63 6044-6052 Sentence denotes Results:
T64 6053-6155 Sentence denotes Three infants in a caseload of 32 eligible patients were confirmed with CMA at challenge (see Table) .
T65 6156-6246 Sentence denotes This 9.4% proportion represents two to ten-folds the incidence of CMA in open populations.
T66 6247-6258 Sentence denotes Conclusion:
T67 6259-6377 Sentence denotes With its 9.4% incidence, our caseload of SBS children carry a two-to tenfold risk of CMA compared to open populations.
T68 6378-6488 Sentence denotes This suggests that a low digestive capacity may play a role in the high incidence of food allergy in children.
T69 6489-6602 Sentence denotes As their peptic digestion is not complete during early life, protein remnants of the diet could act as allergens.
T70 6603-6796 Sentence denotes If the overexposure to milk allergens is among the causes of CMA in these children, our results warn against the hypothesis of massive antigen exposure as instrument of food allergy prevention.
T71 6797-6860 Sentence denotes Characteristics of the caseload of infants with SBS Background:
T72 6861-6918 Sentence denotes Resistance to antibiotics is a serious worldwide problem.
T73 6919-7167 Sentence denotes When antibiotic choices are limited due to resistance, treatment alternatives for resistant infections may have higher toxicity, be more costly, and be less effective, and thus patients with resistant infections have higher morbidity and mortality.
T74 7168-7268 Sentence denotes Core methods to prevent antibiotic resistance include the appropriate use and choice of antibiotics.
T75 7269-7279 Sentence denotes Objective:
T76 7280-7586 Sentence denotes To reduce the use of prophylactic vancomycin, levofloxacin, and clindamycin in patients with a history of penicillin allergy undergoing surgery by implementing a new clinical pathway consisting of allergy consultation and penicillin allergy skin testing as part of the preoperative evaluation clinic visit.
T77 7587-7595 Sentence denotes Methods:
T78 7596-7942 Sentence denotes The participants in this clinical practice improvement project were patients with a history of penicillin allergy who were scheduled to undergo surgery and referred by the Preoperative Evaluation Clinic team for allergy consultation and penicillin allergy skin testing from August 2012 to August 2013, the first year of this new clinical pathway.
T79 7943-8147 Sentence denotes The primary outcomes were the percent reductions in the use of prophylactic vancomycin, levofloxacin, and clindamycin in patients with a history of penicillin allergy when compared to historical controls.
T80 8148-8156 Sentence denotes Results:
T81 8157-8439 Sentence denotes Of the 384 patients with a history of penicillin allergy who underwent allergy consultation and penicillin allergy skin testing, 360 (94%) had negative penicillin allergy skin test results and were given clearance by the allergist to receive penicillin or cephalosporin antibiotics.
T82 8440-8699 Sentence denotes For patients who had reported penicillin allergy, within six months of implementation of this new clinical pathway, vancomycin use was reduced by 54%, levofloxacin use was reduced by 40%, and clindamycin use was reduced by 22% compared to historical controls.
T83 8700-8712 Sentence denotes Conclusions:
T84 8713-8961 Sentence denotes Prophylactic use of vancomycin, levofloxacin, and clindamycin in patients with a history of penicillin allergy undergoing surgery can be reduced by allergy consultation and penicillin allergy skin testing during the preoperative evaluation process.
T85 8962-8966 Sentence denotes S.B.
T86 8967-8983 Sentence denotes Sindher * , S.P.
T87 8984-9010 Sentence denotes DaVeiga, Philadelphia, PA.
T88 9011-9024 Sentence denotes Introduction:
T89 9025-9217 Sentence denotes Most fruit allergies manifest as pollen-food allergy syndrome characterized by pruritus and edema of the lips, tongue, palate and throat usually a few minutes after ingestion of the raw fruit.
T90 9218-9325 Sentence denotes Orange is among fruits that are associated with pollen-food allergy syndrome but rarely causes anaphylaxis.
T91 9326-9334 Sentence denotes Methods:
T92 9335-9453 Sentence denotes We review the case of a 31-month-old girl who developed severe anaphylaxis after the consumption of one Cutie® orange.
T93 9454-9462 Sentence denotes Results:
T94 9463-9548 Sentence denotes A 31-monthold female presented in anaphylactic shock to an emergency department (ED).
T95 9549-9657 Sentence denotes Prior to presentation, she was at a supermarket, ate one Cutie® orange and was playing with the orange peel.
T96 9658-9731 Sentence denotes Within a few minutes she had bilateral periorbital swelling and pruritis.
T97 9732-9788 Sentence denotes She was treated with diphenhydramine at the supermarket.
T98 9789-9913 Sentence denotes The patient developed lip and tongue swelling and respiratory distress so her parents drove her to the ED within 10 minutes.
T99 9914-10060 Sentence denotes Examination was notable for a pulse oximetry reading of 79% on room air, diffuse wheezing in all lung fields, lip and tongue angioedema and hives.
T100 10061-10224 Sentence denotes She was treated with nebulized albuterol, IV diphenhydramine, ranitidine, 2 doses of subcutaneous epinephrine, methylprednisolone and an IV bolus of normal saline.
T101 10225-10395 Sentence denotes She continued to have worsening respiratory distress and hypoxia and subsequently required intubation; she was noted to have significant upper airway edema on intubation.
T102 10396-10485 Sentence denotes After intubation she was transferred via a helicopter to a Pediatric Intensive Care Unit.
T103 10486-10627 Sentence denotes A chest x-ray was performed to check endotracheal tube placement and revealed right upper lobe atelectasis and pulmonary edema ( Figure 1 ).
T104 10628-10719 Sentence denotes Her symptoms improved overnight and she was discharged home after a 48hour hospitalization.
T105 10720-10830 Sentence denotes Her past medical history was notable for a varied diet and prior consumption of orange juice without reaction.
T106 10831-10931 Sentence denotes She had reported nightly cough at baseline with cough on exertion but was not on therapy for asthma.
T107 10932-11047 Sentence denotes In follow up at Allergy/Immunology as a new patient, she had a positive skin prick test result to orange and peach.
T108 11048-11125 Sentence denotes She was advised to avoid orange and peach and also started on asthma therapy.
T109 11126-11137 Sentence denotes Conclusion:
T110 11138-11220 Sentence denotes We present the first case report of near-fatal anaphylaxis to orange in a toddler.
T111 11221-11360 Sentence denotes This case confirms that poorly controlled asthma is a risk factor for difficult to treat IgE-mediated reactions to foods, including orange.
T112 11361-11372 Sentence denotes Background:
T113 11373-11453 Sentence denotes Food protein-induced enterocolitis syndrome (FPIES) usually presents in infancy.
T114 11454-11679 Sentence denotes In the acute form, when food is ingested on an intermittent basis or following a period of avoidance, FPIES typically presents with profuse vomiting, diarrhea, and dehydration, starting 1-3h following specific food ingestion.
T115 11680-11814 Sentence denotes FPIES diagnosis is based on history and typical symptoms that improve with food avoidance, and with the exclusion of other etiologies.
T116 11815-11881 Sentence denotes Oral food challenge (OFC) remains the gold standard for diagnosis.
T117 11882-11887 Sentence denotes Case:
T118 11888-11963 Sentence denotes A 6-month-old female infant was referred for FPIES of difficult management.
T119 11964-12141 Sentence denotes The child was admitted to the hospital at 6 weeks of life for suspected sepsis occurred 15 days after receiving milk thickened with rice cream; sepsis evaluations were negative.
T120 12142-12314 Sentence denotes At 5 months, soon after her first rice-containing meal, she developped emesis, pallor, followed by diarrhea and lethargy, so she was hospitalized for suspected anaphylaxis.
T121 12315-12453 Sentence denotes Negative allergy tests (SPT, ImmunoCAP for rice, milk, egg, wheat) and the clinical history indicated the diagnosis of rice-induced FPIES.
T122 12454-12603 Sentence denotes For the investigation of cereal tolerance she was challenged with commercial maize to which she reacted with vomiting, hypotonia and bloody diarrhea.
T123 12604-12664 Sentence denotes Industrial maize food contamination with rice was suspected.
T124 12665-12768 Sentence denotes We requested a pure whole wheat flour from Heinz Baby Food, Italy ® , which was tolerated at challenge.
T125 12769-12901 Sentence denotes A special diet was initiated, in col-laboration with Heinz, using the same rice-free flour to make pasta to which she did not react.
T126 12902-13063 Sentence denotes Introduction of solids was predicated on a series of OFCs, including wheat, beef, pork, chicken, potato, carrot, spinach, zucchini, tomatoes which were negative.
T127 13064-13178 Sentence denotes However, each introduction of foods contaminated with rice determined the characteristic symptoms of the syndrome.
T128 13179-13295 Sentence denotes In one occasion, a typical FPIES reaction followed the administration of mauve suppositories containing rice starch.
T129 13296-13307 Sentence denotes Conclusion:
T130 13308-13491 Sentence denotes This case highlights how FPIES onset can be very early and how tiny amount of food can be enough to provoke symptoms, reflecting the degree of hypersensitivity in individual patients.
T131 13492-13624 Sentence denotes Early recognition of this condition and the management with cross-contaminant-free baby foods are crucial in preventing recurrences.
T132 13625-13704 Sentence denotes The co-operation among pediatricians and industry is of outstanding importance.
T133 13705-13707 Sentence denotes A.
T134 13708-13722 Sentence denotes Barbir *1 , M.
T135 13723-13737 Sentence denotes Janelli 1 , M.
T136 13738-13750 Sentence denotes Lin 1 , R.A.
T137 13751-13762 Sentence denotes Wolf 2 , J.
T138 13763-13780 Sentence denotes Dennerlein 1 , 1.
T139 13781-13795 Sentence denotes Boston, MA; 2.
T140 13796-13811 Sentence denotes Plantation, FL.
T141 13812-13825 Sentence denotes Introduction:
T142 13826-14071 Sentence denotes Various auto-injectors differ in their form factor, mechanism of drug delivery, and user instructions, which can affect the successful use of the device through applied force capability and consistency of device orientation during drug delivery.
T143 14072-14314 Sentence denotes We hypothesized that (1) a device's form factor will impact users' capability of applying force as measured by the maximum applied force and (2) a device's form factor, mechanism, and instruction will impact motor control performance metrics.
T144 14315-14327 Sentence denotes Methodology:
T145 14328-14579 Sentence denotes Trainer devices of 3 commercially available epinephrine auto-injectors with 3 different form factors (cylindrical, elliptical, and prismatic) were tested in a laboratory-based repeated measures experiment with 20 adult (aged 18-30 years) participants.
T146 14580-14914 Sentence denotes Participants performed 2 tasks using a power grip with each of the 3 injectors: a maximum force capability task in which they applied their maximum possible force onto a force plate positioned over their thigh and an application task in which, after watching the device's training video, they practiced an injection using the trainer.
T147 14915-15063 Sentence denotes For the application task, device performance included time to hold force, force, and device orientation and its variability during the hold segment.
T148 15064-15139 Sentence denotes Participants rated their force confidence and preference for the 3 devices.
T149 15140-15148 Sentence denotes Results:
T150 15149-15395 Sentence denotes Greatest force capability was exhibited by the device with the elliptical form factor followed by the prismatic and then the cylindrical, with the difference between the elliptical and the cylindrical form factors being statistically significant.
T151 15396-15486 Sentence denotes For the application task, the elliptical form factor device had the fastest time to force.
T152 15487-15602 Sentence denotes The prismatic form factor device had the largest angle and variability in the angle of the resultant applied force.
T153 15603-15766 Sentence denotes Participants reported the highest force confidence when using the elliptical and cylindrical form factor devices, ranking the elliptical as their preferred device.
T154 15767-15778 Sentence denotes Conclusion:
T155 15779-15906 Sentence denotes The results suggest that the elliptical form factor may have better success in drug delivery in a larger set of the population.
T156 15907-16028 Sentence denotes Table 1 Parameters measured for (I) maximum force capability task, (II) application task, and (III) self-reported survey.
T157 16029-16113 Sentence denotes For significant main effects, Tukey's post hoc groupings are ranked such that A > B.
T158 16114-16489 Sentence denotes Values with the same superscript letters indicate no significant difference. uary 1, 1993 1, , through March 31, 2014 PubMed, Medline, CENTRAL, EMBASE, Scopus, ISI, Regulatory Documents, Web of Science and manufacturers' web clinical trial registries (GlaxoSmithKline and AstraZeneca) with the clinical trial filters using multiple search terms with no language restrictions.
T159 16490-16725 Sentence denotes We included all studies that compared patients 14 years of age and older on ICS and not on ICS relative to the risk of incident pneumonia (community acquired, lower respiratory tract infection, non-tuberculous mycobacterial pneumonia).
T160 16726-16914 Sentence denotes We then summarized individual study estimates into two random-effect meta-analyses, one including randomized controlled trials (RCTs) and another one including observational studies (OBS).
T161 16915-16923 Sentence denotes Results:
T162 16924-17038 Sentence denotes There were total of 12 studies, 7 RCTs including total of 10,585 and 5 OBS including total of 44,127 participants.
T163 17039-17170 Sentence denotes There was no heterogeneity in RCTs and summarized estimated effect of ICS was protective of pneumonia; OR 0.75 (0.57-0.99. p=0.05).
T164 17171-17363 Sentence denotes On the contrary, OBS showed moderate heterogeneity (I 2 =48%) with resulting summed OR of 1.94 (1.42-2.65, p<0.0001), suggesting increased risk of pneumonia with use of ICS in asthma patients.
T165 17364-17424 Sentence denotes However, OBS had lower grade of confidence compared to RCTs.
T166 17425-17610 Sentence denotes Conclusions: ICS may carry protective effect or at the very least do not have increased risk of incident pneumonia in patients with asthma, based on our meta-analysis of available RCTs.
T167 17611-17814 Sentence denotes While observational studies suggested higher risk of pneumonia in similar patients, the observed heterogeneity and inherent methodological limitations confered lower grade of confidence in these studies.
T168 17815-17918 Sentence denotes Meta-analysis of RCTs and OBS for pneumonia (Risk estimates shown are odds Ratio (OR) for RCTs and OBS.
T169 17919-17921 Sentence denotes H.
T170 17922-17932 Sentence denotes Li *1 , A.
T171 17933-17946 Sentence denotes Reshef 2 , H.
T172 17947-17960 Sentence denotes Farkas 3 , J.
T173 17961-17973 Sentence denotes Baker 4 , G.
T174 17974-17989 Sentence denotes Porebski 5 , D.
T175 17990-18003 Sentence denotes McNeil 6 , A.
T176 18004-18016 Sentence denotes Relan 7 , A.
T177 18017-18034 Sentence denotes Zanichelli 8 , 1.
T178 18035-18054 Sentence denotes Chevy Chase, MD; 2.
T179 18055-18079 Sentence denotes Tel Hashomer, Israel; 3.
T180 18080-18101 Sentence denotes Budapest, Hungary; 4.
T181 18102-18121 Sentence denotes Lake Oswego, OR; 5.
T182 18122-18140 Sentence denotes Krakow, Poland; 6.
T183 18141-18157 Sentence denotes Columbus, OH; 7.
T184 18158-18181 Sentence denotes Leiden, Netherlands; 8.
T185 18182-18195 Sentence denotes Milan, Italy.
T186 18196-18207 Sentence denotes Background:
T187 18208-18347 Sentence denotes Hereditary angioedema (HAE) due to C1 inhibitor deficiency is characterized by recurrent episodes of disabling and painful tissue swelling.
T188 18348-18479 Sentence denotes Although some attacks are self-limiting and may resolve spontaneously, many attacks progress before taking several days to improve.
T189 18480-18621 Sentence denotes We reviewed the efficacy of recombinant human C1 inhibitor (rhC1INH) in the treatment of severe HAE attacks in a randomized controlled study.
T190 18622-18630 Sentence denotes Methods:
T191 18631-18757 Sentence denotes Seventy-five HAE patients were randomized (3:2) to receive 50 IU/kg of rhC1INH or saline in a multi-center double-blind study.
T192 18758-18851 Sentence denotes Severity of attack symptoms was assessed at baseline using a 100mm visual analog scale (VAS).
T193 18852-18917 Sentence denotes Patients could be randomized if the baseline VAS score was ≥50mm.
T194 18918-18987 Sentence denotes Severe attacks were defined as those with a baseline VAS score ≥75mm.
T195 18988-19242 Sentence denotes The primary endpoint was time to onset of symptom relief, assessed as time from start of study drug infusion to onset of sustained beneficial effect, defined by patient responses demonstrating improved symptoms on a Treatment Effects Questionnaire (TEQ).
T196 19243-19437 Sentence denotes Rescue treatment with open-label rhC1INH was permitted if there was no relief of symptoms by 4 hours or in case of life-threatening symptoms; these attacks were censored in the primary analysis.
T197 19438-19512 Sentence denotes IRB approval and written informed con-sent was obtained from all patients.
T198 19513-19521 Sentence denotes Results:
T199 19522-19598 Sentence denotes Among the 75 randomized patients, the median VAS score at baseline was 76mm.
T200 19599-19668 Sentence denotes Forty-three patients were determined to have severe attacks (rhC1INH:
T201 19669-19680 Sentence denotes 24; saline:
T202 19681-19685 Sentence denotes 19).
T203 19686-19926 Sentence denotes Among patients with severe attacks, the median (95% CI) time to onset of symptom relief in rhC1INH-and saline-treated patients respectively, was 90 min (47, 120) versus 334 min (105, not estimable); hazard ratio 2.52, log rank p-value 0.02.
T204 19927-20098 Sentence denotes The proportion of patients with severe attacks who received open-label rhC1INH as rescue medication was 1/24 (4%) in the rhC1INH group and 10/19 (53%) in the saline group.
T205 20099-20270 Sentence denotes After receiving rescue with rhC1INH, saline-treated patients with severe attacks had a median time to relief of 60 min, as measured from the time of rescue administration.
T206 20271-20338 Sentence denotes Conclusions: rhC1INH was effective in resolving severe HAE attacks.
T207 20339-20472 Sentence denotes Patients randomized to saline who had worsening or sustained angioedema symptoms had rapid improvement following rescue with rhC1INH.
T208 20473-20477 Sentence denotes J.J.
T209 20478-20493 Sentence denotes Anderson * , P.
T210 20494-20520 Sentence denotes Pityn, London, ON, Canada.
T211 20521-20534 Sentence denotes Introduction:
T212 20535-20622 Sentence denotes The long harsh winter of 2013-14 prompted allergy experts to predict a "pollen vortex".
T213 20623-20742 Sentence denotes They reasoned that delayed antithesis would result in the sudden release of greater than normal amounts of tree pollen.
T214 20743-20860 Sentence denotes We evaluated the actual tree pollen data for London Ontario (Canada) to determine if experts had predicted correctly.
T215 20861-20869 Sentence denotes Methods:
T216 20870-21002 Sentence denotes Daily samples of airborne pollen were collected during the 2014 tree season with a Burkard spore trap located 3 stories above grade.
T217 21003-21073 Sentence denotes The samples were analyzed and compared to our historical 12 year data.
T218 21074-21213 Sentence denotes The pollen counts were normalized against the 12 year average count for each of the respective pollen types to assess the 2014 tree season.
T219 21214-21365 Sentence denotes The total tree pollen count and preponderance of 15 individual tree pollen types were examined, along with the start and duration of their pollination.
T220 21366-21374 Sentence denotes Results:
T221 21375-21594 Sentence denotes Contrary to the experts' predictions, the total seasonal pollen count was not elevated, but was down considerably and several individual tree pollen levels were far lower than at any other time in the previous 12 years.
T222 21595-21743 Sentence denotes Specifically, pollen levels of maple, juniper, birch, ash, mulberry and walnut were considerably lower, as much as 4-5 times lower than the average.
T223 21744-21798 Sentence denotes The other tree pollen counts were within normal range.
T224 21799-21811 Sentence denotes Conclusions:
T225 21812-21916 Sentence denotes Not only did the forecasted pollen burst fail to materialize this year, but the exact opposite happened.
T226 21917-21997 Sentence denotes In 2014, the total tree pollen counts were at historic lows for London, Ontario.
T227 21998-22146 Sentence denotes Six major pollen producers of the fifteen tree types were at historic lows despite otherwise typical duration and start of their respective seasons.
T228 22147-22255 Sentence denotes Experts need to refine their modelling skills to better predict pollen in the face of global climate change.
T229 22256-22279 Sentence denotes Background and Purpose:
T230 22280-22459 Sentence denotes The cyanobacteria specie, Microcystis aeruginosa (Ma), produces microcystin (MC) and an array of diverse metabolites believed responsible for their toxicity and/or immunogenicity.
T231 22460-22717 Sentence denotes Previously, chronic rhinitis patients were demonstrated to elicit a specific IgE response to non-toxic strains of Ma by skin-prick testing (SPT) indicating that cyanobacteria allergenicity likely resides in the non-toxin producing component of the organism.
T232 22718-22866 Sentence denotes The objective of this study was to investigate the functional interactions between cyanobacteria toxins and their co-expressed immunogenic peptides.
T233 22867-22875 Sentence denotes Methods:
T234 22876-23012 Sentence denotes Sera collected from chronic rhinitis patients previously found to be sensitized by SPT to Ma were used to identify sensitizing proteins.
T235 23013-23094 Sentence denotes Direct and indirect IgE-specific ELISAs were used to confirm sensitization to Ma.
T236 23095-23243 Sentence denotes A 2-D gel electrophoresis followed by specific IgE immunoblot and mass spectroscopy (MS) was performed to identify the relevant allergenic peptides.
T237 23244-23363 Sentence denotes Cyto-toxicity and mediator release assays were performed using lysates from Ma toxic (MC+) and non-toxic strain (MC-) .
T238 23364-23372 Sentence denotes Results:
T239 23373-23524 Sentence denotes Using lysates from MC+ and MC-Ma strains and sera from Ma sensitized patients, specific IgE was increased in response to the MC-but not the MC+ strain.
T240 23525-23617 Sentence denotes In addition, MC-extracts induced b-hexosaminidase release using rat basophil leukemia cells.
T241 23618-23814 Sentence denotes 2-D gel electrophoresis followed by MS revealed the relevant sensitizing peptides were phycocyanin and the core-membrane linker peptide, both components of the cyanobacteria phycobilisome complex.
T242 23815-23925 Sentence denotes Of note, the IgE specific response was dose-dependently inhibited by addition of microcystin to the MC-lysate.
T243 23926-23938 Sentence denotes Conclusions:
T244 23939-24114 Sentence denotes The allergenicity of Ma is inversely proportional to its microcystin content suggesting a direct or indirect interaction between microcystin toxin and the allergenic peptides.
T245 24115-24270 Sentence denotes Further investigation is warranted to understand the interplay between immunogenicity and toxicity of cyanobacteria under diverse environmental conditions.
T246 24271-24275 Sentence denotes D.A.
T247 24276-24289 Sentence denotes Jara * , C.S.
T248 24290-24300 Sentence denotes Barnes, J.
T249 24301-24312 Sentence denotes Portnoy, M.
T250 24313-24335 Sentence denotes Dhar, Kansas City, MO.
T251 24336-24346 Sentence denotes Rationale:
T252 24347-24494 Sentence denotes Fungus can be found outdoors and indoors and can enter the home through multiple mechanisms such as a window, on clothing, or openings in the home.
T253 24495-24559 Sentence denotes Patients have shown a higher risk of atopy with fungal exposure.
T254 24560-24684 Sentence denotes To determine if indoor mold count was elevated in relation to elevated outdoor mold counts we conducted the following study.
T255 24685-24693 Sentence denotes Methods:
T256 24694-24812 Sentence denotes Data was retrieved from the Kansas City mold and spore database for a 15 year period from March 1998 thru August 2013.
T257 24813-24942 Sentence denotes The community wide outdoor spore count was performed with a with a Burkard device according to National Allergy Bureau Protocols.
T258 24943-25156 Sentence denotes The indoor spore count data was collected from an Allergenco MK3 or a Buck Bioaire from about 150 homes with a mean of 4 collections taken from each home (Basement, Bedrooms, Living Room, Kitchen, Bathroom, etc) .
T259 25157-25274 Sentence denotes Outdoor ground level data is the outdoor collection taken at each home at the time the indoor collections were taken.
T260 25275-25387 Sentence denotes Data included here for comparative purposes is for 8 spore types that are easily identifiable individual genera.
T261 25388-25465 Sentence denotes Data is reported by percent of collections in which each genera was observed.
T262 25466-25538 Sentence denotes Spore counts were stored in an Access database and analyzed using Excel.
T263 25539-25547 Sentence denotes Results:
T264 25548-25592 Sentence denotes Total spore percentages are seen in table 1.
T265 25593-25663 Sentence denotes Cladosporium was the most common spore collected indoors and outdoors.
T266 25664-25781 Sentence denotes When comparing indoor counts, Cladosporium was most commonly seen in basement at 52% followed by child's bedroom 20%.
T267 25782-25894 Sentence denotes Alterneria was most commonly seen in the child's bedroom at 30% followed by bathroom 19% and master bedroom 15%.
T268 25895-25987 Sentence denotes Overall spores were most commonly seen in child's bedroom 16%, basement 13% and kitchen 10%.
T269 25988-26072 Sentence denotes Alternaria was least commonly seen in family room 4% basement 9% and living room 9%.
T270 26073-26166 Sentence denotes Cladosporium was least commonly seen in family room 2%, master bedroom 3% and living room 6%.
T271 26167-26263 Sentence denotes Overall spores were least commonly seen in family room 1%, master bedroom 2% and living room 6%.
T272 26264-26275 Sentence denotes Conclusion:
T273 26276-26401 Sentence denotes Increased outdoor spore count is associated with higher indoor spore counts but origin could not be inferred from this study.
T274 26402-26485 Sentence denotes Cladosporium was the most identified fungi both indoors and outdoors in this study.
T275 26486-26648 Sentence denotes Interestingly the child's bedroom seems to be the most susceptible to indoor mold amplification, while the living room and family room had the lowest spore count.
T276 26649-26770 Sentence denotes This may be secondary to the aesthetic desire most families put into maintaining a home while negating lesser used rooms.
T277 26771-26817 Sentence denotes Table 1 Percentage of Total spore counts seen.
T278 26818-26820 Sentence denotes V.
T279 26821-26837 Sentence denotes Rodinkova 1 , A.
T280 26838-26854 Sentence denotes Prikhodko 2 , A.
T281 26855-26869 Sentence denotes Maleeva 2 , O.
T282 26870-26888 Sentence denotes Palamarchuk 1 , I.
T283 26889-26902 Sentence denotes Motruk 1 , L.
T284 26903-26919 Sentence denotes Kremenska 1 , K.
T285 26920-26937 Sentence denotes Musatova 1 , L.M.
T286 26938-26953 Sentence denotes DuBuske *3 , 1.
T287 26954-26975 Sentence denotes Vinnitsa, Ukraine; 2.
T288 26976-27001 Sentence denotes Zaporizhzhia, Ukraine; 3.
T289 27002-27014 Sentence denotes Gardner, MA.
T290 27015-27026 Sentence denotes Background:
T291 27027-27187 Sentence denotes Ambrosia is increasing in abundance in south and east Ukraine including Donetsk, Zaporizhzhia, Mykolaiv, Kherson, Kirovograd and Dnepropetrovsk regions Methods:
T292 27188-27276 Sentence denotes Pollen collection was done by gravimetric sampling in Vinnitsa for years 1999 and 2000 .
T293 27277-27452 Sentence denotes From 2009 to 2013 volumetric methods employing a Burkard trap placed at a height of 25 meters above the ground on the roof of a Vinnitsa Medical University building were used.
T294 27453-27648 Sentence denotes Pollen counts in Zaporizhya from 2006 to 2013 and in Poltava, Donetsk, Dnepropetrovsk, Odessa and Simferopol in 2010 used volumetric Burkard spore traps sampling from the March 1 until October 1.
T295 27649-27657 Sentence denotes Results:
T296 27658-27892 Sentence denotes Greatest ragweed pollen counts were in the third ten-day period of August and for the first or second ten-day period of September, seen in Vinnitsa since 1999 and in Zaporizhya from 2006 until 2010 similar to all other cities in 2010.
T297 27893-28070 Sentence denotes Ragweed pollen increase occurred in the third ten-day period of August being maximal August 22 (Zaporizhya) until August 29 (Odessa) and August 25 in Vinnitsa for 2011 and 2012.
T298 28071-28354 Sentence denotes The second period of increased Ambrosia pollen concentrations occurs after September 5 each year but has been shifting to a later time being September 2, 2010 in Dnepropetrovsk and September 5 in Vinnitsa in 1999 and Zaporizhya in 2007 later occurring September 18, 2012 in Vinnitsa.
T299 28355-28482 Sentence denotes Greater ragweed counts are now being seen later in Vinnitsa including 200 p.g./m 3 on September 18 versus 100 August 25, 2012).
T300 28483-28611 Sentence denotes In 2012 the seasonal peak was observed for the second ten-day period of September in much of Ukraine, something not seen before.
T301 28612-28958 Sentence denotes In 2010 and 2013 rapid increases of ragweed pollen were seen in the second ten-day period of August, two weeks earlier than usual being greater than the mean seasonal maximum on August 27, 2010 (102 p.g./m 3 versus 76 p.g./m 3 ) in Vinnitsa with 2013 ragweed pollen count increased to 82 p.g./m 3 on August 11 peaking at 92 p.g./m 3 on August 27.
T302 28959-29013 Sentence denotes Seasonal maximum in Zaporizhya was on August 19, 2013.
T303 29014-29025 Sentence denotes Conclusion:
T304 29026-29313 Sentence denotes The changing pattern of ragweed pollination in Ukraine with early ragweed pollen count increases for the second ten-day period of August and changes in maximum in September may be evidence of the primary impact of temperature increase on Ambrosia season in Ukraine due to global warming.
T305 29314-29325 Sentence denotes Background:
T306 29326-29404 Sentence denotes Elevations in serum tryptase are used to support the diagnosis of anaphylaxis.
T307 29405-29591 Sentence denotes Although tryptase has been studied in anaphylaxis to insect stings and drugs, it has not been measured systematically in patients who have systemic reactions (SRs) to immunotherapy (IT).
T308 29592-29600 Sentence denotes Methods:
T309 29601-29792 Sentence denotes This study was an IRB-approved, prospective cohort study of aeroallergen or venom IT patients who experienced SRs during the 30-minute post-IT period and were treated as clinically indicated.
T310 29793-29916 Sentence denotes Consent and serum total tryptase were obtained after a onehour observation period when the patient was ready for discharge.
T311 29917-29964 Sentence denotes A baseline tryptase was drawn 2-7 days post SR.
T312 29965-30037 Sentence denotes Tryptase levels were determined using commercially available ELISA kits.
T313 30038-30046 Sentence denotes Results:
T314 30047-30109 Sentence denotes Twelve patients had 13 reactions over a 20-month study period.
T315 30110-30156 Sentence denotes Patient and SR specifics are shown (Table 1 ).
T316 30157-30201 Sentence denotes All reactions were grade 1 or 2 in severity.
T317 30202-30250 Sentence denotes Flushing was the most common, objective symptom.
T318 30251-30311 Sentence denotes One or 2 doses of epinephrine were administered for all SRs.
T319 30312-30402 Sentence denotes All SRs were non-life-threatening and occurred during the build-up phase of immunotherapy.
T320 30403-30518 Sentence denotes Median time from SR onset to resolution and from SR onset to tryptase lab draw was 26 and 85 minutes, respectively.
T321 30519-30621 Sentence denotes No elevation in tryptase post-SR or change from reaction to baseline tryptase (>2 ng/ml) was observed.
T322 30622-30633 Sentence denotes Discussion:
T323 30634-30769 Sentence denotes Tryptase is a marker of mast cell degranulation with clinical utility, but it is not consistently elevated in all cases of anaphylaxis.
T324 30770-30839 Sentence denotes In this study, SRs after IT were of short duration and mild severity.
T325 30840-30936 Sentence denotes Unlike field anaphylaxis due to insect stings, post-IT SRs were promptly recognized and treated.
T326 30937-31044 Sentence denotes The low total serum tryptase levels may reflect post-epinephrine effects of a terminated systemic reaction.
T327 31045-31189 Sentence denotes Additionally, IT-associated SRs may represent a unique or undefined phenomenon involving complement, anaphylatoxins, kinins, or lipid mediators.
T328 31190-31281 Sentence denotes Basophils rather than mast cells may be activated in the early stages of IT-associated SRs.
T329 31282-31338 Sentence denotes These data suggest that tryptase is of lim-Introduction:
T330 31339-31476 Sentence denotes The most common adverse events (AEs) with sublingual immunotherapy tablets (SLIT-T) are local allergic reactions of the mouth and throat.
T331 31477-31618 Sentence denotes These AEs are expected as the allergen extract presumably elicits an IgE-associated mediator release from mast cells located in oral tissues.
T332 31619-31774 Sentence denotes Our objective was to report the duration of local allergic reactions in response to SLIT-T for 3 different allergens to characterize the reaction patterns.
T333 31775-31783 Sentence denotes Methods:
T334 31784-32108 Sentence denotes Symptoms and duration in minutes of local allergic reactions after SLIT-T administration were collected during phase 1 studies of Timothy grass SLIT-T 2800 BAU (MK-7243) and short ragweed SLIT-T 12 Amb a 1-U (MK-3641), and during phase 1 and 2b studies for house dust mite (HDM) SLIT-T 12 DU (MK-8237; all Merck/ALK-Abelló).
T335 32109-32277 Sentence denotes Additionally, the duration in days (number of days that an event recurs) was collected for local allergic reactions during the phase 3 trials for each of these tablets.
T336 32278-32343 Sentence denotes IRB approval and informed consent was obtained from all subjects.
T337 32344-32352 Sentence denotes Results:
T338 32353-32491 Sentence denotes The median durations in minutes for the most common local adverse reactions after SLIT-T or placebo administration are shown in the Table.
T339 32492-32559 Sentence denotes For each of the events, reactions typically resolve within minutes.
T340 32560-32635 Sentence denotes Events generally recur over several days prior to resolution of the events.
T341 32636-32803 Sentence denotes The median recurrence of symptoms after active treatment varies in duration, ear pruritus (4 to 14 days); oral pruritus (5 to 8 days); throat irritation (5 to 9 days).
T342 32804-32816 Sentence denotes Conclusions:
T343 32817-32992 Sentence denotes The occurrence and duration of local adverse reactions related to SLIT-T were similar across studies, and appear to be a class effect consistent with an IgE-mediated response.
T344 32993-33206 Sentence denotes Although cautious interpretation is required due to the limited sample size, the data reveals that the reactions generally resolve within minutes of SLIT-T administration and are experienced for less than 2 weeks.
T345 33207-33302 Sentence denotes SLIT-T *Sum of daily durations throughout entire 28-day trial. †Duration on day 1 of treatment.
T346 33303-33379 Sentence denotes AE=adverse event; ND=not determined; SLIT-T=sublingual immunotherapy tablet.
T347 33380-33518 Sentence denotes rospective survey was used to evaluate the association between the loss of skin test reactivity during IT and long-term clinical efficacy.
T348 33519-33527 Sentence denotes Methods:
T349 33528-33648 Sentence denotes Patients (Age 18-65) were mailed a follow-up survey if they had stopped IT prior to 2010 and met the following criteria:
T350 33649-33728 Sentence denotes Skin test (+) to mountain cedar (MC) with ≥ moderate AR during MC pollinations.
T351 33729-33828 Sentence denotes Achieved 1:1 vial dosing for > 12 months and had repeated skin testing prior to IT discontinuation.
T352 33829-33837 Sentence denotes Results:
T353 33838-33899 Sentence denotes Of 200 surveyed, 28 of 40 respondents met inclusion criteria.
T354 33900-34099 Sentence denotes Among the 14 patients reaching the monthly goal of 0.5cc (mode volume), 100% reported "significant improvement" of AR while receiving IT and a fall in skin test grading by ≥ 2 grades was seen in 93%.
T355 34100-34218 Sentence denotes A sustained complete remission (CR) of symptoms was reported by 43% while off IT for 5 to 10.1 years (median 6.9 yrs).
T356 34219-34402 Sentence denotes In contrast, among those who had received a lower maintenance dose (Mean = 0.22 ± 0.17cc.), a fall in skin test reactivity was seen in only 42% and CR was reported in only 21% (n=14).
T357 34403-34563 Sentence denotes No differences between groups were observed for: initial symptom severity or skin test grading, subjective treatment efficacy (while on IT), or the IT duration.
T358 34564-34667 Sentence denotes Conclusion: "Real-world" JTF-compliant IT is highly effective, both during and after treatment courses.
T359 34668-34811 Sentence denotes Aeroallergen IT, formulated and administered per JTF-recommendations, can induce allergen-specific skin test anergy in a dose-dependant manner.
T360 34812-34948 Sentence denotes The induction of a persistent remission was significantly more common among those in whom the loss of skin test reactivity was observed.
T361 34949-34951 Sentence denotes A.
T362 34952-34975 Sentence denotes Gonzalez-Estrada * , L.
T363 34976-34992 Sentence denotes Cuervo Pardo, B.
T364 34993-35002 Sentence denotes Ghosh, F.
T365 35003-35014 Sentence denotes Pazheri, M.
T366 35015-35024 Sentence denotes Smith, K.
T367 35025-35033 Sentence denotes Zell, X.
T368 35034-35044 Sentence denotes Wang, D.M.
T369 35045-35065 Sentence denotes Lang, Cleveland, OH.
T370 35066-35077 Sentence denotes Background:
T371 35078-35158 Sentence denotes Asthma affects over 300 million people globally, including 25 million in the US.
T372 35159-35253 Sentence denotes Patients with asthma frequently use the internet as a source of information (Cabana MD, Le TT.
T373 35254-35277 Sentence denotes J Allergy Clin Immunol.
T374 35278-35284 Sentence denotes 2005).
T375 35285-35393 Sentence denotes YouTube, a video sharing website, is one of the three most popular websites (http://www.alexa.com/topsites).
T376 35394-35466 Sentence denotes We sought to determine the educational quality of asthma YouTube videos.
T377 35467-35475 Sentence denotes Methods:
T378 35476-35553 Sentence denotes We performed a YouTube search using the keyword "asthma" from June 4-8, 2014.
T379 35554-35617 Sentence denotes The 200 most viewed relevant videos were included in the study.
T380 35618-35686 Sentence denotes Asthma videos were analyzed for characteristics, source and content.
T381 35687-35840 Sentence denotes Source was further classified as asthma healthcare provider, other health-care provider, patient, pharmaceutical company, and professional society/media.
T382 35841-35910 Sentence denotes A scoring system was created to evaluate quality (-10 to +30 points).
T383 35911-35968 Sentence denotes Negative points were assigned for misleading information.
T384 35969-36069 Sentence denotes Five blinded reviewers scored each video independently; a mean score was calculated by video source.
T385 36070-36267 Sentence denotes Two-tailed analysis was performed for video characteristics, ANOVAs were performed to compare scores by video type, and intraclass correlation was used to assess similarity in scoring by reviewers.
T386 36268-36276 Sentence denotes Results:
T387 36277-36403 Sentence denotes Two hundred videos were analyzed, with a median of 18,073.5 views, 31.5 likes, 2 dislikes, and lasted a median of 172 seconds.
T388 36404-36444 Sentence denotes More video presenters were male (60.5%).
T389 36445-36522 Sentence denotes The most common type of video source was other health-care providers (34.5%).
T390 36523-36756 Sentence denotes The most common video content was alternative treatments (38.0%), including live-fish ingestion, reflexology, acupressure/acupuncture, ayurveda, yoga, raw food/vegan/gluten free diets, marijuana, Buteyko breathing, salt therapy, etc.
T391 36757-36934 Sentence denotes Scores for videos supplied by asthma healthcare providers were statistically significantly different from all other sources (p < 0.001) and had the highest average score (9.91).
T392 36935-36981 Sentence denotes Table 1 summarizes all scores by video source.
T393 36982-37069 Sentence denotes Overall, there was a high degree of agreement among reviewers (rho = 0.847; p < 0.001).
T394 37070-37081 Sentence denotes Conclusion:
T395 37082-37193 Sentence denotes We found that YouTube videos on asthma are frequently viewed, but are a poor source of health care information.
T396 37194-37263 Sentence denotes Videos by asthma health-care providers were rated highest in quality.
T397 37264-37379 Sentence denotes The Allergy/Immunology community has a clear opportunity to enhance the value of educational materials via YouTube.
T398 37380-37390 Sentence denotes Gavino, R.
T399 37391-37401 Sentence denotes Rossen, F.
T400 37402-37411 Sentence denotes Orson, A.
T401 37412-37434 Sentence denotes Casillas, Houston, TX.
T402 37435-37448 Sentence denotes Introduction:
T403 37449-37534 Sentence denotes Local reactions are commonly noted during allergen immunotherapy (IT) administration.
T404 37535-37651 Sentence denotes These are usually mild and self-limiting; with more than 80% of reactions smaller than the size of a palm (8-10 cm).
T405 37652-37747 Sentence denotes Studies have shown that local reactions may not be predictive of subsequent systemic reactions.
T406 37748-37882 Sentence denotes A common practice to empirically enhance safety is to repeat or reduce the IT dose based on the size of the post-administration wheal.
T407 37883-37981 Sentence denotes Conservative management of local reactions less than 25 mm in size may lead to inadequate therapy.
T408 37982-38211 Sentence denotes We report the incidence of local and systemic reactions with IT administration and the time taken to reach maintenance therapy at our institution which follows a conservative management of local reactions less than 25 mm in size.
T409 38212-38220 Sentence denotes Methods:
T410 38221-38434 Sentence denotes We reviewed data on patients receiving aeroallergen immunotherapy at an academic medical center where dosing practices are based on a protocol that is altered according to local wheal size after IT administration.
T411 38435-38496 Sentence denotes Patients on immunotherapy for 23 weeks or more were included.
T412 38497-38600 Sentence denotes Post injection reactions were graded from 1-5, and dose adjustments were made accordingly (see table) .
T413 38601-38718 Sentence denotes Other factors which led to dosage changes were a change to a new vial and time delays over two weeks since last dose.
T414 38719-38727 Sentence denotes Results:
T415 38728-38822 Sentence denotes Fifty-six patients received 6633 IT injections over 0.5-7 years (mean of 2.1years ±1.2 years).
T416 38823-38945 Sentence denotes Local reactions were observed in 89% of patients with an incidence rate of 13% (grade 2 = 37%, grade 3=15% & grade 4=48%).
T417 38946-38995 Sentence denotes Half of the reactions (52%) were less than 25 mm.
T418 38996-39112 Sentence denotes Thirty-eight percent of the reactions occurred during build up phase delaying the initiation of maintenance therapy.
T419 39113-39257 Sentence denotes The mean time taken to reach maintenance (1:1 concentration) was 7.6 ± 3.4 months with 61% of all patients reaching this level over 5-22 months.
T420 39258-39317 Sentence denotes Only 4 patients (7%) reached the final therapeutic IT dose.
T421 39318-39330 Sentence denotes Conclusions:
T422 39331-39408 Sentence denotes We note that more than half of the reactions were smaller than 25 mm in size.
T423 39409-39511 Sentence denotes Most (93%) patients did not achieve the prescribed maintenance IT dosage over the time period studied.
T424 39512-39649 Sentence denotes It may be possible to increase efficacy of IT by changing the dose adjustment criteria for reactions that are smaller than 25 mm in size.
T425 39650-39652 Sentence denotes A.
T426 39653-39671 Sentence denotes Crans Yoon *1 , W.
T427 39672-39687 Sentence denotes Crawford 1 , J.
T428 39688-39701 Sentence denotes Sheikh 1 , A.
T429 39702-39713 Sentence denotes Gong 1 , R.
T430 39714-39729 Sentence denotes Nakahiro 2 , M.
T431 39730-39743 Sentence denotes Schatz 2 , 1.
T432 39744-39763 Sentence denotes Los Angeles, CA; 2.
T433 39764-39778 Sentence denotes San Diego, CA.
T434 39779-39792 Sentence denotes Introduction:
T435 39793-39989 Sentence denotes A new Healthcare Effectiveness Data and Information Set (HEDIS) asthma measure has been implemented, however it is unknown if meeting this care measure is associated with improved asthma outcomes.
T436 39990-40116 Sentence denotes We examined if the HEDIS Medication Management for people with Asthma measure ("MMA measure") associates with asthma outcomes.
T437 40117-40125 Sentence denotes Methods:
T438 40126-40244 Sentence denotes Administrative data was used to identify 30,040 patients who met the HEDIS criteria for persistent asthma during 2012.
T439 40245-40348 Sentence denotes They were classified as meeting or not meeting the MMA measure at the 75% and 50% adherence thresholds.
T440 40349-40432 Sentence denotes Association between MMA adherence in 2012 and asthma outcomes in 2013 was assessed.
T441 40433-40569 Sentence denotes Patients who were not MMA adherent but met the HEDIS asthma medication ratio measure were compared to those adherent to the MMA measure.
T442 40570-40578 Sentence denotes Results:
T443 40579-40831 Sentence denotes Patients who met the 75% or 50% MMA measure in 2012 had no difference in asthma related hospitalizations, ED visits, short-acting beta agonist (SABA) dispensing, and oral steroid dispensing events in 2013 compared to those who did not meet the measure.
T444 40832-40969 Sentence denotes Stepwise comparison of patients who were 75% compliant, 50-75% compliant and < 50% compliant also showed no difference in these outcomes.
T445 40970-41285 Sentence denotes To address confounding by patients who met the measure due to having a later index date, patients who met the 75% MMA measure with index dates late in the year were compared to those who did not meet the 75% measure whose index dates were early in the year and no difference was found in their 2013 asthma outcomes.
T446 41286-41424 Sentence denotes Additionally, patients who met the 75% and 50% MMA measures were compared to those who did not but had an asthma medication ratio of >0.5.
T447 41425-41566 Sentence denotes Asthma outcomes of hospitalization, ED visits and greater than 6 SABA canisters dispensed were higher in the 75% adherent group Introduction:
T448 41567-41800 Sentence denotes In clinical practice where time and resources are limited, the asthma control test (ACT) and the childhood asthma control test (C-ACT) were developed by Nathan et al and Liu et al, respectively , to identify poorly controlled asthma.
T449 41801-41938 Sentence denotes The ACT contains questions for the patient >12 yrs of age and the C-ACT contains questions for the caregiver and child 4-11 years of age.
T450 41939-42134 Sentence denotes The goal of this study was to evaluate whether patients are on optimal asthma treatment based on subjective reporting of asthma control from the child and the parent as assessed by the ACT/C-ACT.
T451 42135-42143 Sentence denotes Methods:
T452 42144-42252 Sentence denotes A random selection of office visits made by children, ages 4-20 years, with asthma during 2013 was surveyed.
T453 42253-42276 Sentence denotes We reviewed 171 charts:
T454 42277-42386 Sentence denotes 114 children 4-11 years completed the C-ACT with their caregivers; 57 children 12-20 years completed the ACT.
T455 42387-42533 Sentence denotes For children ages 4-11 years old, a comparison was made between the responses of children and their caregivers on their measure of asthma control.
T456 42534-42718 Sentence denotes All surveyed charts were examined for step-up in medications if they had uncontrolled asthma (ACT/C-ACT score < 20) or appropriate maintenance or decrease in medications if controlled.
T457 42719-42727 Sentence denotes Results:
T458 42728-43051 Sentence denotes In children ages 4-11 years, it was noted that while caregivers' ACT scores had a moderate correlation (R 2 = 0.52) with their child's score, the caregiver's score was, on average, 7% higher than the child's score, suggesting that caregivers may perceive their child's asthma as more controlled than what the child reports.
T459 43052-43241 Sentence denotes In children ages 4-11 years, 39% with uncontrolled asthma received an appropriate increase in medications, while 76% with controlled asthma were maintained on their medication or decreased.
T460 43242-43421 Sentence denotes In children > 12 years of age, 36% with uncontrolled asthma received an increase in medications, while 81% with controlled asthma were maintained on their medication or decreased.
T461 43422-43433 Sentence denotes Conclusion:
T462 43434-43701 Sentence denotes Although results suggest a discrepancy between ACT scores for uncontrolled asthma and subsequent step-up in asthma management, there are other objective factors which play a role in determining asthma management, such as the pulmonary function test and physical exam.
T463 43702-43791 Sentence denotes Analysis of these measures along with the ACT should be considered for asthma management.
T464 43792-43932 Sentence denotes A communication gap about asthma symptom severity might exist between caregiver and child, which may be mitigated through patient education.
T465 43933-43935 Sentence denotes P.
T466 43936-43950 Sentence denotes Agarwal * , A.
T467 43951-43964 Sentence denotes Chowdhary, S.
T468 43965-43984 Sentence denotes Gaur, Delhi, India.
T469 43985-43996 Sentence denotes Background:
T470 43997-44220 Sentence denotes High attenuating mucus (HAM) impaction and other radiologic features (ORF) have been considered as important radiologic parameters while diagnosing and classifying patients of Allergic bronchopulmonary aspergillosis (ABPA).
T471 44221-44299 Sentence denotes However, the exact significance of these radiologic findings is controversial.
T472 44300-44307 Sentence denotes Method:
T473 44308-44537 Sentence denotes A total of 63 patients diagnosed as ABPA based on the Rosenberg-Patterson criteria were categorized on the basis of HRCT findings into 4 groups; ABPA-S (Serological), ABPA-CB (Central bronchiectasis), ABPA-CB-HAM and ABPA-CB-ORF.
T474 44538-44729 Sentence denotes These groups were studied for their baseline characteristics at initial visit and their clinical, serological and functional severity were assessed on follow up visits and ABPA exacerbations.
T475 44730-44804 Sentence denotes IEC approval and informed consent was obtained from all research subjects.
T476 44805-44813 Sentence denotes Results:
T477 44814-44888 Sentence denotes The prevalence of HAM and ORF was found to be 9.5% and 41.3% respectively.
T478 44889-45229 Sentence denotes A statistically significant higher correlation was observed for expectoration of brownish black mucus plugs (P < 0.03), anorexia (P<0.05), weight loss (P<0.008), mean number of ward admission per year (P<0.015), mean number of ABPA exacerbations per year (P<0.001), mean total IgE levels (P<0.001) in patients with HAM on the initial visit.
T479 45230-45361 Sentence denotes Also, significantly more number of ORF patients had history of anti tubercular treatment for sputum positive tuberculosis (P<0.01).
T480 45362-45461 Sentence denotes Furthermore, severe and very severe grades of obstruction on spirometry were observed in ORF group.
T481 45462-45725 Sentence denotes The prospective analysis revealed mean serum total IgE levels (P<0.03) to be significantly high in HAM group, whereas, mean specific IgE levels against Aspergillus fumigatus were found to be significantly higher (P<0.007) in patients with central bronchiectasis .
T482 45726-45860 Sentence denotes The follow up HRCT done during exacerbations detected presence of HAM in 3 patients of ABPA-CB, 1 of ABPA-CB-ORF and 4 of ABPA-CB-HAM.
T483 45861-45975 Sentence denotes A high serum total IgE and specific IgE values were found in HAM impaction but were not statistically significant.
T484 45976-46113 Sentence denotes Finally, comparisons made in the exacerbation group between HAM positive and HAM negative patients were also statistically insignificant.
T485 46114-46246 Sentence denotes Conclusion: HAM and ORF appear to be associate findings in ABPA patients which may or may not influence the severity of the disease.
T486 46247-46354 Sentence denotes Also, these findings could not be used as a diagnostic tool independently and do not predict the outcome. .
T487 46355-46368 Sentence denotes Introduction:
T488 46369-46461 Sentence denotes Medication non-adherence leads to increased pediatric emergency visits and hospitalizations.
T489 46462-46544 Sentence denotes Tools to predict adherence in adults with asthma have been successfully validated.
T490 46545-46657 Sentence denotes No tool currently exists in pediatrics that reliably predicts adherence to use of controller asthma medications.
T491 46658-46749 Sentence denotes We developed a PAAT to quantitatively predict adherence in children with persistent asthma.
T492 46750-46758 Sentence denotes Methods:
T493 46759-46930 Sentence denotes Patients between ages of 2 and 18 with a new diag-nosis of persistent asthma who were started on inhaled corticosteroids were prospectively enrolled with informed consent.
T494 46931-46963 Sentence denotes Each subject completed the PAAT.
T495 46964-47036 Sentence denotes The PAAT was scored such that a higher score suggested better adherence.
T496 47037-47165 Sentence denotes Refill history was assessed through phone calls to the subject's pharmacy at 1 week, 3 months, and 6 months after initial visit.
T497 47166-47232 Sentence denotes Adherence was defined as 4 or more medication refills at 6 months.
T498 47233-47307 Sentence denotes IRB approval and informed consent was obtained from all research subjects.
T499 47308-47316 Sentence denotes Results:
T500 47317-47407 Sentence denotes At 6 months, only 10/74 subjects (13.5%) of patients filled 4 or more controller inhalers.
T501 47408-47646 Sentence denotes The median number of refills for controller medication at 6 months was higher for subjects who answered "agree or strongly agree" compared to "neutral" to the question regarding if their controller was necessary (median 3 vs. 2, p=0.028).
T502 47647-47758 Sentence denotes There was no difference in total PAAT score between the adherent and non-adherent group (20 vs 18.5, p=0.406) .
T503 47759-47877 Sentence denotes Additionally, there were no clinically significant differences in refill history for subjects for all other questions.
T504 47878-47890 Sentence denotes Conclusions:
T505 47891-48019 Sentence denotes We have demonstrated that the vast majority of patients receiving a new controller medication for their asthma are non-adherent.
T506 48020-48152 Sentence denotes The PAAT was able to identify that adherence is better in patients who believe that their controller was necessary for their asthma.
T507 48153-48366 Sentence denotes Asking this question during a pediatric visit may indicate a patient at higher risk for non-adherence, and may improve patient outcome through early intervention focusing on essential role of medication education.
T508 48367-48489 Sentence denotes Unfortunately, total PAAT score failed to identify adherent versus non-adherent patients in our asthma patient population.
T509 48490-48621 Sentence denotes Further investigation is necessary to determine the validity of the tool to predict a child's adherence to a controller medication.
T1 48622-48813 Sentence denotes Graph, Results of exposure, allergen sensitivity and morbidity. (+) ssIgE was determined as ≥ .35 kU/L." Group 1 is made up of children with reported exposure to roach and positive roach SPT.
T2 48814-48900 Sentence denotes Group 2 is made up of children with reported exposure to mouse and positive mouse SPT.
T3 48901-48995 Sentence denotes Group 3 is made up of children with positive roach SPT but without reported exposure to roach.
T4 48996-49090 Sentence denotes Group 4 is made up of children with positive mouse SPT but without reported exposure to mouse.
T5 49091-49179 Sentence denotes Group 5 is made up of children with reported exposure to roach and positive roach ssIgE.
T6 49180-49268 Sentence denotes Group 6 is made up of children with reported exposure to mouse and positive mouse ssIgE.
T7 49269-49365 Sentence denotes Group 7 is made up of children with positive roach ssIgE but without reported exposure to roach.
T8 49366-49462 Sentence denotes Group 8 is made up of children with positive mouse ssIgE but without reported exposure to mouse.
T9 49463-49639 Sentence denotes Introduction: X-linked hyper-IgM syndrome (XHIM) is a primary immunodeficiency with absent IgG, IgA, IgE and normal/elevated IgM due to defects in the CD40 ligand (CD40L) gene.
T10 49640-49806 Sentence denotes Hematopoietic stem cell transplantation (HSCT) is the only curative modality, but it carries significant risks, suggesting the need for improved methods of treatment.
T11 49807-50003 Sentence denotes Previous studies using CD40L-/-bone marrow corrected by retroviral-vector transfer of CD40L cDNA in mouse models resulted in abnormal lymphoproliferation due to unregulated expression of the gene.
T12 50004-50015 Sentence denotes Hypothesis:
T13 50016-50373 Sentence denotes Custom TAL effector nucleases (TALENs) or Clustered Regularly Interspaced Short Palindromic Repeats (CRISPRs), combined with the effective delivery of a homologous donor sequence containing normal CD40L DNA, will allow for targeted integration and provide physiologic expression of the endogenous CD40L gene to safely provide longterm immune reconstitution.
T14 50374-50512 Sentence denotes Methods/Data: TALENs targeting the 5' UTR of the CD40L gene were created and their function validated using a surveyor endonuclease assay.
T15 50513-50592 Sentence denotes Allelic disruption of up to 31% at the target locus in K562 cells was achieved.
T16 50593-50856 Sentence denotes In order to evaluate the capacity for targeted integration of a cassette at the cut site, K562 and Jurkat cells were electroporated with the TALEN pair and a donor molecule with a promoterless GFP reporter gene flanked by homology arms that parallel the cut site.
T17 50857-51028 Sentence denotes In/Out PCR using a forward primer within the GFP region and a reverse primer in the genomic DNA outside the donor molecule demonstrated proper integration into K562 cells.
T18 51029-51164 Sentence denotes Targeted insertion of the GFP reporter into the CD40L locus should also provide a measure of physiologic induction of CD40L expression.
T19 51165-51343 Sentence denotes Thus, expression of the GFP reporter was evaluated in Jurkat cells (which naturally express 60% CD40L), with up to 10% detected by FACs and increasing to 22% upon PHA activation.
T20 51344-51459 Sentence denotes In addition, CRISPRs targeting a patient-specific mutation in intron 3 achieved >50% gene disruption in K562 cells.
T21 51460-51639 Sentence denotes Co-electroporation with a template donor modified to contain a unique restriction enzyme site demonstrated site-specific gene integration by enzyme digest and gel electrophoresis.
T22 51640-51651 Sentence denotes Conclusion:
T23 51652-51859 Sentence denotes These results demonstrate that site-specific modification at CD40L is achievable and that physiologic expression of the endogenous CD40L gene could provide a viable therapy for immune reconstitution in XHIM.
T24 51860-51862 Sentence denotes R.
T25 51863-51876 Sentence denotes Steele * , M.
T26 51877-51892 Sentence denotes Littlefield, I.
T27 51893-51906 Sentence denotes Voloshyna, M.
T28 51907-51923 Sentence denotes Davis-Lorton, M.
T29 51924-51934 Sentence denotes Aquino, L.
T30 51935-51947 Sentence denotes Fonacier, A.
T31 51948-51967 Sentence denotes Reiss, Mineola, NY.
T32 51968-51981 Sentence denotes Introduction:
T33 51982-52105 Sentence denotes Classically activated M1 macrophages drive Th1 responses, while alternatively activated M2 macrophages drive Th2 responses.
T34 52106-52187 Sentence denotes A shift away from Th2 toward Th1 is associated with decreased incidence of atopy.
T35 52188-52337 Sentence denotes Anti-IgE monoclonal antibody (mAb) therapy (omalizumab; a humanized IgG1 mAb) is an FDA approved treatment for allergic asthma and chronic urticaria.
T36 52338-52511 Sentence denotes In recent studies, patients with non-allergic asthma and those with low serum IgE showed improvement in clinical measures with omalizumab treatment independent of IgE level.
T37 52512-52585 Sentence denotes This may represent an unrecognized immunomodulatory effect of omalizumab.
T38 52586-52741 Sentence denotes IgE-independent effects of this mAb in antigen presenting cells were examined in polarization of the THP-1 human monocytic cell line in an IgE free system.
T39 52742-52904 Sentence denotes Methods: THP1 were differentiated into adherent macrophages (PMA), then stimulated with IFNγ/LPS and IL-4 to polarize them into the M1 and M2 state, respectively.
T40 52905-53040 Sentence denotes Cells were stimulated with omalizumab at varying concentrations (0.1, 1, 10 mg/mL) ± IFNγ/LPS and IL-4 (during and after polarization).
T41 53041-53165 Sentence denotes Then mRNA was isolated and subjected to QRT-PCR to examine profile markers for M1 (CCR7 and IL12), and M2 (CD163 and CCL17).
T42 53166-53199 Sentence denotes Results were normalized to GAPDH.
T43 53200-53208 Sentence denotes Results:
T44 53209-53336 Sentence denotes Costimulation with mAb-IFNγ/LPS upregulated M1 markers CCR7 (17-fold) and IL12 (3-fold) above polarization with IFNγ/LPS alone.
T45 53337-53442 Sentence denotes Treatment of already polarized cells with mAb did not significantly impact transcription of CCR7 or IL12.
T46 53443-53577 Sentence denotes The M2 marker CD163 was downregulated by costimulation by mAb-IFNγ/LPS (15-fold) vs. IFNγ/LPS alone (8-fold) compared to PMA controls.
T47 53578-53629 Sentence denotes IL-4 did not significantly affect M1 or M2 markers.
T48 53630-53748 Sentence denotes M2 marker CCL17 transcription was enhanced by omalizumab alone (11-fold) and with IFNγ/LPS (9-fold) over PMA controls.
T49 53749-53761 Sentence denotes Conclusions:
T50 53762-53911 Sentence denotes This proof-of-concept study suggests that IgG mAB enhances transcription of M1 markers in THP1 cells and attenuates transcription of some M2 markers.
T51 53912-54006 Sentence denotes This effect may be due to the Fab portion (omalizumab specific) or be isotype specific (IgG1).
T52 54007-54171 Sentence denotes Interestingly, CCL17 is an inducer of chemotaxis in T-cells, particularly Th2 cells that play a critical role in atopic disease and this was upregulated by our mAb.
T53 54172-54325 Sentence denotes The interaction of the mAb may represent a point of immunomodulation by omalizumab not previously recognized, or a novel immunomodulatory effect of IgG1.
T54 54326-54495 Sentence denotes SNP [rs731236 A> G], ApaI [rs7975232 A> C], BsmI [rs1544410 C> T] and FokI [rs2228570 A> G] with susceptibility to asthma in children from the Caribbean Coast Colombian.
T55 54496-54504 Sentence denotes Methods:
T56 54505-54567 Sentence denotes This was a case-control study that included 1000 individuals :
T57 54568-54773 Sentence denotes 500 asthmatic children belonging to a poor community and 500 non asthmatic children from the same socioeconomic characteristic living in Barranquilla a city on the north of the Caribbean coast of Colombia.
T58 54774-54828 Sentence denotes The SNPs were genotyped by RT-PCR and TaqMan ® probes.
T59 54829-55090 Sentence denotes Allelic and genotypic frequencies were estimated using a Arlequin v3.5 software; D'and r2 statistic Linkage disequilibrium (LD) were studied using Haploview v4.2 software and associated haplotypes were identified by haplo.stats v1.6.8 software package R v3.0.2.
T60 55091-55099 Sentence denotes Results:
T61 55100-55460 Sentence denotes Our results showed that only the SNP BsmI [rs1544410 C> T] was associated with the disease with a significantly higher frequency of the CC genotype (57%, n = 280) in the asthmatic groups compared with controls(49.2% n = 244)It was also found that the frecuency of CT genotype was 35.6% in cases, n = 175, compared with the controls (43.8%, n = 217), p = 0.031.
T62 55461-55743 Sentence denotes Haplotype analysis showed that the haplotype A / C / T / G was found to be a protective factor for asthma (OR = 0.49, 95% CI = 0.26 to 0.88, P = 0.028), while haplotype A / C / C / G was showed as a risk factor for disease susceptibility (OR = 1.28, 95% CI = 1.03 -1.60, p = 0.049).
T63 55744-55875 Sentence denotes The LD analysis showed that the best D'and r2 found in SNPs block understood by TaqI, ApaI and BsmI; was D '= 0.753 and r2 = 0.565.
T64 55876-55887 Sentence denotes Conclusion:
T65 55888-56031 Sentence denotes This is the first study conducted in asthmatic Colombian children searching for the association of the VDR polymorphisms with pediatric asthma.
T66 56032-56214 Sentence denotes Our results demonstrate that the VDR gene locus is associated with susceptibility of asthma in this specific admixed ethnic group of children seated in the Colombian Caribbean Coast.
T67 56215-56219 Sentence denotes J.M.
T68 56220-56232 Sentence denotes Diaz *1 , X.
T69 56233-56243 Sentence denotes Xue 2 , M.
T70 56244-56258 Sentence denotes Solanki 2 , M.
T71 56259-56271 Sentence denotes Gupta 2 , P.
T72 56272-56291 Sentence denotes Chatterjee 2 , V.R.
T73 56292-56307 Sentence denotes Bonagura 2 , C.
T74 56308-56319 Sentence denotes Metz 2 , 1.
T75 56320-56342 Sentence denotes North Bellmore, NY; 2.
T76 56343-56357 Sentence denotes Manhasset, NY.
T77 56358-56369 Sentence denotes Background:
T78 56370-56493 Sentence denotes The obesity epidemic has contributed to the development of a new phenotype of "obese asthmatics" who are steroid resistant.
T79 56494-56615 Sentence denotes To develop more effective treatments for these asthmatics, it is important to understand the etiology of this resistance.
T80 56616-56730 Sentence denotes Using a mouse model of obese asthma, we previously reported a macrophage-(MΦ) predominant infiltrate in the lungs.
T81 56731-56819 Sentence denotes We hypothesize this non-eosinophilic cell composition contributes to steroid resistance.
T82 56820-56951 Sentence denotes Because MΦ can be pro-inflammatory (M1) & anti-inflammatory (M2), we examined the infiltrating MΦ in lean vs. obese asthmatic mice.
T83 56952-56960 Sentence denotes Methods:
T84 56961-57036 Sentence denotes Mice (C57BL/6, males) were fed a regular "lean" or high fat chow (60% fat).
T85 57037-57145 Sentence denotes After 6 months, mice were given intranasal saline or house dust mite extract (HDM), 5 days/week for 4 weeks.
T86 57146-57250 Sentence denotes During the last 2 weeks, mice were given either saline or dexamethasone (dex) (1 mg/kg, IP) 5 days/week.
T87 57251-57337 Sentence denotes After pentobarbital euthanasia, bronchoalveolar lavage (BAL) and lungs were collected.
T88 57338-57397 Sentence denotes Differentials were established using Modified Wright stain.
T89 57398-57520 Sentence denotes Quantitative PCR (qPCR) using lung tissue was performed using F4/80 (MΦ marker), Fizz (M2), Arg1 (M2) & Nos2 (M1) primers.
T90 57521-57529 Sentence denotes Results:
T91 57530-57696 Sentence denotes The absolute cell count in the BAL was low in untreated obese & lean mice (<1x10 6 cells/mL), while HDM exposure significantly increased cell count in both (3x10 6 ).
T92 57697-57802 Sentence denotes Dex significantly decreased BAL counts in lean-HDM mice (<1x10 6 ) but not in obese-HDM mice (2.5x10 6 ).
T93 57803-57898 Sentence denotes Both HDM groups had a significant increase in eosinophils when compared to saline control mice.
T94 57899-58025 Sentence denotes BAL of lean-HDM mice was comprised of equal numbers of MΦ & eosinophils, while obese-HDM mice had more MΦ & fewer eosinophils.
T95 58026-58239 Sentence denotes Obese-HDM-dex mice had almost no eosinophils, but high levels of MΦ. qPCR revealed increased expression of F4/80, M1 (Nos2) & M2 (Fizz, Arg1) markers in obese-HDM vs. lean-HDM mice in comparison to their controls.
T96 58240-58347 Sentence denotes Finally, DEX-significantly reduced M2 marker expression but did not reduce M1 expression in obese-HDM mice.
T97 58348-58359 Sentence denotes Discussion:
T98 58360-58522 Sentence denotes Using a novel model of obesity & asthma our findings suggest a potential role of dex-resistant M1 MΦ in the etiology of steroid resistance in the obese asthmatic.
T99 58523-58760 Sentence denotes Because these findings are consistent with what has been observed in the obese population, this model might be useful to test new treatments that target reducing MΦ infiltration or shifting M1 pro-inflammatory to M2-antiiinflammatory MΦ.
T100 58761-58792 Sentence denotes LONGITUDINAL STUDY OF CVID ILD.
T101 58793-58797 Sentence denotes P.J.
T102 58798-58813 Sentence denotes Maglione * , C.
T103 58814-58847 Sentence denotes Cunningham-Rundles, New York, NY.
T104 58848-58861 Sentence denotes Introduction:
T105 58862-59029 Sentence denotes Evidence of interstitial lung disease (ILD) is a frequent radiologic finding in common variable immunodeficiency (CVID), however, the long-term consequence is unclear.
T106 59030-59205 Sentence denotes We retrospectively examined CVID patients who had pulmonary function testing (PFT) over the duration of 20 months or more to gain insight into the natural history of CVID ILD.
T107 59206-59214 Sentence denotes Methods:
T108 59215-59376 Sentence denotes Retrospective chart review and statistical analysis was performed for 10 subjects with CVID who had CT chest evidence of ILD and PFT covering at least 20 months.
T109 59377-59566 Sentence denotes CT evidence of ILD was defined as the presence of numerous pulmonary nodules, ground glass opacity, or interstitial infiltrate as noted by boardcertified radiologists in the medical record.
T110 59567-59681 Sentence denotes Patients who received rituximab had PFT measured 6-12 months after the completion of a single course of treatment.
T111 59682-59690 Sentence denotes Results:
T112 59691-59977 Sentence denotes Of the 10 patients studied, 5 had evidence of progressive ILD indicated by (1) DLCO less than 50% of predicted, (2) DLCO less than 80% of predicted that decreased by 20% or more during the duration of the study, or (3) FVC that decreased by 20% or more during the duration of the study.
T113 59978-60272 Sentence denotes Initial PFT parameters and conventional laboratory tests (quantitative immunoglobulins, CBC with differential, alkaline phosphatase) did not statistically differentiate these two groups, however initial serum IgM trended higher in patients with progressive ILD (68±28 mg/dL vs. 13±4, P = 0.08).
T114 60273-60476 Sentence denotes Four of the 5 patients with progressive ILD received treatment with rituximab and had a significant improvement in FVC (73±1% vs. 62±2%, P = 0.01), but no significant restitution of other PFT parameters.
T115 60477-60489 Sentence denotes Conclusions:
T116 60490-60629 Sentence denotes Half of the CVID patients with CT evidence of ILD in this retrospective study had worsening of PFTs suggestive of progressive lung disease.
T117 60630-60818 Sentence denotes Initial serum IgM trended higher in patients with progressive ILD, but other conventional laboratory parameters did not significantly differentiate those who went on to have worsening PFT.
T118 60819-60927 Sentence denotes Treatment with a single course of rituximab in patients with progressive ILD resulted in improvement of FVC.
T119 60928-61147 Sentence denotes Larger studies are indicated to define the natural history of CVID ILD and determine the optimal indication and mode of treatment 31 MULTIPLE UNRELATED HETEROZYGOUS GENE DEFECTS PRESENTING AS A PRIMARY IMMUNODEFICIENCY.
T120 61148-61150 Sentence denotes P.
T121 61151-61165 Sentence denotes Abghari * , E.
T122 61166-61176 Sentence denotes Secord, P.
T123 61177-61202 Sentence denotes Poowuttikul, Detroit, MI.
T124 61203-61216 Sentence denotes Introduction:
T125 61217-61332 Sentence denotes Many syndromes of primary immunodeficiencies (PID) are well described and have been identified by genetic analysis.
T126 61333-61587 Sentence denotes We present a case of a boy with hypogammaglobulinemia, malabsorption and recurrent skin lesions with multiple heterozygous defects on genotyping; any of these alone would not likely be clinically significant, but together constitute an immune deficiency.
T127 61588-61605 Sentence denotes Case Description:
T128 61606-61677 Sentence denotes A 2 year old Chaldean boy was born full-term to consanguineous parents.
T129 61678-61772 Sentence denotes At approximately 7 weeks of age he presented with skin lesions over the umbilicus and buttock.
T130 61773-61822 Sentence denotes Biopsy revealed exuberant epithelial hyperplasia.
T131 61823-61957 Sentence denotes By 6 months of age he developed chronic diarrhea, oral thrush, bacteremia, failure to thrive, poor wound healing and wound dehiscence.
T132 61958-62186 Sentence denotes Laboratory evaluation at 6 months revealed hypogammaglobinemia, inadequate pneumococcal titers, normal oxidative burst, normal CD11, CD18, CD54 levels, normal T, B and NK cell populations and normal mitogen proliferation assays.
T133 62187-62246 Sentence denotes Intravenous immunoglobulin (IVIG) infusions were initiated.
T134 62247-62396 Sentence denotes The diarrhea and skin lesions responded to low dose prednisone, however despite the response, total parenteral nutrition was necessary for nutrition.
T135 62397-62503 Sentence denotes Genetic testing revealed a negative panel for SCID, agammaglobulinemia, and chronic granulomatous disease.
T136 62504-62588 Sentence denotes Whole exome sequencing revealed multiple mutations of unknown clinical significance.
T137 62589-62688 Sentence denotes Two defects in DOCK 8 were detected, however protein was demonstrated to be present and functional.
T138 62689-62842 Sentence denotes A heterozygous mutation for microvillus inclusion disease and a separate heterozygous defect for congenital malabsorption type 4 were identified as well.
T139 62843-63121 Sentence denotes In addition, a heterozygous mutation of PRKDC, which has been linked to severe combined immunodeficiency when homozygous defects are present and a heterozygous mutation of the IKBKB gene which has also been linked to an immune deficiency when homozygous defects were identified.
T140 63122-63210 Sentence denotes Finally, a heterozygous mutation of the IGFB2 gene, which codes for CD18 was identified.
T141 63211-63267 Sentence denotes All were separately reported as of unknown significance.
T142 63268-63279 Sentence denotes Conclusion:
T143 63280-63413 Sentence denotes This case illustrates that multiple heterozygous defects, although not previously reported as related, together can present as a PID.
T144 63414-63598 Sentence denotes Whole genome sequencing was able to provide us with results and should be considered more often in PID cases that are not straightforward and not easily diagnosed by immunology workup.
T145 63599-63730 Sentence denotes PIDD patients are frequently managed by several physicians and care settings, and usually only see Immunologist 1-4 times per year.
T146 63731-64075 Sentence denotes Given increased scrutiny on number of infections per year as a determinant of therapy and patient success, with risk that more frequent infections may contribute to more severe outcomes, we asked if present care model is sufficient for collecting rate of infection data and whether new data acquisition technology could improve data collection.
T147 64076-64430 Sentence denotes We compared sample of 16 PIDD patients from 4 physicians in single academic immunology clinic by conducting chart review of office visit encounters, with sample of 40 PIDD patients from 23 physicians and 266 data collection points on CareExchange®, to compare time between data collections, frequency of reported infections, and infection rates per year.
T148 64431-64603 Sentence denotes CareEx-change® is data collection software with multiple parameters focusing on the patient's infection rate, antibiotic use, provider visit, and overall health assessment.
T149 64604-64787 Sentence denotes Chart review of PIDD patients on IG replacement from single academic center showed mean time between visits was 5.2 (1-24 months) and the mean number of infections/year was 1.2 (0-5).
T150 64788-64832 Sentence denotes Mean age for this group was 21 (8-39 years).
T151 64833-64882 Sentence denotes Primary diagnosis for single academic center was:
T152 64883-64938 Sentence denotes 31.3% Bruton's, 43.8% CVID, 12.5% SCID, 6.3% Hyper-IgM.
T153 64939-65063 Sentence denotes CareExchange patients had data collected on average 6.7 (1-15 times/year) and mean infection rate of 0.69 between infusions.
T154 65064-65147 Sentence denotes Mean sum of infections from all sources at any one time between infusions was 1.38.
T155 65148-65268 Sentence denotes Mean acute health care used between infusions was 0.4, and mean rate of new antibiotic usage between infusions was 0.25.
T156 65269-65333 Sentence denotes Mean age for the CareExchange group was 39.2 years (range 5-75).
T157 65334-65370 Sentence denotes Primary diagnoses for the group was:
T158 65371-65453 Sentence denotes 48% CVID, 28% Hypogammaglobulinemia NOS 28%, 10% Congenital Hypogammaglobulinemia.
T159 65454-65716 Sentence denotes This pilot study was limited, but revealed known gap in data collection, challenge of patient recall, and variability of physician questions/notes/visit schedule as compared to an automated system which can collect patient infection data as frequently as needed.
T160 65717-65813 Sentence denotes There's no established acceptable rate of infections for a patient to be deemed well controlled.
T161 65814-65894 Sentence denotes There is no well-validated system of acquiring data from home infusion patients.
T162 65895-66000 Sentence denotes Further study is needed to validate utility of this automated uniform system of clinical data collection.
T163 66001-66003 Sentence denotes S.
T164 66004-66018 Sentence denotes Challa *1 , E.
T165 66019-66030 Sentence denotes King 2 , K.
T166 66031-66043 Sentence denotes Patel 2 , S.
T167 66044-66057 Sentence denotes Anghel 2 , J.
T168 66058-66075 Sentence denotes Brensilver 2 , L.
T169 66076-66090 Sentence denotes Bielory 2 , 1.
T170 66091-66110 Sentence denotes Springfield, NJ; 2.
T171 66111-66122 Sentence denotes Summit, NJ.
T172 66123-66227 Sentence denotes Rationale: PA generally leads to the use of broad-spectrum abx that may increase complications and cost.
T173 66228-66397 Sentence denotes A PST pilot protocol was developed at Overlook Medical Center to help reduce the use of broad-spectrum/high-cost (BS/HC) abx and determine the cost effectiveness of PST.
T174 66398-66406 Sentence denotes Methods:
T175 66407-66528 Sentence denotes A retrospective analysis was conducted on patients who had PST performed by an allergist between November 2013 -May 2014.
T176 66529-66674 Sentence denotes PST included prick and intradermal testing with major (Pre-Pen™) and minor (penicillin G) determinants followed by an oral amoxicillin challenge.
T177 66675-66721 Sentence denotes Abx were de-escalated based on results of PST.
T178 66722-66784 Sentence denotes Reduction in cost of abx, and adverse reactions were assessed.
T179 66785-66865 Sentence denotes Cost analysis was based on the material cost of abx and skin testing components.
T180 66866-66889 Sentence denotes Study was IRB approved.
T181 66890-66898 Sentence denotes Results:
T182 66899-66936 Sentence denotes A total of 38 adult patients had PST.
T183 66937-67082 Sentence denotes Median age was 64 yrs; 97%(n=37) were allergic to penicillin alone; piperacillin/tazobactam (n=1), and a history of multiple abx allergies (n=9).
T184 67083-67190 Sentence denotes Sixty three percent had a reaction >20yrs ago with cutaneous reaction being the most common reaction (45%).
T185 67191-67367 Sentence denotes Aztreonam was the most common initial abx used prior to PST (55%).Urinary tract (26.3%) and intra-abdominal infections (18%) were the most common indications for abx treatment.
T186 67368-67510 Sentence denotes Skin testing was negative in 38 (100%) patients but one patient had anaphylaxis to oral amox-icillin challenge following a negative skin test.
T187 67511-67621 Sentence denotes A cost analysis was performed in 29 patients who had antibiotics switched to a beta-lactam after negative PST.
T188 67622-67758 Sentence denotes Fourteen patients (48%) were switched to a narrow-spectrum agent (i.e. aminopenicillins, oxacillin, and non-pseudomonal cephalosporins).
T189 67759-67821 Sentence denotes Total cost of therapy with a beta-lactam after PST was $3,518.
T190 67822-67905 Sentence denotes Total cost of therapy if initial BS/HC abx prior to PST were continued was $14,670.
T191 67906-67968 Sentence denotes Approximate cost for PST materials for 38 patients was $3,631.
T192 67969-68123 Sentence denotes Overall cost savings was $7,521.The additional savings of impact on developing adverse reactions and superinfections (i.e. C. difficile) was not assessed.
T193 68124-68136 Sentence denotes Conclusions:
T194 68137-68274 Sentence denotes Following the implementation of a PST protocol, we observed a decrease in BS/HC antibiotic use in patients with previously documented PA.
T195 68275-68403 Sentence denotes PST is a safe and costeffective procedure to serve as a negative predictor test for penicillin hypersensitivity mediated by IgE.
T196 68404-68406 Sentence denotes K.
T197 68407-68421 Sentence denotes Winkler * , T.
T198 68422-68443 Sentence denotes Abramowitz Saadia, J.
T199 68444-68466 Sentence denotes Moallem, New York, NY.
T200 68467-68548 Sentence denotes Adverse effects of MMR vaccination, mostly self-limited and benign, are reported.
T201 68549-68745 Sentence denotes Fever in up to 15% of vaccinees 6 to 12 days after vaccination(1, 2), transient rash in up to 5%, febrile seizure 5 to 12 days after immunization, as well as mild lymphadenopathy (2) are reported.
T202 68746-68828 Sentence denotes Thrombocytopenia after MMR vaccination is reported in 1:25,000 to 1:2,000,000 (1).
T203 68829-69047 Sentence denotes There is no report of thrombocytopenia resulting in severe hemorrhagic complications or death in immunocompetent recipients (2).Infrequency with which it occurs makes it a challenging diagnostic task for practitioners.
T204 69048-69275 Sentence denotes 13 month old African American male presented to the emergency department due to two episodes of bloody vomitus.Two days prior he had fallen from a height of two stairs and sustained a rapidly enlarging hematoma on his forehead.
T205 69276-69404 Sentence denotes A hematoma to the lip was noted on the day of presentation.10 days prior to presentation he was vaccinated with the MMR vaccine.
T206 69405-69912 Sentence denotes There was no reported history of fever, recent upper respiratory illness or other illness.Physical examination in the ED demonstrated a fussy but alert child, HR 145, RR 36, T 100.2F, with a five centimeter hematoma on the forehead, hemorrhagic lesion on the upper lip, gingival bleeding and multiple petechiae on the upper and lower extremities.The rest of the physical examination was unremarkable.Laboratory investigation was significant for platelet count of 5K/uL, Hgb 8.4 g/dL and Hct of 24.7% on CBC.
T207 69913-70039 Sentence denotes Indirect Coombs test and Stool Guaiac were positive.In PICU his hemoglobin further dropped to 4.0 g/dL, requiring transfusion.
T208 70040-70156 Sentence denotes Bone marrow aspiration revealed absence of lymphoblasts with increased megakaryocytes and red blood cell precursors.
T209 70157-70320 Sentence denotes He was treated with IVIG 1g/kg/day for 2 days and Methylprednisolone 4mg/kg/day for 4 days then continued on PO prednisone 2mg/kg/day to be continued for one week.
T210 70321-70445 Sentence denotes CBC on the seventh day of admission showed platelets of 311 K/uL, and increase of hemoglobin hematocrit to 9.4 g/dL and 28%.
T211 70446-70566 Sentence denotes ITP after MMR vaccination typically occurs within 6 weeks of vaccination (3).Mild bruising and petechiae are common (4).
T212 70567-70889 Sentence denotes Hospitalization is rarely required.Transfusion is required in 1 of 1.8 million vaccinees (5).Platelet counts are typically >20,000 K/uL, higher than non-vaccine associated ITP (6).This is the first report of thrombocytopenia resulting in severe hemorrhagic complications in an immunocompetent recipient of the MMR vaccine.
T213 70890-70892 Sentence denotes E.
T214 70893-70907 Sentence denotes Willits * , A.
T215 70908-70929 Sentence denotes Joshi, Rochester, MN.
T216 70930-70943 Sentence denotes Introduction:
T217 70944-71113 Sentence denotes Granulomatous interstitial lung disease (GL-ILD) develops in a subset of patients with common variable immunodeficiency (CVID) and is commonly confused with sarcoidosis.
T218 71114-71198 Sentence denotes Little is known about the immunophenotyping of T and B lymphocyte subsets in GL-ILD.
T219 71199-71260 Sentence denotes We reviewed the charts of four patients with CVID and GL-ILD.
T220 71261-71269 Sentence denotes Methods:
T221 71270-71364 Sentence denotes The presentation, laboratory and imaging studies, and treatment recommendations were reviewed.
T222 71365-71479 Sentence denotes Each patient presented with thrombocytopenia and splenomegaly, and was subsequently found to have CVID and GL-ILD.
T223 71480-71562 Sentence denotes Two patients, an 18 yr/M (#1), and a 12 yr/M (#2), presented with Evan's Syndrome.
T224 71563-71571 Sentence denotes Results:
T225 71572-71632 Sentence denotes All patients demonstrated significant hypogammaglobulinemia.
T226 71633-71716 Sentence denotes Chest CTs were obtained in all patients and demonstrated diffuse nodular opacities.
T227 71717-71879 Sentence denotes All patients underwent BAL and bronchoscopy to rule out an acute or chronic infection in addition to immunostaining and pathology studies on a lung biopsy sample.
T228 71880-71975 Sentence denotes Tissue sam-ples were obtained to confirm the diagnosis of GL-ILD in three out of four patients.
T229 71976-72149 Sentence denotes Finally, B-Cell Immunophenotyping was obtained for all patients and showed decrease in total memory B-Cells (CD27+),especially low class switched memory B Cells (CD27+M-D-).
T230 72150-72162 Sentence denotes Conclusions:
T231 72163-72278 Sentence denotes These four cases illustrate the association between low class switched memory B Cells with GL-ILD in CVID patients.
T232 72279-72420 Sentence denotes Specifically, it was found that all patients had decreased percent (3/4) or decreased absolute number (4/4) of class switched memory B Cells.
T233 72421-72538 Sentence denotes B cell immunophenotyping may therefore be a useful tool for identifying patients with CVID and granulomatous disease.
T234 72539-72771 Sentence denotes Implications for early identification include early initiation of specific treatment regimens, since this subset of patients may have a poorer prognosis and decreased survival when compared to their granuloma-free CVID counterparts.
T235 72772-72972 Sentence denotes In this specific population of CVID patients, the combination of Rituximab and Azathioprine has been shown in preliminary studies to result in improvement in pulmonary function tests and lung disease.
T236 72973-73161 Sentence denotes The combination of low serum IgA levels, splenomegaly and low class switched memory B cells can be used to create a prediction model for the diagnosis of GL-ILD in CVID patients in future.
T237 73162-73173 Sentence denotes Background:
T238 73174-73386 Sentence denotes Rituximab is a chimeric anti-CD20 antibody used in the treatment of non-Hodgkin lymphomas, chronic lymphocytic leukemia, rheumatoid arthritis, granulomatosis with polyangiitis (GPA), and microscopic polyangiitis.
T239 73387-73517 Sentence denotes Rituximab is comprised of human IgG1(κ) heavy and light chain constant regions with murine anti-human CD20 IgG1κ variable regions.
T240 73518-73682 Sentence denotes Treatment with rituximab results in complement-dependent cytotoxicity, antibodydependent cellular toxicity and direct cytotoxicity to CD20-expressing B-lymphocytes.
T241 73683-73856 Sentence denotes Pharmacokinetic studies suggest that serum levels of rituximab can still be detected 3 to 6 months after treatment with a half-life of elimination ranging from 5 to 78 days.
T242 73857-73949 Sentence denotes As an IgG antibody, rituximab may cross the placenta and be secreted into human breast milk.
T243 73950-74095 Sentence denotes However, it remains unknown what concentrations rituximab achieves in neonates in utero, and if breast feeding after rituximab treatment is safe.
T244 74096-74104 Sentence denotes Methods:
T245 74105-74188 Sentence denotes Rituximab was quantified by mass spectroscopy (MS) from serum of mother and infant.
T246 74189-74197 Sentence denotes Results:
T247 74198-74413 Sentence denotes A 31 year old primigravid woman with GPA required a fourth cycle of rituximab (375 mg/m 2 ) weekly for four weeks starting at 30 weeks gestation for management of headache stemming from pituitary involvement by GPA.
T248 74414-74492 Sentence denotes She delivered a healthy term infant by cesarean section at 40 weeks gestation.
T249 74493-74557 Sentence denotes The baby was exclusively breast fed without major health issues.
T250 74558-74616 Sentence denotes Cord blood samples were not taken at the time of delivery.
T251 74617-74721 Sentence denotes At four months post-partum, serum samples from the infant and mother were checked and shown in Table 1 .
T252 74722-74870 Sentence denotes Trace amounts of peptides corresponding to both the heavy chain and light chain of rituximab were detected in the infant's and mother's serum by MS.
T253 74871-74883 Sentence denotes Conclusions:
T254 74884-75008 Sentence denotes Rituximab peptides were detected in the serum of an infant who was exposed to rituximab in utero and exclusively breast fed.
T255 75009-75176 Sentence denotes The infant's B-cell population and immunoglobulin levels did not appear to be affected at four months of age (approximately 6 months after initial rituximab exposure).
T256 75177-75289 Sentence denotes Measuring rituximab concentrations in breast milk may help to clarify if rituximab is secreted into breast milk.
T257 75290-75501 Sentence denotes Laboratory results from infant and mother at 4 months post-partum Background: X-linked agammaglobulinemia (XLA) is a primary immunodeficiency characterized by low immunoglobulins and an absence of B-lymphocytes.
T258 75502-75624 Sentence denotes XLA is secondary to a mutation of the Bruton tyrosine kinase (BTK) gene, which prevents the maturation of B cell lineages.
T259 75625-75755 Sentence denotes Patients with XLA most commonly present with recurrent sinopulmonary infections and are at risk for severe enteroviral infections.
T260 75756-75928 Sentence denotes We report the case of a 3 year old patient with a history of recurrent infections, treated for atypical Guillain-Barré syndrome (GBS), who was later discovered to have XLA.
T261 75929-75941 Sentence denotes Case Report:
T262 75942-76092 Sentence denotes The patient initially presented to our facility with proximal upper and lower extremity weakness, which progressed to near complete flaccid paralysis.
T263 76093-76229 Sentence denotes After initial laboratory and radiographic studies were unremarkable, he was diagnosed with an axonal variant of Guillain-Barré syndrome.
T264 76230-76301 Sentence denotes Empiric treatment with intravenous immunoglobulin (IVIG) was initiated.
T265 76302-76384 Sentence denotes Despite therapy, his weakness progressed and the patient underwent plasmapheresis.
T266 76385-76483 Sentence denotes After plasmapheresis he continued to receive pulse doses of IVIG for residual neurologic deficits.
T267 76484-76553 Sentence denotes Prior to his diagnosis of GBS our patient had recurrent otitis media.
T268 76554-76690 Sentence denotes In the following 24 months, he experienced recurrent infections such as sinusitis, pneumonia and an episode of S. pneumoniae bacteremia.
T269 76691-76749 Sentence denotes Infections often occurred 4-6 months after receiving IVIG.
T270 76750-76814 Sentence denotes He was thereafter found to have low total immunoglobulin levels.
T271 76815-76929 Sentence denotes Flow cytometry revealed a total absence of CD19 B lymphocytes and nonprotective antibody responses to vaccination.
T272 76930-77035 Sentence denotes Mutation analysis detected a c.595A>T nonsense mutation of the BTK gene, confirming the diagnosis of XLA.
T273 77036-77152 Sentence denotes He was begun on monthly IVIG replacement therapy and transitioned to weekly subcutaneous immunoglobulin replacement.
T274 77153-77230 Sentence denotes He has remained infection free since beginning a regular replacement program.
T275 77231-77242 Sentence denotes Discussion:
T276 77243-77339 Sentence denotes Patients with X-linked agammaglobulinemia often present with recurrent sinopulmonary infections.
T277 77340-77428 Sentence denotes However, this patient presented with atypical GBS that required plasmapheresis and IVIG.
T278 77429-77571 Sentence denotes Pulse IVIG therapy inadvertently resulted in intervals without recurrent infection that likely contributed to a delay in his diagnosis of XLA.
T279 77572-77755 Sentence denotes This case demonstrates the importance of considering primary immunodeficiency in pediatric patients with a history of recurrent or severe infections and atypical neurologic syndromes.
T280 77756-77760 Sentence denotes C.J.
T281 77761-77786 Sentence denotes Calais * , Rockville, MD.
T282 77787-77800 Sentence denotes Introduction:
T283 77801-77950 Sentence denotes The purpose of this case is to shed more light on the link of alcohol-induce respiratory symptoms with aspirin exacerbated respiratory disease(AERD).
T284 77951-77961 Sentence denotes Rationale:
T285 77962-78054 Sentence denotes There is a distinct link between alcohol-induced respiratory symptoms in patients with AERD.
T286 78055-78368 Sentence denotes A recent questionnaire based study of 50 patients which consisted of (4) clinical types (aspirin challenge confirmed AERD, aspirin tolerant asthma, aspirin tolerance with chronic rhinosinusitis, and a healthy control), characterized the prevalence of alcohol-induced reactions to be highest in patients with AERD.
T287 78369-78575 Sentence denotes We present a case of a patient with confirmed AERD/Samter's triad and alcohol-induced respiratory reaction that experienced resolution of alcohol-induced symptoms with aspirin (ASA) desensitization therapy.
T288 78576-78584 Sentence denotes Methods:
T289 78585-78744 Sentence denotes Review of clinical course, documentation as well as ASA desensitization/challenge was conducted at Walter Reed National Military Medical Center Allergy Clinic.
T290 78745-78753 Sentence denotes Results:
T291 78754-79002 Sentence denotes Our 56 year old patient had a history of facial flushing and profuse rhinorrhea with ingestion of alcoholic beverages, which arose concurrently with his diagnosis of severe recurrent nasal polyposis, asthma, allergic rhinitis, anosmia, and ageusia.
T292 79003-79253 Sentence denotes He first experienced hypersensitivity to motrin in 2008 followed by ASA hypersensitivity in 2012 for which he related the symptoms of cephalic flushing, profuse rhinorrhea and ocular watering all of which mirrored his symptoms with alcohol ingestion.
T293 79254-79383 Sentence denotes ASA challenge/desensitization in 2014 elicited upper respiratory symptoms and a reversible decline in FEV1 of >10% from baseline.
T294 79384-79545 Sentence denotes Since the desensitization therapy, he has remained on ASA 650mg twice daily and has regained his sense of smell, taste, and can now tolerate alcohol consumption.
T295 79546-79558 Sentence denotes Conclusions:
T296 79559-79765 Sentence denotes The pathogenesis of alcohol-induced respiratory symptoms association with AERD is unknown; however, current thought postulates that alcohol may have an inhibitory effect on the catabolism of leukotriene E4.
T297 79766-79921 Sentence denotes This case lends clinical evidence that bolsters the idea of a common pathway for both conditions since ASA desensitization improved both disease processes.
T298 79922-80093 Sentence denotes Clinically, allergists should be cognizant of this link and the possibility that such patients may be able to tolerate alcohol following successful aspirin desentization .
T299 80094-80152 Sentence denotes A SUCCESSFUL TREATMENT OF SOLAR URTICARIA WITH OMALIZUMAB.
T300 80153-80155 Sentence denotes M.
T301 80156-80168 Sentence denotes Chong * , M.
T302 80169-80179 Sentence denotes Aquino, M.
T303 80180-80196 Sentence denotes Davis-Lorton, L.
T304 80197-80219 Sentence denotes Fonacier, Mineola, NY.
T305 80220-80231 Sentence denotes Background:
T306 80232-80309 Sentence denotes Solar urticaria is a rare physical urticaria caused by ultraviolet radiation.
T307 80310-80479 Sentence denotes Managing solar urticaria can be challenging as treatment options are limited to anti-histamines, sunscreen and UV light-hardening therapy, which are usually ineffective.
T308 80480-80653 Sentence denotes As Omalizumab has been shown to effectively treat refractory chronic urticaria, we hypothesized that Omalizumab may be effective in the treatment of solar urticaria as well.
T309 80654-80728 Sentence denotes We present a case of solar urticaria treated successfully with Omalizumab.
T310 80729-80741 Sentence denotes Case Report:
T311 80742-80869 Sentence denotes A 29 year old male was evaluated for a 9 year history of solar urticaria involving both exposed and lightly covered skin areas.
T312 80870-80969 Sentence denotes He noted improvement in his symptoms while working as a construction worker in Florida for 4 years.
T313 80970-81190 Sentence denotes However, upon return to New York 1 year ago he began to experience urticarial lesions every time he was exposed to sunlight despite the use of high-dose antihistamines (Zyrtec 40mg or Allegra 360 mg daily) and sunscreen.
T314 81191-81251 Sentence denotes His urticaria was not exacerbated by other physical factors.
T315 81252-81309 Sentence denotes Challenge tests were negative to visible and laser light.
T316 81310-81472 Sentence denotes However, multiple erythematous macules developed within 15 minutes of sun exposure through a window pane and 5 minutes of direct sun exposure on a different site.
T317 81473-81649 Sentence denotes A skin biopsy of the macular lesion revealed a superficial to deep perivascuar inflammatory cell infiltrate consisting of lymphocytes, histiocytes, neutrophils and eosinophils.
T318 81650-81735 Sentence denotes The biopsy and clinical findings were consistent with a diagnosis of solar urticaria.
T319 81736-81825 Sentence denotes The patient was placed on a monthly trial of Omalizumab 300 mg SQ for a total of 3 doses.
T320 81826-82032 Sentence denotes With daily challenges of sun exposure, the frequency of urticarial lesions significantly decreased 7 days after the first dose with complete control of urticaria after an additional two doses of Omalizumab.
T321 82033-82044 Sentence denotes Discussion:
T322 82045-82153 Sentence denotes Omalizumab is a monoclonal anti-IgE antibody that is FDA-approved for allergic asthma and chronic urticaria.
T323 82154-82370 Sentence denotes A few case reports have shown variable effectiveness of Omalizumab in the treatment of solar urticaria; one case showed resolution, one showed improvement and the last case did not show any effect on solar urticaria.
T324 82371-82484 Sentence denotes To our knowledge, this is the first case reporting rapid symptom improvement within 7 days of initiating therapy.
T325 82485-82657 Sentence denotes Although the evidence is limited, Omalizumab may be considered in patients with solar urticaria that is refractory to standard therapies with anti-histamines and sunscreen.
T326 82658-82671 Sentence denotes Introduction:
T327 82672-82927 Sentence denotes The term Immunoglobulin G4-related disease (IgG4-RD) refers to a newly recognized collection of fibroinflammatory disorders characterized by tissue infiltration of IgG4-positive plasma cells and eosinophils, obliterative phlebitis and elevated serum IgG4.
T328 82928-83121 Sentence denotes While the clinical presentation of IgG4-related disease will depend on the affected organ(s), the histopathological features, which are the cornerstone of the diagnosis, are strikingly similar.
T329 83122-83290 Sentence denotes Little is known about the pathogenesis of IgG4-RD, but TH2 cell responses are activated at the affected sites and patients may present with concomitant atopic symptoms.
T330 83291-83309 Sentence denotes Case Presentation:
T331 83310-83502 Sentence denotes A 66-year old Vietnamese man with a history of allergic rhinitis and chronic urticaria presented with a one year history of worsening neck lymphadenopathy and bilateral parotid gland swelling.
T332 83503-83667 Sentence denotes Laboratory evaluation showed serum eosinophils 18.2%, IgE 270 mg/ml, total IgG 2870 mg/L, IgG1 640mg/dL, IgG2 1240mg/dL, IgG3 245mg/dL, IgG4 >300mg/dL, ESR 37mm/hr.
T333 83668-83877 Sentence denotes Serum protein electrophoresis resulted in a total protein 8.1gdL, albumin 52.7%, alpha 2 globulins 7.5%, beta globulins 6.3%, gamma globulins 31.7%, with a possible monoclonal band present in the gamma region.
T334 83878-84020 Sentence denotes Histopathological analysis of lymph node biopsy found plasma cell dyscrasia arising in the background of IgG4-related sclerosing sialadenitis.
T335 84021-84265 Sentence denotes Immunohistochemical studies detected sheets of monotypic plasma cells positive for IgG4 (IgG4 infiltrate >150/hpf), IgG (IgG4/IgG ratio 80-90%), CD138, and Kappa light chain restriction, with periductal and perivascular onion-skinning fibrosis.
T336 84266-84356 Sentence denotes The lymphadenopathy and parotid swelling improved following oral corticosteroid treatment.
T337 84357-84368 Sentence denotes Discussion:
T338 84369-84514 Sentence denotes Because of the intrinsic TH2 bias that characterizes IgG4-related disease, patients' initial clinical features may suggest an allergic condition.
T339 84515-84651 Sentence denotes The presence of lymphadenopathy, swollen parotid or salivary glands or evidence of organ dysfunction should raise suspicion for IgG4-RD.
T340 84652-84779 Sentence denotes Prompt recognition is key because, if untreated, the expanding inflammatory lesions can potentially destroy the involved organ.
T341 84780-84866 Sentence denotes Moreover, up to 16% of patients develop malignancies during the course of the disease.
T342 84867-84877 Sentence denotes Rationale:
T343 84878-84990 Sentence denotes Eosinophilic esophagitis (EoE) is a clinicopathological Th2driven atopic disorder with an escalating prevalence.
T344 84991-85070 Sentence denotes The condition is characterized by esophageal mucosal eosinophilic inflammation.
T345 85071-85134 Sentence denotes Untreated EoE can lead to irreversible damage of the esophagus.
T346 85135-85243 Sentence denotes Random food elimination appears to be effective; however, this regimen is empiric and is not evidence-based.
T347 85244-85547 Sentence denotes The goal of the present study was to investigate the association of EoE and food allergy by means of an allergy evaluation, in order to determine the potential pathogenic role of specific food allergen(s), and to avoid prolonged random, unnecessary, and unsubstantiated empiric food elimination diet(s).
T348 85548-85555 Sentence denotes Method:
T349 85556-85764 Sentence denotes We evaluated 54 patients (n=54; mean age= 43 years) with the diagnosis of EoE based on clinical history of dysphagia, esophagogastroduodenoscopies (Figure 1) , biopsies with > 15 eosinophils/high-power field.
T350 85765-85904 Sentence denotes Patients underwent food allergy evaluation by means of clinical history, allergy skin testing, and in vitro specific IgE ImmunoCAP testing.
T351 85905-85994 Sentence denotes Study participants eliminated the putative offending specific food allergen for 16 weeks.
T352 85995-86168 Sentence denotes Clinical and pathological improvement was assessed by a patient symptom scoring system (PSSS) and by upper GI endoscopy with esophageal biopsy to monitor treatment response.
T353 86169-86177 Sentence denotes Results:
T354 86178-86287 Sentence denotes The primary symptoms of EoE in our study included dysphagia (94%), food impaction (35%), and heartburn (96%).
T355 86288-86413 Sentence denotes The common food allergens detected included wheat (58%), dairy (53%), egg (35%), soy (28%), peanut (25%) and tree nuts (21%).
T356 86414-86622 Sentence denotes Avoidance of the above offending food allergens for a 16-week period resulted in improvement of symptoms, with a decrease (PSSS) of 98%, 100% and 90% in dysphagia, food impaction, and heartburn, respectively.
T357 86623-86799 Sentence denotes Mean average density esophageal eosinophilic infiltration (eos/hpf) from mid-esophageal biopsies before and after specific food elimination diet decreased from 36 to 6 eos/hpf.
T358 86800-86865 Sentence denotes Amelioration and sustained remission occurred in 82% of patients.
T359 86866-86877 Sentence denotes Conclusion:
T360 86878-87162 Sentence denotes The results of this study support the role of food allergy in EoE and illustrate the need for a collaborative gastroenterologic/allergic approach not only for successful management of EoE, but also for avoidance of unnecessary and potentially harmful, unsubstantiated exclusion diets.
T361 87163-87292 Sentence denotes This requires a multidisciplinary collaboration of gastroenterologists, allergist-immunologists, pathologists, and nutritionists.
T362 87293-87297 Sentence denotes A.L.
T363 87298-87313 Sentence denotes Humphrey * , M.
T364 87314-87323 Sentence denotes Reddy, J.
T365 87324-87334 Sentence denotes Shroba, C.
T366 87335-87360 Sentence denotes Ciaccio, Kansas City, MO.
T367 87361-87374 Sentence denotes Introduction:
T368 87375-87511 Sentence denotes The prevalence of food allergy has been difficult to assess, but previous studies report a range of 3.4%-8% in the pediatric population.
T369 87512-87593 Sentence denotes It is unclear how or if geographic factors affect the prevalence of this disease.
T370 87594-87808 Sentence denotes As our institution is the primary provider of pediatric allergy/immunology consultation within the urban core of Kansas City, we aimed to estimate the prevalence of food allergy in children residing in this region.
T371 87809-87817 Sentence denotes Methods:
T372 87818-87882 Sentence denotes This study was approved by the local Institutional Review Board.
T373 87883-87993 Sentence denotes Pediatric outpatient clinic data from 2004-2014 was obtained through our hospital's electronic medical record.
T374 87994-88101 Sentence denotes Patients with ICD-9 codes 995.3, 995.60-995.69, 995.7, 693.1, 708, V15.01-V15.05, and V15.09 were selected.
T375 88102-88178 Sentence denotes United States Census data was used to estimate total population by ZIP code.
T376 88179-88237 Sentence denotes Multiple encounters by the same patient were consolidated.
T377 88238-88246 Sentence denotes Results:
T378 88247-88346 Sentence denotes Representing 545 unique ZIP codes, 12,612 distinct food allergic children were seen from 2004-2014.
T379 88347-88456 Sentence denotes Two thousand six hundred and fifty nine children were identified within the city's urban core (26 ZIP codes).
T380 88457-88556 Sentence denotes The average prevalence of food allergy in this urban core was 5.2% with the range being 1.6%-10.3%.
T381 88557-88568 Sentence denotes Conclusion:
T382 88569-88698 Sentence denotes The prevalence of pediatric food allergy in urban Kansas City over the past decade is consistent with previously reported values.
T383 88699-88808 Sentence denotes Further investigation is needed to determine if variations exist between urban, suburban, and rural settings.
T384 88809-88811 Sentence denotes A.
T385 88812-88830 Sentence denotes Tripathi *1 , L.J.
T386 88831-88847 Sentence denotes Workman 1 , S.P.
T387 88848-88862 Sentence denotes Commins 1 , R.
T388 88863-88880 Sentence denotes Hamilton 2 , E.A.
T389 88881-88895 Sentence denotes Erwin 3 , T.A.
T390 88896-88915 Sentence denotes Platts-Mills 1 , 1.
T391 88916-88939 Sentence denotes Charlottesville, VA; 2.
T392 88940-88957 Sentence denotes Baltimore, MD; 3.
T393 88958-88971 Sentence denotes Columbus, OH.
T394 88972-88983 Sentence denotes Background:
T395 88984-89194 Sentence denotes In the investigation of food allergy syndromes, serum assays detecting IgE antibodies (Ab) to food allergens use whole extracts on the solid phase, which contain specific allergen components in varying amounts.
T396 89195-89444 Sentence denotes The interpretation of results assumes that the causative allergen components are adequately represented in the extract and that the presence and level of specific IgE titer to the whole extract of the relevant food(s) are diagnostic of the syndrome.
T397 89445-89547 Sentence denotes IgE assays for beef or pork can underestimate the IgE Ab to a minor component of mammalian meat, αgal.
T398 89548-89710 Sentence denotes The inciting food allergens in Eosinophilic Esophagitis (EoE) remain unclear, although IgE Ab to milk, wheat, soy, and peanut are frequently present in low titer.
T399 89711-89718 Sentence denotes Method:
T400 89719-89914 Sentence denotes IgE Ab to relevant allergens and their components were measured in the sera of adults and chil-dren with peanut allergy, delayed anaphylaxis to mammalian meat, or esophageal biopsy-diagnosed EoE.
T401 89915-89938 Sentence denotes Assay methods included:
T402 89939-90106 Sentence denotes ImmunoCAP (CAP) using whole and component extracts, CAP assays on serial dilutions (1:2 to 1:8) of sera, and ImmunoCAP ISAC (biochip assay for 112 purified allergens).
T403 90107-90271 Sentence denotes Results:Analysis with ISAC correlated well with results using component-specific CAP assays for both peanut allergens (peanut allergy) and inhalant allergens (EoE).
T404 90272-90405 Sentence denotes By contrast, no positive results for food allergens were found by ISAC in EoE sera that were positive for milk, wheat, or soy by CAP.
T405 90406-90734 Sentence denotes Dilution assays showed no change (undiluted value vs. calculated titer) for peanut in peanut allergy sera or inhalants (dust mite and cat) in EoE sera in contrast, calculated titers up to six times the undiluted value were noted for foods in EoE sera (milk, wheat, and peanut) and in mammalian meat allergy sera (beef and pork).
T406 90735-90832 Sentence denotes CAP assays for 5 milk components revealed positivity to minor components in over 50% of EoE sera.
T407 90833-90947 Sentence denotes CAP assays for αgal revealed positivity in 100% of patients presenting with delayed anaphylaxis to mammalian meat.
T408 90948-90959 Sentence denotes Conclusion:
T409 90960-91199 Sentence denotes Differences in the results of the dilution assays demonstrate that assaying undiluted sera can significantly underestimate IgE Ab levels if the IgE Ab are directed against a quantitatively minor component of the extract on the solid phase.
T410 91200-91355 Sentence denotes These results strongly suggest that the IgE Ab to milk and other foods in EoE sera are directed against a minor component that has not yet been identified.
T411 91356-91358 Sentence denotes R.
T412 91359-91372 Sentence denotes Gupta *1 , L.
T413 91373-91399 Sentence denotes DeSantiago-Cardenas 2 , V.
T414 91400-91414 Sentence denotes Rivkina 1 , 1.
T415 91415-91430 Sentence denotes Chicago, IL; 2.
T416 91431-91443 Sentence denotes Phoenix, AZ.
T417 91444-91533 Sentence denotes According to the CDC, food allergy prevalence has increased by 50% between 1997 and 2011.
T418 91534-91635 Sentence denotes Currently, approximately 1 out of every 13 children, or 2 children per classroom, has a food allergy.
T419 91636-91890 Sentence denotes In addition, it is estimated that more than 15% of school aged children with food allergies have had a reaction in school and that 20-25% of epinephrine administrations in schools involve individuals whose allergy was unknown at the time of the reaction.
T420 91891-92038 Sentence denotes For this reason, it is important for schools to have undesignated emergency epinephrine available for use in the event of an anaphylactic reaction.
T421 92039-92047 Sentence denotes Purpose:
T422 92048-92321 Sentence denotes The aim of this presentation is to demonstrate how Chicago Public Schools (CPS) was the first large urban school district in the United States to develop and implement a comprehensive stock epinephrine policy in accordance with state guidelines and present Year 1 findings.
T423 92322-92335 Sentence denotes Significance:
T424 92336-92530 Sentence denotes Understanding how CPS developed and implemented their Emergency Epinephrine Initiative will help districts across the United States appreciate the benefits and challenges of such an undertaking.
T425 92531-92543 Sentence denotes Methodology:
T426 92544-92745 Sentence denotes After updating a key health-related policy to include District Issued Emergency Epinephrine, EpiPens were distributed to all schools in the district prior to the beginning of the 2012/2013 school year.
T427 92746-92869 Sentence denotes Data was collected on District Issued EpiPen usage based on school nurse progress notes and principal reporting mechanisms.
T428 92870-92879 Sentence denotes Findings:
T429 92880-93054 Sentence denotes During Year 1 of the CPS District Issued Emergency Epinephrine Initiative, 38 lives were saved because of the availability of stock epinephrine in schools across Chicagoland.
T430 93055-93216 Sentence denotes Of these 38 individuals, 2 were school staff, and 36 were students between the ages of 3 and 19, with more than half of the reactions being first time incidents.
T431 93217-93228 Sentence denotes Conclusion:
T432 93229-93488 Sentence denotes After evaluating the distribution and tracking the usage of District Issued EpiPens, the CPS Office of Student Health and Wellness has learned key lessons which will inform the strategy for future years of the District Issued Emergency Epinephrine Initiative.
T433 93489-93677 Sentence denotes As the first large urban school district to implement such a project, CPS is poised to be a national model of what a school district can do to save the lives of its students. respectively.
T434 93678-93970 Sentence denotes The quality of exposure assessment ranged from measured exposure by validated questionnaire (n=2) to exposure surrogates, including plant (30 exposures), job title linked to job exposure matrices (n=3), geographic information system (n=2) to self-reported exposures without validation (n=16).
T435 93971-94110 Sentence denotes Concerning outcome definition, no studies used the current clinical EPOS CRS definition (symptoms plus objective evidence of inflammation).
T436 94111-94374 Sentence denotes Studies were thus classified based on the likelihood that their CRS definition represented true CRS: "probable" n = 17 for objective criteria; "possible" n = 8 for validated definition without objective evidence; and "least likely" n = 23 for varying definitions.
T437 94375-94443 Sentence denotes Associations were assessed for the "probable" or "possible" studies.
T438 94444-94735 Sentence denotes Fishing, grain farming, diving, cotton, pickling and glass blowing, World Trade Center rescue work (n=1 study for each), self-reported work exposure (n=5), second hand smoking (n=5), wood stove use (n=1) and air pollution (n=2) were the exposures that showed a positive association with CRS.
T439 94736-94835 Sentence denotes Since most exposures were only evaluated by one study, no between-study evidence could be assessed.
T440 94836-95148 Sentence denotes Among exposures with 3 or more studies, unclear or non-quantitative exposure assessment, biased study design, varied outcomes (eg. second hand smoking n=1 incident CRS, n=3 difficult-to-treat CRS with 3 different outcomes), and approach to analysis did not allow rigorous comparison or meta-analysis Conclusions:
T441 95149-95284 Sentence denotes The published literature offers little evidence of whether and how occupational and environmental exposures may be associated with CRS.
T442 95285-95391 Sentence denotes Studies are needed using current clinical case definitions and rigorous approaches to exposure assessment.
T443 95392-95394 Sentence denotes K.
T444 95395-95407 Sentence denotes Kumar * , A.
T445 95408-95427 Sentence denotes Shah, Delhi, India.
T446 95428-95441 Sentence denotes Introduction:
T447 95442-95552 Sentence denotes Allergic rhinitis (AR), chronic rhinosinusitis (CRS) and nasal polyposis (NP) are known to coexist frequently.
T448 95553-95644 Sentence denotes AR and CRS impair the quality of life (QoL) and also adversely affect the quality of sleep.
T449 95645-95767 Sentence denotes NP remains largely undiagnosed and is thought to independently affect negatively the quality of sleep in patients with AR.
T450 95768-95776 Sentence denotes Methods:
T451 95777-95958 Sentence denotes The study comprised 106 consecutive patients with AR (males/females, 60/46), between 18 to 60 years, enrolled from outpatients department of VP Chest Institute, University of Delhi.
T452 95959-96033 Sentence denotes IRB approval and informed consent was obtained from all research subjects.
T453 96034-96120 Sentence denotes AR was diagnosed according to "Allergic Rhinitis and its Impact on Asthma" guidelines.
T454 96121-96183 Sentence denotes CT-PNS, done in all patients, assessed the presence of CRS/NP.
T455 96184-96315 Sentence denotes The patients were divided into three groups: AR alone (group 1), AR with CRS without NP (group 2) and AR with CRS and NP (group 3).
T456 96316-96476 Sentence denotes To assess the severity of the disease and impact on QoL, patients responded to Visual Analogue Scale (VAS) and Sinonasal Outcome Test 22 (SNOT-22) respectively.
T457 96477-96685 Sentence denotes To study the effect of NP on sleep, patients responded to Nocturnal Rhinoconjunctivitis Quality of Life Questionnaire (NRQLQ), the Epworth Sleepiness Scale (ESS) and the Pittsburgh Sleep Quality Index (PSQI).
T458 96686-96694 Sentence denotes Results:
T459 96695-96821 Sentence denotes The 106 patients were categorised as follows: group 1 with 34 (32%), group 2 with 36 (34%) and group 3 with 36 (34%) patients.
T460 96822-96924 Sentence denotes Mean global VAS score increased from 7.12 in group 1 to 7.66 in group 2 and 8.03 in group 3 (P=0.004).
T461 96925-97027 Sentence denotes Mean SNOT-22 score increased from 45.47 in group 1 to 66.83 in group 2 and 70.22 in group 3 (P=0.001).
T462 97028-97136 Sentence denotes Similarly, mean NRQLQ score increased from 32.94 in group 1 to 49 in group 2 and 63.19 in group 3 (P=0.002).
T463 97137-97238 Sentence denotes Mean ESS score too increased from 9.76 in group 1 to 11.14 in group 2 and 12.24 in group 3 (P=0.001).
T464 97239-97348 Sentence denotes Mean global PSQI score also increased from 7.17 in group 1 to 9.67 in group 2 and 13.58 in group 3 (P=0.001).
T465 97349-97423 Sentence denotes Conclusions: NP occurs in half of the patients with AR and associated CRS.
T466 97424-97527 Sentence denotes The presence of NP significantly increased the severity of the disease and negatively impacted the QoL.
T467 97528-97643 Sentence denotes Instruments to assess the effect on sleep highlighted the significant adverse impact of NP on the quality of sleep.
T468 97644-97746 Sentence denotes Its presence denotes a more severe form of the disease, thus emphasising the need for early diagnosis.
T1 97747-97749 Sentence denotes M.
T2 97750-97761 Sentence denotes Duse * , A.
T3 97762-97772 Sentence denotes Zicari, M.
T4 97773-97785 Sentence denotes Nebbioso, F.
T5 97786-97796 Sentence denotes Occasi, L.
T6 97797-97809 Sentence denotes Leonardi, A.
T7 97810-97830 Sentence denotes Zicari, Rome, Italy.
T8 97831-97995 Sentence denotes Vernal keratoconjunctivitis (VKC) is a chronic disease affecting conjunctiva even though the immunopathogenetic mechanisms underlying this inflammation are unclear.
T9 97996-98272 Sentence denotes Although many clinical and laboratory findings support the presence of an IgE-dependent immediate hypersensitivity reaction in VKC [2], the conflicting results concerning the association between VKC and atopy sug-gest that an IgE-independent mechanisms could also be involved.
T10 98273-98675 Sentence denotes High-mobility group box protein 1 (HMGB1) has been recently identified as an important proinflammatory mediator with many characteristics similar to classic proinflammatory cytokines The aim of our study is to investigate serum levels of HMGB1 and circulating sRAGE in children affected by VKC before and after treatment with cyclosporine A (CsA) eye drops and in a group of otherways healthy children.
T11 98676-98769 Sentence denotes Methods Twenty-four children affected by VKC aged between 5 and 12 yrs of life were enrolled.
T12 98770-98928 Sentence denotes Twenty-four healthy children without atopy, ocular, and systemic disease, cross-matched for sex and age to patients affected by VKC, represented the controls.
T13 98929-99161 Sentence denotes All children affected by VKC were treated with CsA 1% eye drops for 4 wks, and blood samples were collected before and 2 wks after the end of treatment while the controls underwent to a single blood sample at the time of enrollment.
T14 99162-99288 Sentence denotes Statistical analyses were performed using SPSS (Statistical Package of Social Sciences, Chicago, IL, USA) software version 19.
T15 99289-99327 Sentence denotes Ethical Committee approuved the study.
T16 99328-99579 Sentence denotes Results Serum basal levels of HMGB1 and sRAGE were higher in children with VKC when compared with controls while, in patients affected by VKC, no difference was detected between atopic and non-atopic, and between ANA-positive and ANAnegative children.
T17 99580-99701 Sentence denotes A significant reduction in serum HMGB1 and sRAGE levels was found after the therapy while CsA serum levels were negative.
T18 99702-99850 Sentence denotes Discussion Our study gives a support to the definition of VKC as a systemic inflammation in which HMGB1 and its soluble receptors could play a role.
T19 99851-100020 Sentence denotes We did not find any detectable levels of systemic CsA at the end of our study, but serum levels of HMGB1 and sRAGE showed a significant reduction after 4 wks of therapy.
T20 100021-100203 Sentence denotes Our findings lead us to hypothesize that the topical administration of CsA may influence not only the ocular immunological responses but also the regulation of systemic inflammation.
T21 100204-100215 Sentence denotes Background:
T22 100216-100325 Sentence denotes Serum periostin (SP) has been proposed as a potential biomarker of TH2-related airway inflammation in asthma.
T23 100326-100411 Sentence denotes However, allergic rhinitis (AR), another TH2 disease, commonly co-exists with asthma.
T24 100412-100557 Sentence denotes There is limited information on periostin expression in rhinitis and whether this could confound the use of SP as a biomarker in allergic asthma.
T25 100558-100932 Sentence denotes Here, we aimed to 1) To compare the presence and extent of periostin immuno-expression in nasal biopsies from subjects with both IN and OUT-OF-season (grass pollen) AR, perennial (house dust mite, HDM) AR, healthy subjects and in subjects with non-atopic rhinitis; 2) To assess whether airborne ragweed challenge affects SP levels in OUT-OF-Season ragweed-allergic subjects.
T26 100933-100941 Sentence denotes Methods:
T27 100942-101235 Sentence denotes Periostin immunostaining was assessed in nasal biopsies obtained from subjects with IN-season AR (n=17), perennial AR (n=13), non-atopic rhinitis (NAR, n=9), OUT-OF-Season subjects 6hrs after a nasal allergen challenge (NAC) (n=9) and healthy (n=9) and non-rhinitic subjects (n=9) (Figure 1 ).
T28 101236-101478 Sentence denotes Serum SP was evaluated in subjects with ragweed-induced seasonal AR (n=15) and healthy (non-rhinitic, HNV) controls (n=5) before and after a 4 hour exposure to ragweed allergen in an environmental exposure chamber (EEC) on 2 consecutive days.
T29 101479-101487 Sentence denotes Results:
T30 101488-101705 Sentence denotes The extent of nasal biopsy periostin immuno-expression was significantly increased IN-Season AR (p<0.05), OUT-OF-Season NAC AR (P<0.05) and perennial AR (p<0.05) compared to non-allergic rhinitis and healthy subjects.
T31 101706-101867 Sentence denotes No significant differences were noted between seasonal and perennial AR groups (p=0.950) or between healthy and non-atopic rhinitis groups (p=0.233) (Figure 1 ).
T32 101868-101976 Sentence denotes There were no significant differences seen in SP after ragweed challenge compared to HNV studied in the EEC.
T33 101977-101988 Sentence denotes Conclusion:
T34 101989-102115 Sentence denotes Mucosal but not SP expression is increased in both seasonal and perennial AR compared to non-atopic rhinitis and HNV controls.
T35 102116-102233 Sentence denotes This suggests SP does not reflect local nasal inflammation and is therefore not a reliable systemic biomarker for AR.
T36 102234-102332 Sentence denotes Concomitant nasal disease should thus not interfere with the value of SP as a biomarker in asthma.
T37 102333-102343 Sentence denotes Rationale:
T38 102344-102575 Sentence denotes Studies have suggested that vitamin D deficiency is associated with increased prevalence of atopic disorders such as asthma, food allergy, and atopic dermatitis; however it has never been assessed in eosinophilic esophagitis (EoE).
T39 102576-102674 Sentence denotes Our objective was to determine the levels of 25-hydroxyvitamin D in a cohort of patients with EoE.
T40 102675-102683 Sentence denotes Methods:
T41 102684-102832 Sentence denotes We measured total serum 25-hydroxyvitamin D using liquid chromatography with tandem mass spectrometry in adults (n=35) and children (n=34) with EoE.
T42 102833-102977 Sentence denotes We compared the results to our patient demographics, EoE specific disease parameters, and markers of allergy using multiple logistic regression.
T43 102978-102986 Sentence denotes Results:
T44 102987-103027 Sentence denotes The median vitamin D level was 29 ng/ml.
T45 103028-103205 Sentence denotes Patients with insufficient vitamin D (<30 ng/ml) were older (age 25.5 compared with 16.2 years) and had a higher body mass index (BMI) (median 25.2 compared with 19.8, p<0.001).
T46 103206-103413 Sentence denotes Peak esophageal eosinophil counts were not different in vitamin D insufficient and sufficient patients; however, higher vitamin D levels were associated with higher tissue eosinophil counts (R=0.26, p<0.05).
T47 103414-103668 Sentence denotes While there were no differences in total IgE or titers of specific IgE in insufficient and sufficient patients, positive skin prick test to peanut was more common in patients who were vitamin D insufficient with odds ratio (O.R.) 5.98 (95% CI 1.51-23.7).
T48 103669-103789 Sentence denotes This result remained significant in a logistic regression model in which the results were adjusted for age and BMI (O.R.
T49 103790-103814 Sentence denotes 7.57 (95% CI 1.66-34.6).
T50 103815-103827 Sentence denotes Conclusions:
T51 103828-104009 Sentence denotes In our group of adult and pediatric patients with EoE, vitamin D levels were low overall (median <30 ng/ml) indicating that this is a population at risk for vitamin D insufficiency.
T52 104010-104108 Sentence denotes Interestingly lower vitamin D levels were not associated with higher esophageal eosinophil counts.
T53 104109-104236 Sentence denotes The only marker of allergy associated with having an insufficient level in EoE patients was positive skin prick test to peanut.
T54 104237-104425 Sentence denotes Poor understanding of allergic conditions can influence patient care through unnecessary diagnostic testing and/or management thus negatively impacting quality of care, cost, and outcomes.
T55 104426-104595 Sentence denotes We conducted an anonymous electronic survey of pediatric (Ped) and internal medicine (IM) residents and faculty physicians at two tertiary care academic medical centers.
T56 104596-104703 Sentence denotes Participants completed a 6 (IM) or 9 (Ped) item questionnaire regarding allergy evidence and/or guidelines.
T57 104704-104801 Sentence denotes 409 surveys were collected (Ped faculty=129, Ped residents=106, IM fac-ulty=78, IM residents=96).
T58 104802-104895 Sentence denotes An elective rotation in allergy (A/I) was completed by <50% of faculty and <20% of residents.
T59 104896-105147 Sentence denotes When asked for the best first treatment for a patient experiencing urticaria and emesis immediately following ingestion of a known food allergen, physicians reported: epinephrine=64%, 1 st generation antihistamine=31%, H2 antagonist=3%, prednisone=1%.
T60 105148-105210 Sentence denotes Only 50% of all IM physicians answered epinephrine (p<0.0001).
T61 105211-105368 Sentence denotes Regarding allergies that should be inquired about prior to ordering an imaging study with radiocontrast media: iodine=80%, shellfish=40%, artificial dye=21%.
T62 105369-105471 Sentence denotes IM physicians reported iodine (89 vs 73%) and shellfish (47 vs 34%) more than Ped physicians (p<0.05).
T63 105472-105650 Sentence denotes Regarding contraindicated (CI) immunizations in egg allergic patients, they answered: influenza=85%, yellow fever=49%, measles, mumps, rubella (MMR)=18%, varicella=8%, rabies=4%.
T64 105651-105786 Sentence denotes Ped physicians answered correctly regarding influenza (not CI) and yellow fever (CI) (49,50%) more than IM physicians (12,16%)(p<0.05).
T65 105787-105854 Sentence denotes IM residents (22%) answered MMR more than any other group (p<0.05).
T66 105855-106048 Sentence denotes Only 27% of all Ped physicians correctly identified common causes of IgE mediated food allergy in children <4 years old: egg=69%, milk=40%, whereas strawberry=34%, artificial food coloring=13%.
T67 106049-106197 Sentence denotes The majority of Ped physicians (47%) responded that skin prick testing for food or inhalant allergens is not accurate or reliable until 3 years old.
T68 106198-106382 Sentence denotes Of all physicians, 58% answered that medications may interfere with serum IgE results and 38% felt serum IgE testing was a useful screening test to detect the presence of food allergy.
T69 106383-106531 Sentence denotes Our survey identified substantial knowledge gaps regarding common A/I conditions among IM and Ped faculty and residents at academic medical centers.
T70 106532-106672 Sentence denotes Improved education and quality improvement strategies are needed to help provide the most accurate and up to date medical care for patients.
T71 106673-106679 Sentence denotes MO; 3.
T72 106680-106696 Sentence denotes Lynbrook, NY; 4.
T73 106697-106712 Sentence denotes Houston, TX; 5.
T74 106713-106729 Sentence denotes Springfield, NJ.
T75 106730-106740 Sentence denotes Rationale:
T76 106741-106906 Sentence denotes The purpose of this study was to evaluate the prevalence and severity of dry eye disease (DED) in a consecutive series of patients presenting to an allergy practice.
T77 106907-106915 Sentence denotes Methods:
T78 106916-107129 Sentence denotes 68 consecutive patients were tested for tear hyperosmolarity and polled for binary DED symptoms: fluctuating vision, lens discomfort, light sensitivity, watery eyes, tired eyes, redness, burning, itching and grit.
T79 107130-107234 Sentence denotes Data were compared to 9,407 subjects polled nationally across ophthalmologist and optometrist practices.
T80 107235-107243 Sentence denotes Results:
T81 107244-107394 Sentence denotes Of the patients reporting to the allergy clinic, 42.6% were highly symptomatic (reporting ≥ 5 symptoms), while 15.8% reported ≥ 5 symptoms nationally.
T82 107395-107513 Sentence denotes However, only 37.5% of the symptomatic subjects were hyperosmolar in the allergy clinic, compared to 51.6% nationally.
T83 107514-107713 Sentence denotes Although a smaller prevalence, the hyperosmolar subjects presenting to the allergy center displayed a significantly higher severity, averaging 337±28 mOsm/L vs. 323±16 mOsm/L nationally (p < 0.0001).
T84 107714-107930 Sentence denotes Non-DED subjects were clinically identical, averaging 295.7 mOsm/L vs. 297.8 mOsm/L nationally, which ruled out the possibility of instrumental variation or analytical drift accounting for the difference in severity.
T85 107931-108094 Sentence denotes These data suggest that dry eye in the presence of allergy may be more severe than dry eye alone, and that symptoms alone were insufficient to determine diagnosis.
T86 108095-108107 Sentence denotes Conclusions:
T87 108108-108187 Sentence denotes There is a significant overlap in symptoms of both allergy and dry eye disease.
T88 108188-108256 Sentence denotes Objective testing can help differentiate between the two etiologies.
T89 108257-108343 Sentence denotes Further, concomitant DED in the presence of allergy may be more severe than DED alone.
T90 108344-108348 Sentence denotes C.S.
T91 108349-108362 Sentence denotes Barnes * , F.
T92 108363-108374 Sentence denotes Pacheco, R.
T93 108375-108389 Sentence denotes Allenbrand, L.
T94 108390-108398 Sentence denotes Gard, C.
T95 108399-108424 Sentence denotes Ciaccio, Kansas City, MO.
T96 108425-108438 Sentence denotes Introduction:
T97 108439-108542 Sentence denotes Exposure to cigarette smoke is a major asthma trigger and has a detrimental impact on pediatric asthma.
T98 108543-108665 Sentence denotes Allergists frequently estimate pediatric exposure to cigarette smoke through questions directed to parents or care givers.
T99 108666-108809 Sentence denotes To evaluate the relationship of reported indoor smoking to actual levels of nicotine measured in house dust we performed the following studies.
T100 108810-108818 Sentence denotes Methods:
T101 108819-108908 Sentence denotes Dust was collected from homes enrolled in the Kansas City Safe and Healthy Homes Project.
T102 108909-109097 Sentence denotes Project enrollees were asked a series of questions concerning smoking in the home including the number of persons in the home who smoke and if anyone was allowed to smoke inside the house.
T103 109098-109223 Sentence denotes A convenience sample of 58 homes containing 0 to 5 individuals who declared they smoked cigarettes was selected for analysis.
T104 109224-109353 Sentence denotes For all samples, nicotine was extracted from 0.2 grams of dust and analyzed by immunoassay using commercially available reagents.
T105 109354-109514 Sentence denotes For conformation in one-third of samples nicotine was extracted from 0.5 grams of dust and analyzed for nicotine by gas chromatography mass spectroscopy (GCMS).
T106 109515-109523 Sentence denotes Results:
T107 109524-109642 Sentence denotes Enzyme immunoassay results indicated nicotine values for the 58 dusts ranged from 0 to 330 nanograms per gram of dust.
T108 109643-109713 Sentence denotes GCMS analysis results ranged from 0 to 340 nanograms per gram of dust.
T109 109714-109772 Sentence denotes Correlation between the two methods was strong (r = 0.90).
T110 109773-109922 Sentence denotes The lower limit of detection for the immunoassay was calculated at 4.0 nanograms per gram of dust and for the GCMS at 100 nanograms per gram of dust.
T111 109923-110019 Sentence denotes Dustborne nicotine concentrations were greatest in homes where up to 3 declared smokers resided.
T112 110020-110118 Sentence denotes The highest nicotine concentrations came from houses with declared smokers who smoked in the home.
T113 110119-110258 Sentence denotes Dustborne nicotine concentrations in homes where smoking was not permitted inside the house ranged from 0 to 50 nanograms per gram of dust.
T114 110259-110270 Sentence denotes Conclusion:
T115 110271-110370 Sentence denotes Nicotine concentration in house dust can be measured by commercially available immunoassay methods.
T116 110371-110473 Sentence denotes Homes where smoking was permitted had higher dust nicotine than homes where smoking was not permitted.
T117 110474-110570 Sentence denotes However, homes where smoking was declared not permitted were not without nicotine in house dust.
T118 110571-110575 Sentence denotes K.M.
T119 110576-110591 Sentence denotes Maples * , T.C.
T120 110592-110603 Sentence denotes Burch, A.M.
T121 110604-110617 Sentence denotes Perkins, K.M.
T122 110618-110631 Sentence denotes Cunnion, N.K.
T123 110632-110643 Sentence denotes Krishna, H.
T124 110644-110655 Sentence denotes Minto, L.K.
T125 110656-110668 Sentence denotes Willis, J.O.
T126 110669-110692 Sentence denotes Nyalwidhe, Norfolk, VA.
T127 110693-110706 Sentence denotes Introduction:
T128 110707-110850 Sentence denotes Currently there is no noninvasive assay to evaluate for the possibility of eosinophilic esophagitis (EoE) in patients with suggestive symptoms.
T129 110851-110947 Sentence denotes The current standard of diagnosis and monitoring is endoscopy but this is an imperfect approach.
T130 110948-111187 Sentence denotes Endoscopy is invasive, esophageal epithelial eosinophilia is not uniform, there is not a standardized high-power field (hpf) size and current diagnostic thresholds for eosinophils per hpf correlate poorly with clinical measures of disease.
T131 111188-111314 Sentence denotes Identification of a truly noninvasive biomarker for EoE and a standardized, reliable assay is an important unmet medical need.
T132 111315-111323 Sentence denotes Methods:
T133 111324-111461 Sentence denotes Urine samples were obtained from patients with biopsy proven EoE (n=27) and from atopic controls (n=24) without eosinophilic esophagitis.
T134 111462-111612 Sentence denotes We used a targeted Single Ion Monitoring LC-MS-MS strategy to quantify the levels of 3-Bromotyrosine (3-BrTyr) in creatinine-normalized urine samples.
T135 111613-111746 Sentence denotes Descriptive statistical analysis was performed for 3-BrTyr level following stratification and compared using the Mann-Whitney U test.
T136 111747-111755 Sentence denotes Results:
T137 111756-111958 Sentence denotes The median urine 3-BrTyr level was 12-fold higher for all subjects with EoE (169.50 picograms 3-BT/400 mg creatinine/dL, IQR 40.74-412.86) compared with atopic controls (12.87, IQR 3.51-114.69 (P=.01)).
T138 111959-112164 Sentence denotes In order to evaluate the potential utility of urine 3-BrTyr as a screening test we performed a subset analysis evaluating only newly diagnosed and untreated patients with EoE compared with atopic controls.
T139 112165-112326 Sentence denotes The median urine 3-BrTyr level was 13-fold higher for untreated subjects with EoE (172.62, .60) compared with atopic controls (12.87, IQR 3.51-114.69 (P=.0459)).
T140 112327-112412 Sentence denotes Using a threshold cutoff of 145 yields a sensitivity of 67% and a specificity of 79%.
T141 112413-112506 Sentence denotes Thus, a 3-BrTyr level<145 yields a negative predictive value of 90.48% in atopic individuals.
T142 112507-112519 Sentence denotes Conclusions:
T143 112520-112598 Sentence denotes This proof-of-concept study demonstrates a reliable assay for urinary 3-BrTyr.
T144 112599-112719 Sentence denotes Further, urinary 3-BrTyr has the potential to be a useful, noninvasive biomarker in the diagnosis and management of EoE.
T145 112720-112733 Sentence denotes Introduction:
T146 112734-113029 Sentence denotes Released in April 2014 by the Center for Medicare and Medicaid Services (CMS),the Provider Utilization and Payment Data Physician and Other Supplier Public Use File includes reimbursement information on 6000 different procedures/ services reimbursed to over 880,000 healthcare providers in 2012.
T147 113030-113178 Sentence denotes We have analyzed this database hoping to better understand how Allergy/Immunology providers are contributing to the care of the Medicare population.
T148 113179-113187 Sentence denotes Methods:
T149 113188-113404 Sentence denotes Using the Physician and Other Supplier PUF Aggregate file, the average number of unique beneficiaries seen, total paid by medicare to each physician, and the average amount paid per unique beneficiary was calculated.
T150 113405-113528 Sentence denotes These values were calculated for the other provider types for contextualization of the results across the healthcare field.
T151 113529-113695 Sentence denotes We excluded any organizational provider types, non-MD/DO provider types, non-face-to-face diagnostic specialties, as well as specialties with less than 100 providers.
T152 113696-113831 Sentence denotes Eighty nine providers types are included in the Physician and Other Supplier PUF with 53 provider types included in the final analysis.
T153 113832-114010 Sentence denotes Focusing on Allergy/Immunology providers only, we calculated the average number of unique beneficiaries seen as new or established patients was also calculated from the database.
T154 114011-114019 Sentence denotes Results:
T155 114020-114187 Sentence denotes A total of 3119 Allergy/Immunology providers saw for an average of 160.4 (SD ±179.6) unique Medicare beneficiaries and collected an average of $52,762 (SD ± $103,425).
T156 114188-114291 Sentence denotes Among Allergy/Immunology providers, the average amount paid per unique beneficiary was $313 (SD ±$449).
T157 114292-114522 Sentence denotes Of the 53 provider types included in the final analysis, Allergists ranked 45 th in average number of unique beneficiaries seen, 40 th in average amount collected from CMS, and 16 th in average amount paid per beneficiary in 2012.
T158 114523-114659 Sentence denotes Allergy/Immunology providers billed for an average of 35.2 (SD ± 31.9) unique Medicare beneficiaries for new patient visits (all types).
T159 114660-114803 Sentence denotes The average number of established visit by A/I Providers were 123.34 (SD±178.5) for an average of 69.1 (SD±77.1) unique Medicare beneficiaries.
T160 114804-114816 Sentence denotes Conclusions:
T161 114817-114980 Sentence denotes The Physician and Other Supplier PUF provides a unique opportunity to better understand how Allergy/Immunology providers fit into the overall healthcare landscape.
T162 114981-115095 Sentence denotes Allergy/Immunology providers can use this data better to understand how their practice compares to national norms.
T163 115096-115107 Sentence denotes Background:
T164 115108-115301 Sentence denotes Many authorities have recognized that gene-environment interactions likely play a key role in the developmental origins of allergy, now known to be mediated largely by epigenetic modifications.
T165 115302-115546 Sentence denotes Prospective epigenetic studies, beginning in utero involving the collection of umbilical cord blood provides a window into the prenatal environment and a prospective sample to identify epigenetic markers that precede the development of allergy.
T166 115547-115555 Sentence denotes Methods:
T167 115556-115788 Sentence denotes The Kingston Allergy Birth Cohort (KABC) now includes over 400 children born in Kingston, Ontario, and surrounding rural areas with mother/child pairs recruited during the prenatal period, many of whom are between 18mo to 3y of age.
T168 115789-116049 Sentence denotes 60 mother/child pairs thus far have returned to undergo skin testing (common environmental and food panel) and surveys completed regarding symptoms of potential atopic disease in the child as well as relevant home and dietary exposures in the first 2y of life.
T169 116050-116139 Sentence denotes Some children have also been evaluated in local Allergists offices for suspected allergy.
T170 116140-116148 Sentence denotes Results:
T171 116149-116234 Sentence denotes Of 60 children evaluated thus far, 11 (18.3%) demonstrated at least one positive SPT:
T172 116235-116348 Sentence denotes 8 had positive SPT to a food allergen, only 4 of whom had a clinical history of supporting food allergy, however.
T173 116349-116456 Sentence denotes 5 children had at least one positive environmental SPT, 2 of which had symptoms suggestive of early asthma.
T174 116457-116695 Sentence denotes On preliminary analysis, factors associated with, or trending with, positive SPT include furry pet ownership (P=0.038; Fisher's Exact Test), early-life second hand smoke exposure (P=0.1) and breastfeeding for less than 3 months (P=0.074).
T175 116696-116708 Sentence denotes Conclusions:
T176 116709-116736 Sentence denotes Data collection is ongoing.
T177 116737-116835 Sentence denotes Our early high rate of atopy likely reflects interest-bias from parents concerned about allergies.
T178 116836-116903 Sentence denotes Pets, second-hand smoke and breastfeeding will be further explored.
T179 116904-117130 Sentence denotes We anticipate epigenetic analysis of cord blood from atopic children compared to age/gender-matched controls will provide a window into the prenatal environment and potentially identify biomarkers that precede allergic disease
T180 117131-117133 Sentence denotes R.
T181 117134-117146 Sentence denotes Kumar * , K.
T182 117147-117156 Sentence denotes Singh, U.
T183 117157-117166 Sentence denotes Mehto, S.
T184 117167-117176 Sentence denotes Nagar, R.
T185 117177-117198 Sentence denotes Prasad, Delhi, India.
T186 117199-117210 Sentence denotes Background:
T187 117211-117339 Sentence denotes Indoor air pollution is the third leading cause of disease burden in South East Asia as per Global burden of disease study 2010.
T188 117340-117444 Sentence denotes Children are much more susceptible to household air pollutants as they spend most of their time indoors.
T189 117445-117570 Sentence denotes The present study was thus planned to assess the effect of indoor air pollution on childhood asthma and/or allergic rhinitis.
T190 117571-117579 Sentence denotes Methods:
T191 117580-117844 Sentence denotes The present study is a cross sectional study to assess the difference in household air quality in houses having children (<17 years age) with or without asthma and/or allergic rhinitis in a rural setting (Village Khanpurjupti, Loni, Ghaziabad) of Delhi NCR region.
T192 117845-118030 Sentence denotes Seventy households were selected in which none of the child had symptoms of asthma and/or rhinitis while the other seventy households had at least one child with asthma and/or rhinitis.
T193 118031-118235 Sentence denotes A standard questionnaire was filled for all children enrolled in study, information was collected from parents of child during the study and potential pollutant sources were identified in their residence.
T194 118236-118423 Sentence denotes PM 2.5 was measured by using UCB Particle and Temperature Sensor (UCB-PATS) from Berkley Air monitoring group, USA.VOCs were measured by using Phocheck Tiger PID, Ion Science limited, UK.
T195 118424-118534 Sentence denotes The measurements of PM 2.5 and VOC were done at an interval of 10 minutes in each of 140 households for a day.
T196 118535-118542 Sentence denotes Result:
T197 118543-118747 Sentence denotes There were a total of 108 children (52 asthma alone, 20 allergic rhinitis alone and 36 with co-existent asthma and allergic rhinitis) in the 70 houses having children affected with asthma and/or rhinitis.
T198 118748-118859 Sentence denotes The level of pollutants was found to be twice higher in affected children houses as compared to control houses.
T199 118860-118987 Sentence denotes The average PM2.5 levels were significantly higher (9.68mg/m3vs 4.31mg/m3; p 0.011) in affected houses as compared to controls.
T200 118988-119117 Sentence denotes Similarly VOCs levels were higher in these houses (2.222 ppm vs 1.161 ppm; p 0.128) but could not reach statistical significance.
T201 119118-119215 Sentence denotes It was also seen that houses of children with asthma and/or rhinitis had higher sec-Introduction:
T202 119216-119388 Sentence denotes Little is known about how quickly chronic idiopathic/spontaneous urticaria (CIU/CSU) patients respond to omalizumab treatment and for how long they maintain their response.
T203 119389-119469 Sentence denotes We report patterns of treatment response from ASTERIA I and ASTERIA II (pooled).
T204 119470-119478 Sentence denotes Methods:
T205 119479-119666 Sentence denotes Subjects were randomized 1:1:1:1 and received placebo (PLB) or omalizumab 75, 150, or 300 mg (OMA75, OMA150, OMA300) every 4 weeks for 3 (ASTERIA II, n=322) or 6 (ASTERIA I, n=318) doses.
T206 119667-119839 Sentence denotes Patients completed the Urticaria Patient Daily Diary (twice-daily), from which a daily Urticaria Activity Score (UAS) was calculated; the 7-day sum of UAS is given as UAS7.
T207 119840-119968 Sentence denotes Response was defined in two ways: (1) well-controlled urticaria (UAS7≤6) and (2) complete response (itch and hive free, UAS7=0).
T208 119969-120099 Sentence denotes The duration of response was defined as the percentage of the treatment period, during which patients experienced their responses.
T209 120100-120175 Sentence denotes IRB approval and informed consent were obtained from all research subjects.
T210 120176-120184 Sentence denotes Results:
T211 120185-120336 Sentence denotes From baseline to week 12, UAS7≤6 was achieved at some point in time by 28% of PLB, 49% of OMA75, 56% of OMA150, and 73% of OMA300 patients; for UAS7=0:
T212 120337-120405 Sentence denotes 13% of PLB, 26% of OMA75, 33% of OMA150, and 53% of OMA300 patients.
T213 120406-120701 Sentence denotes During the 12-week treatment period, patients who reached a UAS7≤6 at some point in time, had this level of response for a mean percent of time of 45% (PLB), 42% (OMA75), 54% (OMA150) or 65% (OMA300); for UAS7=0 the mean percent of time was 34% (PLB), 29% (OMA75), 37% (OMA150), or 52% (OMA300).
T214 120702-120823 Sentence denotes The median time to achieve UAS7≤6 was 10 weeks (OMA150) and 4 weeks (OMA300) and to achieve UAS7=0 was 10 weeks (OMA300).
T215 120824-120976 Sentence denotes Less than 50% of patients achieved UAS7≤6 in PLB and OMA75 and UAS7=0 in PLB, OMA75, and OMA150, thus we did not calculate their median time to respond.
T216 120977-120988 Sentence denotes Conclusion:
T217 120989-121106 Sentence denotes More CIU/CSU patients in OMA300 achieved well-controlled or complete responses than patients in other treatment arms.
T218 121107-121214 Sentence denotes OMA300 patients achieved their responses sooner and maintained them for longer than those in any other arm.
T219 121215-121330 Sentence denotes These results provide additional insights about how CIU/CSU patients might respond to omalizumab therapy over time.
T220 121331-121495 Sentence denotes These data can help healthcare providers by setting expectations of likelihood of response in CIU/CSU patients at different time points after omalizumab initiation.
T221 121496-121625 Sentence denotes Number and percentage of patients who achieved the state of well-controlled urticaria or complete response by week and study arm.
T222 121626-121714 Sentence denotes BSL = baseline; PLB = placebo; OMA = omalizumab, UAS7 = Weekly Urticaria Activity Score.
T223 121715-121728 Sentence denotes Introduction:
T224 121729-121854 Sentence denotes Patients with lower health literacy (HL) have poorer understanding and self-management of chronic diseases, including asthma.
T225 121855-122050 Sentence denotes We hypothesized that parents/caregivers were an important source of HL for teenage students, which would be indicated by agreement between student and caregiver HL scores on standard instruments.
T226 122051-122215 Sentence denotes Methods: HL status was assessed as part of Puff City, a randomized controlled trial of a web-based asthma education intervention in four rural Georgia high schools.
T227 122216-122260 Sentence denotes Baseline sociodemographic data was obtained.
T228 122261-122356 Sentence denotes Due to the small percentage of "other race," whites and other races were combined for analyses.
T229 122357-122501 Sentence denotes Three validated instruments were used: REALM (Rapid Estimate of Adolescent/Adult Literacy in Medicine) and SILS (Single Item Literacy Screener).
T230 122502-122581 Sentence denotes To examine agreement between scores, weighted kappa statistics were calculated.
T231 122582-122663 Sentence denotes Bowker's test of symmetry was used to examine equality of disagreement in scores.
T232 122664-122743 Sentence denotes Differences in REALM and SILS scores were examined with t-and chi-square tests.
T233 122744-122752 Sentence denotes Results:
T234 122753-122843 Sentence denotes 243 students and 203 caregivers completed HL assessments yielding 198 paired observations.
T235 122844-122964 Sentence denotes The students attended grades 9-12, were 60.6% female, 72.7% African American (AA), with mean age of 15.3 (SD 0.9) years.
T236 122965-123060 Sentence denotes Parent education ranged from less than high school diploma (19.1%) to college graduate (24.0%).
T237 123061-123192 Sentence denotes Significant differences of REALM scores were seen between AA and white students, 56.2 (10.6) vs 60.8 (6.8), p<0.0005, respectively.
T238 123193-123354 Sentence denotes Agreement between student and caregiver REALM categories was poor (κ w =0.26) while disagreement did not significantly differ by scores or demographic variables.
T239 123355-123535 Sentence denotes There was significant disagreement between student and caregiver scores on SILS and this differed by caregiver race, with students having higher scores when their caregiver was AA.
T240 123536-123724 Sentence denotes Agreement in SILS scores between student and caregiver was poor for both caregiver race groups, but whites/other race caregivers had a higher weighted kappa (κ w =0.31) than AA caregivers.
T241 123725-123736 Sentence denotes Conclusion:
T242 123737-123859 Sentence denotes The poor agreement between student and caregiver HL scores suggest that teens do not primarily acquire HL from caregivers.
T243 123860-123974 Sentence denotes Consistent with previous adult literature, there appears to be a disparity in adolescent HL between AA and whites.
T244 123975-124113 Sentence denotes The lower HL among AA teens suggests that they are likely to require more physician effort to become proficient in asthma self-management.
T245 124114-124127 Sentence denotes Introduction:
T246 124128-124328 Sentence denotes The aim of this study is to summarize and visualize the utilization and cost relational system between providers for pediatric asthma care in the Medicaid system using large patient-level claims data.
T247 124329-124463 Sentence denotes We investigate an inferential and graphical approach for uncovering patterns in the healthcare utilization within the Medicaid system.
T248 124464-124585 Sentence denotes We pilot this study for pediatric asthma patients in Georgia and North Carolina using the 2009 patient-level claims data.
T249 124586-124594 Sentence denotes Methods:
T250 124595-124879 Sentence denotes We apply sequence clustering analysis (SCA) to classify patients according to their utilization profiles, and for each cluster, we derive a probabilistic network of care where the probabilities are determined based on the patient-level utilization across providers of different types.
T251 124880-124987 Sentence denotes The underlying utilization networks are the basis in deriving the cost relational system between providers.
T252 124988-124996 Sentence denotes Results:
T253 124997-125156 Sentence denotes We use the Markov chain representation of the utilization profiles to visualize the network model for each profile as derived from the SCA with three profiles.
T254 125157-125301 Sentence denotes Profile 1 is dominated by patients primarily utilizing Emergency Department (ED) care services with a small proportion referred to primary care.
T255 125302-125429 Sentence denotes Profile 2 is dominated by patients primarily utilizing primary care once or multiple times with a small proportion visiting ED.
T256 125430-125476 Sentence denotes Profile 3 has a high variation in utilization.
T257 125477-125674 Sentence denotes Among the children with asthma in the 2009 Medicaid system of Georgia, about half of the patients utilize primary care whereas the other half either seek care through ED or from multiple providers.
T258 125675-125845 Sentence denotes The cost analysis shows that the distribution of cost-per-visit for ED visits is similar across the three profiles with a higher median for the ED-care prevalent profile.
T259 125846-125993 Sentence denotes The costs for other provider types have similar symmetricallyshaped distribution but with some differences in the median across all three profiles.
T260 125994-126005 Sentence denotes Conclusion:
T261 126006-126255 Sentence denotes It is not surprising to find that ED visits contribute to a large portion of the cost for pediatric asthma care where most of the ED costper-visit values are in the range of other care visit types suggesting that many ED visits are for routine care.
T262 126256-126314 Sentence denotes However, we also find that about half of the Introduction:
T263 126315-126476 Sentence denotes Reslizumab (RES), a humanized anti-human interleukin-5, is in development for patients with moderate to severe persistent asthma with elevated eosinophils (EOS).
T264 126477-126598 Sentence denotes We compared patient-reported outcomes (PROs) and safety of RES vs placebo (PBO) in patients with asthma and elevated EOS.
T265 126599-126607 Sentence denotes Methods:
T266 126608-126897 Sentence denotes This multicenter, double-blind, 16-week study (NCT01270464) included patients (N=311), 12-75 years of age, with uncontrolled asthma on at least medium-dose inhaled corticosteroids with/without additional controllers, Asthma Control Questionnaire score ≥1.5, and blood EOS level of ≥400/mL.
T267 126898-127059 Sentence denotes Randomization was to intravenous RES 0.3 mg/kg (n=104) or 3.0 mg/kg (n=106) or PBO (n=105) Baseline clinical characteristics were similar among treatment groups.
T268 127060-127194 Sentence denotes At 16 weeks, RES 0.3 mg/kg and 3.0 mg/kg improved AQLQ from baseline (mean treatment difference vs PBO 0.278 and 0.359, respectively).
T269 127195-127281 Sentence denotes The difference between RES 3.0 mg/kg and PBO was statistically significant (P=0.0241).
T270 127282-127396 Sentence denotes The percentage of patients with a MID in AQLQ at week 16 was 59%, RES 0.3 mg/kg; 64%, RES 3.0 mg/kg; and 48%, PBO.
T271 127397-127483 Sentence denotes The difference between RES 3.0 mg/kg and PBO was statistically significant (P=0.0189).
T272 127484-127604 Sentence denotes RES-treated patients had statistically significant (P≤0.016) ASUI improvements vs PBO (mean treatment difference vs PBO:
T273 127605-127647 Sentence denotes 0.51, RES 0.3 mg/kg; 0.47, RES 3.0 mg/kg).
T274 127648-127705 Sentence denotes Most (86%) patients received 4 complete infusions of RES.
T275 127706-127775 Sentence denotes Incidence of adverse events (AEs) was similar among treatment groups.
T276 127776-127972 Sentence denotes Serious AEs for RES occurred in the 3.0 mg/kg group (1 patient with pneumonia, road accident/rib fracture, and asthma exacerbation; 1 patient with sinusitis; 2 patients with asthma exacerbations).
T277 127973-128084 Sentence denotes AEs led to discontinuation in 10%, <1%, and 6% of PBO, RES 0.3 mg/kg, and RES 3.0 mg/kg patients, respectively.
T278 128085-128097 Sentence denotes Conclusions:
T279 128098-128275 Sentence denotes In patients with uncontrolled asthma and elevated blood EOS, 4 monthly doses of RES were well tolerated and associated with improvements in PROs of quality of life and symptoms.
T280 128276-128325 Sentence denotes This study was sponsored by Teva Pharmaceuticals.
T281 128326-128337 Sentence denotes Background:
T282 128338-128440 Sentence denotes Current models for calculating asthma related risk require clinical parameters or administrative data.
T283 128441-128567 Sentence denotes Often, programs that conduct disease management, community outreach and environmental assessment do not have access to either.
T284 128568-128708 Sentence denotes The aim of this study is to develop a simple risk stratification model to help allocate limited resources to children with high risk asthma.
T285 128709-128717 Sentence denotes Methods:
T286 128718-128961 Sentence denotes This is an IRB approved retrospective study of 11,915 patients <18 years seen for an asthma diagnosis at one of 23 outpatient clinics at our institution between 1/1/10 and 5/31/12, regardless of whether asthma was the principal diagnosis (PD).
T287 128962-129205 Sentence denotes The frequency of asthma related acute care visits (ACVs) in the 12 months prior to the outpatient visit was determined and a risk score calculated based on ACV type (ED/UCC visit=1 point, inpatient admission=2 points, PICU admission=3 points).
T288 129206-129267 Sentence denotes The total risk score was used to create four risk categories:
T289 129268-129348 Sentence denotes Very Low (0 points), Low (1-2 points), Medium (3-6 points) and High (≥7 points).
T290 129349-129499 Sentence denotes The odds of an asthma related ACV in the 12 months following the outpatient visit were then compared across risk categories using logistic regression.
T291 129500-129508 Sentence denotes Results:
T292 129509-129596 Sentence denotes Our study sample included 27,083 outpatient visits representing 11,915 unique patients.
T293 129597-129723 Sentence denotes Of these visits, 74% were Very Low risk, followed by approximately 19%, 6% and 1% for Low, Medium and High risk, respectively.
T294 129724-129886 Sentence denotes Eighty-two percent of High, 57% of Medium, 36% of Low and 11% of Very Low risk patients had an asthma related ACV in the 12 months following the outpatient visit.
T295 129887-130150 Sentence denotes After accounting for clustering of visits by patient, the odds of a future ACV was significantly higher for High risk (odds ratio (OR)=36.8; p<0.001), Medium risk (OR=10.6; p<0.001) and Low risk (OR=4.5; p<0.001) patients, when compared to Very Low risk patients.
T296 130151-130305 Sentence denotes The odds of a future ACV was significantly higher for High (OR=8.2; p<0.001) and Medium (OR=2.4; p<0.001) risk patients, as compared to Low risk patients.
T297 130306-130411 Sentence denotes High risk patients had 3.5 times greater odds of having a future ACV than Medium risk patients (p=0.001).
T298 130412-130423 Sentence denotes Conclusion:
T299 130424-130524 Sentence denotes This scoring algorithm effectively stratified asthmatic patient risk for future asthma related ACVs.
T300 130525-130721 Sentence denotes The potential utility and scope of this model could be significant in the allocation of asthma resources to those who need them most, particularly when access to detailed clinical data is limited.
T301 130722-130735 Sentence denotes Introduction:
T302 130736-130944 Sentence denotes Early recognition of severe combined immunodeficiency (SCID) is integral in the adoption of timely life-saving interventions, like hematopoietic stem cell transplantation for an infant born with the disorder.
T303 130945-131146 Sentence denotes Population-based, inexpensive, and sensitive newborn screening (NBS) for SCID involves measurement of T-cell receptor excision circles (TRECs) via a quantitative polymerase chain reaction (qPCR) assay.
T304 131147-131219 Sentence denotes Here we summarize the results of Iowa's one year SCID NBS pilot program.
T305 131220-131228 Sentence denotes Methods:
T306 131229-131414 Sentence denotes A TREC qPCR assay using DNA isolated from dried blood spots was developed by the State Hygienic Lab and ran on all infants born in Iowa during the June 3, 2013-June 31, 2014 pilot year.
T307 131415-131540 Sentence denotes Samples with initial abnormal results were repeated and immunophenotyping was performed on all infants with abnormal results.
T308 131541-131549 Sentence denotes Results:
T309 131550-131664 Sentence denotes Of 43,930 infants screened, 13 were presumptive positive for SCID; one remained indeterminate on repeat screening.
T310 131665-131731 Sentence denotes Threshold for abnormal results was revised twice during the pilot.
T311 131732-132036 Sentence denotes Of these 14 infants, 6 were identified in the first month of the pilot and 8 were identified after cut-offs were revised in February 2014; 10 (71%) were male, 8 (57%) were in an intensive care unit, 3 (21%) were Hispanic, 3 (21%) were infants of diabetic mothers and 2 (14%) had congenital heart disease.
T312 132037-132269 Sentence denotes Immunophenotyping was without significant Tcell lymphopenia ( CD3 < 1500 cells/ml, or absence/marked reduction in CD4 naïve T cells [CD4/CD45RA] < 5% of total CD3 T cells) in 11 infants, including one with 22q11.2 deletion syndrome.
T313 132270-132460 Sentence denotes Significant T-cell lymphopenia was found in 3 (21%) infants; however, T-cell function (assessed as lymphocyte proliferation to phytohemagglutinin) was normal and none was found to have SCID.
T314 132461-132577 Sentence denotes Three infants with significant T-cell lymphopenia underwent additional testing and clinical outcomes were monitored.
T315 132578-132780 Sentence denotes One infant was diagnosed with Jacobsen syndrome with associated cytopenias, one with 18p deletion syndrome and complex congenital heart disease and one with no causative genetic mutation yet identified.
T316 132781-132792 Sentence denotes Conclusion:
T317 132793-132943 Sentence denotes In the first year of Iowa's SCID NBS program no SCID babies were identified; however, a variety of other conditions with Tcell lymphopenia were found.
T318 132944-133110 Sentence denotes This finding is similar to that of other states reporting TREC NBS and may help to improve our understanding of other conditions that present with T-cell lymphopenia.
T319 133111-133115 Sentence denotes S.E.
T320 133116-133134 Sentence denotes Henrickson *1 , J.
T321 133135-133149 Sentence denotes Heimall 2 , S.
T322 133150-133166 Sentence denotes Jyonouchi 2 , 1.
T323 133167-133186 Sentence denotes Haddonfield, NJ; 2.
T324 133187-133204 Sentence denotes Philadelphia, PA.
T325 133205-133334 Sentence denotes Introduction: TREC based NBS identifies newborns with asymptomatic SCID and allows HSCT with lower morbidity, mortality and cost.
T326 133335-133405 Sentence denotes TREC NBS started in PA statewide July 2013, but hospitals can opt out.
T327 133406-133470 Sentence denotes We review the cases of 4 PA born infants who recently presented:
T328 133471-133592 Sentence denotes 2 via positive NBS and 2 who were born in hospitals not participating in TREC NBS and developed opportunistic infections.
T329 133593-133601 Sentence denotes Results:
T330 133602-133638 Sentence denotes Patients identified by positive NBS:
T331 133639-133644 Sentence denotes Pt 1:
T332 133645-133708 Sentence denotes Outpatient phenotyping showed T-B+NK-SCID; confirmed as X-SCID.
T333 133709-133765 Sentence denotes Prophylactically admitted for 9d due to sibling illness.
T334 133766-133838 Sentence denotes Readmitted DOL26 for 48h for unconditioned MRD PBSC transplant (PBSCT) .
T335 133839-133939 Sentence denotes Readmitted with emesis and blood streaked stools (15d), asymptomatic CMV and EBV reactivation (48h).
T336 133940-133961 Sentence denotes Total admissions 28d.
T337 133962-133979 Sentence denotes Now well day+106.
T338 133980-133985 Sentence denotes Pt 2:
T339 133986-134059 Sentence denotes Outpatient phenotyping demonstrated T+B-NK+; found to have RAG1 mutation.
T340 134060-134195 Sentence denotes Admitted DOL120 for myeloablative conditioned UCB transplant (UCBT), hospitalized 39d, including transplant associated microangiopathy.
T341 134196-134244 Sentence denotes Readmitted with fever (7d), poor weight gain (6d
T342 134246-134325 Sentence denotes November 8-9, 2014 georgia world congress center atlanta, georgia Introduction:
T343 134326-134572 Sentence denotes Pompe disease (PD) is an inherited disorder caused by a deficiency of the lysosomal enzyme alpha-1,4-glucosidase and characterized by accumulation of lysosomal glycogen in many organs, including the heart and skeletal muscle, leading to myopathy.
T344 134573-134716 Sentence denotes Patients with infantile-onset PD can develop severe cardiomyopathy, which if left untreated, may result in death within the first year of life.
T345 134717-134940 Sentence denotes A recent breakthrough treatment with recombinant enzyme replacement has significantly improved patients' survival, but is often complicated by the development of enzyme specific antibodies precluding further administration.
T346 134941-135116 Sentence denotes Here we report a case of successful desensitization to alglucosidase alfa in an infant who previously developed a systemic allergic reaction during enzyme replacement therapy.
T347 135117-135125 Sentence denotes Methods:
T348 135126-135202 Sentence denotes Specific IgE to alglucosidase alfa was obtained and reported to be negative.
T349 135203-135449 Sentence denotes The patient underwent desensitization using our protocol starting approximately at a 1:10,000 dilution of the therapeutic dose, with doubling of the dose every 15 minutes until the cumulative dose approximated the therapeutic dose (See Table 1 ).
T350 135450-135458 Sentence denotes Results:
T351 135459-135588 Sentence denotes Patient was a 7 week-old neonate with infantile-onset PD receiving weekly intravenous infusions of alglucosidase alfa at 20mg/kg.
T352 135589-135747 Sentence denotes He developed a diffuse urticarial rash, respiratory distress with wheezing, and periorbital and oral angioedema approximately 5 minutes into his 4th infusion.
T353 135748-135801 Sentence denotes The following day, we proceeded with desensitization.
T354 135802-135921 Sentence denotes He developed two generalized cutaneous allergic reactions during dose titration, but was able to complete the protocol.
T355 135922-136046 Sentence denotes He was continued on dose escalation weekly and was eventually able to transition to his former outpatient infusion protocol.
T356 136047-136058 Sentence denotes Discussion:
T357 136059-136167 Sentence denotes The incidence of anaphylaxis from administration of this medication has been reported in the range of 1-14%.
T358 136168-136232 Sentence denotes It is unclear if these cases are truly IgE vs. non-IgE mediated.
T359 136233-136349 Sentence denotes Our patient's clinical history and cutaneous reactions during his desensitization suggest an IgE mediated mechanism.
T360 136350-136484 Sentence denotes The specific IgE blood sample was obtained within hours of his anaphylactic reaction and thus may have caused a false-negative result.
T361 136485-136675 Sentence denotes We report our case to illustrate a protocol that was effective in inducing temporary drug tolerance to alglucosidase alfa, allowing continuation of lifesustaining treatment for this patient.
T362 136676-136687 Sentence denotes Background:
T363 136688-136857 Sentence denotes Food Protein Induced Enterocolitis Syndrome (FPIES) is a rare, but increasingly prevalent non-immunoglobulin E (IgE) mediated gastrointestinal reaction to food proteins.
T364 136858-136989 Sentence denotes It is outgrown in the majority of children by 30 months of age, and does not show predominance for atopic indi-viduals or families.
T365 136990-137132 Sentence denotes We present the case of a 7 year old girl with severe atopic dermatitis that was controlled with topical steroids and the soak and seal method.
T366 137133-137220 Sentence denotes She had a history of multiple food reactions consistent with IgE mediated food allergy.
T367 137221-137346 Sentence denotes At 18 months, she ingested sweet potato, resulting in profuse vomiting that was diagnosed by her pediatrician as anaphylaxis.
T368 137347-137355 Sentence denotes Methods:
T369 137356-137480 Sentence denotes Skin prick and ImmunoCapp testing was performed followed by a food challenge to sweet potato in an observed medical setting.
T370 137481-137489 Sentence denotes Results:
T371 137490-137666 Sentence denotes Skin prick testing with commercial extracts revealed sensitivity to multiple foods including peanut, tree nuts, milk, egg, shellfish and wheat but was negative to sweet potato.
T372 137667-137753 Sentence denotes The patient's total serum IgE was 4504 kUA/L, and ImmunoCapp to sweet potato was 2.73.
T373 137754-137791 Sentence denotes In comparison, her milk IgE was >100.
T374 137792-137852 Sentence denotes Based on these results an oral food challenge was performed.
T375 137853-137960 Sentence denotes There was no immediate reaction (within 20 minutes) to sweet potato given in increasing doses over 2 hours.
T376 137961-138149 Sentence denotes One hour after the full serving, she began to vomit profusely, and continued to vomit over the following 3 hours, despite treatment with diphenhydramine, IM epinephrine and IV ondansetron.
T377 138150-138192 Sentence denotes IV fluid resuscitation was also performed.
T378 138193-138337 Sentence denotes A complete blood count obtained during the reaction revealed a significantly elevated neutrophil count of 17,100, compared to baseline of 2,800.
T379 138338-138369 Sentence denotes She also had a normal tryptase.
T380 138370-138438 Sentence denotes These results are consistent with an FPIES reaction to sweet potato.
T381 138439-138611 Sentence denotes Conclusion: FPIES is generally considered in the differential diagnosis when infants and toddlers present with acute reactions to food ingestion, but not in older children.
T382 138612-138728 Sentence denotes This child posed a further diagnostic challenge given her concomitant IgE mediated food allergies to multiple foods.
T383 138729-138889 Sentence denotes This unusual case, never reported in the literature, demonstrates the potential for distinct pathogenic mechanisms in children with multiple food sensitivities.
T384 138890-139059 Sentence denotes Physicians should consider in the differential diagnosis and be prepared to treat FPIES in any child with a history of profuse vomiting after ingestion of certain foods.
T385 139060-139062 Sentence denotes A.
T386 139063-139078 Sentence denotes CaJacob *1 , C.
T387 139079-139092 Sentence denotes Adkins 2 , M.
T388 139093-139109 Sentence denotes Descartes 1 , C.
T389 139110-139122 Sentence denotes Allen 1 , J.
T390 139123-139138 Sentence denotes Anderson 1 , 1.
T391 139139-139157 Sentence denotes Birmingham, AL; 2.
T392 139158-139169 Sentence denotes Hoover, AL.
T1 139170-139183 Sentence denotes Introduction:
T2 139184-139390 Sentence denotes Morquio A Syndrome (also known as mucopolysaccharidase type IVA deficiency) is an autosomal-recessive lysosomal storage disease characterized by a deficiency of the N-acetylgalactosamine-6 sulfatase enzyme.
T3 139391-139578 Sentence denotes Until the recent FDA-approval of elosulfase alfa (Vimizim™) enzyme replacement therapy (ERT) in February 2014, treatment of this progressive, multiorgan disease had been symptomatic care.
T4 139579-139663 Sentence denotes In pre-market clinical trials it was determined to carry a 7.7% risk of anaphylaxis.
T5 139664-139770 Sentence denotes We present a patient who was successfully desensitized to elosulfase alfa after an anaphylactoid reaction.
T6 139771-139779 Sentence denotes Methods:
T7 139780-139830 Sentence denotes An nine hour desensitization protocol was devised.
T8 139831-139962 Sentence denotes We began with an approximate initial dose of 1/10,000, with doubling of the dose until the patient received her goal dose of 200mg.
T9 139963-139971 Sentence denotes Results:
T10 139972-140059 Sentence denotes A 54 year old female with Morquio A syndrome began elosulfase alfa ERT in October 2013.
T11 140060-140311 Sentence denotes She tolerated weekly infusions without difficulty until March 2014 when after approximately 2.5 hours into her twenty-third infusion she developed a reaction characterized by fever to 102.7, tachycardia, hypotension, wheezing and hypoxia (O2 sat 75%).
T12 140312-140417 Sentence denotes Reaction was treated with intravenous fluids, antihistamines, nebulized albuterol and methylprednisolone.
T13 140418-140488 Sentence denotes She was referred to the Allergy service one week later for evaluation.
T14 140489-140604 Sentence denotes Skin prick testing (patient and control) was negative to 1:1, 1:10 and 1:100 dilutions with good histamine control.
T15 140605-140671 Sentence denotes The patient's intradermal testing was positive at a 1:10 dilution.
T16 140672-140745 Sentence denotes The control's intradermal testing was negative at 1:10 and 1:1 dilutions.
T17 140746-140829 Sentence denotes One month after her reaction, we proceeded with the above desensitization protocol.
T18 140830-140869 Sentence denotes The desensitization was well-tolerated.
T19 140870-140976 Sentence denotes After its completion, the patient resumed her weekly infusions at a slower rate without further reactions.
T20 140977-141077 Sentence denotes Repeat skin testing four months from initial desensitization was negative at 1:10 and 1:1 dilutions.
T21 141078-141090 Sentence denotes Conclusions:
T22 141091-141189 Sentence denotes Vimizim™ is an FDA-approved ERT for Morquio A syndrome patients which carries an anaphylaxis risk.
T23 141190-141336 Sentence denotes The immunologic basis of our patient's anaphylactoid reaction is unclear, particularly given the fever and the absence of any skin manifestations.
T24 141337-141404 Sentence denotes After desensitization, she had conversion to negative skin testing.
T25 141405-141446 Sentence denotes No antibody assay is currently available.
T26 141447-141555 Sentence denotes To our knowledge, this case represents the only elosulfase alfa ERT desensitization in published literature.
T27 141556-141620 Sentence denotes Anaphylaxis is a serious allergic reaction that may cause death.
T28 141621-141790 Sentence denotes The present study examined the symptoms, triggers and demographic patterns of patients treated for anaphylaxis at a large tertiary care hospital in Riyadh, Saudi Arabia.
T29 141791-141867 Sentence denotes The protocol was approved by the Institutional Review Board of the hospital.
T30 141868-141999 Sentence denotes All the patients who were prescribed Epinephrine auto-injectors ( EA ) between 1/1/2010 and 31/12/2011 were included in this study.
T31 142000-142122 Sentence denotes 238 new patients were identified using hospital pharmacy database and the medical records of these patients were reviewed.
T32 142123-142218 Sentence denotes To date, Epinephrine auto-injectors ( EA ) are available at very few hospitals in Saudi Arabia.
T33 142219-142384 Sentence denotes Since our hospital is the main tertiary care hospital with allergy&immunology service in the Kingdom, these data may reflect Anaphylaxis presentations in our region.
T34 142385-142472 Sentence denotes The mean age at the time of first EA prescription was 22.9 years, (2years to 73 years).
T35 142473-142515 Sentence denotes SD +/-18.2 Female to male ratio was 52:48.
T36 142516-142564 Sentence denotes 54% for subjects were less than 18 years of age.
T37 142565-142614 Sentence denotes 18 % were Non Saudis living in the Riyadh region.
T38 142615-142680 Sentence denotes Most of these were employees of the hospital or their dependents.
T39 142681-142814 Sentence denotes Although most of the signs and symptoms were similar to other published data, there were some differences observed in our population.
T40 142815-142984 Sentence denotes Urticaria and angioedema was the most common presentation accounting for 70% in adults and children followed by shortness of breath in 33% in adults and 23% in children.
T41 142985-143104 Sentence denotes Food was the commonest trigger for anaphylaxis with Tree Nuts and Egg the most frequent, followed by Sesame and Peanut.
T42 143105-143193 Sentence denotes Drug Allergy was also a common trigger, with Penicillins and NSAIDs being the commonest.
T43 143194-143275 Sentence denotes Regarding Insect allergy, Samsum Ant was the commonest trigger in our population.
T44 143276-143336 Sentence denotes This is the first such study on Anaphylaxis in Saudi Arabia.
T45 143337-143501 Sentence denotes While there are many similarities, some of the presenting signs, symptoms, and triggers of anaphylaxis are significantly different in our population than in others.
T46 143502-143572 Sentence denotes While treating Anaphylaxis, we should be mindful of these differences.
T47 143573-143690 Sentence denotes This improved understanding should help reduce the morbidity and mortality associated with Anaphylaxis in our region.
T48 143691-143831 Sentence denotes Introduction: DRESS is a severe and potentially fatal drug reaction characterized by fever, rash, lymphadenopathy and visceral organ damage.
T49 143832-143942 Sentence denotes We describe the case of a patient with Phenytoin induced DRESS presenting as eosinophilia and laryngeal edema.
T50 143943-143955 Sentence denotes Case Report:
T51 143956-144120 Sentence denotes The patient is a 59 yo AA Female with Hypertension, Type 2 Diabetes, Hyperlipidemia, Hypothyroidism and a history of Cerebral Vascular Event and subsequent seizure.
T52 144121-144163 Sentence denotes She has no history of previous angioedema.
T53 144164-144347 Sentence denotes Her home medications include alendronate, atorvastatin, cholecalciferol, folic acid, insulin, levothyroxine, lisinopril, omeprazole and phenytoin which was initiated 2-3 months prior.
T54 144348-144464 Sentence denotes Initially she presented to the ED for fever and an urticarial and maculopapular rash on her neck, chest and abdomen.
T55 144465-144618 Sentence denotes She was placed on antimicrobial therapy for presumed UTI for which she took for two days before returning to the ED with worsening rash and desquamation.
T56 144619-144674 Sentence denotes At this evaluation she was given oral prednisone burst.
T57 144675-144776 Sentence denotes Five days following completion of steroids she again presented to the ED with fever and facial edema.
T58 144777-144837 Sentence denotes She was emergently intubated by ENT for oropharyngeal edema.
T59 144838-144995 Sentence denotes She was started on Dexamethasone 8mg q8 for edema and a CT obtained demonstrated extensive angioedema of her tongue and larynx with cervical lymphadenopathy.
T60 144996-145078 Sentence denotes On exam she had no rash, but was noted to have desquamation on her torso and arms.
T61 145079-145185 Sentence denotes Her initial laboratory evaluation showed WBC 21,700 cells/mm 3 , AEC 10,200 cells/mm 3 , normal C3 and C4.
T62 145186-145261 Sentence denotes With three days of systemic steroids, her AEC improved to 8650 cells/mm 3 .
T63 145262-145400 Sentence denotes The edema was not improved and she developed hepatic injury (AST 215, ALT 242, Alk Phos 1201) with mild hepatitis suggested on ultrasound.
T64 145401-145485 Sentence denotes Phenytoin and Lisinopril were discontinued as her picture was consistent with DRESS.
T65 145486-145568 Sentence denotes She quickly improved and was extubated 4 days following Phenytoin discontinuation.
T66 145569-145580 Sentence denotes Discussion:
T67 145581-145685 Sentence denotes Facial edema is common in DRESS however oropharyngeal and laryngeal involvement have not been described.
T68 145686-145795 Sentence denotes Tongue edema has been reported previously in a patient concomitantly on an ACE inhibitor, as was our patient.
T69 145796-145877 Sentence denotes This may implicate a synergistic effect of ACE inhibitors and DRESS presentation.
T70 145878-145982 Sentence denotes To our knowledge this is the first report of DRESS presenting with laryngeal involvement and intubation.
T71 145983-145996 Sentence denotes Introduction:
T72 145997-146150 Sentence denotes Patients with suspected peanut allergy (PA) come to medical attention following an adverse food reaction or in the course of in vivo or in vitro testing.
T73 146151-146319 Sentence denotes An IgE level of 15 kU/L or above has been suggested as 95% likelihood of PA, however the majority of patients sensitized to peanut have an IgE level below this cut off.
T74 146320-146455 Sentence denotes As some patients avoid peanut after initial symptoms, a negative history of systemic reaction to peanut has uncertain predictive value.
T75 146456-146584 Sentence denotes This creates a diagnostic dilemma for clinicians who wish to recommend avoidance, consumption or the option of a food challenge.
T76 146585-146658 Sentence denotes At what lower limit of peanut IgE should component testing be considered?
T77 146659-146848 Sentence denotes Peanut component testing provides a more certain decision point; sensitization to peanut seed storage proteins (SSP), Ara h 2 in particular, correlates well with symptomatic peanut allergy.
T78 146849-147033 Sentence denotes Based on food challenges, Codreanu proposed an IgE threshold for Ara h 2 of 0.23 kU/L for identifying peanut allergic subjects, Nicolaou and Custovic proposed 0.35 kU/L as a threshold.
T79 147034-147142 Sentence denotes This study considers the peanut IgE level that may be used as a decision point for reflex component testing.
T80 147143-147151 Sentence denotes Methods:
T81 147152-147235 Sentence denotes This prospective study utilized sera with de-identified patient health information.
T82 147236-147452 Sentence denotes Samples from 25 peanut sensitized subjects, age 12 years and younger with specific IgE 0.35-15 kU/L, were assayed for peanut SSP Ara h 1, Ara h 2, Ara h 3, for PR-10 Ara h 8, and lipid transfer protein (LTP) Ara h 9.
T83 147453-147461 Sentence denotes Results:
T84 147462-147591 Sentence denotes 76% of the subjects were sensitized to peanut SSP, 56% to Ara h 2, 20% were sensitized to PR-10, Ara h 8 and 12% to LTP, Ara h 9.
T85 147592-147679 Sentence denotes Ara h 2 of at least 0.35 kU/L was seen at the lowest extent of the peanut IgE data set.
T86 147680-147769 Sentence denotes In one sample a value for Ara h 2 of 0.44 kU/L corresponded to a peanut IgE of 0.41 kU/L.
T87 147770-147947 Sentence denotes Within the complete data set it was not possible to predict sensitization to Ara h 2 or SSP based on peanut IgE as the profile may contain IgE to SSP or cross-reactive proteins.
T88 147948-147960 Sentence denotes Conclusions:
T89 147961-148111 Sentence denotes There is not a lower peanut IgE threshold for component testing and it is not possible to predict the component profile based on the peanut IgE alone.
T90 148112-148223 Sentence denotes Peanut IgE values <15 kU/L may be associated with values of Ara h 2 exceeding peanut challenge decision points.
T91 148224-148289 Sentence denotes Component testing has improved in availability and affordability.
T92 148290-148425 Sentence denotes Medical decision-making based on the component profile allows a more accurate risk assignment than decisions based on peanut IgE alone.
T93 148426-148439 Sentence denotes Introduction:
T94 148440-148815 Sentence denotes Fixed drug eruption is characterized by the sudden onset of a single or few circular macular erythematous-violaceous lesions, that could happen in a specific location repeatedly after exposure to a particular drug in 85 to 100 % of cases; drugs most often involved are sulfonamides, NSAIDs, tetracyclines, paracetamol, anticonvulsants and other anecdotal drugs as antifungal.
T95 148816-149057 Sentence denotes There are five clinical forms: a) classic characterized by an asymmetric and erythematous pigmented shape b) symmetrical form with erythematous unpigmented plaques, c) is minor or individual lesion, d) Disseminated bullous form, e) linearly.
T96 149058-149113 Sentence denotes The responsable drug was identified through patch test.
T97 149114-149132 Sentence denotes Case Presentation:
T98 149133-149365 Sentence denotes Thirty eight years old female presents multiple slim, erythematous, assymetrical lesions 24 hours after treatment with Trimethoprim -Sulfamethoxazole located in the back with regular discoid margins with slow progressive involution.
T99 149366-149473 Sentence denotes After suspension of TMP-SMZ exposure the patient preserved a lesion in the calf with residual pigmentation.
T100 149474-149631 Sentence denotes She had a history of previous similar episodes with unspecified drug exposure, 6 weeks later fixed drug eruption by TMP-SMZ was confirmed with patch testing.
T101 149632-149643 Sentence denotes Discussion:
T102 149644-150017 Sentence denotes Fixed drug eruption has a better prognosis than other drug induced skin lesions and is considered a form of delayed hypersensitivity mediated by T cells CD8 +, the disease could determine important physical and psychological impairment due to discomfort and cosmetic appearance, thereby physicians should be alert of this possibility to avoid subsequent recurrent episodes.
T103 150018-150315 Sentence denotes The literature indicates that patch testing is less dangerous than oral challenge to identify the responsible drug with positivity of 23.6% to 20%, which proved effectiveness in the presented case, thereby this diagnostic tool should be considered as a first step approach for fixed drug eruption.
T104 150316-150329 Sentence denotes Introduction:
T105 150330-150391 Sentence denotes Rashes are common in patients receiving multiple medications.
T106 150392-150538 Sentence denotes Most rashes are benign but some can be life-threatening and require urgent identification & discontinuation of the culprit which can be difficult.
T107 150539-150544 Sentence denotes Case:
T108 150545-150781 Sentence denotes A 49-y-o AA man was transferred from another hospital because of severe generalized rash started 2 wk earlier as pustules on legs then spread as bullous-pustular all over his body except the face; accompanied by on-off fever up to 101F.
T109 150782-150895 Sentence denotes He did not improve on TMP/SMX & rifampicin or on IV vancomycin, piperacillin-tazobactam & prednisone 20 mg daily.
T110 150896-151110 Sentence denotes Review of systems revealed HTN, RA, gout, obstructive sleep apnea & peptic ulcer; on amlodipine, olmesartan, aliskiren, nebivolol, clonidine, methotrexate, allopurinol, modafinil, pantoprazole, iron and folic acid.
T111 151111-151197 Sentence denotes He was started on adali-mumab (Humira) for his RA 7 wk & 1 wk before the rash started.
T112 151198-151345 Sentence denotes On presentation, his VS & PE were normal except for generalized ulcerated bullous pustular eruption without facial or mucous membranes involvement.
T113 151346-151420 Sentence denotes Lab findings: WBC 23000 with 95% N, ESR 81mm/hr, CRP 45mg/dl & normal CMP.
T114 151421-151493 Sentence denotes Lesion smear showed neutrophils with negative culture & no fungi or AFB.
T115 151494-151526 Sentence denotes Blood culture was also negative.
T116 151527-151640 Sentence denotes He was treated with hydrotherapy, wound care, and IV methylprednisolone 60mg daily & diphenhydramine 25mg q 6 hr.
T117 151641-151749 Sentence denotes Biopsy showed dermal microabscesses & leukocytoclastic vasculitis consistent with pyoderma gangrenosum (PG).
T118 151750-151847 Sentence denotes Methylprednisolone was increased to 1 g daily for 5 d then switched to PO prednisone 60 mg daily.
T119 151848-151983 Sentence denotes Further evaluation showed positive ANA with no specific pattern, and negative RF, CCP, Ds-DNA, anti-Smith Abs, ANCA & PSTPIP1 mutation.
T120 151984-152038 Sentence denotes Serum & urine electrophoresis and C3 & C4 were normal.
T121 152039-152076 Sentence denotes Serum Humira Abs (IgG) was 15.8 U/ml.
T122 152077-152214 Sentence denotes The rash gradually improved until completely resolved over 3 wk while prednisone was being gradually tapered to 20 mg daily on discharge.
T123 152215-152315 Sentence denotes Conclusion: PG was diagnosed based on biopsy & negative workup for other bullous pustular disorders.
T124 152316-152477 Sentence denotes Humira was the most suspect because it was the most recent medication received, elevated serum Humira IgG Abs, and resolution while on all his other medications.
T125 152478-152534 Sentence denotes This may be the first reported PG case caused by Humira.
T126 152535-152711 Sentence denotes PG is uncommon neutrophilic dermatosis affecting mainly young adults; > 50% of cases have an associated systemic inflammatory disease (e.g., IBD, hematologic or rheumatologic).
T127 152712-152788 Sentence denotes Most patients achieve remission on immunosuppressants but relapse can occur.
T128 152789-152802 Sentence denotes Introduction:
T129 152803-152942 Sentence denotes Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe acute drug reaction with a highly variable clinical presentation.
T130 152943-153198 Sentence denotes It is characterized by a polymorphic skin eruption associated with fever, eosinophilia, lymphadenopathy and the involvement of multiple organs (liver, kidney and lung) along with a long latency (two to eight weeks) between drug exposure and disease onset.
T131 153199-153207 Sentence denotes Methods:
T132 153208-153347 Sentence denotes We evaluated a 14-year-old boy with history of allogenic peripheral blood stem cell (PBSC) transplant for acute myelogenous leukemia (AML).
T133 153348-153419 Sentence denotes He presented to Allergy clinic for evaluation of rash and eosinophilia.
T134 153420-153428 Sentence denotes Results:
T135 153429-153550 Sentence denotes The patient received a matched unrelated donor PBSC transplantation for high-risk AML 7 months prior to his presentation.
T136 153551-153651 Sentence denotes He had history of chronic skin graft-versus-host disease requiring longterm therapy with prednisone.
T137 153652-153775 Sentence denotes Daily medications also included lisinopril, acyclovir, cetirizine, vitamin D, omeprazole and sulfamethoxazole/trimethoprim.
T138 153776-153872 Sentence denotes After 6 months of therapy, prednisone was slowly weaned to a physiologic dose of hydrocortisone.
T139 153873-154115 Sentence denotes Within a week of stopping prednisone he developed intermittent low-grade fevers and an erythematous and pruritic rash on his legs that progressively worsened despite treatment with topical triamcinolone 0.1% ointment and oral diphenhydramine.
T140 154116-154211 Sentence denotes Over a period of 2 months he had 3 hospital admissions for work-up of fever and worsening rash.
T141 154212-154241 Sentence denotes Blood cultures were negative.
T142 154242-154330 Sentence denotes During his 3 rd admission new-onset eosinophilia and worsening transaminitis were noted.
T143 154331-154383 Sentence denotes Based on these findings he was diagnosed with DRESS.
T144 154384-154513 Sentence denotes Therapy with sulfamethoxazole/trimethoprim was stopped and he received 7 days of prednisone resulting in improvement of his rash.
T145 154514-154633 Sentence denotes Within a few days of completing the prednisone course he developed recurrence of his fever and rash and was readmitted.
T146 154634-154674 Sentence denotes A skin biopsy confirmed a drug reaction.
T147 154675-154767 Sentence denotes He was initiated on a 3-month course of prednisone with complete resolution of his symptoms.
T148 154768-154780 Sentence denotes Conclusions:
T149 154781-154852 Sentence denotes Our case report highlights the difficulty of diagnosing DRESS syndrome.
T150 154853-155040 Sentence denotes Though the syndrome is known for its long latency between exposure and symptom onset, the diagnosis and symptoms in our patient were likely initially masked by his chronic prednisone use.
T151 155041-155054 Sentence denotes Introduction:
T152 155055-155289 Sentence denotes Mycophenolate mofetil (MMF) is increasingly being used in place of azathioprine in organ transplantation, as it is associated with less bone marrow suppression, fewer opportunistic infections, and a lower incidence of acute rejection.
T153 155290-155415 Sentence denotes MMF, a purine nucleotide analogue, blocks lymphocyte proliferation by inhibiting guanine nucleotide synthesis in lymphocytes.
T154 155416-155424 Sentence denotes Methods:
T155 155425-155447 Sentence denotes A case report Results:
T156 155448-155626 Sentence denotes A 46-year-old African-American female with systemic lupus erythematosus (SLE) induced dilated cardiomyopathy and end stage renal disease underwent double heart-kidney transplant.
T157 155627-155726 Sentence denotes Following the transplant the patient was placed on azathioprine, tacrolimus and methylprednisolone.
T158 155727-155907 Sentence denotes MMF was not included in her immunosuppressive regimen due to a previous episode of oral pruritus within minutes after the first dose for lupus nephritis approximately 10 years ago.
T159 155908-156005 Sentence denotes A second trial of MMF three weeks after the first resulted in urticaria, pruritus and angioedema.
T160 156006-156149 Sentence denotes MMF was discontinued and her symptoms subsided within 3 days.Allergy and Immunology was consulted to evaluate for possible reinitiation of MMF.
T161 156150-156253 Sentence denotes Skin testing to MMF was performed, however the patient had a blunted response to the histamine control.
T162 156254-156443 Sentence denotes Given the urgency of the situation and inability to interpret our skin tests, we designed a novel 12step desensitization protocol (Table I) adapted from current Drug practice parameters 1 .
T163 156444-156604 Sentence denotes In an intensive care unit setting, an oral desensitization with MMF was performed with diphenhydramine 25 mg IV and famotidine 20 mg IV given as premedications.
T164 156605-156665 Sentence denotes She completed the desensitization without adverse reactions.
T165 156666-156677 Sentence denotes Conclusion:
T166 156678-156845 Sentence denotes The use of MMF has become standard practice in many solid organ transplant recipients due its efficacy and favorable risk profile compared to other immunosuppressants.
T167 156846-156919 Sentence denotes There has been a single case report of successful MMF desensitization 2 .
T168 156920-157028 Sentence denotes However, this protocol did not follow current Drug practice parameters and was done over a three-day period.
T169 157029-157121 Sentence denotes We report a successful desensitization to MMF in a double heart-kidney transplant recipient.
T170 157122-157132 Sentence denotes Rationale:
T171 157133-157189 Sentence denotes Although rare, amphotericin adverse reactions may occur.
T172 157190-157198 Sentence denotes Methods:
T173 157199-157245 Sentence denotes Report of a case and review of the literature.
T174 157246-157264 Sentence denotes Case Presentation:
T175 157265-157398 Sentence denotes A 39 year old male with disseminated cryptococcus meningitis infection after exposure to deceased birds and feces presents with rash.
T176 157399-157468 Sentence denotes His only new medications were flucytosine and liposomal amphotericin.
T177 157469-157624 Sentence denotes The rash presented as itchy, slightly raised, diffuse erythema most consistent with an urticarial lesion on bilateral knees on Day 7 of antifungal therapy.
T178 157625-157699 Sentence denotes No lip/tongue swelling, difficulty breathing, abdominal pain, or vomiting.
T179 157700-157731 Sentence denotes No oral ulcers or skin peeling.
T180 157732-157840 Sentence denotes Flucytosine was continued and liposomal amphotericin was held to help further determine the causative agent.
T181 157841-157898 Sentence denotes On Day 8 of antifungal therapy, he tolerated flucytosine.
T182 157899-157928 Sentence denotes The rash was nearly resolved.
T183 157929-158005 Sentence denotes On Day 9, flucytosine was continued and liposomal amphotericin re-initiated.
T184 158006-158098 Sentence denotes 1 hour into liposomal amphotericin infusion, he developed a similar rash on bilateral knees.
T185 158099-158182 Sentence denotes Thirty minutes after the infusion, he developed chest tightness lasting 30 minutes.
T186 158183-158403 Sentence denotes On Day 10, he underwent liposomal amphotericin desensitization with an initial concentration of 1 ng/ml infused at 1.67 ml/min rate with 3 fold increments in concentration every 30 minutes for a cumulative dose of 300mg.
T187 158404-158440 Sentence denotes There were a total of 14 increments.
T188 158441-158565 Sentence denotes 4 hours after completing the desensitization, he developed a similar rash on his bilateral knees, left calf, and right foot.
T189 158566-158602 Sentence denotes On Day 11, rash was nearly resolved.
T190 158603-158780 Sentence denotes On Day 11 evening, he underwent a conventional amphotericin (without liposomal component) desensitization with a similar protocol except to a cumulative dose of 0.7mg/kg (54mg).
T191 158781-158817 Sentence denotes There were a total of 10 increments.
T192 158818-158826 Sentence denotes Results:
T193 158827-158949 Sentence denotes He was successfully desensitized to conventional amphotericin B after failing desensitization with liposomal amphotericin.
T194 158950-158961 Sentence denotes Discussion:
T195 158962-159048 Sentence denotes Amphotericin is the drug of choice for treatment of severe invasive fungal infections.
T196 159049-159133 Sentence denotes The use of liposomal amphotericin has increased given the less adverse side effects.
T197 159134-159275 Sentence denotes In review of the literature, there was a case of a child who had urticaria to liposomal amphotericin but tolerated conventional amphotericin.
T198 159276-159549 Sentence denotes In patients who adversely react to liposomal amphotericin, one may consider desensitization to conventional amphotericin B, as the patient may be reacting to the liposomal component or to an epitope array of amphotericin that only gets presented by a liposomal formulation.
T199 159550-159563 Sentence denotes Introduction:
T200 159564-159753 Sentence denotes Catamenial anaphylaxis, a.k.a. cyclical anaphylaxis, is characterized by recurrent episodes of serious, possibly fatal, multisystem allergic reactions occurring at the time of menstruation.
T201 159754-159805 Sentence denotes It is an uncommon clinical entity with few reports.
T202 159806-159819 Sentence denotes Presentation:
T203 159820-160018 Sentence denotes A 38-year-old Caucasian female patient with recurrent anaphylaxis: abdominal cramping, diarrhea, injection and swelling of the eyes, nasal congestion, wheezing, respiratory distress, throat closing.
T204 160019-160090 Sentence denotes First episode occurred while she was working at a breakfast restaurant.
T205 160091-160170 Sentence denotes She had worked there on and off for 4 years previously without any such issues.
T206 160171-160259 Sentence denotes Continued to have recurrent episodes x 2 over the next three months, then every 4 weeks.
T207 160260-160317 Sentence denotes Each time, the episodes resolved with oral antihistamine.
T208 160318-160407 Sentence denotes The patient never used epinephrine and never sought medical attention after the episodes.
T209 160408-160452 Sentence denotes No identifiable food or medication triggers.
T210 160453-160486 Sentence denotes CBC and CMP within normal limits.
T211 160487-160542 Sentence denotes RAST IgE positive for dog, cat, ragweed, total IgE 179.
T212 160543-160609 Sentence denotes Baseline tryptase normal at 3.2; did not get acute tryptase drawn.
T213 160610-160675 Sentence denotes No prior medical history other than asthma and allergic rhinitis.
T214 160676-160866 Sentence denotes On questioning, patient noted that she had very good control of asthma symptoms except during her perimenstrual period, when she would have wheezing and dyspnea on otherwise normal exertion.
T215 160867-161010 Sentence denotes Patient also noted that all anaphylactic episodes were occurring on/around Day 1 of menses and that she was completely asymptomatic in between.
T216 161011-161080 Sentence denotes Patient was successfully treated with hormonal suppression of menses.
T217 161081-161092 Sentence denotes Discussion:
T218 161093-161170 Sentence denotes Catamenial anaphylaxis is a rare, possibly underdiagnosed clinical condition.
T219 161171-161368 Sentence denotes It is a diagnosis of exclusion which can be identified after an appropriate evaluation, and when conditions such as mastocytosis and C1esterase inhibitor deficiency/dysfunction have been ruled out.
T220 161369-161533 Sentence denotes No obvious pathogenesis identified, but possible theories include hypersensitivity to progesterone, hypersensitivity to estrogen, prostaglandins in menstrual fluid.
T221 161534-161642 Sentence denotes There is no one universal method of treatment, as several of these pathways require different interventions.
T222 161643-161645 Sentence denotes S.
T223 161646-161661 Sentence denotes Joychan *1 , K.
T224 161662-161673 Sentence denotes Dass 2 , 1.
T225 161674-161691 Sentence denotes Kalamazoo, MI; 2.
T226 161692-161704 Sentence denotes Chicago, IL.
T227 161705-161834 Sentence denotes Anaphylaxis is an acute, potentially life-threatening systemic hypersensitivity reaction, resulting from exposure to an allergen.
T228 161835-161990 Sentence denotes Classically, this occurs when an individual is exposed to an allergen, leading to sensitization and subsequent exposures result in an immunologic response.
T229 161991-162077 Sentence denotes A 22-year-old female with a history of polysubstance abuse presented with anaphylaxis.
T230 162078-162238 Sentence denotes The patient had a history of frequently presenting to the emergency room (ER) with vague complaints of abdominal pain, nausea, and vomiting usually after meals.
T231 162239-162328 Sentence denotes No cause had been found for her symptoms, which were attributed to drug-seeking behavior.
T232 162329-162460 Sentence denotes She presented to the ER one day prior to admission with mild uvular swelling, tachycardia, diffuse urticaria, and voice hoarseness.
T233 162461-162534 Sentence denotes Her symptoms were attributed to an allergic reaction of unknown etiology.
T234 162535-162669 Sentence denotes She was given intravenous (IV) methylprednisolone, IV famotidine, IV diphenhydramine, and two doses of intramuscular (IM) epinephrine.
T235 162670-162734 Sentence denotes The patient was monitored and discharged when symptoms resolved.
T236 162735-162839 Sentence denotes The next day, she presented again with dyspnea, nausea, and urticaria after consumption of garlic bread.
T237 162840-162893 Sentence denotes She reported "outgrowing" a childhood peanut allergy.
T238 162894-163010 Sentence denotes She also reported having recently started working at an Italian restaurant but denied workplace exposure to peanuts.
T239 163011-163048 Sentence denotes She was unaware of any new exposures.
T240 163049-163176 Sentence denotes IV methylprednisolone, IV famotidine, IV diphenhydramine and IM epinephrine were given, in addition to aggressive IV hydration.
T241 163177-163338 Sentence denotes Tree nut panel confirmed allergy to almond, Brazil nut, cashew, coconut, hazelnut, macadamia nut, pecan, pine nut, pistachio, peanut, sweet chestnut, and walnut.
T242 163339-163413 Sentence denotes Upon further questioning, the patient noted pine nuts on her garlic bread.
T243 163414-163452 Sentence denotes All other allergy tests were negative.
T244 163453-163544 Sentence denotes The patient received extensive counseling regarding her allergies and risk for anaphylaxis.
T245 163545-163673 Sentence denotes She was provided with a prescription for an epinephrine auto-injector and recommended to follow up with an allergist outpatient.
T246 163674-163829 Sentence denotes This case demonstrates the importance of taking a detailed allergy history and performing a thorough examination when presented with a case of anaphylaxis.
T247 163830-163938 Sentence denotes Clinicians should be conscientious about recognizing vague symptoms that might precede an allergic reaction.
T248 163939-164123 Sentence denotes This case also highlights the importance of differentiating signs and symptoms related to a patient's substance abuse from similar symptoms that can represent a true allergic reaction.
T249 164124-164152 Sentence denotes PATIENT WITH DRESS SYNDROME.
T250 164153-164157 Sentence denotes J.A.
T251 164158-164171 Sentence denotes Mendez * , C.
T252 164172-164186 Sentence denotes Acantilado, S.
T253 164187-164218 Sentence denotes Nazario, San Juan, Puerto Rico.
T254 164219-164232 Sentence denotes Introduction:
T255 164233-164402 Sentence denotes Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare and life threatening delayed hypersensitivity reaction caused by exposure to certain medications.
T256 164403-164523 Sentence denotes However, identification of the culprit drug may be challenging, particularly in patients receiving multiple medications.
T257 164524-164641 Sentence denotes Patch testing is a well-known method used to identify the culprit drug in delayed Type IV hypersensitivity reactions.
T258 164642-164782 Sentence denotes Here, we report the case of a pediatric patient in whom lamotrigine-induced DRESS syndrome was successfully confirmed through patch testing.
T259 164783-164800 Sentence denotes Case description:
T260 164801-164901 Sentence denotes A 5 year-old boy with epilepsy had been receiving valproic acid for over 1 year to control seizures.
T261 164902-165044 Sentence denotes He had persisted with symptoms despite medical therapy and a follow-up electroencephalogram (EEG) still revealed abnormal electrical activity.
T262 165045-165128 Sentence denotes A decision was made to change his antiepileptic therapy to lamotrigine 125mg daily.
T263 165129-165278 Sentence denotes Two weeks after starting therapy with lamotrigine, the patient experienced the sudden onset of fever of 103° F and a diffuse maculopapular skin rash.
T264 165279-165361 Sentence denotes Laboratory workup was remarkable for an elevated eosinophil count of 0.86x10 9 /L.
T265 165362-165462 Sentence denotes A hypersensitivity reaction to lamotrigine was suspected and the medication was stopped immediately.
T266 165463-165524 Sentence denotes A complete resolution of symptoms was observed after 2 weeks.
T267 165525-165586 Sentence denotes He was referred to our clinics due to suspected drug allergy.
T268 165587-165666 Sentence denotes Patch testing was performed to lamotrigine 30% in water and in petroleum jelly.
T269 165667-165749 Sentence denotes Patch test reading at 72 hours revealed a positive result to lamotrigine in water.
T270 165750-165761 Sentence denotes Conclusion:
T271 165762-165896 Sentence denotes Patch testing of medical products is a useful tool in the evaluation of patients with delayed Type IV hypersensitivity drug reactions.
T272 165897-166030 Sentence denotes In this case, patch testing was successfully used to confirm lamotrigine-induced DRESS syndrome in a pediatric patient with epilepsy.
T273 166031-166091 Sentence denotes Positive patch test to lamotrigine 30% in water at 72 hours.
T274 166092-166105 Sentence denotes Introduction:
T275 166106-166318 Sentence denotes Drug reaction with eosinophilia and systemic symptoms (DRESS) is a drug-induced hypersensitivity reaction that includes skin eruptions, eosinophilia, lymphocytosis, lymphadenopathy and internal organ involvement.
T276 166319-166460 Sentence denotes First line therapy includes high dose corticosteroids, however, patients with DRESS often require a slow, prolonged taper to prevent relapse.
T277 166461-166585 Sentence denotes Here, we describe the case of a patient with DRESS effectively treated with mycophenolate mofetil as a steroid sparing drug.
T278 166586-166604 Sentence denotes Case Presentation:
T279 166605-166674 Sentence denotes Our patient is a 14-year-old white female, previously in good health.
T280 166675-166773 Sentence denotes She developed a cough, malaise and sore throat treated at home with ibuprofen and pseudoephedrine.
T281 166774-166858 Sentence denotes Her father also gave her one dose of amoxicillin left over from an old prescription.
T282 166859-166898 Sentence denotes A few days later her symptoms subsided.
T283 166899-167031 Sentence denotes Four weeks after the onset of the initial illness, she developed a flat pink rash, joint pains, fever, and cervical lymphadenopathy.
T284 167032-167133 Sentence denotes Her symptoms continued to escalate until she became lethargic, had altered mental status and dyspnea.
T285 167134-167202 Sentence denotes She was brought to the hospital hypotensive and required intubation.
T286 167203-167321 Sentence denotes A CT scan revealed diffuse cervical, axillary, hilar, intra-abdominal, pelvic mesenteric and inguinal lymphadenopathy.
T287 167322-167524 Sentence denotes She had leukocytosis of 80 K/ml, 20% bands, eosinophilia of 28 K/mL, lymphocytosis 29 K/mL, acute hemolytic anemia, thrombocytopenia, elevated creatinine, ferritin of 5500 ng/ml, and sIL2R 79,000 pg/ml.
T288 167525-167614 Sentence denotes A bone marrow and lymph node biopsy showed no evidence of hemophagocytosis or malignancy.
T289 167615-167672 Sentence denotes Workup for lupus, vasculitis, and infection was negative.
T290 167673-167702 Sentence denotes She was diagnosed with DRESS.
T291 167703-167839 Sentence denotes She received 1gm IV steroids for three days with remarkable recovery of pulmonary, renal and hepatic function and normalization of labs.
T292 167840-167955 Sentence denotes She was transitioned to oral prednisone at 1mg/kg and started on mycophenolate mofetil 500 mg bid before discharge.
T293 167956-168000 Sentence denotes Her steroid dose is tapered without relapse.
T294 168001-168197 Sentence denotes Conclusion: DRESS is characterized by a profound immunologic response involving overproduction of multiple cell lines including T-cells, B-cells, eosinophils and production of abnormal antibodies.
T295 168198-168331 Sentence denotes Mycophenolate mofetil is a non-competitive inhibitor of inosine monophosphate dehydrogenase that inhibits T and B Cell proliferation.
T296 168332-168446 Sentence denotes To our knowledge, this is the first described case of using this agent to successfully treat a patient with DRESS.
T297 168447-168458 Sentence denotes Background:
T298 168459-168548 Sentence denotes Hymenoptera stings can cause allergic reactions in individuals sensitized to their venom.
T299 168549-168647 Sentence denotes There is few epidemiological data on the prevalence of this type of allergy in children in México.
T300 168648-168765 Sentence denotes The aim of this study is to know the prevalence of Hymenoptera sting allergy in school children of Monterrey, Mexico.
T301 168766-168773 Sentence denotes Method:
T302 168774-168910 Sentence denotes We conducted a transversal and observational study where hymenoptera allergy was surveyed among children attending to elementary school.
T303 168911-168949 Sentence denotes The study was divided into two phases.
T304 168950-169046 Sentence denotes First phase consisted in design and validation of a questionnaire to survey hymenoptera allergy.
T305 169047-169184 Sentence denotes In the second phase, questionnaire was applied to parents whose children attended to any of the different elementary schools of the city.
T306 169185-169250 Sentence denotes Finally, questionnaires were collected and submitted to analysis.
T307 169251-169355 Sentence denotes The clinical reactions and epidemiological characteristics to ant bites, bee and wasp were investigated.
T308 169356-169431 Sentence denotes Allergy to hymenoptera sting was correlated with personal history of atopy.
T309 169432-169440 Sentence denotes Results:
T310 169441-169512 Sentence denotes A total of 323 questionnaires were completed and selected for analysis.
T311 169513-169604 Sentence denotes The age of the students ranged from 5-13 years (mean 9.6 ± 21) and 162 (50.2%) were female.
T312 169605-169712 Sentence denotes Ninety-three children (28.8%) had a personal history of atopy and 23% had some clinical suspicion of atopy.
T313 169713-169794 Sentence denotes Of the total sample, 217 children (67%) had a history of at least one wasp sting.
T314 169795-169871 Sentence denotes The 10.5% of children had large local reactions and 6.5% systemic reactions.
T315 169872-169917 Sentence denotes Anaphylaxis occurred in 0.9% of the children.
T316 169918-170047 Sentence denotes We found no significant difference in the prevalence of allergy to Hymenoptera between atopic and non-atopic subjects (p = 0.09).
T317 170048-170060 Sentence denotes Conclusions:
T318 170061-170199 Sentence denotes The prevalence of large local reactions and systemic reactions found in this study was similar to what has been reported by other authors.
T319 170200-170349 Sentence denotes However, the prevalence of anaphylactic reactions was lower than what has been reported in other epidemiological studies in the pediatric population.
T320 170350-170363 Sentence denotes Introduction:
T321 170364-170494 Sentence denotes Drug induced immune hemolytic anemia (DIIHA) is a rare but often severe cause of hemolysis that was first described in the 1950's.
T322 170495-170642 Sentence denotes Currently, there are more then 125 different drugs known to cause DIIHA with cephalosporin and penicillin antibiotics being the most common agents.
T323 170643-170754 Sentence denotes A diagnosis of DIIHA is made by a clinical history of drug associated hemolysis and positive serologic testing.
T324 170755-170973 Sentence denotes Once DIIHA is identified, the causal drug should be discontinued, and avoidance of similar classes of medications is generally recommended since the cross reactivity between related medications is not well established.
T325 170974-170982 Sentence denotes Methods:
T326 170983-171003 Sentence denotes Case Report Results:
T327 171004-171258 Sentence denotes A 43 year old female with cystic fibrosis (CF) and a history of life-threatening, piperacillin-induced immune hemolytic anemia was hospitalized with worsening productive cough and shortness of breath refractory to tobramycin, aztreonam, and azithromycin.
T328 171259-171557 Sentence denotes Sputum cultures were notable for persistent pseudomonas aeruginosa infection sensitive to piperacillin/tazobactam (PT) and meropenem (MP); however, two years prior to admission, the patient developed severe hemolytic anemia with her hemoglobin reaching a nadir of 2.7gm/dL 5 days after starting PT.
T329 171558-171705 Sentence denotes Laboratory evaluation at that time was significant for an elevated LDH and bilirubin, an undetectable haptoglobin, and a strongly IgG positive DAT.
T330 171706-171829 Sentence denotes The patient was admitted to the ICU and required multiple blood transfusions but improved within a few days of stopping PT.
T331 171830-172017 Sentence denotes Given the patient's history of DIIHA to piperacillin and serious nature of her current CF exacerbation, MP was deemed medically necessary for treatment, and informed consent was obtained.
T332 172018-172151 Sentence denotes A 16 day graded dose challenge was performed starting at 1mg IV to a goal dose of 2 grams IV q8hrs without any evidence of hemolysis.
T333 172152-172242 Sentence denotes The patient has continued to tolerate subsequent courses of MP without any adverse events.
T334 172243-172254 Sentence denotes Conclusion:
T335 172255-172423 Sentence denotes This is the first known report of a patient with a history of piperacillininduced immune hemolytic anemia tolerating meropenem through a cautious graded dose challenge.
T336 172424-172426 Sentence denotes A.
T337 172427-172442 Sentence denotes Blaziene 1 , N.
T338 172443-172464 Sentence denotes Buterleviciute 1 , V.
T339 172465-172485 Sentence denotes Paltarackiene 1 , K.
T340 172486-172506 Sentence denotes Linauskiene 1 , L.M.
T341 172507-172522 Sentence denotes DuBuske *2 , 1.
T342 172523-172545 Sentence denotes Vilnius, Lithuania; 2.
T343 172546-172558 Sentence denotes Gardner, MA.
T344 172559-172570 Sentence denotes Background:
T345 172571-172615 Sentence denotes Anaphylaxis is a life threatening condition.
T346 172616-172683 Sentence denotes NSAIDs a most common pain relief medicine, may induced anaphylaxis.
T347 172684-172692 Sentence denotes Methods:
T348 172693-172837 Sentence denotes 70 patients (38 women (54.3%) and 32 men (45.7%) with anaphylaxis hospitalized in a Vilnius University Hospital from 2009 to 2012 were assessed.
T349 172838-172905 Sentence denotes The mean age of patients was 47.31 ± 17.63 (range 20-83) years old.
T350 172906-172987 Sentence denotes A total of 26 patients with drug-induced anaphylaxis were included in this study.
T351 172988-173071 Sentence denotes The causes, symptoms and diagnosis of anaphylaxis were analyzed using WAO criteria.
T352 173072-173157 Sentence denotes Results: NSAIDs were the main suspected cause of anaphylaxis for 10 (38.5%) patients.
T353 173158-173263 Sentence denotes Other triggers of anaphylaxis were antibiotics (30.8%), local anesthetics (3.8%) and other drugs (26.9%).
T354 173264-173391 Sentence denotes 9 cases of NSAIDs induced anaphylaxis fulfilled the second WAO criteria for anaphylaxis diagnosis and 1 met the third criteria.
T355 173392-173535 Sentence denotes 90.0% of patients had cardiovascular symptoms, 70.0% had skin symptoms, 60.0% had respiratory symptoms and 40.0% had gastrointestinal symptoms.
T356 173536-173592 Sentence denotes One patient experienced NSAID induced anaphylaxis twice.
T357 173593-173681 Sentence denotes Provocation tests were performed and safe alternative NSAIDs were chosen for 2 patients.
T358 173682-173693 Sentence denotes Conclusion:
T359 173694-173755 Sentence denotes Drug induced anaphylaxis was most commonly induced by NSAIDS.
T360 173756-173869 Sentence denotes Anaphylaxis manifestation typically involved the cardiovascular system, followed by skin and respiratory systems.
T361 173870-173883 Sentence denotes Introduction:
T362 173884-174006 Sentence denotes Cyclosporine is an immunosuppressive and immunomodulatory drug that acts selectively on T-cells by inhibiting calcineurin.
T363 174007-174119 Sentence denotes It has been used in the treatment of a variety of T cell-mediated inflammatory and immunemediated skin diseases.
T364 174120-174128 Sentence denotes Methods:
T365 174129-174251 Sentence denotes A 40 year old Caucasian female was started on a beta adrenergic receptor blocker (metoprolol) for ischemic cardiomyopathy.
T366 174252-174438 Sentence denotes On the third day, the patient developed a non-urticarial, pruritic and vesicular rash on her upper chest and extensor surface of her hands, along with angioedema of her face and fingers.
T367 174439-174482 Sentence denotes The patient had no other systemic symptoms.
T368 174483-174576 Sentence denotes The medication was discontinued and the patient responded to oral prednisone and hydroxyzine.
T369 174577-174666 Sentence denotes After a few weeks, her cardiologist started her on a different beta blocker (carvedilol).
T370 174667-174813 Sentence denotes The patient had a similar cutaneous reaction with angioedema on the third day without anaphylaxis, again responding to prednisone and hydroxyzine.
T371 174814-174822 Sentence denotes Results:
T372 174823-174983 Sentence denotes We believed her cutaneous reactions were not IgE-mediated; rather they were T-cell mediated, occurring within a few days of the initiation of two beta blockers.
T373 174984-175100 Sentence denotes There are no validated skin testing or in vitro serum testing assays available for proving beta-blocker sensitivity.
T374 175101-175250 Sentence denotes We empirically suggested the patient start a low dose beta-blocker under cover of oral cyclosporine in an attempt to abrogate the cutaneous reaction.
T375 175251-175349 Sentence denotes With the reinitiation of carvedilol the patient developed no rash, dermal pruritus, or angioedema.
T376 175350-175472 Sentence denotes After two months the cyclosporine dose was slowly tapered, the carvedilol dose was escalated, and such was well tolerated.
T377 175473-175692 Sentence denotes After 6 months, we recommended that the patient discontinue the low dose cyclosporine (25 mg twice daily) while continuing the carvedilol (12.5 mg twice daily), but the patient relocated to Europe prior to dose changes.
T378 175693-175705 Sentence denotes Conclusions:
T379 175706-175816 Sentence denotes Cyclosporine has been used off-label for the treatment of various inflammatory and autoimmune skin conditions.
T380 175817-175915 Sentence denotes This is a prime example of successful use of cyclosporine to prevent a drug-induced skin reaction.
T381 175916-176097 Sentence denotes Further studies need to be performed to evaluate the efficacy of cyclosporine in T cell-mediated, drug-induced allergic dermatoses, wherein the use of such drug is deemed necessary.
T382 176098-176100 Sentence denotes T.
T383 176101-176114 Sentence denotes Kelbel * , F.
T384 176115-176136 Sentence denotes Ishmael, Hershey, PA.
T385 176137-176150 Sentence denotes Introduction:
T386 176151-176276 Sentence denotes The diagnosis of T-cell mediated drug hypersensitivity reactions is challenging due to lack of sensitive and specific assays.
T387 176277-176520 Sentence denotes We describe a case of delayed hypersensitivity reaction to docetaxel and use of an in vitro assay using T-cell gene expression response to characterize the reaction and preemptively test navelbine as a safe, alternative chemotherapy treatment.
T388 176521-176537 Sentence denotes Patient History:
T389 176538-176719 Sentence denotes A 59 year old woman with stage 3 breast cancer developed whole body erythematous rash shortly followed by desquamation about 24 hours after cyclophosphamide and docetaxel treatment.
T390 176720-176802 Sentence denotes It was not clear whether the reaction was caused by cyclophosphamide or docetaxel.
T391 176803-176811 Sentence denotes Methods:
T392 176812-177057 Sentence denotes An in vitro Tcell assay was used to quantify gene expression changes in a panel of cytokines and inflammatory mediators (IL-2, -4, -5, -6, -8, -10, -13, -17a, GM-CSF, TNFα, CCL2, IFN-γ, Fas ligand) when exposed to docetaxel and cyclophosphamide.
T393 177058-177191 Sentence denotes Additionally, her oncologist requested navelbine be preemptively tested as it would be indicated as her next chemotherapeutic option.
T394 177192-177200 Sentence denotes Results:
T395 177201-177350 Sentence denotes In vitro testing showed significant elevation of T-cell response of IL-6 and CCL2 to docetaxel compared to cyclophosphamide and navelbine ( Figure) .
T396 177351-177453 Sentence denotes These results suggest that the reaction was a type IVa delayed hypersensitivity reaction to docetaxel.
T397 177454-177557 Sentence denotes The patient was successfully treated with navelbine and cyclophosphamide and is currently in remission.
T398 177558-177569 Sentence denotes Conclusion:
T399 177570-177719 Sentence denotes In vitro T-cell response testing may be used to characterize docetaxel allergy while also predicting the absence of a type IVa reaction to navelbine.
T400 177720-177828 Sentence denotes This is a novel approach to chemotherapeutic drug reactions with significant clinical application potential.
T401 177829-177897 Sentence denotes Nevertheless, more research is needed before mainstream application.
T402 177898-177900 Sentence denotes P.
T403 177901-177923 Sentence denotes Oza * , Ann Arbor, MI.
T404 177924-177937 Sentence denotes Introduction:
T405 177938-177999 Sentence denotes Drug induced hypersensitivity reaction to amlodipine is rare.
T406 178000-178187 Sentence denotes We present a 59 year old woman who presented with a 3 month history of a cutaneous manifestation drug induced hypersensitivity which started 2 days after she was re-started on Amlodipine.
T407 178188-178196 Sentence denotes Methods:
T408 178197-178291 Sentence denotes Evaluation, diagnosis, and treatment of a patient with serum sickness secondary to amlodipine.
T409 178292-178300 Sentence denotes Results:
T410 178301-178453 Sentence denotes A 59 year old woman presented with a 3-month history of severe rash which started 2 days after being placed on Amlodipine for uncontrolled hypertension.
T411 178454-178559 Sentence denotes The patient recalls taking the drug before, but did not know the duration or why she stopped the therapy.
T412 178560-178614 Sentence denotes Her rash was located primarily on her palms and soles.
T413 178615-178726 Sentence denotes It was painful, pruritic, showed significant desquamation and was associated with a constant burning sensation.
T414 178727-178761 Sentence denotes She also had swelling of her legs.
T415 178762-178828 Sentence denotes Amlodipine was discontinued after 2 weeks, but the rash persisted.
T416 178829-179010 Sentence denotes She was treated with a Medrol dose pack which improved her symptoms, but the lesions recurred despite follow on therapy with Clobetasol cream BID, Vaseline, Vitamin E, and Benadryl.
T417 179011-179068 Sentence denotes Her pain was debilitating and prevented her from walking.
T418 179069-179234 Sentence denotes Dermatology obtained a punch biopsy of her hands and feet revealed eczematous dermatitis, and was noted to have mild largely perivascular dermal lymphoid infiltrate.
T419 179235-179304 Sentence denotes She was prescribed modified Goeckerman regimen which was not helpful.
T420 179305-179443 Sentence denotes Upon presenting to our clinic, her rash was clearly demarcated by erythematous marginal lines present on both palms and soles (see image).
T421 179444-179483 Sentence denotes Her ESR was noted to be elevated at 30.
T422 179484-179522 Sentence denotes She was started on a prednisone taper.
T423 179523-179668 Sentence denotes At her 2 week follow up visit, she showed resolution of the cracking on the palms and burning sensation, with presence of mild residual erythema.
T424 179669-179680 Sentence denotes Conclusion:
T425 179681-179767 Sentence denotes There have been only 3 case reports suggesting a cutaneous reaction to amlodipine use.
T426 179768-179828 Sentence denotes The cutaneous manifestations of serum sickness are variable.
T427 179829-180055 Sentence denotes Prominent skin changes at the lateral aspect of the feet and hands, especially at the junction of the sole and side of the foot and at the junction of palm and dorsal skin surface has been noted to be unique to serum sickness.
T428 180056-180187 Sentence denotes Given that amlodipine is lipid-soluble, it can take months for the body to clear, which explains the persistent nature of the rash.
T429 180188-180364 Sentence denotes Conclusion This case demonstrates Amlodipine induced drug hypersensitivity can present as an isolated cutaneous manifestation that is responsive to treatment with oral steroid.
T430 180365-180367 Sentence denotes S.
T431 180368-180381 Sentence denotes Spriet * , T.
T432 180382-180391 Sentence denotes Banks, T.
T433 180392-180411 Sentence denotes Love, Bethesda, MD.
T434 180412-180425 Sentence denotes Introduction:
T435 180426-180692 Sentence denotes Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare, drug-induced reaction characterized by rash, fever, lymphadenopathy, elevated liver enzymes, and leukocytosis with eosinophilia and has a long latency period between exposure and disease onset.
T436 180693-180774 Sentence denotes We describe a case of recurrent DRESS triggered by a structurally unrelated drug.
T437 180775-180793 Sentence denotes Case Presentation:
T438 180794-181031 Sentence denotes A 54-year-old female with Neurofibromatosis type I and seizure disorder presented to her primary physician with a diffuse morbilliform eruption and facial edema approximately 4 weeks after transitioning from levetiracetam to lamotrigine.
T439 181032-181193 Sentence denotes As a result, lamotrigine was discontinued; however, the patient was soon admitted due to persistent cutaneous symptoms and new fever, abdominal pain and dyspnea.
T440 181194-181415 Sentence denotes Laboratory studies were significant for a leukocytosis of 35,000 cells/mcL, an absolute eosiniphilia count of 7500 cells/mcL, elevated liver enzymes and an increase in serum creatinine from a baseline of 0.7 to 2.7 mg/dL.
T441 181416-181480 Sentence denotes Bilateral pulmonary infiltrates were noted on chest radiography.
T442 181481-181514 Sentence denotes There was no mucosal involvement.
T443 181515-181625 Sentence denotes Intravenous corticosteroids were initiated and the patient's symptoms and laboratory values steadily improved.
T444 181626-181701 Sentence denotes Following discharge, the patient continued on a planned oral steroid taper.
T445 181702-181830 Sentence denotes Three weeks later she was started on a ten day course of clindamycin (1200mg/day) for treatment of a newly diagnosed cellulitis.
T446 181831-182070 Sentence denotes This process quickly resolved, but on day 10 of the antibiotic course she developed a recurrence of her morbilliform rash, evolving to significant erythroderma that resolved with an increase in the daily dose of prednisone from 50 to 60mg.
T447 182071-182211 Sentence denotes Due to the clinical course and temporal relation to clindamycin, the patient was diagnosed with recurrent DRESS triggered by the antibiotic.
T448 182212-182223 Sentence denotes Discussion:
T449 182224-182433 Sentence denotes Antibiotics are the most commonly implicated drugs in cases of recurrent DRESS however, the mechanism by which these or other structurally unrelated agents trigger the abnormal immune response remains unclear.
T450 182434-182511 Sentence denotes As in our case, recurrent reactions tend to be limited to cutaneous findings.
T451 182512-182649 Sentence denotes Providers should be aware of this potential complication in patients with a history of DRESS and recognize the need for prompt treatment.
T452 182650-182726 Sentence denotes Bacitracin is a polypeptide antibiotic that was approved by the FDA in 1948.
T453 182727-182810 Sentence denotes Topical bacitracin ointment has traditionally been used to prevent skin infections.
T454 182811-182903 Sentence denotes More recently prophylactic bacitracin irrigations are being used during surgical procedures.
T455 182904-183017 Sentence denotes Seven cases of intraoperative anaphylaxis after exposure to bacitracin irrigations have been previously reported.
T456 183018-183153 Sentence denotes Here we present the cases of two patients who developed hypersensitivity reactions after receiving prophylactic bacitracin irrigations.
T457 183154-183339 Sentence denotes The first case is a 47 year-old female with a history of breast cancer status post mastectomy and prior patch testing that was positive for bacitracin who presented for breast revision.
T458 183340-183497 Sentence denotes Upon starting the procedure, lidocaine 1% with epinephrine was employed for local anesthesia and the surgical wound was irrigated with a bacitracin solution.
T459 183498-183598 Sentence denotes A few minutes after receiving these medications, she developed generalized erythema and hypotension.
T460 183599-183709 Sentence denotes Intravenous hydrocortisone, diphenhydramine, and famotidine were given with improvement in her blood pressure.
T461 183710-183731 Sentence denotes Full recovery ensued.
T462 183732-183855 Sentence denotes Laboratory tests done later that day were all normal, except for an elevated serum tryptase at 77.9 mg/L (normal <11 mg/L).
T463 183856-183917 Sentence denotes Subsequent skin testing for lidocaine and latex was negative.
T464 183918-184054 Sentence denotes The second case is a 51 year-old female with a history of breast cancer status post mastectomy who also presented for a breast revision.
T465 184055-184215 Sentence denotes She was given cefazolin before the procedure, prepped with chlorhexidine and, as in the prior case, the surgical wound was irrigated with a bacitracin solution.
T466 184216-184254 Sentence denotes No immediate complications were noted.
T467 184255-184397 Sentence denotes One day after the procedure she developed a pruritic erythematous papular rash over the left breast that later spread to her back and abdomen.
T468 184398-184467 Sentence denotes The rash resolved after completing a short course of oral prednisone.
T469 184468-184525 Sentence denotes Bacitracin patch testing done in our clinic was positive.
T470 184526-184598 Sentence denotes In addition, skin testing for penicillin and chlorhexidine was negative.
T471 184599-184756 Sentence denotes In summary, these are two very interesting cases of patients who developed hypersensitivity reactions after intraoperative exposure to a bacitracin solution.
T472 184757-184887 Sentence denotes This problem is particularly relevant since prophylactic bacitracin irrigations of clean surgical wounds are becoming more common.
T473 184888-184890 Sentence denotes C.
T474 184891-184906 Sentence denotes Collins *1 , J.
T475 184907-184919 Sentence denotes Sherr 2 , A.
T476 184920-184930 Sentence denotes Liu 2 , 1.
T477 184931-184948 Sentence denotes Cupertino, CA; 2.
T478 184949-184963 Sentence denotes Palo Alto, CA.
T1 184964-185103 Sentence denotes DRESS (drug reaction with eosinophilia and systemic symptoms) is a serious and sometimes fatal drug reaction that is difficult to diagnose.
T2 185104-185193 Sentence denotes Mexiletine has been reported as a cause of DRESS in case reports in the adult literature.
T3 185194-185357 Sentence denotes Here we report the first case of drug reaction with eosinophilia and systemic symptoms (DRESS) in a pediatric patient caused by the antiarrhythmic drug mexiletine.
T4 185358-185504 Sentence denotes Our patient developed DRESS on mexiletine started for non-sustained ventricular tachycardia associated with nonischemic idiopathic cardiomyopathy.
T5 185505-185653 Sentence denotes Her symptoms included fever, rash and facial swelling, lymphadenopathy, and peripheral eosinophilia approximately 6 weeks after starting mexilitene.
T6 185654-185926 Sentence denotes Though mexilitene was initially discontinued with improvement in reaction symptoms, it was restarted when the patient had multiple PVCs and there was concern for the subsequent development of ventricular tachycardia, for which she did not have good long-term alternatives.
T7 185927-186061 Sentence denotes This case is unusual and significant because a re-exposure was associated with syndrome recurrence, confirming the culprit medication.
T8 186062-186190 Sentence denotes Perioperative anaphylaxis is often a difficult diagnostic dilemma as multiple medications are administered in a short timeframe.
T9 186191-186241 Sentence denotes Considering all agents in this setting is prudent.
T10 186242-186328 Sentence denotes Anaphylaxis due to corticosteroids is rare with only about 100 case reports available.
T11 186329-186451 Sentence denotes Hydrocortisone, prednisolone, and methylprednisolone are the formulations most often implicated in anaphylactic reactions.
T12 186452-186539 Sentence denotes We present a case of near-fatal anaphylaxis attributed to methylprednisolone succinate.
T13 186540-186629 Sentence denotes A 45-year-old female presented for ophthalmological surgery requiring general anesthesia.
T14 186630-186743 Sentence denotes Within 30 minutes, the patient suffered severe hypotension and cardiac arrest with pulseless electrical activity.
T15 186744-186792 Sentence denotes She was resuscitated and transferred to the ICU.
T16 186793-186882 Sentence denotes The Allergy/Immunology service was asked to confirm anaphylaxis and identify the culprit.
T17 186883-186965 Sentence denotes Our institution has recently adopted a new electronic medical record system (EMR).
T18 186966-187129 Sentence denotes The system allows recording of operative events which are presented in graphical format including vital signs and medication administration in the context of time.
T19 187130-187220 Sentence denotes This format proved helpful in identifying the causative agent of anaphylaxis in this case.
T20 187221-187303 Sentence denotes According to the operative record, the patient entered the OR in stable condition.
T21 187304-187372 Sentence denotes Induction of anesthesia included propofol, rocuronium, and fentanyl.
T22 187373-187408 Sentence denotes She also received ocular lidocaine.
T23 187409-187522 Sentence denotes Approximately 30 minutes later, a second dose of rocuronium was administered with 500mg of IV methylprednisolone.
T24 187523-187634 Sentence denotes Vital signs were stable prior to dosing; however, within minutes, severe hypotension and cardiac arrest ensued.
T25 187635-187715 Sentence denotes The patient received epinephrine and CPR with return of spontaneous circulation.
T26 187716-187758 Sentence denotes There were no reports of rash or flushing.
T27 187759-187886 Sentence denotes Using information from the EMR graph, skin testing was planned for rocuronium, cisatracurium, fentanyl, and methylprednisolone.
T28 187887-187972 Sentence denotes SPT and intradermal testing to rocuronium, cisatracurium, and fentanyl were negative.
T29 187973-188040 Sentence denotes SPT to methylprednisolone was positive with wheal/flare of 10/35mm.
T30 188041-188123 Sentence denotes Positive and negative controls had wheal/flare of 10/30mm and 0/5mm, respectively.
T31 188124-188209 Sentence denotes This case illustrates the need to consider corticosteroids as a cause of anaphylaxis.
T32 188210-188321 Sentence denotes The EMR and graphical record are useful tools in recognizing the timing of anaphylaxis and guided drug testing.
T33 188322-188447 Sentence denotes The EMR in combination with positive and negative SPT results helped in making a diagnosis of methylprednisolone anaphylaxis.
T34 188448-188459 Sentence denotes Background:
T35 188460-188607 Sentence denotes Anaphylaxis is a severe and potentially life-threatening reaction caused by an IgE-mediated systemic response to drugs, foods, and other allergens.
T36 188608-188699 Sentence denotes Anaphylaxis associated with laboratory animal exposure is a recognized but rare occurrence.
T37 188700-188892 Sentence denotes The development of atopic symptoms such as rhinoconjunctivitis and asthma is common among those who work with laboratory animals, estimated to affect 11-44% in close contact with rats or mice.
T38 188893-188958 Sentence denotes However, only a few cases of true anaphylaxis have been reported.
T39 188959-188969 Sentence denotes Objective:
T40 188970-189114 Sentence denotes To report a case of anaphylaxis which occurred after rat bite in a laboratory worker with history of atopic disease exacerbated by rat exposure.
T41 189115-189206 Sentence denotes We will review this case and published literature for diagnosis and management guide-lines.
T42 189207-189229 Sentence denotes Materials and Methods:
T43 189230-189330 Sentence denotes We will review the medical record of this patient, including results of laboratory and RAST testing.
T44 189331-189414 Sentence denotes We conducted a MeSH search for "anaphylaxis", "rat", "mouse", "murine", and "bite".
T45 189415-189423 Sentence denotes Results:
T46 189424-189535 Sentence denotes Review of literature revealed 7 previously reported cases of severe allergic reaction after rat or mouse bites.
T47 189536-189622 Sentence denotes One case was an anaphylactoid reaction in a 9-year-old that was bitten by a pet mouse.
T48 189623-189685 Sentence denotes 6 other cases of true anaphylaxis involved laboratory workers.
T49 189686-189790 Sentence denotes 5 of the 7 previously reported reactions occurred in patients with atopy exacerbated by murine exposure.
T50 189791-189921 Sentence denotes Our patient was evaluated in the ER for an episode of anaphylaxis that occurred minutes after sustaining a rat bite to the finger.
T51 189922-190048 Sentence denotes He was treated with epinephrine, prednisone, and antihistamines with prompt recovery and referred to our clinic for follow up.
T52 190049-190226 Sentence denotes We used RAST testing to assess for sensitization to laboratory animals, and he was found to have strongly positive IgE to rat and mouse urine and epithelium (rat urine IgE>100).
T53 190227-190343 Sentence denotes Recommendations were made for avoidance of laboratory animals, and he was provided with an epinephrine autoinjector.
T54 190344-190355 Sentence denotes Conclusion:
T55 190356-190440 Sentence denotes Murine anaphylaxis is an unusual but important entity to recognize in the workplace.
T56 190441-190674 Sentence denotes Laboratory workers who develop allergic sensitization to animals as evidenced by exacerbation of asthma and rhinoconjunctivitis should be aware of the risks of development of serious reactions, and career counseling may be indicated.
T57 190675-190728 Sentence denotes Murine specific immunotherapy can also be considered.
T58 190729-190821 Sentence denotes The genetic and molecular bases of murine anaphylaxis are unknown and require further study.
T59 190822-190833 Sentence denotes Background:
T60 190834-191007 Sentence denotes The stability of short ragweed allergens in immunotherapy vaccines can be compromised by mixing with other extracts, particularly those containing active hydrolytic enzymes.
T61 191008-191143 Sentence denotes Delivery of inaccurate or inconsistent allergen levels can reduce the effectiveness of patient treatment regimens using these mixtures.
T62 191144-191155 Sentence denotes Objectives:
T63 191156-191464 Sentence denotes To confirm the compatibilities of standardized short ragweed extracts in mixtures with a variety of other phenolated, glycerinated, high-protease (mold, cockroach) and low-protease (tree, grass, cat, dog epithelia, dust mite) extracts at concentrations targeted for maintenance immunotherapy administrations.
T64 191465-191473 Sentence denotes Methods:
T65 191474-191772 Sentence denotes Two-part and three-part mixtures containing short ragweed and other glycerinated extract concentrates were analyzed by Amb a 1 radial immunodiffusion assay, the method currently used for short ragweed extract standardization, after storage for up to 12 months at 2-8°C or up to 6 months at 20-25°C.
T66 191773-191781 Sentence denotes Results:
T67 191782-191906 Sentence denotes Short ragweed extract controls and all mixtures displayed favorable Amb a 1 recoveries during storage at either temperature.
T68 191907-192089 Sentence denotes Control sample recoveries ranged from 90-107 (2-part) and 49-72 (3part) Amb a 1 U/mL, and mixtures retained 85-117% (2-part) and 70-116% (3-part) of control values in these analyses.
T69 192090-192190 Sentence denotes There was no evidence of progressive changes in short ragweed extract potency in the stored samples.
T70 192191-192203 Sentence denotes Conclusions:
T71 192204-192384 Sentence denotes Diverse combinations of short ragweed and other glycerinated extracts frequently used for immunotherapy displayed very stable ragweed allergen levels under all conditions examined.
T72 192385-192504 Sentence denotes These data support refrigerated storage of these and related extract mixtures for up to 12 months in clinical settings.
T73 192505-192683 Sentence denotes Ambient temperatures (20-25°C) were evaluated as an accelerated (worst-case) experimental condition, and are not recommended for storage of actual patient immunotherapy formulas.
T74 192684-192695 Sentence denotes Background:
T75 192696-192833 Sentence denotes Preparation of optimal extract mixtures for allergen immunotherapy can be restricted by changing regulations or limits for reimbursement.
T76 192834-193114 Sentence denotes Stabilization of allergen combinations known to be incompatible under conventional storage conditions, such as pollens mixed with proteaserich fungi or insects, can provide viable alternatives to help allergists administer the desired immunotherapy formulations to their patients.
T77 193115-193126 Sentence denotes Objectives:
T78 193127-193404 Sentence denotes To examine the compatibilities of standardized Meadow fescue and Timothy grass pollen extracts in mixtures containing fungal or insect extracts at elevated glycerin concentrations after storage for up to 12 months at refrigerator (2-8°C) or freezer (-15 to -20°C) temperatures.
T79 193405-193413 Sentence denotes Methods:
T80 193414-193658 Sentence denotes Meadow fescue and Timothy extracts were combined with individual fungal (Alternaria, Aspergillus, Penicillium) or insect (American cockroach, German cockroach, fire ant) extracts at glycerin concentrations ranging from 25-50%, in 5% increments.
T81 193659-193765 Sentence denotes Extract levels corresponded to those producing effective maintenance doses for subcutaneous immunotherapy.
T82 193766-193888 Sentence denotes Grass extract potencies were determined by IgE ELISA inhibition assay, the same method used to standardize these products.
T83 193889-193897 Sentence denotes Results:
T84 193898-194023 Sentence denotes Grass allergens in mixtures with fungal or insect extracts were stabilized considerably by storage in a conventional freezer.
T85 194024-194137 Sentence denotes Several mixtures at 25-30% glycerin were partially frozen, but those at 35-50% glycerin remained in liquid phase.
T86 194138-194327 Sentence denotes All combinations exhibited significant improvements in grass allergen potency relative to identical mixtures maintained at 2-8°C (up to 10fold for Meadow fescue; up to 16-fold for Timothy).
T87 194328-194431 Sentence denotes Recoveries for most mixtures at 25% glycerin in freezer exceeded those at 50% glycerin in refrigerator.
T88 194432-194444 Sentence denotes Conclusions:
T89 194445-194663 Sentence denotes Storage of glycerinated extract mixtures at freezer temperatures stabilizes labile allergens, supporting formulation of specific product combinations that must currently be separated into different treatment vial sets.
T90 194664-194675 Sentence denotes Background:
T91 194676-194885 Sentence denotes Aeroallergen surveys help clinicians select appropriate allergens for skin testing and immunotherapy.Knowing local pollen and spore patterns might also help optimize access to care and scheduling for patients.
T92 194886-194897 Sentence denotes Objectives:
T93 194898-195127 Sentence denotes To evaluate patterns of pollen and spore dispersal in Louisville, Kentucky and correlate these with the number of new appointments scheduled with an Allergist-Immunologist and with the number of acute visits for pediatric asthma.
T94 195128-195136 Sentence denotes Methods:
T95 195137-195663 Sentence denotes A National Allergy Bureau certified counter in Louisville, Kentucky performed daily pollen and spore counts.The mean daily pollen/spore count was determined and graphs were generated indicating the onset, peak, and duration of total tree, grass, and weed pollen and mold spores.These graphs were compared to the number of monthly new office visits in a large Allergy-Immunology practice.In addition, the pollen counts were compared to the monthly emergency room visits and admissions for asthma in a large children's hospital.
T96 195664-195672 Sentence denotes Results:
T97 195673-195747 Sentence denotes Daily pollen/spore counts were available for 7 of 10 years from 2003-2013.
T98 195748-195915 Sentence denotes Tree pollen was present from mid-February through mid-June with a bimodal peak; the first in mid-March dominated by juniper and the second in mid-May dominated by oak.
T99 195916-195990 Sentence denotes Grass pollen was present from April through August with a peak in mid-May.
T100 195991-196089 Sentence denotes Weed pollen increased in mid-August with a peak in early September and resolution by late-October.
T101 196090-196298 Sentence denotes Mold spores were present year round, but began rising around the first week of April, with maximum levels occurring from June 01 through October 01, and decreasing to baseline winter levels in early December.
T102 196299-196411 Sentence denotes New allergy visits showed a bimodal peak with the first occurring in early May and the second in late September.
T103 196412-196595 Sentence denotes These peaks occurred approximately 4 weeks later than peak pollen and the adjusted total monthly pollen curve demonstrated significant correlation with new office visits (R 2 =0.725).
T104 196596-196818 Sentence denotes The pollen curve also correlated with total monthly asthma visits from March through September (R 2 =0.77), but asthma visits and pollen count did not correlate when including the winter months in the data set (R 2 =0.03).
T105 196819-196831 Sentence denotes Conclusions:
T106 196832-197029 Sentence denotes Acute asthma visits correlate with the pollen count during the pollen season and demand for new office Allergy-Immunology visits correlates with peak pollen counts with a lag time of about 4 weeks.
T107 197030-197040 Sentence denotes Rationale:
T108 197041-197117 Sentence denotes Hayfever symptoms directly correlate with atmospheric pollen concentrations.
T109 197118-197212 Sentence denotes Climatic and environmental factors have the ability to influence local botany and aerobiology.
T110 197213-197355 Sentence denotes National Allergy Bureau pollen count stations determine the presence of local, clinically relevant allergens and track patterns of prevalence.
T111 197356-197609 Sentence denotes This data is extremely valuable to treating allergists as knowledge regarding yearly and seasonal fluctuations in pollen counts is important in the managing patients with allergic rhino-conjunctivitis, in order to provide appropriate treatment regimens.
T112 197610-197618 Sentence denotes Methods:
T113 197619-197782 Sentence denotes Atmospheric sampling for aeroallergens in Atlanta, GA was preformed over a nine-year interval according to National Allergy Bureau standards using Rotorod sampler.
T114 197783-197872 Sentence denotes Samples were collected each morning by trained observers and various pollens are counted.
T115 197873-197950 Sentence denotes Atmospheric concentrations are determined by calculation from the raw counts.
T116 197951-198021 Sentence denotes The pollen counting station was moved a distance of 2.2 miles in 2010.
T117 198022-198129 Sentence denotes The staff is certified through the American Academy of Allergy, Asthma and Immunology Aeroallergen Network.
T118 198130-198138 Sentence denotes Results:
T119 198139-198223 Sentence denotes The southeast has an intense spring pollen season with very high tree pollen counts.
T120 198224-198322 Sentence denotes Late summer-fall pollen season in past years is less intense and characterized by a ragweed bloom.
T121 198323-198420 Sentence denotes However, through 2009-2013, there were very high levels of Cedar Elm during August and September.
T122 198421-198555 Sentence denotes The pollen counts were consistently within the moderate range as determined by NAB criteria as greater than 15 grains per cubic meter.
T123 198556-198676 Sentence denotes Peak counts ranged between 39.1-475.2 grains/cubic meter and 4-day average ranged between 23.5-206.2 grains/cubic meter.
T124 198677-198776 Sentence denotes Notable, was the increasing duration of the season and days spent within the moderate pollen range.
T125 198777-198789 Sentence denotes Conclusions:
T126 198790-198863 Sentence denotes Cedar Elm has not been a dominant local aeroallergen in Atlanta, Georgia.
T127 198864-199030 Sentence denotes It appears that due to a variety of climatic and environmental factors over the last several years, the prevalence of Cedar Elm pollen in metro-Atlanta has increased.
T128 199031-199388 Sentence denotes The change of positioning of the pollen collection device may also be a factor for these extremely high counts, nevertheless Cedar Elm is an important aeroallergen and should be considered in patients having predominant summer-fall symptoms, especially if they fail to respond to Ragweed testing or immunotherapy which presents during the same time of year.
T129 199389-199402 Sentence denotes Introduction:
T130 199403-199516 Sentence denotes Medical adhesive bandages frequently cause irritant contact dermatitis, occasionally allergic contact dermatitis.
T131 199517-199603 Sentence denotes Systemic hypersensitivity reactions from the adhesive bandages are exceptionally rare.
T132 199604-199713 Sentence denotes We report alginate, a component of compression bandages used after hemodialysis (HD), as causing anaphylaxis.
T133 199714-199719 Sentence denotes Case:
T134 199720-200007 Sentence denotes A 31-year-old woman with end stage renal disease due to prolong hypertension, received HD therapy via arteriovenous fistula for 8 years, presented with 5-months of recurrent generalized pruritus urticarial eruption, along with shortness of breath immediately after hemodialysis sessions.
T135 200008-200099 Sentence denotes She had no history of angioedema; and no history of chemical, medication or food allergies.
T136 200100-200321 Sentence denotes Skin prick testing to hydrocolloid gel from TipStop® (Gambo, Hechingen, Germany) bandage was positive and negative to medications administered at the time of HD including intravenous iron, erythropoietin and paricalcitol.
T137 200322-200381 Sentence denotes Total IgE, latex IgE and tryptase levels were unremarkable.
T138 200382-200479 Sentence denotes The patient was advised to avoid TipStop® bandage and became symptoms free for 3-month follow up.
T139 200480-200491 Sentence denotes Discussion:
T140 200492-200575 Sentence denotes TipStop® is one of the modern compression bandage that claims to be hypoallergenic.
T141 200576-200729 Sentence denotes The Bandage has hydrocolloid gel in the center made from alginate which is designed to stop bleeding after vascular punctures and to protect the fistula.
T142 200730-200927 Sentence denotes Alginate, an extract from brown seaweed, is used extensively in medical devices and products such as dental impressions, prosthetics, soft tissue dermal fillers, dressings and compression bandages.
T143 200928-200995 Sentence denotes It is also used in food industry, for thickening soups and jellies.
T144 200996-201046 Sentence denotes This is the first case of anaphylaxis to bandages.
T145 201047-201151 Sentence denotes The more severe reaction in our case might be caused by direct contact of alginate with vascular system.
T146 201152-201163 Sentence denotes Conclusion:
T147 201164-201244 Sentence denotes The allergenic potential of modern wound dressings should not be underestimated.
T148 201245-201256 Sentence denotes Background:
T149 201257-201317 Sentence denotes Asthma exacerbations triggers include environmental factors.
T150 201318-201328 Sentence denotes Objective:
T151 201329-201458 Sentence denotes The objective of this study was to investigate the relationship between Emergency Department visits for asthma and pollen counts.
T152 201459-201467 Sentence denotes Methods:
T153 201468-201612 Sentence denotes The number of emergency department visits for Asthma between the years 2008-2013 was recorded at John Muir Hospital in Walnut Creek, California.
T154 201613-201696 Sentence denotes Pollen counts were collected in Pleasanton, California during the same time period.
T155 201697-201705 Sentence denotes Results:
T156 201706-201837 Sentence denotes The number of emergency department (ED) visits for Asthma varied throughout the year with a peak number of visits occurring in May.
T157 201838-201916 Sentence denotes We found a significant correlation between the number of Asthma ED visits and:
T158 201917-201919 Sentence denotes 1.
T159 201920-201987 Sentence denotes The monthly averaged total pollen counts (rho=0.629, p<0.05) and 2.
T160 201988-202048 Sentence denotes The monthly averaged tree pollen counts (rho=0.678, p<0.05).
T161 202049-202110 Sentence denotes The daily ED visits for Asthma significantly correlated with:
T162 202111-202113 Sentence denotes 1.
T163 202114-202163 Sentence denotes The total pollen counts (rho=0.212, p<0.0001), 2.
T164 202164-202216 Sentence denotes The grass pollen counts (rho=0.192, p<0.0001) and 3.
T165 202217-202262 Sentence denotes The tree pollen counts (rho=0.201, p<0.0001).
T166 202263-202423 Sentence denotes There was a significant difference in the number of daily visits between days with high grass pollen counts vs. low grass pollen counts (Mann Whitney. p<0.0005.
T167 202424-202447 Sentence denotes High grass pollen days:
T168 202448-202474 Sentence denotes Mean=2.024 visits per day.
T169 202475-202497 Sentence denotes Low grass pollen days:
T170 202498-202525 Sentence denotes Mean=1.302 visits per day).
T171 202526-202698 Sentence denotes A significant difference in the number of daily visits was also observed when comparing days with high tree pollen counts vs. low tree pollen counts (Mann Whitney. p<0.001.
T172 202699-202721 Sentence denotes High tree pollen days:
T173 202722-202748 Sentence denotes Mean=1.894 visits per day.
T174 202749-202770 Sentence denotes Low tree pollen days:
T175 202771-202798 Sentence denotes Mean=1.312 visits per day).
T176 202799-202912 Sentence denotes Conclusions: ED Asthma visits in this study were associated with tree pollen counts and with grass pollen counts.
T177 202913-203018 Sentence denotes Monthly averages of the different pollen types and ED Asthma visits between the years 2008-2013 with SEM.
T178 203019-203074 Sentence denotes Pollen data presented as pollen grains per cubic meter.
T179 203075-203145 Sentence denotes Asthma visits data presented as the monthly averaged number of visits.
T180 203146-203159 Sentence denotes Introduction:
T181 203160-203353 Sentence denotes In the US, the standardized extracts, grass pollen, dust mite, short ragweed, cat hair/pelt, and venoms have expiration dating determined by formal manufacturer studies and approved by the FDA.
T182 203354-203424 Sentence denotes Non-standardized extracts have expiration dating specified by the FDA.
T183 203425-203593 Sentence denotes 50% glycerin extracts are dated for 6 years from extraction, but only 3 years from shipping, and nonglycerin extracts are dated for 3 years and 1.5 years from shipping.
T184 203594-203773 Sentence denotes Little evidence is available to support this dating, so the purpose of this study is to evaluate various extracts produced over the last 10 years for protein and allergen content.
T185 203774-203782 Sentence denotes Methods:
T186 203783-203861 Sentence denotes Allergen extract concentrates were analyzed for protein diversity by SDS-PAGE.
T187 203862-204046 Sentence denotes Potency of some extracts was determined by IgE binding and major allergen assays such as Bet v 1 in Birch, Pla l 1 in English plantain, Ara h 1,2,6 in peanut and tropomyosin in shrimp.
T188 204047-204170 Sentence denotes The commercial extract lots were manufactured over a 10 year period and were stored in their final container vials at 2-8C.
T189 204171-204280 Sentence denotes Results: SDS-PAGE protein patterns generally maintain consistent patterns for the mandated expiration dating.
T190 204281-204414 Sentence denotes Most aqueous extracts began to show changes after the 3 year expiration and most glycerin extracts showed little change over 6 years.
T191 204415-204489 Sentence denotes Remarkably, some extracts maintain consistent patterns for up to 10 years.
T192 204490-204533 Sentence denotes Potency assays helped support the gel data.
T193 204534-204545 Sentence denotes Conclusion:
T194 204546-204681 Sentence denotes The characterization methods used in this study provide evidence for the expiration dating for many non-standardized allergen extracts.
T195 204682-204745 Sentence denotes The stability enhancing ability of glycerin has been confirmed.
T196 204746-204750 Sentence denotes T.J.
T197 204751-204766 Sentence denotes Walker * , L.M.
T198 204767-204777 Sentence denotes Steacy, B.
T199 204778-204792 Sentence denotes Hobsbawn, A.K.
T200 204793-204821 Sentence denotes Ellis, Kingston, ON, Canada.
T201 204822-204833 Sentence denotes Background:
T202 204834-205060 Sentence denotes Certainty of continual Rotorod® impact sampler revolutions per minute(RPM) is unknown during normal operation using accepted traditional design and RPM calibration techniques; only during RPM calibration can one be definitive.
T203 205061-205198 Sentence denotes As EEU pollen concentration levels are monitored and\or adjusted based on accurate sampling, monitored constant RPM values are preferred.
T204 205199-205207 Sentence denotes Methods:
T205 205208-205427 Sentence denotes Custom programmable microcontroller boards, optical encoder technology, secure digital(SD) storage, wireless connectivity, and touch screen control are combined to provide real time monitoring, alerts, and data storage.
T206 205428-205566 Sentence denotes Pulse width modulation(PWM) using the proportional-integral-derivative controller(PID) and encoder feedback ensure accurate motor control.
T207 205567-205746 Sentence denotes The 2400 RPM speed is calculated and recorded per second and stored along with device name, date, time, and user stamp on the onboard storage or wirelessly to a separate location.
T208 205747-205973 Sentence denotes A standard 30 second spin cycle was initiated multiple times over a 15 minute period while simultaneously taking RPM measurements with a handheld National Institute of Science and Technology(NIST) certified optical tachometer.
T209 205974-206069 Sentence denotes Voltage was monitored until the rotorod system was unable to sustain the minimum RPM and noted.
T210 206070-206132 Sentence denotes All data was stored and then compared in our central database.
T211 206133-206141 Sentence denotes Results:
T212 206142-206230 Sentence denotes The RPM comparison speeds captured by the new system averaged 2380.90 RPM, st dev 35.86.
T213 206231-206303 Sentence denotes Readings from the handheld tachometer averaged 2394.52 RPM, st dev 9.65.
T214 206304-206368 Sentence denotes The minimum voltage causing RPM under tolerance was 11.85 volts.
T215 206369-206542 Sentence denotes The new design allows for continual, noncontact, real time monitoring and storage of data from multiple devices simultaneously, therefore, lessoning labor time requirements.
T216 206543-206555 Sentence denotes Conclusions:
T217 206556-206691 Sentence denotes The redesigned rotorod particle sampler will allow for real-time verification feedback and alerts for all particle sampling in the EEU.
T218 206692-206829 Sentence denotes This advancement assures that all particle sampling using rotorod impact sampling is accurate for the entire duration of all duty cycles.
T219 206830-206946 Sentence denotes Qualification/ validation of these devices addresses any mitigations deemed necessary to meet regulatory guidelines.
T220 206947-206958 Sentence denotes Background:
T221 206959-207080 Sentence denotes Orchard workers are highly exposed to several allergic agents, especially peach pollen and other Rosaceae family pollens.
T222 207081-207155 Sentence denotes However, no occupational allergy in this branch has been described before.
T223 207156-207164 Sentence denotes Methods:
T224 207165-207391 Sentence denotes First, skin tests, serum-specific IgE tests with home-made extracts of peach pollen and other four Rosaceae family pollens (apricot pollen, cherry pollen, apple pollen and pear pollen) of the working environment were executed.
T225 207392-207536 Sentence denotes Furthermore, conjunctival challenge with peach pollen was performed, western immunoblots with these five Rosaceae family pollens were performed.
T226 207537-207665 Sentence denotes In addition, ELISA inhibition and western blotting and inhibition experiments among five Rosaceae family pollens were performed.
T227 207666-207673 Sentence denotes Result:
T228 207674-207752 Sentence denotes Skin prick tests with five Rosaceae pollens extracts were positive in patient.
T229 207753-207883 Sentence denotes Specific IgE against three pollens (peach pollen, apricot pollen and cherry pollen) could be demonstrated in the patient by ELISA.
T230 207884-208185 Sentence denotes Cross reactivity studies by ELISA inhibition performed with the patient's sera, when peach pollen used as solid phase, IgE binding to peach pollen could be inhibited by precubation the other four pollens with inhibition rate ranging from 45% to 87%, the strongest inhibitor was apricot pollen extract.
T231 208186-208516 Sentence denotes Sera from patient showed clear IgE binding to 20kD,60kD,80kD proteins in peach pollen extract, similarly the patient's sera recognized apricot pollen proteins of 20KD,55kD,80kD, the sera showed weak IgE binding to 20KD,80KD component of cherry pollen, and the IgE reactivity protein in apple pollen appeared to be 80kD and 110 kD.
T232 208517-208641 Sentence denotes The 20KD IgE binding component in patient's serum could be demonstrated with peach pollen, apricot pollen and cherry pollen.
T233 208642-208770 Sentence denotes The IgE binding to the 20kD protein in peach pollen extract was completely inhibited with apricot pollen (10mg/ml) as inhibitor.
T234 208771-208863 Sentence denotes When cherry, apple, and pear pollen were used as inhibitors, 20kD band was partly inhibited.
T235 208864-208875 Sentence denotes Conclusion:
T236 208876-209027 Sentence denotes We conclude that peach pollen is a potential cause of IgE mediated occupational respiratory disease, extensive cross reactivity among Rosaceae pollens.
T237 209028-209238 Sentence denotes An increasing number of patients are needed to confirm these interesting preliminary finding, and epidemiologic studies are necessary to assess the importance of this aeroallergen among exposed orchard workers.
T238 209239-209280 Sentence denotes UNIQUE ALLERGY AND ASTHMA SMARTPHONE APP.
T239 209281-209283 Sentence denotes S.
T240 209284-209307 Sentence denotes Kagen * , Appleton, WI.
T241 209308-209532 Sentence denotes Smartphone applications are now playing a new and critical role in monitoring the success or failure of allergy and asthma treatments, especially as new healthcare reforms reward successful patient outcomes and performances.
T242 209533-209878 Sentence denotes Monitoring allergy patients has been difficult, but a new and unique Smartphone software application (KagenAir ® ) enables consumers to simultaneously monitor their allergy and asthma symptoms and discover local environmental factors that affect how they feel using patent pending methodologies and computer generated animated maps and graphics.
T243 209879-210157 Sentence denotes The KagenAir App is unique in that it measures symptoms scores and also directly connects consumers with uncontrolled allergy and asthma symptoms to Board Certified Allergy-Asthma-Immunology Specialists within their communities using both cell phone and video-chat technologies.
T244 210158-210338 Sentence denotes Beta testing on allergy and asthma patients established the KagenAir App to be easy to understand, simple to use and helpful in connecting consumers with local allergy specialists.
T245 210339-210350 Sentence denotes Background:
T246 210351-210507 Sentence denotes Though exposure to pets is a known trigger of allergic disease, it has been shown that such exposures, particularly at a young age, can be immunoprotective.
T247 210508-210612 Sentence denotes Early dog exposure especially has been associated with decreased risk of wheezing and atopic dermatitis.
T248 210613-210621 Sentence denotes Methods:
T249 210622-210873 Sentence denotes Data from the Cincinnati Childhood Allergy and Air Pollution Study (CCAAPS) provided cat and dog allergen levels contained within dust samples collected from the homes of infants born between the years of 2001 and 2003 with at least one atopic parent.
T250 210874-210987 Sentence denotes Cytokine levels were measured from blood samples obtained when CCAAPS study participants were 11-12 years of age.
T251 210988-211062 Sentence denotes IRB approval and informed consent was obtained from all research subjects.
T252 211063-211245 Sentence denotes The study data from the first 40 participants with available serum samples were included in this study, and levels of cytokines were measured via a Luminex® multiplex cytokine assay.
T253 211246-211323 Sentence denotes High allergen level was defined as a level at or above the calculated median.
T254 211324-211406 Sentence denotes High cytokine level was also defined as a level at or above the calculated median.
T255 211407-211530 Sentence denotes Differences in the proportions of high and low allergen levels with high and low cytokine levels were tested by Chi-square.
T256 211531-211539 Sentence denotes Results:
T257 211540-211653 Sentence denotes Although the differences in cytokine levels did not reach statistical significance, impor-tant trends were noted.
T258 211654-211902 Sentence denotes Study participants with early life exposure to high levels of dog allergen had a nearly 50% reduction in levels of the following cytokines compared to those with exposure to low levels of dog allergen: G-CSF, IL-10, MCP-3, TGFalpha, IL-9, and IL-3.
T259 211903-212034 Sentence denotes No cytokine was elevated in participants with exposure to high levels of dog allergen compared to the low dog allergen level group.
T260 212035-212286 Sentence denotes In contrast, study participants with early exposure to high levels of cat allergen had significantly higher levels of the following cytokine compared to those with exposure to low levels of cat allergen: IL-12p70, G-CSF, Mip-1alpha, IL-9, and TNFbeta.
T261 212287-212384 Sentence denotes Only VEGF was substantially elevated in participants with exposure to low levels of cat allergen.
T262 212385-212397 Sentence denotes Conclusions:
T263 212398-212568 Sentence denotes The observed trends support that early exposure to high levels of dog allergen is immunoprotective and associated with lower serum levels of cytokines in later childhood.
T264 212569-212662 Sentence denotes Notably, a similar relationship was not found with high cat allergen exposure at a young age.
T265 212663-212765 Sentence denotes In contrast, early exposure to high levels of cat allergen was associated with higher cytokine levels.
T266 212766-212770 Sentence denotes M.Z.
T267 212771-212788 Sentence denotes Braunstein * , R.
T268 212789-212808 Sentence denotes Joks, Brooklyn, NY.
T269 212809-212820 Sentence denotes Background:
T270 212821-212921 Sentence denotes Obesity has been linked to asthma exacerbations, total serum IgE, and severity of atopic dermatitis.
T271 212922-213009 Sentence denotes The correlation of obesity on allergy testing responsiveness has not been well studied.
T272 213010-213020 Sentence denotes Objective:
T273 213021-213172 Sentence denotes We sought to investigate the relationship of BMI to allergen skin prick tests and serum specific allergen IgE levels of common aeroallergens and foods.
T274 213173-213181 Sentence denotes Methods:
T275 213182-213289 Sentence denotes We reviewed adult patient charts (n=288) who presented to the allergy and immunology clinic from 1998-2013.
T276 213290-213600 Sentence denotes Data from patients with physician diagnosed allergic rhinoconjunctivitis or asthma who underwent routine epicutaneous skin prick testing (SPT) for common environmental allergens (n=124) or who had allergen specific IgE levels (FEIA) to common environmental and food allergens (n=92) were included for analysis.
T277 213601-213766 Sentence denotes Spearman coefficients were generated to determine an association of BMI with the number of positive SPT, the mean wheal diameter, and the maximum specific IgE class.
T278 213767-213898 Sentence denotes Results: BMI significantly correlated with the number of positive SPT (p=0.01) and inversely with the mean wheal diameter (p=0.05).
T279 213899-213972 Sentence denotes There was no significant correlation with the maximum specific IgE class.
T280 213973-213985 Sentence denotes Conclusions:
T281 213986-214082 Sentence denotes Obesity, as measured by BMI, is associated with increased specific cutaneous allergic responses.
T282 214083-214287 Sentence denotes However, the cutaneous response to allergen decreases with increasing BMI, suggesting an attenuated response to allergic mediators released during immediate hypersensitivity reactions with increasing BMI.
T283 214288-214299 Sentence denotes Background:
T284 214300-214359 Sentence denotes Cancer is an important cause of health morbidity in adults.
T285 214360-214409 Sentence denotes One in four deaths are due to cancer (ACS, 2014).
T286 214410-214526 Sentence denotes There is little published literature of serum IgE and eosinophil level associations with cancer on a national level.
T287 214527-214537 Sentence denotes Objective:
T288 214538-214652 Sentence denotes To examine the association between serum IgE, eosinophil % and the overall vs. type-specific prevalence of cancer.
T289 214653-214661 Sentence denotes Methods:
T290 214662-214838 Sentence denotes Data from a nationwide survey conducted by the Centers for Disease Control and Prevention, National Health and Nutrition Examination Survey (NHANES 2005 (NHANES -2006 was used.
T291 214839-215147 Sentence denotes Bivariate analyses with chi-square tests, logistic regression and stratified models assessed the relationship between serum IgE and eosinophil %) and the overall prevalence of cancer (defined as ever having been diagnosed by a physician with cancer of any kind) versus the type-specific prevalence of cancer.
T292 215148-215156 Sentence denotes Results:
T293 215157-215214 Sentence denotes A total of 4,893 adults constituted our study population.
T294 215215-215492 Sentence denotes After controlling for age, gender, ethnicity, education and income, smoking status and duration of cancer diagnosis, subjects with high serum IgE had a negative odds of overall cancer (OR = 0.83, 0.64-1.09), as did subjects with higher eosinophil levels (OR = 0.90, 0.82-0.99).
T295 215493-215653 Sentence denotes Interaction models demonstrated the significant protective effect of cancer for IgE for males (OR= 0.85, and eosinophil levels in females (OR= 0.73, 0.54-0.98).
T296 215654-215767 Sentence denotes Finally, IgE levels had a negative odds of lung (OR= 0.28, 0.15-0.52) and cervical cancers (OR= 0.84, 0.61-0.16).
T297 215768-215885 Sentence denotes High eosinophil levels also had negative odds of lung (OR=0.39, 0.15-1.00) and cervical cancers (OR=0.57, 0.41-0.78).
T298 215886-215897 Sentence denotes Conclusion:
T299 215898-216082 Sentence denotes This study shows that atopy and eosinophilia were associated with a decreased prevalence of overall cancer after covariate adjustment, using a large, nationally representative dataset.
T300 216083-216262 Sentence denotes This suggests the need for continued allergy surveillance and longitudinal studies of the possible protective role of serum IgE and eosinophil levels in lung and cervical cancers.
T301 216263-216276 Sentence denotes Introduction:
T302 216277-216371 Sentence denotes Allergy to metals and acrylates in bone cement have been implicated in joint implant failures.
T303 216372-216453 Sentence denotes Over 900,000 hip and knee replacement surgeries are performed annually in the US.
T304 216454-216586 Sentence denotes The purpose of this study was to evaluate contact hypersensitivity to metals and acrylates in patients undergoing joint replacement.
T305 216587-216595 Sentence denotes Methods:
T306 216596-216692 Sentence denotes Sixty-five subjects were referred for evaluation of possible allergy to metal between 2012-2014.
T307 216693-216907 Sentence denotes Subjects underwent either pre-operative (N=46) or post-operative (N=19) patch testing to a standard panel of metal salts (nickel, cobalt, chromium, palladium, vanadium, and zirconium) and methyl and ethyl acrylate.
T308 216908-217046 Sentence denotes Patients and referring providers were contacted for information regarding component materials in the prostheses and postsurgical outcomes.
T309 217047-217055 Sentence denotes Results:
T310 217056-217228 Sentence denotes Of 65 patients, 46 with a self-reported history of metal allergy were tested pre-operatively (PRE) and 19 patients were referred postoperatively (POST) for implant failure.
T311 217229-217399 Sentence denotes Thirty-five (76%) of the PRE group had a positive patch test; all these patients had an alternative material (eg zirconium, polyethylene, ceramic, or titanium) implanted.
T312 217400-217515 Sentence denotes Fourteen of POST patients had positive patch tests (74%); 8/14 (57%), however, gave no prior metal allergy history.
T313 217516-217636 Sentence denotes Nickel was the most common offending antigen in both groups with 54% of PRE and 32% of POST patients reacting to nickel.
T314 217637-217735 Sentence denotes Rare metals such as palladium caused several reactions with 8 PRE and 4 POST positive patch tests.
T315 217736-217811 Sentence denotes Two PRE and 3 POST patients, all female, reacted to ethyl acrylate as well.
T316 217812-217823 Sentence denotes Conclusion:
T317 217824-217951 Sentence denotes A history of metal allergy and/or contact hypersensitivity confirmed by patch testing may influence choice of implant material.
T318 217952-218088 Sentence denotes In addition to infection and biomechanical failure, metal allergy should be considered as a potential cause of prosthetic joint failure.
T319 218089-218102 Sentence denotes Introduction:
T320 218103-218232 Sentence denotes A 48 year old male presents with a 20 year history of chronic urticaria that has been worsening in severity for the past 4 years.
T321 218233-218336 Sentence denotes He reports a long-standing pruritic urticaria that comes and goes on his arms, legs, abdomen, and back.
T322 218337-218463 Sentence denotes For the past 4 years he has had more painful lesions occurring over a greater area and with increased frequency, almost daily.
T323 218464-218612 Sentence denotes The pain and itch are relieved by oral steroids and antihistamines, but he has been requiring greater doses of short-acting antihistamines recently.
T324 218613-218743 Sentence denotes On review of systems, he also reports nasal congestion, cough, abdominal pain, BRBPR due to hemorrhoids, joint aches and swelling.
T325 218744-218868 Sentence denotes Social history revealed a 25 pack-year smoking history, heavy alcohol consumption, and previous incarceration for ten years.
T326 218869-219021 Sentence denotes Physical examination revealed raised, erythematous, circumscribed lesions that are not blanchable on his upper and lower extremities, abdomen, and back.
T327 219022-219030 Sentence denotes Results:
T328 219031-219096 Sentence denotes Laboratory evaluation revealed mild anemia Hb13.1g/dL, Hct 39.6%.
T329 219097-219109 Sentence denotes IgE 28 kU/L.
T330 219110-219127 Sentence denotes CMP unremarkable.
T331 219128-219147 Sentence denotes Absent CH50 and C4.
T332 219148-219183 Sentence denotes Low C2 (0.9mg/dL) and C3 (36mg/dL).
T333 219184-219211 Sentence denotes Rheumatoid factor positive.
T334 219212-219301 Sentence denotes C1q, ANA, ANCA, ESR (2mm/hr), anti-Smith, anti-dsDNA and anti-RNP antibodies were normal.
T335 219302-219320 Sentence denotes SPEP unremarkable.
T336 219321-219347 Sentence denotes Quantiferon Gold negative.
T337 219348-219361 Sentence denotes HIV negative.
T338 219362-219456 Sentence denotes Hepatitis C antibody reactive, HCV Quantitative 1,160,000 IU/mL and HCV Quantitative Log 6.06.
T339 219457-219481 Sentence denotes Hepatitis C genotype 1b.
T340 219482-219520 Sentence denotes Biopsy was consistent with vasculitis.
T341 219521-219544 Sentence denotes Cryoglobulins positive.
T342 219545-219598 Sentence denotes The patient is scheduled to start anti-viral therapy.
T343 219599-219610 Sentence denotes Discussion:
T344 219611-219735 Sentence denotes Cryoglobulinemia is a systemic inflammatory syndrome that involves small-tomedium vessel vasculitis due to immune complexes.
T345 219736-219791 Sentence denotes Clinical presentations of cryoglobulinemia vary widely.
T346 219792-219914 Sentence denotes Cryoglobulinemia has different underlying etiologies, and is associated with up to 65% of patients with hepatitis C virus.
T347 219915-220149 Sentence denotes Cryoglobulinemia can cause a triad of palpable purpura, arthralgia, and myalgia when viral associated, while cryoglobulinemia due to monoclonal immunoglobulins or hematological malignancies is generally associated with hyperviscosity.
T348 220150-220287 Sentence denotes Cryoglobulinemia is diagnosed by the demonstration of serum cryoglobulins in association with characteristic clinical signs and symptoms.
T349 220288-220377 Sentence denotes Prognosis is generally dependent on the degree of resolution of the underlying condition.
T350 220378-220511 Sentence denotes This case marks the importance of an infectious work-up and vasculitic evaluation in a patient with non-remitting urticarial lesions.
T351 220512-220516 Sentence denotes O.H.
T352 220517-220552 Sentence denotes Al Jiffri * , Jeddah, Saudi Arabia.
T353 220553-220564 Sentence denotes Background:
T354 220565-220682 Sentence denotes Weight loss studies were conducted in children without asthma have demonstrated a reduction in systemic inflammation.
T355 220683-220791 Sentence denotes However, the impact of weight loss in the obese paediatric population with asthma has not been investigated.
T356 220792-220802 Sentence denotes Objective:
T357 220803-220917 Sentence denotes To measure the effects of weight loss on markers of systemic inflammation in obese children with bronchial asthma.
T358 220918-220926 Sentence denotes Methods:
T359 220927-221062 Sentence denotes Eighty obese children with bronchial asthma (42 boys, and 38 girls) with mean age 13.86± 3.21 years were divided into two equal groups.
T360 221063-221236 Sentence denotes The training group received diet regimen, exercise training in addition to the medical treatment for two months, where the control group received the medical treatment only.
T361 221237-221245 Sentence denotes Results:
T362 221246-221525 Sentence denotes There was a 17.5%, 15.5%, 22.4%, 14.1% and 15.9% reduction in mean values of tumor necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6), interleukin-8 (IL-8), Leptin and body mass index (BMI) respectively and 38.7% increase in mean values of adiponectin in the training group.
T363 221526-221724 Sentence denotes While, there was a 0.7%, 9.0%, 2.8%, 1.6% and 1.2% increase in mean values of TNF-alpha, IL-6, IL-8, Leptin and BMI respectively and 3.9% decrease in mean values of adiponectin in the control group.
T364 221725-221925 Sentence denotes The mean values of TNF-alpha, IL-6, IL-8, Leptin and BMI was decreased and adiponectin was increased significantly in the training group, however the results of the control group were not significant.
T365 221926-222011 Sentence denotes Also, there were significant differences between both groups at the end of the study.
T366 222012-222023 Sentence denotes Conclusion:
T367 222024-222124 Sentence denotes Weight loss improves markers of systemic inflammation in obese Saudi children with bronchial asthma.
T368 222125-222176 Sentence denotes Key words: obesity, asthma, weight loss, cytokines.
T369 222177-222298 Sentence denotes Mean value and significance of TNF-α, IL-6, IL-8, Leptin, Adiponectin and BMI in group (A) and group (B) after treatment.
T370 222299-222336 Sentence denotes TNF-α = tumor necrosis factor -alpha.
T371 222337-222398 Sentence denotes IL-6 = Interleukin-6 IL-8= Interleukin-8 BMI= Body Mass Index
T372 222399-222401 Sentence denotes T.
T373 222402-222417 Sentence denotes Shimoda *1 , Y.
T374 222418-222430 Sentence denotes Obase 2 , M.
T375 222431-222444 Sentence denotes Imaoka 1 , R.
T376 222445-222461 Sentence denotes Kishikawa 1 , T.
T377 222462-222476 Sentence denotes Iwanaga 1 , 1.
T378 222477-222495 Sentence denotes Fukuoka, Japan; 2.
T379 222496-222512 Sentence denotes Nagasaki, Japan.
T380 222513-222523 Sentence denotes Rationale:
T381 222524-222658 Sentence denotes Serum high sensitivity C-reactive protein (hs-CRP) has been shown to be useful as a marker of airway inflammation in bronchial asthma.
T382 222659-222727 Sentence denotes However, various factors have been reported to affect hs-CRP levels.
T383 222728-222905 Sentence denotes We conducted a study in patients with mild bronchial asthma without complications to determine whether hs-CRP could serve as a useful indicator in assessing airway inflammation.
T384 222906-222914 Sentence denotes Methods:
T385 222915-223030 Sentence denotes The subject population consisted of 40 healthy volunteer (HV) controls, and 45 patients with bronchial asthma (BA).
T386 223031-223179 Sentence denotes Induction of sputum with the use of inhaled 3% hypertonic saline and bronchial hyperresponsiveness test were performed, in addition to serum hs-CRP.
T387 223180-223188 Sentence denotes Results:
T388 223189-223313 Sentence denotes The log serum hs-CRP levels were higher in BA patients (2.49 ± 0.41) compared with healthy subjects (2.21 ± 0.39) (p=0.002).
T389 223314-223505 Sentence denotes When receiver operator characteristic (ROC) analysis was performed to compare healthy subjects and BA patients, the sensitivity was 0.64 and specificity was 0.71 at a log serum hs-CPR of 2.3.
T390 223506-223705 Sentence denotes The log serum hs-CRP levels were negatively correlated with FEV 1.0,%pred (r = -0.31, p = 0.04), positively with sputum eosinophils (r = 0.34, p = 0.02), but not with log PC 20 (r = -0.09, p = 0.56).
T391 223706-223891 Sentence denotes Multiple regression analysis demonstrated that the log serum hs-CRP concentrations were significantly correlated with both eosinophils (p = 0.004) and neutrophils (p = 0.011) in sputum.
T392 223892-223904 Sentence denotes Conclusions:
T393 223905-224105 Sentence denotes Serum hs-CRP is useful in assessing airway inflammation in BA patients without complications such as heart disease, hypertension, hyperlipidemia, chronic obstructive pulmonary disease, and infections.
T394 224106-224119 Sentence denotes Introduction:
T395 224120-224221 Sentence denotes Studies have shown higher risk of cardiovascular disease (CVD) in asthma than non-asthma populations.
T396 224222-224341 Sentence denotes However, there are limited data examining whether asthma severity is linked to CVD incidence within asthma populations.
T397 224342-224350 Sentence denotes Methods:
T398 224351-224647 Sentence denotes The Evaluating Clinical Effectiveness and Long-Term Safety in Patients with Moderate-to-Severe Asthma study (EXCELS) is a multicenter, prospective, 5-year, observational cohort study of patients with moderate-to-severe persistent asthma, including cohorts treated and not treated with omalizumab.
T399 224648-224804 Sentence denotes This post hoc analysis examined the association between baseline asthma severity factors and longitudinal outcomes over 5 years in the nonomalizumab cohort.
T400 224805-225076 Sentence denotes Cardiovascular-and cerebrovascular-related events were combined into a single endpoint of arterial thrombotic events (ATE), defined as the first of the following: cardiovascular death, myocardial infarction, ischemic stroke, transient ischemic attack, or unstable angina.
T401 225077-225134 Sentence denotes An independent expert panel blindly adjudicated all ATEs.
T402 225135-225411 Sentence denotes Asthma severity measures included spirometry, physician-assessed asthma severity, oral steroid usage, and the Severity of Asthma Score (SOA), a validated instrument that assesses asthma symptoms, asthma medication burden, and asthma emergency utilization history (range 0-28).
T403 225412-225552 Sentence denotes Multivariable Cox models were used to assess risk of ATE for each individual asthma severity measure, controlling for potential confounders.
T404 225553-225561 Sentence denotes Results:
T405 225562-225633 Sentence denotes A total of n=2,829 patients in the non-omalizumab cohort were analyzed.
T406 225634-225713 Sentence denotes Baseline mean age was 46.2±17.1 years, 66.5% were female, and 82.2% were white.
T407 225714-225824 Sentence denotes Mean pre-bronchodilator % predicted forced expiratory volume (FEV 1 ) was 80.0±21.6 and mean SOA was 10.0±4.5.
T408 225825-226049 Sentence denotes After controlling for potential confounders, lower pre-bronchodilator FEV 1 % predicted, higher SOA, and chronic oral corticosteroid usage were each statistically significantly associated with increased risk of ATE (Table) .
T409 226050-226062 Sentence denotes Conclusions:
T410 226063-226155 Sentence denotes Multiple asthma severity measures were associated with increased risk of ATE in this cohort.
T411 226156-226420 Sentence denotes Further work is required to delineate mediators, but this analysis utilizing a large cohort followed over an extended timeframe provides some of the most robust evidence linking higher asthma severity to greater risk of cardiovascular and cerebrovascular outcomes.
T1 226421-226897 Sentence denotes Adjusted Predictions for Time to First ATE Event (n=2,829 Patients) ATE, arterial thrombotic event; FEV1, forced expiratory volume in 1 second a) Analyses of FEV1 % predicted controlled for tobacco history (none, current, former) and education but not age, gender or race/ethnicity because these demographic factors are included in the calculation of percentage predicted. b) Controlling for age, gender, race/ethnicity, education, and tobacco history (none, current, former).
T2 226898-226911 Sentence denotes Introduction:
T3 226912-227065 Sentence denotes Little is known about the effect of omalizumab (OMA) continuation vs. discontinuation after its long-term use on patient-reported asthma symptom control.
T4 227066-227142 Sentence denotes XPORT was the first rigorous study of long-term benefit of OMA continuation.
T5 227143-227339 Sentence denotes Methods: XPORT was a randomized, double-blind, placebo-controlled withdrawal study of patients with moderate-to-severe persistent allergic asthma receiving long-term therapy with OMA for ≥5 years.
T6 227340-227488 Sentence denotes Patients were randomized to either continue the same dose of OMA (n=88) or switch to placebo (PLB, n=88) and were followed every 4 weeks for 1 year.
T7 227489-227631 Sentence denotes Patients completed the Asthma Control Questionnaire (ACQ) and the Asthma Control Test (ACT) at baseline (BSL) and every 4 weeks until week 52.
T8 227632-227722 Sentence denotes High ACQ (range 0-6) and low ACT (range 0-25) scores indicate poor asthma symptom control.
T9 227723-227857 Sentence denotes We compared changes in ACT and ACQ scores from BSL to week 52 and ACT and ACQ scores at each time point against the BSL (ANOVA tests).
T10 227858-228019 Sentence denotes We compared the percentage of PLB and OMA patients (chi-square test) whose decline reached minimal important difference (MID) from BSL to Week 52 on ACT and ACQ.
T11 228020-228095 Sentence denotes IRB approval and informed consent were obtained from all research subjects.
T12 228096-228104 Sentence denotes Results:
T13 228105-228178 Sentence denotes On average, patients had good asthma symptom control at the BSL (Table) .
T14 228179-228288 Sentence denotes Patients randomized to continue OMA maintained better asthma symptom control than patients randomized to PLB.
T15 228289-228415 Sentence denotes The mean change from BSL to Week 52 for ACT score was -2.88 for the PLB arm and -1.16 for the OMA continuation arm [p=0.0188].
T16 228416-228540 Sentence denotes The mean change from BSL to Week 52 for ACQ score was 0.63 in the PLB arm and 0.22 in the OMA continuation arm [p = 0.0039].
T17 228541-228680 Sentence denotes Compared to the BSL, the decline in asthma symptom control in ACT and ACQ was statistically significant for the PLB arm starting at week 4.
T18 228681-228770 Sentence denotes There was no statistically significant change for the OMA arm at any time point (Table) .
T19 228771-228960 Sentence denotes By week 52, the percentage of patients whose decline of asthma control reached MID comprised 28.4% (OMA) vs. 43.2% (PLB) on ACQ (p = 0.041) and 23.9% (OMA) vs. 39.8% (PLB) on ACT (p=0.024).
T20 228961-228973 Sentence denotes Conclusions:
T21 228974-229064 Sentence denotes Patients with allergic asthma who continue on OMA therapy maintain asthma symptom control.
T22 229065-229204 Sentence denotes However, patients who discontinue OMA therapy report significant decline in asthma symptom control, and this is evident as early as week 4.
T23 229205-229291 Sentence denotes ACQ and ACT scores by study visits and treatment arms PLB = placebo; OMA = omalizumab.
T24 229292-229382 Sentence denotes High ACQ and low ACT scores indicate poor asthma symptom control. * P < 0.05. ** P < 0.01.
T25 229383-229444 Sentence denotes P-values were derived from ANOVA, comparing against baseline.
T26 229445-229456 Sentence denotes Background:
T27 229457-229609 Sentence denotes Multiple studies have shown inadequate parental knowledge about asthma is common among pediatric patients seen in Emergency Rooms (ER) for acute asthma.
T28 229610-229758 Sentence denotes Furthermore educational interventions have resulted in improvements in both the asthma knowledge of parents, as well as disease control of patients.
T29 229759-229887 Sentence denotes However in adult populations there are conflicting data regarding the relationship between asthma knowledge and disease control.
T30 229888-229896 Sentence denotes Methods:
T31 229897-230121 Sentence denotes We measured asthma knowledge with the Asthma Self-Management Questionnaire, a validated 24 item true/false instrument, in 49 adult asthmatics while visiting any of 3 primary care clinics at a single tertiary referral center.
T32 230122-230387 Sentence denotes Asthma control was measured by Asthma Control Test (ACT), mini-Asthma Quality of Life Questionnaire (m-AQLQ), as well as patient reported: monthly short acting beta-agonist (SABA) use, ER visits for asthma in the past year, and lifetime hospitalizations for asthma.
T33 230388-230526 Sentence denotes Other demographic, socioeconomic, including literacy as measured by the Newest Vital Sign (NVS), and asthma care data were also collected.
T34 230527-230535 Sentence denotes Results:
T35 230536-230768 Sentence denotes Asthma knowledge was correlated with asthma control as measured by monthly SABA use (r=-0.29 p=0.05) but was not with ACT (r=0.17, p=0.24), m-AQLQ (r=0.19, p=0.19), ER visits (r=-0.13, p=0.13), and hospitalization (r=-0.11, p=0.47).
T36 230769-231105 Sentence denotes Asthma knowledge was correlated with specialist referral (r=0.41, p=0.003) and patient literacy (r=0.37, p=0.01), but not with the patient's reported highest level of formal education (r=0.19, p=0.20), patient income (r=0.08, p=0.60), time since asthma diagnosis (r=0.22, p=0.13), and controller medication prescription (r=0.04, p=0.8).
T37 231106-231117 Sentence denotes Discussion:
T38 231118-231331 Sentence denotes In this population asthma knowledge was correlated with SABA use, patient literacy and specialist referral, but did not correlate with other measures of asthma control, socioeconomic status, and asthma management.
T39 231332-231526 Sentence denotes However this was a small survey conducted in a single facility and the study population had significantly higher scores than the population in which the knowledge measurement tool was validated.
T40 231527-231623 Sentence denotes Consequently further investigation into adult patient knowledge and asthma control is warranted.
T41 231624-231635 Sentence denotes Background:
T42 231636-231831 Sentence denotes Recently published European Respiratory Society (ERS) and American Thoracic Society (ATS) asthma guidelines provide a new definition of severe asthma based on control measures and medication use.
T43 231832-231950 Sentence denotes The relationship between asthma severity and blood eosinophils (EOS) was examined using this new guideline definition.
T44 231951-231961 Sentence denotes Objective:
T45 231962-232058 Sentence denotes To study the association of asthma severity defined by ERS/ATS guidelines with blood EOS levels.
T46 232059-232067 Sentence denotes Methods:
T47 232068-232441 Sentence denotes Records of patients at least 12 years of age with at least two medical claims with a primary or secondary diagnosis of asthma defined by ICD-9-CM code 493.xx between January 2004 and July 2011, were extracted from the EMR-Claims+ database (eMAX Health, White Plains NY) containing electronic medical records linked to insurance claims across 6 Midwestern states in the U.S.
T48 232442-232502 Sentence denotes The date of first diagnosis was defined as the 'index date'.
T49 232503-232632 Sentence denotes Patients were required to have at least 1 peripheral blood EOS test in the 12 month 'assessment' period following the index date.
T50 232633-232822 Sentence denotes Patients' asthma was classified as severe or non-severe using intensity of treatment and level of asthma control during the assessment period, as recommended by the 2014 ERS/ATS guidelines.
T51 232823-232869 Sentence denotes An elevated EOS was defined as > 400 cells/mL.
T52 232870-232989 Sentence denotes Chi-square tests were utilized to compare the proportion of patients with elevated EOS between the two severity groups.
T53 232990-233137 Sentence denotes Multivariable logistic regression was used to assess the relationship between asthma severity and EOS, after controlling for potential confounders.
T54 233138-233146 Sentence denotes Results:
T55 233147-233292 Sentence denotes Among the 2,164 patients with asthma and EOS test results in the assessment period, 9% (n=184) had severe asthma according to ERS/ATS guidelines.
T56 233293-233445 Sentence denotes A significantly greater proportion of patients with severe asthma had elevated EOS, compared to patients with non-severe asthma (30% vs. 19%, p=0.0002).
T57 233446-233706 Sentence denotes In multivariable analysis, severe asthma was associated with an 83% increased odds of elevated EOS (Odds Ratio = 1.83, p=0.0005), compared to those with non-severe asthma after adjusting for differences in patient demographic characteristics and comorbidities.
T58 233707-233718 Sentence denotes Conclusion:
T59 233719-233794 Sentence denotes An elevated EOS is associated with nearly double the odds of severe asthma.
T60 233795-233806 Sentence denotes Background:
T61 233807-234007 Sentence denotes Prior to 2011, patients admitted with asthma to this tertiary care children's hospital received bedside education from a registered respiratory therapist (RRT) with variable intensity and consistency.
T62 234008-234156 Sentence denotes To address this problem, an Inpatient Asthma Class (IAC) was implemented three days a week in 2011, which was increased to five days a week in 2014.
T63 234157-234291 Sentence denotes Our specific aim was to evaluate the relationship between expanding parental access to an IAC and RRT time spent on bedside education.
T64 234292-234364 Sentence denotes Methods: ORI determination was obtained for non human subjects research.
T65 234365-234456 Sentence denotes The study population included children with asthma admitted from February 2011 to May 2014.
T66 234457-234644 Sentence denotes RRT's were asked to document in the electronic medical record (EMR) the amount of time spent on bedside education with each family as: 〈15 minutes, 15 minutes, 30 minutes, or 〉30 minutes.
T67 234645-234801 Sentence denotes Data was extracted from the EMR to investigate RRT time spent on bedside education when the IAC was offered three days a week, compared to five days a week.
T68 234802-234907 Sentence denotes Analyses were performed in Stata 11.2 and Excel (.xlsx) using chi-squares and differences in proportions.
T69 234908-234916 Sentence denotes Results:
T70 234917-235021 Sentence denotes About 100 RRT's provided bedside education for 2546 patients and their families during the study period.
T71 235022-235245 Sentence denotes When the IAC was offered three days a week, 21% (469/2197) of patients did not have documentation of time spent on education, similar to 26% (91/349) who did not have documentation when the IAC was offered five days a week.
T72 235246-235410 Sentence denotes When the IAC was offered three days a week, 46% (787/1728) of parents attended; whereas 61% (157/258) attended when the IAC was offered five days a week (p〈0.0001).
T73 235411-235602 Sentence denotes When the IAC was offered three days a week, 33% (261/787) of families required 〈15 minutes of bedside education, compared to 48% (75/157) when the IAC was offered five days a week (p=0.0005).
T74 235603-235804 Sentence denotes Overall, 8% (75/944) of families required ≥30 minutes of bedside education with parental attendance in the IAC, compared to 17% (172/1042) of patients without parental attendance in the IAC (p〈0.0001).
T75 235805-235816 Sentence denotes Conclusion:
T76 235817-235960 Sentence denotes Expanding the IAC from three days a week to five days a week increased parental attendance, resulting in a reduction in bedside education time.
T77 235961-236067 Sentence denotes This time-savings has allowed reallocation of RRT's to more urgent clinical needs throughout the hospital.
T78 236068-236200 Sentence denotes The increasing importance of cost-efficient, value-based care supports the future provision of educational programs such as the IAC.
T79 236201-236212 Sentence denotes Background:
T80 236213-236370 Sentence denotes The effect of budesonide/formoterol (BUD/FM), BUD, or FM on fixed airflow obstruction (FAO) and withdrawal due to predefined asthma events (PAEs) is unclear.
T81 236371-236379 Sentence denotes Methods:
T82 236380-236535 Sentence denotes This was a post-hoc analysis of a 12-week, randomized, placebo (PBO)-controlled study (NCT00652002) of patients aged ≥12 years with moderate-severe asthma.
T83 236536-236736 Sentence denotes After 2-week run-in with twice-daily BUD 160 mg via pressurized metered dose inhaler (pMDI), patients received twice-daily BUD/FM pMDI 320/9 mg, BUD pMDI 320 mg, FM 9 mg via drypowder inhaler, or PBO.
T84 236737-236798 Sentence denotes Worsening asthma event criteria were predefined (PAEs; Drugs.
T85 236799-236816 Sentence denotes 2006;66:2235-54).
T86 236817-237002 Sentence denotes Postbronchodilator FAO status was assessed at screening, weeks 2, 6, and 12 via forced expiratory volume (FEV 1 )/forced vital capacity (FVC) ratio for patients who completed the study.
T87 237003-237075 Sentence denotes This analysis excluded patient withdrawals for any reason before week 2.
T88 237076-237224 Sentence denotes Persistent FAO− (FEV 1 /FVC ≥ lower limit of normal [LLN] ) and persistent FAO+ (FEV 1 /FVC 〈 LLN) patients retained their FAO status at all visits.
T89 237225-237290 Sentence denotes FAO status of variable patients was not consistent on all visits.
T90 237291-237344 Sentence denotes FAO status and withdrawals due to PAEs were assessed.
T91 237345-237353 Sentence denotes Results:
T92 237354-237452 Sentence denotes In 258/389 patients (66%), FAO status was persistent throughout the study (135 FAO− and 123 FAO+).
T93 237453-237536 Sentence denotes The remaining 131 patients (34%) had variable FAO, changing status after screening.
T94 237537-237753 Sentence denotes The percentage of patients with persistent FAO− (44%, 37%, 28%, and 30%), persistent FAO+ (30%, 29%, 35%, 33%), and variable FAO (26%, 34%, 38%, and 37%) differed in the BUD/FM, BUD, FM, and PBO groups, respectively.
T95 237754-237838 Sentence denotes Overall, persistent FAO− patients had fewer PAEs than FAO+ or FAO variable patients.
T96 237839-238096 Sentence denotes The numbers of patients who withdrew due to PAEs in the persistent FAO− (n = 2, 4, 3, and 7), persistent FAO+ (n = 1, 4, 15, and 15), or FAO variable (n = 6, 8, 15, and 12) classifications also differed for the BUD/FM, BUD, FM, and PBO groups, respectively.
T97 238097-238109 Sentence denotes Conclusions:
T98 238110-238302 Sentence denotes Patients with moderate to severe asthma treated with BUD/FM are most likely to remain persistent FAO−, least likely to become FAO variable, and least likely to withdraw from the study if FAO+.
T99 238303-238406 Sentence denotes Patients who were persistent FAO− vs persistent FAO+ or FAO variable had fewer withdrawals due to PAEs.
T100 238407-238508 Sentence denotes Irrespective of FAO status, patients receiving BUD/FM experienced the fewest withdrawals due to PAEs.
T101 238509-238548 Sentence denotes Supported by AstraZeneca LP Background:
T102 238549-238747 Sentence denotes The effects of fixed airflow obstruction (FAO) on peak expiratory flow (PEF) and rescue medication (RM) use with budesonide/formoterol (BUD/FM) in patients with moderate to severe asthma is unclear.
T103 238748-238756 Sentence denotes Methods:
T104 238757-239094 Sentence denotes In a 12-week, double-blind, double-dummy, placebo (PBO)-controlled study (NCT00652002), moderate to severe asthma patients aged ≥12 years were randomized to twice-daily BUD/FM via pressurized metered dose inhaler (pMDI) 320/9 mg, BUD pMDI 320 mg, FM dry powder inhaler 9 mg, or PBO after a 2-week run-in with twice-daily BUD pMDI 160 mg.
T105 239095-239377 Sentence denotes In a post-hoc analysis, postbronchodilator FAO status was assessed via forced expiratory volume in 1 second/forced vital capacity (FEV 1 /FVC) ratio at screening and weeks 2, 6, and 12 for patients who completed the study, excluding patient withdrawals for any reason before week 2.
T106 239378-239444 Sentence denotes Persistent FAO− (FEV 1 /FVC ≥ lower limit of Introduction and Aim:
T107 239445-239563 Sentence denotes Asthma is chronic respiratory disease characterized with recurrent episodes where environmental factors are important.
T108 239564-239673 Sentence denotes An asthmatic patient whose clinical and radiological findings persisted after lovebird contact was presented.
T109 239674-239679 Sentence denotes Case:
T110 239680-239787 Sentence denotes A nine-years-old allergic asthmatic patient was admitted due to persistant cough and wheezing for 1 months.
T111 239788-239850 Sentence denotes Her complaints increased after living with a lovebird at home.
T112 239851-239936 Sentence denotes Her father, aunt, and cousins had asthma, tuberculosis (TB) contact wasn't mentioned.
T113 239937-240005 Sentence denotes Bilateral roncus and prolonged expiration were found in examination.
T114 240006-240124 Sentence denotes Inflammation in chest X-ray and mite-allergy in prick test (eosinophil 3.9%, ImmunglobulinE 92 mg/dl) were determined.
T115 240125-240253 Sentence denotes Asthma and allergic rhinitis were treated with inhaled steroid, longacting beta-2 agonist, leucotrien antagonist, nasal steroid.
T116 240254-240299 Sentence denotes Macrolid was given for atypical Mycobacteria.
T117 240300-240354 Sentence denotes Symptoms persisted after two weeks of these therapies.
T118 240355-240443 Sentence denotes Computarized tomography revealed atelectasis, infiltrations and frostedglass appearance.
T119 240444-240502 Sentence denotes Extrinsic allergic alveolitis due to lovebird was thought.
T120 240503-240651 Sentence denotes Bird feather specific IgE, Aspergillus antigen, Chlamydia and Mycoplasma serology, and sputum cultures were negative, Quantiferon test was positive.
T121 240652-240735 Sentence denotes Fiberoptic bronchoscopy was normal, ARB in BAL and gastric aspirates were negative.
T122 240736-240844 Sentence denotes Anti-TB therapy was begun due to resistant clinical and radiological symptoms and positive Quantiferon test.
T123 240845-240919 Sentence denotes During the follow-up, Mycobacterium complex was obtained from BAL culture.
T124 240920-241020 Sentence denotes Family screening was negative, after a while her adolescent neighbour had TB was told by the family.
T125 241021-241091 Sentence denotes Clinical and radiological complete improvement was seen after therapy.
T126 241092-241103 Sentence denotes Conclusion:
T127 241104-241246 Sentence denotes The diagnosis of TB disease should be excluded in the patients where clinical and radiological symptoms and findings are resistant to therapy.
T128 241247-241637 Sentence denotes Poorly controlled asthma is diagnosed when despite high doses of inhaled corticosteroids daily plus short and long acting β-2-agonists, and other therapies, symptoms interfere significantly with daily activities, frequent exacerbations need to be solved with the administration of corticosteroids, frequent emergency room visits or hospital admissions and the need for oral corticosteroids.
T129 241638-241659 Sentence denotes Material and Methods:
T130 241660-241733 Sentence denotes We performed a pilot, prospective, open study from June to December 2013.
T131 241734-241823 Sentence denotes We included 30 asthmatic patients who signed informed consent and were over 18 years old.
T132 241824-241976 Sentence denotes They were clasified according to GINA in partly controlled or uncontrolled and treated with inhaled steroids at high doses plus long acting β-2-agonist.
T133 241977-242131 Sentence denotes In the first visit we registered a spirometry with bronchodilator, asthma control test of 5 questions (ACT) and the quality of life of asthma (mini-AQLQ).
T134 242132-242262 Sentence denotes We then indicated ICS and LABA plus tiotropium 2.5 mcgs a day or roflumilast 500 mcgs a day or theophylline 200 mg every 12 hours.
T135 242263-242434 Sentence denotes ACT were evaluated and mini-AQLQ once a month via phone and on 2 visits at 3 and 6 months, spirometry with bronchodilator at 6 months and peak flow meter measured at home.
T136 242435-242543 Sentence denotes The main objective was to measure the ACT, the second objective was to assess mini-AQLQ, FEV1 and peak flow.
T137 242544-242552 Sentence denotes Results:
T138 242553-242575 Sentence denotes Mean age was 48 years.
T139 242576-242591 Sentence denotes 65% were women.
T140 242592-242600 Sentence denotes ACT <16:
T141 242601-242652 Sentence denotes 10 uncontrolled patients and between 16 and 19 ACT:
T142 242653-242686 Sentence denotes 20 patients partially controlled.
T143 242687-242728 Sentence denotes The mean duration of asthma was 11 years.
T144 242729-242811 Sentence denotes Fifteen patientys received tiotropium, 10 patients Roflumilast and 5 theophylline.
T145 242812-242866 Sentence denotes 3 patients discontinued treatment during the 6 months.
T146 242867-242922 Sentence denotes In all 3 groups improved ACT and mini-AQLQ (p <0.0001).
T147 242923-243224 Sentence denotes The total values of lung function with tiotropium improved FEV1 2.46 ± 0.89 L at baseline to 2.60 ± 0.92 L at 6 months (p <0.0001); with roflumilast 2.50 ± 0.90 L at baseline to 2.63 ± 0.96 L at 6 months (p <0.0001); and 2.43 ± 0.84 theophylline L at baseline to 2.53 ± 0.91 L at 6 months (p <0.0001).
T148 243225-243461 Sentence denotes PEF with tiotropium increased from 5.76 ± 2.38 to 6.22 ± 2.47 L / s (p <0.0001); with roflumilast increased from 4.65 ± 2.22 to 5.11 ± 2.32 L / s (p <0.0001); and theophylline increased from 5.13 ± 2.17 to 6.01 ± 2.31 L / s (p <0.0001).
T149 243462-243473 Sentence denotes Conclusion:
T150 243474-243540 Sentence denotes It is premature to ensure that these drugs are safe and effective.
T151 243541-243690 Sentence denotes We conclude that adding tiotropium, theophylline and roflumilast achieves a better disease control, increases FEV1, PEF and improves quality of life.
T152 243691-243798 Sentence denotes This a case report of a 59 year old female presenting with a persistent severe cough of 10 months duration.
T153 243799-243915 Sentence denotes She had multiple evaluations for asthma, GERD, and treament with multiple inhalers and antibiotics without response.
T154 243916-244061 Sentence denotes History was negative for occupational exposures to known agents causing hypersensitivity pneumonitis such as gases, paints (TDI) or other agents.
T155 244062-244158 Sentence denotes There was no history of emphysema in non smokers in her family and she is a lifelong non smoker.
T156 244159-244232 Sentence denotes When asked about pets previously she stated that she had no cats or dogs.
T157 244233-244424 Sentence denotes When questioned in detail about bird exposure such as pigeons close to her windows, etc,she stated that she had a Cockatiel that she purchased 12 months before her presentation to our office.
T158 244425-244536 Sentence denotes On further history she stated that she was the one who cleaned the cage of droppings and that no mask was worn.
T159 244537-244701 Sentence denotes On physical exam she had no dyspnea she did have cough ( with no inspiratory stridor), no clubbing, pO2=95, she had diffuse crackling breath sounds on auscultation.
T160 244702-244765 Sentence denotes Her Spirometry showed FVC=59% predicted and FEV1=69% predicted.
T161 244766-245061 Sentence denotes We ordered chest xray, arranged for a Spirometry with DLCO gas exchange, titers for Chlamydia pneumonia and Mycoplasma pneumonia,hypersensitivity pnuemonitis panel plus titers and precipitins for parrot/cockatiell ( if available) and alpha 1-antitrypsin was considered if the above was negative.
T162 245062-245144 Sentence denotes Unfortunately due to the expense after insurance the patient declined the testing.
T163 245145-245230 Sentence denotes She removed the Cockatiel from the home and within 3 months her cough totally abated.
T164 245231-245289 Sentence denotes She declined followup spirometry and was lost to followup.
T165 245290-245489 Sentence denotes In patients with chronic respiratory issues or chronic cough a thorough investigation of pets, including birds, and fish ( we had one patient with HSPneumonitis to silkworm powder used to feed fish).
T166 245490-245673 Sentence denotes In this case she refused to do diagnostic studies but our clinic suspicion was that her Cockateil and her exposure to the cage droppings were considered highly likely to be the cause.
T167 245674-245751 Sentence denotes There are studies showing Cockatiel to be an antigen stimulating precipitins.
T168 245752-245885 Sentence denotes McClusky, et.al. published on a case where a similar patient showed positive precipitating antibody to cockatiel dropping mix (CDM) .
T169 245886-245890 Sentence denotes A.B.
T170 245891-245909 Sentence denotes Vutikullird 1 , M.
T171 245910-245926 Sentence denotes Gillespie 2 , S.
T172 245927-245938 Sentence denotes Song 2 , J.
T173 245939-245956 Sentence denotes Steinfeld *2 , 1.
T174 245957-245972 Sentence denotes Cypress, CA; 2.
T175 245973-245984 Sentence denotes Frazer, PA.
T176 245985-245998 Sentence denotes Introduction:
T177 245999-246105 Sentence denotes Fluticasone (Fp), an inhaled corticosteroid, was approved in 1993 for the maintenance treatment of asthma.
T178 246106-246255 Sentence denotes It has well-established safety and efficacy profiles and is available as a dry powder inhaler formulation and a hydrofluoroalkane inhalation aerosol.
T179 246256-246426 Sentence denotes In the present study, Fp is delivered via a novel, inhalation-driven multidose dry powder inhaler (MDPI) that eliminates the need to coordinate actuation with inhalation.
T180 246427-246435 Sentence denotes Methods:
T181 246436-246594 Sentence denotes This was a singlecenter, open-label, randomized, 3-period crossover, single-dose study in healthy Japanese and Caucasian subjects aged 20-45 years, inclusive.
T182 246595-246870 Sentence denotes Subjects (N=30) were randomized to 1 of 6 treatment sequences including combinations of 4 inhalations of Fp MDPI 100 mg (total dose of 400 mg), Fp MDPI 200 mg (total dose of 800 mg), and Fp-DISKUS ® (GlaxoSmithKline, Research Triangle Park, NC) 100 mg (total dose of 400 mg).
T183 246871-247133 Sentence denotes The primary objective was to assess pharmacokinetics (PK) (maximum plasma concentration and time, terminal rate constant and half-life for plasma elimination, area under concentration-vs-time curve) for each treatment; safety and tolerability also were assessed.
T184 247134-247142 Sentence denotes Results:
T185 247143-247247 Sentence denotes Over the range of all Fp doses evaluated, PK parameters were similar in Japanese and Caucasian subjects.
T186 247248-247491 Sentence denotes Differences were observed between the systemic exposures produced by each of the 3 doses, with the Fp plasma concentrationvs-time curves being highest for the Fp MDPI 800 mg total dose and lowest for the Fp DISKUS 400 mg total dose ( Figure) .
T187 247492-247678 Sentence denotes The most frequently occurring adverse event was presyncope, which occurred in 2 Caucasian subjects, 1 treated with Fp MDPI 400 mg total dose and 1 treated with Fp MDPI 800 mg total dose.
T188 247679-247826 Sentence denotes There were no clinical laboratory, electrocardiographic, vital signs, or physical examination findings that were considered clinically significant.
T189 247827-247839 Sentence denotes Conclusions:
T190 247840-248113 Sentence denotes The PK profiles for Fp MDPI 400 mg, Fp MDPI 800 mg, and Fp DISKUS 400 mg were similar in Japanese and Caucasian subjects; however, there were differences in the systemic exposures dependent on total dose, with Fp MDPI 800 mg being highest and Fp DISKUS 400 mg being lowest.
T191 248114-248214 Sentence denotes The safety and tolerability profiles of all treatments were consistent with the known profile of Fp.
T192 248215-248277 Sentence denotes This study was sponsored by Teva Pharmaceuticals Introduction:
T193 248278-248517 Sentence denotes A novel, inhalation-driven, multidose dry powder inhaler (MDPI) has been developed that eliminates the need to coordinate actuation with inhalation and may reduce administration errors in comparison with conventional metered-dose inhalers.
T194 248518-248648 Sentence denotes Studies show that albuterol (AB) is effective and well tolerated for the prevention of exercise-induced bronchoconstriction (EIB).
T195 248649-248657 Sentence denotes Methods:
T196 248658-248907 Sentence denotes This single-dose, double-blind, 2-way crossover study (NCT01791972) randomized adolescents and adults with EIB (≥20% fall from pre-exercise challenge FEV 1 ) to treatment sequences AB MDPI 180 mg/placebo (PBO) MDPI (n=19) or reverse sequence (n=19).
T197 248908-248978 Sentence denotes IEC/IRB approval and informed consent from all subjects were obtained.
T198 248979-249139 Sentence denotes FEV 1 was measured at 30 minutes post-dose, 5 minutes before treadmill exercise challenge (baseline) and 5, 10, 15, 30, and 60 minutes after exercise challenge.
T199 249140-249262 Sentence denotes The primary efficacy endpoint was maximum percentage fall from baseline in FEV 1 up to 60 minutes post-exercise challenge.
T200 249263-249581 Sentence denotes Secondary efficacy endpoints included percentage of patients whose maximum percentage fall from baseline FEV 1 post-exercise challenge was <10% (protected by treatment) and time to recovery (from exercise challenge completion to the first measured post-challenge FEV 1 within 10% of the pre-challenge baseline FEV 1 ).
T201 249582-249590 Sentence denotes Results:
T202 249591-249674 Sentence denotes Age, gender, and baseline FEV 1 were comparable between subjects in both sequences.
T203 249675-249858 Sentence denotes Mean maximum percentage fall in FEV 1 within 60 minutes post-exercise challenge for AB MDPI was 6.21±1.44% (95% CI, 3.28%-9.14%) vs PBO, 22.38±1.44% (95% CI, 19.44%-25.31%; p<0.0001).
T204 249859-249975 Sentence denotes Thirty-two (84.2%) AB MDPI subjects had a <10% maximum FEV 1 fall post-exercise challenge vs 6 (15.8%) PBO subjects.
T205 249976-250137 Sentence denotes Protection with AB MDPI was significant (p<0.001) vs PBO within 5 minutes and maintained through 30 minutes; recovery was complete for both groups at 60 minutes.
T206 250138-250224 Sentence denotes Median time to recovery for AB MDPI was 5.07 minutes vs PBO, 30.07 minutes (p<0.0001).
T207 250225-250328 Sentence denotes Adverse events (AEs) included severe migraine (n=1, PBO) and moderate sinus bradycardia (n=1, AB MDPI).
T208 250329-250393 Sentence denotes No serious AEs, discontinuations due to AEs, or deaths occurred.
T209 250394-250515 Sentence denotes Conclusions: AB MDPI provided clinically significant protection from EIB in adolescents and adults with a history of EIB.
T210 250516-250572 Sentence denotes There were no safety issues with short-term AB MDPI use.
T211 250573-250622 Sentence denotes This study was sponsored by Teva Pharmaceuticals.
T212 250623-250636 Sentence denotes Introduction:
T213 250637-250814 Sentence denotes While recognized as the most effective maintenance treatment for mild-to-moderate persistent asthma, inhaled steroids have the potential to cause growth suppression in children.
T214 250815-251069 Sentence denotes Several studies performed with inhaled corticosteroids demonstrated an impact on growth velocity (ranging from -0.3 cm/yr to -1.8 cm/yr) with recent studies suggesting that this effect is not reversible once treatment with the inhaled steroid is stopped.
T215 251070-251343 Sentence denotes Two 1-year trials were performed with flunisolide HFA (Aerospan), a small-particle inhaled corticosteroid with a built-in spacer for the treatment of asthma in asthmatics 6 years and older, to evaluate growth velocity changes in pre-pubescent children 4 to 11 years of age.
T216 251344-251352 Sentence denotes Methods:
T217 251353-251581 Sentence denotes The first study was an open-label, randomized, 1-year safety study of flunisolide HFA, inhaled beclomethasone (BDP) CFC, and inhaled cromolyn (as a negative control) in children 4 to 11 years of age with mild-to-moderate asthma.
T218 251582-251741 Sentence denotes The second study was a double-blind randomized 1-year safety study of flunisolide HFA and placebo in children 4 to 9 years of age with mild-to-moderate asthma.
T219 251742-251879 Sentence denotes Each study was analyzed similarly for growth velocity (via stadiometry assessments) and change in height over 1 year (measured as cm/yr).
T220 251880-252037 Sentence denotes The dose of flunisolide HFA in both studies was 160 mcg (2 puffs) twice daily, which represents the maximum FDAapproved dose of flunisolide HFA for children.
T221 252038-252046 Sentence denotes Results:
T222 252047-252146 Sentence denotes In the open-label study, 206 patients age 6-11 years, were analyzed for growth and growth velocity.
T223 252147-252269 Sentence denotes Mean changes from baseline height were 6.2 cm for the flunisolide HFA and cromolyn groups versus 5.1 cm for the BDP group.
T224 252270-252383 Sentence denotes Mean growth velocity was 6.2 cm/yr for the flunisolide HFA group versus 5.3 cm/yr (BDP) and 6.9 cm/yr (cromolyn).
T225 252384-252582 Sentence denotes In the double-blind study, of 218 evaluable patients age 4-10 years, the mean growth velocity was 6.01 cm/yr for flunisolide HFA versus 6.19 cm/yr for placebo, a non-significant difference (P=.425).
T226 252583-252594 Sentence denotes Conclusion:
T227 252595-252830 Sentence denotes The results from two trials demonstrated that flunisolide HFA did not result in significant growth suppression in pre-pubescent pediatric asthma patients 4 to 11 years of age when compared to placebo or the negative control (cromolyn).
T228 252831-253018 Sentence denotes Improving asthma control has focused on potentially modifiable clinical and behavioural characteristics including correct inhaler technique, allergic rhinitis (AR), adherence and smoking.
T229 253019-253121 Sentence denotes This research aims to establish these relationships with asthma control, outcomes and quality of life.
T230 253122-253630 Sentence denotes A US crosssectional survey of adult asthma patients seeking routine care, informed Partial Least Squares Path Modelling to quantify inner model relationships between latent variables of patient-reported satisfaction of drug delivery, device functionality, device feedback, concomitant AR, adherence (Morisky Medication Adherence Scale), smoking history, patient-reported outcomes (Asthma Control Test, Jenkins Sleep Questionnaire, EuroQol-5D-3L) and physician-reported asthma exacerbations in last 12 months.
T231 253631-253696 Sentence denotes Patients not receiving inhaled maintenance therapy were excluded.
T232 253697-253724 Sentence denotes 243 patients were included.
T233 253725-253810 Sentence denotes All actual variables were positively correlated with the appropriate latent variable.
T234 253811-254127 Sentence denotes Cronbach's Alpha, a measure of consistency for a group of variables, measured at least 0.659 for latent variables indicating that the hypothetical variables of inhaler satisfaction, smoking history, concomitant AR, adherence and outcomes were well reflected by the composition of the actual variables in the dataset.
T235 254128-254197 Sentence denotes Cross-load-ings were also supportive of the hypothesized outer model.
T236 254198-254346 Sentence denotes Better patient outcomes were significantly associated with patient satisfaction regarding drug delivery attributes related to the inhaler (p=0.002).
T237 254347-254492 Sentence denotes A negative smoking history coupled with absence of concomitant AR were also significantly associated with better patient outcomes (both p<0.001).
T238 254493-254611 Sentence denotes Improved adherence did result in enhanced outcomes, but this relationship was not statistically significant (p=0.060).
T239 254612-254811 Sentence denotes The R 2 value for outcomes was 14.6% and pseudo goodness of fit, measuring overall prediction performance of the path model, was 20.56% indicating a fifth of the variance was explained by this model.
T240 254812-254966 Sentence denotes Improving patient satisfaction with inhaler drug delivery parameters represents one modifiable aspect of asthma management contributing to better control.
T241 254967-255173 Sentence denotes Interventions based on improved recognition of impact of severe AR, allergy phase and smoking on patient's asthma control are also likely to have a positive impact on asthma patient health-related outcomes.
T242 255174-255178 Sentence denotes A.M.
T243 255179-255213 Sentence denotes Koatz * , Buenos Aires, Argentina.
T244 255214-255227 Sentence denotes Introduction:
T245 255228-255336 Sentence denotes Recurrent acute infections of the upper and lower airways are frequent and often require multiple therapies.
T246 255337-255429 Sentence denotes This is especially true for pathologies such as allergic rhinitis and/or asthma and/or COPD.
T247 255430-255591 Sentence denotes The etiology of recurrent infections is generally viral, but the additional complication of bacterial infection worsens the symptoms of the underlying pathology.
T248 255592-255683 Sentence denotes For these reasons, preventive measures should be considered when treating acute infections.
T249 255684-255769 Sentence denotes Methods: a randomized, double-blind, placebo-controlled clinical trial was conducted.
T250 255770-255869 Sentence denotes Patients aged 16-65 years who had not received a lysate vaccine in the previous year were included.
T251 255870-256051 Sentence denotes Eighty-four (84) patients were randomly assigned to 2 groups of 42 subjects each one :-Group A (active) -receive either OM-85 bacterial lysate vaccine capsule or equivalent placebo.
T252 256052-256234 Sentence denotes Capsules were administered daily for 10 consecutive days per month for a duration of 3 consecutive months..Group C (healthy controls) serologic studies were performed in 10 subjects.
T253 256235-256381 Sentence denotes Serum and secretory IgA levels were determined before and after treatment along with symptom score and the number of infections and exacerbations.
T254 256382-256448 Sentence denotes Written informed consent was obtained from all study participants.
T255 256449-256457 Sentence denotes Results:
T256 256458-256654 Sentence denotes Eighty-four (84) patients were enrolled and 42 patients that received OM-85 had a decrease in the number of recurrent infections from 82% to 45.5% (p< 0.05) compared to 78.9% in the placebo group.
T257 256655-257045 Sentence denotes Similarly, the exacerbations of the underlying pathology decreased from 65.7% to 34.9% with OM-85 versus 62.3% in the placebo group (p<0.05) There was also a substantial reduction of the symptoms of the underlying pathology. (p<0.01) A significant increase in serum and secretory IgA levels was observed only in the OM-85 group (both p<0.001) during which parallels the 3 cycles of therapy.
T258 257046-257057 Sentence denotes Conclusion:
T259 257058-257215 Sentence denotes This study demonstrated a clinical benefit of OM-85 for reducing reinfections and exacerbations in patients with allergic rhinitis and/or asthma and/or COPD.
T260 257216-257416 Sentence denotes The use of OM-85 lead to an increase in serum and secretory IgA levels which provides a new perspectives regarding the immunological mechanism of action, namely immunostimulation and immunodesviation.
T261 257417-257500 Sentence denotes Further investigation is warranted to better understand these encouraging outcomes.
T262 257501-257514 Sentence denotes Introduction:
T263 257515-257646 Sentence denotes It is important to identify clinical features associated with asthma for the development of new interventions to be most effective.
T264 257647-257828 Sentence denotes Our clinical observation suggested the hypothesis that the proportion of overweight/obesity is significantly higher in difficult to control (DTC) than in well-controlled asthmatics.
T265 257829-257837 Sentence denotes Methods:
T266 257838-258040 Sentence denotes This was a retrospective chart review of 100 patients, aged 5 to 18 years, who were seen in a CHKD or one of the CSG Allergy outpatient clinics between 5/1/2013 and 3/31/2014, and diagnosed with asthma.
T267 258041-258191 Sentence denotes Cases (n = 50) were identified as severe persistent DTC asthmatics based on their required high dose of ≥1000 mg/day of inhaled corticosteroids (ICS).
T268 258192-258334 Sentence denotes The control group (n = 50) included subjects with well-controlled mild or moderate persistent asthma defined by a dose of ≤ 500 mg/day of ICS.
T269 258335-258482 Sentence denotes A subject's weight status was classified by the BMI percentile for age as normal weight (BMI < 85%), overweight (BMI 85-94%), or obese (BMI ≥ 95%).
T270 258483-258596 Sentence denotes The chisquare test was used to assess the relationship between overweight / obesity status and DTC asthma status.
T271 258597-258712 Sentence denotes IRB and HRC approval and waivers of consent and authorization to access protected health information were obtained.
T272 258713-258721 Sentence denotes Results:
T273 258722-258869 Sentence denotes The BMI percentile in the DTC asthma group was significantly higher than in the well-controlled group (75.74 ± 25.63 vs. 51.69 ± 24.43, p < 0.001).
T274 258870-259109 Sentence denotes 36 % of the DTC asthmatics were obese (vs. 0% of the well-controlled asthmatics, p < 0.001), 14% overweight (vs. 10% of the well-controlled asthmatics, p = 0.99) and 50% normal weight (vs. 90% of the well-controlled asthmatics, p < 0.001).
T275 259110-259212 Sentence denotes Mean age in the DTC asthmatics was 13.2 ± 3.3 vs. 10.0 ± 3.2 in the well-controlled group (p < 0.001).
T276 259213-259325 Sentence denotes Notably, a significant difference was observed in the race between the DTC and the well-controlled asthma group.
T277 259326-259505 Sentence denotes 74% of the DTC asthmatics were African American (AA) (vs. 30% AA in the well-controlled asthma group, p < 0.001), 14% were White (vs. 66% in the well-controlled group, p < 0.001).
T278 259506-259611 Sentence denotes There was no significant difference in gender between the DTC and well-controlled asthmatics. (Table 1) .
T279 259612-259623 Sentence denotes Conclusion:
T280 259624-259747 Sentence denotes The results of this study suggest that there is a significant association between obesity and severe persistent DTC asthma.
T281 259748-259886 Sentence denotes This finding underlines the need for new treatment approaches for DTC asthmatics involving a simultaneous treatment of asthma and obesity.
T282 259887-259900 Sentence denotes Introduction:
T283 259901-259998 Sentence denotes High dose inhaled corticosteroids have been increasingly recognized to cause adrenal suppression.
T284 259999-260088 Sentence denotes Patients reported in the literature typically have presented in the first decade of life.
T285 260089-260186 Sentence denotes We report on the first case of mometasone furoate (MF) induced adrenal suppression on MF therapy.
T286 260187-260204 Sentence denotes Case Description:
T287 260205-260384 Sentence denotes A sixteen-year-old female with asthma and allergic rhinitis since the age of five was initially maintained on a regimen of FP 500mcg per day and MF nasal spray 50-100 mcg per day.
T288 260385-260511 Sentence denotes As she had uncontrolled symptoms she was changed to MF/formoterol fumarate 800/ 20 mcg per day in addition to her nasal spray.
T289 260512-260607 Sentence denotes She was more stable in follow-up but presented with increasing fatigue, weight loss and nausea.
T290 260608-260633 Sentence denotes She also reported striae.
T291 260634-260688 Sentence denotes Extensive initial hospital investigations were normal.
T292 260689-260781 Sentence denotes A random glucose was 5.0 (3.4-7.0) and an AM cortisol was reported at < 50 nmol/L (170-540).
T293 260782-260890 Sentence denotes She was started on hydrocortisone therapy and changed to ciclesonide, as well as montelukast and formoterol.
T294 260891-261068 Sentence denotes Her energy and weight have improved after initiation of replacement hydrocortisone therapy with plans for an ACTH stimulation test after discontinuation of oral corticosteroids.
T295 261069-261080 Sentence denotes Discussion:
T296 261081-261251 Sentence denotes While inhaled FP has been most commonly implicated in adrenal suppression, to our knowledge this is the first reported case of symptomatic MF-induced adrenal suppression.
T297 261252-261504 Sentence denotes Despite having high protein binding, we hypothesize that the pharmacokinetics of MF with a high receptor affinity, long half-life and decreased hepatic clearance when used at a high dose result in similar adrenal suppression as has been reported in FP.
T298 261505-261630 Sentence denotes Physicians need to remain aware of the possibility of adrenal suppression in any patient on high dose inhaled corticosteroid.
T299 261631-261633 Sentence denotes L.
T300 261634-261647 Sentence denotes Greos *1 , J.
T301 261648-261661 Sentence denotes Corren 2 , N.
T302 261662-261673 Sentence denotes Ruiz 3 , J.
T303 261674-261692 Sentence denotes Karafilidis 3 , 1.
T304 261693-261711 Sentence denotes Centennial, CO; 2.
T305 261712-261731 Sentence denotes Los Angeles, CA; 3.
T306 261732-261745 Sentence denotes Somerset, NJ.
T307 261746-261759 Sentence denotes Introduction:
T308 261760-261868 Sentence denotes Inhaled steroids (ICSs) are the most effective maintenance treatment for mild-to-moderate persistent asthma.
T309 261869-262054 Sentence denotes Flunisolide HFA, a small particle ICS with a built-in spacer, is approved for treatment of asthma in patients 12 years and older at doses of 160 mcg (2 puffs) and 320 mcg (4 puffs) BID.
T310 262055-262143 Sentence denotes Efficacy and safety comparisons to each patient's prior ICS offer important perspective.
T311 262144-262152 Sentence denotes Methods:
T312 262153-262489 Sentence denotes This was a multi-center, double-blind, placebo-controlled trial consisting of a 2-week run-in with flunisolide CFC (500 mcg BID), followed by double-blind treatment with placebo, flunisolide HFA (80, 160 and 320 mcg BID), or flunisolide CFC (250, 500 and 1000 mcg BID) for 12 weeks in patients 12 and older with mild-to-moderate asthma.
T313 262490-262565 Sentence denotes The primary efficacy endpoint was change from baseline in % predicted FEV1.
T314 262566-262799 Sentence denotes A retrospective analysis of the primary efficacy endpoint by baseline ICS (all patients were previously treated with an ICS) was performed to evaluate potential differences in efficacy in patients previously treated with another ICS.
T315 262800-262986 Sentence denotes The most commonly used previous ICSs were: fluticasone (FP-195 patients), beclomethasone (BDP-190 patients), triamcinolone acetonide (TAA-174 patients) and flunisolide (FLN-98 patients).
T316 262987-263082 Sentence denotes Patients were required to be on a stable dose of ICS for at least 30 days prior to trial entry.
T317 263083-263091 Sentence denotes Results:
T318 263092-263154 Sentence denotes Of the 669 randomized patients, 548 (82%) completed the trial.
T319 263155-263213 Sentence denotes Compliance was >90% at all visits in each treatment group.
T320 263214-263311 Sentence denotes Patients experienced about a 12% improvement in FEV1 after the 2week run-in with flunisolide CFC.
T321 263312-263614 Sentence denotes After 12 weeks of treatment, patients treated with flunisolide HFA 160 mcg BID maintained the 12% improvement achieved during run-in, patients treated with 320 mcg BID had a 0.4% improvement over run-in, and patients treated with placebo had a 4.5% decrease (p<0.007; active HFA treatments vs placebo).
T322 263615-263836 Sentence denotes LS mean changes from baseline in % predicted FEV1 did not significantly differ based on previous ICS, with the most significant improvements seen with the 160 and 320 mg BID doses of flunisolide HFA compared with placebo.
T323 263837-263848 Sentence denotes Conclusion:
T324 263849-264106 Sentence denotes The results from this retrospective evaluation by baseline ICS suggest that the efficacy with flunisolide HFA 160 and 320 mcg BID is at least equivalent to other ICSs, as demonstrated by similar % improvements in FEV1 for each of the baseline ICS subgroups.
T325 264107-264117 Sentence denotes Rationale:
T326 264118-264193 Sentence denotes Foreign body aspiration (FBA) occurs more commonly in children than adults.
T327 264194-264349 Sentence denotes Diagnosing FBA in adults with allergic asthma and allergies is challenging because patients may not remember choking and there may be confounding symptoms.
T328 264350-264355 Sentence denotes Case:
T329 264356-264475 Sentence denotes A 41 year old female with history of allergic asthma, rhinitis, and nasal polyps was seen for evaluation in March 2014.
T330 264476-264568 Sentence denotes She complained of cough and intermittent wheezing that had worsened since Thanksgiving 2013.
T331 264569-264747 Sentence denotes Her symptoms began with bronchitis that developed into chronic wheeze and productive cough; she had minimal improvement after treatment with antibiotics and oral corticosteroids.
T332 264748-264799 Sentence denotes Chest x-rays were clear in January and March, 2014.
T333 264800-264955 Sentence denotes She was started on inhaled fluticasone-salmeterol by a pulmonologist and referred for allergy evaluation after minimal improvement of respiratory symptoms.
T334 264956-265060 Sentence denotes She had a course of allergen immunotherapy in the early '90s and surgery to remove nasal polyps in 1992.
T335 265061-265070 Sentence denotes Findings:
T336 265071-265151 Sentence denotes On initial visit, she had end-expiratory wheezing auscultated in the right lung.
T337 265152-265187 Sentence denotes FEV1 was 100%, and FeNO was 30 ppb.
T338 265188-265252 Sentence denotes Allergy skin tests were positive to multiple inhalant allergens.
T339 265253-265354 Sentence denotes In-office nasopharyngoscopy showed purulent sinus discharge and scarring from previous nasal surgery.
T340 265355-265509 Sentence denotes She was treated with cefdinir and started on inhaled budesonide, montelukast, mometasone intranasal sprays, sinus irrigations, and allergen immunotherapy.
T341 265510-265651 Sentence denotes Her cough improved somewhat after cefdinir, but she reported a persistent nighttime cough and had end-expiratory wheeze on exam on follow-up.
T342 265652-265754 Sentence denotes In May 2014, CT chest showed calcified granuloma in the intra-inferior aspect of the right lower lobe.
T343 265755-265882 Sentence denotes Subsequent bronchoscopy identified a foreign body (suspicious for peanut) that was removed from the right bronchus intermedius.
T344 265883-265938 Sentence denotes Pathology reported a foreign degraded organic material.
T345 265939-266022 Sentence denotes The patient subsequently recalled an episode of choking on peanuts in January 2014.
T346 266023-266034 Sentence denotes Conclusion:
T347 266035-266178 Sentence denotes This is a report of an adult with previously diagnosed allergic asthma, rhinitis, and nasal abnormalities that confounded the diagnosis of FBA.
T348 266179-266348 Sentence denotes Although initial history and diagnostic evidence did not suggest FBA, FBA should be considered in adult patients with persistent wheezing unresponsive to asthma therapy.
T349 266349-266428 Sentence denotes CT imaging and bronchoscopy are sometimes necessary for a conclusive diagnosis.
T350 266429-266431 Sentence denotes M.
T351 266432-266444 Sentence denotes Chen *1 , E.
T352 266445-266456 Sentence denotes Rael 2 , 1.
T353 266457-266478 Sentence denotes State College, PA; 2.
T354 266479-266491 Sentence denotes Hershey, PA.
T355 266492-266502 Sentence denotes Rationale:
T356 266503-266657 Sentence denotes Eye symptoms are commonly seen in patients with allergic asthma and the combination can have significant effects on quality of life and work productivity.
T357 266658-266782 Sentence denotes Common allergic eye conditions include allergic conjunctivitis, vernal keratoconjunctivitis and atopic keratoconjunctivitis.
T358 266783-266966 Sentence denotes Here we report amongst a cohort of asthmatics at a university based allergy, asthma, and immunology specialty clinic, correlations between subjective eye symptoms and asthma symptoms.
T359 266967-266975 Sentence denotes Methods:
T360 266976-267340 Sentence denotes After informed consent and IRB approval, 370 asthmatics, recruited to the study between 2011 and 2014, underwent clinical assessment including review of the Eye Symptom Score as part of the mini RQLQ score, the total mini RQLQ score, and ACQ quality of life asthma symptom score to determine whether there is a correlation between eye symptoms and asthma severity.
T361 267341-267612 Sentence denotes The mean assessment divided the cohort by ACQ scores into group 1, low risk asthmatics for future asthma events in the next 2 weeks as demonstrated by ACQ < 1.50 and group 2, high risk asthmatics for future asthma events in the next 2 weeks as demonstrated by ACQ > 1.50.
T362 267613-267621 Sentence denotes Results:
T363 267622-267714 Sentence denotes Group 1 asthmatics represented 243 subjects and group 2 asthmatics represented 127 subjects.
T364 267715-267845 Sentence denotes Subjects in group 1 had a mean mini RQLQ eye symptom score of 4.4 in comparison to a higher score of 7.1 amongst group 2 subjects.
T365 267846-267947 Sentence denotes The average total mini RQLQ score in group 1 subjects was 25.9, versus 41.9 amongst group 2 subjects.
T366 267948-267960 Sentence denotes Conclusions:
T367 267961-268157 Sentence denotes This study shows that patients who have higher immediate risk for asthma flares concurrently have higher ocular and total upper airway symptoms scores further validating the one airway hypothesis.
T368 268158-268299 Sentence denotes Further studies are necessary and future research could assess whether there are different ocular phenotypes associated with asthma severity.
T369 268300-268302 Sentence denotes E.
T370 268303-268315 Sentence denotes Egea *1 , G.
T371 268316-268339 Sentence denotes Garavito de Egea 1 , L.
T372 268340-268351 Sentence denotes Fang 1 , G.
T373 268352-268363 Sentence denotes Egea 1 , L.
T374 268364-268377 Sentence denotes Visbal 1 , N.
T375 268378-268393 Sentence denotes Lecompte 1 , J.
T376 268394-268410 Sentence denotes Escamilla 2 , 1.
T377 268411-268437 Sentence denotes Barranquilla, Colombia; 2.
T378 268438-268458 Sentence denotes Cartagena, Colombia.
T379 268459-268470 Sentence denotes Background:
T380 268471-268581 Sentence denotes Humans have the ability to synthesize vitamin D during the action of ultraviolet (UV) radiation upon the skin.
T381 268582-268649 Sentence denotes The term "vitamin D insufficiency" has been associated with asthma.
T382 268650-268770 Sentence denotes However, little is known about the link between total and serum specific IgE levels and vitamin D in asthmatic children.
T383 268771-268934 Sentence denotes Today dust mite allergens and cockroach are the most important sources of clinically relevant allergens sensitizing patients with asthma in the tropics, Objective:
T384 268935-269160 Sentence denotes To investigate the relevance of Vit D levels on the total Ig E and allergen-specific sensitization(Cr and Mite) in asthmatic children living a poorer communities within a Barranquilla, a city on the Colombian Caribbean Coast.
T385 269161-269168 Sentence denotes Method:
T386 269169-269320 Sentence denotes A case-control study with 1000 individuals, which included 500 asthmatic children and 500 healthy children from the Colombian Caribbean coast was made.
T387 269321-269370 Sentence denotes Serum 25-hydroxy vitamin D was measured by a EIA.
T388 269371-269553 Sentence denotes Total IgE, specific IgE to Dermatophagoides farinae-D f-and Blomia tropicalis-B t.and Periplaneta americana -Cr-were determinated by ELISA (ImmunoCAP ® Phadia AB, Sweden technology).
T389 269554-269702 Sentence denotes The independent effects of these variables were estimated from obtaining odd ratios (OR) trough logistic regression models adjusted for sex and age.
T390 269703-269711 Sentence denotes Results:
T391 269712-269778 Sentence denotes Elevated total IgE (> 100UI/mL) were observed in both study group.
T392 269779-269876 Sentence denotes Showing as a risk factor for susceptibility to childhood asthma (OR = 1.63, 95% CI = 1.08 -2.46).
T393 269877-269996 Sentence denotes Serum levels of vitamin D were found normal or insufficient in both groups (52.21 ng / mL and 52.2 ng / mL, P = 0.907).
T394 269997-270164 Sentence denotes Also, insufficient vitamin D was associated with elevated levels of Total Ig E (15% vs 8.7%, P = 0.037); showing a negative correlation (Spearman r = -0.28, p = 0.00).
T395 270165-270325 Sentence denotes However, our data is not clear regarding what effect it may have the insufficient levels of vitamin D on the IgE immune response (OR = 1.84, 95% CI = 0.9 -3.6).
T396 270326-270465 Sentence denotes On the other hand, elevated Total IgE levels were associated with specific IgE sensitization to B. tropicalis, D. farinae and P. americana.
T397 270466-270477 Sentence denotes Conclusion:
T398 270478-270786 Sentence denotes Despite the growing evidence of the role of vitamin D in incident asthma and asthma exacerbation, studies are not all consistent Taking together our results are showing that insufficient serum levels of vitamin D is not a risk factor for developing asthma in poores comunities children of the Caribbean area.
T399 270787-270800 Sentence denotes Introduction:
T400 270801-270942 Sentence denotes A previous study concluded that blood eosinophil counts in patients with asthma could be used as an indicator of prospective asthma outcomes.
T401 270943-271088 Sentence denotes We aimed to identify risk factors associated with elevated blood eosinophil counts in patients with asthma from UK primary care clinical records.
T402 271089-271097 Sentence denotes Methods:
T403 271098-271226 Sentence denotes Retrospective, observational study using the Clinical Practice Research Datalink and the Optimum Patient Care Research Database.
T404 271227-271311 Sentence denotes Patients were aged 12-80 years with asthma and no other chronic respiratory disease.
T405 271312-271406 Sentence denotes Study period was 1 year before (baseline period) date of last recorded blood eosinophil count.
T406 271407-271528 Sentence denotes Comparison at date of last recorded blood eosinophil count: ≤400 eosinophils/ml (low) vs. >400 eosinophils/ml (elevated).
T407 271529-271627 Sentence denotes Baseline characteristics: biomarkers, demographics, comorbidities and markers of disease severity.
T408 271628-271751 Sentence denotes Univariable logistic regression was used to identify baseline characteristics associated with >400 eosinophils/ml (p≤0.05).
T409 271752-271864 Sentence denotes These characteristics were then included in a multivariable model and reduced to a list of noncollinear factors.
T410 271865-271873 Sentence denotes Results:
T411 271874-271923 Sentence denotes Of 130,248 patients, 16% had >400 eosinophils/ml.
T412 271924-272012 Sentence denotes Thirtynine percent of the patients with ≤400 eosinophils/ml and 31% with >400 were male.
T413 272013-272123 Sentence denotes Median age (Interquartile range) was 45 (31-61) and 50 (37-63) for ≤400 and >400 eosinophils/ml, respectively.
T414 272124-272220 Sentence denotes Table shows baseline risk factors associated with >400 eosinophils/ml (Reference category=1.00).
T415 272221-272232 Sentence denotes Conclusion:
T416 272233-272361 Sentence denotes In this study, several clinical and demographic features were predictive of elevated blood eosinophil counts in asthma patients.
T417 272362-272529 Sentence denotes These data could be used to stratify patients who could benefit from more intensive and/or targeted asthma therapies, potentially improving control and reducing costs.
T418 272530-272619 Sentence denotes Baseline risk factors associated with >400 blood eosinophils/ml (Reference category=1.00)
T419 272620-272622 Sentence denotes A.
T420 272623-272641 Sentence denotes DeWaters *1 , M.P.
T421 272642-272654 Sentence denotes Henao 2 , E.
T422 272655-272666 Sentence denotes Rael 2 , 1.
T423 272667-272686 Sentence denotes Hummelstown, PA; 2.
T424 272687-272699 Sentence denotes Hershey, PA.
T1 272700-272710 Sentence denotes Rationale:
T2 272711-272828 Sentence denotes Gastroesophageal reflux disease and asthma are both among the most common diseases treated in the outpatient setting.
T3 272829-273007 Sentence denotes Studies suggest that asthma and gastroesophageal reflux disease are comorbid conditions and control of gastroesophageal reflux disease may lead to improvement of asthma symptoms.
T4 273008-273149 Sentence denotes Therefore, it was hypothesized that the presence of gastroesophageal reflux disease would be associated with less control of asthma symptoms.
T5 273150-273322 Sentence denotes Here we report the correlation between the presence of gastroesophageal reflux disease and the severity of asthma symptoms, as measured by the Asthma Control Questionnaire.
T6 273323-273331 Sentence denotes Methods:
T7 273332-273558 Sentence denotes After informed consent and IRB approval, 389 asthmatics recruited to the study between 2011 and 2014 underwent clinical assessment including review of the ACQ quality of life, and assessment of gastroesophageal reflux disease.
T8 273559-273673 Sentence denotes The independent sample t-test divided the cohort by ACQ scores into group 1 (ACQ < 1.50) and group 2 (ACQ > 1.50).
T9 273674-273682 Sentence denotes Results:
T10 273683-273824 Sentence denotes 63 percent of 257 asthmatics in group 1 reported having a diagnosis of gastroesophageal reflux disease versus 65 percent of group 2 subjects.
T11 273825-274015 Sentence denotes Group 1 asthmatics with gastroesophageal reflux disease had an average ACQ score of 0.63, whereas group 1 asthmatics without gastroesophageal reflux disease had an average ACQ score of 0.56.
T12 274016-274126 Sentence denotes Group 2 asthmatics with and without gastroesophageal reflux disease had an identical average ACQ score of 2.6.
T13 274127-274138 Sentence denotes Conclusion:
T14 274139-274278 Sentence denotes Among asthmatics with well-controlled symptoms, the presence of gastroesophageal reflux disease resulted in a slightly increased ACQ score.
T15 274279-274429 Sentence denotes However, among asthmatics with uncontrolled symptoms, the presence of gastroesophageal reflux disease did not result in any increase in the ACQ score.
T16 274430-274606 Sentence denotes There was no statistically significant correlation between the presence of gastroesophageal reflux disease and more severe asthma symptoms in patients with uncontrolled asthma.
T17 274607-274617 Sentence denotes Rationale:
T18 274618-274776 Sentence denotes Emergency room visits and hospitalizations due to acute asthma exacerbations result in substantial healthcare costs and loss of productivity in the workforce.
T19 274777-274900 Sentence denotes Although hospitalizations and deaths due to asthma have steadily declined since the 1980s, asthma prevalence is increasing.
T20 274901-275026 Sentence denotes Obesity is also on the rise, and several studies have shown that obesity is a risk factor for asthma and poor asthma control.
T21 275027-275252 Sentence denotes The Asthma Control Questionnaire (ACQ) is a vali-dated instrument for measuring asthma control in adults, with a score greater than 1.5 predicting a higher risk of visiting an emergency department in the subsequent two weeks.
T22 275253-275425 Sentence denotes We hypothesized that in a cohort of asthmatics at a university-based allergy, asthma, and immunology specialty clinic, body mass index (BMI) would correlate with ACQ score.
T23 275426-275434 Sentence denotes Methods:
T24 275435-275607 Sentence denotes After informed consent and IRB approval, 356 asthmatics recruited to the study between 2011 and 2014 underwent clinical assessment including review of BMI and ACQ-7 scores.
T25 275608-275720 Sentence denotes The independent sample t-test divided the cohort by ACQ scores into group 1 (ACQ < 1.5) and group 2 (ACQ > 1.5).
T26 275721-275729 Sentence denotes Results:
T27 275730-275793 Sentence denotes Groups 1 and 2 had 236 subjects and 120 subjects, respectively.
T28 275794-275861 Sentence denotes The average ACQ score for group 1 was 0.6, and for group 2 was 2.6.
T29 275862-275959 Sentence denotes Group 1 had a lower average BMI (27.1, 95% CI 26.2 -28.0) than Group 2 (29.9, 95% CI 28.2 -31.5).
T30 275960-275972 Sentence denotes Conclusions:
T31 275973-276079 Sentence denotes Asthmatics with ACQ scores less than 1.5 had a lower BMI than asthmatics with ACQ scores greater than 1.5.
T32 276080-276175 Sentence denotes This finding contributes to the growing body of evidence showing a link between BMI and asthma.
T33 276176-276234 Sentence denotes Further research is needed to elucidate this relationship.
T34 276235-276248 Sentence denotes Introduction:
T35 276249-276394 Sentence denotes The NHLBI recommends ongoing assessment of asthma control using a validated self-assessment questionnaire such as the Asthma Control Test™ (ACT).
T36 276395-276532 Sentence denotes Variable use and poor electronic medical record (EMR) documentation of the ACT prompted an organization-wide quality improvement project.
T37 276533-276541 Sentence denotes Methods:
T38 276542-276682 Sentence denotes Use of the ACT has been advocated for all children ≥4 years presenting with asthma to clinics within this tertiary care children's hospital.
T39 276683-276862 Sentence denotes In 2011, a process was initiated to facilitate consistent completion at outpatient visits and subsequent documentation in the EMR, with an iPad version of the ACT created in 2012.
T40 276863-276925 Sentence denotes Electronic data reports guided monthly assessment of barriers.
T41 276926-276988 Sentence denotes Plan-Do-Study-Act (PDSA) cycles facilitated local improvement.
T42 276989-277073 Sentence denotes Interventions were spread from the pilot clinic to a total of seven clinics in 2013.
T43 277074-277114 Sentence denotes Data was analyzed using Excel QI Macros.
T44 277115-277218 Sentence denotes The Office of Research Integrity determined that this project does not involve human subjects research.
T45 277219-277227 Sentence denotes Results:
T46 277228-277364 Sentence denotes In 2011, age appropriate paper questionnaires were programmed to print out with registration paperwork for patient/caregiver completion.
T47 277365-277449 Sentence denotes Providers manually entered calculated ACT scores into EMR-based Asthma Action Plans.
T48 277450-277578 Sentence denotes In September 2012, a pilot clinic began patient/caregiver completion of the ACT on iPads with the score auto-populating the EMR.
T49 277579-277692 Sentence denotes This clinic increased ACT documentation from an average of 17% to 75% by May 2014, with one month as high as 92%.
T50 277693-277797 Sentence denotes Iterative PDSA cycles focused on reducing variation and embedding process changes into daily activities.
T51 277798-277832 Sentence denotes Survey results uncovered barriers.
T52 277833-277902 Sentence denotes Provider support tools, such as pictorial EMR guidance, were created.
T53 277903-278031 Sentence denotes Ongoing refinement of electronic reports optimized the approach for identifying the appropriate patients for the iPad-based ACT.
T54 278032-278104 Sentence denotes Sharing incremental results fostered competition that drove improvement.
T55 278105-278196 Sentence denotes The ACT was also set up on each exam room computer in case of a lapse in iPad connectivity.
T56 278197-278321 Sentence denotes Once these processes spread to six more clinics, the aggregate EMR documentation by all clinics improved to 62% by May 2014.
T57 278322-278333 Sentence denotes Conclusion:
T58 278334-278464 Sentence denotes Facilitating PDSA cycles aimed at addressing obstacles and adapting processes can improve completion and documentation of the ACT.
T59 278465-278637 Sentence denotes The goal of 75% was achieved and sustained for 12 months in the pilot clinic, but the overall goal of 90% for all clinics may depend on more direct engagement of providers.
T60 278638-278774 Sentence denotes The pilot clinic increased EMR documentation of the ACT from an average of 17% to 45% by March 2013, but with wide variation in results.
T61 278775-278940 Sentence denotes Iterative PDSA cycles focused at reducing variation and embedding the process changes into daily activities resulted in improvement to an average of 75% by May 2014.
T62 278941-278954 Sentence denotes Introduction:
T63 278955-279083 Sentence denotes Asthma guidelines recommend controller medications for persistent asthma, plus short-acting bronchodilators in case of symptoms.
T64 279084-279198 Sentence denotes It has been shown a greater use of rescue medications than controllers, which associates with poor asthma control.
T65 279199-279342 Sentence denotes The Instituto Mexicano del Seguro Social (IMSS) provides medical care to 58 million people and has a group of medications for asthma treatment.
T66 279343-279353 Sentence denotes Objective:
T67 279354-279465 Sentence denotes To know the trend of the use of controller, rescue and emergency medications for asthma during a 6-year period.
T68 279466-279474 Sentence denotes Methods:
T69 279475-279857 Sentence denotes The use of controller (fluticasone, salmeterol/fluticasone, budesonide/formoterol, beclomethasone, montelukast, zafirlukast), rescue (salbutamol, salbutamol/ipratropium) and emergency (aminophyline, nebulized: salbutamol, salbutamol/ipratropium, beclomethasone and budesonide) medications for asthma was analyzed according to the nationwide registries of the IMSS from 2007 to 2012.
T70 279858-279866 Sentence denotes Results:
T71 279867-280026 Sentence denotes In the analyzed period, the rescue medications increased from 2,537,882 to 3,205,101 units (26.3%), and controllers from 1,702,606 to 3,565,548 units (109.4%).
T72 280027-280146 Sentence denotes The controllers with greater increment were: salmeterol/fluticasone (702%), montelukast (79%) and beclomethasone (77%).
T73 280147-280249 Sentence denotes Between 2010 and 2011 the trend in the use of controllers was greater than that of rescue medications.
T74 280250-280429 Sentence denotes In the emergency medications there was a 56.8% decrease in the use of aminophyline, and a 320% and 244% increase in the use of salbutamol/ipratropium and budesonide, respectively.
T75 280430-280522 Sentence denotes In 2009 we developed and communicated our institutional asthma clinical practice guidelines.
T76 280523-280534 Sentence denotes Conclusion.
T77 280535-280709 Sentence denotes Although both types of medications for chronic asthma increased within the studied period, the trend in the use of controllers greatly surpassed the increase in rescue drugs.
T78 280710-280801 Sentence denotes As to the emergency medications, the antiinflammatory drugs revealed an increased tendency.
T79 280802-280888 Sentence denotes Spreading of the institutional asthma guidelines might partially explain these trends.
T80 280889-280908 Sentence denotes Research Objective:
T81 280909-281088 Sentence denotes Pediatric asthma affects 10% of children age 0-10 and 15% of middle and high school students and is a significant contributor to morbidity in children covered by public insurance.
T82 281089-281267 Sentence denotes To evaluate the impact of interventions, or to design interventions to have the greatest impact with limited resources, it is useful to understand the status quo within a system.
T83 281268-281425 Sentence denotes This study uses retrospective Medicaid claims data to develop and quantify a set of measures around pediatric asthma in Georgia geographically and over time.
T84 281426-281443 Sentence denotes Methods and Data:
T85 281444-281592 Sentence denotes The baseline measures were calculated using Medicaid MAX claims data for children age 4-17 on Medicaid in Georgia and North Carolina from 2005-2009.
T86 281593-281704 Sentence denotes We quantify asthma-related visits by race, age group, location, provider type, and the costs of those services.
T87 281705-281850 Sentence denotes We also identify patients with persistent asthma and develop measures around medication adherence and the use of long term controller medication.
T88 281851-281980 Sentence denotes We use ICD-9-CM codes to extract the relevant data, and we generate measures within areas such as counties and by subpopulations.
T89 281981-281989 Sentence denotes Results:
T90 281990-282143 Sentence denotes The findings include a set of baseline measures for pediatric asthma in Georgia and North Carolina 1) overall, 2) by geographical area, and 3) over time.
T91 282144-282325 Sentence denotes For utilization, we find the highest percentage of patients with an asthma diagnosis among blacks but the highest number of visits in the population that is non-black and non-white.
T92 282326-282437 Sentence denotes The number of patients per 1000 children decreases with age but the cost per visit increases slightly with age.
T93 282438-282577 Sentence denotes On treatment measures, we find no differences with respect to age but statistically lower adherence to medication among the black patients.
T94 282578-282709 Sentence denotes Measures of utilization, cost, and treatment varied significantly across the state, with a few areas identified as extreme on each.
T95 282710-282740 Sentence denotes Some results varied over time.
T96 282741-282753 Sentence denotes Conclusions:
T97 282754-282903 Sentence denotes Significant variations in pediatric asthma measures exist geographically within Georgia and North Carolina, and some measures show changes over time.
T98 282904-283020 Sentence denotes The cost measures tend to be higher in some urban and rural areas and may be driven by different underlying factors.
T99 283021-283034 Sentence denotes Introduction:
T100 283035-283196 Sentence denotes Asthma camp allows children with asthma to participate in camp activities while providing medical support to ensure a safe environment for their camp experience.
T101 283197-283302 Sentence denotes There is minimal data on the ability of asthma camp to increase asthma knowledge in children with asthma.
T102 283303-283434 Sentence denotes This study evaluated the effectiveness of a local asthma camp in increasing asthma knowledge in children ages 7-17 who have asthma.
T103 283435-283443 Sentence denotes Methods:
T104 283444-283572 Sentence denotes The Asthma Self-Management Questionnaire (ASMQ), previously validated in adults, was given to 40 children attending asthma camp.
T105 283573-283629 Sentence denotes The survey was given on the first and sixth day of camp.
T106 283630-283708 Sentence denotes IRB approval and informed consent was obtained from all research participants.
T107 283709-283776 Sentence denotes Statistical significance was determined by a paired-samples t-test.
T108 283777-283785 Sentence denotes Results:
T109 283786-283984 Sentence denotes Topics covered in the curriculum during asthma camp included the definition of asthma, proper inhaler use, asthma symptoms and triggers, and the difference between controller and rescue medications.
T110 283985-284098 Sentence denotes Initial analysis of the full ASMQ demonstrated no significant change between pre-and post-camp scores (p = 0.14).
T111 284099-284220 Sentence denotes Further analysis of the questions from the ASMQ that were not covered in the curriculum during asthma camp was performed.
T112 284221-284297 Sentence denotes There was no significant change between pre-and post-camp scores (p = 0.34).
T113 284298-284565 Sentence denotes Analysis of the questions from the ASMQ that were covered in the curriculum during asthma camp demonstrated a significant increase in the scores between preand post-camp t(39) = 2.32, p < 0.05, with a mean score increase of 0.53, 95% CI for difference = 0.07 to 0.98.
T114 284566-284577 Sentence denotes Conclusion:
T115 284578-284745 Sentence denotes With improvement between preand post-camp test scores, our data suggests that asthma camp can improve short-term asthma knowledge in asthmatic children attending camp.
T116 284746-284855 Sentence denotes It is not possible to draw conclusions regarding which aspect of asthma camp led to the observed improvement.
T117 284856-284942 Sentence denotes Asthma camp may provide opportunities for children to understand their disease better.
T118 284943-285045 Sentence denotes Caution should be used when interpreting these results as the ASMQ has not been validated in children.
T119 285046-285161 Sentence denotes Further studies are needed to investigate other potential benefits that could be provided by attending asthma camp.
T120 285162-285175 Sentence denotes Introduction:
T121 285176-285338 Sentence denotes A novel, inhalation-driven albuterol (AB) multidose dry powder inhaler (MDPI) has been developed that eliminates the need to coordinate actuation with inhalation.
T122 285339-285347 Sentence denotes Methods:
T123 285348-285919 Sentence denotes Subjects aged 12 years and older with persistent asthma were enrolled in 1 of 3 studies: two 12-week, multicenter, randomized, double-blind, repeat-dose, parallel-group studies (NCT01424813 and NCT01747629) to evaluate the efficacy and safety of AB MDPI 180 mg vs placebo MDPI (PBO) administered 4 times a day (QID) and one 52-week study (NCT01698320) that included a 12-week, double-blind phase during which subjects were randomized to receive either AB MDPI 180 mg or PBO QID followed by a 40-week, open-label phase during which all subjects received AB MDPI as needed.
T124 285920-286003 Sentence denotes Safety results from the 12-week phases of all 3 studies were pooled for evaluation.
T125 286004-286070 Sentence denotes IRB approval and informed consent from all subjects were obtained.
T126 286071-286121 Sentence denotes Primary efficacy endpoints are reported elsewhere.
T127 286122-286130 Sentence denotes Results:
T128 286131-286439 Sentence denotes Overall, adverse events occurred in 50% of patients in the PBO group (n=333) and 40% of patients in the AB MDPI group (n=321) during the pooled 12-week dosing period; upper respiratory tract infections (11% PBO and 10% AB MDPI), nasopharyngitis (6% and 5%), and headache (6% and 4%) occurred most frequently.
T129 286440-286556 Sentence denotes The incidences of β 2 -agonist-related events during the pooled 12-week dosing period were low (<1%) in both groups.
T130 286557-286756 Sentence denotes The most frequent adverse events reported in patients treated with AB MDPI during the 40-week open-label phase were nasopharyngitis (12%), sinusitis (11%), and upper respiratory tract infection (9%).
T131 286757-286929 Sentence denotes There were no clinically meaningful trends in clinical laboratory variables and vital signs from screening to week 52 in those who remained on AB MDPI for the entire study.
T132 286930-287161 Sentence denotes There were no electrocardiographic findings considered clinically relevant in AB MDPI-treated subjects at any time point in the 52-week study; no subject had a QTc interval length (Bazett or Fridericia) >500 msec at any time point.
T133 287162-287174 Sentence denotes Conclusions:
T134 287175-287332 Sentence denotes The safety profile of AB MDPI in these studies was comparable to PBO and consistent with that of the wellcharacterized profile of AB in subjects with asthma.
T135 287333-287382 Sentence denotes This study was sponsored by Teva Pharmaceuticals.
T136 287383-287396 Sentence denotes Introduction:
T137 287397-287545 Sentence denotes A novel, inhalation-driven, multidose dry powder inhaler (MDPI) has been developed that eliminates the need to coordinate actuation with inhalation.
T138 287546-287554 Sentence denotes Methods:
T139 287555-287906 Sentence denotes Data from subjects 12 years of age and older with persistent asthma who were enrolled in two 12-week, multicenter, randomized, double-blind, repeat-dose, parallel-group studies (NCT01424813 and NCT01747629) were pooled to evaluate the efficacy and safety of albuterol (AB) MDPI 180 mg compared with placebo MDPI (PBO) administered 4 times a day (QID).
T140 287907-287973 Sentence denotes IRB approval and informed consent from all subjects were obtained.
T141 287974-288014 Sentence denotes Safety endpoints are reported elsewhere.
T142 288015-288154 Sentence denotes The primary efficacy endpoint was baseline-adjusted FEV 1 area-under-the-effect curve over 6 hours postdose (FEV 1 AUC 0-6 ) over 12 weeks.
T143 288155-288431 Sentence denotes Results: AB MDPI-treated subjects (n=153) experienced significantly (p<0.0001) greater improvements in baseline-adjusted FEV 1 AUC 0-6 compared with PBO subjects (n=163) over the 12-week study period (AB MDPI, 1.20 L x hr vs PBO 0.33 L x hr; mean difference 0.87±0.10 L x hr).
T144 288432-288520 Sentence denotes The mean change from baseline in FEV 1 for the pooled population is shown in the Figure.
T145 288521-288799 Sentence denotes Significant (p<0.0001) increases in baseline-adjusted FEV 1 AUC 0-6 in AB MDPI-treated subjects were apparent on days 1 and 8 and maintained through day 85 compared with PBO subjects (mean differences of 1.06, 0.75, and 0.81 L x hr vs PBO for these 3 time points, respectively).
T146 288800-289062 Sentence denotes Of the 153 subjects treated with AB MDPI, 110 (72%) achieved a 12% increase in FEV 1 within 30 minutes postdose on day 1 with a median time to onset of 5.2 minutes, and median duration of effect (12% increase) of @3 hours for one study and 4 hours for the other.
T147 289063-289315 Sentence denotes Ninety-one AB MDPI-treated subjects (59%) achieved a 15% increase in FEV 1 within 30 minutes postdose on day 1 with a median time to onset of 5.4 minutes, and median duration of effect (15% increase) of @2 hours for one study and 3 hours for the other.
T148 289316-289433 Sentence denotes Conclusions: AB MDPI was consistently superior to PBO over the 12-week treatment period on spirometry-based measures.
T149 289434-289592 Sentence denotes These data confirm that during periods of reg-ular usage over 12 weeks, AB MDPI continued to produce clinically significant bronchodilation compared with PBO.
T150 289593-289642 Sentence denotes This study was sponsored by Teva Pharmaceuticals.
T151 289643-289736 Sentence denotes Asthma and obesity are chronic disorders, and are increased in prevalence among young people.
T152 289737-289845 Sentence denotes It is proposed that obesity and overweight has an independent effect on lung function in asthmatic patients.
T153 289846-289903 Sentence denotes We barely know longterm obesity effects in this patients.
T154 289904-289916 Sentence denotes Methodology:
T155 289917-289957 Sentence denotes The study was conducted in our Hospital.
T156 289958-290023 Sentence denotes The study group where obese or overweight with or without asthma.
T157 290024-290175 Sentence denotes It was performed spirometry with reversibility in a baseline measurement and after 5 years follow-up, besides weight, height and BMI (Body Mass Index).
T158 290176-290283 Sentence denotes Symptoms of asthma conducted through validated questionnaires: ISAAC Questionnaire and Asthma Control Test.
T159 290284-290292 Sentence denotes Results:
T160 290293-290366 Sentence denotes We invited to participate 90 patients, of whom 5 decided not participate.
T161 290367-290477 Sentence denotes 85 patients were included but cannot schedule appointment to 35, because change of residence and phone number.
T162 290478-290568 Sentence denotes We studied a total of 50 patients, of whom 33 realize spirometer, and 17 is still pending.
T163 290569-290789 Sentence denotes Institutional Review Board approval and informed consent was obtained from all research subjects.Of the 50 patients studied, 22 were women and 28 men, the average age, after 5 years of follow-up for both groups was 18.7.
T164 290790-290948 Sentence denotes Within the studied groups compared with the 5-year follow-up, significant difference was observed: in weight (p= 0.000), height (p= 0.000) and BMI (p= 0.000).
T165 290949-291334 Sentence denotes In spirometric values, the comparison group at baseline and follow-up, significant differences was found in forced vital capacity (p= 0.000), forced expiratory volume in one second (FEV1 p= 0.000), after bronchodilator FEV1 (p= 0.004), reversibility (p= 0.009), (PEF expiratory flow p=0.001).Of the 50 patients evaluated, at the beginning of the follow up 12 patients (24%) had asthma.
T166 291335-291406 Sentence denotes There were 6 patients who were monitoring newly diagnosed asthma (33%).
T167 291407-291611 Sentence denotes Of the 18 asthmatic patients in total, we classify according to symptoms, through the ACT questionnaire, 5 patients were in poor control, 7 with partly controlled asthma and 6 with well-controlled asthma.
T168 291612-291742 Sentence denotes Initial asthmatic patients significant differences were found in weight and in spirometric values in FVC, FEV1, and PEF (Table no.
T169 291743-291746 Sentence denotes 1).
T170 291747-291758 Sentence denotes Conclusion:
T171 291759-291871 Sentence denotes In this study we found that obese patients with asthma, they referred to be controlled and partially controlled.
T172 291872-291976 Sentence denotes We found that obese asthma patients remained with better spirometric values compared to baseline values.
T173 291977-292057 Sentence denotes In patients with newly found diagnosis were in ranges of overweight and obesity.
T174 292058-292071 Sentence denotes Introduction:
T175 292072-292225 Sentence denotes Albuterol (AB) delivered via a novel, inhalation-driven, multidose dry powder inhaler (MDPI) eliminates the need to coordinate actuation with inhalation.
T176 292226-292504 Sentence denotes In a separate study, treatment of adolescents and adults with persistent asthma with AB MDPI was well tolerated and demonstrated efficacy significantly greater than placebo and comparable to AB hydrofluoroalkane metered dose inhaler (HFA) at the intended doses of 90 and 180 mg.
T177 292505-292513 Sentence denotes Methods:
T178 292514-292825 Sentence denotes This multicenter, randomized, double-blind, double-dummy, cumulative-dose, 2-period crossover study (NCT01056159) evaluated the efficacy, pharmacokinetics (PK), extrapulmonary pharmacodynamics (PD), and safety of cumulative doses (1440 mg) of AB via MDPI or HFA to subjects (aged 18-45 years; N=47) with asthma.
T179 292826-292892 Sentence denotes IRB approval and informed consent from all subjects were obtained.
T180 292893-293027 Sentence denotes Subjects were treated with AB MDPI or AB HFA (90 mg/inhalation) and respective placebo in a randomized-sequence, two-period crossover.
T181 293028-293170 Sentence denotes At each treatment visit, study drug was administered by cumulative dosing of 1+1+2+4+8 inhalations (separated by 30 minutes) from each device.
T182 293171-293230 Sentence denotes Treatment visits were separated by 3 to 14 days of washout.
T183 293231-293338 Sentence denotes The primary efficacy endpoint was baseline-adjusted FEV 1 at 30 minutes after each of the cumulative doses.
T184 293339-293347 Sentence denotes Results:
T185 293348-293482 Sentence denotes Thirty-eight subjects received both AB MDPI and AB HFA and experienced increases in FEV 1 over baseline at each cumulative dose level.
T186 293483-293605 Sentence denotes The differences between treatments in FEV 1 at 30 minutes ranged from −0.07 to −0.03 L and were not clinically meaningful.
T187 293606-293849 Sentence denotes Mean systemic exposure over 14 hours was comparable (AUC 0-t, 23,227 for AB MDPI and 20,939 for AB HFA), C max was higher for AB MDPI (4422.8 pg/mL) vs AB HFA (3303.8 pg/mL), and T max occurred earlier with AB MDPI (2.48 h) vs AB HFA (3.05 h).
T188 293850-293941 Sentence denotes Extrapulmonary PD differences between treatments were not considered clinically meaningful.
T189 293942-294123 Sentence denotes Adverse events reported by ≥5% of subjects treated with AB (cumulative dose of 1440 mg) included tremor (17% AB MDPI and 13% AB HFA), palpitations (9 and 2), and headache (9 and 4).
T190 294124-294136 Sentence denotes Conclusions:
T191 294137-294231 Sentence denotes The overall efficacy, PK, PD, and safety profile of AB MDPI and AB HFA were generally similar.
T192 294232-294342 Sentence denotes The results of this and previous AB MDPI studies support evaluation of a dose of 180 mg in adults with asthma.
T193 294343-294392 Sentence denotes This study was sponsored by Teva Pharmaceuticals.
T194 294393-294542 Sentence denotes onset asthma was diagnosed when first episodes of symptoms occurred before 40 year old and late onset one after 40 according to GINA 2012 guidelines.
T195 294543-294596 Sentence denotes The control group included 285 non-atopic volunteers.
T196 294597-294665 Sentence denotes Single nucleotide polymorphisms of CD14 C-159T were detected by PCR.
T197 294666-294825 Sentence denotes Patients and volunteers were recruited at the Crimean State Medical University, Simferopol, Crime, and provided written informed consent for the genetic study.
T198 294826-294834 Sentence denotes Results:
T199 294835-295047 Sentence denotes In earlyonset asthma patients CC genotype was detected in 74 patients, CT in 142 and TT in 46; in late-onset asthma: CC in 31, CT in 27, and TT in 11; while in the control group CC in 97, CT in 146, and TT in 42.
T200 295048-295412 Sentence denotes The allele frequencies were 55 % (n=290) for the C allele and 45 % (n=234) for the T allele in the earlyonset asthma c (OR, 1.19; 95% CI, 0.94-1.52; P=0.15); 64% (n=89) for the C allele and 36% (n=49) for the T allele in the late-onset asthma (OR, 0.81; 95% CI, 0.55-1.99; P=0.29); and 60% (n=340) for the C allele and 40% (n=230) for the T allele in the controls.
T201 295413-295528 Sentence denotes Conclusion: CD14-C159T polymorphism is not associated with adult early and late-onset asthma in Crimean population.
T202 295529-295623 Sentence denotes The polymorphism in this population did not differ from that seen in healthy control subjects.
T203 295624-295637 Sentence denotes Introduction:
T204 295638-295723 Sentence denotes Allergic rhinitis (AR) is frequently encountered in patients with atopic asthma (AA).
T205 295724-295835 Sentence denotes The influence of allergic rhinitis on clinical symptoms in asthmatics depends significantly on asthma severity.
T206 295836-295844 Sentence denotes Methods:
T207 295845-296012 Sentence denotes Consecutive patients 17-26 years of age with mild intermittent (MI) and mild persistent (MP) allergic asthma were enrolled in the study with informed consent obtained.
T208 296013-296180 Sentence denotes Evaluation included lung function assessment, skin prick tests, broncho-provocation tests,(BPTs), bronchodilator (BDT) response, total and allergenspecific IgE levels.
T209 296181-296189 Sentence denotes Results:
T210 296190-296372 Sentence denotes Patients in both groups, 63 in MI and 72 in MP, had similar age(mean 19 years) and AA duration (mean 5 versus 6 years in MI and MP groups) and were equally of rural and urban origin.
T211 296373-296495 Sentence denotes Prevalence of persistent AR (P-AR) was significantly greater in MP asthma (54% in MI asthma and 78% in MP asthma, p<0.05).
T212 296496-296779 Sentence denotes Patients with persistent AR had on average higher rate of exacerbations independent of asthma severity: more than 1 exacerbation per month occurred in 26% of patients with intermittent AR (I-AR) or without AR versus 68% of patients with persistent AR (p<0.05) in the MI asthma group.
T213 296780-296932 Sentence denotes More then 1 exacerbation per month was seen in 44% of patients with I-AR or without AR versus 86% of patients with P-AR (p<0.05) in the MP asthma group.
T214 296933-297163 Sentence denotes Patients with persistent AR had much higher rates of symptoms in relation to overall dust load both in MP asthma (95% in P-AR patients versus 25% in all others, p<0,05) and MI asthma (95% in P-AR versus 68% in all others, p<0,05).
T215 297164-297514 Sentence denotes In MI asthma patients presence of persistent AR was also associated with a higher mean number of relevant non-specific triggers (1.76±0.93 in P-AR versus 0.97±0,84 in all others, p<0.05), clinical reaction to cold air (27% in P-AR patients versus 3% in all others, p<0.05) and exercise-related symptoms (81% in P-AR versus 48% in all others, p<0.05).
T216 297515-297526 Sentence denotes Conclusion:
T217 297527-297594 Sentence denotes Allergic rhinitis has significantly higher prevalence in MP asthma.
T218 297595-297715 Sentence denotes Patients with persistent allergic rhinitis have two-fold or higher rate of exacerbations independent of asthma severity.
T219 297716-297855 Sentence denotes Among non-specific asthma triggers the most clinically relevant for all patients with persistent allergic rhinitis was the total dust load.
T220 297856-298015 Sentence denotes The number of non-specific asthma triggers was also greater in patients with persistent allergic rhinitis in both mild intermittent and mild persistent asthma.
T221 298016-298027 Sentence denotes Background:
T222 298028-298235 Sentence denotes There is a relationship between atmospheric pollutants and climatic factors and visits to the emergency room for asthma, however there is lack of knowledge on the situation of this phenomenon in Mexico City.
T223 298236-298246 Sentence denotes Objective.
T224 298247-298454 Sentence denotes To assess the correlation of atmospheric pollutants and some climatic factors with the number of cases of asthma exacerbations in children in a third level hospital in Mexico City during the last five years.
T225 298455-298463 Sentence denotes Methods:
T226 298464-298811 Sentence denotes Case registries of asthma exacerbations at pediatric emergency room, stratified by age (0-23 months, 24-71 months, 6-12 years, 12-17 years), and their correlation with daily values of atmospheric pollutants (ozone, sulphur dioxide, nitrogen dioxide, carbon monoxide and PM 10 ), temperature and relative humidity, from 2009 to 2013, were analyzed.
T227 298812-298842 Sentence denotes IRB/HAC approval was obtained.
T228 298843-298851 Sentence denotes Results:
T229 298852-298956 Sentence denotes During these five years there were 5331 visits for asthma exacerbations, with an annual average of 1066.
T230 298957-299035 Sentence denotes There was a gradual decrease in cases, from 2363 in 2009 to 505 (21%) in 2013.
T231 299036-299090 Sentence denotes There was a male predominance in all ages (ratio 1.7 :
T232 299091-299094 Sentence denotes 1).
T233 299095-299215 Sentence denotes The age groups 24-71 months and 6-12 years had the highest number of cases, 1766 (33.1%) and 1827 (34.3%), respectively.
T234 299216-299319 Sentence denotes During fall there was the highest number of visits 2069 (39%), and the lowest was in spring, 801 (15%).
T235 299320-299511 Sentence denotes The correlation between asthma and environmental factors was: CO: R=0.242, NO 2 : R=0.175, SO 2 : R=0.092, PM 10 : R=0.056, O 3 : R=-0.062, relative humidity R=-0.106 and temperature R=-0.36.
T236 299512-299524 Sentence denotes Conclusions:
T237 299525-299659 Sentence denotes A gradual and significant reduction in the number of asthma visits to the emergency room was observed during the period of five years.
T238 299660-299744 Sentence denotes There was a significant increase in asthma exacerbations related to seasonal effect.
T239 299745-299845 Sentence denotes There was a predominance of male pre-school and school children in relation to asthma exacerbations.
T240 299846-299949 Sentence denotes The highest correlation between atmospheric pollutants and asthma cases was related to carbon monoxide.
T241 299950-300056 Sentence denotes There was inverse correlation between asthma exacerbations and weather factors (humidity and temperature).
T242 300057-300070 Sentence denotes Introduction:
T243 300071-300176 Sentence denotes Little is known about benefits of continuous omalizumab (OMA) treatment to asthma patients in real world.
T244 300177-300299 Sentence denotes We examined the lapses in asthma control in patients who continued vs. discontinued OMA treatment in a real-world setting.
T245 300300-300308 Sentence denotes Methods:
T246 300309-300429 Sentence denotes This retrospective cohort study used a large HIPAA-compliant commercial healthcare claims database (1/1/08 to 12/31/10).
T247 300430-300639 Sentence denotes Identified patients were ≥12 years old, had ≥2 medical asthma-associated claims, filled ≥2 asthma controller medications in the identification period (1/1/09-12/31/09), and used OMA continuously for ≥6 months.
T248 300640-300851 Sentence denotes After ≥6 months of OMA therapy, patients were stratified as continuers (continued OMA until dropout or 12/31/10) or early discontinuers (stopped OMA for >90 days) and followed for ≥3 months after the index date.
T249 300852-301129 Sentence denotes The primary outcome was the risk of lapse in asthma control during follow-up, reported as episodes per 100 patientyears (PY), measured as any asthma-related hospitalization or emergency room visit, ≥2 oral corticosteroid (OCS) or ≥6 short-acting beta-agonists filled in 1 year.
T250 301130-301295 Sentence denotes We used Cox regression models to assess risk of the outcome, adjusted for baseline patient characteristics (e.g., demographics and the number of chronic conditions).
T251 301296-301369 Sentence denotes The study did not involve human subjects, thus IRB review was not needed.
T252 301370-301378 Sentence denotes Results:
T253 301379-301464 Sentence denotes We identified 414 continuers and 240 discontinuers among eligible patients; mean age:
T254 301465-301509 Sentence denotes 46.2 years, 62.5% women, and 15.6% had COPD.
T255 301510-301583 Sentence denotes At baseline, the groups were balanced by demographics and asthma control.
T256 301584-301694 Sentence denotes Patients were followed for a median 415 days; the discontinuers had no OMA use after the discontinuation date.
T257 301695-301781 Sentence denotes Overall, there were 32.5 episodes of lapses in asthma control per 100 PY of follow-up:
T258 301782-301871 Sentence denotes 27.9 per 100 PY for continuers vs. 43.3 per 100 PY for discontinuers (p = 0.002, Table) .
T259 301872-301992 Sentence denotes Discontinuers had worse individual clinical outcomes that defined lapses in asthma control than did continuers (Table) .
T260 301993-302166 Sentence denotes Adjusting for patient characteristics, discontinuers had a significantly higher risk of having lapses in asthma control than continuers (adjusted hazard ratio 1.66, p<.001).
T261 302167-302179 Sentence denotes Conclusions:
T262 302180-302377 Sentence denotes Real-world evidence suggests that asthma patients who receive continuous (>6 months) OMA treatment may have fewer lapses in asthma control than those who prematurely discontinue OMA after 6 months.
T263 302378-302627 Sentence denotes The genus Rhodiola is important herb used for thousands of years in Traditional Chinese Medicine for treating various kinds of diseases, including inflammation-related diseases such as pneumonia, chronic bronchitis, asthma, and rheumatoid arthritis.
T264 302628-302854 Sentence denotes Salidroside (p-hydroxyphenethyl-beta-d-glucoside, C14H20O7, molecular weight 300.30), which is one of the most potent ingredients of the genus Rhodiola, has been reported to have a broad spectrum of pharmacological properties.
T265 302855-303042 Sentence denotes Recent study indicates an anti-inflammatory role for salidroside in lipopolysaccharide (LPS)-induced acute lung injury (ALI), but the mechanisms of anti-inflammatory action are not clear.
T266 303043-303198 Sentence denotes In the present study, anti-inflammatory activity of salidroside was analyzed in vitro using LPS-induced inflammatory reactions in rat alveolar macrophages.
T267 303199-303372 Sentence denotes Inflammatory mediators such as TNF-α, IL-6, and NO were measured by the Griess reaction for NO and Enzymelinked immunosorbent assay (ELISA) for other inflammatory mediators.
T268 303373-303540 Sentence denotes QRT-PCR was used to measure the mRNA expression of TNF-α, IL-6, and iNOS, and the protein levels of iNOS, p65, p-p65, IκB-α, and p-IκB-α were analyzed by western blot.
T269 303541-303646 Sentence denotes EMSAs and reporter gene assays were used to evaluate DNA binding and transcriptional activities of NF-κB.
T270 303647-303720 Sentence denotes ChIP analysis was used to detect the binding of p65 to the iNOS promoter.
T271 303721-303778 Sentence denotes NF-κB nuclear translocation was analyzed by western blot.
T272 303779-303885 Sentence denotes Salidroside significantly inhibited LPS-stimulated production of NO by suppressing the expression of iNOS.
T273 303886-304004 Sentence denotes EMSA demonstrated that LPS treatment increased p65-DNA binding, whereas this interaction was decreased by salidroside.
T274 304005-304109 Sentence denotes ChIP analysis revealed that salidroside markedly inhibited LPS-induced p65 binding to the iNOS promoter.
T275 304110-304209 Sentence denotes Western blotting confirmed that salidroside effectively inhibited the nuclear translocation of p65.
T276 304210-304323 Sentence denotes We also examined the effect of salidroside on the induced degradation and phosphorylation of IκBα protein by LPS.
T277 304324-304426 Sentence denotes The results showed that salidroside could change the kinetics of IκBα phosphorylation and degradation.
T278 304427-304549 Sentence denotes Salidroside also suppressed TNF-and IL-6 at the mRNA level, and then reduced the release of TNF-α and IL-6 induced by LPS.
T279 304550-304772 Sentence denotes In conclusion, our results suggest that salidroside can block LPS stimulated inflammatory responses, and may be used as a potential anti-inflammatory agent for the prevention and treatment of inflammation-related diseases.
T280 304773-304907 Sentence denotes Immune response and pathologic events in allergic asthma are regulated by specific T cell subsets and the cytokines that they secrete.
T281 304908-305083 Sentence denotes Mast cells and eosinophils are key effectors in the cascade of airway inflammatory events which induce bronchoconstriction, influx of inflammatory cells and airway remodeling.
T282 305084-305310 Sentence denotes KIT, the receptor for Stem Cell Factor (SCF), is expressed on mast cells and eosinophils in the lung, and for that reason, we are examining inhibition of SCF/KIT signaling as a possible therapeutic in allergy and inflammation.
T283 305311-305395 Sentence denotes KTN0158 is a humanized IgG1 monoclonal antibody that inhibits signaling through KIT.
T284 305396-305522 Sentence denotes This antibody specifically binds the Ig-like domain 4 of KIT, and blocks SCF binding and receptor dimerization and activation.
T285 305523-305689 Sentence denotes In vitro studies demonstrate that KTN0158 is a potent inhibitor of SCF-dependent KIT activation and of degranulation enhanced by SCF in the human LAD2 mast cell line.
T286 305690-305804 Sentence denotes KTN0158 has similar binding affinity for human, monkey, dog and cat KIT, but does not cross-react with murine KIT.
T287 305805-306035 Sentence denotes A placebo-controlled, cross-over design pilot study was conducted to evaluate the ability of KTN0158 to reduce airway eosinophilia and airway reactivity in experimentally asthmatic cats sensitized with Bermuda Grass Antigen (BGA).
T288 306036-306304 Sentence denotes Cats received 20 mg/kg KTN0158 or placebo on days -1 and 14, and airway reactivity was assessed using BGA or methacholine bronchoprovocation (day 0 or day 28) and ventilator-acquired pulmonary mechanics, as well as bronchoalveolar lavage to assess airway inflammation.
T289 306305-306549 Sentence denotes Cats treated with KTN0158 had significant reduction in airway eosinophilia during the early-(p=0.009) and late-phase (p=0.032) asthmatic reactions, suggesting further investigation of KIT inhibition with KTN0158 in allergic asthma is warranted.
T290 306550-306684 Sentence denotes To this end, studies to investigate the potential benefit of KTN0158 in mast cell-related diseases and to evaluate safety are ongoing.
T291 306685-306687 Sentence denotes R.
T292 306688-306701 Sentence denotes Anand *1 , E.
T293 306702-306715 Sentence denotes George 2 , M.
T294 306716-306727 Sentence denotes Yu 2 , J.L.
T295 306728-306741 Sentence denotes Ambrus 2 , L.
T296 306742-306753 Sentence denotes Shen 2 , 1.
T297 306754-306771 Sentence denotes Getzville, NY; 2.
T298 306772-306784 Sentence denotes Buffalo, NY.
T299 306785-306798 Sentence denotes Introduction:
T300 306799-306921 Sentence denotes There is a high incidence of secondary lymphomas in patients with autoimmune diseases, especially Sjogren's syndrome (SS).
T301 306922-307126 Sentence denotes We have developed an animal model, the IL-14alpha transgenic mouse (IL14aTG) that reproduces all the features of SS seen in patients in the same relative time frame, including the development of lymphoma.
T302 307127-307340 Sentence denotes We have evaluated genetic changes in the spleens of these mice during different stages of the disease to determine when genes characteristic of SS lymphoma are aberrantly expressed in the animals with the disease.
T303 307341-307480 Sentence denotes Methods: QPCR was performed on the splenic RNA of IL14aTG mice and control C57BL/6 mice for bcl-6 and bcl-10 at 6, 10 and 14 months of age.
T304 307481-307630 Sentence denotes In this animal model, disease involving the salivary and lacrimal glands starts at 6 months of age while systemic disease starts at 10 months of age.
T305 307631-307764 Sentence denotes Some mice will start developing lymphoma at 14 months of age while the majority of mice develop lymphoma only by 18-20 months of age.
T306 307765-307773 Sentence denotes Results:
T307 307774-307905 Sentence denotes In IL14aTG mice but not C57BL/6 mice, expression of bcl-6 and bcl-10 decreased at 14 months of age, but not at earlier time points.
T308 307906-307977 Sentence denotes None of the mice with these genetic changes had yet developed lymphoma.
T309 307978-307980 Sentence denotes A.
T310 307981-307995 Sentence denotes Gharib *1 , A.
T311 307996-308014 Sentence denotes Gupta Louis 2 , S.
T312 308015-308029 Sentence denotes Agrawal 2 , S.
T313 308030-308042 Sentence denotes Gupta 2 , 1.
T314 308043-308062 Sentence denotes Los Angeles, CA; 2.
T315 308063-308074 Sentence denotes Irvine, CA.
T316 308075-308086 Sentence denotes Background:
T317 308087-308217 Sentence denotes Detailed immunological analyses have not been reported in recently recognized Non-tuberculous mycobacterial infection of the skin.
T318 308218-308402 Sentence denotes The main purpose of this investigation is to present extensive immunological analysis of a patient with cutaneous non-tuberculous mycobacterial infection (mycobacterium avium complex).
T319 308403-308424 Sentence denotes Material and Methods:
T320 308425-308884 Sentence denotes Peripheral blood from the patient and healthy controls were analyzed for CD3+, CD4+, CD8+ T cells, regulatory T cells (FoxP3+CD4+CD25+), naïve, transitional, marginal zone, IgM memory, switched memory B cells and plasmablasts, expression of TACI and BAFF-R on naive and memory B cells, expression of IFN-γ receptor and IL-12 receptor on lymphocytes and monocytes, NK cell phenotype and cytoxicity against K562 target cells using various effector:target ratio.
T321 308885-309055 Sentence denotes Lymphocyte functions were measured by in vitro response to mitogens (PHA, ConA, PWM) and recall antigens (mumps, candidate, PPD, and tetanus toxoid) by 3 H incorporation.
T322 309056-309109 Sentence denotes Toll-like receptors (TLR) were analyzed on monocytes.
T323 309110-309118 Sentence denotes Results:
T324 309119-309265 Sentence denotes Analysis of lymphocyte subsets showed severe T cell lymphopenia of CD3+, CD4+ and CD8+ T cells) and an impaired response to mitogens and antigens.
T325 309266-309312 Sentence denotes T regulatory cells were significantly reduced.
T326 309313-309491 Sentence denotes Analysis of B cells revealed low serum IgM and an increased transitional B cells with normal marginal zone, IgM memory and class switch memory B cells, and marginal zone B cells.
T327 309492-309662 Sentence denotes Expression of TACI and BAFF receptor on both naiive and memory B cells, and expression of and IFN -γ receptor and IL-12 receptor on lymphocytes and monocytes were normal.
T328 309663-309755 Sentence denotes TLR4 expression was increased, whereas the expression of TLR5, TLR7, and TLR9 was decreased.
T329 309756-309794 Sentence denotes NK activity was found to be decreased.
T330 309795-309806 Sentence denotes Conclusion:
T331 309807-310157 Sentence denotes This patient illustrates that cutaneous non-tuberculous mycobacterium infections may be associated with severe immune deficiency including T cell lymphopenia, impaired cell mediated immunity, deficiency of T regulatory cells, alterations in transitional B cells, selective IgM deficiency, altered TLR expression, and an impaired NK cell cytotoxicity.
T332 310158-310160 Sentence denotes L.
T333 310161-310177 Sentence denotes Helfner * , A.M.
T334 310178-310201 Sentence denotes Jongco, Great Neck, NY.
T335 310202-310215 Sentence denotes Introduction:
T336 310216-310370 Sentence denotes Complement component deficiencies are rare, and predispose to autoimmunity or increased susceptibility to recurrent infections with encapsulated bacteria.
T337 310371-310443 Sentence denotes The types of infection relate to the function of the missing components.
T338 310444-310552 Sentence denotes For example, terminal complement component deficiency frequently presents with Neisseria species infections.
T339 310553-310561 Sentence denotes Methods:
T340 310562-310701 Sentence denotes We describe an 11-month old male who presented originally with lethargy and fever that developed into GAS sepsis with toxic shock syndrome.
T341 310702-310786 Sentence denotes He received a 10-day course of IV antibiotics and was discharged on oral cephalexin.
T342 310787-310985 Sentence denotes Shortly after discharge, he was re-admitted with fever and found to have extended-spectrum beta lactamase producing (ESBL) E. coli urosepsis, which responded well to a 10-day course of IV ertapenem.
T343 310986-311124 Sentence denotes For UTI prophylaxis, the patient now receives trimethoprim-sulfamethoxazole daily, and has done well following his second hospitalization.
T344 311125-311194 Sentence denotes He is currently receiving routine vaccinations as per CDC guidelines.
T345 311195-311203 Sentence denotes Results:
T346 311204-311453 Sentence denotes Laboratory evaluation was remarkable for undetectable CH50 on two separate occasions, as well as mild T cell lymphocytosis (CD3+ of 8326/uL (reference range 1700-3600), CD4+ of 6285/uL (range 1700-2800), and CD8+ of 1654/uL (reference of 800-1200)).
T347 311454-311495 Sentence denotes B and NK cells were unremarkable for age.
T348 311496-311567 Sentence denotes Lymphocyte proliferation to pokeweed and phytohemagglutinin was normal.
T349 311568-311625 Sentence denotes G6PD was mildly depressed at 3.5 U/g Hb (range 4.6-13.5).
T350 311626-311659 Sentence denotes Myeloperoxidase stain was normal.
T351 311660-311741 Sentence denotes HIV serologies were negative, and he had detectable hepatitis B surface antibody.
T352 311742-311830 Sentence denotes Total IgE was elevated at 323 IU/mL (range 0-15), with normal IgA, IgM, and IgG for age.
T353 311831-311914 Sentence denotes Levels of C2, C3, C4, C5, C7, C9, C1q, mannose binding lectin and AH50 were normal.
T354 311915-311958 Sentence denotes C8 was decreased at 20 ug/mL (range 33-58).
T355 311959-312024 Sentence denotes Further investigation of other complement components is underway.
T356 312025-312036 Sentence denotes Conclusion:
T357 312037-312257 Sentence denotes This patient had mildly decreased G6PD and C8 with undetectable CH50 but normal AH50, suggesting that other complement components are deficient in quantity and/or function, likely upstream of the membrane attack complex.
T358 312258-312354 Sentence denotes Physicians must remain vigilant and include complement deficiency in the differential diagnosis.
T359 312355-312472 Sentence denotes These patients should receive routine vaccinations, especially against diseases for which they are at increased risk.
T360 312473-312565 Sentence denotes The airway smooth muscle cells (ASMC) hyperplasia is a central feature of airway remodeling.
T361 312566-312764 Sentence denotes ASMC mitogenesis is promoted by several mediators such as epidermal growth factor (EGF) and tumor necrosis factor-α (TNF-α), which are countered by activators of guanylyl cyclases (GC)-cGMP pathway.
T362 312765-312920 Sentence denotes This study evaluated the effect of sodium nitroprusside (SNP), an oxide nitric (NO) donator, and natriuretic peptides (ANP, CNP) on rat ASMC proliferation.
T363 312921-313114 Sentence denotes Cells were isolated from tracheal fragments and were characterized using immunochemistry with specific antibody anti-α smooth muscle actin, indicating that after 3rd passage were 100% positive.
T364 313115-313169 Sentence denotes Proliferation assays were performed by MTS-PMS method.
T365 313170-313226 Sentence denotes Viability was confirmed by trypan blue exclusion method.
T366 313227-313360 Sentence denotes To determined GC enzyme activity, cells were pre-incubated with 100 M IBMX (PDEs inhibitor) and cGMP was measured using Amersham kit.
T367 313361-313516 Sentence denotes SNP (10 -5 M; n=6), ANP and CNP (n=3) in a doses-dependent manner inhibited ASMC proliferation induced by fetal bovine serum (FBS), EGF and TNFα (p <0.05).
T368 313517-313658 Sentence denotes ODQ (sGC inhibitor) reversed the action of SNP (p <0.05, n=3) and improved basal proliferation and mitogenesis induced by FBS (p <0.05, n=3).
T369 313659-313832 Sentence denotes We found increased of cGMP levels in response to SNP, ANP and CNP. cGMP synthesis induced by SNP, but not by natriuretic peptides, was inhibited by 100nM ODQ (p <0.05, n=3).
T370 313833-313935 Sentence denotes NO, ANP and CNP increase cGMP levels by different transduction systems and inhibit ASMC proliferation.
T371 313936-313995 Sentence denotes Moreover, basal activity of sGC regulates ASMC mitogenesis.
T372 313996-314123 Sentence denotes This signaling pathway might be altered in airway remodeling and represent an important therapeutic target to ASMC hyperplasia.
T373 314124-314135 Sentence denotes Background:
T374 314136-314266 Sentence denotes Cytidine deaminase (CDA) and adenosine deaminase (ADA) basal serum activity may be impacted by acute and chronic infection states.
T375 314267-314275 Sentence denotes Methods:
T376 314276-314943 Sentence denotes Two groups formed on a wide (n = 10, male and female, 24-31 age) and narrow (n = 19, only male, 18-25 age) principle of sampling as controls were compared to infectious mononucleosis (IM) patients (n = 10, male and female, 18-34 age), chronic HCV infection patients (n=29, male and female, 27-70 age), and patients with pneumonia developing in the 2012-13 influenza epidemic season (n=10, male and female, 6-16 age) by assessing CDA and ADA activity (indophenol colorimetric test), CD19 + cells content (flow cytometry), B-cells clonal status (immunoglobulin heavy chains rearrangement) and PCR analysis using ISH assay (InVivoscribe, USA) and GelAnalyzer 2010a soft.
T377 314944-315106 Sentence denotes Results: CDA activity in pneumonia (8.14±2.72 U), as well as in infectious mononucleosis (4.37±2.22 U) was found to be high in comparison with the control groups:
T378 315107-315174 Sentence denotes 1.1±0.4 U for the wide cohort and 2.29±0.5 U for the narrow cohort.
T379 315175-315251 Sentence denotes In contrast, chronic HCV patients had no increased CDA levels (1.21±0.17 U).
T380 315252-315354 Sentence denotes A polyclonal pattern was seen in both wide and narrow controls, IM and chronic HCV infection patients.
T381 315355-315409 Sentence denotes Both control cohorts show similar ADA activity levels:
T382 315410-315466 Sentence denotes 12.08±5.24 U for wide and 11.10±2.2 U for narrow cohort.
T383 315467-315625 Sentence denotes A two-fold increase in ADA activity in IM patients (27.56±9.87 U) and the absence of significant deviations in ADA levels for chronic HVC (14.53 U) were seen.
T384 315626-315770 Sentence denotes Despite the low absolute values, CDA and ADA enzymatic activity proved itself to be among the most individually variable immunologic parameters.
T385 315771-315907 Sentence denotes Conclusions: CDA and ADA enzyme activity is an informative parameter with potential to be a biomarker of hidden immunodeficiency status.
T386 315908-315921 Sentence denotes Introduction:
T387 315922-316036 Sentence denotes Oral lichen planus (OPL) is the most common immune disease of oral mucosa, having an increased risk of malignancy.
T388 316037-316138 Sentence denotes Cytokines (IL-1, TNF-α, TGF-β) in blood may impact disease progression in erosive oral lichen planus.
T389 316139-316147 Sentence denotes Methods:
T390 316148-316325 Sentence denotes 97 patients aged 18 to 60 years were studied including 35 with erosive oral lichen planus, 32 with non-erosive oral lichen planus and 30 healthy control subjects of similar age.
T391 316326-316451 Sentence denotes The levels of serum cytokines IL-1, TNF-α, TGF-β were determined by enzyme-linked immunosorbent assay ("Immunotech"; France).
T392 316452-316460 Sentence denotes Results:
T393 316461-316731 Sentence denotes During relapse of erosive oral lichen planus there is change in select cytokines compared with control group levels including IL-1 (0.6±1.5 pg/ml) being 2-fold increased versus the healthy controls and TNF-α being 4.3-fold increased (0.3±1.6 pg/ml versus 1.3±1.2 pg/ml).
T394 316732-316824 Sentence denotes TGF-β ( 3.2±1.2 pg/ml) however is reduced 3.8-fold versus healthy controls (12.3±1.1 pg/ml).
T395 316825-317010 Sentence denotes In erosive chronic OLP there is an increase in IL-1 by 1.8fold, an increase of TNF-α by 1.8-fold and an increase of TGF-β (29.6±2.2 pg/ml) compared to healthy controls (12.3±1.1 pg/ml).
T396 317011-317187 Sentence denotes In chronic OLP IL-1 indexes were increased 3.7-fold in comparison to OLP relapse and TNF-α increased 7.7-fold and TGF-β increased 9.2 -fold compared to disease relapse(p<0.05).
T397 317188-317200 Sentence denotes Conclusions:
T398 317201-317525 Sentence denotes Acute relapse and chronic stages of lichen planus of the oral mucosa are characterized by immunological changes detectable in peripheral blood serum including increases in concentrations of IL-1, TNF -α, TGF-β, characteristic of development of a recurrent inflammatory immune response and chronic persistent erosive disease.
T399 317526-317528 Sentence denotes A.
T400 317529-317545 Sentence denotes Hancharou 1 , N.
T401 317546-317563 Sentence denotes Antonevich 1 , V.
T402 317564-317579 Sentence denotes Chekan 1 , L.M.
T403 317580-317595 Sentence denotes DuBuske *2 , 1.
T404 317596-317614 Sentence denotes Minsk, Belarus; 2.
T405 317615-317627 Sentence denotes Gardner, MA.
T406 317628-317641 Sentence denotes Introduction:
T407 317642-317868 Sentence denotes Nasal mucosa contains olfactory epithelium-derived ectomesenchymal stem cells (hOE-EMSC), which are similar to mesenchymal stem cells derived from bone marrow and adipose tissue and which may have immunosuppressive properties.
T408 317869-317877 Sentence denotes Methods:
T409 317878-317977 Sentence denotes Nasal mucosa samples were taken from 4 patients with non-inflammatory diseases of the nasal cavity.
T410 317978-318037 Sentence denotes Explant culture methods were used to obtain hOE-EMSC cells.
T411 318038-318131 Sentence denotes Cells were assayed for phenotype (CD90, CD105, CD45, CD273, CD274, CD80, CD86, CD40, nestin).
T412 318132-318207 Sentence denotes Culture media from hOE-EMSC were collected and used in further experiments.
T413 318208-318343 Sentence denotes PBMC isolated from donor blood were primed with CFSE, cocultured with hOE-EMSC for 3 days plus PHA, and then assayed for proliferation.
T414 318344-318482 Sentence denotes PBMC were also cultured without hOE-EMSC with the addition of PHA (positive control), and with the addition of hOE-EMSC conditioned media.
T415 318483-318491 Sentence denotes Results:
T416 318492-318543 Sentence denotes Cells obtained were CD90 + CD105 + nestin + CD45 -.
T417 318544-318635 Sentence denotes The ability of hOE-EMSC to inhibit mitogen-induced proliferation of CD4+ T cells was shown.
T418 318636-318748 Sentence denotes The immunosuppressive effect did not depend on soluble factors produced by stem cells, including interleukin-10.
T419 318749-318846 Sentence denotes Direct contact of hOE-EMSC with lymphocytes was required to exhibit immunosuppressive properties.
T420 318847-318946 Sentence denotes HOE-EMSC expressed the co-inhibitory molecules CD273 and CD274 but were negative for CD80 and CD86.
T421 318947-319021 Sentence denotes Immunosuppressive properties were dependent on CD273 and CD274 expression.
T422 319022-319033 Sentence denotes Conclusion:
T423 319034-319264 Sentence denotes The hOE-EMSC possesses immunosuppressive properties and may possibly be used in cellular immunotherapy of immune system disorders including autoimmune diseases and could possibly assist in prevention of organ and tissue rejection.
T424 319265-319267 Sentence denotes A.
T425 319268-319284 Sentence denotes Hancharou 1 , G.
T426 319285-319302 Sentence denotes Davidovich 1 , I.
T427 319303-319318 Sentence denotes Ramanava 1 , E.
T428 319319-319332 Sentence denotes Duzh 1 , L.M.
T429 319333-319348 Sentence denotes DuBuske *2 , 1.
T430 319349-319367 Sentence denotes Minsk, Belarus; 2.
T431 319368-319380 Sentence denotes Gardner, MA.
T432 319381-319394 Sentence denotes Introduction:
T433 319395-319584 Sentence denotes The content of minor leukocyte subsets in the patients with infectious mononucleosis (IM) may be altered including monocyte, dendritic cell (DC) and myeloid-derived suppressor cells (MDSC).
T434 319585-319593 Sentence denotes Methods:
T435 319594-319703 Sentence denotes 12 patients with acute IM, confirmed by blood serum and saliva PCR analysis, were selected for investigation.
T436 319704-319788 Sentence denotes Whole blood from 10 healthy volunteers matched by age and sex was used as a control.
T437 319789-320029 Sentence denotes Relative and absolute counts of leukocyte subsets were assayed using FACSCanto II cytometer: CD1c + and CD141 + myeloid DC, plasmacytoid DC, CD14 + /CD16 + blood monocytes and monocytic (M-MDSC) and granulocytic (CD15 + and CD33 + ) G-MDSC.
T438 320030-320038 Sentence denotes Results:
T439 320039-320188 Sentence denotes In patients with IM statistically significant myeloid DC subset redistribution was seen with increase of CD141 + cells (CD1c/CD141 index in patients:
T440 320189-320222 Sentence denotes 1.9(1.4-2.6), versus in controls:
T441 320223-320289 Sentence denotes 6.2(5.6-7.3), =0.00013), suggesting a role in the pathogenesis IM.
T442 320290-320366 Sentence denotes Decrease of plasmacytoid dendritic cell counts in IM was observed (patients:
T443 320367-320400 Sentence denotes 0.04(0.02-0.11)% versus controls:
T444 320401-320441 Sentence denotes 0.4(0.250-0.520)%, p=0,000001; patients:
T445 320442-320485 Sentence denotes 0.003(0.002-0.01)×10 6 /ml versus controls:
T446 320486-320590 Sentence denotes 0.022(0.013-0.032)×10 6 /ml, p=0.00017), suggesting migration to lymphoid tissue or selective depletion.
T447 320591-320675 Sentence denotes Monocytic myeloid-derived suppressor cell counts were reduced in acute IM (patients:
T448 320676-320711 Sentence denotes 0.075(0.05-0.135)% versus controls:
T449 320712-320862 Sentence denotes 0.32(0.23-0.37)%, p=0.011), explaining EBV-induced immune system hyper-stimulation and increase of HLA-DR expression on virtually all APC and T-cells.
T450 320863-321035 Sentence denotes Increase of absolute (p=0.052) and relative (p=0.09) CD15 + G-MDSC counts were seen in IM but no statistically significant differences in the number of CD33 + G-MDSC cells.
T451 321036-321274 Sentence denotes Significant variability of content of G-MDSC and "intermediate" and "nonclassical" monocyte subsets were noted such as in IM with CD15 + G-MDSC minimum of 0.01% and maximum of 0.22% versus controls minimum of 0.022% and maximum of 0.167%.
T452 321275-321286 Sentence denotes Conclusion:
T453 321287-321372 Sentence denotes Significant changes in the number of minor leukocyte subsets in blood are seen in IM.
T454 321373-321448 Sentence denotes These changes may explain some of the clinical immune manifestations of IM.
T455 321449-321451 Sentence denotes A.
T456 321452-321466 Sentence denotes Khojah *1 , A.
T457 321467-321481 Sentence denotes Bukhari 1 , O.
T458 321482-321494 Sentence denotes Alpan 2 , 1.
T459 321495-321510 Sentence denotes Chicago, IL; 2.
T460 321511-321522 Sentence denotes Vienna, VA.
T1 321523-321533 Sentence denotes Rationale:
T2 321534-321786 Sentence denotes Despite the growing use of flow cytometry in evaluation of various immunodeficiency disorders, there are limited number of studies that discuss the gender effect on the reference range of different B cell subsets, especially in the pediatric age group.
T3 321787-321891 Sentence denotes The aim of this study was to evaluate the effect of gender on B cell maturation in different age groups.
T4 321892-321900 Sentence denotes Methods:
T5 321901-321951 Sentence denotes Total of 988 subjects were included in this study.
T6 321952-322100 Sentence denotes We excluded all adults whose age is 22 or older, all subjects with known primary or secondary immunodeficiency and patients with incomplete work up.
T7 322101-322266 Sentence denotes All Subjects had normal evaluation including CBC, serum immunoglobulin, antibody response to vaccine especially pneumococcal titers (for subjects more than 2 years).
T8 322267-322357 Sentence denotes Clinical and laboratory data including B cell subset were obtained from patients' records.
T9 322358-322417 Sentence denotes Subjects were divided into seven groups based on their age.
T10 322418-322533 Sentence denotes Using T test, we compared between males and females in each age group in terms of different B cell sub-populations.
T11 322534-322575 Sentence denotes Data was analyzed using SPSS, version 22.
T12 322576-322584 Sentence denotes Results:
T13 322585-322695 Sentence denotes Both, the absolute B cell count and the percentage of B cell, drop significantly in the first 7 years of life.
T14 322696-322746 Sentence denotes That drop was equal in the male and female groups.
T15 322747-322887 Sentence denotes The mean of CD5+ B cell was 4 to10 % higher in males versus females in all age categories except in subjects between 19 and 21 years of age.
T16 322888-323082 Sentence denotes This difference reaches statistical significance in the age groups between 13 and18 years, which might suggest a possible, but not previously described, hormonal effect on the B cell maturation.
T17 323083-323185 Sentence denotes Overall, females have higher mean of switched B cell (IgG+, IgA+) and lower mean of IgM+, IgD+ B cell.
T18 323186-323259 Sentence denotes Yet, these differences are more significant between 10 to18 years of age.
T19 323260-323271 Sentence denotes Conclusion:
T20 323272-323473 Sentence denotes These graphs highlight the difference between males and females in terms of B cell sub-populations, and the importance of having gender-specific reference ranges especially in the adolescent age group.
T21 323474-323545 Sentence denotes Our results suggest a possible hormonal influence on B cell maturation.
T22 323546-323600 Sentence denotes Further research is needed to investigate this theory.
T23 323601-323900 Sentence denotes Introduction: CREST syndrome (Calcinosis, Raynaud's phenomenon, esophageal dysmotility, sclerodactyle, and telangiectasia) or systemic sclerosis with limited scleroderma is very rare in children, and mainly involves skin, subcutaneous tissues, muscle and bones, and does not involve internal organs.
T24 323901-323968 Sentence denotes The usual onset of scleroderma is approximately 30-65 years of age.
T25 323969-324018 Sentence denotes Its incidence in children is one per one million.
T26 324019-324036 Sentence denotes Case Description:
T27 324037-324609 Sentence denotes An 8 year old African American girl with past medical history significant for being born at 28 weeks GA, via C-section due to abruptio placenta and pre-eclampcia, intubated right after delivery, required 3 months of NICU care, with multiple blood transfusions, PDA closed with indomethacin, pubarche at 5 years of age, with negative work up, who presented with over all 10 months history of non-pruritic, off white, rashes on elbows, knees that over the course of few months had turned hard and looked as if they were warts and finally calcified over the next few months .
T28 324610-324690 Sentence denotes Also 10 months history of "icy cold" fingers and toes with bluish discoloration.
T29 324691-324949 Sentence denotes On physical examination there were multiple calcified nodules on extensor surfaces of the elbows, finger tips with protruding calcified papules, sclerodactily of fingers, and telangiectasia along with bluish discoloration of finger tips to the level of PIPs.
T30 324950-324999 Sentence denotes Biopsy of the lesions confirmed calcinosis cutis.
T31 325000-325088 Sentence denotes Laboratory investigation including CBC, ESR, CMP, ANA with reflex remained inconclusive.
T32 325089-325132 Sentence denotes Chest x-ray did not indicate any pathology.
T33 325133-325143 Sentence denotes Treatment:
T34 325144-325263 Sentence denotes She was started on monthly IVIG infusion along with daily PO Prednisolone, weekly PO Methotrexate and daily folic acid.
T35 325264-325427 Sentence denotes Her symptoms greatly improved over 4-5 month, calcinosis of the finger tips resolved, while the rate of eruption of the new calcified lesions slowed .and resolved.
T36 325428-325563 Sentence denotes Discussion: CREST syndrome is a very rare disease in children, our patient had 4 out of 5 findings and improved after outlined therapy.
T37 325564-325649 Sentence denotes Treatment for scleroderma needs to be started promptly to avoid future complications.
T38 325650-325721 Sentence denotes In general prognosis of sclerosis in children is better than in adults.
T39 325722-327396 Sentence denotes Rationale:Intravenous gammaglobulin(IVIG) administration for immunodeficiency disease is rarely associated with a delayed serious, adverse reaction of aseptic meningitis.This condition is usually related to high doses of IVIG (1-2gm/kg).The pathogenesis is postulated to be an osmotic shift caused by small amounts of IVIG penetrating the cerebrospinal fluid and/or antineutrophil antibodies in some IVIG products activating neutrophils in the central nervous system.(1) Methods :Case Report We present a 36 year old white female with 1) selective antibody deficiency and hypogammaglobulinemia 2)car-diomyopathy with implanted pacemaker (2009)and recurrent pericaridi-tis3)moderate persistent asthma on Advair and Alvesco 4)depression and 5) a migraine condition admitted with aseptic meningitis after first infusion of IVIG 400mg /kg over 3 hours in a monitored setting.She develped a severe,pulsating, diffuse occipital, temporal and parietal headaches with retro orbital pain beginning 6 hours post infusion.The pain exacerbated with any motion of the head or neck,cough or bearing down and was associated with visual alterations and inability to register words or numbers.She experienced dull pain radiating down the neck to left precordial area and left shoulder and arm with fever,nausea and diarrhea 24 hours prior to admision.CT scan of the head demonstrated right maxillary sinus air fluid levels.Lumbar puncture(LP) revealed normal glucose 49mg/dl,normal protein 36mg/dl,WBC 512/mm3 and RBC 59/mm3 47%segmented neutrophils,51%mononuclear cells and 2%eosinophils with negative cerebrospinal fluid cultures and relief of symptoms consistent with aseptic meningitis .
T40 327397-327739 Sentence denotes She had a history of recurrent sinusitis and admissions for "pneumonia" 2009-13 .Her original immune evaluation demonstrated IgG 651mg/dl(694-1618mg/dl),normal IgM(132mg/dl),A(298mg/dl), and protective tetanus titers but nonprotective pneumococcal titers( 13/14) despite recurrent immunizations and varicella zoster titers were nonprotective.
T41 327740-327828 Sentence denotes Results:Aseptic meningitis was treated with systemic steroids and Omnicef for sinusitis.
T42 327829-327922 Sentence denotes IgG replacement was subsequently changed to subcutaneous route without further complications.
T43 327923-328015 Sentence denotes Conclusion Aseptic meningitis is a rare delayed adverse event following IVIG administration.
T44 328016-328026 Sentence denotes Rationale:
T45 328027-328207 Sentence denotes Hemophagocytic lymphohistiocytosis (HLH) is a rare clinical syndrome characterized by uncontrolled activation of lymphocytes and macrophages producing elevated levels of cytokines.
T46 328208-328384 Sentence denotes A clinically challenging diagnosis to make, HLH manifests as fevers, cytopenias, hepatosplenomegaly, hyperferritinemia, elevated IL-2, hepatic failure, and neurologic symptoms.
T47 328385-328505 Sentence denotes We present a case of a patient with persistently high fevers, pancytopenia, hyperferritinemia that was diagnosed as HLH.
T48 328506-328514 Sentence denotes Methods:
T49 328515-328700 Sentence denotes A 28 year old Native American male presented with fever, chills, myalgias, arthralgias, bilateral lower extremity edema, and a fifty-six pound unintentional weight loss in three months.
T50 328701-328870 Sentence denotes Neither high dose prednisone for Adult Onset Still's disease, nor broad spectrum antibiotics for an infectious etiology improved the fever or hepatic synthetic function.
T51 328871-328879 Sentence denotes Results:
T52 328880-328953 Sentence denotes Ferritin was extremely elevated to 16,173 ng/mL (reference range 22-322).
T53 328954-329032 Sentence denotes Serum immunoglobulins, including IgG, IgA, and IgM, were within normal limits.
T54 329033-329088 Sentence denotes Concentration of sCD25 and IL-2 receptor were elevated.
T55 329089-329136 Sentence denotes Fibrinogen was low and triglycerides were high.
T56 329137-329208 Sentence denotes Infectious serologies and cultures including EBV and CMV were negative.
T57 329209-329242 Sentence denotes Autoimmune markers were negative.
T58 329243-329295 Sentence denotes White blood cell count with differential was normal.
T59 329296-329354 Sentence denotes Liver biopsy showed steatohepatitis with stage 2 fibrosis.
T60 329355-329394 Sentence denotes Flow cytometry showed normal phenotype.
T61 329395-329499 Sentence denotes Bone marrow biopsy showed prominent hemophagocytosis consistent with hemophagocytic lymphohistiocytosis.
T62 329500-329511 Sentence denotes Conclusion:
T63 329512-329738 Sentence denotes Our patient met seven of the eight diagnostic criteria for HLH, including fever, splenomegaly, cytopenias, hypofibrinogenemia and hypertriglyceridemia, elevated ferritin, elevated sCD25 and hemophagocytosis in the bone marrow.
T64 329739-329844 Sentence denotes Delays in this challenging diagnosis can result in high mortality rates due to multisystem organ failure.
T65 329845-329988 Sentence denotes Because biopsies of affected sites may be normal or misinterpreted, repeat biopsies are sometimes necessary if clinical suspicion remains high.
T66 329989-330088 Sentence denotes We suspect hepatic involvement in our patient despite the lack of hemophagocytosis on liver biopsy.
T67 330089-330259 Sentence denotes Treatment algorithms include etoposide, dexamethasone, antithymocyte globulin, cyclosporine A, intravenous immunoglobulin, alemtuzumab, and hematopoietic cell transplant.
T68 330260-330403 Sentence denotes In patients with persistent fever, hepatosplenomegaly and cytopenias, the challenging diagnosis of HLH should be considered for prompt therapy.
T69 330404-330406 Sentence denotes A.
T70 330407-330417 Sentence denotes Ali * , M.
T71 330418-330442 Sentence denotes Segal, Philadelphia, PA.
T72 330443-330456 Sentence denotes Introduction:
T73 330457-330566 Sentence denotes Eosinophilic esophagitis (EoE) is a condition in which inflammatory cells invade the mucosa of the esophagus.
T74 330567-330639 Sentence denotes Few cases have described the association of EoE with parasitic diseases.
T75 330640-330709 Sentence denotes We present a case of EoE in a young man with Strongyloides infection.
T76 330710-330718 Sentence denotes Methods:
T77 330719-330783 Sentence denotes A 21 year old male returns from a medical mission trip to Kenya.
T78 330784-330882 Sentence denotes Upon his return, he develops an eruptive rash on his abdomen that is self-limiting after 3 months.
T79 330883-330983 Sentence denotes He also develops a cough and worsening dysphagia and is initially treated medically for acid reflux.
T80 330984-331025 Sentence denotes Despite treatment, these symptoms worsen.
T81 331026-331114 Sentence denotes He also experiences intermittent diarrhea, ranging from loose to watery bowel movements.
T82 331115-331245 Sentence denotes Labs display eosinophilia (eosinophil count 600 c/mL (10.2%) (normal 500 c/mL)) and normal immunoglobulin E (IgE) level (93 kU/L).
T83 331246-331254 Sentence denotes Results:
T84 331255-331437 Sentence denotes After months of worsening dysphagia and cough, an esophagogastroduodenoscopy reveals mucosal changes including longitudinal furrows and circumferential folds in the entire esophagus.
T85 331438-331602 Sentence denotes Pathology displays squamous mucosal eosinophilia with 57 in 1 high power field (normal <15 per high power field), seen superficially and deep with no microabcesses.
T86 331603-331651 Sentence denotes A diagnosis of eosinophilic esophagitis is made.
T87 331652-331781 Sentence denotes After one month of no resolution with swallowed corticosteroid solution, his allergist is prompted to pursue a parasitic work up.
T88 331782-331886 Sentence denotes A strongyloides immunoglobulin G (IgG) antibody (Ab) ELISA is elevated at 1.22 units/mL (normal, <1.00).
T89 331887-331927 Sentence denotes Ova and parasite stool test is negative.
T90 331928-331967 Sentence denotes Treatment with ivermectin is initiated.
T91 331968-332061 Sentence denotes His dysphagia resolves after anti-parasitic treatment, but his shortness of breath continues.
T92 332062-332186 Sentence denotes Labs show persistent eosinophilia, and he is given a second treatment of ivermectin with resolution of respiratory symptoms.
T93 332187-332198 Sentence denotes Conclusion:
T94 332199-332297 Sentence denotes EoE is a condition that can lead to permanent sequelae including esophageal scarring and fibrosis.
T95 332298-332496 Sentence denotes Strongyloides infection can cause a systemic eosinophilia, and in this patient the eosinophilia from the untreated Strongyloides infection was associated with esophageal infiltration of eosinophils.
T96 332497-332643 Sentence denotes Strongyloides is treated with anti-parasitic agents, and can be monitored by symptom resolution, eosinophilia on labs, or repeat strongyloides Ab.
T97 332644-332654 Sentence denotes Rationale:
T98 332655-332954 Sentence denotes Wolf-Hirschhorn syndrome (WHS) is a genetic disorder due to partial deletion of the distal short arm of chromosome 4, with characteristic features including facial, cardiac and skeletal abnormalities, developmental delay, growth retardation, and a high mortality rate in the first two years of life.
T99 332955-333104 Sentence denotes Though no known genes associated with immunodeficiency reside on the short arm of chromosome 4, these patients can present with immune dysregulation.
T100 333105-333227 Sentence denotes Limited data shows patients with WHS most commonly have defects in humoral immunity, while T-cell immunity remains intact.
T101 333228-333299 Sentence denotes To date, there has been one reported case of an isolated T-cell defect.
T102 333300-333411 Sentence denotes We present the first reported case of a child with WHS with deficiencies in both humoral and cellular immunity.
T103 333412-333420 Sentence denotes Methods:
T104 333421-333546 Sentence denotes The patient is a 2 year old female with 4p16.3 chromosomal deletion and characteristic clinical findings consistent with WHS.
T105 333547-333694 Sentence denotes She was referred to us for severe hypogammaglobulinemia noted on hospital admission for acute respiratory failure secondary to parainfluenza virus.
T106 333695-333703 Sentence denotes Results:
T107 333704-333961 Sentence denotes The patient has a history of methicillin sensitive S. aureus bacteremia, two episodes of pneumonia requiring intravenous antibiotics, recurrent acute otitis media infections requiring two sets of myringotomy tubes, and bacterial colonization of her bladder.
T108 333962-334004 Sentence denotes Her childhood vaccinations are up to date.
T109 334005-334261 Sentence denotes Immunologic evaluation revealed low IgG (185 mg/dL), IgM (13 mg/dL) and IgA (24 mg/dL), poor antibody response to diphtheria vaccination (0.02 IU/mL), and absent antibody response to tetanus (<0.1 IU/mL) and Prevnar 13 (0/23 serotypes protective) vaccines.
T110 334262-334449 Sentence denotes Lymphocyte subset enumeration demonstrated decreased absolute CD3 (998 cells/mcL; normal 1400-3700), CD19 (154 cells/mcL; normal 390-1400) and CD8 (240 cells/mcL; normal 490-1300) counts.
T111 334450-334502 Sentence denotes Mitogen stimulation, CH50, AH50 and MBL were normal.
T112 334503-334552 Sentence denotes Random stool alpha 1antitrypsin level was normal.
T113 334553-334705 Sentence denotes She began monthly immunoglobulin replacement and the severity of her infections has improved, with no further hospital admissions for bacterial illness.
T114 334706-334718 Sentence denotes Conclusions:
T115 334719-334796 Sentence denotes Immunodeficiency is a possible cause of early mortality in patients with WHS.
T116 334797-334892 Sentence denotes This is the first report of a patient with WHS with deficiencies in both B-and T-cell lineages.
T117 334893-335057 Sentence denotes Thorough immunologic evaluation and appropriate management for combined immunodeficiency may drastically improve survival and quality of life for affected patients.
T118 335058-335136 Sentence denotes Bacitracin is often considered to be an innocuous over-the-counter medication.
T119 335137-335286 Sentence denotes However, both T cell-mediated and IgE-mediated allergic reactions have been reported with increasing frequency, presumably due to its widespread use.
T120 335287-335432 Sentence denotes We describe two cases of IgE-mediated reactions to bacitracin confirmed by positive skin prick testing (testing for second case in figure below).
T121 335433-335570 Sentence denotes The first case is of a 53-year-old female who developed diffuse hives following bacitracin irrigation during breast augmentation surgery.
T122 335571-335718 Sentence denotes The second case describes a 40-year-old man who developed anaphylaxis following the application of a topical bacitracin ointment to blistered skin.
T123 335719-335849 Sentence denotes In both cases, the patient had a history of prior reaction to a triple antibiotic preparation before reacting to bacitracin alone.
T124 335850-336116 Sentence denotes This case series demonstrates the variable routes of exposure causing allergic reactions, initially suspected neomycin allergy with resultant recommendation to use bacitracin alone, and the utility of skin prick testing to confirm bacitracin as the culprit allergen.
T125 336117-336356 Sentence denotes Physicians need to be cognizant of the potentially serious consequences of using topical antibiotics on damaged skin and mucosal surfaces, and furthermore, consider bacitracin as equally important as neomycin in causing allergic reactions.
T126 336357-336507 Sentence denotes Allergists can provide skin prick testing to the components of triple antibiotic ointments to confirm an IgEmediated mechanism for allergic reactions.
T127 336508-336586 Sentence denotes Positive skin prick tests to bacitracin and bacitracin/polymixin Introduction:
T128 336587-336729 Sentence denotes Bilateral periorbital swelling raises a wide differential diagnosis that includes both benign inflammatory conditions and malignant disorders.
T129 336730-336959 Sentence denotes It may be a presentation of IgG4-related disease which is a recently emerged systemic condition characterized by unique lymphoplasmacytic infiltration of soft tissues by IgG4 plasma cells that can affect a wide variety of organs.
T130 336960-337128 Sentence denotes Histopathologic and immunohistochemical analysis is important in the diagnosis of this disease and to differentiate it from other inflammatory and malignant conditions.
T131 337129-337239 Sentence denotes We present a case of bilateral periorbital swelling which was initially diagnosed as organ limited vasculitis.
T132 337240-337318 Sentence denotes However with further investigation he was diagnosed with IgG4-related disease.
T133 337319-337331 Sentence denotes Case Report:
T134 337332-337471 Sentence denotes Patient is a 21 year old male with no significant past medical history who presented with fluctuating bilateral eyelid swelling for 1 year.
T135 337472-337550 Sentence denotes The swelling was associated with pain and redness isolated to around the eyes.
T136 337551-337655 Sentence denotes Review of systems was negative for throat swelling, hives, fevers, chills, night sweats, or weight loss.
T137 337656-337749 Sentence denotes He was initially placed on high dose prednisone which only temporarily improved his swelling.
T138 337750-337819 Sentence denotes Shortly after the steroids were discontinued the swelling reappeared.
T139 337820-337878 Sentence denotes MRI showed symmetric bilateral lacrimal gland enlargement.
T140 337879-337955 Sentence denotes Labs including ESR, CRP, ANCA, ANA, and IgG4 level were within normal range.
T141 337956-338025 Sentence denotes He had peripheral eosinophilia with absolute eosinophil count of 830.
T142 338026-338161 Sentence denotes Initial lacrimal gland biopsy was read as non-necrotizing perivascular granulomatous infiltrate that involves small arteries and veins.
T143 338162-338240 Sentence denotes He was initially diagnosed with Eosinophilic Granulomatosis with Polyangiitis.
T144 338241-338342 Sentence denotes He had no other medical history or organ involvement suggestive of small vessel vasculitic syndromes.
T145 338343-338546 Sentence denotes Biopsy slides were sent to a specialty laboratory who reported fibrosis, obliterative phlebitis, as well as 174 IgG4 plasma cells/high powered field consistent with the diagnosis of IgG4-Related Disease.
T146 338547-338653 Sentence denotes He was subsequently treated with azathioprine and had significant improvement of his periorbital swelling.
T147 338654-338665 Sentence denotes Conclusion:
T148 338666-338776 Sentence denotes Integration of clinical, radiographic, and histopathologic data is necessary to diagnose IgG4-related disease.
T149 338777-339016 Sentence denotes Biopsy with special staining for IgG4 plasma cells interpreted by an experienced pathologist is an important part of diagnosis and should be considered in any patient with bilateral lacrimal gland swelling to identify IgG4-related disease.
T150 339017-339030 Sentence denotes Introduction:
T151 339031-339135 Sentence denotes Common variable immunodeficiency (CVID) is the most common clinically significant primary immune defect.
T152 339136-339274 Sentence denotes Although 70% to 80% of patients have had recurrent sinopulmonary infections, auto-immunity and inflammatory complications are also common.
T153 339275-339287 Sentence denotes Case Report:
T154 339288-339415 Sentence denotes We present the case of a 16 years old girl, who was admitted with a history of fatigue, weakness, pallor, edema of lower limbs.
T155 339416-339473 Sentence denotes Physical examination was positive for Raynaud phenomenon.
T156 339474-339546 Sentence denotes The diagnosis of systemic lupus erythematosus (SLE) was made based on 1.
T157 339547-339676 Sentence denotes Proteinuria cellular casts, nephritis with low glomerular filtration rate, requiring replacement management with hemodialysis, 2.
T158 339677-339713 Sentence denotes Hemolytic anemia and lymphopenia, 3.
T159 339714-339738 Sentence denotes Pericardial effusion, 4.
T160 339739-339931 Sentence denotes Central nervous system disorder with acute confusional state with cerebral MRI angiography showing irregular contours in distal segments and beading trend in vessels of medium and small size .
T161 339932-340076 Sentence denotes Laboratory work-up showed Antinuclear antibody with a speckled pattern at a low titer; ANCA, anti DNA, lupus anticoagulant, B2GP1 were negative.
T162 340077-340133 Sentence denotes Hypogammaglobulinemia and hypocomplementemia were found.
T163 340134-340356 Sentence denotes Antibodies in the urine were positive for anti DNA at high titers, 333.2 U/ml (0-9.6U/ml): supporting the diagnosis of SLE.The patient had a torpid evolution, with severe sepsis, pancreatitis and gastrointestinal bleeding.
T164 340357-340489 Sentence denotes She developed neurological impairment, seizures and Broca's aphasia, an MRI revealed ischemia in temporal and generalized vasospasm.
T165 340490-340746 Sentence denotes Given the persistence of hypogammaglobulinemia at the expense of IgG and IgM as well as a history of multiple infectious events including pneumonia requiring mechanical ventilation, urinary tract infection by Pseudomonas aeruginosa and Serratia marscenses.
T166 340747-340920 Sentence denotes Flow cytometry showing impaired lymphocyte subpopulation B (marked decrease in CD19 and CD20), lymphopenia at the expense of the subpopulation of T lymphocytes CD3 +, CD4 +.
T167 340921-340949 Sentence denotes NK cells without alteration.
T168 340950-341082 Sentence denotes Isohemagglutinins (anti A1) for blood groups reported in 1:16 dilution, and no response to immunization of Streptococcus pneumoniae.
T169 341083-341095 Sentence denotes Conclusions:
T170 341096-341184 Sentence denotes Clinicians should be aware about the relation between immunodeficiency and autoimmunity.
T171 341185-341302 Sentence denotes Autoimmune diseases affect about 20% of CVID patients and are commonly the first manifestations of immune deficiency.
T172 341303-341422 Sentence denotes The pathogenesis of autoimmunity in immune deficiency is unclear for the most part, further investigation must be done.
T173 341423-341436 Sentence denotes Introduction:
T174 341437-341706 Sentence denotes Bronchial thermoplasty (BT), approved by the US Food and Drug Administration in 2010, is a novel technique that uses radiofrequency energy during bronchoscopy to reduce the amount of built-up excess smooth muscle tissues and spasms in the airways of asthmatic patients.
T175 341707-341951 Sentence denotes Several randomized clinical trials (AIR, RISA, AIR2 Trials) have reported the efficacy of BT on patients that have been unable to attain adequate control of their disease with high doses of inhaled corticosteroids and long-acting beta-agonists.
T176 341952-342141 Sentence denotes The results from these studies demonstrated overall reduction of symptoms, reduction in the number of asthma attacks requiring emergency room care, and improvement in patients' AQLQ scores.
T177 342142-342306 Sentence denotes Recently, the Global Initiative for Asthma has recognized BT as an add-on treatment option at the GINA Step 5 level for select adults with severe persistent asthma.
T178 342307-342411 Sentence denotes We report a successful case of bronchial thermoplasty in a patient with severe-persistent atopic asthma.
T179 342412-342424 Sentence denotes Case Report:
T180 342425-342629 Sentence denotes We present a 47 year old Iranian American male with allergic rhinitis, nasal polyposis, obstructive sleep apnea, reflux disease, and severe persistent allergic asthma who underwent bronchial thermoplasty.
T181 342630-342894 Sentence denotes Previously, his asthma remained difficult to control despite multi-drug therapy [montelukast,mometasone furoate/ formoterol fumarate dihydrate, theophylline, tiotropium bromide, loratadine, olopatadine nasal spray, fluticasone furoate nasal spray, and omalizumab].
T182 342895-343014 Sentence denotes Prior to the procedure, he had an average FEV1 of 40%, ACT scores <19, and levalbuterol use 3-6 times a day for relief.
T183 343015-343200 Sentence denotes Since the completion of the BT procedure 1 year ago, the patient has been able to decrease his levalbuterol use to about once a day, improve his latest FEV1 to 70%, and ACT score to 25.
T184 343201-343308 Sentence denotes He has not experienced severe exacerbations requiring ER visits or hospitalization over the past 12 months.
T185 343309-343441 Sentence denotes Furthermore, he has been able to discontinue several of his previous medications, such as montelukast, tiotropium, and theophylline.
T186 343442-343453 Sentence denotes Conclusion:
T187 343454-343631 Sentence denotes This is the first case report of an atopic asthmatic patient successfully treated by bronchial thermoplasty after failure of conventional and several non-conventional therapies.
T188 343632-343840 Sentence denotes This case demonstrates that for some highly-select adult patients with difficult to manage allergic asthma, a referral to an asthma specialty center with bronchial thermoplasty should be considered Objective:
T189 343841-344022 Sentence denotes To assess the safety of replacing angiotensin-converting enzyme inhibitors (ACEI) with angiotensin II receptor blockers (ARBs) in patients with a history of ACEI induced angioedema.
T190 344023-344094 Sentence denotes Angioedema has been associated with ACEI use in hypertension treatment.
T191 344095-344236 Sentence denotes Angiotensin II receptor blockers have long been considered a safe alternative treatment for hypertension in cases of ACEI induced angioedema.
T192 344237-344426 Sentence denotes Angiotensin II receptor blockers selectively block the binding of angiotensin II to the AT1 receptor and therefore do not cause accumulation of kinins which subsequently lead to angioedema.
T193 344427-344435 Sentence denotes Methods:
T194 344436-344456 Sentence denotes Case Report Results:
T195 344457-344548 Sentence denotes A 57 yr old Caucasian male experienced an acute episode of angioedema with laryngeal edema.
T196 344549-344604 Sentence denotes He experienced swelling of his tongue, lips and larynx.
T197 344605-344689 Sentence denotes The angioedema failed to respond to two doses of epinephrine and IM diphenhydramine.
T198 344690-344747 Sentence denotes He required a tracheostomy and ICU admission for 14 days.
T199 344748-344839 Sentence denotes The patient was discontinued from his home medications, which included irbesartan (Avapro).
T200 344840-344942 Sentence denotes The angioedema persisted for 7 days, and failed to respond to I.V. corticosteroids and antihistamines.
T201 344943-345034 Sentence denotes His history revealed acute episode of angioedema 5 years prior during a surgical procedure.
T202 345035-345138 Sentence denotes The patient was under conscious sedation, and he experienced unilateral tongue swelling upon awakening.
T203 345139-345236 Sentence denotes He was being treated with lisinopril at the time for hypertension and was switched to irbesartan.
T204 345237-345324 Sentence denotes Subsequently, the patient claimed he experienced intermittent episodes of lip swelling.
T205 345325-345408 Sentence denotes He was evaluated for Hereditary Angioedema, and all labs were within normal limits.
T206 345409-345478 Sentence denotes Immunocap to food and environmental allergy was unremarkable as well.
T207 345479-345517 Sentence denotes An autoimmune panel was also negative.
T208 345518-345609 Sentence denotes He has not experienced any episodes of angioedema since being discontinued from irbesartan.
T209 345610-345622 Sentence denotes Conclusions:
T210 345623-345690 Sentence denotes The patient's angioedema appeared to be related to his ARB therapy.
T211 345691-345812 Sentence denotes In the ONTARGET trial, the incidence of ARB induced angioedema was 0.1 % compared to 0.3% for ACEI associated angioedema.
T212 345813-345948 Sentence denotes Although the incidence of ARB induced angioedema is lower than ACEI, life-threatening complications such as laryngeal edema may result.
T213 345949-346095 Sentence denotes The mechanism of ARB associated angioedema has not been clearly established, but studies have shown that ARBs may also increase bradykinin levels.
T214 346096-346256 Sentence denotes Therefore, other classes of anti-hypertensive medications should be considered as first line replacements in patients with a history of ACEI induced angioedema.
T215 346257-346312 Sentence denotes BLACK RUBBER AND P-PHENYLENEDIAMINE CONTACT DERMATITIS.
T216 346313-346315 Sentence denotes C.
T217 346316-346326 Sentence denotes Lin * , M.
T218 346327-346351 Sentence denotes Frieri, East Meadow, NY.
T219 346352-346365 Sentence denotes Introduction:
T220 346366-346521 Sentence denotes Contact dermatitis is a common skin inflammation that occurs when foreign substances irritate the skin, characterized by erythematous and pruritic lesions.
T221 346522-346597 Sentence denotes Contact dermatitis has been well documented in over 3000 chemical triggers.
T222 346598-346669 Sentence denotes P-Phenylenediamine, as a chemical substance is widely used in hair dye.
T223 346670-346753 Sentence denotes Its partially oxidized state can cause allergic reactions in sensitive individuals.
T224 346754-346759 Sentence denotes Case:
T225 346760-346942 Sentence denotes A 61 year old white female was referred to the allergy clinic from the emergency department for an intensely diffuse rash on her skin disseminated from the neck to waist for 2 weeks.
T226 346943-347018 Sentence denotes She also complained of a pin and needle sticking pain within the rash area.
T227 347019-347102 Sentence denotes She had hair dye at a salon 2 days before she developed the pain and skin reaction.
T228 347103-347164 Sentence denotes There was no shortness of breath, stridor or throat symptoms.
T229 347165-347229 Sentence denotes Past medical history included seasonal allergy and food allergy.
T230 347230-347296 Sentence denotes Skin prick tests revealed positive for grass, trees and dust mite.
T231 347297-347358 Sentence denotes She takes cetirizine all year around for allergy prophylaxis.
T232 347359-347446 Sentence denotes On physical examination, she was alert, oriented, and afebrile with stable vital signs.
T233 347447-347556 Sentence denotes Her skin showed an extensively maculopapular rash randomized throughout from her neck to chest and back area.
T234 347557-347565 Sentence denotes Methods:
T235 347566-347691 Sentence denotes A skin patch test disclosed a positive test for p-Phenylenediamine and black rubber mix. sIgE testing for latex was negative.
T236 347692-347795 Sentence denotes She was advised to avoid known allergic related chemicals, continue to take cetirizine or fexofenadine.
T237 347796-347833 Sentence denotes The rash and pain gradually improved.
T238 347834-347845 Sentence denotes Conclusion:
T239 347846-347907 Sentence denotes Contact dermatitis can result from hair dye hypersensitivity.
T240 347908-348028 Sentence denotes Its severity ranges from a mild localized rash to a widespread allergic dermatitis reaction or even rarely, anaphylaxis.
T241 348029-348099 Sentence denotes The diagnosis relies upon a detailed history and physical examination.
T242 348100-348184 Sentence denotes The skin patch test remains the gold standard to confirm contact allergic reactions.
T243 348185-348266 Sentence denotes Avoidance of exposure to rubber products, causative hair dye should be withdrawn.
T244 348267-348385 Sentence denotes Systemic anti-histamines are often needed and in severe patients, a short course of systemic steroids may be required.
T245 348386-348490 Sentence denotes Prevention could be achieved by testing oxidative dyes before use or switched to non-oxidative hair dye.
T246 348491-348648 Sentence denotes Patients should also be careful with rubber products and cross-reacting chemicals or drugs such as printing inks, temporary black henna tattoos Introduction:
T247 348649-348715 Sentence denotes Drug allergy can limit essential therapeutic options for patients.
T248 348716-348896 Sentence denotes Hypersensitivity to monoclonal antibodies has been documented in adult patients, but desensitization to this class of drugs has not been well described in the pediatric population.
T249 348897-349015 Sentence denotes Here, we present a pediatric patient with hypersensitivity to rituximab who underwent successful drug desensitization.
T250 349016-349024 Sentence denotes Methods:
T251 349025-349126 Sentence denotes Desensitization to rituximab was completed via a modified 12-step, 3-bag method in an inpatient unit.
T252 349127-349331 Sentence denotes The protocol started at an initial dose of .0057 mg with doubling of the dose at 20-minute intervals, with the proposed final step to be infused at 75 cc/hr to provide at total therapeutic dose of 285 mg.
T253 349332-349462 Sentence denotes The child developed significant rash prior to the last step, and thus future protocols reduced the infusion rate of the last step.
T254 349463-349539 Sentence denotes The patient was monitored after completion of each desensitization protocol.
T255 349540-349548 Sentence denotes Results:
T256 349549-349706 Sentence denotes A 7-year-old boy with neonatal biliary atresia status post remote liver transplant developed EBV negative post transplant lymphoproliferative disease (PTLD).
T257 349707-349860 Sentence denotes Rituximab were required for treatment of the child's PTLD, but he developed urticaria and cough with infusions despite premedication with antihistamines.
T258 349861-349959 Sentence denotes As rituximab was a critical part of the child's chemotherapy, urgent desensitization was required.
T259 349960-350085 Sentence denotes The patient underwent the desensitization protocol, but developed diffuse skin erythema prior to completion of the last dose.
T260 350086-350171 Sentence denotes The protocol was therefore modified as described above, with increased premedication.
T261 350172-350273 Sentence denotes The child tolerated subsequent desensitization protocols, and completed his chemotherapeutic regimen.
T262 350274-350286 Sentence denotes Conclusions:
T263 350287-350490 Sentence denotes This is one of the only reported cases of successful desensitization to rituximab monoclonal antibody in a pediatric patient, and includes strategies for patients who have reactions during the procedure.
T264 350491-350576 Sentence denotes This protocol will be beneficial for future patients with rituximab hypersensitivity.
T265 350577-350590 Sentence denotes Introduction:
T266 350591-350810 Sentence denotes Autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED) is a primary immune deficiency (PID) associated with autoimmune sequelae; however, chronic idiopathic urticaria (CIU) is a very rare manifestation.
T267 350811-351004 Sentence denotes While omalizumab is effective in patients with CIU, its mechanism of action in these patients is not completely understood and its role in autoimmunity and anti-FceRI autoantibodies is unclear.
T268 351005-351112 Sentence denotes We present a case of CIU in an APECED patient refractory to standard therapy that resolved with omalizumab.
T269 351113-351239 Sentence denotes Case: APECED was diagnosed at age 9 after an ICU admission for severe hypocalcemia and tetany secondary to hypoparathyroidism.
T270 351240-351363 Sentence denotes Genetic testing revealed the patient was a compound heterozygote with muta-tions R257X and c.967_979del13 in the AIRE gene.
T271 351364-351594 Sentence denotes The patient's clinical manifestations included chronic mucocutaneous candidiasis, hypoparathyroidism, adrenal insufficiency with positive 21-hydroxalase antibodies, vitiligo, hypoplastic dental and nail enamel, and delayed growth.
T272 351595-351692 Sentence denotes At age 13 she developed chronic urticaria despite high dose antihistamines and daily montelukast.
T273 351693-351804 Sentence denotes Laboratory workup revealed the presence of anti-FceRI autoantibodies without progression of autoimmune disease.
T274 351805-351923 Sentence denotes Treatment with omalizumab 150mg led to resolution of symptoms after one month and reduction of daily oral medications.
T275 351924-352074 Sentence denotes The patient is currently under treatment every 8 weeks with omalizumab and will stop therapy soon to evaluate for possible remission of her urticaria.
T276 352075-352087 Sentence denotes Conclusions:
T277 352088-352224 Sentence denotes Omalizumab appears to be an effective therapy for CIU in APECED; however, questions remain regarding its underlying mechanism of action.
T278 352225-352365 Sentence denotes The rare appearance of CIU in this patient population seems to run counter to the hypothesis that CIU is associated with autoimmune disease.
T279 352366-352548 Sentence denotes Our patient highlights the need for further research to better characterize the relationship of CIU with immune dysregulation and how therapy with omalizumab influences this process.
T280 352549-352560 Sentence denotes Background:
T281 352561-352711 Sentence denotes Systemic mastocytosis (SM) can be associated with clonal hematological disorders like myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML).
T282 352712-352791 Sentence denotes Most of the SM-AML cases have translocation t(8;21) and mutation of c-kit gene.
T283 352792-352834 Sentence denotes Rarely, specific SM treatment is required.
T284 352835-352978 Sentence denotes We present a patient with SM-AML without t (8; 21) and c-kit mutation who developed refractory hypotension due to mast cells mediators release.
T285 352979-353034 Sentence denotes Methods: case report; review of literature Case Report:
T286 353035-353264 Sentence denotes 53 year old female was diagnosed with myeloproliferative-myelodysplastic syndrome which evolved to high risk MDS with complex cytogenetics (deletion of chromosomes 5,7 and trisomy 8) for which she received induction chemotherapy.
T287 353265-353392 Sentence denotes After discharge she developed urticaria that slowly responded to daily antihistamines and was thought to be medication related.
T288 353393-353484 Sentence denotes She relapsed with AML (similar cytogenetics) in 3 months and received re-induction therapy.
T289 353485-353568 Sentence denotes The course was complicated by Enterobacter bacteremia that cleared with daptomycin.
T290 353569-353679 Sentence denotes However, she developed severe persistent hypotension along with new diffuse pruritic maculo-erythematous rash.
T291 353680-353710 Sentence denotes Skin biopsy showed spongiosis.
T292 353711-353819 Sentence denotes The patient was transferred to intensive care unit requiring vasopressors which were difficult to taper off.
T293 353820-353896 Sentence denotes Cardiac and septic shock were excluded as causes for refractory hypotension.
T294 353897-354091 Sentence denotes Repeat BM biopsy for induction response revealed clearance of myeloid blasts but showed 20% CD 117 + oval spindle-shaped mast cells, which were positive for tryptase and negative c-kit mutation.
T295 354092-354126 Sentence denotes Serum tryptase level was 42 ng/ml.
T296 354127-354301 Sentence denotes The patient was diagnosed with SM-AML and started on histamine-1, histamine-2 and leukotriene receptors blockers with significant improvement in blood pressure and skin rash.
T297 354302-354349 Sentence denotes After 2 weeks she died from multiorgan failure.
T298 354350-354361 Sentence denotes Conclusion:
T299 354362-354481 Sentence denotes This is the first reported case of refractory hypotension due to mast cells mediators release in a patient with SM-AML.
T300 354482-354570 Sentence denotes Moreover, no cases of SM-AML without t(8;21) or c-kit mutation were previously reported.
T301 354571-354679 Sentence denotes From the sequence of clinical events we believe that the mast cells were uncovered by the treatment for AML.
T302 354680-354750 Sentence denotes As a result, the diagnosis of SM was made after cytoreductive therapy.
T303 354751-354859 Sentence denotes It is imperative that clinicians are aware of coexistence of SM in clonal malignant hematological disorders.
T304 354860-354935 Sentence denotes If clinically suspected, prompt treatment improves the SM-related symptoms.
T305 354936-355034 Sentence denotes Color additives are frequently used in processed foods to impart color and enhance its appearance.
T306 355035-355206 Sentence denotes The US Food and Drug Administration (FDA) is responsible for regulating color additives in commercial foods to ensure safety and accurate labeling of approved ingredients.
T307 355207-355281 Sentence denotes Synthetically produced colors are FDA-certified and listed in food labels.
T308 355282-355378 Sentence denotes However, natural color additives are exempt from FDA-certification and labeled as natural color.
T309 355379-355506 Sentence denotes Annatto is a natural color additive extracted from the seeds of Bixa Orella trees that imparts an orange-yellow color to foods.
T310 355507-355649 Sentence denotes The prevalence of adverse reactions to food additives in the US is less than 1% in adults but 2-7% in children and higher in those with atopy.
T311 355650-355721 Sentence denotes We present an IgE mediated reaction to annatto in a 4 y/o atopic child.
T312 355722-355834 Sentence denotes She developed urticaria within minutes of eating mac and cheese at a chain restaurant on two separate occasions.
T313 355835-355969 Sentence denotes She also had urticaria with angioedema immediately after eating ice cream sandwiches, pasteurized cheese and boxed cheeseburger pasta.
T314 355970-356077 Sentence denotes She tolerates chocolate, peanut, hazelnut, milk, wheat and egg ingredients in above foods without reaction.
T315 356078-356172 Sentence denotes Ingredient review for the mac and cheese and ice cream sandwiches both contained annatto seed.
T316 356173-356243 Sentence denotes The boxed cheeseburger pasta only listed natural flavors and coloring.
T317 356244-356340 Sentence denotes Skin prick test to annatto extract was positive (8x30 mm) compared to negative control (5x9 mm).
T318 356341-356455 Sentence denotes Use of annatto as natural alternative to artificial color is exempt from FDA certification and gaining popularity.
T319 356456-356552 Sentence denotes It is labeled as all natural, no artificial food coloring, achiote, pimentao, bixin or norbixin.
T320 356553-356663 Sentence denotes Annatto is used in cheeses, dairy spreads, rice, custard powder, baked goods, snacks, cereals and smoked fish.
T321 356664-356767 Sentence denotes Despite its widespread use, there have only been 2 cases in adults of IgE mediated reaction to annatto.
T322 356768-356841 Sentence denotes We present the first case of IgE mediated reaction to annatto in a child.
T323 356842-357086 Sentence denotes Our patient had no other food allergies and the timing of ingestion of annatto-containing food and development of symptoms with a positive immediate hypersensitivity skin test to annatto extract is highly suggestive of an IgE mediated reaction.
T324 357087-357220 Sentence denotes It is increasingly important to investigate reactions to natural food coloring in patients with symptoms to multiple unrelated foods.
T325 357221-357360 Sentence denotes As advocates for our patients, allergists should advocate for FDA certification and specific labeling for all natural flavors and coloring.
T326 357361-357372 Sentence denotes Background:
T327 357373-357493 Sentence denotes Dermatomyositis (DM) is an idiopathic autoimmune myopathy that predominantly targets the skin and skeletal musculatures.
T328 357494-357688 Sentence denotes This report describes an unusual case of a patient having both Extraovarian Primary Peritoneal Carcinoma (EOPPC) and Abdominal Cocoon Syndrome (ACS) who initially presented with Dermatomyositis.
T329 357689-357702 Sentence denotes Case Summary:
T330 357703-357769 Sentence denotes This is a case report of 47-year old woman admitted due to rashes.
T331 357770-357923 Sentence denotes History revealed that 7 months prior to admission, there was note of multiple, pruritic erythematous macula rashes prominent on the face, neck and chest.
T332 357924-357990 Sentence denotes She was admitted and managed as case of hypersensitivity reaction.
T333 357991-358278 Sentence denotes Six months prior to admission, the skin lesions over the face and chest recurred associated with raised violaceous, scaly papules on the metacarpophalangeal, proximal interphalangeal and distal interphalangeal joints on both hands and erythematous, cracked and roughened periungal areas.
T334 358279-358337 Sentence denotes Patient was readmitted and diagnosed with dermatomyositis.
T335 358338-358385 Sentence denotes She was started on prednisone and methotrexate.
T336 358386-358579 Sentence denotes Three months prior to admission, an abdominal distention associated with difficulty of breathing was noted and underwent abdominal CT scan revealing moderate ascites thus paracentesis was done.
T337 358580-358636 Sentence denotes Ascitic fluid analysis was positive for malignant cells.
T338 358637-358674 Sentence denotes Medical oncologic consult was sought.
T339 358675-358921 Sentence denotes Patient came in with BMI of 18.3 kg/m2, pale conjunctivae, macular hyperpigmented lesions at the neck and shoulder area, scaly papules at the MCP, PIP, DIP of both hands, distended abdomen with shifting dullness and grade 1 pitting bipedal edema.
T340 358922-358976 Sentence denotes CA-125 was elevated among the requested tumor markers.
T341 358977-359216 Sentence denotes Exploratory laparotomy with tenckhoff catheter insertion was done with. intraoperative findings of encapsulated mass, thick walled containing the bowels adherent to the anterior abdominal wall and sidewalls and foul smelling ascitic fluid.
T342 359217-359255 Sentence denotes Uterus and both ovaries were atrophic.
T343 359256-359309 Sentence denotes Biopsy of peritoneal tissue revealed psammoma bodies.
T344 359310-359371 Sentence denotes With these pertinent findings, EOPPC and ACS were considered.
T345 359372-359444 Sentence denotes Patient endured cycles of chemotherapy using Carboplatin and Paclitaxel.
T346 359445-359456 Sentence denotes Conclusion:
T347 359457-359519 Sentence denotes The incidence of classic DM is 5.5 cases per million per year.
T348 359520-359668 Sentence denotes The reported frequency of malignancy varied from 6% to 60% with most large population based cohort studies revealing a frequency of about 20 to 25%.
T349 359669-359679 Sentence denotes Objective:
T350 359680-359791 Sentence denotes To assess the appropriate evaluation and management options for a patient with Seabather's Eruption (Sea Lice).
T351 359792-359965 Sentence denotes Seabather's Eruption is an entity that should be included in the differential diagnosis of patients presenting with rashes and appropriate supportive care should be offered.
T352 359966-359974 Sentence denotes Methods:
T353 359975-359995 Sentence denotes Case Report Results:
T354 359996-360145 Sentence denotes This is a 12 year old female from South Florida that presented with a rash that started under her bathing suit top after going swimming in the ocean.
T355 360146-360186 Sentence denotes The rash was maculopapular and pruritic.
T356 360187-360296 Sentence denotes It spread from her torso to her hands and feet and then became generalized with sparing of the head and neck.
T357 360297-360358 Sentence denotes Symptoms started about 2 hours after coming out of the ocean.
T358 360359-360464 Sentence denotes Patient had gone into the ocean previously even swimming at the same general beach area without incident.
T359 360465-360577 Sentence denotes Patient also claimed that her family was with her in the same ocean water and did not develop the same symptoms.
T360 360578-360698 Sentence denotes Crusting of the rash with associated blistering with additional pruritis and discomfort followed over the next 3-4 days.
T361 360699-360723 Sentence denotes Vital signs were stable.
T362 360724-360793 Sentence denotes There was blistering and crusting noted on the skin on physical exam.
T363 360794-360979 Sentence denotes Patient was given hydrocortisone 2.5% ointment to be applied topically in a thin layer to the affected areas as needed only and placed on cetirizine 10 mg po daily for 2 weeks duration.
T364 360980-360991 Sentence denotes Discussion:
T365 360992-361111 Sentence denotes Seabather's eruption is a self limited reaction that results in a highly pruritic papular rash on exposure to seawater.
T366 361112-361196 Sentence denotes It results from a hypersensitivity to thimble jellyfish larva (Linuche Unguiculata).
T367 361197-361272 Sentence denotes Cases are noted from March to August but peak incidence is in May and June.
T368 361273-361337 Sentence denotes The eruption is seen in the United States east coast of Florida.
T369 361338-361451 Sentence denotes Bathing suits are believed to trap the larvae which then discharge a venom, the significance of which is unknown.
T370 361452-361679 Sentence denotes Swimmers washing themselves off with fresh water with their bathing suits off and those that refrain from wearing their bathing suits for an extended period of time are found to be better protected against Seabather's Eruption.
T371 361680-361691 Sentence denotes Conclusion:
T372 361692-361793 Sentence denotes Providers should be careful to avoid narrow differential diagnoses when patients present with rashes.
T373 361794-362020 Sentence denotes Seabather's eruption should be considered in the differential in patients presenting with pruritus and papular rash and proper history and physical exam should be conducted to ascertain relevant information for this diagnosis.
T374 362021-362090 Sentence denotes Supportive measures with symptomatic care is the treatment of choice.
T375 362091-362101 Sentence denotes Rationale:
T376 362102-362176 Sentence denotes Drug allergy consults are challenging due to the dearth of published data.
T377 362177-362270 Sentence denotes Furthermore, there are few international journals who publish case reports of drug allergies.
T378 362271-362425 Sentence denotes This study aims to determine the utility of a website-based database of drug allergy case reports and desensitization protocols among American allergists.
T379 362426-362566 Sentence denotes An online survey was administered to American allergists, who are members of the American Academy of Allergy, Asthma and Immunology (AAAAI).
T380 362567-362575 Sentence denotes Methods:
T381 362576-362654 Sentence denotes A semi-structured survey was created and administered to members of the AAAAI.
T382 362655-362729 Sentence denotes The questions were split into two parts: demographics and database design.
T383 362730-362868 Sentence denotes The demographics section of the survey strives to ascertain the types of drugs commonly consulted for and the frequency of these consults.
T384 362869-363072 Sentence denotes The next section attempts to elucidate how American allergists proceed with desensitization protocols-earlier research with Canadian allergists showed that personal experience was the most used resource.
T385 363073-363081 Sentence denotes Results:
T386 363082-363127 Sentence denotes 193 members of the AAAAI answered the survey.
T387 363128-363251 Sentence denotes In terms of what percentage of consults were related to drug allergies 62.1% estimated 1-10%, with 22.6% estimating 10-25%.
T388 363252-363400 Sentence denotes When discussing which drugs patients are consulted about-the vast majority (>95%) said they had been consulted for Peni-cillins, and Cephalosporins.
T389 363401-363527 Sentence denotes Similarly when asked which drugs they had been consulted for a desensitization protocol 93.1% of respondents named penicillin.
T390 363528-363740 Sentence denotes When asked what resources they use for researching desensitization protocols 82.8% said specific E-Journals, 76.6% said E Journal search database, and 69.3% use online search databases such as google or Uptodate.
T391 363741-363972 Sentence denotes When asked if they would utilize a website database of case reports on drug hypersensitivity reactions and desensitization protocols 82.9% responded yes with 54.1% of respondents also being interested in submitting to the database.
T392 363973-364249 Sentence denotes In discussing the characteristics that would be most important in the database respondents felt overwhelmingly (>85%) that it should be structured and contain information pertaining to patient demographics, medication usage, desensitization protocols and patient presentation.
T393 364250-364261 Sentence denotes Conclusion:
T394 364262-364363 Sentence denotes There is widespread support among American Allergists for the creation of a database of drug allergy.
T395 364364-364479 Sentence denotes The next logical step is to gather support to create this database, which will require a multistakeholder approach.
T396 364480-364493 Sentence denotes Introduction:
T397 364494-364755 Sentence denotes The pungency of extra virgin olive oil (EVOO) is attributed to one of its phenolic compounds called oleocanthal (OC) and is mediated through the transient receptor channel potential cation channel ankyrin subtype 1 (TRPA1) expressed in the posterior oropharynx.
T398 364756-364899 Sentence denotes EVOO also mimics the pharmacology of ibuprofen in that both agents cause a dose-dependent inhibition of cyclooxygenase enzymes COX-1 and COX-2.
T399 364900-365002 Sentence denotes EVOO sensitivity has been described in the literature previously however EVOO desensitization has not.
T400 365003-365114 Sentence denotes Herein we report the first case of successful EVOO desensitization using a novel EVOO desensitization protocol.
T401 365115-365132 Sentence denotes Case Description:
T402 365133-365412 Sentence denotes A 25-year-old patient with medical history significant for aspirin sensitivity, exercise induce asthma and mixed vasomotor and allergic rhinitis presented with a history of facial and tongue pruritus, throat irritation, coughing and hives within minutes of olive oil consumption.
T403 365413-365499 Sentence denotes Symptoms required diphenhydramine however several prior episodes required epinephrine.
T404 365500-365617 Sentence denotes A series of food and drug challenges were entertained to establish the mechanism of EVOO sensitivity in this patient.
T405 365618-365673 Sentence denotes Also a novel EVOO desensitization protocol was devised.
T406 365674-365884 Sentence denotes Discussion: EVOO desensitization has not been attempted previously in the literature and in this report we describe the first case of successful EVOO desensitization using a novel EVOO desensitization protocol.
T407 365885-366019 Sentence denotes Furthermore the patient continues to be in a desensitized state 2 years after the procedure maintained with daily doses of 10 ml EVOO.
T408 366020-366214 Sentence denotes Although the mechanism of her reaction is likely due to OC stimulation of TRPA1, the mechanism of desensitization and maintenance of the desensitized state is unclear and requires further study.
T409 366215-366219 Sentence denotes A.S.
T410 366220-366232 Sentence denotes Chau *1 , L.
T411 366233-366249 Sentence denotes Helfner 2 , V.R.
T412 366250-366267 Sentence denotes Bonagura 2 , A.M.
T413 366268-366281 Sentence denotes Jongco 2 , 1.
T414 366282-366297 Sentence denotes Mineola, NY; 2.
T415 366298-366313 Sentence denotes Great Neck, NY.
T1 366314-366325 Sentence denotes Background:
T2 366326-366442 Sentence denotes Mast cell activation disorders (MCAD) affect multiple systems and are caused by episodic mast cell mediator release.
T3 366443-366608 Sentence denotes Intrinsic defects in mast cell proliferation or activation are found in primary MCAD such as systemic mastocytosis (SM) and monoclonal mast cell activation syndrome.
T4 366609-366753 Sentence denotes In secondary MCAD such as allergic disorders, mast cells that are normal in quantity and function respond to external stimuli (i.e., allergens).
T5 366754-366875 Sentence denotes In idiopathic MCAD, such as mast cell activation syndrome (MCAS), there is no identifiable cause of mast cell activation.
T6 366876-366959 Sentence denotes We describe the longitudinal clinical course and management of a patient with MCAS.
T7 366960-366968 Sentence denotes Methods:
T8 366969-367229 Sentence denotes A 49-year-old woman diagnosed with autoimmune disorder, not otherwise specified, status post thymectomy originally presented with chronically elevated IgE and ANA, alopecia universalis, weight loss, chronic idiopathic urticaria and multiple food sensitivities.
T9 367230-367336 Sentence denotes Extensive evaluation revealed multiple aeroallergen hypersensitivity and unremarkable bone marrow studies.
T10 367337-367446 Sentence denotes There was no evidence of immune deficiency, autoimmunity, IgE-mediated food allergies, SM and celiac disease.
T11 367447-367455 Sentence denotes Results:
T12 367456-367512 Sentence denotes Urine histamine and histamine release assay were normal.
T13 367513-367556 Sentence denotes Serum tryptase was unremarkable repeatedly.
T14 367557-367659 Sentence denotes Her symptoms did not improve after trials of immunosuppressive and immunoglobulin replacement therapy.
T15 367660-367951 Sentence denotes In collaboration with the Center of Excellence for Mastocytosis and Mast Cell Activation Disorders at Brigham and Women's Hospital, she was started on an aggressive anti-inflammatory regimen including H1 and H2 antihistamines, cromolyn, monteleukast and omalizumab more than three years ago.
T16 367952-368133 Sentence denotes This resulted in sustained weight gain, improved tolerance to previously sensitive foods and aeroallergens, minimal hair regrowth, and decreased frequency and severity of urticaria.
T17 368134-368239 Sentence denotes Despite improvements on optimal medical therapy, overall symptom control and quality of life remain poor.
T18 368240-368431 Sentence denotes The patient is considering other treatment modalities including allogeneic hematopoietic stem cell transplantation, which has been described in two small series for SM with variable outcomes.
T19 368432-368574 Sentence denotes Conclusions: MCAS is a diagnosis of exclusion that warrants consideration in patients with chronic multisystem complaints of unclear etiology.
T20 368575-368719 Sentence denotes MCAS diagnosis and management are evolving; additional research is necessary for understanding the etiology and natural history of this disease.
T21 368720-368733 Sentence denotes Introduction:
T22 368734-368791 Sentence denotes Breastfeeding anaphylaxis is rare, but potentially fatal.
T23 368792-368890 Sentence denotes Symptoms range from urticaria to hypotension and syncope and occur in close relation to lactation.
T24 368891-369050 Sentence denotes The pathogenesis of the reaction remains unclear; however, hormone shifts related to the end of gestation and the beginning of lactation seemingly play a role.
T25 369051-369383 Sentence denotes Waning levels of progesterone postpartum and loss of its mast cell stabilizing effect has been one hypothesized mechanism, though the roles of oxytocin, prolactin, adrenocorticotrophic hormone (ACTH), corticotropin-releasing hormone (CRH) and increased numbers of antepartum mammary and uterine mast cells have also been questioned.
T26 369384-369438 Sentence denotes In addition, NSAIDs may also be a contributing factor.
T27 369439-369447 Sentence denotes Methods:
T28 369448-369543 Sentence denotes Presentation, evaluation, diagnosis and management of a patient with breastfeeding anaphylaxis.
T29 369544-369549 Sentence denotes Data:
T30 369550-369676 Sentence denotes A 25 year old gravida 3 para 3 woman was admitted with anaphylaxis on postpartum day 3 following the birth of her third child.
T31 369677-369743 Sentence denotes She had breastfed her first child for 2 months without difficulty.
T32 369744-369848 Sentence denotes Three days after the delivery of her second child, she developed isolated urticaria after breastfeeding.
T33 369849-369902 Sentence denotes She discontinued breastfeeding and symptoms resolved.
T34 369903-369963 Sentence denotes Her third child was born via uncomplicated vaginal delivery.
T35 369964-370074 Sentence denotes She had been taking 600 mg of ibuprofen every 8 hours following the delivery, but was on no other medications.
T36 370075-370142 Sentence denotes Breastfeeding was uneventful for the first 48 hours after delivery.
T37 370143-370307 Sentence denotes On postpartum day 3, however, with the first breastfeeding after generation of mature milk, she developed diffuse urticaria, tongue swelling, emesis, and dizziness.
T38 370308-370371 Sentence denotes On admission, she was tachycardic, tachypneic, and hypotensive.
T39 370372-370473 Sentence denotes A tryptase level obtained 6 hours after the episode was elevated at 14.6 ng/mL (normal < 11.5 ng/mL).
T40 370474-370520 Sentence denotes The patient desired to continue breastfeeding.
T41 370521-370606 Sentence denotes She was placed on prophylactic cetirizine 10 mg BID and all NSAIDs were discontinued.
T42 370607-370690 Sentence denotes She subsequently breastfed successfully for 24 hours while under close observation.
T43 370691-370703 Sentence denotes Conclusions:
T44 370704-370805 Sentence denotes Our patient had anaphylaxis with breastfeeding on postpartum day 3 when lactogenesis was established.
T45 370806-370939 Sentence denotes She subsequently tolerated 24 hours of breastfeeding without difficulty with the use of cetirizine 10 mg BID and avoidance of NSAIDs.
T46 370940-371101 Sentence denotes Our case suggests that mothers with a history of breastfeeding anaphylaxis and a desire to breastfeed can likely do so with appropriate treatment and counseling.
T47 371102-371112 Sentence denotes Objective:
T48 371113-371257 Sentence denotes To determine the safety of replacing mesalamine with other 5aminosalicylic (5-ASA) formulations in patients with hypersensitivity to mesalamine.
T49 371258-371395 Sentence denotes Patients with inflammatory bowel disease (IBD) such as ulcerative colitis are usually treated with 5-ASA preparations such as mesalamine.
T50 371396-371522 Sentence denotes These drugs are first line medications used to treat mild to moderate ulcerative colitis due to their steroid-sparing effects.
T51 371523-371638 Sentence denotes Balsalazide is a dimerized 5-ASA preparation that may be tolerated in patients with hypersensitivity to mesalamine.
T52 371639-371786 Sentence denotes Due to its structural differences, dimerized 5-ASA medications may be considered to be safe alternatives due to a presumed lack of crossreactivity.
T53 371787-371795 Sentence denotes Methods:
T54 371796-371816 Sentence denotes Case Report Results:
T55 371817-371941 Sentence denotes A 39-year-old Caucasian female presented to our service after experiencing anaphylaxis following use of mesalamine (Asacol).
T56 371942-372036 Sentence denotes She had been using mesalamine for 19 years to control her mild to moderate ulcerative colitis.
T57 372037-372165 Sentence denotes Six months ago, she experienced diffuse urticaria and generalized pruritus one hour after taking her morning dose of mesalamine.
T58 372166-372231 Sentence denotes She took diphenhydramine, and her symptoms resolved within hours.
T59 372232-372324 Sentence denotes The next day, she took her morning dose of mesalamine and experienced immediate anaphylaxis.
T60 372325-372400 Sentence denotes She developed laryngeal edema, diffuse urticaria, and generalized pruritus.
T61 372401-372470 Sentence denotes The patient was treated with epinephrine, and her symp-toms resolved.
T62 372471-372575 Sentence denotes The patient underwent a provocative drug challenge with balsalazide (Giazo) in our clinic over two days.
T63 372576-372682 Sentence denotes The patient reacted on the second day when she experienced swelling of her hands and generalized pruritus.
T64 372683-372796 Sentence denotes The patient was administered oral antihistamines and corticosteroids and her symptoms resolved within four hours.
T65 372797-372809 Sentence denotes Conclusions:
T66 372810-372911 Sentence denotes Cross-reactivity may occur between different 5-ASA preparations despite their structural differences.
T67 372912-373035 Sentence denotes Patients with inflammatory bowel disease who are hypersensitive to mesalamine may also react to balsalazide and olsalazine.
T68 373036-373162 Sentence denotes Mesalamine hypersensitive patients should not be started on these medications without undergoing a provocative drug challenge.
T69 373163-373271 Sentence denotes We designed an outpatient protocol that will safely enable patients to undergo testing in an office setting.
T70 373272-373285 Sentence denotes Introduction:
T71 373286-373360 Sentence denotes Allergists are commonly asked to evaluate the etiology of tongue swelling.
T72 373361-373513 Sentence denotes We report a case of a woman with 16 days of tongue swelling secondary to endotracheal tube (ETT)-induced vascular obstruction of the base of the tongue.
T73 373514-373522 Sentence denotes Methods:
T74 373523-373535 Sentence denotes Case Report.
T75 373536-373541 Sentence denotes Data:
T76 373542-373756 Sentence denotes A 55 year-old female with systemic lupus erythematosis, end-stage renal disease, hypertension, and congestive heart failure presented to the emergency department with acute onset shortness of breath and somnolence.
T77 373757-373845 Sentence denotes MRI revealed bilateral intraventricular hemorrhage and chest imaging revealed pneumonia.
T78 373846-373898 Sentence denotes She was intubated secondary to respiratory distress.
T79 373899-373986 Sentence denotes Tongue swelling was reported 2 days after intubation and worsened over the next 2 days.
T80 373987-374112 Sentence denotes Physical examination revealed a swollen tongue, which was at least 2-3 times the size of normal, protruding out of her mouth.
T81 374113-374166 Sentence denotes Pressure ulcers were noted on the base of the tongue.
T82 374167-374215 Sentence denotes Laboratory evaluation revealed normal C3 and C4.
T83 374216-374285 Sentence denotes Due to concern for oropharyngeal edema, a tracheostomy was performed.
T84 374286-374422 Sentence denotes Swelling had not improved 14 days after intubation and a 4 day course of dexamethasone was administered without improvement in swelling.
T85 374423-374497 Sentence denotes Tongue swelling improved 1 day post-extubation and resolved within 2 days.
T86 374498-374569 Sentence denotes Past medical history was significant for lisinopril-induced angioedema.
T87 374570-374729 Sentence denotes The patient did not receive an ACE-inhibitor or ARB prior to or during admission and medication regimen did not change prior to or post-resolution of swelling.
T88 374730-374933 Sentence denotes The differential diagnosis of tongue swelling includes hereditary angioedema (AE), acquired AE, medication-related AE, mechanical obstruction, and sublingual hematoma secondary to a difficult intubation.
T89 374934-375062 Sentence denotes Tongue swelling was attributed to venous obstruction secondary to local mechanical compression of the base of the tongue by ETT.
T90 375063-375216 Sentence denotes This is supported by a normal C4, onset of swelling after ETT placement and resolution after ETT removal, and the prolonged course of swelling (16 days).
T91 375217-375230 Sentence denotes Introduction:
T92 375231-375330 Sentence denotes Immunoglobulins (Ig) are routinely used in management of Primary Immune Deficiency diseases (PIDD).
T93 375331-375414 Sentence denotes Ig formulations differ based on the content of IgG, IgA, osmolality and stabilizer.
T94 375415-375507 Sentence denotes Most adverse reactions to IVIG are either due to a rapid rate of infusion or IgA deficiency.
T95 375508-375594 Sentence denotes We report a case of hypersensitivity reaction to the stabilizer in the Ig formulation.
T96 375595-375603 Sentence denotes Methods:
T97 375604-375760 Sentence denotes A 50 year old female with a 3-year history of CVID was referred by her allergist for management of hypersensitivity reaction to subcutaneous immunoglobulin.
T98 375761-375923 Sentence denotes She had been treated with subcutaneous hizentra weekly for 2 years; however, 2 months ago she developed an urticarial rash 20 minutes after taking her usual dose.
T99 375924-376119 Sentence denotes Subsequent doses caused immediate symptoms of throat closure, difficulty breathing, swallowing and low blood pressure requiring treatment with epinephrine, prednisone and antihistamine in the ER.
T100 376120-376187 Sentence denotes She denied symptoms of nausea, vomiting, fever, chills or headache.
T101 376188-376279 Sentence denotes Hizentra was subsequently discontinued and she was referred to UTMB for further evaluation.
T102 376280-376413 Sentence denotes On evaluation, her history was negative for allergic or anaphylactic reactions to other medications and IgA deficiency was ruled out.
T103 376414-376478 Sentence denotes Skin prick testing to Ig was not helpful due to dermatographism.
T104 376479-376596 Sentence denotes The patient was treated with Gammagard, chosen for the differences in osmolality and stabilizer content vs. Hizentra.
T105 376597-376720 Sentence denotes Patient received a slow infusion of Gammagard and was subsequently switched to SC administration without further reactions.
T106 376721-376732 Sentence denotes Discussion:
T107 376733-376837 Sentence denotes Hizentra contains the stabilizers L-proline and polysorbate 80, whereas Gammagard contains only glycine.
T108 376838-376920 Sentence denotes Polysorbate 80 is commonly used in vaccines, chemotherapy and tablet formulations.
T109 376921-377096 Sentence denotes It has been reported to cause non IgE mediated anaphylactic reactions in patients receiving Docetaxal and is the most likely cause of hypersensitivity reaction in our patient.
T110 377097-377175 Sentence denotes No hypersensitivity reactions with L-proline have been reported in literature.
T111 377176-377369 Sentence denotes Hizentra also has higher osmolality as compared to Gammagard but the adverse reactions due to high osmolality usually include thrombosis and kidney injury which were not present in our patient.
T112 377370-377381 Sentence denotes Conclusion:
T113 377382-377507 Sentence denotes We report a rare case of hypersensitivity reaction to a stabilizer in Hizentra, an Ig formulation used for treatment of PIDD.
T114 377508-377660 Sentence denotes This report alerts the allergist/immunologist about work up and management of patient's with hypersensitivity reaction to an immunoglobulin formulation.
T115 377661-377663 Sentence denotes L.
T116 377664-377677 Sentence denotes Finkas * , R.
T117 377678-377697 Sentence denotes Katial, Denver, CO.
T118 377698-377711 Sentence denotes Introduction:
T119 377712-377782 Sentence denotes A rare case of eosinophilic cholecystitis in a patient with AERD Case:
T120 377783-377883 Sentence denotes 50-year-old male with past medical history of asthma, chronic sinusitis with nasal polyps, and AERD.
T121 377884-377996 Sentence denotes He underwent aspirin desensitization a few years prior and had improvement in both his asthma and sinus disease.
T122 377997-378109 Sentence denotes Following desensitization, he was maintained on aspirin 650 mg BID and was subsequently decreased to 325 mg BID.
T123 378110-378255 Sentence denotes He presented for routine 6 month follow up at which time he had been experiencing significant gastrointestinal symptoms for the previous 3 weeks.
T124 378256-378344 Sentence denotes His symptoms began as indigestion and heartburn and progressed to diarrhea and vomiting.
T125 378345-378451 Sentence denotes His PMD had placed him on a course of antibiotics, but despite antibiotics, he continued to have symptoms.
T126 378452-378504 Sentence denotes Stool studies were obtained and C-diff was negative.
T127 378505-378580 Sentence denotes His aspirin dose was decreased to 81 mg without improvement in GI symptoms.
T128 378581-378723 Sentence denotes Further diagnostics were pursued and complete blood count was notable for an elevated WBC of 14,000 with an absolute eosinophil count of 6100.
T129 378724-378784 Sentence denotes Liver function tests, ESR and CRP were within normal limits.
T130 378785-378890 Sentence denotes He was evaluated in the emergency room given his persistent symptoms and was found to have cholecystitis.
T131 378891-379023 Sentence denotes He underwent a cholecystectomy and pathology revealed transmural inflammatory cell infiltrate composed predominantly of eosinophils.
T132 379024-379119 Sentence denotes Bone marrow biopsy, EGD and colonoscopy were performed for possible hypereosinophilic syndrome.
T133 379120-379226 Sentence denotes His bone marrow biopsy was negative for FIP1L1/PDGFRA mutation and was only notable for mild eosinophilia.
T134 379227-379289 Sentence denotes EGD and colonoscopy were negative for eosinophilic infiltrate.
T135 379290-379382 Sentence denotes He remained on aspirin during this time and following his surgery increased to 325 mg daily.
T136 379383-379537 Sentence denotes Following cholecystectomy, the patient had significant improvement in his peripheral eosinophilia and his eosinophil count retuned to his baseline of 400.
T137 379538-379577 Sentence denotes His gastrointestinal symptoms resolved.
T138 379578-379589 Sentence denotes Conclusion:
T139 379590-379789 Sentence denotes This is the first case of a rare eosinophilic process isolated to the gallbladder in a patient with AERD, which in itself is manifested by increased circulating eosinophils in over half the patients.
T140 379790-379962 Sentence denotes The authors have previously reported rare complication of pancreatitis after aspirin desensitization and a few unpublished cases of increased GI symptoms with eosinophilia.
T141 379963-380050 Sentence denotes This shows another possible complication in AERD patients with underlying eosinophilia.
T142 380051-380053 Sentence denotes C.
T143 380054-380067 Sentence denotes Dutmer * , E.
T144 380068-380088 Sentence denotes Gelfand, Denver, CO.
T145 380089-380102 Sentence denotes Introduction:
T146 380103-380281 Sentence denotes Cystic fibrosis (CF) is a disease caused by mutations in the CF transmembrane conductance regulator (CFTR) gene, resulting in deleterious effects on epithelia of various tissues.
T147 380282-380544 Sentence denotes Though the classic CF phenotype is characterized by progressive pulmonary disease and associated exocrine pancreatic insufficiency in childhood, disease phenotype varies greatly by specific CFTR mutations, associated genetic modifiers, and environmental factors.
T148 380545-380656 Sentence denotes Nearly 2,000 CFTR gene mutations have been identified, highlighting the allelic heterogeneity in the CFTR gene.
T149 380657-380815 Sentence denotes Discovery of new mutations (and associated factors) may explain the diverse nature of CF-related disease phenotypes with varying age of onset and recognition.
T150 380816-380905 Sentence denotes We describe a 59-year-old woman evaluated for immune deficiency in whom CF was diagnosed.
T151 380906-380923 Sentence denotes Case Description:
T152 380924-381156 Sentence denotes A 59-year-old Caucasian woman with chronic obstructive pulmonary disease and a 40 pack-year cigarette smoking history presented with an 18-month history of recurrent pneumonia and sinus disease as well as an episode of pancreatitis.
T153 381157-381224 Sentence denotes Prior history was notable for the absence of significant infection.
T154 381225-381370 Sentence denotes She recently required numerous hospitalizations and had subsequently required supplemental oxygen while suffering from chronic dyspnea and cough.
T155 381371-381476 Sentence denotes Expectorated sputum and bronchoalveolar lavage bacterial cultures revealed mucoid Pseudomonas aeruginosa.
T156 381477-381585 Sentence denotes Cylindrical and varicoid bronchiectasis as well as chronic maxillary sinusitis were evident on CT (Image 1).
T157 381586-381685 Sentence denotes Quantitative serum immunoglobulin levels were normal as was the remainder of her immune evaluation.
T158 381686-381832 Sentence denotes Family history identified a paternal first cousin once removed with CF as well as carrier status for a CF gene mutation in the patient's daughter.
T159 381833-381960 Sentence denotes Sweat chloride testing was elevated at 72 mmol/L and CFTR gene sequencing analysis revealed two mutations: deltaF508 and R117H.
T160 381961-381972 Sentence denotes Discussion:
T161 381973-382130 Sentence denotes New-onset sinopulmonary infections in the 6 th decade of life of a long-standing smoker prompted initial concern for secondary or acquired immune deficiency.
T162 382131-382258 Sentence denotes Con-sideration of CF as an explanation of recurrent sinopulmonary disease in a previously "healthy" adult is certainly unusual.
T163 382259-382497 Sentence denotes Growing evidence of the diverse genotype-phenotype relationships in CF and reported variability in diseaseonset suggests that a diagnosis of CF be evaluated in adults with recent-onset pneumonia, bronchiectasis, and sinopulmonary disease.
T164 382498-382511 Sentence denotes Introduction:
T165 382512-382656 Sentence denotes According to package inserts, use of Diprivan brand propofol or Fresenius brand propofol is contraindicated in patients with soy or egg allergy.
T166 382657-382781 Sentence denotes This is due to the use of soybean oil and egg lecithin as excipients and the potential for soy or egg protein contamination.
T167 382782-382909 Sentence denotes Fresenius is additionally contraindicated in peanut allergic patients due to potential cross-reactivity between peanut and soy.
T168 382910-382922 Sentence denotes Case Report:
T169 382923-383053 Sentence denotes A 9-year-old girl with history of Chiari malformation was noted to have swelling of her face, lips, and tongue after neurosurgery.
T170 383054-383206 Sentence denotes She had a history of identical reactions to fresh egg and peanut, and anesthesiology suspected her reaction was due to Fresenius and her peanut allergy.
T171 383207-383288 Sentence denotes She had tolerated Diprivan at least 7 times before, most recently 2 months prior.
T172 383289-383448 Sentence denotes She was given H1 and H2-blockers and was extubated postoperatively, but then developed stridor, wheezing, desaturations, and again had lip and tongue swelling.
T173 383449-383566 Sentence denotes She continued to be symptomatic despite anaphylaxis management and required an epinephrine drip and nasal intubation.
T174 383567-383614 Sentence denotes She required a slow 7 day wean off epinephrine.
T175 383615-383623 Sentence denotes Results:
T176 383624-383676 Sentence denotes Total tryptase level drawn at hour four was 4 ng/mL.
T177 383677-383725 Sentence denotes C4 and C1 esterase inhibitor levels were normal.
T178 383726-383824 Sentence denotes IgE levels for egg white, egg yolk, and soy were negative, while peanut was positive at 1.27 kU/L.
T179 383825-383915 Sentence denotes Follow up skin testing to egg and soy were negative, and peanut was positive (5 mm wheal).
T180 383916-383927 Sentence denotes Discussion:
T181 383928-384061 Sentence denotes After literature review, we found that the vast majority of patients with soy, egg, or peanut allergy receive propofol without issue.
T182 384062-384154 Sentence denotes In one study, there were no adverse reactions to propofol amongst 45 food allergic patients.
T183 384155-384345 Sentence denotes Despite its contraindication in peanut allergic patients, Fresenius does not contain any ingredients which make it more allergenic than Diprivan in patients with egg, soy, or peanut allergy.
T184 384346-384493 Sentence denotes While we have not yet been able to identify the cause of our patient's protracted reaction, we do not suspect it was related to her peanut allergy.
T185 384494-384505 Sentence denotes Conclusion:
T186 384506-384677 Sentence denotes Care should be taken to understand the reasoning behind food allergy contraindications of medications, as these can often be given to food allergic patients without issue.
T187 384678-384821 Sentence denotes Such contraindications may cause unnecessary avoidance of medications and/or may distract from the identification of a true medication allergy.
T188 384822-384835 Sentence denotes Introduction:
T189 384836-385065 Sentence denotes In a country where the transmission of many diseases has been largely eliminated by vaccination, the widespread outbreak of preventable illness could modify management and treatment options of patients with hypogammaglobulinemia.
T190 385066-385192 Sentence denotes We describe two patients with a history of hypogammaglobulinemia who were in the process of transitioning off IgG replacement.
T191 385193-385314 Sentence denotes In light of the measles and mumps outbreak in Ohio, these patients were either continued or restarted on IgG replacement.
T192 385315-385484 Sentence denotes This was due to their unvaccinated status and the recommended interval between receiving antibody-containing products and administration of a measles-containing vaccine.
T193 385485-385498 Sentence denotes Case Reports:
T194 385499-385636 Sentence denotes Case 1 involves a 5 year-old female who was introduced to the Immunology service at 5 weeks of age during an admission for bronchiolitis.
T195 385637-385699 Sentence denotes Immunology was consulted for recurrent respiratory infections.
T196 385700-385803 Sentence denotes Her clinical course was complicated by pneumothorax, bronchopleural fistula, and necrotizing pneumonia.
T197 385804-385876 Sentence denotes Her immune workup was normal except for a gradually declining IgG level.
T198 385877-386005 Sentence denotes Stool α-1-antitrypsin initially high, favoring the diagnosis of hypogammaglobulinemia secondary to a protein-losing enteropathy.
T199 386006-386047 Sentence denotes She started IgG replacement at 15 months.
T200 386048-386121 Sentence denotes By 4 years of age, there was discussion to begin weaning IgG replacement.
T201 386122-386190 Sentence denotes This was halted due to concern about the measles and mumps outbreak.
T202 386191-386303 Sentence denotes Case 2 is that of a 2 year-old male who presented in the first month of life with enterocolitis and dehydration.
T203 386304-386427 Sentence denotes He had a low total protein, albumin, and IgG level thought to be due to GI losses, although stool α-1-antitrypsin negative.
T204 386428-386474 Sentence denotes Work-up for a unifying diagnosis was negative.
T205 386475-386565 Sentence denotes History now thought to be most consistent with transient hypogammaglobulinemia of infancy.
T206 386566-386612 Sentence denotes He was started on IgG replacement at 4 months.
T207 386613-386687 Sentence denotes At 2 years he was weaned off IgG replacement and remained off for 6 weeks.
T208 386688-386835 Sentence denotes Secondary to concern over the increased risk of exposure to measles or mumps through his particular daycare setting, IgG replacement was restarted.
T209 386836-386848 Sentence denotes Conclusions:
T210 386849-387009 Sentence denotes These cases highlight the challenges that exist for our patient population with Immunoglobulin Deficiency due to the reemergence of vaccine-preventable illness.
T211 387010-387136 Sentence denotes As these exposures continue to increase, we must modify our treatment plans to provide optimal care and ensure patient safety.
T212 387137-387150 Sentence denotes Introduction:
T213 387151-387215 Sentence denotes Food is the most common cause of anaphylaxis (Lieberman P et al.
T214 387216-387239 Sentence denotes J Allergy Clin Immunol.
T215 387240-387246 Sentence denotes 2010).
T216 387247-387317 Sentence denotes Very few cases of mustard seed induced anaphylaxis have been reported.
T217 387318-387364 Sentence denotes We present a case of mustard seed anaphylaxis.
T218 387365-387373 Sentence denotes Methods:
T219 387374-387396 Sentence denotes A case report Results:
T220 387397-387471 Sentence denotes 29 year old man presented to our department for evaluation of anaphylaxis.
T221 387472-387661 Sentence denotes He had an episode of generalized urticaria ( Figure A) , chest tightness, vomiting, facial flushing and angioedema ( Figure B) , within 30 minutes of eating a prepared quinoa dish at home.
T222 387662-387792 Sentence denotes He did not seek medical attention and his symptoms resolved within hours of self-administration of loratadine and diphenhydramine.
T223 387793-387872 Sentence denotes He had no relevant past medical history of previous adverse reactions to foods.
T224 387873-388066 Sentence denotes Upon further questioning, the ingredients in the quinoa dish included: chicken, rice, avocado, ginger, onion, potatoes, tomato, nutmeg, yeast, soy, wheat, black pepper, thyme, and mustard seed.
T225 388067-388128 Sentence denotes He had previously tolerated quinoa without adverse reactions.
T226 388129-388194 Sentence denotes However, the two last ingredients were obtained from a new brand.
T227 388195-388230 Sentence denotes His physical exam was unremarkable.
T228 388231-388316 Sentence denotes Percutaneous skin testing was positive to soy and prickprick testing to mustard seed.
T229 388317-388427 Sentence denotes He was instructed on avoidance measures including food label reading and prescribed epinephrine auto injector.
T230 388428-388440 Sentence denotes Conclusions:
T231 388441-388554 Sentence denotes This case report demonstrates the importance of an adequate clinical history and detailed content of ingredients.
T232 388555-388568 Sentence denotes Introduction:
T233 388569-388803 Sentence denotes We present a case of a toddler with recurrent bacterial meningitis of unclear etiology, various upper respiratory infections, allergic rhinitis, and persistent cough who was eventually found to have a cerebral spinal fluid (CSF) leak.
T234 388804-389025 Sentence denotes The case is interesting in that there were vague clues to her CSF leak over the years, but it was not until her second case of meningitis that prompted a cisternogram, which confirmed the diagnosis of a Mondini deformity.
T235 389026-389039 Sentence denotes Case History:
T236 389040-389300 Sentence denotes A 3 year-old female with a past history of bacterial menin-gitis and subsequent left-sided stroke, allergic rhinitis (based on positive skin testing), and asthma, who presented to the hospital for headaches and vomiting after two minor head traumas at daycare.
T237 389301-389440 Sentence denotes Because of her history, CSF studies were obtained and revealed recurrent meningitis, which prompted further workup confirming the CSF leak.
T238 389441-389541 Sentence denotes She was found to have a congenital cochlear malformation, which was then repaired by otolaryngology.
T239 389542-389563 Sentence denotes Outcome & Discussion:
T240 389564-389658 Sentence denotes Retrospectively, her history and various hospital visits were all consistent with CFS leakage.
T241 389659-389780 Sentence denotes The patient actually presented to the hospital at 9 months of age after a minor fall with reported vomiting and lethargy.
T242 389781-389936 Sentence denotes Afterwards, she was seen at various points for upper respiratory infections, allergic rhinitis, as well as meningitis with stroke, and asthma with hypoxia.
T243 389937-390028 Sentence denotes She was also seen by an allergist/immunologist for workup of her food allergies and asthma.
T244 390029-390157 Sentence denotes She was diagnosed with allergic rhinitis based on clinical history of rhinorrhea and mildly positive environmental skin testing.
T245 390158-390243 Sentence denotes The rhinorrhea showed moderate improvement with intranasal corticosteroid treatments.
T246 390244-390410 Sentence denotes During her first episode of meningitis, she had a basic immunological workup including immunoglobulin and complement levels and vaccine titers, which were all normal.
T247 390411-390541 Sentence denotes It was not until her second episode of known meningitis that there were considerations for CSF leak as a source of her infections.
T248 390542-390627 Sentence denotes Both instances of meningitis were only suspected because of acute neurological signs.
T249 390628-390639 Sentence denotes Conclusion:
T250 390640-390759 Sentence denotes Though rare, CSF leakage should always be considered in the differential for clear rhinorrhea and recurrent meningitis.
T251 390760-390988 Sentence denotes In our case, there were several clues for CSF leakage including: history of head trauma, persistent clear rhinorrhea despite appropriate therapy for allergic rhinitis, and recurrent meningitis despite a normal immune evaluation.
T252 390989-391051 Sentence denotes OMALIZUMAB MAY PREVENT PERFUME TRIGGERED LARYNGEAL ANGIOEDEMA.
T253 391052-391056 Sentence denotes R.M.
T254 391057-391069 Sentence denotes Young * , P.
T255 391070-391096 Sentence denotes Ciminera, East Meadow, NY.
T256 391097-391110 Sentence denotes Introduction:
T257 391111-391303 Sentence denotes Omalizumab is a monoclonal antibody to IgE indicated for use in asthma but also used in other IgE mediated conditions i.e.Allergic Rhinitis and recently indicated for use in chronic urticaria.
T258 391304-391360 Sentence denotes But could it have a role in irritant induced angioedema?
T259 391361-391386 Sentence denotes Methods: N/A Case Report:
T260 391387-391478 Sentence denotes This is a 16yr old female who had multiple hospitalizations for status asthmaticus x 2 yrs.
T261 391479-391615 Sentence denotes Sinusitis, GERD, allegies to environment/foods were diagnosed as well as Paradoxical Vocal Cord (PVC) dysfunction by ENT via rhinoscopy.
T262 391616-391787 Sentence denotes On exposure to dust, acid reflux, chlorine in a pool or indoor pollutants like perfumes, she'd develop nasal congestion, hoarseness, a barking cough, and throat tightness.
T263 391788-391975 Sentence denotes She was placed on maximal medicines of steroid inhaler/LABA, montelukast, oral antihistamines, steroid nasal spray, pantoprazole, and oral steroids in an effort to control these symptoms.
T264 391976-392079 Sentence denotes But since PVC was also a problem, speech therapy/counseling were started as well as immunotherapy (IT).
T265 392080-392306 Sentence denotes Despite this regimen, when the patient was exposed to perfume in school, she required Epinephrine, Diphenhydramine, and Albuterol for symptoms of cough, throat closure and syncope with eventual admittance to the Pediatric ICU.
T266 392307-392406 Sentence denotes This reaction was so severe that the child became home tutored due to the fear of perfume exposure.
T267 392407-392526 Sentence denotes A similar reaction but milder to dust mite IT was witness and quickly reversed with Epinephrine and Diphenhydramine IM.
T268 392527-392597 Sentence denotes The patient had an IgE level of 1033 IU/ml, so Omalizumab was started.
T269 392598-392659 Sentence denotes For the past 1 year, she has received 375mg SQ every 2 weeks.
T270 392660-392796 Sentence denotes She has returned to school and normal activities and hasn't had any symptoms requiring Epinephrine or Albuterol on exposure to perfumes.
T271 392797-392808 Sentence denotes Conclusion:
T272 392809-392963 Sentence denotes Since the patient was on medicines to control asthma, GERD, and sinusitis, it was thought that her throat closure was due to PVC triggered by the perfume.
T273 392964-393012 Sentence denotes But Laryngeal angioedema seem to be the culprit.
T274 393013-393173 Sentence denotes Irritants like perfume may have an IgE mediated process or a mechanism of destablizing mast cells similar to idiopathic anaphylaxis that hasn't been identified.
T275 393174-393236 Sentence denotes Therefore, Omalizumab should be considered as a trial therapy.
T276 393237-393294 Sentence denotes More studies are needed using omalizumab for these cases.
T277 393295-393498 Sentence denotes Primary cilia dyskinesia (PCD) is an autosomal recessive genetic disorder characterized by recurrent and chronic infections of the upper and lower respiratory tract due to impaired mucociliary clearance.
T278 393499-393545 Sentence denotes Patients with PCD can have co-existing asthma.
T279 393546-393707 Sentence denotes Omalizumab is a high affinity recombinant humanized monoclonal anti-IgE antibody which is commonly used to treat uncontrolled moderate to severe allergic asthma.
T280 393708-393973 Sentence denotes We report a case of 58 year old female with known diagnosis of PCD and persistent allergic asthma who presented with symptoms consistent with infections and expected course of PCD but were in fact due to uncontrolled asthma and successfully treated with Omalizumab.
T281 393974-394071 Sentence denotes At the time of presentation, she was already on maximal therapy for airway clearance for her PCD.
T282 394072-394189 Sentence denotes She had been treated with numerous courses of antibiotics for infection without improvement for the previous 5 years.
T283 394190-394327 Sentence denotes At her initial visit, her pulmonary function test revealed component of obstruction with airway hyper-responsiveness that was reversible.
T284 394328-394425 Sentence denotes Her physical exam revealed coarse breath sounds and wheezing that improved after bronchodilation.
T285 394426-394544 Sentence denotes Despite PCD being her dominant disease pathology, she was thought to have a component of uncontrolled allergic asthma.
T286 394545-394703 Sentence denotes As she was maximized on Beta 2 agonist and inhaled corticosteroid therapy, the decision was made to start Omalizumab given her elevated total serum IgE level.
T287 394704-394847 Sentence denotes Within 3 months of starting Omalizumab, the patient reported significant improvement in her shortness of breath from baseline and her appetite.
T288 394848-395060 Sentence denotes At the time of this report, approximately 2 years after starting Omalizumab, she has an overall improvement in FEV1, improved symptoms of shortness of breath, and decreased exercise induced bronchospasm symptoms.
T289 395061-395183 Sentence denotes In summary, due to their motile cilia disorder, PCD patients have variable degrees of decline in their pulmonary function.
T290 395184-395407 Sentence denotes While a majority of their respiratory symptoms are likely due to structural lung damage related to recurrent infections, other etiologies for shortness of breath such as concomitant allergic asthma should not be overlooked.
T291 395408-395618 Sentence denotes In addition, the use of Omalizumab in the treatment of allergic asthma as addon therapy should be considered in patients with elevated total IgE level even in the setting of significant structural lung disease.
T292 395619-395621 Sentence denotes F.
T293 395622-395637 Sentence denotes Pazheri *1 , B.
T294 395638-395652 Sentence denotes Schroer 2 , 1.
T295 395653-395675 Sentence denotes Shaker Heights, OH; 2.
T296 395676-395690 Sentence denotes Cleveland, OH.
T297 395691-395702 Sentence denotes Background:
T298 395703-395776 Sentence denotes Beetroot is a common food ingredient and are consumed all over the world.
T299 395777-395829 Sentence denotes It is used as a food additive in many food products.
T300 395830-395874 Sentence denotes Allergy to beetroot (Beta Vulgaris) is rare.
T301 395875-396132 Sentence denotes Until now only one case of apparent anaphylaxis to beet root consumption has been reported (de Oliveira et al, Clinical and Translational Allergy 2011) ; there are a few reports of asthma and rhinoconjunctivitis induced by inhaling the vapor of cooked beet.
T302 396133-396141 Sentence denotes Methods:
T303 396142-396241 Sentence denotes We report a case of a 17 year old young man who had an anaphylactic reaction after eating beetroot.
T304 396242-396383 Sentence denotes His medical history was notable for anaphylaxis to tree nuts, allergic rhinitis, Latex allergy and a subsequent diagnosis of Crohn's disease.
T305 396384-396641 Sentence denotes The patient had oral and throat itching, vomiting, and a sensation of throat closing up within one minute after ingestion of one shot glass amount of a juice smoothie containing ¼ of a beet, carrots, and apples in 16 Oz glass of juice smoothie made at home.
T306 396642-396757 Sentence denotes Symptoms slowly resolved over the next hour after 50 mg of diphenhydramine and monitoring in an urgent care clinic.
T307 396758-396857 Sentence denotes He had never eaten beets before and there are no tree nuts in his home due to his tree nut allergy.
T308 396858-396916 Sentence denotes He has safely eaten carrots and apples after the reaction.
T309 396917-397009 Sentence denotes He was evaluated for possible allergy to beetroot with blood testing and skin prick testing.
T310 397010-397018 Sentence denotes Results:
T311 397019-397077 Sentence denotes Food specific IgE to beet root were positive at 2.52 KU/L.
T312 397078-397304 Sentence denotes Skin prick test using fresh beetroot juice using a prick-prick method with a bifurcated needle on the forearm was positive with a 9 mm wheal and 20 mm flare (Negative control 0/0 mm wheal/flare, histamine 6/20 mm wheal/flare).
T313 397305-397372 Sentence denotes Beet sugar prickprick skin testing and food challenge was negative.
T314 397373-397455 Sentence denotes Patient has not had a subsequent allergic reaction to any food since the reaction.
T315 397456-397467 Sentence denotes Conclusion:
T316 397468-397605 Sentence denotes Anaphylaxis to beetroot is very rare and this is the first case reported with positive fresh food prick-prick testing that we could find.
T317 397606-397677 Sentence denotes Refined beet sugar may not lead to reactions in beet allergic patients.
T318 397678-397826 Sentence denotes Introduction: DRESS is a potentially life-threatening hypersensitivity reaction associated with a variety of medications, generally anti-epileptics.
T319 397827-398006 Sentence denotes Patients present with rash, fever, hypereosinophilia, lymphadenopathy, and internal organ involvement, often hepatitis, usually within two months after initiation of a medication.
T320 398007-398015 Sentence denotes Methods:
T321 398016-398036 Sentence denotes Case report Results:
T322 398037-398178 Sentence denotes A 50 year old African American Male with HIV (CD4=400), HCV Genotype 1a, and HTN, presenting with rash for one week prior to admission (PTA).
T323 398179-398368 Sentence denotes Patient was in his usual state of stable health, with undetectable HIV viral load on HIV treatment, until 3 months PTA when he started Interferon gamma (IFN-g) for asymptomatic hepatitis C.
T324 398369-398436 Sentence denotes One week post IFN-g therapy, patient developed dyspnea and fatigue.
T325 398437-398523 Sentence denotes Two weeks PTA, patient self discontinued IFN-g and then one week PTA developed a rash.
T326 398524-398624 Sentence denotes Patient noted a pruritic rash starting on his scrotum which he initially attributed to tinea cruris.
T327 398625-398784 Sentence denotes He used nystatin powder, which temporarily relieved the itching however the rash began to spread to his bilateral lower extremities and then to his upper body.
T328 398785-398906 Sentence denotes During the three months preceding admission, HIV regimen was also adjusted multiple times for increase in HIV viral load.
T329 398907-398994 Sentence denotes Review of laboratory studies showed peripheral eosinophilia (absolute eosinophil count:
T330 398995-399155 Sentence denotes 1.8 K/cumm), peripheral smear with atypical lymphocytosis, and stool examination for ova and parasites as well as serum testing for Strongyloides were negative.
T331 399156-399204 Sentence denotes Patient suffered from acute renal insufficiency.
T332 399205-399240 Sentence denotes Liver involvement was not detected.
T333 399241-399274 Sentence denotes Patient was diagnosed with DRESS.
T334 399275-399386 Sentence denotes Diagnostic criteria included fever, acute rash, hypereosinophilia, lymphadenopathy, and atypical lymphocytosis.
T335 399387-399517 Sentence denotes DRESS was likely attributed to abacavir; however, other HIV medications or IFN-g could not be ruled out definitively as the cause.
T336 399518-399616 Sentence denotes Patient required large doses of steroids to control symptoms and had an extensive hospital course.
T337 399617-399747 Sentence denotes Post-mortem exam revealed cause of death to be gramnegative sepsis (Acinetobacter baumannii) without evidence of hepatic necrosis.
T338 399748-399759 Sentence denotes Conclusion:
T339 399760-399863 Sentence denotes In general, DRESS carries a mortality rate of 5-10%, which is in patients without co-morbid conditions.
T340 399864-399991 Sentence denotes This case is unique because it illustrates patients with DRESS and underlying HIV maybe suspect to even higher mortality rates.
T341 399992-400005 Sentence denotes Introduction:
T342 400006-400098 Sentence denotes T helper1 (Th1) lymphocytes have important role in immune response against Tuberculosis(TB).
T343 400099-400276 Sentence denotes Relationship between TB and high immunoglobulin E(Ig E) levels with Th1 related mechanism was told in recent studies and reduction in high Ig E levels was noted with TB therapy.
T344 400277-400281 Sentence denotes Aim:
T345 400282-400353 Sentence denotes To discuss relationship between high and persistant Ig E levels and TB.
T346 400354-400359 Sentence denotes Case:
T347 400360-400595 Sentence denotes Twelve-years-old female patient who have had chronic productive cough, frequent otitis and sinusitis since 6 months-old and was followed-up with asthma, resistant atelectasis of right middle lobe, bilateral bronchiectasis was admitted.
T348 400596-400688 Sentence denotes Previous tests were normal except high IgE (494 mg/dl), TB history of her uncle 5 years ago.
T349 400689-400807 Sentence denotes After admission, atelectasis was found in computarized tomography (CT) and bronchoscopy revealed dense purulent mucus.
T350 400808-400885 Sentence denotes Aspergillus fumigatus and Hemophilus influenzae were observed in BAL culture.
T351 400886-400970 Sentence denotes Symptoms persisted and total IgE increased (1750 mg/dl) despite appropriate therapy.
T352 400971-401100 Sentence denotes Aspergillus fumigatus in prick test, Aspergillus spesific IgE, control sputum culture, and immune deficiency tests were negative.
T353 401101-401203 Sentence denotes PPD, Quantiferon test, and ARB in gastric aspiratation were 20mm, positive and negative, respectively.
T354 401204-401284 Sentence denotes Control CT revealed multiple intrathoracic conglomerated lymph-nodes (30x25 mm).
T355 401285-401351 Sentence denotes Mediastinoscopic biopsy for Lyphoma resulted reactive hyperplasia.
T356 401352-401513 Sentence denotes Anti-TB therapy was given to patient who had TB disease contact, PPD and quantiferon positivity, infiltration and conglomerated lymph-nodes resistant to therapy.
T357 401514-401623 Sentence denotes Clinical and radiological improvement and reduction of IgE (289 mg/dl) were seen in second months of therapy.
T358 401624-401635 Sentence denotes Conclusion:
T359 401636-401743 Sentence denotes This case was presented due to rare presentation TB with high Ig E levels with almost complete improvement.
T360 401744-401800 Sentence denotes EVALUATION OF EOSINOPHILIA: HYPEREOSINOPHILIC SYN-DROME.
T361 401801-401803 Sentence denotes G.
T362 401804-401820 Sentence denotes Rosner *1 , D.W.
T363 401821-401837 Sentence denotes Rosenthal 2 , 1.
T364 401838-401854 Sentence denotes New York, NY; 2.
T365 401855-401870 Sentence denotes Great Neck, NY.
T366 401871-401882 Sentence denotes Background:
T367 401883-401981 Sentence denotes Eosinophilia can have multiple etiologies including atopy, parasitic infections and Churg-Strauss.
T368 401982-402076 Sentence denotes Hypereosinophilic syndrome(HES) can be initiated by myeloproliferative and lymphocytic causes.
T369 402077-402089 Sentence denotes Case Report:
T370 402090-402191 Sentence denotes A 16 year old male was admitted for a 2-week history of new onset chest pain and shortness of breath.
T371 402192-402383 Sentence denotes Four months prior to admission(PTA), the patient presented with transaminitis and peripheral eosinophilia to another academic medical center, where corticosteroids were tapered over 2 months.
T372 402384-402601 Sentence denotes Two weeks PTA, the patient developed intermittent, severe, mid-sternal chest pain, shortness of breath, a racing heart, blurred vision, and dizziness, which progressively worsened as he developed bilateral joint pain.
T373 402602-402610 Sentence denotes Results:
T374 402611-402694 Sentence denotes Upon admission the patient had eosinophilia(3.9x10 9 /L), ESR 38, IgE 130, LDH 375.
T375 402695-402855 Sentence denotes Results from the prior admission showed an ultrasound with hepatic inflammation, and a liver biopsy with fibrosis, and rare portal and lobular eosinophils(Eos).
T376 402856-402973 Sentence denotes Esophageal biopsy revealed mild Eos infiltrates and bone marrow biopsy showed myeloid hyperplasia with increased Eos.
T377 402974-403026 Sentence denotes Cytogenetic studies for FIP1L1-PDGFRA were negative.
T378 403027-403168 Sentence denotes During this admission, transaminases, bilirubin, alkaline phosphatase, cardiac enzymes, ANCA, tryptase, vitamin B12 and IL-5 were all normal.
T379 403169-403213 Sentence denotes CTA chest and cardiac MRI were unremarkable.
T380 403214-403357 Sentence denotes Chest X-ray showed bibasilar small pleural effusions, spirometry showed restrictive lung disease, and bronchial biopsy had mild Eos infiltrate.
T381 403358-403403 Sentence denotes Infectious disease studies were unremarkable.
T382 403404-403480 Sentence denotes The patient was restarted on corticosteroids and Eos decreased(1.8x10 9 /L).
T383 403481-403650 Sentence denotes As corticosteroids were tapered over weeks, chest pain recurred with associated increased Eos, C-reactive protein and LDH, which resolved with increased corticosteroids.
T384 403651-403662 Sentence denotes Discussion:
T385 403663-403853 Sentence denotes Multiple etiologies of eosinophilia were considered including infection, hematopoietic clonal eosinophilic proliferation, over-production of eosinophilic cytokines, Churg-Strauss and others.
T386 403854-403900 Sentence denotes Symptoms were controlled with corticosteroids.
T387 403901-403983 Sentence denotes The diagnosis of HES remains without a specific molecular or laboratory biomarker.
T388 403984-404319 Sentence denotes Thus, it remains essential to diagnose and treat HES when patients present with peripheral hypereosinophilia(>1.5x 10 9 /L on 2 examinations separated in time by at least 1 month) with tissue hypereosinophilia(20% eosinophils on bone marrow biopsy, or significant eosinophilic tissue infiltration) and with organ damage or dysfunction.
T389 404320-404333 Sentence denotes Introduction:
T390 404334-404541 Sentence denotes Autosomal dominant hyper IgE syndrome (HIES) is a complex primary immunodeficiency disorder characterized by recurrent skin and sinopulmonary infections, eczematoid dermatitis, and elevated serum IgE levels.
T391 404542-404641 Sentence denotes Disseminated infections by endemic dimorphic fungi have been reported to affect patients with HIES.
T392 404642-404761 Sentence denotes However, invasive histoplasmosis rendering a catastrophic terminal ileum perforation has not been previously described.
T393 404762-404779 Sentence denotes Case Description:
T394 404780-404958 Sentence denotes We present the case of a 21-year-old man with HIES who developed recurrent episodes of diffuse abdominal pain, low-grade fever, intermittent emesis and unintentional weight loss.
T395 404959-405042 Sentence denotes CT of the abdomen and pelvis on admission revealed partial small bowel obstruction.
T396 405043-405231 Sentence denotes Laboratory findings demonstrated significantly elevated urine histoplasma antigen (15.82 ng/mL) and positive serum histoplasma antibody, implying a disseminated infection by H. capsulatum.
T397 405232-405435 Sentence denotes He responded well to fluid resuscitation, GI decompression, and intravenous liposomal amphotericin B which was later transitioned to oral itraconazole 200 mg twice a day after the acute episode resolved.
T398 405436-405566 Sentence denotes While he was maintained on itraconazole over the following year, the level of urine histoplasma antigen was assessed periodically.
T399 405567-405694 Sentence denotes The level was trending down gradually but still remained detectable, likely due to his noncompliance to the antifungal therapy.
T400 405695-405845 Sentence denotes The patient ultimately developed terminal ileum perforation which was successfully treated with partial small bowel resection and primary anastomosis.
T401 405846-405933 Sentence denotes GMS staining of the resected small intestine revealed H. capsulatum within histiocytes.
T402 405934-406007 Sentence denotes He recovered well after the surgery and continued the antifungal therapy.
T403 406008-406019 Sentence denotes Discussion:
T404 406020-406151 Sentence denotes In HIES, STAT-3 mutations result in an aberrant T H 17 cell response and impaired β-defensin production and neutrophil trafficking.
T405 406152-406234 Sentence denotes These defects likely account for the susceptibility to invasive fungal infections.
T406 406235-406308 Sentence denotes Ileocecal histoplasmosis may clinically mimic inflammatory bowel disease.
T407 406309-406398 Sentence denotes Thus clinicians should be vigilant for the development of histoplamosis in HIES patients.
T408 406399-406495 Sentence denotes Timely diagnosis and adequate antifungal therapy are crucial in preventing severe complications.
T409 406496-406554 Sentence denotes Stings and bites are a common cause of allergic reactions.
T410 406555-406612 Sentence denotes We report a case of anaphylaxis by Pogonomyrmex ant bite.
T411 406613-406681 Sentence denotes It was diagnosed by clinical features and confirmed with skin tests.
T412 406682-406733 Sentence denotes Currently in treatment with specific immunotherapy.
T413 406734-406746 Sentence denotes Case Report:
T414 406747-406772 Sentence denotes Fifty-six years old male.
T415 406773-406985 Sentence denotes A year ago, while working in the garden home, he is bitten by an ant on his right hand presenting erythematous, pruritic confluent hives, swelling of eyelids, face and hands without cough or respiratory distress.
T416 406986-407023 Sentence denotes He improved with oral antihistamines.
T417 407024-407149 Sentence denotes Six months ago he suffers again an ant bite and besides the previous symptoms, he has nasal obstruction, rhinorrhea, fatigue.
T418 407150-407218 Sentence denotes He received treatment with intramuscular antihistamine and steroids.
T419 407219-407268 Sentence denotes A month ago, he is bitten a third time by an ant.
T420 407269-407415 Sentence denotes He presented confluent pruritic erythematous rash, eyelids, mouth and hands edema, cough and dyspnea, within minutes he had loss of consciousness.
T421 407416-407594 Sentence denotes He treated with oxygen, 0.5 ml intramuscular epinephrine, intravenous steroids and intramuscular antihistamines, intravenous fluids and improves gradually until he is discharged.
T422 407595-407872 Sentence denotes Complementary studies show 7100 leukocytes with 59% neutrophils (4200), 30% lymphocytes (2200), 2.3% eosinophils (200), 0.4% basophils (4), blood chemistry, renal function tests and liver function tests are normal, nasal cytology with eosinophils, serum total IgE 1220 IU / ml.
T423 407873-407942 Sentence denotes Skin tests were performed with the criteria AAAIC at a dilution of 1:
T424 407943-408005 Sentence denotes 10,000 with a positive result for Pogonomyrmex harvester ants.
T425 408006-408187 Sentence denotes Nonpharmacological therapy (information, "allergic to ant" bracelets and emergency actions) and pharmacological (epinephrine, steroids, antihistamines, and albuterol) was initiated.
T426 408188-408249 Sentence denotes Immunotherapy starting at 1:1,000,000 dilution was indicated.
T427 408250-408327 Sentence denotes He is currently asymptomatic and in a dose escalating immunotherapy protocol.
T428 408328-408339 Sentence denotes Discussion:
T429 408340-408426 Sentence denotes We show allergic reaction to Pogonomyrmex spp ant with positive intradermal skin test.
T430 408427-408456 Sentence denotes Immunotherapy is safe so far.
T431 408457-408626 Sentence denotes Although it is still not established the positive predictive value of a skin test, the combination of symptoms and skin test reaction indicated an IgE-mediated reaction.
T432 408627-408664 Sentence denotes Pogonomyrmex allergy could be deadly.
T433 408665-408772 Sentence denotes The immunological mechanism of anaphylaxis in this patient is caused by a type I hypersensitivity reaction.
T434 408773-408784 Sentence denotes Background:
T435 408785-409155 Sentence denotes Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare, possibly life-threatening drug reaction typically consisting of recent exposure to a high-risk medication (initiation weeks to months prior to symptoms) accompanied by skin eruption, systemic symptoms (fever, lymphadenopathy, hematologic abnormalities like eosinophilia) and end-organ involvement.
T436 409156-409359 Sentence denotes Failure to recognize this disease, especially with a history of exposure to a high-risk medication, may lead to significant morbidity and mortality while removal of the offending agent can be lifesaving.
T437 409360-409365 Sentence denotes Case:
T438 409366-409545 Sentence denotes A 9 year-old African American male with a history of cerebral palsy, epilepsy, and GERD presented with a diffuse erythematous rash along with fever, cough and progressive dyspnea.
T439 409546-409676 Sentence denotes His medications included phenobarbital and valproic acid started two weeks prior to presentation with long-term use of omeprazole.
T440 409677-409721 Sentence denotes Family and social history were unremarkable.
T441 409722-409846 Sentence denotes Initial physical exam was significant for a diffuse maculopapular rash without mucosal involvement and coarse breath sounds.
T442 409847-409914 Sentence denotes His chest x-ray demonstrated patchy airspace opacities bilaterally.
T443 409915-410041 Sentence denotes He was admitted to the hospital with continuation of his home medications and initiation of ampicillin for possible pneumonia.
T444 410042-410065 Sentence denotes He clinically worsened.
T445 410066-410107 Sentence denotes He required CPAP for respiratory support.
T446 410108-410186 Sentence denotes He developed facial edema, eosinophilia (max AEC of 1560) and a transaminitis.
T447 410187-410222 Sentence denotes His renal function remained normal.
T448 410223-410324 Sentence denotes Differential diagnosis included drug reaction such as DRESS, infection or hypereosinophilic syndrome.
T449 410325-410417 Sentence denotes His phenobarbital and valproic acid were discontinued four and six days later, respectively.
T450 410418-410470 Sentence denotes He concomitantly received high-dose corticosteroids.
T451 410471-410595 Sentence denotes His clinical status and laboratory findings returned to baseline with a slow corticosteroid taper over the next eight weeks.
T452 410596-410607 Sentence denotes Conclusion:
T453 410608-410793 Sentence denotes A history of high-risk medication use as well as clinical manifestations of skin eruption with systemic symptoms and end-organ involvement should prompt the possible diagnosis of DRESS.
T454 410794-410888 Sentence denotes The most effective treatment is to remove the offending agent along with supportive treatment.
T455 410889-410993 Sentence denotes The use of systemic corticosteroids is typically implored in patients with severe end-organ involvement.
T456 410994-411065 Sentence denotes Laboratory abnormalities should be monitored closely until nor-malized.
T457 411066-411196 Sentence denotes Importantly, the allergist should be familiar with and serve as a knowledgeable resource for the diagnosis and treatment of DRESS.
T458 411197-411210 Sentence denotes Introduction:
T459 411211-411287 Sentence denotes Idiopathic CD4 lymphocytopenia (ICL) is a rare disorder of unknown etiology.
T460 411288-411518 Sentence denotes Diagnostic criteria include a persistent CD4 T cell lymphopenia with no underlying primary or secondary immunodeficiencies, with a CD4 T cell count < 300 cell/mL or a CD4 T cell count < 20% total lymphocytes on multiple occasions.
T461 411519-411531 Sentence denotes Case Report:
T462 411532-411727 Sentence denotes 52 year old Caucasian female, with history of SLE controlled on plaquinil, presented with a 2 month history of headaches associated with confusion, dizziness, nausea/vomiting, and right eye pain.
T463 411728-411787 Sentence denotes Upon admission, an MRI revealed leptomeningeal enhancement.
T464 411788-411832 Sentence denotes Cryptococcus neoformans grew on CSF culture.
T465 411833-411879 Sentence denotes Amphotericin B and flucytosine were initiated.
T466 411880-411928 Sentence denotes An absolute CD4 count was 86 (normal (N): >500).
T467 411929-412053 Sentence denotes HIV testing with PCR, HSV, hepatitis panel, PPD, HTLV, and histoplasmosis and blastomycosis antigen tests were all negative.
T468 412054-412086 Sentence denotes Immunology consult was obtained.
T469 412087-412195 Sentence denotes B cell lymphocytes, NK cells, immunoglobulin levels, mitogen proliferation studies, CH50 and C2 were normal.
T470 412196-412292 Sentence denotes Antibody titers for diphtheria, tetanus, and streptococcus pneumonia revealed protective levels.
T471 412293-412414 Sentence denotes Based on the presentation, lab findings, and no identifiable cause for low CD4 count, the patient was diagnosed with ICL.
T472 412415-412542 Sentence denotes She was discharged on amphotericin and flucytosine and prophylactic treatment with trimethoprim/sulfamethoxazole was initiated.
T473 412543-412627 Sentence denotes The patient was medication compliant and asymptomatic at her 2 week follow-up visit.
T474 412628-412735 Sentence denotes The repeat labs revealed an absolute CD4 and CD8 count of 37 and 91 (N: >200), and a CD4/CD8 ratio of 0.41.
T475 412736-412747 Sentence denotes Discussion:
T476 412748-412851 Sentence denotes Patients with ICL are usually identified when the CD4 count is less than 200 and complications develop.
T477 412852-412920 Sentence denotes Opportunistic infections are the most common initial manifestations.
T478 412921-412986 Sentence denotes Patients also present with autoimmune conditions or malignancies.
T479 412987-413046 Sentence denotes The incidence of asymptomatic patients with ICL is unknown.
T480 413047-413101 Sentence denotes Currently, there are no specific treatment guidelines.
T481 413102-413251 Sentence denotes Therapies used to increase CD4 levels, IL-2, interferon-gamma, and IL-7 or allogeneic hematopoietic stem cell transplantation, have variable results.
T482 413252-413306 Sentence denotes In children, immunoglobulin replacement is considered.
T483 413307-413409 Sentence denotes Prophylactic treatments for opportunistic infections based on the CD4 cell count should be considered.
T484 413410-413521 Sentence denotes Conclusion: ICL is a diagnosis of exclusion when there is no identifiable underlying cause for a low CD4 count.
T485 413522-413605 Sentence denotes A thorough immune system evaluation is necessary when contemplating this diagnosis.
T486 413606-413662 Sentence denotes SUCCESSFUL TREATMENT OF ACUTE URTICARIA WITH OMALIZUMAB.
T487 413663-413665 Sentence denotes K.
T488 413666-413678 Sentence denotes Patel * , R.
T489 413679-413694 Sentence denotes Ten-Boquera, K.
T490 413695-413723 Sentence denotes Gundling, San Francisco, CA.
T491 413724-413737 Sentence denotes Introduction:
T492 413738-413871 Sentence denotes Omalizumab is a monoclonal antibody that binds free IgE and is used in treatment of allergic asthma and chronic idiopathic urticaria.
T493 413872-413996 Sentence denotes We report the first case of acute urticaria refractory to maximal conventional therapy that responded to omalizumab therapy.
T494 413997-414005 Sentence denotes Methods:
T495 414006-414049 Sentence denotes A case report and review of the literature.
T496 414050-414055 Sentence denotes Data:
T497 414056-414214 Sentence denotes A previously healthy 36 year old woman presented with an acute episode of facial edema and full body hives 24 hours after receiving new furniture in her home.
T498 414215-414369 Sentence denotes She presented to the ED where she received epinephrine, solumedrol, diphenhydramine and ranitidine; she was discharged home after symptomatic improvement.
T499 414370-414488 Sentence denotes The following day she had recurrent symptoms; she was treated similarly as her prior episode with overall improvement.
T500 414489-414542 Sentence denotes She was discharged home on prednisone and loratadine.
T501 414543-414619 Sentence denotes The next day she again had similar symptoms and was admitted for management.
T502 414620-414706 Sentence denotes During the next 3 days of her admission, she received the following daily medications:
T503 414707-414856 Sentence denotes 150 to 200 mg of diphenhydramine, 60mg prednisone, 150mg ranitidine, 25 to 50 mg hydroxyzine, 10 to 40 mg cetirizine, and 10 to 20 mg of montelukast.
T504 414857-414957 Sentence denotes Despite this maximal therapy, she continued to have full body urticaria with facial and pedal edema.
T505 414958-414998 Sentence denotes A skin biopsy confirmed acute urticaria.
T506 414999-415117 Sentence denotes Due to ongoing severe symptoms, she was given omalizumab (300mg), and within 24 hours had rapid resolution of disease.
T507 415118-415296 Sentence denotes A large panel of laboratory studies was negative, except for elevated levels of plasma histamine (3.6 ng/mL) and total tryptase (12 ng/mL), supporting mast cell mediator release.
T508 415297-415423 Sentence denotes To further evaluate the furniture as a possible cause, fabric was ground with sterile water; the skin prick test was negative.
T509 415424-415456 Sentence denotes Patch testing was also negative.
T510 415457-415585 Sentence denotes Her medications were tapered over a month, and she continued to be symptom free at her 3 month follow up off of all medications.
T511 415586-415597 Sentence denotes Conclusion:
T512 415598-415707 Sentence denotes A trial of omalizumab for severe, refractory acute urticaria was associated with rapid resolution of disease.
T513 415708-415844 Sentence denotes Although cause and effect is not definitive, the patient had not previously responded to five days of aggressive conventional therapies.
T514 415845-415970 Sentence denotes Review of the literature indicates that this may be the first successful treatment of severe acute urticaria with omalizumab.
T515 415971-416135 Sentence denotes The cause of this patient's outbreak remains unclear, but might be associated with chemicals used in the furniture, as indicated by other reports in the literature.
T516 416136-416204 Sentence denotes A RARE CASE OF ACUTE COMPARTMENT SYNDROME SEC-ONDARY TO INSECT BITE.
T517 416205-416207 Sentence denotes F.
T518 416208-416221 Sentence denotes Farri *1 , T.
T519 416222-416235 Sentence denotes Akande 2 , S.
T520 416236-416252 Sentence denotes Baghian 2 , Y.K.
T521 416253-416267 Sentence denotes Persaud 2 , 1.
T522 416268-416284 Sentence denotes Ossining, NY; 2.
T523 416285-416295 Sentence denotes Bronx, NY.
T1 416296-416309 Sentence denotes Introduction:
T2 416310-416463 Sentence denotes Acute compartment syndrome (ACS) is a surgical emergency, mostly seen as a rare but severe complication of trauma; however there are nontraumatic causes.
T3 416464-416598 Sentence denotes ACS secondary to insect bite is very rare; to our knowledge, there is only one previously reported case of ACS due to a mosquito bite.
T4 416599-416611 Sentence denotes Case Report:
T5 416612-416744 Sentence denotes A 21-month old female with past medical history of recurrent insect bites presented with extensive swelling of the hand and forearm.
T6 416745-416855 Sentence denotes She had a small pruritic bump on dorsum of the left hand from a witnessed flying insect bite a few days prior.
T7 416856-416973 Sentence denotes Subsequently, she developed decreased movement of the left wrist and tenderness with passive extension of the digits.
T8 416974-417071 Sentence denotes There was no improvement of the swelling with topical antibiotic ointment and oral antihistamine.
T9 417072-417184 Sentence denotes X-rays of the wrist and forearm showed soft tissue swelling, but was negative for fractures and or dislocations.
T10 417185-417288 Sentence denotes A diagnosis of Acute Compartement Syndrome was made and immediate surgical intervention was undertaken.
T11 417289-417419 Sentence denotes Intra-operative findings showed maximally elevated pressures (45mmHg) in the adductor-pollicis compartment of the left upper limb.
T12 417420-417530 Sentence denotes Surgical decompression of the affected area was performed with subsequent resolution of the pain and swelling.
T13 417531-417703 Sentence denotes Diagnostic evaluation showed normal white blood cell counts with differential, complement levels, total tryptase levels, total serum IgE, and IgE to mosquito and house fly.
T14 417704-417846 Sentence denotes Blood and wound cultures showed no growth during both episodes, she did however have significantly elevated serum histamine levels Discussion:
T15 417847-417983 Sentence denotes Most reaction's to insect bites are non-allergic manifestations of the venom's toxic effect, and present as erythema, pain and swelling.
T16 417984-418143 Sentence denotes Insect bite hypersensitivity, may be mediated by immunologic mechanisms (IgE-mediated or non-IgE-mediated venom allergy) but also by nonimmunologic mechanisms.
T17 418144-418312 Sentence denotes An important question in the clinical management of the patient was: did an infectious process (i.e. cellulitis) contribute to the initial clinical presentation of ACS?
T18 418313-418540 Sentence denotes The absence of fever, the short duration from time of bite to presentation, the absence of differential warmth, the normal white cell count as well as negative blood and wound cultures made a bacterial super-infection unlikely.
T19 418541-418703 Sentence denotes The patient was placed on daily antihistamines and the parents were instructed to be vigilant in accessing immediate medical care during each subsequent reaction.
T20 418704-418706 Sentence denotes R.
T21 418707-418720 Sentence denotes Gupta *1 , M.
T22 418721-418733 Sentence denotes Segal 2 , 1.
T23 418734-418754 Sentence denotes Vernon Hills, IL; 2.
T24 418755-418772 Sentence denotes Philadelphia, PA.
T25 418773-418783 Sentence denotes Rationale:
T26 418784-418932 Sentence denotes Fungal sinusitis is generally limited to immunocompromised hosts including those with hematological malignancies, diabetes, and chronic steroid use.
T27 418933-419029 Sentence denotes The most responsible culprits include Aspergillus, Fusarium, Mucorales, and dermatiaceous molds.
T28 419030-419162 Sentence denotes Here we present a young female found to have a rare fungal species causing maxillary sinusitis requiring long term fungal treatment.
T29 419163-419171 Sentence denotes Methods:
T30 419172-419287 Sentence denotes Computed Tomography of Sinuses, Magnetic Resonance Imaging of Head, and sinus biopsies with gram stain and culture.
T31 419288-419296 Sentence denotes Results:
T32 419297-419427 Sentence denotes Our patient has a longstanding history of allergic rhinitis and asthma with 3-4 hospital visits a year never requiring intubation.
T33 419428-419581 Sentence denotes She presented with complaints of severe sinus symptoms and subsequently had a CT scan demonstrating sinusitis with bony erosion at the base of the skull.
T34 419582-419680 Sentence denotes Endoscopic surgery and maxillary sinus biopsies revealed fungal species of Schizophyllum radiatum.
T35 419681-419839 Sentence denotes Itraconazole treatment was started with frequent monitoring of QT-interval and drug levels, with microbiology confirming adequate susceptibility of treatment.
T36 419840-419886 Sentence denotes Clinically her sinusitis continued to improve.
T37 419887-419964 Sentence denotes She remained on Itraconazole for 6 months, with total resolution of symptoms.
T38 419965-419976 Sentence denotes Conclusion:
T39 419977-420042 Sentence denotes We believe this patient's case demonstrates two facets of rarity.
T40 420043-420135 Sentence denotes One, our patient does not fit the typical demographic of those who acquire fungal sinusitis.
T41 420136-420232 Sentence denotes Second, Schizophyllum radiatum is an unfamiliar species to cause infection and bony destruction.
T42 420233-420392 Sentence denotes This case provides insight into evaluation of patients deemed minimal risk for fungal sinusitis and the rare although morbid complications of fungal sinusitis.
T43 420393-420406 Sentence denotes Introduction:
T44 420407-420643 Sentence denotes Granulomatous-lymphocytic interstitial lung disease (GLILD) is a non-infectious pulmonary complication of common variable immune deficiency (CVID) that can have a profound impact on the quality of life and survival of affected patients.
T45 420644-420803 Sentence denotes Combination chemotherapy with rituximab and azathioprine has been previously shown to improve pulmonary function and imaging in this subgroup ofthese patients.
T46 420804-420932 Sentence denotes We describe a case of CVID with GLILD treated with rituximab and oral mycophenolate mofetil that had a similar positive outcome.
T47 420933-420950 Sentence denotes Case Description:
T48 420951-421123 Sentence denotes A 37 year-old female with history of idiopathic thrombocytopenic purpura (ITP), initially presented to our clinic for evaluation of a chronic cough and shortness of breath.
T49 421124-421230 Sentence denotes Pulmonary function testing showed a restrictive pattern, without evidence of obstruction or reversibility.
T50 421231-421382 Sentence denotes Laboratory results were remarkable for profound hypogammaglobulinemia (IgG 75, IgA < 5, IgM 13) with normal numbers of T and B cells on flow cytometry.
T51 421383-421581 Sentence denotes Computed tomography (CT) of the chest showed extensive interstitial disease, including innumerable bilateral pulmonary nodules, as well as multiple enlarged mediastinal lymph nodes and splenomegaly.
T52 421582-421714 Sentence denotes She was started on monthly intravenous immunoglobulin (IVIG) therapy and underwent wedge biopsy of the lung for diagnostic purposes.
T53 421715-421908 Sentence denotes Pathology reported follicular bronchiolitis, lymphocytic interstitial pneumonia, and non-necrotizing granulomatous inflammation as well as areas with fibrin deposition and organizing pneumonia.
T54 421909-422025 Sentence denotes She was treated with 2 doses of rituximab (2g) two weeks apart and 1000mg of oral mycophenolate mofetil twice daily.
T55 422026-422057 Sentence denotes The therapy was well tolerated.
T56 422058-422248 Sentence denotes Six months following initiation of therapy, repeat imaging showed near resolution of pulmonary nodules with significant improvement in mediastinal lymphadenopathy and ground-glass opacities.
T57 422249-422352 Sentence denotes Pulmonary function had returned to normal and the patient's cough and shortness of breath had resolved.
T58 422353-422365 Sentence denotes Conclusions:
T59 422366-422475 Sentence denotes Multiple authors have previously documented that monotherapy for treatment of GLILD in CVID is not effective.
T60 422476-422576 Sentence denotes Combination chemotherapy using rituximab and azathioprine has previously been shown to be effective.
T61 422577-422715 Sentence denotes This is the first case describing case describing successful treatment of GLILD with a combination of rituximab and mycophenolate mofetil.
T62 422716-422720 Sentence denotes A.C.
T63 422721-422739 Sentence denotes Netterville * , A.
T64 422740-422763 Sentence denotes Ochoa, New Orleans, LA.
T65 422764-422777 Sentence denotes Introduction:
T66 422778-422931 Sentence denotes Mastocytic enterocolitis is a proposed term for cases of diarrhea-predominant irritable bowel syndrome (IBS) with elevated numbers of mucosal mast cells.
T67 422932-423068 Sentence denotes GI mast cells excess is defined as the presence of greater than 20 mast cells per high-power field of microscopy in the GI tract mucosa.
T68 423069-423329 Sentence denotes Presentation is chronic intractable diarrhea, often associated with abdominal pain with unremarkable colonic or duodenal biopsy specimens on routine hematoxylin-eosin staining, but increased numbers of mast cells on immunohistochemistry for mast cell tryptase.
T69 423330-423347 Sentence denotes Case Description:
T70 423348-423452 Sentence denotes This is a 6 year old male who initially presented at 23 months with chronic diarrhea and abdominal pain.
T71 423453-423621 Sentence denotes He was evaluated by GI with an upper and lower endoscopy, and was found on immunohistochemical stains for CD117 to have greater than 20 mast cells per high power field.
T72 423622-423682 Sentence denotes Elevated numbers were found throughout the colon and rectum.
T73 423683-423860 Sentence denotes He had extensive additional evaluation which revealed normal total immunoglobulins, IgG subclasses, tryptase, C1 esterase inhibitor level and function, and complete blood count.
T74 423861-423936 Sentence denotes He also had negative immunocaps to all foods and inhalant allergens tested.
T75 423937-424017 Sentence denotes He was initially treated with hydroxyzine and singulair with little improvement.
T76 424018-424194 Sentence denotes He was later started on gastrocrom four times a day, and at that time demonstrated significant improvement, with near resolution of his symptoms of diarrhea and abdominal pain.
T77 424195-424265 Sentence denotes Upon evaluation by us we recommended adding an H2 receptor antagonist.
T78 424266-424277 Sentence denotes Conclusion:
T79 424278-424383 Sentence denotes Mast cells play an important role in the regulation of GI visceral sensitivity and vascular permeability.
T80 424384-424641 Sentence denotes Increased numbers of GI mucosal mast cells has been documented in several studies in patients with irritable bowel syndrome, mastocytic enterocolitis, systemic mastocytosis, mast cell activation syndrome, and allergic mastocytic gastroenteritis and colitis.
T81 424642-424752 Sentence denotes Patients with chronic unexplained diarrhea should undergo colonoscopic biopsies with special mast-cell stains.
T82 424753-424906 Sentence denotes If elevated mast cells are demonstrated on biopsies patients should be treated with H1 and H2 receptor antagonist and also a mast cell stabilizing agent.
T83 424907-425005 Sentence denotes In more severe cases it has been proposed to add an antileukotriene or a 5-lipoxygenase inhibitor.
T84 425006-425019 Sentence denotes Introduction:
T85 425020-425068 Sentence denotes Cow's milk protein allergy is common in infancy.
T86 425069-425196 Sentence denotes About half of all cases are non-IgE-mediated, and allergic proctocolitis with bloody stools is considered the most benign form.
T87 425197-425205 Sentence denotes Methods:
T88 425206-425218 Sentence denotes Case Report.
T89 425219-425227 Sentence denotes Results:
T90 425228-425353 Sentence denotes A 4-monthold Hispanic female presented with complex febrile seizure and was incidentally noted to have grossly bloody stools.
T91 425354-425466 Sentence denotes After a full-term delivery, she had been treated with prophylactic antibiotics due to maternal chorioamnionitis.
T92 425467-425589 Sentence denotes During the NICU stay she was breastfed with cow's milk formula supplementation, and had intermittent heme-positive stools.
T93 425590-425735 Sentence denotes Grossly bloody stools first occurred at 1 month of age, after which the mother eliminated cow's milk formula and began to exclusively breastfeed.
T94 425736-425882 Sentence denotes Over the subsequent months, the patient had multiple episodes of grossly bloody stools after maternal dairy ingestion, but was otherwise thriving.
T95 425883-425922 Sentence denotes Serum IgE to milk protein was negative.
T96 425923-426057 Sentence denotes Review of laboratory studies showed peripheral eosinophilia (1.9k/mm 3 ) 4 days after birth and at time of presentation (3.3k/ mm 3 ).
T97 426058-426168 Sentence denotes Stool examination for ova and parasites as well as serum testing for Strongyloides and Toxocara were negative.
T98 426169-426291 Sentence denotes Given severe eosinophilia over a 4-month period beginning shortly after birth, screening was done for target organ damage.
T99 426292-426443 Sentence denotes Urinalysis and liver tests were normal, but Brain Natriuretic Peptide (BNP) was elevated at 626 pg/mL, (no cardiac symptoms and echocardiogram normal).
T100 426444-426624 Sentence denotes All dairy products were eliminated from the maternal diet, with subsequent resolution of eosinophilia (absolute eosinophils 100/ mm 3 ) and significant decrease in BNP (211 pg/mL).
T101 426625-426637 Sentence denotes Conclusions:
T102 426638-426731 Sentence denotes Milk protein allergy presenting with bloody stools is common and generally considered benign.
T103 426732-426900 Sentence denotes The diagnosis is based upon clinical presentation and resolution of symptoms upon withdrawal of the presumed food antigen, and therefore labs are not routinely checked.
T104 426901-427113 Sentence denotes However, this case illustrates that even intermittent exposure to cow's milk protein over several months may lead to persistent eosinophilia, which in other conditions has been shown to cause target organ damage.
T105 427114-427189 Sentence denotes Elevated BNP levels have not previously been reported in hypereosinophilia.
T106 427190-427354 Sentence denotes This case suggests that BNP may be a sensitive early marker for eosinophilic myocardial insult, although further studies would be needed to support this hypothesis.
T107 427355-427359 Sentence denotes A.K.
T108 427360-427371 Sentence denotes Wong * , C.
T109 427372-427383 Sentence denotes Parrish, S.
T110 427384-427395 Sentence denotes Thobani, M.
T111 427396-427402 Sentence denotes Li, L.
T112 427403-427426 Sentence denotes Scott, Los Angeles, CA.
T113 427427-427440 Sentence denotes Introduction:
T114 427441-427644 Sentence denotes Angioimmunoblastic T-cell Lymphoma (AITL) is a peripheral T-cell lymphoma which presents with non-specific systemic illness including lymphadenopathy, hepatosplenomegaly, B-symptoms, rash, and/or anemia.
T115 427645-427763 Sentence denotes Rash is present in 20-60% of patients, and they are usually pruritic with lymphohistiocytic vasculitis seen on biopsy.
T116 427764-427772 Sentence denotes Methods:
T117 427773-427793 Sentence denotes Case Report Results:
T118 427794-428003 Sentence denotes A 64 year-old Hispanic male with no prior medical history presented to an outside clinic with a 2-week history of generalized, erythematous, papular, nonblanching, pruritic rash over his trunk and extremities.
T119 428004-428058 Sentence denotes After a 5-day steroid burst, the rash did not improve.
T120 428059-428102 Sentence denotes 2 weeks later, he presented for evaluation.
T121 428103-428140 Sentence denotes He was noted to have lymphadenopathy.
T122 428141-428205 Sentence denotes Lymph node and bone marrow biopsies yielded a diagnosis of AITL.
T123 428206-428279 Sentence denotes He received 1 round of chemotherapy with complete resolution of his rash.
T124 428280-428396 Sentence denotes He was well for 2 weeks until he presented to the emergency room with fever of 101.3°F and neutropenia of 700/mm 3 .
T125 428397-428576 Sentence denotes Cefepime and vancomycin were started on admission, and 2 days later he developed generalized facial swelling with a maculopapular erythematous rash over his trunk and extremities.
T126 428577-428730 Sentence denotes The patient developed a fever of 101.8°F around the time of rash onset, and on physical exam, he was noted to have axillary and inguinal lymphadenopathy.
T127 428731-428863 Sentence denotes Review of laboratory studies showed peripheral eosinophilia which increased from 0/mm 3 on admission to 1100/mm 3 on hospital day 7.
T128 428864-428979 Sentence denotes Allergy and Immunology was consulted to evaluate for drug reaction with eosinophilia and systemic symptoms (DRESS).
T129 428980-428992 Sentence denotes Conclusions:
T130 428993-429103 Sentence denotes Allergists/Immunologists are commonly consulted for rashes, especially in relation to drug hypersensitivities.
T131 429104-429276 Sentence denotes While DRESS is a potentially life-threatening adverse reaction to medications, the onset of DRESS is typically 2-8 weeks after initial exposure to the offending medication.
T132 429277-429346 Sentence denotes The time course of this patient's rash was not consistent with DRESS.
T133 429347-429523 Sentence denotes This case illustrates the importance of maintaining a broad differential diagnosis including infection or malignancy in the evaluation of a patient with rash of unknown origin.
T134 429524-429760 Sentence denotes Generalized non-specific rash is a common presenting feature of AITL, and in this particular patient, his DRESS-like symptoms of fever, lymphadenopathy, and eosinophilia and systemic symptoms were explained by his underlying malignancy.
T135 429761-429851 Sentence denotes His rash and DRESS-like symptoms improved after starting his second round of chemotherapy.
T136 429852-429862 Sentence denotes Rationale:
T137 429863-430021 Sentence denotes Dyshidrotic eczema is a known rare side effect of intravenous immunoglobulin (IVIG) therapy in patients who are most commonly treated for neurologic diseases.
T138 430022-430055 Sentence denotes Its pathophysiology is not clear.
T139 430056-430232 Sentence denotes Eczematous eruption has never been reported in patients treated with IVIG for immunodeficiency states, highlighting the role of high doses of IVIG in this peculiar side effect.
T140 430233-430351 Sentence denotes The skin changes usually respond well to topical steroids and some patients may improve with continuation of the IVIG.
T141 430352-430360 Sentence denotes Methods:
T142 430361-430607 Sentence denotes Review of the literature and case report of a patient in which the use of Gamunex resulted in appropriate myasthenia gravis control but intolerable dyshidrotic eczema, which resolved when the formulation was switched to the Gammagard liquid form.
T143 430608-430616 Sentence denotes Results:
T144 430617-430728 Sentence denotes 37 year-old female with history of myasthenia gravis was started on Gamunex 2g/kg over 3 days, every six weeks.
T145 430729-430867 Sentence denotes After the first infusion she developed dryness and scaling lesions over hands, scalp and chest which were diagnosed as dyshidrotic eczema.
T146 430868-430936 Sentence denotes Patient did not have a history of eczema prior to receiving Gamunex.
T147 430937-431025 Sentence denotes She was started on topical corticosteroids without much improvement in her skin lesions.
T148 431026-431114 Sentence denotes Patch testing with common contact allergens and Gamunex was negative at 48 and 96 hours.
T149 431115-431252 Sentence denotes Drug reaction was suspected and the patient's formulation of IVIG was switched from Gamunex to Gammagard 2g/kg over 3 days every 6 weeks.
T150 431253-431349 Sentence denotes The skin changes remitted with the new product, but she developed 2 flairs of myasthenia gravis.
T151 431350-431398 Sentence denotes The decision was made to switch back to Gamunex.
T152 431399-431529 Sentence denotes Unfortunately, the patient's eczema reoccurred but her treatment with Gamunex was continued for optimum myasthenia gravis control.
T153 431530-431542 Sentence denotes Conclusions:
T154 431543-431735 Sentence denotes This is the first reported case of dyshidrotic eczema in a patient receiving Gamunex IVIG that did not improve with topical steroids but resolved after switching to an alternative formulation.
T155 431736-431789 Sentence denotes It is unclear why the eczema improved with Gammagard.
T156 431790-431860 Sentence denotes Both formulations use glycine and have similar osmolarity and content.
T157 431861-431989 Sentence denotes Gamunex uses bromobutyl rubber stoppers in their vials while Gammagard liquid utilizes halobutyl or chlorobutyl rubber stoppers.
T158 431990-432140 Sentence denotes Currently no comparative data exist describing the side effect profile in terms of appearance of dyshidrotic eczema among different IVIG formulations.
T159 432141-432143 Sentence denotes H.
T160 432144-432156 Sentence denotes Shah *1 , K.
T161 432157-432170 Sentence denotes Gipson 2 , L.
T162 432171-432182 Sentence denotes Wall 2 , 1.
T163 432183-432202 Sentence denotes Yorba Linda, CA; 2.
T164 432203-432219 Sentence denotes New Orleans, LA.
T165 432220-432356 Sentence denotes Löffler syndrome is a hypersensitivity response to parasite larval migration through the lungs, and is rare in the modern United States.
T166 432357-432436 Sentence denotes It is classically attributed to Ascariasis, but can occur with other parasites.
T167 432437-432546 Sentence denotes A previously healthy 8year-old male was hospitalized with tachypnea, cough, and fever of one week's duration.
T168 432547-432689 Sentence denotes History revealed exposure to pigs on his family's farm in southernmost Louisiana, no travel, no asthma or atopy, and normal review of systems.
T169 432690-432767 Sentence denotes He was hypoxemic and imaging revealed diffuse reticulonodular lung opacities.
T170 432768-432862 Sentence denotes He demonstrated leukocytosis, peripheral eosinophilia (39%), and high serum IgE (3,480 IU/mL).
T171 432863-432940 Sentence denotes Given his acute respiratory failure, systemic corticosteroids were initiated.
T172 432941-433030 Sentence denotes He was treated empirically for atypical pneumonia while undergoing diagnostic evaluation.
T173 433031-433179 Sentence denotes Despite increasing serum IgE levels (peaking at 12,700 IU/mL), he demonstrated rapid clinical improvement and was weaned off of supplemental oxygen.
T174 433180-433264 Sentence denotes Pulmonary function testing demonstrated a mixed obstructive and restrictive pattern.
T175 433265-433340 Sentence denotes Broncho-alveolar lavage fluid showed profound pulmonary eosinophilia (86%).
T176 433341-433482 Sentence denotes Subsequent evaluation of his eosinophilia revealed highly elevated serology to both Ascaris and Toxocara, which was treated with albendazole.
T177 433483-433596 Sentence denotes Strongyloides serology was negative, as was an extensive evaluation for other infectious and allergic etiologies.
T178 433597-433669 Sentence denotes This case demonstrates that Löffler syndrome may be severe, yet elusive.
T179 433670-433853 Sentence denotes It may present with pulmonary involvement and fever without the involvement of other organs expected from larval migration, requiring a high degree of suspicion to make the diagnosis.
T180 433854-433991 Sentence denotes One should consider it even in the absence of travel history, especially in endemic areas for Ascaris such as southeastern United States.
T181 433992-434084 Sentence denotes Strikingly elevated eosinophils in the lung washings should prompt evaluation for parasites.
T182 434085-434219 Sentence denotes Other aspects unique to our patient include living in close association with pigs and being seropositive to both Ascaris and Toxocara.
T183 434220-434334 Sentence denotes Moreover, Ascaris suum is known to infect pigs and has rarely been reported with visceral larva migrans in humans.
T184 434335-434508 Sentence denotes Systemic corticosteroids were effective in treating the patient's respiratory compromise, despite concern for dissemination of the parasite when host immunity is suppressed.
T185 434509-434666 Sentence denotes Giant cell arteritis (GCA) is a chronic vasculitis of large and medium caliber blood vessels, mostly affecting individuals in the fifth decade of their life.
T186 434667-434846 Sentence denotes It is caused by arterial wall inflammation that leads to the clinical manifestations of vasculitis and tissue ischemia such as jaw claudication, temporal headache and visual loss.
T187 434847-434995 Sentence denotes Although it may be generalized, vessel inflammation most prominently involves the cranial branches of the arteries originating from the aortic arch.
T188 434996-435074 Sentence denotes We present an uncommon manifestation of GCA in a patient with tongue swelling.
T189 435075-435087 Sentence denotes Case Report:
T190 435088-435194 Sentence denotes A previously healthy 68-year-old female was presenting submandibular swelling a month prior to evaluation.
T191 435195-435290 Sentence denotes She was treated with antibiotics and intermittent doses of steroids for suspected sialadenitis.
T192 435291-435441 Sentence denotes Despite therapy, the patient presented increased swelling of the tongue and pain with minimal headache, but had no blurred vision or jaw claudication.
T193 435442-435538 Sentence denotes She was admitted to the hospital where a lingual biopsy revealed no amyloidosis or malignancies.
T194 435539-435664 Sentence denotes Upon further testing, hereditary angioedema screening was negative but she still had elevated C-reactive Peptide (1.3 mg/dL).
T195 435665-435747 Sentence denotes A trial of icatibant was administered for suspected bradykinin-induced angioedema.
T196 435748-435855 Sentence denotes With no improvement of the symptoms, the patient was transferred to our institution for further evaluation.
T197 435856-435962 Sentence denotes A biopsy of the temporal arteries revealed GCA and treatment was initiated with high-dose corticosteroids.
T198 435963-436041 Sentence denotes Unfortunately, the necrosis of the tongue led to its eventual self-amputation.
T199 436042-436053 Sentence denotes Conclusion:
T200 436054-436124 Sentence denotes Lingual swelling and necrosis are extremely rare complications in GCA.
T201 436125-436224 Sentence denotes That atypical presentation may mimic an angioedema episode when classic symptoms of GCA are subtle.
T202 436225-436392 Sentence denotes This case reinforces the importance of suspecting GCA upon evaluating elderly individuals that present lingual swelling as to avoid a delay in diagnosis and treatment.
T203 436393-436444 Sentence denotes We conducted a literature search review using Ovid.
T204 436445-436567 Sentence denotes A search using the keywords "Giant Cell Arteritis and tongue necrosis" resulted in 43 published cases dating back to 1967.
T205 436568-436683 Sentence denotes All cases were almost identical in clinical presentation to our case with the exception of some subtle differences.
T206 436684-436769 Sentence denotes Six of the published GCA and lingual necrosis cases were triggered by ergotamine use.
T207 436770-436949 Sentence denotes Also, the severity and extent of necrosis varied among cases, ranging from unilateral partial lingual necrosis to extensive necrosis of the tongue, scalp or bilateral vision loss.
T208 436950-436952 Sentence denotes A.
T209 436953-436966 Sentence denotes Asawa *1 , R.
T210 436967-436979 Sentence denotes Bonds 2 , 1.
T211 436980-436998 Sentence denotes Sugar Land, TX; 2.
T212 436999-437013 Sentence denotes Galveston, TX.
T213 437014-437027 Sentence denotes Introduction:
T214 437028-437220 Sentence denotes Serum sickness is a type III hypersensitivity reaction caused by antigen-antibody complexes and presents with fever, urticaria, poly-arthralgia/poly-arthritis, and/or acute glomerulonephritis.
T215 437221-437312 Sentence denotes In this type of reaction an antigen binds to antigen specific IgG forming immune complexes.
T216 437313-437425 Sentence denotes These then bind to IgG receptors on inflammatory cells and activate complement causing an inflammatory reaction.
T217 437426-437434 Sentence denotes Methods:
T218 437435-437542 Sentence denotes We report the case of a 44 year old female referred to Allergy/Immunology clinic for hives and arthralgias.
T219 437543-437688 Sentence denotes Patient first noted symptoms 4 years ago after she was treated with trimethoprim-sulfamethoxazole and mupirocin for cellulitis of her right foot.
T220 437689-437796 Sentence denotes Two weeks later she noted diffuse erythematous, well defined, burning, circular skin lesions that blanched.
T221 437797-437908 Sentence denotes She also had swelling and increased warmth in both knees and arthralgias in her knees, neck, elbows, and hands.
T222 437909-437961 Sentence denotes Numerous antihistamines were tried, but not helpful.
T223 437962-438010 Sentence denotes The symptoms gradually resolved in a few months.
T224 438011-438047 Sentence denotes She was asymptomatic for four years.
T225 438048-438128 Sentence denotes In April 2014 she treated blisters at the base of her right foot with mupirocin.
T226 438129-438211 Sentence denotes One day later she noted a return of her diffuse urticaria, arthralgias, and fever.
T227 438212-438297 Sentence denotes She was treated with a corticosteroid injection which did not alleviate her symptoms.
T228 438298-438400 Sentence denotes Subsequently, she was started on cyclosporine which has provided her with moderate relief of symptoms.
T229 438401-438412 Sentence denotes Discussion:
T230 438413-438579 Sentence denotes The patient's history of repeat episodes of arthralgias, fever, urticarial rash triggered by a medication raises concern for serum sickness versus drug induced lupus.
T231 438580-438959 Sentence denotes Laboratory evaluation revealed normal levels of C3 (123 mg/dl; reference range 86-184 mg/dl) and C4 (26.5 mg/dl reference range 20.0-59.0 mg/dl), elevated C1Q binding (4.7 ugE/mL; reference range 0.0 -3.9 ugE/mL), and ESR (45 mm/hr; reference rage 0-20 mm/hr) suggesting evidence of circulating immune complexes supporting the diagnosis of serum sickness over drug induced lupus.
T232 438960-439063 Sentence denotes In our literature search, we did not identify any previous reports of mupirocin causing serum sickness.
T233 439064-439075 Sentence denotes Conclusion:
T234 439076-439279 Sentence denotes We report a 44 year old female old presenting with elevated C1Q binding and ESR along with recurrent fevers, arthralgias, and urticarial rash most likely secondary to serum sickness induced by mupirocin.
T235 439280-439293 Sentence denotes Introduction:
T236 439294-439437 Sentence denotes Bronchiectasis can occur in children due to cystic fibrosis, primary ciliary dyskinesia, infections, immunodeficiency, and anatomic etiologies.
T237 439438-439514 Sentence denotes Primary symptoms include productive cough, chest pain, dyspnea, and fatigue.
T238 439515-439603 Sentence denotes High-resolution computed tomography (HRCT) is the diagnostic imaging modality of choice.
T239 439604-439720 Sentence denotes Management involves treatment of the underlying disease process, mucociliary clearance, and treatment of infections.
T240 439721-439822 Sentence denotes Untreated, bronchiectasis causes worsening inflammation, airway obstruction, morbidity and mortality.
T241 439823-439831 Sentence denotes Methods:
T242 439832-439970 Sentence denotes We review a case of an adolescent female who presented with uncontrolled asthma and seasonal allergies to the Allergy/Immunology Division.
T243 439971-439979 Sentence denotes Results:
T244 439980-440061 Sentence denotes A 17 year old female presented with "uncontrolled asthma" and seasonal allergies.
T245 440062-440146 Sentence denotes She had transient tachypnea of the newborn and RSV bronchiolitis at 2 months of age.
T246 440147-440204 Sentence denotes At 1 year of age, she had her first episode of pneumonia.
T247 440205-440269 Sentence denotes She then had pneumonia about once a year, requiring antibiotics.
T248 440270-440359 Sentence denotes She had required high dose inhaled steroids and frequent oral steroid courses for asthma.
T249 440360-440481 Sentence denotes She reported wheezing when recumbent and a feeling of fullness in her left lung with inability to sleep on her left side.
T250 440482-440600 Sentence denotes Her examination was significant for crackles and inspiratory wheeze with dullness to percussion at the left lung base.
T251 440601-440655 Sentence denotes Spirometry demonstrated reversible airway obstruction.
T252 440656-440698 Sentence denotes Skin prick tests were positive to pollens.
T253 440699-440837 Sentence denotes Sweat test was negative and immunologic evaluation demonstrated increase in antibody levels to pneumococcus following booster vaccination.
T254 440838-440897 Sentence denotes Chest CT scan showed bronchiectasis in the left lower lobe.
T255 440898-441087 Sentence denotes Bronchoscopy demonstrated narrowing of the orifice of the left lower lobe due to collapsibility of the posterior wall of the bronchus and thick, white secretions within the left lower lobe.
T256 441088-441173 Sentence denotes Biopsy of the bronchus demonstrated chronic inflammation with ciliary disorientation.
T257 441174-441290 Sentence denotes She was diagnosed with impaired mucociliary clearance and retained secretions due to left lower lobe bronchomalacia.
T258 441291-441405 Sentence denotes She started an airway clearance regimen with significant clinical improvement and capacity to wean asthma therapy.
T259 441406-441417 Sentence denotes Conclusion:
T260 441418-441553 Sentence denotes In an asthmatic with wheezing, chronic cough, sputum production and focal findings on examination, bronchiectasis should be considered.
T261 441554-441659 Sentence denotes Missed diagnosis, can create undue burden of disease and significant sequelae from excess asthma therapy.
T262 441660-441795 Sentence denotes 51 year-old female suffered from recurrent lip, tongue and laryngeal angioedema for almost 2 years and she required two tracheostomies.
T263 441796-441839 Sentence denotes Her daughter had a history of lip swelling.
T264 441840-441938 Sentence denotes Laboratory reports: C4 undetectable, C1 esterase low, C1 esterase function was 40% and C1q normal.
T265 441939-441966 Sentence denotes She was diagnosed with HAE.
T266 441967-441987 Sentence denotes Danazol was started.
T267 441988-442141 Sentence denotes Because of persistent cramping abdominal pain, and because she was going to start danazol, a CT of the abdomen was obtained; it showed mild splenomegaly.
T268 442142-442262 Sentence denotes She was then evaluated by the oncologist who entertained the possibility of hereditary versus acquired angioedema (AAE).
T269 442263-442404 Sentence denotes A bone marrow biopsy revealed the presence of a small CD5 negative, CD10 negative, CD19 & CD 20 positive Lambda restricted B-cell population.
T270 442405-442592 Sentence denotes The pathologist felt that the presence of a small abnormal monoclonal B-cell population was suspicious but not definitive for the diagnosis of lymphomatous involvement of the bone marrow.
T271 442593-442713 Sentence denotes Given the non-definitive bone marrow diag-nosis, the oncologist and the patient decided to observe with close follow up.
T272 442714-442798 Sentence denotes Despite danazol, she suffered from continued life threatening attacks of angioedema.
T273 442799-442926 Sentence denotes Two months later, C1 Esterase Inhibitor (Cinryze) infusion therapy was started in an attempt to prevent episodes of angioedema.
T274 442927-442983 Sentence denotes By this time, her spleen was found be palpably enlarged.
T275 442984-443071 Sentence denotes Repeat complement studies showed C1q to be low, in contrast to a normal C1q previously.
T276 443072-443170 Sentence denotes After 2 months of Cinryze therapy, the patient underwent a splenectomy for Non-Hodgkin's lymphoma.
T277 443171-443239 Sentence denotes During the period she received Cinryze, she did not have angioedema.
T278 443240-443288 Sentence denotes One month post splenectomy, Cinryze was stopped.
T279 443289-443342 Sentence denotes She continued to be free from episodes of angioedema.
T280 443343-443429 Sentence denotes Four months later, C4 and C1q remained depressed, but C1INH function recovered nicely.
T281 443430-443475 Sentence denotes This patient had an initial diagnosis of HAE.
T282 443476-443588 Sentence denotes Later, the low C1q and palpably enlarged spleen prompted a diagnosis of AAE secondary to non-Hodgkin's lymphoma.
T283 443589-443676 Sentence denotes This was an unusual presentation with an initially normal C1q in this patient with AAE.
T284 443677-443805 Sentence denotes Cinryze therapy is not approved for use in acquired angioedema but was necessary in this patient with life threatening episodes.
T285 443806-443938 Sentence denotes Cinryze therapy prevented further episodes of life-threatening angioedema until definitive therapy with a splenectomy was performed.
T286 443939-444070 Sentence denotes Our patient has been completely free of angioedema for more than one year after splenectomy and discontinuation of cinryze therapy.
T287 444071-444084 Sentence denotes Introduction:
T288 444085-444263 Sentence denotes Orofacial granulomatosis (OFG) is a rare, disfiguring illness of unknown etiology characterized by the development of non-caseating granulomas in the oral and maxillofacial area.
T289 444264-444494 Sentence denotes OFG can manifest as Melkersson-Rosenthal syndrome, which is a triad of persistent lip or facial swelling, recurrent facial paralysis and fissured tongue, or as cheilitis granulomatosa of Miescher, which primarily affects the lips.
T290 444495-444662 Sentence denotes Although OFG can be associated with systemic diseases such as tuberculosis, Crohn's disease and sarcoidosis, it has not been reported with hereditary angioedema (HAE).
T291 444663-444668 Sentence denotes Case:
T292 444669-444786 Sentence denotes A 43-year-old woman presented with complaints of recurrent swelling of the face, lips, uvula, neck, tongue and limbs.
T293 444787-444849 Sentence denotes The episodes occurred twice weekly and resolved over 2-4 days.
T294 444850-444895 Sentence denotes High-dose antihistamines were not beneficial.
T295 444896-444983 Sentence denotes Laboratory work-up revealed normal C4 level and normal C1 inhibitor level and function.
T296 444984-445124 Sentence denotes She was diagnosed with HAE with normal C1 inhibitor level and successfully treated with C1 inhibitor concentrate, ecallantide and icatibant.
T297 445125-445278 Sentence denotes However, six months after her initial presentation, the episodic lip swelling progressed to persistent lip swelling despite resolution of other symptoms.
T298 445279-445374 Sentence denotes Physical exam revealed diffusely edematous upper and lower lips with mild overlying maceration.
T299 445375-445606 Sentence denotes A lip biopsy demonstrated diffuse, submucosal infiltrate of lymphocytes, histiocytes, and multinucleated giant cells forming non-caseating granulomas, as well as negative Congo red stain, Periodic Acid-Schiff stain, and Fite stain.
T300 445607-445667 Sentence denotes These findings were consistent with cheilitis granulomatosa.
T301 445668-445817 Sentence denotes Oral and intravenous corticosteroids led to only mild temporary improvement, while dietary modification and topical corticosteroids were ineffective.
T302 445818-445894 Sentence denotes The patient is scheduled to undergo intralesional corticosteroid injections.
T303 445895-446008 Sentence denotes If these are unsuccessful, the next management consideration would be topical and/or systemic immunosuppressants.
T304 446009-446020 Sentence denotes Conclusion:
T305 446021-446118 Sentence denotes Orofacial granulomatosis is rare illness that can significantly affect patients' quality of life.
T306 446119-446189 Sentence denotes Our case describes a unique presentation of OFG in the setting of HAE.
T307 446190-446301 Sentence denotes Delay in recognition and diagnosis can result in permanent disfigurement and impairment in eating and drinking.
T308 446302-446470 Sentence denotes Therefore, it is imperative for clinicians to consider OFG in their differential diagnosis for orofacial edema, and recognize that it can develop in the setting of HAE.
T309 446471-446484 Sentence denotes Introduction:
T310 446485-446596 Sentence denotes Acute antibody mediated rejection (AMR) is characterized by graft dysfunction manifesting over months or years.
T311 446597-446692 Sentence denotes It is a result of donor specific antibodies that usually develop de novo after transplantation.
T312 446693-446794 Sentence denotes A diagnosis of AMR typically indicates an increased incidence of allograft dysfunction and mortality.
T313 446795-446906 Sentence denotes IVIG has been cited in previous studies as being used successfully to treat AMR in cardiac transplant patients.
T314 446907-447069 Sentence denotes However, there are currently no studies that investigate the use of SCIG in the management of acute AMR, which has shown in this case to be a promising treatment.
T315 447070-447087 Sentence denotes Case Description:
T316 447088-447234 Sentence denotes Patient is a 68 year old female who is currently being treated for hypogammaglobulinemia (HGG) and acute rejection s/p cardiac transplant in 2008.
T317 447235-447351 Sentence denotes Multiple biopsies of the endomyocardium post-transplant from 2008-2009 showed evidence of Grade 1A and 1B rejection.
T318 447352-447531 Sentence denotes In 2010, the patient was found to have multiple grade 3A rejections, and received 3 days of IV Solu-Medrol and 7days of Thymoglobulin for presumed T-cell mediated acute rejection.
T319 447532-447663 Sentence denotes She was subsequently admitted for photopharesis for 2 days and plasmapheresis with concomitant IVIG for 3 days the following month.
T320 447664-447796 Sentence denotes In March 2013, the patient was admitted for another episode of 3A rejection, at which time she was also found to have low Ig levels:
T321 447797-447857 Sentence denotes IgG 326, IgA 119, IgM 41, and IgE 1.9 with increased BUN/Cr.
T322 447858-447899 Sentence denotes Patient was given IVIG, 1 gm/kg x 2 days.
T323 447900-448002 Sentence denotes Subsequent biopsy revealed grade 1B rejection, and the patient had much improvement in her IgG levels.
T324 448003-448144 Sentence denotes Patient was continued on monthly subcutaneous immunoglobulins (SCIG) at 500 mg/kg for treatment of acute antibody mediated rejection and HGG.
T325 448145-448238 Sentence denotes She continued to maintain IgG levels within normal range in spite of end stage renal disease.
T326 448239-448392 Sentence denotes Her subsequent pathology specimen reports, with the most recent from 4/2014, show grade 1B rejection, which is much improved from previous 3A rejections.
T327 448393-448404 Sentence denotes Discussion:
T328 448405-448507 Sentence denotes This case illustrates the potential benefit of using SCIG as part of the management for recurrent AMR.
T329 448508-448674 Sentence denotes Early institution of this form of treatment could reduce the incidence of AMR, and therefore, prevent its complications including allograft dysfunction and mortality.
T330 448675-448711 Sentence denotes Research on this topic is warranted.
T331 448712-448714 Sentence denotes M.
T332 448715-448738 Sentence denotes Gogna * , Glenshaw, PA.
T333 448739-448967 Sentence denotes Kabuki syndrome (KS) is a multiple malformation/mental retardation syndrome with an estimated frequency of 1/32,000 that is characterized by distinctive facial features, skeletal anomalies, short stature, and mental retardation.
T334 448968-449073 Sentence denotes Increased infections especially otitis media, URIs, and Pneumonia have been identified in 60-70%patients.
T335 449074-449230 Sentence denotes It is unclear if these infections are due to Immune problems (Hypogammaglobulinemia is a frequent finding in Kabuki syndrome) or craniofacial abnormalities.
T336 449231-449367 Sentence denotes We present the case of a 15 year old female with Kabuki syndrome who presented with persistently low B cells and Autoimmune enteropathy.
T337 449368-449428 Sentence denotes Both these findings have previously not been reported in KS.
T338 449429-449613 Sentence denotes Her Immunoglobulins have been trending down since last 5 years (table 1) Our patient gets mostly line infections with MSSA, CONS, Ecoli and Klebsiella and not sinopulmonary infections.
T339 449614-449728 Sentence denotes This can possibly be explained by a disruption in skin barrier and disruption in GI barrier(h/o chronic diarrhea).
T340 449729-449801 Sentence denotes Her Memory B cells and Mitogen assays were wnl which is very reassuring.
T341 449802-449870 Sentence denotes She had significantly low B cells over the course of atleast 5years.
T342 449871-449996 Sentence denotes Low B cells cannot be explained by chronic diarrhea or use of Tacrolimus ( started on Tacrolimus for Autoimmune-enteropathy).
T343 449997-450225 Sentence denotes She was diagnosed with Autoimmune enteropathy based on the following 1.Inflammation and increased intraepithelial lymphocytes and numerous apoptoses on biopsy and 2.positive anti-enterocyte antibody and 3. anal fissures on exam.
T344 450226-450242 Sentence denotes Recommendations:
T345 450243-450379 Sentence denotes We recommend that a basic Immunological work up -quantitative Immunoglobulins, Specific antibody titers be done in all patients with KS.
T346 450380-450507 Sentence denotes If the Initial work up is abnormal, we recommend further work up including Lymphocyte subsets, Mitogen assays and B CELL panel.
T347 450508-450600 Sentence denotes An index of suspicion should be kept for Autoimmune enteropathy leading to Chronic Diarrhea.
T348 450601-450612 Sentence denotes Background:
T349 450613-450714 Sentence denotes Hashimoto's encephalopathy is a rare and likely under recognized immune-mediated neurologic syndrome.
T350 450715-450850 Sentence denotes While the exact pathophysiology remains unclear, the encephalopathy itself appears to be independent of the biochemical thyroid status.
T351 450851-450945 Sentence denotes Due to the rarity of the syndrome, minimal evidence is available to guide treatment decisions.
T352 450946-451052 Sentence denotes The mainstay of treatment is corticosteroids, with some patients requiring other immunosuppressive agents.
T353 451053-451107 Sentence denotes Cases of success with use of IVIG have been published.
T354 451108-451265 Sentence denotes Few case reports exist in the literature of successful treatment involving thyroidectomy, with the rational of removing the thyroid as an antigenic stimulus.
T355 451266-451284 Sentence denotes Case Presentation:
T356 451285-451434 Sentence denotes We report a case of a 39 year old man who initially presented with a goiter and non-specific symptoms of dizziness, palpitations and general malaise.
T357 451435-451501 Sentence denotes He was found to be hypothyroid and started on replacement therapy.
T358 451502-451670 Sentence denotes He subsequently developed ataxia, thought to be cerebellar in nature with head titubation, gait dysfunction, cognitive impairment and inappropriate emotional responses.
T359 451671-451727 Sentence denotes The severity of his symptoms caused him to be bed-bound.
T360 451728-451856 Sentence denotes He had a reassuring MRI head, LP, and CT of his chest, abdomen and pelvis as well as a negative paraneoplastic antibody work-up.
T361 451857-451958 Sentence denotes His anti-thyroid peroxidase antibodies and anti-thyroglobulin antibodies were significantly elevated.
T362 451959-452115 Sentence denotes The treatment regimen initiated included high dose corticosteroids, with a prolonged taper as well as IVIG, addition of mycophenolic acid and thyroidectomy.
T363 452116-452240 Sentence denotes Interestingly, pathology from the thyroidectomy revealed micropapilary cancer with local micrometastases in the lymph nodes.
T364 452241-452381 Sentence denotes The patient returned to his baseline status, and presently is continued on monthly IVIG, mycophenolic acid and a continued prednisone taper.
T365 452382-452424 Sentence denotes He has not had recurrence of his symptoms.
T366 452425-452436 Sentence denotes Conclusion:
T367 452437-452618 Sentence denotes The above case highlights a rare and likely under-diagnosed immunologic syndrome for which little guidance in the literature exists with respect to treatment beyond corticosteroids.
T368 452619-452765 Sentence denotes This case report serves to review the clinical presentation, pathogenic theories, diagnosis and management options for Hashimoto's encephalopathy.
T369 452766-452854 Sentence denotes The case also adds support to previous cases of successful treatment with thyroidectomy.
T370 452855-452868 Sentence denotes Introduction:
T371 452869-452977 Sentence denotes A twenty-four-year-old male was admitted to the ICU with deteriorating mental status and cogwheel movements.
T372 452978-453148 Sentence denotes Two healthy individuals who accompanied the patient on a recent trip to Wyoming had spontaneous resolution of similar prodromal symptoms after exposure to mosquito bites.
T373 453149-453299 Sentence denotes He was subsequently found to have neuroinvasive West Nile virus infection with positive IgM antibodies in his CSF and serum, and detectable serum RNA.
T374 453300-453414 Sentence denotes The patient had a history of recurrent sinopulmonary infections, chronic warts, and leukopenia with monocytopenia.
T375 453415-453493 Sentence denotes His father and grandfather died before 50 years of age due to viral illnesses.
T376 453494-453583 Sentence denotes There was no known family history of leukemia or nontuberculous mycobacterial infections.
T377 453584-453592 Sentence denotes Methods:
T378 453593-453641 Sentence denotes Peripheral blood was analyzed by flow cytometry.
T379 453642-453761 Sentence denotes NK cell function was measured by the release of radioactive chromium from lysis of the erythroleukemia cell line, K562.
T380 453762-453897 Sentence denotes DNA amplification of all exons, flanking splice sites, and intronic noncoding regulatory regions of GATA2 was performed on whole blood.
T381 453898-454026 Sentence denotes The patient received 1.2 g/kg IVIG divided over 3 days and 3 million units of subcutaneous interferon alfa-2b daily for 14 days.
T382 454027-454035 Sentence denotes Results:
T383 454036-454145 Sentence denotes Monocytes (0), B lymphocytes (8), CD4+ and CD8+ T lymphocytes (161 and 68), and NK cells (13) (/mL) were low.
T384 454146-454263 Sentence denotes Absolute CD16+56+ and CD56 bright NK cell counts were markedly reduced, with relative frequency within normal limits.
T385 454264-454292 Sentence denotes NK cell function was normal.
T386 454293-454450 Sentence denotes Genomic sequencing revealed a heterozygous single base deletion, c.1021delG; p.A341Pfs, causing the loss of the highly conserved second zinc finger of GATA2.
T387 454451-454515 Sentence denotes DNA sequencing for the same mutation in his mother was negative.
T388 454516-454650 Sentence denotes The patient had a significant improvement in his neurologic function and most of his warts subsided after IVIG and interferon alfa-2b.
T389 454651-454803 Sentence denotes He was referred to our Hematopoietic Stem Cell Transplantation Program for bone marrow aspiration/biopsy and evaluation for bone marrow transplantation.
T390 454804-454816 Sentence denotes Conclusions:
T391 454817-454922 Sentence denotes This is the first report of a patient with GATA2 deficiency presenting with West Nile virus encephalitis.
T392 454923-455143 Sentence denotes Patients with heterozygous GATA2 mutations may be more susceptible to neuroinvasive disease from West Nile virus infection, even in the absence of a nontuberculous mycobacterial infection or familial history of leukemia.
T393 455144-455243 Sentence denotes IVIG and interferon alfa-2b may have been beneficial for this patient with impaired viral immunity.
T394 455244-455257 Sentence denotes Introduction:
T395 455258-455351 Sentence denotes Erythropoietin replacement is a key therapy of anemia associated with chronic kidney disease.
T396 455352-455597 Sentence denotes Rapid desensitization has been successful in patients with immediate type I hypersensitivity to epoetin alfa, and a slower two-day protocol has been described in an adult patient who had delayed type hypersensitivity reactions to the same agent.
T397 455598-455855 Sentence denotes An eleven-year-old girl with a history of end stage focal segmental glomerulosclerosis on hemodialysis developed a diffuse, pruritic, maculopapular rash one day after starting epoetin alfa, which recurred when darbepoetin alfa was subsequently administered.
T398 455856-455998 Sentence denotes She then failed a two-day epoetin alfa desensitization protocol but subsequently tolerated epoetin alfa after a seventeen-day desensitization.
T399 455999-456007 Sentence denotes Methods:
T400 456008-456171 Sentence denotes Binding and neutralizing anti-epoetin alfa and anti-darbepoetin alfa antibodies were measured using biosensor immunoassay (GE Healthcare-Biocare, Uppsala, Sweden).
T401 456172-456355 Sentence denotes A two-day subcutaneous epoetin alfa (Epogen, Amgen) desensitization schedule, adjusted by weight, was modeled after a previously published adult epoetin alfa desensitization protocol.
T402 456356-456455 Sentence denotes The patient developed an intensely pruritic, maculopapular rash prior to the first dose of day two.
T403 456456-456548 Sentence denotes She was started on prednisone 0.3 mg/kg (10 mg) daily and a prolonged protocol was designed.
T404 456549-456557 Sentence denotes Results:
T405 456558-456625 Sentence denotes Anti-epoetin alfa and anti-darbepoetin alfa antibodies were absent.
T406 456626-456697 Sentence denotes On day 4, the patient's rash resolved, and desensitization was resumed.
T407 456698-456757 Sentence denotes She did not have pruritic rashes prior to subsequent doses.
T408 456758-456844 Sentence denotes On day 17, she reached her target dose of 700 IU, and the prednisone was discontinued.
T409 456845-456949 Sentence denotes At her three-month follow-up visit, she continued to tolerate the epoetin alfa without adverse reaction.
T410 456950-456962 Sentence denotes Conclusions:
T411 456963-457132 Sentence denotes To our knowledge, this is the first epoetin alfa desensitization for a child with delayed type hypersensitivity who experienced an adverse reaction to a two-day regimen.
T412 457133-457303 Sentence denotes Subsequently, a slower dose escalation (seventeen days), with the support of a low dose systemic steroid, was successful at building a desensitized state to epoetin alfa.
T413 457304-457439 Sentence denotes This case corroborates the princi-ple that slower desensitization may increase tolerability in delayed type hypersensitivity reactions.
T414 457440-457450 Sentence denotes Rationale:
T415 457451-457596 Sentence denotes Contact dermatitis (CD) is one of the most common inflammatory skin diseases diagnosed by allergists, dermatologists, and primary care providers.
T416 457597-457740 Sentence denotes The presentation of CD is variable based on its time course; it can range from red clustered vesicles to bullae with both scaling and pruritus.
T417 457741-457823 Sentence denotes Allergic CD can complicate or co-exist in the patient with atopic dermatitis (AD).
T418 457824-457832 Sentence denotes Methods:
T419 457833-458074 Sentence denotes An 11 year old female with a history of AD was referred to the Allergy/Immunology Clinic at Winthrop University Hospital for evaluation of persistent chelitis despite evaluation and management by her primary care physician and dermatologist.
T420 458075-458160 Sentence denotes Over the last four years, the patient reported worsening of perioral and lip lesions.
T421 458161-458251 Sentence denotes She had been treated with topical tacrolimus and corticosteroids with minimal improvement.
T422 458252-458372 Sentence denotes She denied any perioral pruritis, worsening of lesions with food ingestion, or use of any cosmetic or lip balm products.
T423 458373-458459 Sentence denotes She reported using the same toothpaste on a regular basis and denied licking her lips.
T424 458460-458545 Sentence denotes She reported skin irritation with costume jewelry and hobbies included flute playing.
T425 458546-458690 Sentence denotes Physical examination revealed dyshidrosis and chelitis (dry cracked lips and perioral erythema with no other active eczematous lesions present).
T426 458691-458748 Sentence denotes Suspicion for allergic CD exacerbating atopic dermatitis.
T427 458749-458835 Sentence denotes The patient was treated with emollients and continued use of a low potency topical CS.
T428 458836-458844 Sentence denotes Results:
T429 458845-459040 Sentence denotes The patient underwent patch testing with the North American Contact Dermatitis panel which included a total of 69 allergens including metals, cosmetics, fragrances, preservatives and medications.
T430 459041-459112 Sentence denotes She had positive results to nickel (3+), cobalt (2+), and neomycin(2+).
T431 459113-459223 Sentence denotes The nickel and cobalt were determined to be of probable relevance as they were likely components of her flute.
T432 459224-459287 Sentence denotes The neomycin was considered to be of unknown or past relevance.
T433 459288-459349 Sentence denotes She was counseled on a trial avoidance of her metallic flute.
T434 459350-459362 Sentence denotes Conclusions:
T435 459363-459431 Sentence denotes Nickel remains the most common allergen obtained from patch testing.
T436 459432-459586 Sentence denotes In patients with lip dermatitis one must consider allergens including lip balms, lipsticks, toothpastes, gums and hobbies including playing an instrument.
T437 459587-459797 Sentence denotes In patients with co-existing AD consider allergic CD, if there is not a response to medical pharmacotherapy and interventions, identification and avoidance of relevant allergens is the mainstay treatment of CD.
T438 459798-459809 Sentence denotes Background:
T439 459810-459984 Sentence denotes Antithymocyte globulin (ATG) is a lymphocyte-selective immunosuppressant indicated for the management of allograft rejection in renal transplant patients and aplastic anemia.
T440 459985-460196 Sentence denotes ATG has the potential for adverse reactions including type I hypersensitivity reactions as well as other more com-mon adverse reactions including fever, chills, rash, nausea, arthralgia, headache, and phlebitis.
T441 460197-460273 Sentence denotes Skin testing evaluates the potential for a type I hypersensitivity reaction.
T442 460274-460433 Sentence denotes Despite a positive skin test, there are circumstances in which receiving ATG is deemed necessary and in such circumstances, ATG desensitization is recommended.
T443 460434-460497 Sentence denotes Previous ATG desensitizations in adults have been unsuccessful.
T444 460498-460516 Sentence denotes Clinical Vignette:
T445 460517-460602 Sentence denotes The patient was a 43 year old male with aplastic anemia and mild intermittent asthma.
T446 460603-460651 Sentence denotes His treatment started with cyclosporine and ATG.
T447 460652-460855 Sentence denotes On the first dose of ATG, he developed dyspnea, fevers, hypotension, and tachycardia, which were treated with infusion cessation, acetaminophen, morphine, and hydrocortisone, with relief of his symptoms.
T448 460856-461026 Sentence denotes A second infusion was attempted the next day per his initial protocol and again symptoms developed including dyspnea, tachypnea, chest tightness, fevers, and hypotension.
T449 461027-461219 Sentence denotes The infusion was stopped, supplemental oxygen given, and a CT chest with contrast was obtained, which showed bilateral scattered ground glass opacities with a few areas of focal consolidation.
T450 461220-461344 Sentence denotes Given the possibility of ATG-induced lung toxicity, no further ATG was given and the patient was maintained on cyclosporine.
T451 461345-461467 Sentence denotes Eighteen months later, the patient was found to have worsening pancytopenia despite therapeutic cyclosporine serum levels.
T452 461468-461554 Sentence denotes Given failure of treatment with cyclosporine, treatment with ATG was deemed necessary.
T453 461555-461658 Sentence denotes As skin testing results would not have changed the plan for desensitization, skin testing was deferred.
T454 461659-461802 Sentence denotes The patient underwent the ATG desensitization protocol outlined in Table I which was based on the protocol put forth by Ferdman and colleagues.
T455 461803-461923 Sentence denotes He tolerated the protocol well without symptoms except fever on day 2 of the protocol which resolved with acetaminophen.
T456 461924-461935 Sentence denotes Conclusion:
T457 461936-462106 Sentence denotes Successful desensitization to ATG has been documented in only pediatric patients as adult patients have developed symptoms necessitating cessation of the desensitization.
T458 462107-462206 Sentence denotes This case illustrates a successful desensitization to ATG in an adult patient with aplastic anemia.
T1 462207-462220 Sentence denotes Introduction:
T2 462221-462351 Sentence denotes Adrenal suppression and Cushing's syndrome have been reported due to the interaction between ritonavir and intranasal fluticasone.
T3 462352-462520 Sentence denotes We report the successful use of an alternative intranasal steroid (INS) in a patient who previously had adrenal suppression due to ritonavir and intranasal fluticasone.
T4 462521-462529 Sentence denotes Methods:
T5 462530-462542 Sentence denotes Case report.
T6 462543-462548 Sentence denotes Data:
T7 462549-462769 Sentence denotes A 50 yo M with HIV on a boosting dose of ritonavir 100 mg BID as well as emtricitabine-tenofavir, raltegravir, and darunavir was treated with fluticasone intranasal spray 2 sprays per nostril daily for allergic rhinitis.
T8 462770-462875 Sentence denotes After 6 months, he reported good control of rhinitis and lacked signs or symptoms of adrenal suppression.
T9 462876-462951 Sentence denotes Three months later he was noted to have abdominal striae and easy bruising.
T10 462952-463012 Sentence denotes Early morning cortisol was <1.0 and ACTH was found to be <5.
T11 463013-463109 Sentence denotes He was started on a tapering dose of hydrocortisone and intranasal fluticasone was discontinued.
T12 463110-463209 Sentence denotes Upon further inquiry, on some occasions the patient self-increased his INS dose up to 2 sprays tid.
T13 463210-463352 Sentence denotes After completion of the hydrocortisone taper, early morning cortisol and ACTH were within normal range and his Cushingoid appearance resolved.
T14 463353-463572 Sentence denotes After 9 months of treatment with intranasal antihistamines, oral antihistamines, as well as leukotriene antagonist therapy, his rhinitis symptoms were still not controlled and were greatly affecting his quality of life.
T15 463573-463622 Sentence denotes A baseline morning cortisol and ACTH were normal.
T16 463623-463741 Sentence denotes Intranasal mometasone was prescribed and he was counseled on the strict usage of mometasone 1 spray per nostril daily.
T17 463742-463827 Sentence denotes After 4 weeks of continuous therapy, early morning cortisol and ACTH remained normal.
T18 463828-463961 Sentence denotes After 6 months of follow-up, he continues to have excellent symptom control and absence of Cushing's syndrome on repeat examinations.
T19 463962-463973 Sentence denotes Conclusion:
T20 463974-464147 Sentence denotes Our case demonstrates that adrenal suppression with the concomitant use of intranasal fluticasone and ritonavir can also occur while on the lower boosting dose of ritonavir.
T21 464148-464289 Sentence denotes This case also suggests that intranasal mometasone is safe and effective with concomitant ritonavir 100 mg twice a day in a patient with HIV.
T22 464290-464301 Sentence denotes Background:
T23 464302-464431 Sentence denotes We will describe two unique cases regarding the potential effects of allergy immunotherapy (IT) on eosinophilic esophagitis (EE).
T24 464432-464440 Sentence denotes Methods:
T25 464441-464571 Sentence denotes Patients underwent a complete history, physical exam, skin prick testing (SPT) by classical method, and an accelerated IT program.
T26 464572-464658 Sentence denotes Both patients reached their maintenance doses, which was 0.5ml of a 1:1 concentration.
T27 464659-464695 Sentence denotes EE was diagnosed via EGD and biopsy.
T28 464696-464704 Sentence denotes Results:
T29 464705-464712 Sentence denotes Case 1:
T30 464713-464794 Sentence denotes Patient presented for evaluation of seasonal allergy symptoms and food allergies.
T31 464795-464885 Sentence denotes Patient had a known history of EE that was previously controlled with an elimination diet.
T32 464886-465012 Sentence denotes SPT revealed positive results to dust mites, cat, dog, grass, trees, weeds, milk, egg, peanut, multiple tree nuts, and sesame.
T33 465013-465204 Sentence denotes Patient was started on IT for allergic rhinitis, and after six months of treatment the patient reported that dysphagia had progressively worsened despite avoidance of all known food triggers.
T34 465205-465212 Sentence denotes Case 2:
T35 465213-465290 Sentence denotes Patient presented with complaints of dysphagia and seasonal allergy symptoms.
T36 465291-465358 Sentence denotes SPT revealed positive results to trees, grass, weeds and cockroach.
T37 465359-465438 Sentence denotes Daily symptoms of dysphagia were uncontrolled on a proton pump inhibitor alone.
T38 465439-465555 Sentence denotes The patient was referred to a GI specialist for a definitive diagnosis, and EE was confirmed with an EGD and biopsy.
T39 465556-465594 Sentence denotes An elimination diet was not initiated.
T40 465595-465747 Sentence denotes Patient was prescribed a daily swallowed budesonide and Splenda mixture for three months after which treatment was stopped with improvement in symptoms.
T41 465748-465866 Sentence denotes Three months after swallowed budesonide was discontinued, allergy IT was initiated for treatment of allergic rhinitis.
T42 465867-465932 Sentence denotes IT was continued for 1.5 years until discontinued by the patient.
T43 465933-466029 Sentence denotes Upon completion, the patient reported that dysphagia had continued to improve since starting IT.
T44 466030-466042 Sentence denotes Conclusions:
T45 466043-466156 Sentence denotes The inhalation of aeroallergens may have an effect on the inflammation occurring in the esophagus of EE patients.
T46 466157-466352 Sentence denotes It is hypothesized that using IT to reduce sensitization would greatly impact this inflammatory response, however, there are no controlled studies on allergy IT as an adjunctive treatment for EE.
T47 466353-466490 Sentence denotes Our case reports indicate that there is conflicting data on whether or not IT can impact EE, and if this impact is harmful or beneficial.
T48 466491-466703 Sentence denotes Our recommendations are to continue research on the role of aeroallergens in the pathogenesis of EE, to consider the effects of IT on EE, and to assess the risks and benefits of continuing IT on patients with EE.
T49 466704-466706 Sentence denotes K.
T50 466707-466721 Sentence denotes Anthony * , L.
T51 466722-466744 Sentence denotes Wild, New Orleans, LA.
T52 466745-466758 Sentence denotes Introduction:
T53 466759-466854 Sentence denotes Chronic abdominal pain associated with bowel dysfunction affects 15% of the general population.
T54 466855-466961 Sentence denotes These patients often undergo extensive negative work-ups and are diagnosed with functional pain disorders.
T55 466962-467227 Sentence denotes Gastrointestinal mast cell disorders are not always considered in the differential diagnosis; however, recent studies suggest patients with chronic abdominal pain may have an underlying gastrointestinal mast cell disorder that will improve with appropriate therapy.
T56 467228-467334 Sentence denotes We present a case suggesting these patients should be evaluated for a gastrointestinal mast cell disorder.
T57 467335-467343 Sentence denotes Methods:
T58 467344-467499 Sentence denotes A 32 y.o. male with allergic rhinitis presented with a 3 year history of diffuse abdominal pain, diarrhea, and a sensation of "itching" inside the abdomen.
T59 467500-467595 Sentence denotes He denied any associated flushing, rash, wheezing, difficulty breathing, syncope, or dizziness.
T60 467596-467722 Sentence denotes He had undergone an extensive evaluation including endoscopy, colonoscopy, CT abd/pelvis, CBC, CMP, ESR, and celiac screening.
T61 467723-467843 Sentence denotes Given his persistent symptoms, he underwent a repeat endoscopy/colonoscopy with biopsies and staining for CD 117+ cells.
T62 467844-467916 Sentence denotes Results: CT abd/pelvis, CBC, CMP, ESR, and celiac screening were normal.
T63 467917-467966 Sentence denotes Previous endoscopy and colonoscopy were negative.
T64 467967-468130 Sentence denotes Repeat endoscopy and colonoscopy with staining for CD 117+ cells was significant for >20-40 mast cells per hpf in the stomach, duodenum, terminal ileum, and colon.
T65 468131-468224 Sentence denotes Systemic mastocytosis was ruled out with normal serum tryptase and normal bone marrow biopsy.
T66 468225-468328 Sentence denotes He was started on daily H1 and H2 blockers with significant improvement in abdominal pain and diarrhea.
T67 468329-468340 Sentence denotes Conclusion:
T68 468341-468448 Sentence denotes Chronic abdominal pain and diarrhea in this patient were likely secondary to mast cell gastroenterocolitis.
T69 468449-468598 Sentence denotes Treatments for mast cell gastrointestinal disorders including oral antihistamines and oral mast cell stabilizers are available and usually effective.
T70 468599-468723 Sentence denotes Accurate diagnosis enables patients to start appropriate treatment, leading to improved symptom control and quality of life.
T71 468724-468911 Sentence denotes This case suggests patients with persistent abdominal pain and bowel dysfunction may need evaluation for a mast cell GI disorder, even in the absence of symptoms of systemic mastocytosis.
T72 468912-468914 Sentence denotes P.
T73 468915-468927 Sentence denotes Uong *1 , K.
T74 468928-468944 Sentence denotes Christine 1 , D.
T75 468945-468956 Sentence denotes Wong 2 , 1.
T76 468957-468972 Sentence denotes Phoenix, AZ; 2.
T77 468973-468982 Sentence denotes Mesa, AZ.
T78 468983-468996 Sentence denotes Introduction:
T79 468997-469132 Sentence denotes We teach patient with allergies to avoid allergen as the first step in treatment, but what if that allergen is a life-saving treatment?
T80 469133-469316 Sentence denotes We present a case of a child with severe hemophilia B who developed anaphylaxis to coagulation factor IX with subsequent desensitization attempts and associated medical complications.
T81 469317-469507 Sentence denotes Case: TL is a 15 year-old male with severe hemophilia B who presented to the hospital for severe right arm pain and swelling, found to be compartment syndrome requiring an urgent fasciotomy.
T82 469508-469670 Sentence denotes Despite his ill-ness, TL was not on coagulation factor IX, the one protein that he was missing, because of multiple instances of anaphylaxis and inhibitors to it.
T83 469671-469810 Sentence denotes Interestingly, he had undergone two desensitizations as a toddler with eventual fair control of his bleeding despite high inhibitor levels.
T84 469811-470048 Sentence denotes However, in recent years, allergic symptoms to factor IX started to escalate, requiring change of therapy to factor VII, which bypassed the factor IX-dependent step in the coagulation cascade and kept his bleeding under variable control.
T85 470049-470245 Sentence denotes Outcome: TL continues to struggle with allergies to factor IX, acute on chronic pain exacerbations, and ongoing complications including a recent large deep venous thrombosis (DVT) in his left arm.
T86 470246-470378 Sentence denotes He is now undergoing desensitization to factor IX again but is now using Rixubis instead of BeneFIX, with the addition of rituximab.
T87 470379-470542 Sentence denotes Because the protocol by Sarah Alexander was denied by insurance, TL is now desensitizing according to the protocol by Dioun et. al at Boston's Children's Hospital.
T88 470543-470677 Sentence denotes Advantages for rituximab include lowering inhibitor levels and bleeding symptoms with a reported beneficial change in factor kinetics.
T89 470678-470809 Sentence denotes The disadvantage, however, is that rituximab can be associated with anaphylaxis, and in rare cases, multifocal leukoencephalopathy.
T90 470810-471034 Sentence denotes With his debilitating disorder, depression is certainly a concern, but TL is now doing better than ever before, and hope exists for even newer therapies on the horizon, including several longacting formulations of factor IX.
T91 471035-471046 Sentence denotes Conclusion:
T92 471047-471250 Sentence denotes Hemophilia B is a chronic, lifethreatening, debilitating condition, but with a history of allergies and anaphylaxis to the one protein that is missing, treatment and management becomes much more complex.
T93 471251-471441 Sentence denotes This case report is an important reminder of the need for a strong interdisciplinary team to stay involved and to stay abreast of new medical advances to help maximize care for this patient.
T94 471442-471444 Sentence denotes P.
T95 471445-471457 Sentence denotes Uong *1 , N.
T96 471458-471469 Sentence denotes Jain 2 , 1.
T97 471470-471485 Sentence denotes Phoenix, AZ; 2.
T98 471486-471498 Sentence denotes Gilbert, AZ.
T99 471499-471512 Sentence denotes Introduction:
T100 471513-471615 Sentence denotes Defects in the gene Artemis are known to result in a form of severe combined immune deficiency (SCID).
T101 471616-471727 Sentence denotes The incidence of this defect in the Athabascan-speaking Native American population is about 1/2000 live births.
T102 471728-471870 Sentence denotes Here, we describe a case of an infant with SCID with the Artemis gene defect who presented with severe neutropenia despite a normal IgG level.
T103 471871-471876 Sentence denotes Case:
T104 471877-472053 Sentence denotes A 5-month-old Navajo female with a history of poor weight gain and frequent respiratory tract infections was admitted to the hospital due to hypoxemia and respiratory distress.
T105 472054-472189 Sentence denotes Initial chest radiograph from the ED revealed bilateral infiltrates, and the child was placed on supplemental oxygen via nasal cannula.
T106 472190-472276 Sentence denotes Respiratory culture was positive for respiratory syncytial virus (RSV) and rhinovirus.
T107 472277-472498 Sentence denotes Initial lab work up revealed an abnormal complete blood count (CBC) with leukopenia, lymphopenia, and profound neutropenia (absolute lymphocyte count approximately 1000/mm 3 and an absolute neutrophil count of 300/mm 3 ).
T108 472499-472523 Sentence denotes HIV screen was negative.
T109 472524-472597 Sentence denotes IgG was preserved at 811 mg/dL, IgA was < 8 mg/dL, and IgM was 301 mg/dL.
T110 472598-472712 Sentence denotes IgG subclasses revealed a total IgG at 799 mg/dL (IgG1 681mg/dL, IgG2 8 mg/dL, IgG3 6 mg/dL, and IgG4 undectable).
T111 472713-472865 Sentence denotes The patient developed ecthyma gangrenosum of the nose secondary to infection at the site of nasal cannula with culture positive for pseudomonas species.
T112 472866-472947 Sentence denotes The patient was put on anti-pseudomonal therapy with meropenum and ciprofloxacin.
T113 472948-473037 Sentence denotes Immunology consult was obtained due to persistent severe neutropenia of unclear etiology.
T114 473038-473180 Sentence denotes Recommendations were made for bronchoscopy, which revealed P. jirovici pneumonia and the patient was started on sulfamethoxazole/trimethoprim.
T115 473181-473275 Sentence denotes T-cell receptor excision circles (TREC) assay revealed <74 TREC/10 6 cells suggestive of SCID.
T116 473276-473518 Sentence denotes Due to her Navajo background, the patient was suspected of having a defect in the Artemis gene and was transferred to the University of California at San Francisco Medical Center for further management including a bone marrow transplantation.
T117 473519-473530 Sentence denotes Conclusion:
T118 473531-473666 Sentence denotes This is the first reported case of a child with a defect in the Artemis gene presenting with severe neutropenia and a normal IgG level.
T119 473667-473766 Sentence denotes This unusual lab presentation led to a delay in immunology consultation and a definitive diagnosis.
T120 473767-473883 Sentence denotes Although the patient's absolute lymphocyte count was also low, initial work up focused on the patient's neutropenia.
T121 473884-473886 Sentence denotes D.
T122 473887-473900 Sentence denotes Hirsch * , V.
T123 473901-473926 Sentence denotes Bonagura, Great Neck, NY.
T124 473927-473937 Sentence denotes Rationale:
T125 473938-474096 Sentence denotes Hip replacement surgery is an increasingly common procedure in the United States, as more than 300,000 individuals undergo total hip replacement (THR) yearly.
T126 474097-474252 Sentence denotes Common causes of joint replacement failure have historically included mechanical loosening, infection, fractures around the implant, and joint instability.
T127 474253-474359 Sentence denotes Failure rates are as high as 6.1% for metal-on-metal THR and 3.3% for ceramic-on-ceramic articulations[i].
T128 474360-474513 Sentence denotes In the general population, 10-15% of individuals have metal hypersensitivity [ii] , which may represent an increasing cause of joint replacement failure.
T129 474514-474682 Sentence denotes We describe the presentation, clinical course, and evaluation of a patient with recurrent infections after THR who was ultimately diagnosed with metal hypersensitivity.
T130 474683-474691 Sentence denotes Methods:
T131 474692-474795 Sentence denotes A 48-yearold man presented for an immunological evaluation because of recurrent infections after a THR.
T132 474796-474909 Sentence denotes Three days after the operation, he developed a fever and underwent a washout and temporary insertion of a spacer.
T133 474910-475094 Sentence denotes A few weeks later, he underwent re-implantation of hardware, but the wound did not heal properly so a spacer was inserted and he had another re-implantation of hardware 3 months later.
T134 475095-475183 Sentence denotes One year after the original procedure, he developed an abscess and a fistula in the hip.
T135 475184-475272 Sentence denotes He was treated with intravenous antibiotics and had another re-implantation of hardware.
T136 475273-475404 Sentence denotes One year later, he again developed a joint infection which required removal of the hardware and implantation of a temporary spacer.
T137 475405-475492 Sentence denotes Prior to the hip replacements, he had been very healthy with no significant infections.
T138 475493-475501 Sentence denotes Results:
T139 475502-475654 Sentence denotes After an immunological workup was unremarkable, patch testing to metals contained in the prosthetics elicited positive responses to nickel and chromium.
T140 475655-475667 Sentence denotes Conclusions:
T141 475668-475824 Sentence denotes It is important to include metal hypersensitivity in the differential diagnosis of individuals presenting with recurrent infections after joint replacement.
T142 475825-475838 Sentence denotes Introduction:
T143 475839-476020 Sentence denotes Shwachman-Diamond Syndrome (SDS) is a rare, autosomal recessive disorder characterized by pancreatic dysfunction, hematologic abnormalities, small stature, and recurrent infections.
T144 476021-476163 Sentence denotes Dysgammaglobulinemia in SDS has been reported, but the use of Intravenous Immunoglobulin (IVIg) to reduce infection rate has not been studied.
T145 476164-476268 Sentence denotes We present siblings with SDS treated with (IVIg) whose rate of hospitalization was dramatically reduced.
T146 476269-476286 Sentence denotes Case Description:
T147 476287-476445 Sentence denotes We present brothers, ages 15 and 17, diagnosed with SDS in early childhood, who have exocrine pancreatic dysfunction, small stature, and recurrent infections.
T148 476446-476523 Sentence denotes Since diagnosis, they have required repeated hospitalizations for infections.
T149 476524-476660 Sentence denotes Both had normal immunoglobulin levels, MBL function, total complement, neutrophil oxidative burst, and post-vaccination antibody levels.
T150 476661-476809 Sentence denotes Since initiation of IVIg, both patients reported significant improvement in their quality of life with improved fatigue and less missed school days.
T151 476810-476895 Sentence denotes Discussion: SDS is a rare congenital disorder with limited data on treatment options.
T152 476896-477039 Sentence denotes Recurrent respiratory infections, beginning early in childhood, are frequently reported and often require hospitalization to rule out sequelae.
T153 477040-477228 Sentence denotes While SDS may be associated with immunoglobulin deficiencies, a literature search did not reveal any publications documenting the use of IVIg to reduce infection rate in patients with SDS.
T154 477229-477514 Sentence denotes In the two patients presented, the use of monthly IVIg has shown objective health benefits including decreased overall infection rate and decreased hospitalization rate; as well as subjective improvement in quality of life, improved fatigue, and decreased number of missed school days.
T155 477515-477630 Sentence denotes This unique case study supports the use of monthly IVIg infusions in patients with SDS by providing objective data.
T156 477631-477812 Sentence denotes It also supports the important need for the development of more scientifically supported clinical guidelines in the treatment of rare genetic conditions causing immune deficiencies.
T157 477813-477826 Sentence denotes Introduction:
T158 477827-477961 Sentence denotes 65-year-old female with linear scleroderma was evaluated for recurrent angioedema refractory to high dose steroids and antihistamines.
T159 477962-478071 Sentence denotes She was initially found to have a mildly elevated serum tryptase, elevated serum histamine, and eosinophilia.
T160 478072-478135 Sentence denotes Bone marrow analysis and cytogenetic studies were unremarkable.
T161 478136-478241 Sentence denotes Serum abnormalities and angioedema resolved on high dose antihistamines and a modified mastocytosis diet.
T162 478242-478250 Sentence denotes Methods:
T163 478251-478362 Sentence denotes Immunological, genetic, and pathological evaluations of a patient, LL, with atypical angioedema were performed.
T164 478363-478462 Sentence denotes Results: LL had a history of benign multinodular goiter and recent diagnosis of linear scleroderma.
T165 478463-478620 Sentence denotes She presented with facial and both proximal and distal extremity angioedema that was poorly responsive to oral corticosteroids, antihistamines and plaquenil.
T166 478621-478708 Sentence denotes There was no associated urticaria or pruritus and no identifiable exacerbating factors.
T167 478709-478805 Sentence denotes C4 complement (44 mg/dL), C1 Esterase inhibitor (40 mg/dL), and C1q (8.3 mg/dL) were all normal.
T168 478806-478894 Sentence denotes Quantitative immunoglobulins (IgG 1010 mg/dL, IgM 206 mg/dL, IgA 141 mg/dL) were normal.
T169 478895-478936 Sentence denotes Serum protein electrophoresis was normal.
T170 478937-479023 Sentence denotes Auto-antibodies (anti-DNA, anti-SCL70, anti-nuclear, anti-TPO, anti-TG) were negative.
T171 479024-479143 Sentence denotes Over a period of 2 months, serum IgG decreased from 1010 mg/dL to 659 mg/dL and serum IgG2 from 206 mg/dL to 153 mg/dL.
T172 479144-479231 Sentence denotes Serum histamine was elevated (8.7ng/mL) and tryptase was slightly elevated at 13 ng/mL.
T173 479232-479341 Sentence denotes She acutely developed a marked hypereosinophilia, AEC 3200/mL up from a baseline of 400/mL, 2 months earlier.
T174 479342-479376 Sentence denotes Parasitic workup was unremarkable.
T175 479377-479509 Sentence denotes Bone marrow and cytogenetic evaluations for hypereosinophilic syndrome, mastocytosis, and myeloproliferative disorders was negative.
T176 479510-479717 Sentence denotes She was started on hydroxyzine 200 mg daily and a low histamine diet with resolution of the angioedema, tryptase levels dropped to 6ng/ml and serum histamine to 2.2 ng/mL and eosinophils decreased to 400/ml.
T177 479718-479730 Sentence denotes Conclusions:
T178 479731-479914 Sentence denotes We report a case of atypical angioedema, mildly elevated tryptase levels and histaminemia which has been responsive to high dose antihistamines and modified histamine-restricted diet.
T179 479915-479982 Sentence denotes Evaluations for mastocytosis and neoplasias have been unremarkable.
T180 479983-479985 Sentence denotes T.
T181 479986-479996 Sentence denotes Lee * , P.
T182 479997-480017 Sentence denotes Busse, New York, NY.
T183 480018-480244 Sentence denotes Acquired deficiency of C1 esterase inhibitor (ACID) is a rare disorder with recurrent episodes of self-limited angioedema that typically affects the skin or mucosal tissues of the upper respiratory and gastrointestinal tracts.
T184 480245-480402 Sentence denotes An underlying defect of ACID may be an undiagnosed malignancy or autoimmune disease, therefore further investigation to rule out these disorders is critical.
T185 480403-480623 Sentence denotes The management of a patient with ACID involves education about potential triggers (including surgery, trauma, medications), ready access to acute treatment, and in some patients consideration of a prophylactic treatment.
T186 480624-480778 Sentence denotes We present an 82 year old male that developed multiple episodes of angioedema of his extremities and in an episode of airway swelling around age 75 years.
T187 480779-480879 Sentence denotes A diagnosis of ACID was made by a decreased C4, C1-inh function, C1-inh protein level and a low C1Q.
T188 480880-480930 Sentence denotes There was no evidence of an underlying malignancy.
T189 480931-481091 Sentence denotes He was initially given C1 inhibitor concentrate (C1INHRP) for treatment of acute attacks and danazol for prophylaxis as his attacks were becoming more frequent.
T190 481092-481240 Sentence denotes Initially his attack rate and severity decreased, but over the following years, he required nearly weekly rescue dosing of C1INHRP for acute attaks.
T191 481241-481305 Sentence denotes His danazol was changed to aminocaproic acidwithout improvement.
T192 481306-481414 Sentence denotes A high antibody titer to C1-inh was detected and the patient was also given icatibant for rescue medication.
T193 481415-481545 Sentence denotes He was subsequently given a round of rituximab which significantly decreased his frequency of attacks and need for rescue therapy.
T194 481546-481726 Sentence denotes After approximately 1 year, his angioedema symptoms increased in frequency and he was given another course of rituximab with improvement again, which waned over the following year.
T195 481727-481772 Sentence denotes A third course of rituximab was administered.
T196 481773-481857 Sentence denotes The patient has been monitor for lymphocyte numbers and specific antibody responses.
T197 481858-481934 Sentence denotes In conclusion, treatment of ACID can be difficult and may require rituximab.
T198 481935-482067 Sentence denotes Although additional courses of rituximab may be warranted, it should be done with careful monitoring of the patient's immune status.
T199 482068-482079 Sentence denotes Background:
T200 482080-482187 Sentence denotes Hereditary angioedema (HAE) is a rare disease, characterized by localized swelling, inflammation, and pain.
T201 482188-482257 Sentence denotes It is the over production of bradykinin that leads to the angioedema.
T202 482258-482376 Sentence denotes Icatibant (FIRAZYR®) is used to treat acute attacks of hereditary angioedema by inhibition of the bradykinin receptor.
T203 482377-482466 Sentence denotes Icatibant is approved for use in type I and II, but is often used off label for type III.
T204 482467-482594 Sentence denotes Icatibant is contraindicated in pregnancy and at this time no data are available on the safety of using icatibant in pregnancy.
T205 482595-482712 Sentence denotes We report a case of type III HAE with frequent use of icatibant that suggests icatibant may be safe during pregnancy.
T206 482713-482721 Sentence denotes Methods:
T207 482722-482845 Sentence denotes The patient was first diagnosed with type III hereditary angioedema based on her history and normal compliment blood tests.
T208 482846-482884 Sentence denotes C1inhibitor was given for prophylaxis.
T209 482885-483014 Sentence denotes Icatibant was used frequently for attacks and continued to be used despite onset of pregnancy without the prescribers' knowledge.
T210 483015-483089 Sentence denotes During the first two trimesters, icatibant was used multiple times a week.
T211 483090-483098 Sentence denotes Results:
T212 483099-483191 Sentence denotes Despite the use, two births resulted in normal fetuses without apparent teratogenic effects.
T213 483192-483335 Sentence denotes One fetus was premature by 2 weeks and slightly below gestational weight; however, is physically normal and up to date on developmental skills.
T214 483336-483348 Sentence denotes Conclusions:
T215 483349-483516 Sentence denotes It appears that the use of icatibant early during pregnancy is safe; however, additional cases of accidental use during pregnancy are needed to confirm this suspicion.
T216 483517-483519 Sentence denotes T.
T217 483520-483533 Sentence denotes Ocampo * , T.
T218 483534-483556 Sentence denotes Rans, San Antonio, TX.
T219 483557-483788 Sentence denotes Eosinophilic granulomatosis with polyangitis (EGPA), formerly known as Churg-Strauss syndrome, is a rare multisystem, antineutrophil cytoplasmic antibody (p-ANCA) associated vasculitis characterized by asthma and hypereosinophilia.
T220 483789-483889 Sentence denotes Its clinical manifestations are variable and often develop over years, making diagnosis challenging.
T221 483890-484100 Sentence denotes We present a previously healthy 30 year old female marathon runner with abrupt onset rhinitis without polyps, productive cough of mucus plugs, intermittent dyspnea, and chest tightness while living in Missouri.
T222 484101-484242 Sentence denotes Although diagnosed clinically with allergic rhinitis and asthma, antihistamines and inhaled corticosteroid (ICS) use provided minimal relief.
T223 484243-484371 Sentence denotes Symptoms initially improved upon relocation to Texas, but occasional respiratory exacerbations occurred over the following year.
T224 484372-484504 Sentence denotes Abruptly, during a bout of sinusitis, she endorsed fatigue, weight loss, burning leg pain, facial angioedema, and a blistering rash.
T225 484505-484592 Sentence denotes Routine CBC demonstrated marked eosinophilia (AEC 16,100) prompting hospital admission.
T226 484593-484753 Sentence denotes Initial investigation of primary (FIP1L1-PDGFRA) and secondary (medications, infectious, malignancy, rheumatologic) etiologies of eosinophilia were unrevealing.
T227 484754-484855 Sentence denotes Rheumatoid factor (RF), antineutrophil antibody (ANA), and ANCA (PR3 Ab 0.5, MPO Ab 0) were negative.
T228 484856-484908 Sentence denotes Sinus CT revealed extensive paranasal sinus disease.
T229 484909-485036 Sentence denotes Chest CT revealed tree in bud and ground glass opacities, mucus plugging, and lymphadenopathy (normal chest CT the year prior).
T230 485037-485093 Sentence denotes Serum IgE (3901 IU/ml) and CRP (1.4mg/dL) were elevated.
T231 485094-485132 Sentence denotes Aspergillus precipitans were negative.
T232 485133-485295 Sentence denotes Skin biopsy revealed eosinophil infiltration and findings consistent with vasculitis, which along with her constellation of symptoms led to the diagnosis of EGPA.
T233 485296-485454 Sentence denotes Prednisone (75mg daily) was started with rapid resolution of peripheral eosinophilia and she has continued to clinically improve on a prolonged steroid taper.
T234 485455-485567 Sentence denotes Retrospectively, this patient demonstrated the prodromal, eosinophilic, and vasculitic phases described in EGPA.
T235 485568-485688 Sentence denotes However, her diagnosis was elusive to her multidisciplinary team until a rapid surge of symptoms prompted a skin biopsy.
T236 485689-485884 Sentence denotes This case reminds the practicing Allergist of the importance of frequent reassessments and to maintain a high index of suspicion for alternative diagnoses in patients with emerging presentations.
T237 485885-485898 Sentence denotes Introduction:
T238 485899-486070 Sentence denotes Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare, systemic vasculitis characterized by a prodromal phase of chronic rhinosinusitis, asthma, and eosinophilia.
T239 486071-486153 Sentence denotes Treatment of asthma with CS (corticosteroids) may suppress clinical signs of EGPA.
T240 486154-486270 Sentence denotes Further, agents such as omalizumab or leukotriene modifiers may enable weaning from CS, subsequently unmasking EGPA.
T241 486271-486406 Sentence denotes We report a case of EGPA with onset following cessation of systemic CS and complicated by mesenteric vasculitis with bowel perforation.
T242 486407-486425 Sentence denotes Case Presentation:
T243 486426-486758 Sentence denotes A 56-year-old man with allergic rhinitis, chronic sinusitis, one-year history of steroid-dependent asthma, and eosinophilia (0.4-1.9K/uL) was hospitalized with severe epigastric abdominal pain, worsening dyspnea, and left upper extremity weakness and numbness that developed one week after abrupt discontinuation of oral prednisone.
T244 486759-486867 Sentence denotes Asthma therapies included inhaled CS, long-acting bronchodilators, montelukast, systemic CS, and omalizumab.
T245 486868-486922 Sentence denotes Extensive eosinophilia workup was previously negative.
T246 486923-487083 Sentence denotes Physical examination on presentation was significant for bibasilar crackles, periumbilical tenderness, and decreased sensation to and weakness of the left hand.
T247 487084-487226 Sentence denotes Data: WBC 26K/uL, absolute eosinophil count 15.2K/uL, CT chest: peribronchial ill-defined ground glass opacities and tree in bud nodules, BAL:
T248 487227-487392 Sentence denotes 35% eosinophils, EGD: patchy erosions from distal duodenum to the middle jejunum, C-ANCA positive with a titer 1:256, Myeloperoxidase antibody elevated at 111 AU/mL.
T249 487393-487470 Sentence denotes A diagnosis of EPGA was made and pulse dose methylprednisolone was initiated.
T250 487471-487512 Sentence denotes Xolair and montelukast were discontinued.
T251 487513-487581 Sentence denotes He was subsequently treated with Rituxumab 375mg/m 2 for four weeks.
T252 487582-487684 Sentence denotes Six weeks following discharge, he developed severe abdominal pain and presented with an acute abdomen.
T253 487685-487768 Sentence denotes Exploratory laparotomy revealed full thickness perforation of the proximal jejunum.
T254 487769-487867 Sentence denotes Histopathological evaluation of the resected segment was consistent with eosinophilic vascultitis.
T255 487868-488009 Sentence denotes Post-operatively, prednisone 25 mg and cyclophosphamide 100 mg daily have resulted in resolution of eosinophilia and improvement in symptoms.
T256 488010-488119 Sentence denotes Conclusion: EGPA may be precipitated by CS withdrawal in patients with adult onset, steroid-dependent asthma.
T257 488120-488271 Sentence denotes Consequently, clinicians should cautiously monitor for signs of EGPA when tapering CS in severe asthma patients, especially in those with eosinophilia.
T258 488272-488283 Sentence denotes Background:
T259 488284-488562 Sentence denotes Macrophage Activation Syndrome (MAS), a potentially fatal complication of sJIA (systemic juvenile idiopathic arthritis), is characterized by high persistent fevers, hepatosplenomegaly, lymphadenopathy, pancytopenia, hyperferritinemia, hypertriglyceridemia and liver dysfunction.
T260 488563-488573 Sentence denotes Objective:
T261 488574-488674 Sentence denotes To describe a case of sJIA and MAS requiring high dose anakinra (interleukin-1 receptor antagonist).
T262 488675-488692 Sentence denotes Case Description:
T263 488693-488888 Sentence denotes An 8-year-old female with sJIA improved with pulse methylprednisolone (30 mg/kg/day IV x 3 days), anakinra (3 mg/kg/day SQ), and tocilizumab (monoclonal interleukin-6 receptor antibody) infusion.
T264 488889-488969 Sentence denotes Two weeks later, she developed unremitting fevers (105°F) and MAS was suspected.
T265 488970-488978 Sentence denotes Results:
T266 488979-489065 Sentence denotes She had hyperferritinemia, elevated d-dimers, transaminitis, and hypertriglyceridemia.
T267 489066-489169 Sentence denotes Bone marrow biopsy revealed hemophagocytosis and anti-CD163 staining identifying activated histiocytes.
T268 489170-489342 Sentence denotes She received high dose methylprednisolone (30 mg/kg/day IV x 6 days, then tapered over 7 months), cyclosporine, intravenous immunoglobulin, and anakinra (Table 1) for MAS.
T269 489343-489399 Sentence denotes Anakinra was increased from 3 mg/kg/day to 12 mg/kg/day.
T270 489400-489493 Sentence denotes Fever resolved in 4 days, laboratory markers improved and she was discharged home in 14 days.
T271 489494-489534 Sentence denotes Medications were tapered over 12 months.
T272 489535-489596 Sentence denotes She subsequently flared and was controlled on daily anakinra.
T273 489597-489703 Sentence denotes She was then switched to monthly Canakinumab, and her disease continues to be in remission on Canakinumab.
T274 489704-489715 Sentence denotes Discussion:
T275 489716-489790 Sentence denotes We report a case of MAS occurring during the initial presentation of sJIA.
T276 489791-489917 Sentence denotes Excess interleukin-1 can lead to the clinical and laboratory findings of sJIA and MAS, and the up regulation of interleukin-6.
T277 489918-490145 Sentence denotes Uncontrolled production and activation of macrophages and T lymphocytes lead to MAS manifestations, including prolonged high fever, pancytopenia, coagulopathy, lymphadenopathy, hepatic insufficiency, and neurologic dysfunction.
T278 490146-490232 Sentence denotes MAS can rapidly progress to multi-organ failure and death if not treated aggressively.
T279 490233-490329 Sentence denotes Anakinra is a recombinant interleukin-1 receptor antagonist with a short halflife (~ 4-6 hours).
T280 490330-490375 Sentence denotes The usual dosage of anakinra is 1-2mg/kg/day.
T281 490376-490462 Sentence denotes Our patient responded to a 4-fold increase in standard dosing, without adverse events.
T282 490463-490569 Sentence denotes Our experience suggests that high dose anakinra is effective and safe in refractory MAS secondary to sJIA.
T283 490570-490581 Sentence denotes Background:
T284 490582-490734 Sentence denotes The clinical evolution of anaphylaxis is highly variable, depending on the volume of antigen exposure and degree of sensitization amongst other factors.
T285 490735-490826 Sentence denotes Such a reaction may even progress in a stepwise fashion with sequential allergen exposures.
T286 490827-491054 Sentence denotes A phenomenon of "anaphylactic priming" can be conceived given that the magnitude of basophil, Langerhans and mast cell activation is quantitatively linked to the degree of IgE binding via FcεRI, FcεRII and Galactin 3 receptors.
T287 491055-491258 Sentence denotes It thus follows that an intimate series of individually small allergen challenges may translate into a summation of effector cell activation and 'readiness' for histamine and vasoactive mediator release.
T288 491259-491331 Sentence denotes We report a case of anaphylaxis that likely exemplifies this phenomenon.
T289 491332-491350 Sentence denotes Case presentation:
T290 491351-491469 Sentence denotes A healthy 35 year-old male with no prior atopic history was outdoors when he was bitten on the left leg by a fire ant.
T291 491470-491566 Sentence denotes The reaction that ensued was limited to local swelling and irritation of the affected extremity.
T292 491567-491638 Sentence denotes A few hours later, he ate lunch consisting of beef, sea bass and pesto.
T293 491639-491762 Sentence denotes After 15 minutes, he developed facial and lip swelling, throat closure and dyspnea and heralded emergency medical services.
T294 491763-491908 Sentence denotes His management in the field and in the emergency room entailed intramuscular epinephrine and intravenous diphenhydramine with relief of symptoms.
T295 491909-492013 Sentence denotes Work-up in the allergy clinic found him to have an obstructive pattern on spirometry with reversibility.
T296 492014-492163 Sentence denotes Skin prick testing demonstrated significant reactions to peanut, tree nut, dust mite, grass mix, Bermuda mix, weed mix, fire ant, horse, dog and cat.
T297 492164-492263 Sentence denotes He was advised to avoid NSAIDs, sulphites, peanuts, tree nuts, fish and exposure to fire ant venom.
T298 492264-492416 Sentence denotes He was prescribed oral cetirizine 10 mg with an epinephrine auto-injector and an albuterol inhaler to use as needed for anaphylaxis and/or bronchospasm.
T299 492417-492428 Sentence denotes Conclusion:
T300 492429-492622 Sentence denotes Anaphylaxis due to immediate hypersensitivity represents a state of clinically significant histamine and inflammatory mediator release from effector cells upon binding and cross-linking of IgE.
T301 492623-492757 Sentence denotes The short chemical half-life argues that such mediators are released not only in remarkable quantity but in synchrony in this setting.
T302 492758-492991 Sentence denotes Recent allergen exposure in the form of fire ant venom in this case may have recruited effector cells into a state of readiness, thereby orchestrating a more profound level of mediator release following the second allergen challenge.
T303 492992-492994 Sentence denotes J.
T304 492995-493007 Sentence denotes Regan * , W.
T305 493008-493019 Sentence denotes Stevens, B.
T306 493020-493029 Sentence denotes Stein, P.
T307 493030-493049 Sentence denotes Avila, Chicago, IL.
T308 493050-493193 Sentence denotes Good's Syndrome is a rare disorder associated with thymoma, hypogammaglobulinemia, low peripheral B cells, and abnormal cell-mediated immunity.
T309 493194-493292 Sentence denotes Complications from this disease include increased incidence of infections and autoimmune diseases.
T310 493293-493439 Sentence denotes Since the discovery of Good's Syndrome in 1955, the prevalence of this disease is estimated to be only approximately 5% of patients with thymomas.
T311 493440-493653 Sentence denotes We present a case of a 62 year-old male with a history of Good's Syndrome status post thymectomy receiving intravenous immunoglobulin replacement who presented with mild dyspnea on exertion and right arm swelling.
T312 493654-493737 Sentence denotes The patient was found to have a right upper extremity deep venous thrombosis (DVT).
T313 493738-493878 Sentence denotes Interestingly, he was also incidentally found to be pancytopenic with a white blood cell count of 3, hemoglobin of 4.9, and platelets of 27.
T314 493879-494074 Sentence denotes A bone marrow biopsy showed normocellular marrow with lack of red blood cell precursors and very rare megakaryocytic precursors concerning for developing aplastic anemia or pure red cell aplasia.
T315 494075-494230 Sentence denotes Infectious workup including screening for human immunodeficiency virus, parvovirus, herpes virus, Epstein-Barr virus, and cytomegalovirus was unremarkable.
T316 494231-494412 Sentence denotes Hypercoagulability workup for the DVT was negative including screening for Factor V Leiden, Prothrombin, Protein S, Protein C, Lupus Anticoagulant, and Antithrombin III dysfunction.
T317 494413-494574 Sentence denotes The patient was started on prednisone 100mg daily and cyclosporine 250mg twice a day with improvement in anemia but very little response in his thrombocytopenia.
T318 494575-494791 Sentence denotes Unfortunately, the patient re-presented 1 month later with hearing loss, elevated liver function studies, and acute renal failure attributed to cyclosporine toxicity and this medication was subsequently discontinued.
T319 494792-494879 Sentence denotes As he continued to be thrombocytopenic, the patient was then started on N-plate weekly.
T320 494880-494982 Sentence denotes The patient's condition continued to deteriorate with multiple hospitalizations for failure to thrive.
T321 494983-495110 Sentence denotes His poor performance status precluded aggressive treatments including immunosuppression and the patient ultimately passed away.
T322 495111-495216 Sentence denotes In summary, this is a very interesting case of a patient with Good's syndrome found to have pancytopenia.
T323 495217-495230 Sentence denotes Introduction:
T324 495231-495325 Sentence denotes Minocycline is a semisynthetic tetracycline derivative used in the treatment of acne vulgaris.
T325 495326-495490 Sentence denotes It is associated with several adverse effects including drug-induced lupus erythematosus, drug reaction with eosinophilia and systemic symptoms, and serum sickness.
T326 495491-495550 Sentence denotes There are few reported cases of anaphylaxis to minocycline.
T327 495551-495561 Sentence denotes Objective:
T328 495562-495649 Sentence denotes To describe a patient with acne vulgaris who developed minocycline-induced anaphylaxis.
T329 495650-495667 Sentence denotes Case Description:
T330 495668-495850 Sentence denotes A 16 year old female with acne vulgaris treated with minocycline presented with a 2 day history of diffuse, erythematous and pruritic rash, and fever (maximum temperature of 38.8°C).
T331 495851-496027 Sentence denotes Symptoms began approximately one hour following minocycline ingestion and progressed to the development of arthralgias, emesis, edema of the hands and feet and throat swelling.
T332 496028-496098 Sentence denotes Patient was tachycardic upon presentation in the emergency department.
T333 496099-496176 Sentence denotes She received a 1 liter normal saline bolus, diphenhydramine and was admitted.
T334 496177-496185 Sentence denotes Results:
T335 496186-496257 Sentence denotes Patient had elevated c-reactive protein (12.6mg/dL) and sterile pyuria.
T336 496258-496476 Sentence denotes Complete blood count, complete metabolic panel C1 Esterase inhibitor functional assay, antinuclear antibody (ab), anti-neutrophilic cytoplasmic ab, anti-double stranded DNA ab, complements C3 and C4, were within range.
T337 496477-496516 Sentence denotes Blood and urine cultures were negative.
T338 496517-496605 Sentence denotes Patient discontinued minocycline 2 days prior upon onset of symptoms when rash appeared.
T339 496606-496676 Sentence denotes Patient was started on Solumedrol (2 mg/kg/day divided every 6 hours).
T340 496677-496743 Sentence denotes On HD (hospital day) #2, she was switched to Prednisone 20 mg BID.
T341 496744-496845 Sentence denotes Patient complained of "scratchy" throat, shortness of breath and flushing concerning for anaphylaxis.
T342 496846-496901 Sentence denotes 0.3 mg of Epinephrine was administered intramuscularly.
T343 496902-497000 Sentence denotes Patient's rash continued to improve and symptoms of edema, shortness of breath and fever resolved.
T344 497001-497105 Sentence denotes Patient was discharged on HD#3 with Cetirizine, Ranitidine, 7-day steroid taper and EpiPen prescription.
T345 497106-497117 Sentence denotes Discussion:
T346 497118-497218 Sentence denotes Minocylcine-induced anaphylaxis has been discussed in a few case reports in the existing literature.
T347 497219-497294 Sentence denotes Our patient developed symptoms 1 month after the initiation of minocycline.
T348 497295-497482 Sentence denotes Patient's symptoms partially improved after treatment with antihistamines and steroids, but she required an intramuscular dose of epinephrine, and was continued on an oral steroid course.
T349 497483-497627 Sentence denotes As minocycline continues to be one of the important treatments for acne vulgaris, clinicians must be vigilant for its potential adverse effects.
T350 497628-497641 Sentence denotes Introduction:
T351 497642-497878 Sentence denotes Drug Related Eosinophilia with Systemic Symptoms (DRESS) is a rare reaction to medications that occurs 2-6 weeks after drug exposure and typically presents with fever, rash, facial edema, lymphadenopathy, eosinophilia and transaminitis.
T352 497879-497998 Sentence denotes Common medications are aromatic anti-convulsants, sulfonamides, and Dapsone with immunosuppression being a risk factor.
T353 497999-498066 Sentence denotes Reactivation of herpes virus family is seen in 60-75% of the cases.
T354 498067-498147 Sentence denotes The mainstay treatment is removal of the offending agent and high-dose steroids.
T355 498148-498165 Sentence denotes Case Description:
T356 498166-498486 Sentence denotes 17 year-old white male with history of sideroblastic anemia status post bone marrow transplant, immunosuppression, Posterior Reversible Encephalopathy Syndrome (PRES) since January, adrenal insufficiency and atopic diseases that presented to the hospital with a very pruritic, bright red rash, shaking chills and fevers.
T357 498487-498587 Sentence denotes He was admitted for presumed adrenal insufficiency and graft-versushost disease leading to the rash.
T358 498588-498663 Sentence denotes Rash was biopsied, he was started on hydrocortisone 15 mg TID and cefepime.
T359 498664-498815 Sentence denotes Family remarked that the fevers and chills have been present since diagnosis of PRES that was being treated with levetiracetam, amlodipine, furosemide.
T360 498816-498860 Sentence denotes Patient was also on Dapsone for prophylaxis.
T361 498861-498981 Sentence denotes He continued to have fevers and absolute eosinophil count was noted to be 5,420 on steroids with elevated liver enzymes.
T362 498982-499045 Sentence denotes Allergy was consulted, viral titers at this time were negative.
T363 499046-499185 Sentence denotes All the mentioned drugs were discontinued and prednisone 100 mg daily was started with resolution of symptoms and laboratory abnormalities.
T364 499186-499343 Sentence denotes A few months later, the patient had reactivation of EBV treated with Rituximab and developed erythroderma, mild transaminitis and later eosinophilia (1,240).
T365 499344-499411 Sentence denotes Prednisone was increased back to 50 mg daily and symptoms resolved.
T366 499412-499578 Sentence denotes Conclusion: DRESS is a rare reaction to drugs that can be difficult to diagnose and even more difficult to determine the culprit medication due to the delayed timing.
T367 499579-499768 Sentence denotes There are common drugs associated with this disorder, such as dapsone and amlodipine, but multiple medications have been reported as individual cases including Levetiracetam and furosemide.
T368 499769-499810 Sentence denotes Our patient was taking all four of these.
T369 499811-499876 Sentence denotes Reactivation of herpes viruses is common and should be evaluated.
T370 499877-500084 Sentence denotes Finally, immunosuppression is thought to be a risk factor and DRESS should be included in the differential in these patients presenting with rash, systemic symptoms and especially if eosinophilia is present.
T371 500085-500102 Sentence denotes Rash biopsy site.
T372 500103-500105 Sentence denotes S.
T373 500106-500119 Sentence denotes Patel *1 , E.
T374 500120-500140 Sentence denotes Nwaobasi-Iwuh 2 , A.
T375 500141-500153 Sentence denotes Wolff 3 , 1.
T376 500154-500168 Sentence denotes Summit, NJ; 2.
T377 500169-500187 Sentence denotes Morristown, NJ; 3.
T378 500188-500199 Sentence denotes Newark, NJ.
T379 500200-500213 Sentence denotes Introduction:
T380 500214-500368 Sentence denotes Anticonvulsant hypersensitivity syndrome (AHS) is a known potentially life-threatening complication of phenytoin, carbamazepine and phenobarbital therapy.
T381 500369-500470 Sentence denotes Although its occurrence is rare, when AHS occurs, it often results in hospitalization and even death.
T382 500471-500626 Sentence denotes Although the exact mechanism is unknown, it is thought to be an immunologic adverse drug event that is a Tcell-mediated, delayed hypersensitivity reaction.
T383 500627-500632 Sentence denotes Case:
T384 500633-500816 Sentence denotes An 8 year old male with a history of seizure disorder maintained on phenytoin for 10 days, presented to the ED with high fevers and a pruritic rash on his trunk, extremities and face.
T385 500817-500928 Sentence denotes On exam, pertinent positives included a temperature of 102F and a generalized erythematous, maculopapular rash.
T386 500929-500956 Sentence denotes Phenytoin was discontinued.
T387 500957-501019 Sentence denotes His fevers and rash resolved within 48 hours without steroids.
T388 501020-501131 Sentence denotes He was subsequently discharged only to return to the ED 24 hours later with worsening rash and a fever of 103F.
T389 501132-501197 Sentence denotes On examination, he appeared ill with tachycardia and hypotension.
T390 501198-501315 Sentence denotes His pharynx was erythematous with cervical lymphadenopathy and he had a generalized maculopapular, nonblanching rash.
T391 501316-501398 Sentence denotes He was started on a dopamine drip, vancomycin and ceftriaxone for presumed sepsis.
T392 501399-501407 Sentence denotes Results:
T393 501408-501521 Sentence denotes His CBC revealed a WBC count of 14,000/ml, with 73% neutrophils, 11% lym-phocytes, 10% monocytes, 2% eosinophils.
T394 501522-501598 Sentence denotes His LFTs were significant for an elevated AST of 80 U/L, and ALT of 100 U/L.
T395 501599-501651 Sentence denotes Sepsis workup including blood cultures was negative.
T396 501652-501732 Sentence denotes Skin biopsy was consistent with the diagnosis of drug hypersensitivity reaction.
T397 501733-501744 Sentence denotes Discussion:
T398 501745-501871 Sentence denotes The time from starting phenytoin and appearance of rash with other positive findings noted above were all consistent with AHS.
T399 501872-501935 Sentence denotes The patient was treated with intravenous steroids and improved.
T400 501936-502063 Sentence denotes AHS is unusual in that it occurs later than most other drug reactions; about 2-6 weeks after initiation of the offending agent.
T401 502064-502186 Sentence denotes Frequently, the hallmark features of fever, rash, and lymphadenopathy are accompanied by multiorgan-system decompensation.
T402 502187-502328 Sentence denotes Recognition of this syndrome, which may have variable presentations, is the key to prompt discontinuation of the drug and further management.
T403 502329-502506 Sentence denotes This case demonstrates one such variable presentation and stresses the importance of recognizing a symptom free period prior to progression of the disease to the state of shock.
T404 502507-502616 Sentence denotes Furthermore, it reinforces the importance of including AHS and DRESS in the differential diagnosis of sepsis.
T405 502617-502619 Sentence denotes J.
T406 502620-502645 Sentence denotes Giacinto Lawrence *1 , P.
T407 502646-502658 Sentence denotes Ponda 2 , 1.
T408 502659-502673 Sentence denotes Roslyn, NY; 2.
T409 502674-502688 Sentence denotes Manhasset, NY.
T410 502689-502862 Sentence denotes Introduction: FPIES is a disorder presenting as repeated bouts of emesis within 1-3 hours with or without subsequent diarrhea 5-8 hours after ingestion of an offending food.
T411 502863-502958 Sentence denotes It is primarily a non-IgE-mediated hypersensitivity disorder commonly diagnosed during infancy.
T412 502959-503169 Sentence denotes The pathophysiology although not yet fully defined, likely involves stimulation of antigen-specific T cells and a resulting proinflammatory cytokine cascade inducing increased permeability of intestinal mucosa.
T413 503170-503235 Sentence denotes The gold standard for diagnosis is the oral food challenge (OFC).
T414 503236-503324 Sentence denotes The most common food triggers are milk and soy though solid foods can also induce FPIES.
T415 503325-503455 Sentence denotes We present a case of IgE-mediated soy allergy treated with years of avoidance that presented as FPIES upon re-introduction of soy.
T416 503456-503464 Sentence denotes Methods:
T417 503465-503651 Sentence denotes A 6 month old female with eczema who developed a facial rash after drinking soy formula was found to have positive serum and skin prick tests (SPT) to soy, milk and eggs (see Figure 1 ).
T418 503652-503721 Sentence denotes She had an OFC for baked egg at approximately 3 years old and passed.
T419 503722-503812 Sentence denotes One year after incorporating baked egg into the diet, the patient presented for a soy OFC.
T420 503813-503821 Sentence denotes Results:
T421 503822-503930 Sentence denotes The patient tolerated 5oz. (150mL) of liquid soy challenge without reaction and was subsequently discharged.
T422 503931-504018 Sentence denotes She returned approximately 2 hours after initiation of the soy challenge due to emesis.
T423 504019-504134 Sentence denotes The patient's vital signs remained stable; exam was unremarkable with the exception of pallor; no rash was present.
T424 504135-504224 Sentence denotes She remained alert, responsive and talking with continued repetitive nausea and vomiting.
T425 504225-504401 Sentence denotes She received IM Benadryl and Epinephrine and was subsequently transferred to the ER by ambulance for continued monitoring where she received fluids, steroids and an antiemetic.
T426 504402-504451 Sentence denotes The patient recovered and continues to avoid soy.
T427 504452-504463 Sentence denotes Conclusion:
T428 504464-504548 Sentence denotes Although rare, cases of IgE-mediated allergy converting to FPIES have been reported.
T429 504549-504656 Sentence denotes Although FPIES is thought to be a predominantly non-IgE-mediated reaction, the role of IgE remains unclear.
T430 504657-504857 Sentence denotes A future role for other diagnostic measures, such as patch testing, to quantify the risks of food challenge has been suggested however more research is necessary before these tests can be recommended.
T431 504858-505049 Sentence denotes Given these rare cases, there should be a higher awareness and vigilance when diagnosing or challenging a patient with prior IgE-mediated food allergy for possible non-IgE mediated reactions.
T432 505050-505063 Sentence denotes Introduction:
T433 505064-505168 Sentence denotes Chronic Eosinophilic Pneumonia (CEP) is an eosinophilic lung disease that is idiopathic and progressive.
T434 505169-505304 Sentence denotes It is an uncommon disorder affecting females, usually of the fifth decade, who present with chronic respi-ratory and systemic symptoms.
T435 505305-505564 Sentence denotes An atopic history is common but may not be present.The diagnosis is supported by eosinophilia greater than 1000cells/uL, biopsy or bronchoalveolar lavage, pulmonary function tests (PFT), imaging and the exclusion of other causes for eosinophilic lung disease.
T436 505565-505738 Sentence denotes We present a case of an uncommon condition with an atypical presentation which illustrates the importance of having a differential diagnosis in cases that may seem ordinary.
T437 505739-505757 Sentence denotes Case Presentation:
T438 505758-505903 Sentence denotes A 64 year old female without a smoking history presented to clinic with a four month history of left posterior cervical painless lymphadenopathy.
T439 505904-505994 Sentence denotes She denied any weight changes, fever, chills, hemoptysis, poor appetite, dyspnea or cough.
T440 505995-506140 Sentence denotes Physical examination showed she was breathing on room air at 97% with clear lungs sounds bilaterally without egophony nor dullness to percussion.
T441 506141-506215 Sentence denotes There were two lymph nodes which were smooth, nontender and mobile of 1cm.
T442 506216-506390 Sentence denotes HRCT showed multiple mediastinal, and bilateral hilar lymphadenopathy measuring 1.3 to 2.2 cm with groundglass opacities in subpleural distribution with basilar predominance.
T443 506391-506487 Sentence denotes No honeycombing, bronchiectasis, pleural effusion, consolidation, nodules nor masses were noted.
T444 506488-506569 Sentence denotes She was referred to pulmonary clinic for workup for an inflammatory lung process.
T445 506570-506637 Sentence denotes PFT showed a FEV1/FVC ratio of 82% and a diffusion capacity of 59%.
T446 506638-506736 Sentence denotes Additional findings showed eosinophilia of 43.4%, with absolute eosinophil count of 5,000cells/uL.
T447 506737-506811 Sentence denotes Hypersensitivity pneumonitis panel, ANA, ANCA, and anti-CCP were negative.
T448 506812-506841 Sentence denotes IgE was elevated at 838IU/mL.
T449 506842-507000 Sentence denotes She had a right lung wedge resection which showed patchy eosinophilic infiltrates and intra-alveolar macrophages indicative of chronic eosinophilic pneumonia.
T450 507001-507012 Sentence denotes Discussion:
T451 507013-507142 Sentence denotes The initial presentation of posterior cervical lymphadenopathy and lack of respiratory symptoms presented a diagnostic challenge.
T452 507143-507207 Sentence denotes CEP shows peripheral consolidation with upper lobe predominance.
T453 507208-507343 Sentence denotes Although the pattern of HRCT indicated an interstitial lung pneumonia such as usual or fibrotic subtype, biopsy confirmed it to be CEP.
T454 507344-507484 Sentence denotes The combination of clinical history and supporting clinical studies will guide the clinician towards a diagnosis for appropriate management.
T455 507485-507489 Sentence denotes J.G.
T456 507490-507504 Sentence denotes Ghably *1 , A.
T457 507505-507518 Sentence denotes Kapila 1 , G.
T458 507519-507530 Sentence denotes Shaw 1 , T.
T459 507531-507541 Sentence denotes Roy 1 , R.
T460 507542-507553 Sentence denotes Byrd 1 , K.
T461 507554-507562 Sentence denotes Guha 2 ,
T1 507563-507823 Sentence denotes A 59 year old male with a history of type 2 diabetes, peripheral vascular disease, chronic kidney disease, and multiple lacunar infarcts is hospitalized for pontine stroke and treated for klebsiella and enterococcus pneumonia and Clostridium difficile colitis.
T2 507824-507967 Sentence denotes He was readmitted following month for oxygen desaturation and altered mental status eventually requiring intubation and mechanical ventilation.
T3 507968-508017 Sentence denotes EEG and lumbar puncture revealed normal findings.
T4 508018-508181 Sentence denotes Cultures of sputum and bronchial washings grew Klebsiella pneumonia, vancomycin resistant enterococcus, candida, HSV1 and he was placed on appropriate antibiotics.
T5 508182-508267 Sentence denotes Stool studies were positive for C. difficile and he was continued on oral vancomycin.
T6 508268-508363 Sentence denotes Patient developed transient eosinophilia that was initially attributed to underlying infection.
T7 508364-508459 Sentence denotes Eventually, tracheotomy was performed and patient was placed on chronic mechanical ventilation.
T8 508460-508656 Sentence denotes After completion of antibiotics, he continued to exhibit leukocytosis and eosinophilia, chest infiltrates remained stable, and his diarrhea had not resolved despite continued vancomycin treatment.
T9 508657-508787 Sentence denotes Strongyloides titer tested normal so further infective workup was pursued revealing sinusitis, otitis media, and candida cystitis.
T10 508788-508866 Sentence denotes Despite receiving appropriate treatments, leukocytosis and diarrhea persisted.
T11 508867-508962 Sentence denotes Stool was tested for ova and parasites and results were positive for Strongyloides stercoralis.
T12 508963-509099 Sentence denotes After receiving 3 doses of invermectin, his diarrhea and encephalopathy resolved and he was able to be weaned completely off ventilator.
T13 509100-509204 Sentence denotes Immunodeficiency evaluation revealed elevated IgE levels, low IgM levels, and normal IgG and IgA levels.
T14 509205-509387 Sentence denotes Hyperinfection with Strongyloides stercoralis is generally seen in immunocompromised hosts with prolonged steroid therapy, acquired immune deficiency, malignancy, or chronic illness.
T15 509388-509516 Sentence denotes Since the disseminated infection has a high mortality rate, it is imperative to recognize the disease and offer early treatment.
T16 509517-509555 Sentence denotes Ivermectin is the treatment of choice.
T17 509556-509746 Sentence denotes This nematode primarily affects the gastrointestinal system and the lungs, but may rarely manifest in the central nervous system as mycotic aneurysm, intracranial hemorrhages, or vasculitis.
T18 509747-509900 Sentence denotes Primary selective Ig M deficiency is a rare form of the immune disorder associated with severe life threatening infections and severe allergic reactions.
T19 509901-509992 Sentence denotes Intravenous immunoglobulin is the only treatment modality available without clear benefits.
T20 509993-510166 Sentence denotes Hypereosinophilic syndromes (HES) are characterized by persistent hypereosinophilia with eosinophilic infiltration and mediator release that cause damage to multiple organs.
T21 510167-510314 Sentence denotes The peripheral blood hypereosinophilia is defined as eosinophils exceeding 1.5 x 10 9 /L on two separate occasions separated by at least one month.
T22 510315-510569 Sentence denotes We describe a 53 year old female with a history of ovarian cancer, asthma, chronic rhinosinusitis with nasal polyps (CRSwNP) and eosinophilia who presented with chest pain of 4 days duration and was found to have an absolute eosinophil count (AEC) of 15.
T23 510570-510582 Sentence denotes 4 x 10 9 /L.
T24 510583-510619 Sentence denotes Her troponins and CKs were elevated.
T25 510620-510665 Sentence denotes She denied initiation of any new medications.
T26 510666-510743 Sentence denotes She was previously seen as an outpatient for eosinophilia, asthma and CRSwNP.
T27 510744-510886 Sentence denotes At her most recent clinic visit 18 months ago, while undergoing chemotherapy with steroids for the ovarian cancer, her eosinophil count was 0.
T28 510887-510931 Sentence denotes Her highest previous AEC was 8.85 x 10 9 /L.
T29 510932-511043 Sentence denotes Previous workup for Churg Strauss and skin testing for Aspergillus fumigatus to evaluate for ABPA was negative.
T30 511044-511132 Sentence denotes Workup included a peripheral smear showing absolute eosinophilia with normal morphology.
T31 511133-511206 Sentence denotes ANA, cANCA, pANCA, tryptase and quantitative immunoglobulins were normal.
T32 511207-511228 Sentence denotes She was HIV negative.
T33 511229-511288 Sentence denotes Strongyloides serology as well as stool O &P were negative.
T34 511289-511380 Sentence denotes An echocardiogram showed an ejection fraction (EF) of 59% and a small pericardial effusion.
T35 511381-511526 Sentence denotes A cardiac MRI revealed a normal EF, subtle evidence of edema and diffusely elevated gadolinium ECV fractions thought consistent with myocarditis.
T36 511527-511651 Sentence denotes FISH analysis was negative for the presence of a deletion of CHIC2, or translocations involving the FIP1L1 and PDGFRA genes.
T37 511652-511936 Sentence denotes She was treated with methylprednisolone 60mg IV every 6 hours with decline of her AEC to 0.4 x 10 9 /L She was discharged home on prednisone 60 mg daily for 1 week with follow up with hematology for possible bone marrow biopsy and cardiology for a cardiac catheterization with biopsy.
T38 511937-512022 Sentence denotes However, she was unable to follow up and presented 1 month later with chest pressure.
T39 512023-512070 Sentence denotes She was found to have an AEC of 11.5 x 10 9 /L.
T40 512071-512204 Sentence denotes She underwent an endomyocardial biopsy that showed eosinophilic myocarditis and was treated with high dose steroids with improvement.
T41 512205-512249 Sentence denotes The most likely diagnosis is idiopathic HES.
T42 512250-512390 Sentence denotes A bone marrow biopsy is pending to exclude other etiologies such as primary HES due to myeloproliferative disorder or systemic mastocytosis.
T43 512391-512393 Sentence denotes P.
T44 512394-512417 Sentence denotes Buddiga * , Fresno, CA.
T45 512418-512431 Sentence denotes Introduction:
T46 512432-512610 Sentence denotes Henna painting or temporary Henna tattooing traditionally known as "Mehndi" is a custom used for centuries in the eastern world for bridal parties or other celebratory occasions.
T47 512611-512732 Sentence denotes The dyeing agent is Hennotannic acid and very rarely leads to an allergic reaction or an adverse skin hypersensitization.
T48 512733-512929 Sentence denotes Nevertheless Henna tattoos or painting are usually mixed with paraphenylenediamine [PPD] to assist with drying as well as darkening the color hence beautifying the different patterns of Henna art.
T49 512930-512938 Sentence denotes Methods:
T50 512939-513241 Sentence denotes A 21 year old girl with history of allergic rhinitis on Allergen Immunotherapy presents for her weekly allergy shot and complains that 6 weeks ago she attended a bridal shower for one of her friends and along with another 6 girls in the same age range had Henna tattoos painted on their hands and feet.
T51 513242-513365 Sentence denotes She noticed that a week later after placement it started to itch, burn and started to swell only at the site of the tattoo.
T52 513366-513442 Sentence denotes She immediately applied itch cream and 1% Hydrocortisone with no resolution.
T53 513443-513525 Sentence denotes She did not seek any professional medical care hoping it would resolve on its own.
T54 513526-513596 Sentence denotes Henna tattoos usually dissipate by themselves on their own in 2 weeks.
T55 513597-513714 Sentence denotes This case is clearly abnormal since the swelling and coloring is still very distinct at 6 weeks out from application.
T56 513715-513902 Sentence denotes Upon a serendepity consultation in the Allergy shot room she was given high dose topical corticosteroid plus dimethicone and wrapping at the site with periodic ice compresses for comfort.
T57 513903-513999 Sentence denotes No blisters or other adverse events occured and the lesion dissipated in 10 days with treatment.
T58 514000-514011 Sentence denotes Conclusion:
T59 514012-514116 Sentence denotes Henna is a potent contact dermatitis agent and must be skin tested or patch tested prior to application.
T60 514117-514181 Sentence denotes It contains paraphenyldiamine that can be a significant trigger.
T61 514182-514366 Sentence denotes Recommendations are to patch test this agent prior to use and if the Henna artwork does not dissipate in 2 weeks to see your local allergist or dermatologist for relief and resolution.
T62 514367-514387 Sentence denotes ANNALS Introduction:
T63 514388-514564 Sentence denotes Granulomatous disease is a well-documented complication of Common Variable Immunodeficiency, primarily seen in lung, but can also involve skin, liver, spleen, and the GI tract.
T64 514565-514634 Sentence denotes Autoimmune and lymphoproliferative disorders are common associations.
T65 514635-514771 Sentence denotes We present a case of unexplained granuloma involvement of skin and bone marrow in the setting of selective antibody deficiency and MGUS.
T66 514772-514784 Sentence denotes Case Report:
T67 514785-514942 Sentence denotes A 56 year-old man with history of vitiligo, shingles, and pneumonia presented with a 9-year history of chronic leg ulceration after falling on a boat anchor.
T68 514943-514973 Sentence denotes Vascular work-up was negative.
T69 514974-515108 Sentence denotes Lesions were recurrent despite wound care, antibiotics for secondary infections and hyperbaric oxygen, but were prednisone responsive.
T70 515109-515179 Sentence denotes Exam showed numerous pustular ulcers on legs and was otherwise normal.
T71 515180-515276 Sentence denotes Studies for HIV, hepatitis, cryogloblulins, ANA, RF, anti-SSA, anti-SSB, and ACEI were negative.
T72 515277-515312 Sentence denotes MRI was negative for osteomyelitis.
T73 515313-515395 Sentence denotes Multiple ulcer biopsies showed extensive granulomatous process with no vasculitis.
T74 515396-515455 Sentence denotes Bacterial, fungal and mycobacterial cultures were negative.
T75 515456-515517 Sentence denotes Immune evaluation showed low IgA and IgM and high IgG levels.
T76 515518-515574 Sentence denotes SPEP/IFE was positive for IgG lambda monoclonal protein.
T77 515575-515596 Sentence denotes Antibody titers to H.
T78 515597-515645 Sentence denotes Influenzae, diphtheria, and tetanus were normal.
T79 515646-515744 Sentence denotes Streptococcus titers were low despite repeated vaccination with Pneumococcal and Prevnar vaccines.
T80 515745-515845 Sentence denotes Lymphocyte subsets showed low lymphocytes and NK cells and stimulation was low with PHA and tetanus.
T81 515846-515884 Sentence denotes IL-1 and IFN-gamma responses were low.
T82 515885-515961 Sentence denotes Complement levels, toll-like receptor, and IL-12 receptor assay were normal.
T83 515962-516034 Sentence denotes CT chest did not show any ILD or lymphadenopathy, including mediastinal.
T84 516035-516111 Sentence denotes Subsequent work-up for myeloma revealed normal bone scan and flow cytometry.
T85 516112-516302 Sentence denotes However, bone marrow biopsy revealed numerous non-caseating granulomas and 15 % plasma cells with normal cytogenetic studies and negative cultures for bacteria, fungus, AFB and mycobacteria.
T86 516303-516401 Sentence denotes Patient responded to treatment with prolonged steroids and IVIG for selective antibody deficiency.
T87 516402-516504 Sentence denotes Trial off IVIG after six months resulted in increased sinus and wound infections and thus was resumed.
T88 516505-516516 Sentence denotes Conclusion:
T89 516517-516695 Sentence denotes Diminished cellular responses with IL-1 and IFN-gamma have been implicated in host defenses against mycobacterium; however numerous biopsy cultures in this case were unrevealing.
T90 516696-516812 Sentence denotes Further studies are needed to elucidate the underlying etiology of granulomatous disease in immunodeficiency states.
T91 516813-516826 Sentence denotes Introduction:
T92 516827-516947 Sentence denotes Aspirin-exacerbated respiratory disease (AERD) usually join sinonasal polyposis and bronchial asthma exacerbated by ASA.
T93 516948-517046 Sentence denotes Given the persistence of symptoms like rhinorrea is important to consider differential diag-noses.
T94 517047-517262 Sentence denotes Cerebrospinal fluid (CSF) leak could be classified as traumatic and nontraumatic causes, it's considered idiopathic when no cause is identified, and benign conditions of elevated intracranial pressure are ruled out.
T95 517263-517429 Sentence denotes The cardinal clinical presentation is persistent rinorraquia confirmed by cytology/cytochemical detection of CSF or ß2-transferrin as part of the diagnostic approach.
T96 517430-517442 Sentence denotes Case Report:
T97 517443-517996 Sentence denotes Female of 52 years old with 1 year of evolution with hyaline anterior rhinorrhea, persistent nasal pruritus, without identificable pattern of presentation, coughing and wheezing exacerbated with the intake of ASA; spirometry with bronchodilator reversibility of 14%, partial response to conventional therapy for persistent rhinorrhea, no trauma history, CT scan of nose and paranasal sinuses showed soft tissue density in entire left maxillary sinus, with concommitant occupation of anterior left ethmoid cells in intimate contact with cribriform plate.
T98 517997-518061 Sentence denotes Cytochemical and cytological study confirms the presence of CSF.
T99 518062-518255 Sentence denotes As intraoperative finding concommitant maxillary chronic rhinosinusitis were identified due to sinonasal polyposis, after endoscopic closure of CSF leak total control of symptoms were achieved.
T100 518256-518549 Sentence denotes Discussion: AERD is a persistent inflammation condition of nasal mucosa, that has been linked to asthma exacerbations, sometimes sinonasal polyps are not evident clinically or endoscopically, its important to assess the specific anatomy of patients with suboptimal control sino-nasal symptoms.
T101 518550-518679 Sentence denotes The non-traumatic CSF leak is one of the differential diagnoses that should be considered in patients with persistent rhinorrhea.
T102 518680-518693 Sentence denotes Introduction:
T103 518694-518817 Sentence denotes We report a case of a patient with 3 mechanistically different reactions to rituximab and a successful management approach.
T104 518818-518826 Sentence denotes Methods:
T105 518827-518847 Sentence denotes Case report Results:
T106 518848-519174 Sentence denotes A 30 year old male with steroid-dependent oral pemphigus vulgaris developed subjective chest and throat tightness, hoarseness, and difficulty breathing 1 hour after his first rituximab infusion at an outside facility, which resolved within 15 minutes of stopping the infusion and treatment with intramuscular (IM) epinephrine.
T107 519175-519242 Sentence denotes He was evaluated by us 2 years later for rituximab desensitization.
T108 519243-519469 Sentence denotes Based on his symptoms, we considered the possibility of drug-induced vocal cord dysfunction, and he received his rituximab dose after premedication with H1/H2 antagonists and oral corticosteroids without any initial reactions.
T109 519470-519626 Sentence denotes Eleven days later, he noted a pruritic, red facial and truncal rash along with severe joint pain which he self-treated by increasing his daily steroid dose.
T110 519627-519745 Sentence denotes Serum sickness-like reaction was diagnosed, and he was recommended to receive high-dose corticosteroids post-infusion.
T111 519746-520014 Sentence denotes He developed objective tongue, soft palate, lip, and facial swelling; pruritus; and throat tightness within 30 minutes of his next dose, which resolved over 1 hour with stopping the infusion and treatment with IM epinephrine, IV methylprednisolon, and diphenhydramine.
T112 520015-520102 Sentence denotes Due to the immediacy of the visible angioedema, an IgE-mediated reaction was diagnosed.
T113 520103-520170 Sentence denotes He underwent a 17 step rapid desensitization protocol to rituximab.
T114 520171-520285 Sentence denotes The infusion was briefly halted at step 11 (32.5 cc/hr at 4mg/ml) after he experienced subjective chest tightness.
T115 520286-520456 Sentence denotes It was restarted 30 minutes later at 20 cc/hr when the patient noted subjective lip edema and palmar pruritus without objective evidence of rash, angioedema, or wheezing.
T116 520457-520539 Sentence denotes He was treated with IV diphenhydramine and lorazepam with improvement of symptoms.
T117 520540-520677 Sentence denotes At a maintenance dose of 20 cc/hr, he developed 2 urticarial episodes that resolved with IM epinephrine, antihistamines, and montelukast.
T118 520678-520797 Sentence denotes After desensitization, he completed 10 days of prednisone 60 mg with no recurrence of the serum sickness-like reaction.
T119 520798-520810 Sentence denotes Conclusions:
T120 520811-520889 Sentence denotes Allergists should be familiar with the various adverse reactions to rituximab.
T121 520890-521070 Sentence denotes This case illustrates a patient with multiple reactions (including serum sickness) who successfully received rituximab via desensitization and post-infusion corticosteroid therapy.
T122 521071-521073 Sentence denotes L.
T123 521074-521084 Sentence denotes Rampur, A.
T124 521085-521099 Sentence denotes Rubinstein, Z.
T125 521100-521118 Sentence denotes Ren * , Bronx, NY.
T126 521119-521132 Sentence denotes Introduction:
T127 521133-521222 Sentence denotes Recurrent abdominal pain is frequent in patients with hereditary and acquired angioedema.
T128 521223-521376 Sentence denotes We present a case of recurrent abdominal pain presumed to have abdominal angioedema, found to have eosinophilic segmental serosal and muscular enteritis.
T129 521377-521385 Sentence denotes Methods:
T130 521386-521411 Sentence denotes Case description Results:
T131 521412-521531 Sentence denotes 31 year female was referred for episodic abdominal pain since 2007, recurring every 3 to 6 months lasting several days.
T132 521532-521666 Sentence denotes She was presumed to have abdominal visceral angioedema in 2009 treated with systemic steroids with relief of symptoms within 2-3 days.
T133 521667-521769 Sentence denotes MRI during several episodes was consistent with localized Jejunal wall edema in the same 5-6" segment.
T134 521770-522098 Sentence denotes Lab work at baseline and during attacks revealed normal C1 esterase inhibitor function of 102%, normal C4 (20mg/dl), C3 (97mg/dl), Tryptase (5.9 ug/L), autoimmune antibody panel, Celiac panel, alpha 1 anti-trypsin and quantitative immunoglobulin assay including ESR, electrolytes, liver and renal function and stool examination.
T135 522099-522137 Sentence denotes But C1q level was low (< 1.2 ugeq/ml).
T136 522138-522256 Sentence denotes Absolute Eosinophil count was1400k/ul (15%) when she was asymptomatic and as high as 3500k/ul (33%) during an episode.
T137 522257-522281 Sentence denotes IL-5 levels were normal.
T138 522282-522444 Sentence denotes FISH analysis did not detect translocations or deletions of the chromosome 4q12 resulting fusion of FIP1L1 and PDGFRA genes and rearrangement of PDGFRB and FGFR1.
T139 522445-522611 Sentence denotes Peripheral blood did not show a mutation for JAK2 V617F myeloproliferative disorder and and molecular analysis showed normal alleles detected RT-PCR for BCR-ABL P210.
T140 522612-522708 Sentence denotes Multiple upper endoscopies and colonoscopies including capsule endoscopy have been unremarkable.
T141 522709-522799 Sentence denotes In a recent admission a MRI showed further spread of the jejunal thickening to around 10".
T142 522800-522992 Sentence denotes A laparoscopic jejunal biopsy of the edematous region showed dense serosal and muscularis propria eosinophil infiltrates suggestive of eosinophilic enteritis, not involving the jejunal mucosa.
T143 522993-523004 Sentence denotes Conclusion:
T144 523005-523142 Sentence denotes This patient's presentation of recurrent abdominal pain with localized jejunal wall edema was suggestive of abdominal angioedema attacks.
T145 523143-523204 Sentence denotes Work up for hereditary or autoimmune angioedema was negative.
T146 523205-523365 Sentence denotes The only clue for the diagnosis was the fluctuating peripheral eosinophilia albeit with absence of increased eosinophil infiltrates in mucosal jejunal biopsies.
T147 523366-523464 Sentence denotes Hyper eosinophilic syndrome was excluded by the absence of the relevant mutations in FIP1L1/PDGRA.
T148 523465-523554 Sentence denotes Diagnosis was obtained by serosal and muscularis biopsy of the edematous jejunal segment.
T149 523555-523568 Sentence denotes Introduction:
T150 523569-523690 Sentence denotes A deficiency in C1 esterase inhibitor (C1-INH) can be caused by hereditary angioedema (HAE) or acquired angioedema (AAE).
T151 523691-523797 Sentence denotes HAE occurs from a gene mutation that leads to either lack of C1-INH or production of nonfunctional C1-INH.
T152 523798-523910 Sentence denotes AAE results from consumption or inactivation of C1-INH, usually in the setting of lymphoproliferative disorders.
T153 523911-524056 Sentence denotes Several cases of AAE have been reported in conjunction with monoclonal gammopathy of undetermined significance (MGUS) and non-Hodgkin's lymphoma.
T154 524057-524165 Sentence denotes We report a rare case of a patient, who presented with AAE, leading to a diagnosis of multiple myeloma (MM).
T155 524166-524171 Sentence denotes Case:
T156 524172-524319 Sentence denotes A 70-year-old male with asthma and chronic idiopathic urticaria presented to the ED with tongue and right anterior neck swelling without urticaria.
T157 524320-524396 Sentence denotes Because his uvula could not be visualized on presentation, he was intubated.
T158 524397-524505 Sentence denotes The patient's admission laboratory results were indicative of anemia, acute kidney injury and hypercalcemia.
T159 524506-524628 Sentence denotes They also showed an increased globulin gap, an elevated serum IgG level, high serum free lambda light chains and a low C4.
T160 524629-524711 Sentence denotes The patient's presentation was concerning for AAE due to an underlying malignancy.
T161 524712-524821 Sentence denotes His angioedema did not improve approximately 12 hours after administration of intravenous steroids in the ED.
T162 524822-524928 Sentence denotes The patient received 1 dose of C1-INH concentrate and within a few hours his angioedema rapidly regressed.
T163 524929-525035 Sentence denotes C1-INH and C1-INH functional levels were normal, but the C1q level was found to be low, suggestive of AAE.
T164 525036-525118 Sentence denotes A bone marrow biopsy revealed 35% plasma cells, consistent with a diagnosis of MM.
T165 525119-525235 Sentence denotes The patient's angioedema resolved after administration of C1-INH concentrate and initiation of treatment for his MM.
T166 525236-525247 Sentence denotes Discussion:
T167 525248-525319 Sentence denotes The most common malignancies known to cause AAE are indolent lymphomas.
T168 525320-525378 Sentence denotes However, we report a unique case of MM manifesting as AAE.
T169 525379-525514 Sentence denotes The patient in our case suffered from AAE likely secondary to autoantibodies against C1-INH that are produced by aberrant plasma cells.
T170 525515-525710 Sentence denotes Mechanistically, it is believed that autoantibodies bind to and destabilize the C1-INH complex, leading to proteolytic cleavage and inactivation of C1-INH and downstream generation of bradykinin.
T171 525711-525722 Sentence denotes Conclusion:
T172 525723-525790 Sentence denotes To our knowledge, this is the first reported case of AAE due to MM.
T173 525791-525949 Sentence denotes This case highlights the principle that the management of AAE requires treatment of its underlying cause, which may be an autoimmune disorder or a malignancy.
T174 525950-525963 Sentence denotes Introduction:
T175 525964-526063 Sentence denotes Human enteroviral infections are the most common cause of meningoencephalitis in the United States.
T176 526064-526119 Sentence denotes Enteroviral infection is usually a selflimited disease.
T177 526120-526186 Sentence denotes However, in an immunocompromised patient, infections can be fatal.
T178 526187-526517 Sentence denotes We present a case of an adult female patient with a history of Evan's syndrome treated with prior splenectomy and rituximab who subsequently developed panhypogammaglobulinemia after which, despite receiving antibody replacement, she developed a progressive and ultimately fatal meningoencephalitis due to human Coxsackie B3 virus.
T179 526518-526535 Sentence denotes Case Description:
T180 526536-526656 Sentence denotes A 28-year-old white female presented to the University of Virginia with a 4-month history of progressive encephalopathy.
T181 526657-526862 Sentence denotes She had a history of Evan's Syndrome (autoimmune hemolytic anemia and idiopathic thrombocytopenia purpura) for which she had received treatment with rituximab and splenectomy 5 years prior to presentation.
T182 526863-526982 Sentence denotes 5 months previously, she was hospitalized for Influenza A with concurrent facial Pseudomonas cellulitis and bacteremia.
T183 526983-527144 Sentence denotes During that admission, she was found to have severe panhypogammaglobulinemia with 0% circulating CD19+ B cells and intravenous immunoglobulin (IVIG) was started.
T184 527145-527211 Sentence denotes Her exam on admission was also consistent with aseptic meningitis.
T185 527212-527349 Sentence denotes She was subsequently readmitted with worsening encephalopathy and repeat lumbar puncture and MRI were negative for an infectious process.
T186 527350-527430 Sentence denotes A stereotactic brain biopsy was obtained, which was also negative for infection.
T187 527431-527561 Sentence denotes Despite empiric treatment with broad-spectrum antibiotics, she continued to decline neurocognitively and hospice care was pursued.
T188 527562-527752 Sentence denotes The patient expired and subsequent post-mortem brain biopsy identified human Coxsackie virus B3, on the basis of positive viral protein (VP)2, VP4 and VP 5` untranslated region (UTR) by PCR.
T189 527753-527764 Sentence denotes Conclusion:
T190 527765-527930 Sentence denotes Previous treatment of this patient with rituximab for Evan's syndrome was associated with persistent profound B cell lymphopenia and secondary hypogammaglobulinemia.
T191 527931-528324 Sentence denotes Given the observation that some patients treated with rituximab will develop persistent lymphopenia and hypogammaglobulinemia, and the increasing use of rituximab in the treatment of malignancies and autoimmune disorders, physicians must have increased awareness of the risk of secondary B cell and antibody deficiency and susceptibility to enteroviral meningeal infections in this population.
T192 528325-528327 Sentence denotes J.
T193 528328-528345 Sentence denotes McCracken *1 , C.
T194 528346-528361 Sentence denotes Schlegel 2 , S.
T195 528362-528372 Sentence denotes Sur 2 , 1.
T196 528373-528392 Sentence denotes League City, TX; 2.
T197 528393-528407 Sentence denotes Galveston, TX.
T198 528408-528421 Sentence denotes Introduction:
T199 528422-528527 Sentence denotes Kounis syndrome is a rare condition when allergy or hypersensitivity can lead to cardiovascular symptoms.
T200 528528-528668 Sentence denotes Symptoms are caused by the release of inflammatory mediators from mast cells which can have cardiovascular effects including coronary spasm.
T201 528669-528677 Sentence denotes Methods:
T202 528678-528944 Sentence denotes We report the case of a 61 year old male with a history of allergic rhinitis, asthma, monoclonal gammopathy of undetermined significance (MGUS) and eosinophilic esophagitis who was referred to us for evaluation of urticaria, chest pain and shortness of breath (SOB).
T203 528945-529051 Sentence denotes His symptoms have been occurring over the past 2.5 years and rash typically precedes the cardiac symptoms.
T204 529052-529167 Sentence denotes Six months prior to his first visit in our clinic, he had an acute myocardial infarction requiring stent placement.
T205 529168-529193 Sentence denotes Physical exam was normal.
T206 529194-529326 Sentence denotes Laboratory work-up was significant for elevated eosinophils, elevated IgE, and intermittently elevated tryptase with these episodes.
T207 529327-529414 Sentence denotes Skin prick testing was positive for trees, weeds, grass, dust mite, cockroach, and cat.
T208 529415-529453 Sentence denotes Bone marrow biopsy was c-kit negative.
T209 529454-529572 Sentence denotes He was started on fexofenadine 180 mg in the morning, cetirizine 10 mg in the evening, and ketotifen 1 mg twice a day.
T210 529573-529703 Sentence denotes Two weeks later, he again had chest and jaw pain associated with development of a rash on his palms that required hospitalization.
T211 529704-529736 Sentence denotes Angiography showed patent stent.
T212 529737-529866 Sentence denotes His medications were increased to fexofenadine 180 mg 2 tabs in AM, cetirizine 10 mg 2 tabs in PM and ketotifen 2 mg twice a day.
T213 529867-529998 Sentence denotes He was unable to tolerate the increased doses of fexofenadine and cetirizine so he resumed his initial dosing of those medications.
T214 529999-530053 Sentence denotes He now reports symptoms improved since last follow-up.
T215 530054-530065 Sentence denotes Discussion:
T216 530066-530182 Sentence denotes We believe his presentation of urticaria associated with severe chest pain and SOB is suggestive of Kounis syndrome.
T217 530183-530315 Sentence denotes Current literature focuses more on the acute treatment of the allergic and cardiac symptoms, and less on the prevention of symptoms.
T218 530316-530434 Sentence denotes In this patient, ketotifen, a mast cell stabilizer, and non-sedating antihistamines were utilized to control symptoms.
T219 530435-530446 Sentence denotes Conclusion:
T220 530447-530587 Sentence denotes We present a case of possible Kounis syndrome in a patient who is successfully being treated with non-sedating antihistamines and ketotifen.
T221 530588-530727 Sentence denotes This reports to the allergists that this combination therapy can be a useful management option when treating patients with Kounis syndrome.
T222 530728-530741 Sentence denotes Introduction:
T223 530742-530925 Sentence denotes Perioperative anaphylaxis is a life threatening IgE or non-IgE mediated condition presenting with symptoms including urticaria, angioedema, bronchospasm, arrhythmias, and hypotension.
T224 530926-531019 Sentence denotes 1 Its prevalence has been reported from 1:3,500 to 1:20,000 with a mortality rate of 3 to 9%.
T225 531020-531187 Sentence denotes The most common culprits include antibiotics, neuromuscular blocking agents, latex, hypnotics, opioids, colloids, dyes, and nonsteroidal anti-inflammatory medications.
T226 531188-531205 Sentence denotes Case Description:
T227 531206-531406 Sentence denotes The patient was a 24 year old female with a history of asthma, rhinitis, egg allergy, eczema, and prior tonsillectomy who presented after two episodes of anaphylaxis while undergoing oral jaw surgery.
T228 531407-531515 Sentence denotes During the first surgery she developed hypotension, wheezing, and hypoxia leading to cardiopulmonary arrest.
T229 531516-531578 Sentence denotes She was treated with epinephrine, fluids, and corticosteroids.
T230 531579-531724 Sentence denotes Skin prick testing was found positive to vecuronium, succinylcholine, rocuronium, cisatracurium, penicillin, sulfa, ciprofloxacin, and cefazolin.
T231 531725-531809 Sentence denotes These agents were avoided during the next operation, but systemic symptoms recurred.
T232 531810-531970 Sentence denotes Further evaluation showed a normal FEV1 with 14% reversibility post bronchodilator and an exhaled nitric oxide (eNO) of 52ppb indicative of airway inflammation.
T233 531971-532036 Sentence denotes Urine tryptase and thyroid stimulating hormone (TSH) were normal.
T234 532037-532082 Sentence denotes She was started on an inhaled corticosteroid.
T235 532083-532250 Sentence denotes Twenty four hours prior to her third surgery she was treated with corticosteroids and antihistamines, and neuromuscular blocking agents and beta blockers were avoided.
T236 532251-532311 Sentence denotes She tolerated her subsequent surgeries without complication.
T237 532312-532323 Sentence denotes Discussion:
T238 532324-532394 Sentence denotes This case illustrates the serious nature of perioperative anaphylaxis.
T239 532395-532462 Sentence denotes Despite avoidance of the sensitized agents, anaphylaxis reoccurred.
T240 532463-532577 Sentence denotes This led to further exploration discovering poorly controlled asthma which is a known risk factor for anaphylaxis.
T241 532578-532640 Sentence denotes 2 P185 LYMPHOPENIA AND AGAMMAGLOBULINEMIA OF UNCLEAR ETIOLOGY.
T242 532641-532643 Sentence denotes L.
T243 532644-532660 Sentence denotes Bornstein * , R.
T244 532661-532682 Sentence denotes Herzog, New York, NY.
T245 532683-532696 Sentence denotes Introduction:
T246 532697-532814 Sentence denotes Early diagnosis of severe combined immune deficiency has led to timely treatment and improved prognosis for patients.
T247 532815-532949 Sentence denotes We present a 17 month old male with lymphopenia and agammaglobulinemia of unclear etiology identified by TREC assay on newborn screen.
T248 532950-532962 Sentence denotes Case Report:
T249 532963-533054 Sentence denotes The patient was a full term newborn with low T-cell receptor excision circle (TREC) levels.
T250 533055-533172 Sentence denotes The patient was well until 53 days of age, when he developed fever to 38.5C and upper respiratory infection symptoms.
T251 533173-533309 Sentence denotes Labs revealed low T and B cell counts and agammaglobulinemia, and he was treated with antibiotics and intravenous gamma globulin (IGIV).
T252 533310-533347 Sentence denotes Cultures and viral PCR were negative.
T253 533348-533496 Sentence denotes Thereafter, the patient developed recurrent otitis media and viral infections due to RSV, coronavirus, rhinovirus, enterovirus, and metapneumovirus.
T254 533497-533669 Sentence denotes In addition to IGIV, the patient has been given prophylaxis with palivizumab, acyclovir, pentamidine (due to intermittent neutropenia on TMP-SMX), and filgrastim as needed.
T255 533670-533723 Sentence denotes The patient has been developing normally for his age.
T256 533724-533732 Sentence denotes Results:
T257 533733-533811 Sentence denotes Newborn TREC was 132, 132, 164 (nl>200/ml), with repeat of 0, 0, 0, 31, 33/ml.
T258 533812-533847 Sentence denotes Naïve CD45RA+ CD4 count was normal.
T259 533848-534086 Sentence denotes Absolute lymphocyte count (ALC) was 900/ml (1,000-4,800), CD4+CD3+ 468/mm, 48% (2,780-3,908, 50-57%), CD8+CD3+ 127/mm, 13% (351-2,479, 8-31%), CD19+ 63/mm, 7% (432-3,345, 11-45%), normal NK function, IgG 522, IgA: <7, IgM 9 (20-87 mg/dl).
T260 534087-534214 Sentence denotes T cell proliferative response to phytohemagglutinin (PHA), Concanavalin (con A), OKT3, and mixed lymphocyte culture was normal.
T261 534215-534264 Sentence denotes Responses to Candida and Tetanus were low normal.
T262 534265-534334 Sentence denotes There was no evidence of maternal engraftment or clonal T or B cells.
T263 534335-534393 Sentence denotes Immunization with DTaP did not result in increased titers.
T264 534394-534435 Sentence denotes Anti-neutrophil antibodies were negative.
T265 534436-534651 Sentence denotes Artemis, RAG1, RAG2, adenosine deaminase (ADA), purine nucleoside phosphorylase (PNP), DNA ligase 4, TAC1, BTK, and 22q11 deletion studies were negative and telomeres were not consistent with dyskeratosis congenita.
T266 534652-534688 Sentence denotes Thymus was identified on ultrasound.
T267 534689-534700 Sentence denotes Conclusion:
T268 534701-534826 Sentence denotes Early detection of T cell lymphopenia has led to early treatment and improved prognosis of severe combined immune deficiency.
T269 534827-534923 Sentence denotes We present a case of T and B lymphopenia and IgM and IgA deficiency of unclear etiology to date.
T270 534924-534997 Sentence denotes Further studies including whole exome sequencing may reveal the etiology.
T271 534998-535115 Sentence denotes A 24 year old male presented to the allergy clinic with a four month history of persistent clear left nasal drainage.
T272 535116-535210 Sentence denotes Patient denied any history of facial trauma, facial surgery, nasal polyps, or nasal deviation.
T273 535211-535279 Sentence denotes Beyond the rhinorrhea, the review of systems was otherwise negative.
T274 535280-535472 Sentence denotes Prior to presenting to allergy clinic, the patient was seen by his primary care physician and was on daily cetirizine, montelukast, and fluticasone nasal spray without any symptom improvement.
T275 535473-535592 Sentence denotes Given the persistent unilateral rhinorrhea without history of trauma or surgery, further diagnostic workup was pursued.
T276 535593-535801 Sentence denotes Computed tomography sinus imaging revealed a 6.5 x 5.6 x 4.4 cm infiltrative, destructive mass centered in the sella turcica with intracranial nasopharyngeal extension which was subsequently confirmed by MRI.
T277 535802-535928 Sentence denotes Laboratory results were remarkable for a positive beta-2 transferrin and an elevated prolactin (532, normal range 3-13 ng/mL).
T278 535929-536045 Sentence denotes An endoscopic left nasopharyngeal biopsy was performed with pathology consistent with an atypical pituitary adenoma.
T279 536046-536104 Sentence denotes The staining profile of the adenoma was of a prolactinoma.
T280 536105-536219 Sentence denotes The patient subsequently underwent neurosurgery for repair of the CSF leak followed by treatment with cabergoline.
T281 536220-536335 Sentence denotes Conclusion:Nasal symptoms such as rhinorrhea are commonly encountered in both the allergy and primary care clinics.
T282 536336-536448 Sentence denotes Frequently, these symptoms are related to inflammatory conditions such as sinusitis, rhinitis, and nasal polyps.
T283 536449-536506 Sentence denotes However, rarely they may be related to malignant lesions.
T284 536507-536695 Sentence denotes Red flags of a unilateral distribution along with a refractory response to standard medical treatment should prompt the physician to examine for other differentials including sinus masses.
T285 536696-536812 Sentence denotes MRI demonstrating a infiltrating mass in the sella turcica with biopsy and pathology consistent with a prolactinoma.
T286 536813-536940 Sentence denotes Rituximab is a B cell depleting anti-CD20 monoclonal antibody often used in the setting of malignancy or autoimmune conditions.
T287 536941-537034 Sentence denotes Transient B cell depletion is often seen but immunoglobulin levels are not often affected 1 .
T288 537035-537176 Sentence denotes However, there is growing literature documenting hypogammaglobulinemia requiring intravenous immunoglobulin following rituximab therapy 1,2 .
T289 537177-537285 Sentence denotes In some cases, the presentation of hypogammaglobulinemia was years after completion of rituximab therapy 3 .
T290 537286-537533 Sentence denotes We present the case of a 71 year old female with a history microvascular polyangiitis treated with rituximab, cyclophosphamide and prednisone who was diagnosed hypogammaglobulinemia, specifically IgG deficiency, two years after completing therapy.
T291 537534-537691 Sentence denotes The patient had a history of recurrent pneumonias preceding the immune modulating regiment, however all episodes required only outpatient antibiotic therapy.
T292 537692-537842 Sentence denotes After completion of treatment the patient required frequent inpatient admissions for pulmonary infections, including three to the intensive care unit.
T293 537843-537937 Sentence denotes Subsequent evaluation revealed an IgG of 412 mg/dL, IgM of 31mg/dL and IgA level of 129 mg/dL.
T294 537938-538048 Sentence denotes She had an appropriate antibody response to pneumococcal polysaccharide vaccine with 11 of 23 titers positive.
T295 538049-538088 Sentence denotes B cells were present in normal numbers.
T296 538089-538139 Sentence denotes Thus, a diagnosis of IgG deficiency was made 4,5 .
T297 538140-538242 Sentence denotes She was started in intravenous immunoglobulin therapy and has been well since initiation of treatment.
T298 538243-538376 Sentence denotes This patient adds to the cases in the literature of hypogammaglobulinemia requiring immunoglobulin therapy after rituximab treatment.
T299 538377-538593 Sentence denotes In our patient the immunoglobulin levels prior to initiation of therapy are not available so it is not known if treatment accelerated an already existing condition or represents a truly new illness following therapy.
T300 538594-538767 Sentence denotes There are case reports of clinically asymptomatic patients with reduced immunoglobulin prior to rituximab treatment that experienced clinical deterioration after therapy 1 .
T301 538768-538900 Sentence denotes It is possible a similar scenario occurred in our patient given the history of frequent, though milder, infections prior to therapy.
T302 538901-539099 Sentence denotes Retrospective studies have shown that only a small minority of patients develop hypogammaglobulinemia following rituximab therapy indicating there is likely a specific subset of patients at risk 6 .
T303 539100-539236 Sentence denotes More research is needed to determine if this association is due to an aggravation of an existing condition and the utility of screening.
T304 539237-539250 Sentence denotes Introduction:
T305 539251-539434 Sentence denotes The development of Factor IX (FIXi) inhibitor (antibodies) in severe Hemophilia B (FIX deficiency) patients is a rare phenomenon (1%-6% incidence), increasing morbidity and mortality.
T306 539435-539569 Sentence denotes Treatment of these patients can be complicated by the association of FIX inhibitor (FIXi) with anaphylaxis to FIX replacement therapy.
T307 539570-539648 Sentence denotes More recently, the use of rituximab to eradicate inhibitors has been reported.
T308 539649-539657 Sentence denotes Methods:
T309 539658-539853 Sentence denotes We describe two Hemophilia B patients (Pt#1-8 year old and Pt#2-4 year old males) who developed anaphylaxis to recombinant FIX replacement product, BeneFIX (RFIX), in the setting of an inhibitor.
T310 539854-539862 Sentence denotes Results:
T311 539863-540004 Sentence denotes After 9 months of RFIX therapy for the treatment and prevention of bleeding episodes, Pt#1 developed anaphylaxis shortly after RFIX infusion.
T312 540005-540027 Sentence denotes FIXi titer was 4.3 BU.
T313 540028-540140 Sentence denotes Pt#2 was receiving RFIX therapy that was discontinued due to detection of a FIXi of 0.6 BU on routine screening.
T314 540141-540219 Sentence denotes After his inhibitor titer became undetectable, he was re-challenged with RFIX.
T315 540220-540288 Sentence denotes He developed an anaphylactic reaction after 5 weeks of RFIX therapy.
T316 540289-540305 Sentence denotes FIXi was 2.4 BU.
T317 540306-540400 Sentence denotes Skin testing to RFIX and plasma derived FIX, Mononine (PFIX), was performed for both patients.
T318 540401-540460 Sentence denotes Pt#1's skin test was negative to RFIX but positive to PFIX.
T319 540461-540508 Sentence denotes Pt#2's skin test was negative to both products.
T320 540509-540626 Sentence denotes The patients were treated with rituximab 375mg/m2/dose weekly x 4 and successfully completed desensitization to RFIX.
T321 540627-540745 Sentence denotes Pt#1's FIXi decreased to 0, and he has been tolerating RFIX with no resurgence of his inhibitor for 9 months thus far.
T322 540746-540829 Sentence denotes Pt#2's FIXi and Bcells dropped from 6.3 BU to 0 and 603 cells/uL to 0 respectively.
T323 540830-540951 Sentence denotes After 6 months of tolerance, Pt#2 developed diffuse urticaria and dyspnea within minutes of completing his RFIX infusion.
T324 540952-540999 Sentence denotes FIXi was 0.8 BU, and B-cells were 270 cells/uL.
T325 541000-541072 Sentence denotes Repeat skin testing was minimally positive to RFIX and negative to PFIX.
T326 541073-541147 Sentence denotes Subsequently, patient failed graded challenge to PFIX (generalized hives).
T327 541148-541159 Sentence denotes Conclusion:
T328 541160-541280 Sentence denotes These cases highlight the importance of recognizing that an inhibitor can play a role in anaphylaxis to biologic agents.
T329 541281-541365 Sentence denotes Skin testing to FIX preparations is not necessarily predictive of systemic reaction.
T330 541366-541434 Sentence denotes Rituximab has been used to eradicate the inhibitor in some patients.
T331 541435-541556 Sentence denotes As B-cells recover, the inhibitor may reappear in selected patients, and maintenance rituximab may need to be considered.
T332 541557-541561 Sentence denotes J.T.
T333 541562-541576 Sentence denotes Abraham * , J.
T334 541577-541602 Sentence denotes Fernandez, Cleveland, OH.
T335 541603-541614 Sentence denotes Background:
T336 541615-541718 Sentence denotes Autoimmune Progesterone Dermatitis is an IgE mediated reaction to endogenous or exogenous progesterone.
T337 541719-541830 Sentence denotes Clinical presentations are described as varied, with cutaneous lesions mostly on abdomen and lower extremities.
T338 541831-541950 Sentence denotes The rash occurs cyclically, typically during the luteal phase of the menstrual cycle when progesterone levels are high.
T339 541951-541959 Sentence denotes Methods:
T340 541960-542109 Sentence denotes A 28 year-old healthy Caucasian female presents to Allergy and Immunology clinic with intermittent lower extremity and abdominal rash since May 2013.
T341 542110-542210 Sentence denotes The erythematous maculopapular rash occurred every 4-6 weeks initially, then increased in frequency.
T342 542211-542259 Sentence denotes It normally lasted three days and self-resolved.
T343 542260-542327 Sentence denotes The rash progressively became associated with myalgias and malaise.
T344 542328-542393 Sentence denotes She had been using a NuvaRing for contraception during this time.
T345 542394-542402 Sentence denotes Results:
T346 542403-542514 Sentence denotes The patient was initially evaluated by rheumatology with concern for the rash being consistent with vasculitis.
T347 542515-542638 Sentence denotes Skin biopsy was performed, demonstrating perivascular dermatitis with eosinophils and neutrophils as well as extravasation.
T348 542639-542802 Sentence denotes Laboratory evaluation was remarkable for elevated IgG levels (2960 mg/dL), a speckled pattern ANA (1:1280), positive SSA (122 units) and SSB (75 units) antibodies.
T349 542803-542941 Sentence denotes She was sent to Allergy and Immunology for evaluation due to the cyclical nature of her rash and concurrent use of hormonal contraception.
T350 542942-543096 Sentence denotes Epicutaneous and intradermal skin testing was performed with progesterone (50mg/ml) as well as positive (histamine) and negative (normal saline) controls.
T351 543097-543154 Sentence denotes Epicutaneous testing with 1:1 concentration was negative.
T352 543155-543288 Sentence denotes Intradermal injection of 1:1000 and 1:100 dilutions showed positive wheal/flare reactions of 5mm x 12mm and 8mm x 15mm, respectively.
T353 543289-543408 Sentence denotes Intradermal injections were also placed in three healthy subjects to ensure the dilutions used were not irritant doses.
T354 543409-543479 Sentence denotes The healthy controls showed minimal to no reaction to these dilutions.
T355 543480-543492 Sentence denotes Conclusions:
T356 543493-543666 Sentence denotes Autoimmune Progesterone Dermatitis is a rare condition, however it should be considered in women of child bearing age who present with cutaneous lesions in a cyclic pattern.
T357 543667-543680 Sentence denotes Introduction:
T358 543681-543743 Sentence denotes Methimazole is a common reagent used to treat hyperthyroidism.
T359 543744-543937 Sentence denotes Its side effects such as rash, vasculitis, have been widely reported but rarely has an IgE mediated reaction been reported in a child and no desensitization protocol exists for this medication.
T360 543938-544146 Sentence denotes We present a case of IgE mediated allergic reaction after administration of methimazole on two occasions along with a successful desensitization to the medication with subsequent treatment of hyperthyroidism.
T361 544147-544164 Sentence denotes Case Description:
T362 544165-544357 Sentence denotes A 7 year old Hispanic female with a history of intermittent asthma and hyperthyroidism treated with methimazole and developped a generalized itchy rash and hives with myalgias and arthralgias.
T363 544358-544423 Sentence denotes Her symptoms resolved within 1 day after stopping the medication.
T364 544424-544490 Sentence denotes She was then switched to propylthiouracil (PTU) and had no issues.
T365 544491-544646 Sentence denotes Another trial of methimazole lead to the same symptoms and the patient was again switched to PTU which result in elevated liver enzyme within a few months.
T366 544647-544706 Sentence denotes The patient presented to our allergy clinic for evaluation.
T367 544707-544796 Sentence denotes Skin prick testing showed a positive reaction to methimazole at 100 mcg/ml concentration.
T368 544797-544867 Sentence denotes Intradermal testing showed a 6 mm wheal to the 1 mcg/ml concentration.
T369 544868-544995 Sentence denotes The starting dose of desensitization was calculated to be 100 fold less than that which yielded a 5-8 mm wheal by skin testing.
T370 544996-545073 Sentence denotes Patient was monitored in our clinic for possible local and systemic reaction.
T371 545074-545187 Sentence denotes Desensitization was started at a concentration of 10 ng/ml in a volume of 0.3 ml (dose of 3 ng) with no reaction.
T372 545188-545285 Sentence denotes The dose was increased half log every 15 minuntes until a cumulative dose of 29.5 mg was reached.
T373 545286-545440 Sentence denotes Our patient had no reactions during the desensitization and was started on a dose of 5 mg daily and increased to therapeutic dose for her hyperthyroidism.
T374 545441-545452 Sentence denotes Conclusion:
T375 545453-545629 Sentence denotes Drug desensitization protocols exist for a few medications mainly beta lactam antibiotics, vancomycin, aspirin, NSAIDS and some chemotherapy reagents and monoclonal antibodies.
T376 545630-545702 Sentence denotes To our knowledge, no methimazole desensitization case has been reported.
T377 545703-545840 Sentence denotes Our report provides a useful tool in treating hyperthyroism of patients with allergic reaction to methimazole who are not tolerating PTU.
T378 545841-546049 Sentence denotes A 15-year-old male with a history of hereditary angioedema (HAE) type 1 presented to the local children's hospital emergency department (ED) with a chief complaint of 4 days of sore throat and abdominal pain.
T379 546050-546117 Sentence denotes He had 7 prior admissions for HAE attacks, with 2 in the past year.
T380 546118-546212 Sentence denotes His typical attacks included angioedema of his feet and face, and occasionally abdominal pain.
T381 546213-546262 Sentence denotes He was always treated with C1 esterase inhibitor.
T382 546263-546404 Sentence denotes Preventative therapy had been discussed at his prior allergy clinic visits, however he had been lost to follow-up prior to this presentation.
T383 546405-546551 Sentence denotes On his current presentation, the patient noted that his abdominal pain was similar to prior flares, but denied any emesis, dyspnea, or angioedema.
T384 546552-546612 Sentence denotes He had multiple sick contacts at home with similar symptoms.
T385 546613-546657 Sentence denotes On exam, the patient had stable vital signs.
T386 546658-546697 Sentence denotes He appeared to be in no acute distress.
T387 546698-546897 Sentence denotes On HEENT examination he had clear tympanic membranes, PERRLA, clear oropharynx with 2+ tonsils with mild erythema and without palatal, tongue, or uvula edema, moist mucous membranes, and supple neck.
T388 546898-546994 Sentence denotes His lungs were clear to auscultation, and heart had regular rate and rhythm without any murmurs.
T389 546995-547105 Sentence denotes His abdominal examination was positive for mild tenderness to palpation diffusely without rebound or guarding.
T390 547106-547179 Sentence denotes His skin exam was unre-markable and there was no swelling or edema noted.
T391 547180-547213 Sentence denotes A rapid strep test was performed.
T392 547214-547303 Sentence denotes Approximately 30 minutes passed and on reexamination the uvula was noted to be edematous.
T393 547304-547407 Sentence denotes The patient then began to have progressive palatal edema that involved the entire posterior oropharynx.
T394 547408-547569 Sentence denotes The patient had no respiratory distress and continued to have stable vital signs, however the decision was made to electively intubate him to protect his airway.
T395 547570-547627 Sentence denotes C1 esterase inhibitor therapy was initiated at this time.
T396 547628-547756 Sentence denotes On direct laryngoscopy, the patient's palate was noted to be edematous, however the glottis, trachea and larynx were all normal.
T397 547757-547878 Sentence denotes The patient remained intubated for less than 24 hours, was successfully extubated and discharged to home within 72 hours.
T398 547879-548104 Sentence denotes Our case of an HAE attack with isolated palatal edema after the rapid strep test was performed raised the unique question: did the rapid strep test incite enough trauma to the posterior oropharynx to provoke an attack of HAE?
T399 548105-548289 Sentence denotes Our case suggests that the patient was at the beginning of an attack and the trauma of the rapid strep test may have caused him to have isolated angioedema to the posterior oropharynx.
T400 548290-548501 Sentence denotes 41-year-old female with past medical history of Gastroesophageal Reflux (GERD) well-controlled on famotidine and obesity status post lap-band surgery three years prior presented with a one year history of cough.
T401 548502-548694 Sentence denotes Her cough was intermittently productive of yellow (morning) to clear sputum (later in the day) alternating with dry cough that was worse with exertion and associated with wheezing and dyspnea.
T402 548695-548733 Sentence denotes She had frequent nocturnal awakenings.
T403 548734-548834 Sentence denotes She also had perennial clear rhinorrhea with postnasal drip, nasal and ocular pruritus and sneezing.
T404 548835-548902 Sentence denotes Social history was notable for cat and dog at home and tobacco use.
T405 548903-549016 Sentence denotes Physical exam was unremarkable except for obesity, clear rhinorrhea, postnasal drainage and non-productive cough.
T406 549017-549072 Sentence denotes Percutaneous skin testing was positive for cat and dog.
T407 549073-549144 Sentence denotes Pulmonary function tests (PFTs), chest x-ray, and sinus CT were normal.
T408 549145-549212 Sentence denotes She was diagnosed with perennial allergic rhinitis, cough and GERD.
T409 549213-549305 Sentence denotes Initial treatment included environmental controls, a nasal steroid and albuterol for rescue.
T410 549306-549363 Sentence denotes She continued to have nocturnal rhinitis and a wet cough.
T411 549364-549464 Sentence denotes Pulmonary function tests progressively declined and demonstrated a positive bronchodilator response.
T412 549465-549659 Sentence denotes Management over the next few years included trials of immunotherapy for cat and dog, high dose proton pump inhibitor, antibiotics, montelukast, steroids (nasal, inhaled and oral) and omalizumab.
T413 549660-549736 Sentence denotes Cough with frequent nocturnal awakenings continued to be her main complaint.
T414 549737-549816 Sentence denotes GERD was repeatedly assessed and reported to be well-controlled by the patient.
T415 549817-549988 Sentence denotes Approximately four years after initial presentation, chest CT and esophagogastroduodenoscopy (EGD) were performed due to worsening of symptoms and oral steroid dependence.
T416 549989-550131 Sentence denotes The CT showed a fluid distended thoracic esophagus, and EGD revealed food in her esophagus despite being NPO the night prior to the procedure.
T417 550132-550246 Sentence denotes She recalled two episodes over the past several months of coughing up food that she had eaten 24-48 hours earlier.
T418 550247-550367 Sentence denotes It was subsequently realized that her lap-band was inflated one to two years prior to the initial onset of her symptoms.
T419 550368-550441 Sentence denotes Her lap-band was deflated with dramatic improvement in symptoms and PFTs.
T420 550442-550519 Sentence denotes She was able to discontinue oral steroids and maintenance asthma medications.
T421 550520-550615 Sentence denotes There is one other report of chronic cough and nocturnal rhinorrhea following lap-band surgery.
T422 550616-550727 Sentence denotes Chronic cough is a complication of lap-band that may be under-recognized outside the general surgery community.
T423 550728-550741 Sentence denotes Introduction:
T424 550742-550906 Sentence denotes Although NTM infection is known to exist in patients with chronic lung diseases, it is seldom considered in the evaluation of severe or difficult-to-control asthma.
T425 550907-550919 Sentence denotes Case Report:
T426 550920-551008 Sentence denotes A 66 year old woman was referred to the allergy clinic with difficult-to-control asthma.
T427 551009-551104 Sentence denotes She had recurrent daytime productive cough with yellow sputum and frequent nocturnal awakening.
T428 551105-551294 Sentence denotes She described repeated use of short acting β agonist despite compliance with combination (high dose) inhaled corticosteroids (ICS)/long acting β agonist and leukotriene receptor antagonist.
T429 551295-551383 Sentence denotes Pulmonary function tests were consistent with severe obstructive ventilatory limitation.
T430 551384-551460 Sentence denotes A High resolution chest CT scan showed multiple bilateral pulmonary nodules.
T431 551461-551596 Sentence denotes She had two positive sputum cultures for Mycobacterium avium-intracellularae and was started on ethambutol, rifabutin and azithromycin.
T432 551597-551695 Sentence denotes She has had marked improvement in symptoms and decrease in albuterol use since starting treatment.
T433 551696-551707 Sentence denotes Discussion:
T434 551708-551881 Sentence denotes A recent study showed that the estimated prevalence of NTM infections among asthmatic patients was 1.7% with an average interval of 2 years from symptom change to diagnosis.
T435 551882-552030 Sentence denotes Patients commonly present with symptoms of worsening lung disease including progressive dyspnea, productive cough and frequent asthma exacerbations.
T436 552031-552101 Sentence denotes Imaging studies may reveal bronchiectasis, nodules < 5 mm or fibrosis.
T437 552102-552282 Sentence denotes American Thoracic Society (ATS)/ Infectious Diseases Society of America (IDSA) guidelines require at least two positive expectorated sputum cultures for diagnosis of NTM infection.
T438 552283-552446 Sentence denotes Recent studies have indicated that older patients with severe airflow limitation receiving long term high dose ICS are at a higher risk of acquiring NTM infection.
T439 552447-552653 Sentence denotes The current recommended treatment for pulmonary disease comprises a triple drug regimen with azithromycin, ethambutol and rifabutin for duration of at least 12 months after conversion of sputum to negative.
T440 552654-552799 Sentence denotes It is imperative to consider NTM infection in the differential of difficult-to-control asthma that has been unresponsive to conventional therapy.
T441 552800-552802 Sentence denotes S.
T442 552803-552816 Sentence denotes Waqar *1 , S.
T443 552817-552830 Sentence denotes Farzan 2 , 1.
T444 552831-552848 Sentence denotes Dix Hills, NY; 2.
T445 552849-552864 Sentence denotes Great Neck, NY.
T1 552865-552878 Sentence denotes Introduction:
T2 552879-553059 Sentence denotes Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) is a rare, but potentially life-threatening syndrome, which typically presents two to eight weeks after drug exposure.
T3 553060-553254 Sentence denotes It is characterized by multiple system involvement, which may include skin eruption, hematologic abnormalities, lymphadenopathy, and affect internal organs such as the liver, kidneys, and lungs.
T4 553255-553330 Sentence denotes Patients usually face several relapses despite discontinuation of the drug.
T5 553331-553433 Sentence denotes Here we describe the presentation, diagnosis, and clinical course of a patient with early-onset DRESS.
T6 553434-553442 Sentence denotes Methods:
T7 553443-553663 Sentence denotes A 15-year-old male, with past medical history of hypertension presents with recurrent pruritic rash and shortness of breath two weeks after treatment of a MRSA skin infection with trimethoprim-sulfamethoxazole (TMP-SMX).
T8 553664-553725 Sentence denotes He reports initial development of a rash on day 4 of TMP-SMX.
T9 553726-553845 Sentence denotes The rash was a full-body pruritic erythematous papular rash sparing the mucus membranes and most prominent on the face.
T10 553846-553871 Sentence denotes TMP-SMX was discontinued.
T11 553872-553997 Sentence denotes He was treated with an oral prednisone taper, as well as intravenous fluids for acute kidney injury with a creatinine of 1.5.
T12 553998-554056 Sentence denotes The rash resolved within two days but reappeared on day 6.
T13 554057-554171 Sentence denotes He was readmitted approximately 10 days after initial TMP-SMX treatment with fever, rash, and shortness of breath.
T14 554172-554371 Sentence denotes On readmission, his physical exam was notable for fever of 39.4 degrees C and a pruritic full-body morbilliform erythematous rash including the palms and soles, and again sparing the mucus membranes.
T15 554372-554380 Sentence denotes Results:
T16 554381-554493 Sentence denotes Laboratory work-up showed eosinophilia (1200 per microliter; 13.9%) with an elevated C-reactive protein of 18.7.
T17 554494-554583 Sentence denotes ESR, hepatitis panel, liver function tests, Lyme screen, rapid plasma reagin were normal.
T18 554584-554605 Sentence denotes HIV was non-reactive.
T19 554606-554655 Sentence denotes EBV testing was consistent with a past infection.
T20 554656-554703 Sentence denotes ANA, dsDNA, and histone antibodies were normal.
T21 554704-554759 Sentence denotes Chest X-ray revealed small bilateral pleural effusions.
T22 554760-554845 Sentence denotes Urinalysis, respiratory viral panel, throat culture and blood cultures were negative.
T23 554846-554918 Sentence denotes He was started on a very slow taper of prednisone for early-onset DRESS.
T24 554919-554985 Sentence denotes On follow-up, rash had not recurred and eosinophilia had resolved.
T25 554986-554997 Sentence denotes Conclusion:
T26 554998-555090 Sentence denotes In patients with recurrent rash and multiple system involvement, DRESS should be considered.
T27 555091-555274 Sentence denotes Early-onset DRESS should be in the differential in cases consistent with the syndrome but with presentation of symptoms earlier than expected, and after exclusion of other etiologies.
T28 555275-555288 Sentence denotes Introduction:
T29 555289-555430 Sentence denotes Erythema multiforme (EM) is an immune-mediated hypersensitivity reaction typically presenting with cutaneous and mucous membrane involvement.
T30 555431-555503 Sentence denotes EM is known to be associated with exposure to drugs and viral pathogens.
T31 555504-555572 Sentence denotes The most commonly associated pathogen is herpes simplex virus (HSV).
T32 555573-555654 Sentence denotes However, there are reports of EM in patients diagnosed with Mycoplasma pneumonia.
T33 555655-555814 Sentence denotes We describe a case of oral EM, a distinct but less well-recognized variant of EM, presenting as isolated oral mucositis in a patient with Mycoplasma pneumonia.
T34 555815-555829 Sentence denotes Clinical Case:
T35 555830-555934 Sentence denotes A 10 year old previously healthy male presented to his pediatrician with fever, cough, and lip swelling.
T36 555935-556034 Sentence denotes Crackles were found on exam and he was prescribed azithromycin for treatment of atypical pneumonia.
T37 556035-556107 Sentence denotes His facial swelling spread and he presented to the emergency department.
T38 556108-556196 Sentence denotes He had buccal mucosal lesions with sloughing of oral mucous membranes without skin rash.
T39 556197-556292 Sentence denotes There was concern for Stevens Johnson Syn-drome in response to azithromycin, so it was stopped.
T40 556293-556451 Sentence denotes Symptoms progressed and he was seen in allergy/immunology clinic 1 day later where he was thought to have herpetic stomatitis and was started on valaciclovir.
T41 556452-556483 Sentence denotes Oral swab for HSV-1/2 was sent.
T42 556484-556527 Sentence denotes He was seen 2 days later when he had hives.
T43 556528-556595 Sentence denotes He continued to have oral mucositis with improving facial swelling.
T44 556596-556655 Sentence denotes His HSV-1/2 PCR were negative, so valaciclovir was stopped.
T45 556656-556689 Sentence denotes Mycoplasma IgG and IgM were sent.
T46 556690-556968 Sentence denotes After consultation with dermatology, his mucositis, which was characterized by extensive ulcerations covered with a pseudomembrane on the buccal mucosa, labial mucosa, tongue, and palate as well as with bloody crusted lip ulcerations, was determined to be diagnostic of oral EM.
T47 556969-557059 Sentence denotes Positive Mycoplasma IgM and IgG titers confirmed the infection as the trigger for oral EM.
T48 557060-557133 Sentence denotes He was treated with topical and systemic steroids with rapid improvement.
T49 557134-557145 Sentence denotes Conclusion:
T50 557146-557204 Sentence denotes Oral EM is a unique and much less described variant of EM.
T51 557205-557319 Sentence denotes It is most often triggered by HSV infections, less commonly by drug reactions, and rarely by Mycoplasma infection.
T52 557320-557489 Sentence denotes Unlike acute herpetic stomatitis, which involves keratinized mucosa and which can be confused with oral EM, our patient developed lesions only on nonkeratinized tissues.
T53 557490-557677 Sentence denotes The triggers of oral EM and its characteristic presentation are important to recognize as repeated attacks often result in more severe forms of EM involving both the oral mucosa and skin.
T54 557678-557689 Sentence denotes Background:
T55 557690-557821 Sentence denotes Immediate hypersensitivity reactions (IHR) to low osmolar radiocontrast media (RCM) have an overall reported incidence of up to 3%.
T56 557822-557899 Sentence denotes Pre-medication regimens reduce IHR rates in subsequent studies requiring RCM.
T57 557900-557996 Sentence denotes However, breakthrough IHR (BIHR) may occur despite the use of premedication and low osmolar RCM.
T58 557997-558095 Sentence denotes Consensus on successful pre-medication protocols for patients requiring RCM after BIHR is lacking.
T59 558096-558108 Sentence denotes Case Report:
T60 558109-558220 Sentence denotes A 50 year old male with a history of asthma presented for elective cardiac catheterization for unstable angina.
T61 558221-558301 Sentence denotes He reported one previous RCM reaction with sneezing, hives, and ocular pruritis.
T62 558302-558531 Sentence denotes Prior to catheterization, the patient received a modified Greenberger pre-medication protocol with oral prednisone 50mg (13, 7, and 1 hr pre-procedure), oral diphenhydramine 50mg and methylprednisolone 125mg 1 hour pre-procedure.
T63 558532-558727 Sentence denotes Despite pre-medication, the patient developed generalized urticaria, periorbital angioedema, nasal congestion, and wheezing upon administration of a 3cc dose of low osmolar iohexol (640 mosm/kg).
T64 558728-558887 Sentence denotes The procedure was immediately terminated and albuterol, diphenhydramine, and methylprednisolone were administered at that time and for two days post procedure.
T65 558888-559128 Sentence denotes As the patient still required catheterization, a subsequent pre-medication protocol was implemented: prednisone 80mg daily, montelukast 10mg daily, cetirizine 10mg and famotidine 20mg twice daily for four days prior to the subsequent study.
T66 559129-559238 Sentence denotes Additionally, he received methylprednisolone 125mg, diphenhydramine 75mg, and albuterol 1 hour pre-procedure.
T67 559239-559433 Sentence denotes The patient underwent second cardiac catheterization one week later with successful placement of two drug-eluting stents using lower osmolar iodixanol (290 mosm/kg) with-out any adverse effects.
T68 559434-559445 Sentence denotes Discussion:
T69 559446-559586 Sentence denotes Breakthrough IHR to RCM are reported to occur at a rate of 0.11-18% and patients may experience symptoms comparable to their index reaction.
T70 559587-559741 Sentence denotes Successful pre-medication regimens to prevent repeat BIHR in patients requiring utilization of RCM for subsequent imaging studies are not well documented.
T71 559742-559832 Sentence denotes We describe a regimen which allowed our patient to receive critical coronary intervention.
T72 559833-559986 Sentence denotes Further investigation into effective pre-medication in patients who successfully receive RCM may elucidate optimal regimens which may be most beneficial.
T73 559987-559989 Sentence denotes S.
T74 559990-560008 Sentence denotes Draikiwicz *1 , S.
T75 560009-560023 Sentence denotes Arakali 2 , E.
T76 560024-560038 Sentence denotes Capitle 3 , 1.
T77 560039-560060 Sentence denotes Scotch Plains, NJ; 2.
T78 560061-560082 Sentence denotes New Brunswick, NJ; 3.
T79 560083-560094 Sentence denotes Newark, NJ.
T80 560095-560695 Sentence denotes Adverse reactions have been reported in up to twenty percent of all patients receiving IVIG infusion.1 From October 1997 through July 2007, there were 10 reports of stroke, 6 reports of thrombosis, 4 reports of myocardial infarction, 2 reports of pulmonary embolus and 1 report of transient ischemic attack suspected of being associated with IVIG.2 While multiple known factors such as hypertension and diabetes contribute to the development of coronary artery disease and myocardial infarction (MI), it is also important to acknowledge the association of IVIG and post-therapy myocardial infarction.
T81 560696-560859 Sentence denotes Our case is a 48 year-old man with a history of diet-controlled hypertension, steroid induced diabetes mellitus and polymyositis who developed a MI following IVIG.
T82 560860-560919 Sentence denotes The patient was diagnosed with polymyositis in August 2013.
T83 560920-561026 Sentence denotes His initial CPK was 10,000, elevated ANA titer at 1:640, and with a positive single-stranded DNA antibody.
T84 561027-561128 Sentence denotes His polymyositis was refractory to multiple therapies including prednisone and mycophenolate mofitil.
T85 561129-561165 Sentence denotes He was then started on IVIG therapy.
T86 561166-561234 Sentence denotes He completed a three day course of IVIG from July 7 through July 10.
T87 561235-561320 Sentence denotes On the morning of July 16th, he developed severe, constant, non-radiating chest pain.
T88 561321-561416 Sentence denotes He presented to the ED more than 12 hours later and was diagnosed with a myocardial infarction.
T89 561417-561481 Sentence denotes He had no history of cigarette smoking or prior cardiac history.
T90 561482-561553 Sentence denotes His admission troponin T was elevated to 7.29 and he had a CPK of 2315.
T91 561554-561673 Sentence denotes Cardiac catheterization revealed a 100% occlusion of the mid left circumflex artery for which he underwent angioplasty.
T92 561674-562103 Sentence denotes We believe that IVIG caused a MI in this patient due to his lack of prior cardiac disease, relatively short term course of steroid induced diabetes mellitus (approximately 6-12 months), and a time course consistent with prior reported thromboembolic events caused by IVIG.3 This case is important because the application of IVIG continues to grow and providers need to be aware of the possible risks associated with this therapy.
T93 562104-562117 Sentence denotes Introduction:
T94 562118-562367 Sentence denotes Granulomatosis with Polyangiitis (GPA) is an antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAVs) with hallmark features of necrotizing granulomatous inflammation and pauci-immune vasculitis in small-and medium-size blood vessels.
T95 562368-562429 Sentence denotes It has a predilection for the respiratory system and kidneys.
T96 562430-562519 Sentence denotes GPA is extremely rare in children and adolescents especially of African American descent.
T97 562520-562606 Sentence denotes Here we report a case of Granulomatosis with Polyangiitis in an African American teen.
T98 562607-562619 Sentence denotes Case Report:
T99 562620-562811 Sentence denotes 13 year old black boy born and lived in Grenada, in his usual state of health began to experience productive cough, blood tinged sputum, dyspnea, chest pain, malaise, and intermittent fevers.
T100 562812-562908 Sentence denotes Chest x-ray (CXR) showed bilateral infiltrates, cystic changes and a 2.3 cm RUL cavitary lesion.
T101 562909-563041 Sentence denotes Intradermal tuberculin test as well as sputum and gastric aspirate for acid fast bacilli (AFB) and HIV / HTV antibody were negative.
T102 563042-563165 Sentence denotes Despite a 2 weeks course of antibiotics and 18 months empiric treatment for tuberculosis in Grenada his symptoms persisted.
T103 563166-563272 Sentence denotes 17 months after initial symptoms he demonstrated microscopic hematuria along with rising serum creatinine.
T104 563273-563457 Sentence denotes Five months later, in USA, his chest CT revealed a large thick walled cavity with an air fluid level in the RUL, tree and bud formation and a thin walled cavity in the left upper lobe.
T105 563458-563711 Sentence denotes Laboratory investigation was significant for serum BUN / Creatinine of 65/4.1, positive ANA, and anti-Proteinase 3 .Renal biopsy revealed pauci-immune diffuse sclerosing and cresent glomerulonephritis with severe tubular atrophy and interstial fibrosis.
T106 563712-563793 Sentence denotes He was diagnosed with GPA and started on high dose steroids and cyclophosphamide.
T107 563794-563831 Sentence denotes Relapses were treated with rituximab.
T108 563832-564205 Sentence denotes Currently he has hemodialysis dependent end stage renal disease, hypertension, dilatation of coronary artery, pericardial effusion required pericardiocentesis, concentric left ventricular hypertrophy, hypogammaglobinemia secondary to chemotherapy, on IVIG infusion, bilateral cataract secondary to chronic use of prednisone and posterior reversible encephalopathy syndrome.
T109 564206-564302 Sentence denotes Conclusion: GPA is extremely rare in children and aldolescents especially of African descendant.
T110 564303-564452 Sentence denotes Attributing symptoms of GPA to more common but less harmful disease processes, especially in areas of the world where it is less prevalent may occur.
T111 564453-564545 Sentence denotes Earlier diagnosis and treatment is extremely important in preventing permanent renal damage.
T112 564546-564559 Sentence denotes Introduction:
T113 564560-564707 Sentence denotes Acquired angioedema with C1 inhibitor deficiency is a rare disease characterized by recurrent episodes of angioedema without urticaria or pruritis.
T114 564708-564831 Sentence denotes Attacks may be triggered by trauma, psychological stress, or infection, but may also occur without an identifiable trigger.
T115 564832-565006 Sentence denotes The etiology of ACID is frequently due an underlying malignancy (lymphatic or adenocarcinoma), a monoclonal gammunopathy of uncertain significance or an autoimmune condition.
T116 565007-565025 Sentence denotes Case Presentation:
T117 565026-565150 Sentence denotes A 70 year old female was referred for evaluation after a recent onset of recurrent episodes of angioedema without urticaria.
T118 565151-565238 Sentence denotes Her initial episode developed in her lip approximately 24 hours after cataract surgery.
T119 565239-565339 Sentence denotes A subsequent episode of angioedema occurred in her neck and jaw after a respiratory tract infection.
T120 565340-565416 Sentence denotes Treatment with anti-histamines and corticosteroids did not improve symptoms.
T121 565417-565630 Sentence denotes Blood work revealed a C4 <5 mg/dL (normal 10-40 mg/dL), C1-INH function=23% (normal >41%), C1-INH protein=6 mg/dL (normal 21-39 mg/dL) and a C1q < 3.6 mg/dL (normal 5.0-8.6 mg/dL) and a diagnosis of ACID was made.
T122 565631-565740 Sentence denotes The patient was started on Aminocaproic acid 1gm TID to prevent attacks and Icatibant to treat acute attacks.
T123 565741-565970 Sentence denotes To evaluate for a possible underlying malignancy, the patient had a CBC, lymphocyte profile, and a MRI of her abdomen, all of which were unremarkable except for a mildly elevated B-cell number at 482/cu mm (normal range 75 -375).
T124 565971-566009 Sentence denotes Her ANA titer was 1:320 (normal 1:40).
T125 566010-566230 Sentence denotes As part of the evaluation a SPEP and immunofixation was performed which revealed an IgG at 438 (normal 700-1600 mg/dL), and IgA 59 (normal 70-400 mg/dL), and normal IgM 81 (normal 40-230 mg/dL) with a polyclonal pattern.
T126 566231-566317 Sentence denotes On review of symptoms, the patient reported 2 episodes of pneumonia, confirmed on CXR.
T127 566318-566472 Sentence denotes Specific IgG to pneumococcal antigens was detectable for 7/14 serotypes, which decreased 5 months later (to 6/14 seropyes) after Pneumovax administration.
T128 566473-566595 Sentence denotes Conclusion:To our knowledge, this is the first reported patient with ACID and a specific antibody deficiency Introduction:
T129 566596-566804 Sentence denotes Severe combined immunodeficiency (SCID) syndromes are primary immunodeficiencies that result from the absence or diminished function of T cells and are classified by the presence or absence of B and NK cells.
T130 566805-567009 Sentence denotes T-B-NK+ SCID occurs with autosomal recessive genetic defects involving V(D)J recombination or DNA repair mechanisms necessary to produce diverse T and B cell receptors and ultimately mature T and B cells.
T131 567010-567142 Sentence denotes We present a case of T-B-NK+ SCID presenting with microcephaly, growth retardation, hypogammaglobulinemia, and recurrent infections.
T132 567143-567148 Sentence denotes Case:
T133 567149-567399 Sentence denotes An 18 month old female with a history of a multicystic, dysplastic right kidney, microcephaly, failure to thrive, and eczema presented with hypogammaglobulinemia identified while inpatient for a recurrent sinopulmonary infection and chronic diarrhea.
T134 567400-567544 Sentence denotes History was significant for oral candidiasis at 8 months of age, sinusitis, recurrent acute otitis media, and diaper dermatitis since 16 months.
T135 567545-567714 Sentence denotes Physical examination was notable for a small female with microcephaly, and xerotic, excoriated skin on the trunk and lower extremities, as well as inguinal erythroderma.
T136 567715-567896 Sentence denotes Previous laboratory evaluation was significant for lymphopenia on CBC, undetectable IgG, IgA, and IgE, low IgM, and stool culture positive for yeast and rare Pseudomonas aeruginosa.
T137 567897-567905 Sentence denotes Results:
T138 567906-567970 Sentence denotes Repeat analysis confirmed hypogammaglobulinemia and lymphopenia.
T139 567971-568132 Sentence denotes T, B, and NK cell quantification revealed low T and B cell counts with an increased number of activated, memory T cells and NK cell numbers that were low normal.
T140 568133-568234 Sentence denotes T cell receptor analysis showed a polyclonal V beta repertoire for both CD4+ and CD8+ T cell subsets.
T141 568235-568345 Sentence denotes The patient's lymphocytes did not proliferate in response to mitogens, confirming a diagnosis of T-B-NK+ SCID.
T142 568346-568520 Sentence denotes Genetic testing revealed a previously reported H282R missense mutation and a novel L242IfsX5 frameshift mutation in the LIG4 gene producing a truncated DNA ligase IV protein.
T143 568521-568532 Sentence denotes Conclusion:
T144 568533-568678 Sentence denotes Hypomorphic mutations in DNA ligase IV are a rare cause of radiosensitive, SCID that can have a delayed clinical presentation from classic forms.
T145 568679-568914 Sentence denotes Patients with LIG4 mutations typically have microcephaly and growth retardation, but can have a wide range in phenotype from mild immune deficiency to embryonic lethality depending on the residual function of the DNA ligase IV protein.
T146 568915-568928 Sentence denotes Introduction:
T147 568929-569071 Sentence denotes Mutations in glucose-6-phosphatase catalytic subunit 3 (G6PC3) are characterized by syndromic and non-syndromic severe congenital neutropenia.
T148 569072-569264 Sentence denotes The syndromic form is associated with a wide spectrum of clinical findings, including thymic hypoplasia, primary pulmonary hypertension, cardiac, urogenital, and musculoskeletal abnormalities.
T149 569265-569440 Sentence denotes Dursun Syndrome, a rare condition characterized by familial primary pulmonary hypertension, leukopenia, and atrial septal defect (ASD), is in the spectrum of G6PC3 deficiency.
T150 569441-569506 Sentence denotes To date, over 60 patients with G6PC3 mutation have been reported.
T151 569507-569661 Sentence denotes Here we present a patient with G6PC3 mutation associated with severe congenital neutropenia, lymphopenia, pulmonary hypertension, ASD and Poland syndrome.
T152 569662-569749 Sentence denotes To our knowledge this is the first reported case of G6PC3 mutation and Poland syndrome.
T153 569750-569762 Sentence denotes Case Report:
T154 569763-569917 Sentence denotes A 3-year-old boy from non-consanguineous parents of Dominican descent with leukopenia and recurrent infections presented to our clinic at 8 months of age.
T155 569918-570280 Sentence denotes He also has Poland syndrome (associated with absence of left pectoralis muscle, shortened left upper extremity, and syndactyly of the 3 rd and 4 th fingers of the left hand), a large secundum atrial septal defect, pulmonary hypertension, chronic lung disease, failure to thrive, aspiration, grade III vesicoureteral reflux, hydronephrosis and an inguinal hernia.
T156 570281-570436 Sentence denotes He has had recurrent pneumonia as well as cellulitis and skin abscesses caused by S. aureus (MRSA), P. aeruginosa, E. coli, S. maltophilia, and E. cloacae.
T157 570437-570531 Sentence denotes These illnesses have prompted many hospitalizations including ICU admissions for septic shock.
T158 570532-570578 Sentence denotes Laboratory analysis is summarized in Table 1 .
T159 570579-570674 Sentence denotes Genetic analysis revealed a homozygous G6PC3 mutation c.218+1G>A which was previously reported.
T160 570675-570778 Sentence denotes He continues to have recurrent skin infections requiring hospitalizations despite filgastrim treatment.
T161 570779-570790 Sentence denotes Discussion:
T162 570791-570909 Sentence denotes Dursun Syndrome is a rare condition recently linked to G6PC3 deficiency associated with severe congenital neutropenia.
T163 570910-570990 Sentence denotes Here we report a case of G6PC3 deficiency, Dursun syndrome, and Poland syndrome.
T164 570991-571071 Sentence denotes Our patient's findings emphasize the wide clinical spectrum of G6PC3 deficiency.
T165 571072-571074 Sentence denotes G.
T166 571075-571091 Sentence denotes Imperato *1 , A.
T167 571092-571106 Sentence denotes Khokhar 2 , S.
T168 571107-571121 Sentence denotes LaBarba 1 , P.
T169 571122-571134 Sentence denotes Ponda 1 , 1.
T170 571135-571153 Sentence denotes Great Neck, NY; 2.
T171 571154-571168 Sentence denotes Manhasset, NY.
T172 571169-571182 Sentence denotes Introduction:
T173 571183-571271 Sentence denotes Streptococcus pyogenes pharyngitis causes an associated exanthem in a minority of cases.
T174 571272-571396 Sentence denotes Here we report a patient with an atypical prolonged and recrudescent exanthem secondary to Streptococcus pyogenes infection.
T175 571397-571405 Sentence denotes Methods:
T176 571406-571571 Sentence denotes A 51 year-old Hispanic female with no significant past medical history presented for evaluation of an erythematous and pruritic rash on her bilat-eral arms and legs.
T177 571572-571816 Sentence denotes The rash first appeared approximately four weeks previously; six days after the rash appeared, the patient presented to a local emergency department for evaluation and was prescribed benadryl and instructed to be evaluated in an allergy clinic.
T178 571817-571957 Sentence denotes Over the next three weeks, the rash gradually resolved with benadryl, and subsequently recurred four days prior to her initial clinic visit.
T179 571958-572036 Sentence denotes The patient reported no history of food, environmental, or seasonal allergies.
T180 572037-572175 Sentence denotes The patient works as a housecleaner, and reported a history of contact exposure to various household chemicals on regular a regular basis.
T181 572176-572269 Sentence denotes Review of systems was positive for throat soreness which preceded the appearance of the rash.
T182 572270-572438 Sentence denotes Physical examination revealed 1-2 cm erythematous blanching macules on the bilateral lower extremities with sparing of the soles, with scattered overlying excoriations.
T183 572439-572552 Sentence denotes Erythematous papules were noted on the bilateral upper extremities, with a follicular eruption noted on the back.
T184 572553-572671 Sentence denotes Areas of periungual desquamation (not present during the initial episode of rash) were noted on the hands bilaterally.
T185 572672-572680 Sentence denotes Results:
T186 572681-572835 Sentence denotes Laboratory studies included a comprehensive metabolic panel, as well as a complete blood count with differential, both of which were within normal limits.
T187 572836-572911 Sentence denotes An anti-streptolysin O screen was elevated at 1220 IU/mL (ref 0-408 IU/mL).
T188 572912-572991 Sentence denotes A throat culture grew Streptococcus pyogenes and mixed upper respiratory flora.
T189 572992-573148 Sentence denotes The patient was treated with a five-day course of amoxicillin; her rash gradually improved but was still present ten weeks following its initial appearance.
T190 573149-573160 Sentence denotes Conclusion:
T191 573161-573252 Sentence denotes Streptococcal infection may cause prolonged and recrudescent exanthem in affected patients.
T192 573253-573498 Sentence denotes While a range of diagnoses may be considered, Streptococcal pharyngitis should remain a leading suspicion for both adult and pediatric patients with atypical dermatologic findings when there is a clear clinical history of antecedent pharyngitis.
T193 573499-573501 Sentence denotes S.
T194 573502-573516 Sentence denotes LaBarba * , P.
T195 573517-573539 Sentence denotes Ponda, Great Neck, NY.
T196 573540-573550 Sentence denotes Rationale:
T197 573551-573665 Sentence denotes Attention Deficit Hyperactivity Disorder (ADHD) is characterized by hyperactivity, impulsivity and/or inattention.
T198 573666-573755 Sentence denotes ADHD affects 8-10% of all children, making it one of the most common childhood disorders.
T199 573756-573869 Sentence denotes In the 2011 National Survey of Children's Health, the prevalence of ADHD in U.S children ages 4-17 years was 11%.
T200 573870-573927 Sentence denotes This is a 42% increase from a prevalence of 7.8% in 2003.
T201 573928-574010 Sentence denotes Up to 70% of children with this diagnosis have persistent symptoms into adulthood.
T202 574011-574126 Sentence denotes Currently, ADHD is treated with 3 different types of medications: phenylphenidates, amphetamines and "other" class.
T203 574127-574304 Sentence denotes These medications work to various degrees to inhibit norepinephrine and dopamine reuptake, thereby increasing the concentration of these neurotransmitters in the synaptic cleft.
T204 574305-574384 Sentence denotes This in turn improves executive functioning, motivation, and reward perception.
T205 574385-574479 Sentence denotes We describe three patients who had delayed reactions to different classes of ADHD medications.
T206 574480-574488 Sentence denotes Methods:
T207 574489-574590 Sentence denotes A 9 year old boy with ADHD was started on amphetamine and developed diffuse urticaria one week later.
T208 574591-574650 Sentence denotes The rash resolved within two days of stopping the medicine.
T209 574651-574790 Sentence denotes He then tried methylphenidate and lisdexamfetamine dimesylate respectively and developed urticaria one week after starting each medication.
T210 574791-574865 Sentence denotes The rash resolved one day after stopping the medication on both occasions.
T211 574866-574917 Sentence denotes Skin prick testing to all three drugs was negative.
T212 574918-575001 Sentence denotes The patient was then placed on guanfacine and tolerated this drug without reaction.
T213 575002-575082 Sentence denotes A 5 year old boy developed diffuse urticaria one week after starting guanfacine.
T214 575083-575144 Sentence denotes This resolved two days after the medication was discontinued.
T215 575145-575236 Sentence denotes A 34 year woman developed generalized pruritis five days after starting bupropion for ADHD.
T216 575237-575277 Sentence denotes This resolved one day after stopping it.
T217 575278-575416 Sentence denotes She then started lisdexamfetamine dimesylate and developed generalized erythema, pruritis, and sensation of throat closure one week later.
T218 575417-575480 Sentence denotes These symptoms resolved after this medication was discontinued.
T219 575481-575493 Sentence denotes Conclusions:
T220 575494-575705 Sentence denotes Given the increasing frequency of ADHD in the U.S. population and the persistence into adulthood, it is important for clinicians to recognize ADHD medications as a possible source of delayed cutaneous reactions.
T221 575706-575766 Sentence denotes Therefore skin testing may not be predictive in these cases.
T222 575767-575908 Sentence denotes Both IgE mediated and non-IgE mediated reactions to these medications should be considered when the appropriate clinical history is elicited.
T223 575909-576136 Sentence denotes Rationale:Eosinophilic cystitis (EC) is an inflammatory condition, often misrepresented as a bladder tumor due to its presenting symptoms of gross/microscopic hematuria, urinary frequency, dysuria and suprapubic abdominal pain.
T224 576137-576304 Sentence denotes It is a rare condition seen in children and is thought to be caused by antigenic stimulation of IgE-mediated activation of eosinophils causing mast cell degranulation.
T225 576305-576381 Sentence denotes This accounts for much of the inflammation and fibrosis to the bladder wall.
T226 576382-576470 Sentence denotes We review our experience of treating patients with this condition in our allergy clinic.
T227 576471-576737 Sentence denotes Methods:Two children with a history of acute onset of urinary frequency, suprapubic abdominal pain and gross hematuria were referred to allergy with the diagnosis of eosinophilic cystitis for the evaluation of potential allergens as a cause of eosinophilic cystitis.
T228 576738-576944 Sentence denotes Results:Our patients include a 4 year old female and a 17 year old male who present with a history of hematuria referred for evaluation after routine urine and microscopy showed > 50 RBC's/high power field.
T229 576945-576972 Sentence denotes Urine culture was negative.
T230 576973-577121 Sentence denotes Both patients were diagnosed via cystourethroscopy with biopsy demonstrating a prominence of eosinophils with scattered neutrophils and lymphocytes.
T231 577122-577201 Sentence denotes Allergic disease (asthma, allergic rhinitis, etc) was present in both patients.
T232 577202-577299 Sentence denotes The 4 year old female had skin testing to common indoor and outdoor allergens which was negative.
T233 577300-577374 Sentence denotes She was treated with antihistamines with resolution by 2 months follow-up.
T234 577375-577530 Sentence denotes The 17 year old male did not have skin testing although immunocap testing showed egg IgE 38, milk IgE 52, peanut IgE 14, wheat IgE >100 and total IgE 1156.
T235 577531-577622 Sentence denotes He was not started on any medications and had spontaneous resolution at 3 months follow-up.
T236 577623-577634 Sentence denotes Conclusion:
T237 577635-577712 Sentence denotes Eosinophilic cystitis is a rare inflammatory disorder of the urinary bladder.
T238 577713-577822 Sentence denotes The exact etiology of eosinophilic esophagitis remains elusive though an allergic response has been proposed.
T239 577823-577928 Sentence denotes Management comprises of removal of any suspected allergen, followed by antihistamine and corticosteroids.
T240 577929-578094 Sentence denotes The course is usually benign and self-limited in children, although progression to fibrosis of the bladder with obstructive uropathy has been reported in some cases.
T241 578095-578244 Sentence denotes Food Protein-Induced Enterocolitis (FPIES) is a non-IgE mediated food hypersensitivity that typically presents in infancy with vomiting and diarrhea.
T242 578245-578458 Sentence denotes The diagnosis is made based on history and clinical presentation, and is confirmed by a supervised oral food challenge; there is no specific laboratory test to aid in diagnosis or in identifying the inciting food.
T243 578459-578618 Sentence denotes Knowledge of potential trigger foods for FPIES thus is important in making the diagnosis, and subsequently counseling patients appropriately on food avoidance.
T244 578619-578691 Sentence denotes In young infancy, the most common triggers are cow milk and soy formula.
T245 578692-578883 Sentence denotes In older infants and children, FPIES may occur with ingestion of solid foods such as grains (most commonly rice and oat), meat and poultry, egg white, vegetables, fruit, legumes, and seafood.
T246 578884-578961 Sentence denotes FPIES to cashew, however, has not been previously reported in the literature.
T247 578962-579050 Sentence denotes In this report, we present the case of a 2.5 year-old boy who developed FPIES to cashew.
T248 579051-579199 Sentence denotes His allergic history includes infantile FPIES to cow milk, which transitioned to development of IgE mediated allergy to cow milk at 9 months of age.
T249 579200-579282 Sentence denotes After ingesting several cashews at 2.5 years of age, he had one episode of emesis.
T250 579283-579389 Sentence denotes When skin testing with an allergist was negative for cashew, the mother was advised to reintroduce cashew.
T251 579390-579617 Sentence denotes On re-introduction of cashew however, the patient had a reaction consistent with FPIES 2 hours afterwards: he developed repetitive emesis, lethargy, cyanosis, and diarrhea, notably without any cutaneous or respiratory symptoms.
T252 579618-579758 Sentence denotes He was brought by ambulance to the emergency department for treatment, where he improved rapidly after administration of intravenous fluids.
T253 579759-579941 Sentence denotes On repeat testing 3 months after this reaction, he was found to have small wheal in response to cashew on skin testing with diameter of induration 3 mm and diameter of erythema 0 mm.
T254 579942-580007 Sentence denotes He also had mildly elevated specific IgE to cashew at 0.75 kIU/L.
T255 580008-580231 Sentence denotes In conclusion, here we present the first reported case of atypical (older age of onset and association with detectable serum cashew-specific IgE) FPIES to cashew, adding to the list of potential allergic triggers for FPIES.
T256 580232-580399 Sentence denotes Though rare, tree nuts such as cashew should be considered when identifying potential inciting food in children infants presenting with symptoms consistent with FPIES.
T257 580400-580413 Sentence denotes Introduction:
T258 580414-580564 Sentence denotes Dialyzer reactions refer to all of the abnormal sequelae resulting from the interaction between blood constituents and the hemodialysis (HD) membrane.
T259 580565-580633 Sentence denotes There are two types of reactions: type A (0.004%) and type B (3-5%).
T260 580634-580763 Sentence denotes In the past, these reactions were grouped under the term "first use syndrome" because they primarily occurred with new dialyzers.
T261 580764-580836 Sentence denotes Here we present a case of hypersensitivity reaction during hemodialysis.
T262 580837-580842 Sentence denotes Case:
T263 580843-580957 Sentence denotes A 28 year old male was referred to the allergy clinic for diffuse urticarial rash during HD for the past 2 months.
T264 580958-581063 Sentence denotes The pruritic rash starts within 2 hours of HD, on his face, chest and back sparing his lower extremities.
T265 581064-581135 Sentence denotes The discomfort was such that he could not finish his 4 hours treatment.
T266 581136-581250 Sentence denotes His Vitals remained stable and he denied any respiratory symptoms such as difficulty breathing, wheezes and cough.
T267 581251-581317 Sentence denotes There was no angioedema, headache, blurry vision or GI complaints.
T268 581318-581396 Sentence denotes He denied any history of medication, food, contact or environmental allergies.
T269 581397-581418 Sentence denotes Past medical history:
T270 581419-581478 Sentence denotes End-stage renal disease from IgA nephropathy, hypertension.
T271 581479-581499 Sentence denotes Current medications:
T272 581500-581524 Sentence denotes Procardia XL 30mg daily.
T273 581525-581546 Sentence denotes Physical examination:
T274 581547-581564 Sentence denotes He was alert, BP:
T275 581565-581596 Sentence denotes 126/84 mm Hg, pulse 96/min, RR:
T276 581597-581604 Sentence denotes 16/min.
T277 581605-581663 Sentence denotes Cardiopulmonary and neurological examinations were normal.
T278 581664-581772 Sentence denotes Skin revealed diffuse urticarial rash with blanching wheals on the face, trunk and upper extremities [Fig] .
T279 581773-581781 Sentence denotes Methods:
T280 581782-581809 Sentence denotes Laboratory data showed WBC:
T281 581810-581839 Sentence denotes 5.2K/mm3 with 10% eosinophil.
T282 581840-581861 Sentence denotes Serum tryptase level:
T283 581862-581908 Sentence denotes 22.8mg/L (2hours after rash started); IgE-EIA:
T284 581909-581923 Sentence denotes 44 U/ml, CH50:
T285 581924-581959 Sentence denotes 57U/ml and C1Q binding: <1.2 Eq/ml.
T286 581960-582012 Sentence denotes We suspected that the reaction was dialyzer related.
T287 582013-582095 Sentence denotes We contacted the dialysis center and suggested that dialyzer be changed or reused.
T288 582096-582190 Sentence denotes Prewashing the dialyzer with the patient's blood temporarily helped to alleviate his symptoms.
T289 582191-582275 Sentence denotes We then prescribed Prednisone PO 40mg the night before, and 2 hours before dialysis.
T290 582276-582316 Sentence denotes PO Benadryl 50mg just prior to dialysis.
T291 582317-582435 Sentence denotes On follow up visit, the patient did very well with premedication, even when prednisone dose was tapered down to 10 mg.
T292 582436-582447 Sentence denotes Conclusion:
T293 582448-582526 Sentence denotes Common causes for dialysis resulted reactions include sensitivity to dialyzer.
T294 582527-582621 Sentence denotes However, some patients continue to exhibit hypersensitivity reaction despite dialyzer changes.
T295 582622-582688 Sentence denotes Premedication with steroid can successfully prevent the reactions.
T296 582689-582844 Sentence denotes More studies are needed to better identify the cause of hemodialysis reactions in order to develop better management strategies to treat affected patients.
T297 582845-582856 Sentence denotes Background:
T298 582857-582986 Sentence denotes Angioedema causes self-limited, localized subcutaneous swelling especially likely to affect the periorbital and circumoral areas.
T299 582987-583162 Sentence denotes Here we report a case of lip swelling in the context of angiotensin-converting-enzyme inhibitor (ACEi) use caused by extensive odontologic, maxillary and paraseptal abscesses.
T300 583163-583168 Sentence denotes Case:
T301 583169-583408 Sentence denotes A 44-year-old African American female smoker with a history of obstructive lung disease, atopy, hypertension on ACEi for 2 months, and diabetes mellitus type 2 was admitted to the hospital for her eighth pulmonary exacerbation in one year.
T302 583409-583515 Sentence denotes She was treated with IV steroids and antibiotics, her second course of high dose IV steroids in six weeks.
T303 583516-583702 Sentence denotes One week later, she reported sore throat and right ear pain, nasal discharge, pain in upper teeth, fevers, chills, neck tenderness and progressive swelling of nose, cheeks and upper lip.
T304 583703-583766 Sentence denotes Allergy consult was made to evaluate patient's facial swelling.
T305 583767-583775 Sentence denotes Results:
T306 583776-583840 Sentence denotes Physical exam showed swelling of upper lip, nostrils and cheeks.
T307 583841-583928 Sentence denotes Laboratory results significant for normal C1 esterase level but WBC elevated to 34,000.
T308 583929-584015 Sentence denotes Sinus CT scan done 3 days prior to lip swelling showed a maxillary periapical abscess.
T309 584016-584121 Sentence denotes Lip swelling and pain persisted for several days in spite of stopping ACEi and starting oral antibiotics.
T310 584122-584216 Sentence denotes She then had spontaneous eruption of a large foul-smelling fluid collection from her nostrils.
T311 584217-584442 Sentence denotes Subsequent maxillary-facial CT demonstrated cortical breakthrough of maxillary periapical abscess and interval development of septal abscess extending down into the philtrum with likely phlegmonous infection of the upper lip.
T312 584443-584554 Sentence denotes She underwent I&D of septal abscess with aspiration of frank purulent material and placement of septal splints.
T313 584555-584616 Sentence denotes She received more aggressive antibiotic treatment thereafter.
T314 584617-584704 Sentence denotes Discussion: ACEi involvement is the culprit of the majority of drug-induced angioedema.
T315 584705-584814 Sentence denotes However, angioedema that persists and worsens over time after ACEi discontinuation may point to other causes.
T316 584815-584941 Sentence denotes In this case, a severe sinus infection with multiple abscesses led to inflammatory changes resulting in local facial swelling.
T317 584942-585160 Sentence denotes Propensity toward development of this infection is likely multifactorial, including high dose steroids and poor oral hygiene, and protracted use of IV steroids likely made control of her sinus infection more difficult.
T318 585161-585163 Sentence denotes R.
T319 585164-585179 Sentence denotes Kreiner *1 , R.
T320 585180-585196 Sentence denotes Rosenbaum 1 , A.
T321 585197-585214 Sentence denotes Rubinstein 2 , 1.
T322 585215-585231 Sentence denotes New York, NY; 2.
T323 585232-585242 Sentence denotes Bronx, NY.
T324 585243-585256 Sentence denotes Introduction:
T325 585257-585384 Sentence denotes Anterior uveitis is the process of intraocular inflammation that results most commonly from a systemic immune-mediated disease.
T326 585385-585393 Sentence denotes Methods:
T327 585394-585606 Sentence denotes We evaluated a 9 year old previously healthy female who presented with anterior uveitis poorly responsive to conventional medical management and subsequently found to have an underlying familial immunodeficiency.
T328 585607-585615 Sentence denotes Results:
T329 585616-585798 Sentence denotes 9-yr-old female BZ was referred for immunologic evaluation after developing acute anterior uveitis presenting as red right eye, absent pupillary reaction to light and blurred vision.
T330 585799-585868 Sentence denotes Initial diagnosis was made by ophthalmology on slit lamp examination.
T331 585869-585992 Sentence denotes She was seen by multiple specialists including rheumatology for a suspicion of JIA as she briefly complained of joint pain.
T332 585993-586075 Sentence denotes She also had a history of a mycoplasma pneumonia affecting several family members.
T333 586076-586168 Sentence denotes BZ, however, had a persisting IgM response to Mycoplasma with a delayed class switch to IgG.
T334 586169-586236 Sentence denotes At the onset of uveitis BZ was otherwise asymptomatic and afebrile.
T335 586237-586375 Sentence denotes She was started on ophthalmic steroid drops for 6 weeks with resolution of symptoms and decreased signs of inflammation on slit lamp exam.
T336 586376-586451 Sentence denotes Several weeks later she was found to have recurrent insidious inflammation.
T337 586452-586526 Sentence denotes She was placed back on steroid ophthalmic drops with a marked improvement.
T338 586527-586597 Sentence denotes Upon further analysis she was found to have low serum immunoglobulins.
T339 586598-586836 Sentence denotes The family history revealed that her paternal grandfather and a paternal aunt suffer from Common Variable Immunodeficiency (CVID) who presented with recurrent infection and are being treated with periodic intravenous gammaglobulin (IVIG).
T340 586837-586908 Sentence denotes BZ had no history of infections other than recurrent otitis in infancy.
T341 586909-586920 Sentence denotes Conclusion:
T342 586921-587036 Sentence denotes This is the first case report describing a patient with an underlying immune deficiency and family history of CVID.
T343 587037-587107 Sentence denotes Her immune parameters do not completely fulfill the criteria for CVID.
T344 587108-587234 Sentence denotes She presented with a persisting IgM to Mycoplasma infection with delayed class switch to IgG as well as an autoimmune uveitis.
T345 587235-587370 Sentence denotes BZ responded well to topical and systemic steroids but the uveitis recurred promptly with a decrease of or discontinuation of steroids.
T346 587371-587481 Sentence denotes She had a sustained response after 3 doses of IVIG at 1 gram/Kg and is now on prophylactic periodic treatment.
T347 587482-587557 Sentence denotes Uveitis is a challenging disease as the differential is largely idiopathic.
T348 587558-587641 Sentence denotes Early diagnosis is key as untreated uveitis can result in severely impaired vision.
T349 587642-587837 Sentence denotes The IDEaL Patient Registry collects longitudinal information on subjects receiving immunoglobulin (Ig) replacement therapy from Coram CVS/specialty infusion services in an alternate care setting.
T350 587838-587986 Sentence denotes Long-term outcomes and patient-reported quality-of-life assessments are not widely available for patients on Ig therapy for different disease types.
T351 587987-588160 Sentence denotes In the IDEaL primary immune deficiency (PID) population, we examined baseline lab values for treated patients, and infection rates and quality-of-life assessments over time.
T352 588161-588210 Sentence denotes Patients from our 140 investigators are eligible.
T353 588211-588284 Sentence denotes IRB approval was obtained, as well as informed consent from all subjects.
T354 588285-588375 Sentence denotes Information collected by Coram nurses and pharmacists was entered into the IDEaL database.
T355 588376-588508 Sentence denotes Additionally, patients were asked to complete an SF-36 questionnaire and a Life Quality Index Questionnaire (LQIQ) every six months.
T356 588509-588561 Sentence denotes Currently 310 subjects are enrolled in the Registry.
T357 588562-588672 Sentence denotes The average age for diagnosis of adult patients was 59 years, and their average serum IgG level was 508 mg/dL.
T358 588673-588787 Sentence denotes The average dose for subcutaneous Ig (SCIg) was 134 mg/kg/week; for intravenous Ig (IVIg), it was 465 mg/kg/month.
T359 588788-588872 Sentence denotes In patients who switched from IVIg to SCIg, the average conversion ratio was 1:1.21.
T360 588873-588985 Sentence denotes The average annual number of infections was three, with no significant difference between administration routes.
T361 588986-589096 Sentence denotes Similar side-effect incidence rates, with differences in specific side effects depending on route, were noted.
T362 589097-589295 Sentence denotes LQIQ results showed that most patients had a positive perception of their treatment, including how worthwhile and effective they felt it was, but were evenly split on how expensive they felt it was.
T363 589296-589390 Sentence denotes These results from the IDEaL Registry suggest an overall profile of PID patients receiving Ig.
T364 589391-589603 Sentence denotes Key findings include that adult patients were diagnosed later in life, SCIG dose was toward the lower end of the recommended dose range, and in patients switched from IVIg to SCIg, the dose conversion was 1:1.21.
T365 589604-589745 Sentence denotes Patients appeared to have good infection control; however, with a limited dose spread, we could not demonstrate a strong dose response curve.
T366 589746-589779 Sentence denotes Side effects were generally mild.
T367 589780-589845 Sentence denotes Patients reported generally positive quality-of-life perceptions.
T368 589846-589959 Sentence denotes Continued data collection will allow for further long-term data analysis on outcomes of patients on Ig treatment.
T369 589960-589962 Sentence denotes B.
T370 589963-590000 Sentence denotes Esquivel * , Mexico City, DF, Mexico.
T371 590001-590005 Sentence denotes Aim:
T372 590006-590362 Sentence denotes This study was aimed to determine the allelic frequencies of 22 related immune polymorphism (10488631, 1061170, 1265159, 12722489, 1799964, 1800629, 1800630, 2187668, 2476601, 3087243, 3135388, 3761847, 3890745, 4112788, 4140564, 6457617, 6822844, 6897932, 725613, 7574865, 800292, 9888739) in Mexican population and estimated the risk for immune diseases.
T373 590363-590730 Sentence denotes These polymorphism have been commonly associated whit 9 immune diseases as; rheumatoid arthritis, macular degeneration, Type 1 diabetes, celiac disease, graves' disease, multiple sclerosis, lupus, osteoarthritis and psoriasis, and also are located in several of the most important immune genes as; HLA, STAT4, TNF, TNPO3, IL21, IL2RA, IL7R, MHC, C2, CFH among others.
T374 590731-590738 Sentence denotes Method:
T375 590739-590947 Sentence denotes Genotyping was carried out in 100 genomic DNA samples from dried blood spots supplied by the Mexican patients of Gene Test TQMedicine using custom made multiplex array in Sequenom Massarray System technology.
T376 590948-590956 Sentence denotes Results:
T377 590957-591094 Sentence denotes The frequency for all the polymorphism was calculated and previous risk alleles for autoimmune diseases determined in Mexican population.
T378 591095-591268 Sentence denotes Our data shows similarities with those frequencies founded in human genome project and suggest an increase genetic probability for psoriasis and lupus in Mexican population.
T379 591269-591372 Sentence denotes Patients with several risk alleles show an exacerbated immune response for several clinical conditions.
T380 591373-591579 Sentence denotes For this patients that shown genetic risk for immune diseases, relevant clinical events were not observed since nutritional and clinical care were established to avoid the previous calculated genetic risk..
T381 591580-591591 Sentence denotes Conclusion:
T382 591592-591766 Sentence denotes The Mexican population showed a slight frequency of immune associated diseases polymorphism, however those who have several risk alleles shown an exacerbated immune response.
T383 591767-591864 Sentence denotes Follow up with immune modulators should be perform in this population to control this conditions.
T1 591865-591867 Sentence denotes M.
T2 591868-591880 Sentence denotes Stein 1 , R.
T3 591881-591893 Sentence denotes Price 2 , A.
T4 591894-591909 Sentence denotes Koterba *1 , W.
T5 591910-591921 Sentence denotes Tuer 3 , 1.
T6 591922-591946 Sentence denotes North Palm Beach, FL; 2.
T7 591947-591973 Sentence denotes Palm Beach Gardens, FL; 3.
T8 591974-591994 Sentence denotes West Palm Beach, FL.
T9 591995-592162 Sentence denotes Reports from JS Rankin in the surgical literature suggest that cardiopulmonary bypass (CPB) may have immune depleting effects with some patients having low IgG levels.
T10 592163-592278 Sentence denotes He reports that this in turn leads to pulmonary dysfunction which improves with intravenous immune globulin (IVIG).
T11 592279-592377 Sentence denotes In our practice in the past 3 years, 3 patients with PID have undergone aortic valve replacements.
T12 592378-592440 Sentence denotes One patient had significant post operative pulmonary problems.
T13 592441-592454 Sentence denotes Case Reports:
T14 592455-592569 Sentence denotes Case 1, 61 year old female with PID was receiving IVIG 25 gm every 5 weeks with trough IgG = 866 mg/dl on12/12/12.
T15 592570-592626 Sentence denotes The next dose of IVIG was increased to 35 gm on 1/14/13.
T16 592627-592696 Sentence denotes Aortic valve was replaced on 1/22/13, and she was on CPB for 87 mins.
T17 592697-592792 Sentence denotes On 1/25/13 respiratory distress with a small infiltrate on chest X-ray leading to reintubation.
T18 592793-592852 Sentence denotes On 1/29/13 IgG = 490 mg/dl and patient received IVIG 30 gm.
T19 592853-592915 Sentence denotes There was subsequent rapid improvement over the next 48 hours.
T20 592916-593018 Sentence denotes Two other females with PID had aortic valve replacement with no pulmonary or infectious complications.
T21 593019-593108 Sentence denotes Case 2, 72 year old on 30 gm IVIG with trough IgG = 799 mg/dl and was on CPB for 85 mins.
T22 593109-593187 Sentence denotes Case 3, 58 year old was on subcutaneous immune globulin 29.7 gm every 2 weeks.
T23 593188-593244 Sentence denotes IgG trough was 1300mg/dl and she was on CPB for 64 mins.
T24 593245-593256 Sentence denotes Conclusion:
T25 593257-593341 Sentence denotes Reports from the surgical literature suggest that CPB may lead to a decrease in IgG.
T26 593342-593489 Sentence denotes In one of three patients with therapeutic levels of IgG preoperatively, there was a significant drop in IgG after CPB and aortic valve replacement.
T27 593490-593636 Sentence denotes Multiple factors could contribute to this drop including dilutional effects of intravenous fluids, active bacterial infection, and the use of CPB.
T28 593637-593726 Sentence denotes The pulmonary infection and respiratory distress were accompanied by the decrease in IgG.
T29 593727-593862 Sentence denotes A prospective study is needed in patients with and without PID, with measurement of IgG before surgery and 24,48 and 72 hours post CPB.
T30 593863-594127 Sentence denotes At the present time it is important to consider whether there is a need for an extra loading dose of IVIG before surgery or whether careful monitoring of IgG levels after surgery will help assure that the PID patient will not have serious postoperative infections.
T31 594128-594280 Sentence denotes Introduction: MWS is characterized by peculiar facial appearance, heart defects, Hirschsprung disease (HD), genitourinary anomalies and brain anomalies.
T32 594281-594319 Sentence denotes It is caused by mutation of ZEB2 gene.
T33 594320-594463 Sentence denotes Pons et al have described congenital hypo/asplenia in 4 patients with MWS and ZEB2 mutation, and suggest ZEB2 as a candidate gene for asplenia.
T34 594464-594524 Sentence denotes Immune abnormalities have not been reported in MWS patients.
T35 594525-594651 Sentence denotes Here we report two unrelated patients with MWS, ZEB2 mutation, congenital and/or functional asplenia and immune abnormalities.
T36 594652-594660 Sentence denotes Methods:
T37 594661-594697 Sentence denotes Chart and literature review Results:
T38 594698-594780 Sentence denotes Patient 1 is a 6year-old boy with MWS, HD, heart defects, and congenital asplenia.
T39 594781-594821 Sentence denotes He had no significant infection history.
T40 594822-594912 Sentence denotes His immunological studies showed low IgG, IgA and IgM, but normal response to vaccination.
T41 594913-595050 Sentence denotes T&B cell phenotyping showed normal percentages and numbers of mature B cells (CD19/CD20), but low percentages of CD19/27+ memory B cells.
T42 595051-595175 Sentence denotes CD3 and CD8 T cell numbers were low but lymphoproliferative studies showed normal responses to mitogen and specific antigen.
T43 595176-595230 Sentence denotes He lacked serologic evidence for past viral infection.
T44 595231-595472 Sentence denotes In vitro cytotoxic-T-lymphocyte (CTL) function appeared normal with cellular ability to release interferon g in response to autologous EBV-transformed B cells (Elispot assay) and kill EBV-transformed B cells in cytotoxicity assay documented.
T45 595473-595513 Sentence denotes In sum, no T cell defect was identified.
T46 595514-595685 Sentence denotes Patient 2 is a 4-year-old girl with MWS, malrotation, hypogangolionosis, developmental delay, seizure disorder, and minimal splenic function from presumed splenic infarct.
T47 595686-595745 Sentence denotes She had recurrent infections of URI, otitis, and sinusitis.
T48 595746-595831 Sentence denotes Her immunological studies showed low IgG and IgA, and normal response to vaccination.
T49 595832-595997 Sentence denotes T&B cell phenotyping showed normal percentages and numbers of T (CD3, CD4, CD8) and B (CD19, CD20, CD19/27+) cells including transitional and class-switched B cells.
T50 595998-596089 Sentence denotes This child received empiric immunoglobulin supplementation and then antibiotic prophylaxis.
T51 596090-596101 Sentence denotes Conclusion:
T52 596102-596240 Sentence denotes Like the MWS patients reported by Pons et al, our 2 subjects also had congenital and/or functional asplenia associated with ZEB2 mutation.
T53 596241-596323 Sentence denotes Both patients had evidence of immune discrepancies with low immunoglobulin levels.
T54 596324-596459 Sentence denotes Physicians caring for patients with MWS should be aware of asplenia risk and possible immune abnormalities specifically B cell defects.
T55 596460-596550 Sentence denotes Abdominal ultrasound and immune evaluation are recommended to reduce infectious morbidity.
T56 596551-596674 Sentence denotes CVID is a collection of diverse and distinct diseases characterized by primary antibody deficiency (hypogammaglobulinemia).
T57 596675-596833 Sentence denotes Clinical manifestations include autoimmunity, inflammatory disease, recurrent infections and increased malignancies, especially lymphoproliferative disorders.
T58 596834-596974 Sentence denotes Inflammatory disease of the gastrointestinal tract is seen in about 50 % of patients and lymphocytic intraepithelial infiltration is common.
T59 596975-597090 Sentence denotes Gastrointestinal infections, especially in patients with absent IgA are common and Giardia is a recognized culprit.
T60 597091-597281 Sentence denotes We describe the case of a 21 year old male who was diagnosed with CVID at the age of 17 years after an episode of prolonged diarrhea and weight loss that required total parenteral nutrition.
T61 597282-597421 Sentence denotes His quantitative Immunoglobulins were decreased (IgG 146 mg/dl (700-1600 mg/dL) IgA= <7 mg/dl (70-400 mg/dL) (IgM=<5 mg/dl (40-230 mg/dL)).
T62 597422-597538 Sentence denotes He had protective antibody levels to measles, mumps, rubella and varicella but absent antibodies to tetanus vaccine.
T63 597539-597663 Sentence denotes Replacement with intravenous immunoglobulins (IVIG) was started; because of low trough levels dose increases were necessary.
T64 597664-597801 Sentence denotes A biopsy of his Duodenum showed complete absence of plasma cells, several non-necrotizing microgranulomata were found in gastric samples.
T65 597802-597867 Sentence denotes Diphenoxylate and atropine was started for treatment of diarrhea.
T66 597868-597967 Sentence denotes In the following the patient continued to have daily extensive diarrhea that prevented weight gain.
T67 597968-598008 Sentence denotes Giardia was identified by stool culture.
T68 598009-598103 Sentence denotes Despite prolonged treatment with various antibiotic regimens no eradication could be achieved.
T69 598104-598246 Sentence denotes Treatment with Metronidazole, Tinidazole, Nitazoxanide, Paromomycin, Quinacrine alone and in different combinations was attempted for 2 years.
T70 598247-598331 Sentence denotes Oral Budesonide and Loperamide were needed for control of his diarrhea on most days.
T71 598332-598411 Sentence denotes Control of inflammation was also attempted with oral prednisone intermittently.
T72 598412-598477 Sentence denotes Environmental precautions as avoidance of tap water were advised.
T73 598478-598599 Sentence denotes A prolonged course of Quinacrine and Tinidazole cleared the infection and has kept him in remission for almost 11 months.
T74 598600-598793 Sentence denotes Different components of CVID at interplay in the gastrointestinal tract required a delicate balance of controlling inflammation with corticosteroids and treatment of infection with antibiotics.
T75 598794-598907 Sentence denotes Increased protein loss necessitated various dose adjustments of IVIG to allow adequate protection of reinfection.
T76 598908-599139 Sentence denotes Chronic granulomatous disease (CGD) is an innate defect caused by mutations in any of the five subunits of the NADPH oxidase leading to impaired superoxide production and reduced intracellular killing of certain bacteria and fungi.
T77 599140-599320 Sentence denotes Recurrent infections of the skin, lungs, lymph nodes, and liver are caused by a narrow spectrum of bacteria and fungi with particular susceptibility to catalase positive organisms.
T78 599321-599435 Sentence denotes We report a case of Tsukamurella species pneumonia prompting diagnosis of p47 deficient CGD in a 17 year old male.
T79 599436-599514 Sentence denotes A 17 year old Hispanic male developed cough, fever, and fatigue over one week.
T80 599515-599636 Sentence denotes Cavitary necrotic lobar pneumonia of the right upper lobe, left lower lobe, and lingula was found on computed tomography.
T81 599637-599729 Sentence denotes Sputum culture yielded Tsukamurella species and methicillin-sensitive Staphylococcus aureus.
T82 599730-599860 Sentence denotes Prolonged treatment with meropenem and trimethoprim-sulfamethoxazole led to clinical improvement and resolution of consolidations.
T83 599861-600025 Sentence denotes Past history included bacterial lymphadenitis at 18 months and 12 years, recurrent viral upper respiratory infections, and ulcerative colitis diagnosed at 17 years.
T84 600026-600106 Sentence denotes In addition he had recurrent granulomatous skin disease with slow wound healing.
T85 600107-600190 Sentence denotes Infection with Tsukamurella, an opportunistic organism, prompted immune evaluation.
T86 600191-600296 Sentence denotes Dihydrorhodamine assay revealed abnormal oxidative burst pattern consistent with autosomal recessive CGD.
T87 600297-600412 Sentence denotes Analysis of NCF1 showed a 2 base pair deletion (c.75_76delGT ) confirming the diagnosis of autosomal recessive CGD.
T88 600413-600521 Sentence denotes Tsukamurella species are partially acid fast, aerobic, castalase positive, Gram-positive rods found in soil.
T89 600522-600636 Sentence denotes Infections with Tsukamurella typically occur in immunocompromised hosts, particularly when neutropenia is present.
T90 600637-600704 Sentence denotes Indwelling central venous catheter placement is also a risk factor.
T91 600705-600877 Sentence denotes Cases of Tsukamurella have been reported in patients with severe combined immunodeficiency, leukemia, myelodysplasia, and in those receiving immunosuppressive chemotherapy.
T92 600878-600951 Sentence denotes We report the first case of Tsukamurella infection in a patient with CGD.
T93 600952-600965 Sentence denotes Introduction:
T94 600966-601055 Sentence denotes Primary immunodeficiency diseases can have a variety of complications, mostly infections.
T95 601056-601099 Sentence denotes We report a case with a renal complication.
T96 601100-601105 Sentence denotes Case:
T97 601106-601184 Sentence denotes A 26-y-o male presented with fever, pleuritic pain & productive cough for 1 d.
T98 601185-601264 Sentence denotes He had adenotonsillectomy as a child and multiple pneumonias over the past 4 y.
T99 601265-601492 Sentence denotes He appeared ill, in mild respiratory distress, T 1010F, RR 20/min, HR 118/min, BP 134-151/70-89 mmHg, Wt 97.5 kg, with dry mucous membranes, decreased breath sounds on the right lower lung field, and mild lower extremity edema.
T100 601493-601560 Sentence denotes CXR showed RUL & RLL infiltrate with right-sided pleu-ral effusion.
T101 601561-601565 Sentence denotes CBC:
T102 601566-601705 Sentence denotes Hgb 10.1 g/dL, Hct 29.9%, Platelets 310 K/uL, WBC 20.12 K/uL, N 16.86 K/uL (84%), L 1.7 K/uL (8.4%), M 1.15 K/uL (5.7%), E 0.3 K/uL (1.6%).
T103 601706-601756 Sentence denotes Serum protein was 4.5 g/dL, with albumin 1.1 g/dL.
T104 601757-601844 Sentence denotes He was rehydrated with IVF & started on antibiotics (blood culture grew S. pneumoniae).
T105 601845-601930 Sentence denotes His BUN 13 mg/dL & Cr 2.1 mg/dL increased to BUN 48 mg/dL and Cr 6.5 mg/dL by day 10.
T106 601931-601986 Sentence denotes UA showed 500 mg/dL protein, Pr/Cr ratio 7.9 (nl <0.2).
T107 601987-602077 Sentence denotes Renal biopsy demonstrated post-infectious glomerulonephritis (secondary to S. pneumoniae).
T108 602078-602158 Sentence denotes Our evaluation showed IgG 102 mg/dL, IgM 31 mg/dL, IgA <8 mg/dL, IgE <0.3 IU/mL.
T109 602159-602239 Sentence denotes He had nonprotective Ab titers to diphtheria (<0.1 IU/mL) & tetanus (<0.1IU/mL).
T110 602240-602288 Sentence denotes Pneumococcal Abs were not done due to lab error.
T111 602289-602316 Sentence denotes We administered IVIG 1g/kg.
T112 602317-602456 Sentence denotes Upon obtaining his past medical records, we discovered that 3 y ago he had IgG 169 mg/dL, IgM 2 mg/dL, & IgA <5 mg/dL without intervention.
T113 602457-602503 Sentence denotes At that time had normal BP and renal function.
T114 602504-602526 Sentence denotes HIV test was negative.
T115 602527-602550 Sentence denotes Flow cytometry was WNL.
T116 602551-602655 Sentence denotes UPEP was consistent with non-selective proteinuria & SPEP was suggestive of acute inflammatory response.
T117 602656-602687 Sentence denotes His stool α-1-ATP was negative.
T118 602688-602824 Sentence denotes For glomerulonephritis, he was started on high dose steroid therapy with gradual reduction to 60 mg/day prednisone & anti-hypertensives.
T119 602825-602898 Sentence denotes His findings were compatible with CVID complicated by nephrotic syndrome.
T120 602899-603003 Sentence denotes IVIG continued (500 mg/kg) every 2-3 wk with peak 1280 mg/dL & troughs 370-662; and IgG half-life 6.3 d.
T121 603004-603112 Sentence denotes His renal function fluctuated depending on his adherence to Lisinopril; with Cr 1.3 mg/dL & Pr/Cr ratio 2.3.
T122 603113-603209 Sentence denotes He has remained infection-free with radiographic resolution of his pneumonia & pleural effusion.
T123 603210-603221 Sentence denotes Conclusion:
T124 603222-603380 Sentence denotes To our knowledge, this is the first reported case of CVID complicated with post-streptococcal glomerulonephritis possibly due to marked delay in IVIG therapy.
T125 603381-603383 Sentence denotes A.
T126 603384-603396 Sentence denotes Kleva * , A.
T127 603397-603420 Sentence denotes Jongco, Great Neck, NY.
T128 603421-603434 Sentence denotes Introduction:
T129 603435-603525 Sentence denotes Sarcoidosis is a granulomatous disorder of unclear etiology that affects multiple systems.
T130 603526-603645 Sentence denotes Monocytes, macrophages, and activated T cells increase production of inflammatory mediators in noncaseating granulomas.
T131 603646-603702 Sentence denotes Peripheral lymphopenia correlates with disease severity.
T132 603703-603711 Sentence denotes Methods:
T133 603712-603855 Sentence denotes We report a relatively healthy 22-year old male with a history of psoriasis who presented with fever, cough, malaise after traveling to Cancun.
T134 603856-603928 Sentence denotes He was diagnosed with bibasilar pneumonia and treated with levofloxacin.
T135 603929-604029 Sentence denotes He was readmitted for fever, abdominal pain, diarrhea, hypoxia and neutropenia requiring filgrastim.
T136 604030-604097 Sentence denotes Hospitalization was complicated by pneumothorax after bronchoscopy.
T137 604098-604197 Sentence denotes Bronchoalveolar lavage showed Balantidium coli that was treated with doxycycline and metronidazole.
T138 604198-604321 Sentence denotes After a few days, he was readmitted with fever, hypotension, hypoxia, diarrhea, and a new purpuric rash on the extremities.
T139 604322-604417 Sentence denotes High dose steroids, imipenem, vancomycin and levofloxacin improved respiratory status and rash.
T140 604418-604490 Sentence denotes He returned soon after discharge with pneumothorax needing a chest tube.
T141 604491-604593 Sentence denotes As outpatient, prednisone was titrated to 40 mg daily without exacerbating rash or respiratory status.
T142 604594-604626 Sentence denotes Bactrim prophylaxis was started.
T143 604627-604635 Sentence denotes Results:
T144 604636-604716 Sentence denotes At first readmission, T-cell lymphopenia was found (CD4+ = 83/uL, CD8+ = 35/uL).
T145 604717-604802 Sentence denotes Bone marrow biopsy and extensive autoimmune and infectious workup were nondiagnostic.
T146 604803-604848 Sentence denotes On readmissions, he had low IgG of 547 mg/dL.
T147 604849-604951 Sentence denotes Open lung and skin biopsies showed a predominantly T-cell lymphohistiocytic infiltrate with CD4+>CD8+.
T148 604952-605005 Sentence denotes Noncaseating granulomas were absent in both biopsies.
T149 605006-605110 Sentence denotes As outpatient, lymphopenia persisted (CD4+ = 112/uL, CD8+ = 54/uL, CD19+ =6/uL, and CD 16+/56+ = 20/uL).
T150 605111-605192 Sentence denotes Lymphocyte proliferation to PHA, IgG, IgA, IgM, CH50, and G6PD level were normal.
T151 605193-605305 Sentence denotes He had protective titers to MMR, tetanus, diphtheria, pertussis and polio, but not to pneumococcus or varicella.
T152 605306-605404 Sentence denotes A skin biopsy performed 6 months later showed noncaseating granulomas consistent with sarcoidosis.
T153 605405-605551 Sentence denotes Lymphopenia persists (CD4+ = 82/uL, CD8+ = 32/uL and CD16+/56+ = 33/uL) while on weekly low-dose methotrexate, daily dapsone and prednisone 10 mg.
T154 605552-605563 Sentence denotes Conclusion:
T155 605564-605709 Sentence denotes Whether an underlying immune deficiency was present is unclear, but medication-induced immune suppression does not adequately explain his course.
T156 605710-605778 Sentence denotes This case underscores the need for reevaluation of affected systems.
T157 605779-605857 Sentence denotes Sarcoidosis should be considered in the differential diagnosis of lymphopenia.
T158 605858-605862 Sentence denotes M.R.
T159 605863-605875 Sentence denotes Shams * , L.
T160 605876-605899 Sentence denotes Kobrynski, Atlanta, GA.
T161 605900-605910 Sentence denotes Rationale:
T162 605911-606019 Sentence denotes Whole exome sequencing (WES) is being used as a screening and diagnostic test for a number of rare diseases.
T163 606020-606152 Sentence denotes The significance of mutations identified through WES requires interpretation by experts with knowledge of disease causing mutations.
T164 606153-606161 Sentence denotes Methods:
T165 606162-606256 Sentence denotes A 22 month old male presented to the Immunology clinic after WES revealed a mutation in GATA2.
T166 606257-606381 Sentence denotes Genetic testing was performed because of a history of mild dysmorphic features, laryngomalacia, and obstructive sleep apnea.
T167 606382-606502 Sentence denotes The only infectious history was recurrent acute otitis media requiring tympanostomy tubes and severe gingiva-stomatitis.
T168 606503-606693 Sentence denotes Results: WES revealed a 3 distinct mutations; COMP R381H heterozygous mutation, TMCO C35Y heterozygous mutation and a de novo GATA2 R396W heterozygous mutation associated with known disease.
T169 606694-606917 Sentence denotes GATA 2 defects are inherited in an autosomal dominant and cause increased susceptibility to severe viral infections, the development of mononuclear cytopenias, myelodysplastic syndrome/acute myeloid leukemia and lymphedema.
T170 606918-607184 Sentence denotes GATA2 R396W has been previously reported in 2 patients, who developed symptoms in late childhood with infections with Epstein-Barr virus, herpes-simplex virus, human papilloma virus, mycobacterium avium intracellulare and the development of myelodysplastic syndrome.
T171 607185-607304 Sentence denotes Our patient had a history of oral herpetic lesions due to herpes simplex but had no other significant viral infections.
T172 607305-607348 Sentence denotes T, B, NK lymphocyte enumeration was normal.
T173 607349-607387 Sentence denotes Neither parent had the R396W mutation.
T174 607388-607482 Sentence denotes The other two identified mutations were carried by his father but are of unknown significance.
T175 607483-607560 Sentence denotes Conclusions: WES is a useful testing modality to confirm suspected diagnoses.
T176 607561-607730 Sentence denotes However, providers should use caution when interpreting genetic reports, especially if used as a screening modality, as many genetic variations are benign polymorphisms.
T177 607731-607863 Sentence denotes It is critical to perform WES on both parents and, if available, affected family members to confirm the pathogenicity of a mutation.
T178 607864-607868 Sentence denotes C.M.
T179 607869-607881 Sentence denotes Duff *1 , M.
T180 607882-607893 Sentence denotes Sher 2 , J.
T181 607894-607908 Sentence denotes Leiding 2 , 1.
T182 607909-607924 Sentence denotes Parrish, FL; 2.
T183 607925-607944 Sentence denotes St. Petersburg, FL.
T184 607945-607955 Sentence denotes Rationale:
T185 607956-608138 Sentence denotes Immunoglobulin replacement therapy is prescribed for patients with immunodeficiency characterized by hypogammaglobulinemia and/or the inability to make antibodies to recall antigens.
T186 608139-608196 Sentence denotes Administration can occur intravenously or subcutaneously.
T187 608197-608339 Sentence denotes Currently there is a black box warning on all immunoglobulin replacement products indicating a possible increased risk of thrombogenic events.
T188 608340-608461 Sentence denotes Data regarding the use of subcutaneous immunoglobulin (SCIG) therapy in patients with known thrombotic events is limited.
T189 608462-608470 Sentence denotes Methods:
T190 608471-608742 Sentence denotes A 36 year old Caucasian male with cystic fibrosis was diagnosed with selective antibody deficiency based on absent pneumococcal responses (0/14 protective serotypes) with intact tetanus and diphtheria responses and normal immunoglobulin profile (IgG 1020mg/dl, IgA, IgM).
T191 608743-608843 Sentence denotes He is the survivor of a double lung transplant at 24 years and a single lung transplant at 33 years.
T192 608844-608949 Sentence denotes A left leg deep vein thrombosis and sagittal vein thrombosis developed two years after second transplant.
T193 608950-608996 Sentence denotes Causes of primary thrombophilia were excluded.
T194 608997-609107 Sentence denotes In parallel recurrent bacterial pneumonias, primarily caused by S. pneumonia led to multiple hospitalizations.
T195 609108-609211 Sentence denotes Based on poor antibody responses and clinical status, immunoglobulin replacement therapy was initiated.
T196 609212-609220 Sentence denotes Results:
T197 609221-609333 Sentence denotes To decrease the potential risk of a thrombotic event, 20% SCIG was administered more frequently at twice weekly.
T198 609334-609442 Sentence denotes Concurrent treatment of thrombi continued with warfarin maintaining INR at a therapeutic level of 2-3 units.
T199 609443-609494 Sentence denotes No bleeding or bruising occurred at infusion sites.
T200 609495-609607 Sentence denotes A magnetic resonance angiogram performed 6 months after starting SCIG showed no increase in size or new thrombi.
T201 609608-609797 Sentence denotes Protective pneumococcal titers were measured and were found to be protective to 10/14 serotypes and the patient has had only one hospitalization for bacterial pneumonia since starting SCIG.
T202 609798-609915 Sentence denotes Conclusion: SCIG can be safely and effectively administered to patients with thrombi receiving anticoagulant therapy.
T203 609916-610067 Sentence denotes Concurrent use of anticoagulant medications did not increase the occurrence of local site reactions with the use of 20% SCIG treatment in this patient.
T204 610068-610203 Sentence denotes Introduction: CGD is a rare immunodeficiency of phagocytes characterized by increased susceptibility to bacterial and fungal pathogens.
T205 610204-610332 Sentence denotes We describe the first report of two siblings with X-linked CGD due to the same mutation with significant variation in phenotype.
T206 610333-610341 Sentence denotes Methods:
T207 610342-610420 Sentence denotes A 6 week-old full term boy presented with fever, lymphadenopathy, and dyspnea.
T208 610421-610457 Sentence denotes Imaging showed multifocal pneumonia.
T209 610458-610661 Sentence denotes His hospital course was complicated by ARDS, septic shock, Candida lusitaniea fungemia, a cutaneous Candida and Rhizomucor abscess, multi-organ dysfunction, and HLH (Hemophagocytic Lymphohistoiocytosis).
T210 610662-610801 Sentence denotes The "healthy" 18-month old brother of patient 1 was considered as a stem cell donor, but was found to have CGD caused by the same mutation.
T211 610802-610974 Sentence denotes He was thriving with no major illnesses, but serological evaluation revealed systemic inflammation, normalizing on triple prophylaxis of Bactrim, Itraconazole and INFgamma.
T212 610975-610983 Sentence denotes Results:
T213 610984-611091 Sentence denotes In patient 1, Immunoglobulin B & T cells levels were normal, while NK cells were slightly low (92 c/mm 3 ).
T214 611092-611239 Sentence denotes DHR showed absent neutrophil function: genetic testing revealed a hemizygous mutation in the CYBB gene of gp91 phox , consistent with X-linked CGD.
T215 611240-611388 Sentence denotes After stabilizing medically, he underwent hematopoietic stem cell transplant (HSCT) from an unrelated donor complicated only by mild cutaneous GVHD.
T216 611389-611455 Sentence denotes The second sibling had a negative DHR assay and the same mutation.
T217 611456-611536 Sentence denotes ESR was >120, Plt 719, Hct 26.3, Alk Phos 310 and immunoglobulins were elevated.
T218 611537-611625 Sentence denotes Screening CT showed 2-3 <1cm nonenhancing hepatic hypodensities, not amenable to biopsy.
T219 611626-611701 Sentence denotes Lab abnormalities normalized within weeks of starting prophylactic therapy.
T220 611702-611772 Sentence denotes At age 3, he remains free of recurrent bacterial and fungal infection.
T221 611773-611890 Sentence denotes Discussion: CGD is caused by mutations in phagocyte NADPH oxidase, with considerable variability in disease severity.
T222 611891-611966 Sentence denotes For many years, treatment consisted primarily of antimicrobial prophylaxis.
T223 611967-612079 Sentence denotes Recently, HSCT has emerged as an attractive alternative, though there is debate about candidates for transplant.
T224 612080-612167 Sentence denotes Generally, patients with very low super oxide production have worse long-term survival.
T225 612168-612292 Sentence denotes Previous cases of siblings with AR-CGD have shown variable phenotype, presumably due to penetrance of the functional allele.
T226 612293-612515 Sentence denotes Our cases are unique in that the patients have the same level of phagocyte function but very different phenotypes and highlight the potential difficulty in using level of super oxide production to assess patients for HSCT.
T227 612516-612518 Sentence denotes H.
T228 612519-612532 Sentence denotes Bhatti * , P.
T229 612533-612548 Sentence denotes Poowuttikul, E.
T230 612549-612569 Sentence denotes Secord, Detroit, MI.
T231 612570-612581 Sentence denotes Background:
T232 612582-612719 Sentence denotes Radiosensitive forms of SCID are due to defects in components of the NHEJ DNA repair mechanism during the process of V(D)J recombination.
T233 612720-612803 Sentence denotes Mutations in several genes involved in the NHEJ mechanism result in a T-B-NK+ SCID.
T234 612804-612978 Sentence denotes About 1/3 of patients with SCID have the T-B-NK+ phenotype, which is associated with a poorer prognosis after receiving hematopoietic cell transplantation in various studies.
T235 612979-613141 Sentence denotes The components of DNA repair that are known to lead to radiosensitive SCID include Artemis, DNA Ligase IV, DNA-PKcs, Ku70, Ku80, XRCC4 and Cernunnos-XLF or NHEJ1.
T236 613142-613271 Sentence denotes Patients with NHEJ1 deficient SCID typically have microcephaly with growth retardation; however there are a few cases who do not.
T237 613272-613282 Sentence denotes Objective:
T238 613283-613417 Sentence denotes We report the case of 21-month old female with a heterozygous NHEJ1 defect and T cell deficiency identified on newborn TREC screening.
T239 613418-613430 Sentence denotes Case Report:
T240 613431-613565 Sentence denotes A full term newborn was found to have very low TREC on newborn screening leading to suspected SCID versus a combined immunodeficiency.
T241 613566-613636 Sentence denotes Exam of the baby revealed normal growth parameters and no dysmorphism.
T242 613637-613762 Sentence denotes Subsequent testing revealed T and B cell lymphopenia (CD4 = 750/mm 3 , CD19 = 75/mm 3 ) with normal IgG and IgM with low IgA.
T243 613763-613828 Sentence denotes Genetic testing revealed a heterozygous defect in the NHEJ1 gene.
T244 613829-613896 Sentence denotes The lymphoblastoid cells revealed abnormal radiosensitivity of 15%.
T245 613897-613964 Sentence denotes The T cell lymphopenia progressed until our last labs at 16 months.
T246 613965-614003 Sentence denotes Testing for 22q11 deletion was normal.
T247 614004-614120 Sentence denotes PHA was initially low but was adequate at 16 months and the child experienced no serious infection during that time.
T248 614121-614195 Sentence denotes The family refused further care and the patient remains lost to follow up.
T249 614196-614207 Sentence denotes Discussion:
T250 614208-614274 Sentence denotes Deficiency of NHEJ1 is one of the variants of radiosensitive SCID.
T251 614275-614345 Sentence denotes Five SCID patients reported to date have homozygous mutation of NHEJ1.
T252 614346-614456 Sentence denotes Typically patients with this variant exhibit severe recurrent infections, microcephaly and growth retardation.
T253 614457-614555 Sentence denotes Mild to severe T and B cell lymphopenia have been reported with progressive lymphopenia over time.
T254 614556-614755 Sentence denotes We report a patient with heterozygous NHEJ1 deficiency in which the defect involves the dimerization domain, leading to a malformation of the functional enzyme similarly found in homozygous mutation.
T255 614756-614929 Sentence denotes Our patient does not have microcephaly or growth retardation, but does show clear evidence of radiosensitivity and T cell lymphopenia, which we suspect will worsen with age.
T256 614930-614932 Sentence denotes L.
T257 614933-614950 Sentence denotes Buyantseva * , T.
T258 614951-614970 Sentence denotes Craig, Hershey, PA.
T259 614971-614982 Sentence denotes Background:
T260 614983-615083 Sentence denotes Good syndrome is a rare cause of combined immune deficiency that occurs in association with thymoma.
T261 615084-615173 Sentence denotes TACI and BAFF-R receptor mutations have been described in association with this syndrome.
T262 615174-615316 Sentence denotes Signal transducer and activator of transcription 3 (STAT3) is a transcription factor essential for differentiation of the TH17 helper T cells.
T263 615317-615434 Sentence denotes Mutation of STAT3 gene has been described in association with HyperIgM syndrome and a variety of autoimmune diseases.
T264 615435-615502 Sentence denotes We present a case of STAT 3 mutation associated with Good syndrome.
T265 615503-615521 Sentence denotes Case Presentation:
T266 615522-615621 Sentence denotes A 73-year-old female with Common Variable Immunodeficiency (CVID) and thymoma removed 20 years ago.
T267 615622-615717 Sentence denotes She presented with chronic watery diarrhea, 20 pound weight loss and frequent sinus infections.
T268 615718-615778 Sentence denotes Her physical exam was remarkable for extensive onycomycosis.
T269 615779-615989 Sentence denotes Immune workup showed lymphopenia, deficiency of B and T absolute cell counts (<1% and 58% respectively), normal NK cells count, and low IgA, IgG and IgM levels (<33 mg/dL, 6.7 mg/dL and 4.2 mg/dL respectively).
T270 615990-616065 Sentence denotes Gastroenterology workup revealed celiac disease as a cause of her diarrhea.
T271 616066-616123 Sentence denotes Gluten-free diet was initiated and her diarrhea resolved.
T272 616124-616223 Sentence denotes Patient was started on Atovaquone for prophylaxis of opportunistic infections and IVIG replacement.
T273 616224-616268 Sentence denotes Genetic analysis identified STAT 3 mutation.
T274 616269-616281 Sentence denotes Conclusions:
T275 616282-616379 Sentence denotes This is a first published report of a patient with Good syndrome associated with STAT 3 mutation.
T276 616380-616461 Sentence denotes This case demostrates the variability of phenotypic responce to STAT 3 mutations.
T277 616462-616464 Sentence denotes K.
T278 616465-616478 Sentence denotes Achar *1 , D.
T279 616479-616500 Sentence denotes Ferastraoaru 2 , D.L.
T280 616501-616520 Sentence denotes Rosenstreich 2 , 1.
T281 616521-616537 Sentence denotes New York, NY; 2.
T282 616538-616548 Sentence denotes Bronx, NY.
T283 616549-616562 Sentence denotes Introduction:
T284 616563-616794 Sentence denotes Mannose binding lectin (MBL) recognizes carbohydrate patterns found on the surface of pathogenic microorganisms leading to activation of the lectin pathway of the complement system and contributing to ultimate pathogen elimination.
T285 616795-616957 Sentence denotes MBL plays an important role in the first-line defense against Candida albicans and its deficiency is associated with herpes virus simplex (HSV) infection in mice.
T286 616958-616965 Sentence denotes Method:
T287 616966-617114 Sentence denotes Review of the literature and case report of a patient with MBL deficiency, esophageal candidiasis and recurrent oral herpes virus simplex infection.
T288 617115-617123 Sentence denotes Results:
T289 617124-617346 Sentence denotes 50 yo male with well controlled seasonal allergies was referred for evaluation of a possible immune deficiency after he was found to have one episode of esophageal candidiasis that resolved with oral fluconazole treatment.
T290 617347-617556 Sentence denotes The patient did not have any other factors that could predispose to candidiasis, predisposing factors such as diabetes mellitus or treatment with oral or inhaled corticosteroids, and was HIV antibody negative.
T291 617557-617751 Sentence denotes Further history revealed that he had been experiencing recurrent oral ulcers for the past 10 years the worst of which were over the lip, with more frequent and longer episodes for the past year.
T292 617752-617961 Sentence denotes A repeat immunological evaluation revealed normal lymphocyte subsets, serum immunoglobulin levels, antibody responses (tetanus toxoid and pneumococcal titers), complement levels and a negative repeat HIV test.
T293 617962-618097 Sentence denotes The serum MBL level on the first visit was low (12ng/ml ; normal: >100 ng/ml) and when repeated 3 months later was less than 0.5 ng/ml.
T294 618098-618280 Sentence denotes The patient did not have any recurrence of esophageal candidiasis and he was prescribed acyclovir for recurrent oral HSV which reduced the frequency and severity of the oral lesions.
T295 618281-618292 Sentence denotes Conclusion:
T296 618293-618430 Sentence denotes This is the first documented case of associated esophageal candidiasis and recurrent oral HSV infection in a patient with MBL deficiency.
T297 618431-618594 Sentence denotes The exact mechanism through which MBL deficiency predisposes to mucosal infections in patients with an otherwise normal immune system is not completely understood.
T298 618595-618724 Sentence denotes We would like to highlight the importance of maintaining a high level of suspicion for MBL deficiency in these challenging cases.
T299 618725-618854 Sentence denotes Making a correct diagnosis will help to prevent possible future complications by keeping these patients under closer observation.
T300 618855-618930 Sentence denotes At the present there is no specific treatment available for MBL deficiency.
T301 618931-618935 Sentence denotes L.I.
T302 618936-618951 Sentence denotes Calderon * , A.
T303 618952-618965 Sentence denotes Partida, B.E.
T304 618966-618977 Sentence denotes Del Rio, O.
T305 618978-618989 Sentence denotes Saucedo, C.
T306 618990-619022 Sentence denotes Cicero, Mexico City, DF, Mexico.
T307 619023-619036 Sentence denotes Introduction:
T308 619037-619123 Sentence denotes Haemophagocytic lymphohistiocytosis is a life-threatening disease of immuneregulation.
T309 619124-619180 Sentence denotes A large proportion of deaths occur early into treatment.
T310 619181-619265 Sentence denotes We investigated association with early death for laboratory and clinical parameters.
T311 619266-619274 Sentence denotes Methods:
T312 619275-619464 Sentence denotes A total of 45 children from Federico Gómez Children's Hospital in Mexico city wich fulfill the diagnostic criteria and/or with familiar disease, receiving diferent treatments were included.
T313 619465-619619 Sentence denotes We discribed demographic, clinical and laboratory data with frecuencies and proportions and also stadistics with central tendancy and dispersión tendancy.
T314 619620-619657 Sentence denotes We made a risk analysis in two steps.
T315 619658-619845 Sentence denotes The first was about an univariated análisis with proportional diferences in the survivor group and in non-survivers, using X 2 or exact Fisher test acording to the number of observations.
T316 619846-620125 Sentence denotes From the variables that show statisticaly significant diferences, they were introduced in a model of multiple OR, in wich we also include time in months until clinical presentation, genus and etary group, getting a statisticaly significant model (LR X 2 (6g-l) = 13.32; p=0.038).
T317 620126-620134 Sentence denotes Results:
T318 620135-620248 Sentence denotes We observed a significant relation of risk for mortality for neutropenia (OR 8.96 IC95% 1.08 a 74.49, p = 0.042).
T319 620249-620409 Sentence denotes The presence of clinical infection at the time of diagnosis show a relation with mortality without significant relevance (OR 7.17 IC95% 0.97 a 53.16; p= 0.054).
T320 620410-620503 Sentence denotes The presence of hepatomegaly and absence of epistaxis are perfect predictors of surveillance.
T321 620504-620687 Sentence denotes The surveillance curves point out the group between 1 and 4.9 years to be the more vulnerable with a higher mortality get in the first month after diagnosis of 50% and 70% thereafter.
T322 620688-620742 Sentence denotes The group of less than 1 year show a mortality of 62%.
T323 620743-620801 Sentence denotes The group of 5 to 10.9 years show a mortality rate of 66%.
T324 620802-620898 Sentence denotes Finally the group of 11years and older, get a mortality rate of 55% at 3 months after diagnosis.
T325 620899-620910 Sentence denotes Conclusión:
T326 620911-621063 Sentence denotes In 45 patients with the diagnosis of haemophagocytic lymphohistiocytosis in the Hospital Infantil de México Federico Gomez, we found a mortality of 53%.
T327 621064-621135 Sentence denotes The risk factor asociated to mortality was the presence of neutropenia.
T328 621136-621234 Sentence denotes We also found a relationship with the presence of infection, but it wasn't statistically relevant.
T329 621235-621376 Sentence denotes Moreover, in this study, we found posible protector factors related to mortality like the abscence of epistaxis and presence of hepatomegaly.
T330 621377-621598 Sentence denotes Background: X-linked Agammaglobulinemia (XLA) is a primary immunodeficiency secondary to a mutation in the gene coding for the Bruton's tyrosine kinase (Btk) protein, which is essential for the differentiation of B cells.
T331 621599-621726 Sentence denotes Immunological evaluation typically demonstrates a low/absent CD19+ B cells and agammaglobulinemia/severe hypogammaglobulinemia.
T332 621727-621976 Sentence denotes The clinical presentation of XLA is usually between 6-18 months of age and is characterized by recurrent upper and lower respiratory tract infections gastrointestinal tract infections, conjunctivitis, skin infections/pyoderma, meningitis and sepsis.
T333 621977-622050 Sentence denotes Ten to 20% of patients have neutropenia at the time of initial diagnosis.
T334 622051-622068 Sentence denotes Case Description:
T335 622069-622194 Sentence denotes An 18 month old male with a history of atopic dermatitis was admitted to hospital for a rash concerning for bullous impetigo.
T336 622195-622362 Sentence denotes He had an absolute neutrophil count of 0/mm3 on admission which improved to 3500/mm3 after starting antibiotics for methicillin sensitive staphylococcal aureus (MSSA).
T337 622363-622480 Sentence denotes Quantitative immunoglobulins were obtained revealing IgG<80 mg/dL (431-1109), IgA<6 mg/dL (20-100), and IgM<5 mg/dL .
T338 622481-622566 Sentence denotes Vaccination titers to tetanus, diphtheria, haemophilus, and pneumococcus were absent.
T339 622567-622671 Sentence denotes Flow cytometry on peripheral blood revealed no CD19+ B Cells and absence of BTK expression in monocytes.
T340 622672-622684 Sentence denotes Conclusions:
T341 622685-622826 Sentence denotes Although there are several proposed mechanisms for neutropenia in XLA, two non-mutually exclusive mechanisms have recently gained prominence.
T342 622827-622908 Sentence denotes One proposed mechanism is that Btk is necessary for PMN function and development.
T343 622909-623137 Sentence denotes In mouse models, neutrophils deficient in Btk have decreased expression of granular proteins (elastase, myeloperoxidase, gelatinase, and neutrophilic granular protein) and arrest of maturation at the myelocyte/promylocyte stage.
T344 623138-623291 Sentence denotes Another proposed mechanism is that Btk negatively regulates cytokine and Toll Like Receptors (TLR) induced Reduced Oxygen Intermediates (ROI) production.
T345 623292-623474 Sentence denotes In studies using human PMNs, a deficiency in Btk results in the overproduction of ROI during infection leading to increased neutrophil apoptosis compared to neutrophils from normals.
T346 623475-623653 Sentence denotes However, neither of these mechanisms explains why neutropenia only occurs with infection prior to diagnosis and not subsequently following administration of replacement antibody.
T347 623654-623786 Sentence denotes Regardless, XLA should be on the differential diagnosis of males between the ages of 6-18 months of age presenting with neutropenia.
T348 623787-623802 Sentence denotes Hershey, PA; 3.
T349 623803-623821 Sentence denotes Cincinnati, OH; 4.
T350 623822-623843 Sentence denotes Budapest, Hungary; 5.
T351 623844-623864 Sentence denotes Grenoble, France; 6.
T352 623865-623881 Sentence denotes Milan, Italy; 7.
T353 623882-623899 Sentence denotes Padova, Italy; 8.
T354 623900-623924 Sentence denotes Tel Hashomer, Israel; 9.
T355 623925-623944 Sentence denotes Cracow, Poland; 10.
T356 623945-623967 Sentence denotes Jönköping, Sweden; 11.
T357 623968-623995 Sentence denotes London, United Kingdom; 12.
T358 623996-624017 Sentence denotes Barcelona, Spain; 13.
T359 624018-624036 Sentence denotes Madrid, Spain; 14.
T360 624037-624058 Sentence denotes Lisbon, Portugal; 15.
T361 624059-624078 Sentence denotes Mainz, Germany; 16.
T362 624079-624108 Sentence denotes Berlin, Germany; Germany; 18.
T363 624109-624132 Sentence denotes Frankfurt, Germany; 19.
T364 624133-624149 Sentence denotes Odense, Denmark.
T365 624150-624163 Sentence denotes Introduction:
T366 624164-624386 Sentence denotes Orally administered attenuated androgens (AAs) have been used since the 1970s for prophylactic treatment of hereditary angioedema (HAE) attacks, although they may be associated with dose-dependent undesirable side effects.
T367 624387-624505 Sentence denotes Intravenous plasma derived C1-INH (C1-INH) has become available for prophylaxis in the last 5 years in some countries.
T368 624506-624620 Sentence denotes However, long-term experience and safety data on this therapy is limited and its use varies by region and country.
T369 624621-624790 Sentence denotes Our aim was to assess AA use across several international HAE centers and identify medical reasoning which may support switching patients from AAs to C1-INH prophylaxis.
T370 624791-624799 Sentence denotes Methods:
T371 624800-624972 Sentence denotes An 8-question survey exploring physician opinions on the use of prophylactic medications for HAE was sent to 17 HAE experts' in Europe (EU) and 3 in the United States (US).
T372 624973-625175 Sentence denotes Experts reported on the percentage of patients receiving prophylaxis with AAs, side effects observed in patients receiving AAs and barriers preventing the switching of patients to alternative therapies.
T373 625176-625184 Sentence denotes Results:
T374 625185-625349 Sentence denotes The use of AAs varied among the HAE experts surveyed being most common in the EU compared to the US (Fig 1) , and was more common in men (27.6%) than women (13.4%).
T375 625350-625429 Sentence denotes Other therapies used included C1-INH, antifibrinolytics and progestin (Fig 1) .
T376 625430-625535 Sentence denotes Side effects reported in males receiving AAs included weight gain, lipid abnormal-ities and hypertension.
T377 625536-625634 Sentence denotes Most reported side effects in females were menstrual irregularities, virilization and weight gain.
T378 625635-625780 Sentence denotes A small number of patients discontinued AAs due to side effects (12%) while some patients (12%) switched to alternative treatments, e.g., C1-INH.
T379 625781-625947 Sentence denotes Physicians reported that barriers preventing patients switching to prophylactic C1-INH included AA efficacy (n=10), ease of oral administration (n=10) and cost (n=7).
T380 625948-625960 Sentence denotes Conclusions:
T381 625961-626055 Sentence denotes The HAE expert survey demonstrates that AAs are widely used for prophylaxis in many countries.
T382 626056-626212 Sentence denotes Experts noted that while AAs are effective they may be associated with side effects; however, at low doses (i.e., 50-100 mg/day) they may be well tolerated.
T383 626213-626454 Sentence denotes In the absence of objective, comparative, randomized, controlled studies of the benefit/risks of new prophylactic therapies compared to AAs no consensus could be reached regarding switching patients from AAs to other prophylactic modalities.
T384 626455-626468 Sentence denotes Introduction:
T385 626469-626645 Sentence denotes Mutations of the GATA2 gene have recently been implicated as causes of MonoMAC syndrome, a primary immunodeficiency associated with monocytopenia and B and NK cell lymphopenia.
T386 626646-626800 Sentence denotes The clinical ramifications are broad and include mycobacterial, viral and fungal infections, as well as pulmonary alveolar proteinosis and myelodysplasia.
T387 626801-626896 Sentence denotes Long-term complications of the genetic defect include recurrent infections and likely leukemia.
T388 626897-626915 Sentence denotes Case Presentation:
T389 626916-627058 Sentence denotes A 33 year-old Hispanic woman presented to the emergency department with intermittent fever and a severe frontal headache of one week duration.
T390 627059-627176 Sentence denotes Imaging revealed enhancing leptomeningeal nodules, and subsequent lumbar puncture identified cryptococcal meningitis.
T391 627177-627258 Sentence denotes Her labs were notable for a white count of 6.3x10 3 and a monocyte count of zero.
T392 627259-627437 Sentence denotes On further review, the patient's history was notable for interstitial fibrosis with pulmonary alveolar proteinosis, characterized by intermittent hemoptysis for the past 6 years.
T393 627438-627614 Sentence denotes She also notes a varied infectious history, including Mycobacterium avium and Aspergillus fumigatus pneumonias as well as HPV infection with cervical intraepithelial neoplasia.
T394 627615-627706 Sentence denotes A unifying diagnosis had not been offered in the past 6 years since she became symptomatic.
T395 627707-627755 Sentence denotes There was no family history of immunodeficiency.
T396 627756-628022 Sentence denotes Taking into consideration her disseminated fungal infection and monocytopenia, as well as the history of mycobacterial infection, PAP and HPV, GATA2 deficiency was suspected and genetic analysis revealed a frameshift mutation in the gene leading to MonoMAC syndrome.
T397 628023-628195 Sentence denotes Conclusions: GATA2 deficiency is a relatively newly identified genetic mutation that can lead to a characteristic presentation of pathologic changes and infectious disease.
T398 628196-628297 Sentence denotes Patients in whom this defect is suspected should undergo genetic sequencing to confirm the diagnosis.
T399 628298-628415 Sentence denotes Ultimate treatment involves bone marrow transplant to prevent the likely long-term outcome of hematologic malignancy.
T400 628416-628440 Sentence denotes North Palm Beach, FL; 3.
T401 628441-628459 Sentence denotes Centennial, CO; 4.
T402 628460-628475 Sentence denotes Atlanta, GA; 5.
T403 628476-628493 Sentence denotes Galveston, TX; 6.
T404 628494-628508 Sentence denotes Irvine, CA; 7.
T405 628509-628528 Sentence denotes Vienna, Austria; 8.
T406 628529-628550 Sentence denotes Westlake Village, CA.
T407 628551-628706 Sentence denotes Introduction: IGHy allows for SC administration of IgG at a similar frequency (every 3-4 weeks) and bioavailability to that of intravenous (IV) IgG (IGIV).
T408 628707-628881 Sentence denotes Compared with conventional SC-administered IgG (IGSC), IGHy requires fewer infusions per month (median 1.09 in the pivotal phase 3 study) using one or occasionally two sites.
T409 628882-629006 Sentence denotes We report efficacy, safety and tolerability of IGHy in patients aged ≥16 years who were treated with IGHy for up to 3 years.
T410 629007-629015 Sentence denotes Methods:
T411 629016-629413 Sentence denotes Sixty-one patients aged ≥16 years received IGIV for 3 months followed by IGHy at 3-or 4-week intervals for approximately 18 months; 55 were treated for up to an additional 21 months at the same dose and interval. rHuPH20 was infused at 75U/g IgG followed by IgG at 108% of the IV dose. rHuPH20 was discontinued after up to 3 years of exposure; patients were followed for an additional 6-12 months.
T412 629414-629544 Sentence denotes Assessments included rates of adverse events (AEs), serious AEs (SAEs), and infections; tolerability; and rHuPH20 antibody levels.
T413 629545-629610 Sentence denotes These studies were approved by the appropriate ethics committees.
T414 629611-629619 Sentence denotes Results:
T415 629620-629706 Sentence denotes The maximum IGHy exposure for patients aged ≥16 years was 3 years (144 patient-years).
T416 629707-629842 Sentence denotes Over the full study course, rates of temporallyassociated AEs/patient-year were 2.99 (local) and 2.78 (systemic; excluding infections).
T417 629843-629872 Sentence denotes No SAEs were related to IGHy.
T418 629873-629916 Sentence denotes The annual infection rate was 3.05 (95% CI:
T419 629917-629960 Sentence denotes 2.63-3.52)/patient-year, including ramp-up.
T420 629961-630093 Sentence denotes Of 2307 IGHy infusions administered (including ramp-up), 98% required no administration changes due to tolerability concerns or AEs.
T421 630094-630294 Sentence denotes Thirteen patients ≥16 years developed nonneutralizing anti-rHuPH20 antibody titers ≥1:160 on 1 or more occasion with no associated AEs; titers declined despite continuing rHuPH20 in 12 of 13 patients.
T422 630295-630354 Sentence denotes No patients developed neutralizing anti-rHuPH20 antibodies.
T423 630355-630366 Sentence denotes Conclusion:
T424 630367-630611 Sentence denotes In patients with PI who were treated with IGHy for up to 3 years, infection rates were low and AE rates were comparable to previously reported rates for patients treated with IGSC, but with infusion volumes and rates equivalent to that of IGIV.
T425 630612-630614 Sentence denotes V.
T426 630615-630637 Sentence denotes Cavero Chavez * , S.A.
T427 630638-630660 Sentence denotes Schwartz, Buffalo, NY.
T428 630661-630674 Sentence denotes Introduction:
T429 630675-630772 Sentence denotes DiGeorge syndrome (DGS) is characterized by defective development of the pharyngeal pouch system.
T430 630773-630841 Sentence denotes The triad is: cardiac anomalies, hypoplasic thymus and hypocalcemia.
T431 630842-631084 Sentence denotes Patients are divided in two subtypes: complete DGS, with total absence of thymic tissue that is a type of SCID and fatal within the first year of life unless treated, and partial DGS which usually have not severe variable immunologic defects.
T432 631085-631128 Sentence denotes The typical deletion associated is 22q11.2.
T433 631129-631137 Sentence denotes Methods:
T434 631138-631363 Sentence denotes We describe a 26 year old male patient with partial DGS and Tetralogy of Fallot surgically corrected, who presented with new recurrent sino-pulmonary infections for the past 8 months requiring multiple courses of antibiotics.
T435 631364-631409 Sentence denotes He underwent immunological studies including:
T436 631410-631594 Sentence denotes Lymphocyte subset counts, lymphocyte mitogens an antigen stimulation test, quantification of specific antibody titers for S. pneumoniae pre and post vaccination, immunoglobulin levels.
T437 631595-631603 Sentence denotes Results:
T438 631604-631650 Sentence denotes Immunological evaluation revealed Lymphopenia:
T439 631651-631677 Sentence denotes Absolute lymphocyte count:
T440 631678-631716 Sentence denotes 487/mcl(NR:1400-3300), CD3:409/mcl(NR:
T441 631717-631770 Sentence denotes 1000-2200), CD4:143/mcl(NR:530-1300), CD8:231/mcl(NR:
T442 631771-631829 Sentence denotes 330-920), CD19:25/mcl(NR:110-570), CD56:53/mcl(NR:70-480).
T443 631830-631947 Sentence denotes Mitogen stimulation of mononuclear cells revealed a normal response to Pokeweed, decreased response to PHA and CON-A.
T444 631948-632072 Sentence denotes Antigen studies included positive responses to Tetanus and Streptolysine O antigens, decreased responses to MMR and Candida.
T445 632073-632166 Sentence denotes Serum immunoglobulins included low IgG (396 mg/dL), low IgA (59 mg/dL), normal IgM (55mg/dL).
T446 632167-632231 Sentence denotes Serum antibody responses revealed baseline S. pneumoniae titers:
T447 632232-632294 Sentence denotes 8/23 non-protective and post vaccination S. pneumoniae titers:
T448 632295-632315 Sentence denotes 7/23 non-protective.
T449 632316-632380 Sentence denotes Tetanus toxoid, varicella and Polio antibodies, were protective.
T450 632381-632462 Sentence denotes Karyotype 45, XY, der (19) t(19;22) (p13.3, q11.2), -22, no previously described.
T451 632463-632475 Sentence denotes Conclusions:
T452 632476-632638 Sentence denotes Our 26 year old partial DGS patient with complex chromosome abnormality presented with late onset of humoral deficiency, lymphopenia and impaired T cell function.
T453 632639-632724 Sentence denotes He required immunoglob-ulin replacement and prophylaxis for opportunistic infections.
T454 632725-632873 Sentence denotes In this particular case genetic heterogeneity may play a significant role in time of presentation, manifestations and severity of impaired immunity.
T455 632874-633036 Sentence denotes More understanding of this genetic variations will help to better know about prognosis of Partial DGS patients and continue close follow up even during adulthood.
T456 633037-633050 Sentence denotes Introduction:
T457 633051-633204 Sentence denotes IgG4-related disease is a systemic malady that has been reported to involve multiple organ systems, especially the pancreas with plasma cell infiltrates.
T458 633205-633378 Sentence denotes It has also been found to affect skin, lacrimal glands, salivary glands, thyroid, pericardium, aorta, lungs, kidneys, pancreas, liver, retroperitoneum, breast, and prostate.
T459 633379-633583 Sentence denotes Regardless of which organ is involved, tissue biopsies show great histopathological similarities such as diffuse lymphoplasmacytic infiltrates, abundant IgG4 positive plasma cells, and extensive fibrosis.
T460 633584-633592 Sentence denotes Methods:
T461 633593-633628 Sentence denotes Case files of patient was reviewed.
T462 633629-633720 Sentence denotes Literature reviewed was perofmed using PubMed searches with the terms "IgG4" and "abdomen".
T463 633721-633729 Sentence denotes Results:
T464 633730-633836 Sentence denotes A 53 year old African American female presented to her primary care physician with chronic abdominal pain.
T465 633837-633937 Sentence denotes She was referred for specialty care and had unremarkable esophagogastroduodenoscopy and colonoscopy.
T466 633938-634097 Sentence denotes Subsequent CT scan revealed finding a 28x28x33mm soft tissue mass in the right lower abdomen/pelvis mesentery anteriorly abutting several loops of small bowel.
T467 634098-634191 Sentence denotes Exploratory surgery was performed with abdominal wall mass and partial small bowel resection.
T468 634192-634326 Sentence denotes The pathological report of the mass showed a storiform proliferation of dense fibrous tissue with marked infiltration by plasma cells.
T469 634327-634416 Sentence denotes Immunohistochemistry for IgG4 showed up to 60 plasma cells staining per high power field.
T470 634417-634485 Sentence denotes There was an associated phlebitis with infiltration by plasma cells.
T471 634486-634517 Sentence denotes Blood IgG4 level was increased.
T472 634518-634574 Sentence denotes These findings are consistent with IgG4-related disease.
T473 634575-634587 Sentence denotes Conclusions:
T474 634588-634669 Sentence denotes IgG4-related disease is a disease that can involve a wide range of organ systems.
T475 634670-634747 Sentence denotes The pathological findings of IgG4-related disease have striking similarities.
T476 634748-634832 Sentence denotes IgG4-related disease has broad clinical heterogeneity with multi-system involvement.
T477 634833-634999 Sentence denotes Differentiation of IgG4 related disease from malignancy and other autoimmune disorder along with more clinical insight into the management of this disease are needed.
T478 635000-635208 Sentence denotes More details of the radiologic manifestations of this disease aided by clinical and laboratory findings maybe essential for the accurate diagnosis of this disease and avoiding unnecessary invasive procedures.
T479 635209-635222 Sentence denotes Introduction:
T480 635223-635396 Sentence denotes Common Variable Immunodeficiency (CVID) is a heterogeneous group of disorders characterized by low levels of serum IgG, IgA and /or IgM and with loss of antibody production.
T481 635397-635548 Sentence denotes The diagnosis is most commonly made between the ages of 20 and 40 years of age but children and older adults can also be diagnosed with this condition.
T482 635549-635751 Sentence denotes There are many known clinical manifestations associated with CVID that include acute and chronic infections, inflammatory and autoimmune disease as well as an increased incidence of cancer and lymphoma.
T483 635752-635926 Sentence denotes For patients with inflammatory and hematologic complications, there is a risk of developing lymphadenopathy, splenomegaly, autoimmune cytopenia, and/or granulomatous disease.
T484 635927-636042 Sentence denotes Splenectomy has been used in patients with CVID often in the case of refractory autoimmune cytopenia or malignancy.
T485 636043-636172 Sentence denotes Aside from a recent European report, there is limited information as the medical reasons and outcomes have not been well defined.
T486 636173-636181 Sentence denotes Methods:
T487 636182-636285 Sentence denotes A retrospective chart review on patients seen at an Immunology clinic based a tertiary academic center.
T488 636286-636431 Sentence denotes The IRB approved chart review encompassed patients seen over the last 20 years and includes 43 patients with CVID and a history of a splenectomy.
T489 636432-636440 Sentence denotes Results:
T490 636441-636636 Sentence denotes The most common reasons for splenectomy in our patient cohort included hypersplenism (n=14), ITP (n=14), AIHA (n=8), presumed lymphoma (n=2), staging of Hodgkins disease (n=2) and lymphoma (n=1).
T491 636637-636679 Sentence denotes These were not mutually exclusive reasons.
T492 636680-636804 Sentence denotes Twenty-five patients had resolution of their symptoms at some point after splenectomy for either hypersplenism, AIHA or ITP.
T493 636805-637034 Sentence denotes There were 13 significant complications after splenectomy in this cohort, which included pulmonary hypertension (n=4), hepatopulmonary syndrome (n=2), sepsis/infection (n=3) fistulae development (n=2), liver decompensation (n=2).
T494 637035-637046 Sentence denotes Conclusion:
T495 637047-637125 Sentence denotes There are significant risks associated with splenectomy in patients with CVID.
T496 637126-637211 Sentence denotes Splenectomy has been used in patients with CVID and its role needs to be re-examined.
T1 637212-637214 Sentence denotes M.
T2 637215-637231 Sentence denotes Mortezavi * , E.
T3 637232-637242 Sentence denotes Weis, R.J.
T4 637243-637265 Sentence denotes Looney, Rochester, NY.
T5 637266-637279 Sentence denotes Introduction:
T6 637280-637417 Sentence denotes Non-infectious complications are now the major cause of morbidity and mortality in patients with Common Variable Immunodeficiency (CVID).
T7 637418-637569 Sentence denotes We describe the case of a young woman with CVID who has both granulomatous-lymphocytic interstitial lung disease (GLILD) and unilateral optic neuritis.
T8 637570-637588 Sentence denotes Case Presentation:
T9 637589-637702 Sentence denotes Our patient is a white female who was diagnosed with CVID at age 16 but was not treated due to lack of insurance.
T10 637703-637824 Sentence denotes At age 26, she presented with headaches, difficulty walking and profound hyopgammaglobulinemia (IgG 75, IgA < 5, IgM 32).
T11 637825-637909 Sentence denotes She had multifocal brain lesions, which on biopsy were non-specific lymphoid tissue.
T12 637910-638007 Sentence denotes Her symptoms and lesions resolved after treatment with maintenance IVIG and oral corticosteroids.
T13 638008-638116 Sentence denotes At age 28, she developed dyspnea, a restrictive pattern on spirometry and ground glass opacity on CT thorax.
T14 638117-638171 Sentence denotes She underwent an open lung biopsy, which showed GLILD.
T15 638172-638264 Sentence denotes All her biopsies stained negative for viral and bacterial agents, and for IgG4 plasma cells.
T16 638265-638328 Sentence denotes She was treated with four weekly rituximab infusions for GLILD.
T17 638329-638417 Sentence denotes She improved symptomatically, but a CT two months later showed several new lung nodules.
T18 638418-638484 Sentence denotes Soon after, she developed complete loss of vision in her left eye.
T19 638485-638621 Sentence denotes Ophthalmologic examination showed a bulging optic disc and MRI of the orbit showed enhancing optic nerve consistent with optic neuritis.
T20 638622-638733 Sentence denotes She improved after three doses of 1 gm IV methylprednisolone and mycophenolic acid, but relapsed shortly after.
T21 638734-638837 Sentence denotes MRI of the brain and spine did not show any evidence of a demyelinating central nervous system disease.
T22 638838-638894 Sentence denotes She was treated with pulse dose steroids and infliximab.
T23 638895-638982 Sentence denotes She has regained her vision and continues to do well as her steroids are being tapered.
T24 638983-638994 Sentence denotes Conclusion:
T25 638995-639064 Sentence denotes There is only one previously reported case of optic neuritis in CVID.
T26 639065-639158 Sentence denotes Patients with CVID can present with granulomatous lesions of the lung, skin and other organs.
T27 639159-639259 Sentence denotes Optic neuritis is usually seen in demyelinating neurologic disease, such as multiple sclerosis (MS).
T28 639260-639377 Sentence denotes Patients with MS-related optic neuritis usually show a quick and sustained response to pulse treatment with steroids.
T29 639378-639552 Sentence denotes Given the quick relapse after stopping steroids and lack of evidence for demyelinating disease, we extrapolated that her optic neuritis may be due to a granulomatous process.
T30 639553-639653 Sentence denotes We employed infliximab due to its success in treatment of neurosarcoidosis and had positive results.
T31 639654-639723 Sentence denotes Neutrophil and monocyte function is crucial for normal wound healing.
T32 639724-639863 Sentence denotes GM-CSF enhances function of both neutrophils and monocytes, and has been shown to improve wound healing in neutrophil dysfunction patients.
T33 639864-639934 Sentence denotes Use of GM-CSF in wounds of normal patients has produced mixed results.
T34 639935-640069 Sentence denotes We present case of successful treatment of refractory post-surgical wound with lymphopenia but without any known neutrophilic defects.
T35 640070-640226 Sentence denotes 18 month old male with truncus arteriosus s/p failed surgical repair and subsequent heart transplant developed refractory non-healing post-operative wounds.
T36 640227-640382 Sentence denotes He had history of recurrent fevers with persistent Coagulase-negative Staph Aureus bacteremia, but otherwise negative bacterial, fungal and viral cultures.
T37 640383-640564 Sentence denotes He received multiple courses of empiric broad-spectrum antibiotics as well as antifungals and remained afebrile while on therapy, but was unable to stay afebrile off antimicrobials.
T38 640565-640638 Sentence denotes Prior to transplant he presented with initial IgG 249, IgA 53 and IgM 23.
T39 640639-640749 Sentence denotes He had hypoalbuminemia and high alpha-1-antitrypsin in stool(220 mg/dL) suggesting protein-losing enteropathy.
T40 640750-640870 Sentence denotes He also had severe lymphopenia(200 cells/ml) with CD4 46 cells/ml, CD8 8 cells/ml, CD 19 25 cells/ml and NK 99 cells/ml.
T41 640871-640912 Sentence denotes He received IVIG weekly to keep IgG>1000.
T42 640913-640981 Sentence denotes PMN oxidative index was 60 ruling out Chronic Granulomatous Disease.
T43 640982-641105 Sentence denotes Whole Exome Sequencing found compound heterozygous c.422C>G and c.6064T>C variants of uncertain significance in PRKDC gene.
T44 641106-641216 Sentence denotes Mutations of this gene have been implicated in forms of autosomal recessive SCID due to defects in DNA repair.
T45 641217-641289 Sentence denotes No mutations were found in any genes associated with neutrophil defects.
T46 641290-641385 Sentence denotes GM-CSF aqueous solution was applied to 2 refractory surgical wounds 3 times daily over 2 weeks.
T47 641386-641494 Sentence denotes Significant improvement in color, size and degree of healing was observed by multiple physicians and nurses.
T48 641495-641657 Sentence denotes GM-CSF leads to enhancement of granulation tissue development in wound healing, and has been shown to be beneficial for wounds in neutrophil dysfunction patients.
T49 641658-641772 Sentence denotes Very little data exists in its efficacy in patients with immunodeficiencies other than primary neutrophil defects.
T50 641773-641909 Sentence denotes Given that T-cells are a significant source of GM-CSF, and the observed improvement in wound healing seen in this patient, use of GM-CSF
T51 641910-642044 Sentence denotes ANNALS OF ALLERGY, ASTHMA & IMMUNOLOGY may be considered in refractory wounds in patients with severe primary or acquired lymphopenia.
T52 642045-642047 Sentence denotes G.
T53 642048-642062 Sentence denotes Drannik 1 , F.
T54 642063-642079 Sentence denotes Gaisenyuk 1 , V.
T55 642080-642096 Sentence denotes Driyanska 1 , N.
T56 642097-642115 Sentence denotes Stepanova 1 , L.M.
T57 642116-642131 Sentence denotes DuBuske *2 , 1.
T58 642132-642149 Sentence denotes Kiev, Ukraine; 2.
T59 642150-642162 Sentence denotes Gardner, MA.
T60 642163-642176 Sentence denotes Introduction:
T61 642177-642262 Sentence denotes Cytokines are key factors in pathological processes including urinary tract diseases.
T62 642263-642631 Sentence denotes Urinary tract mucosa contains various protective effector molecules including antimicrobial peptides and inhibitory proteinases such as secretory leukocyte protease inhibitor (SLPI) produced by mucosa cells, macrophages and neutrophils which assists in defense against elastase secreted by activated neutrophils, and has antibacterial and anti-inflammatory properties.
T63 642632-642824 Sentence denotes Levels of cytokines and SLPI in plasma and urine of the patients with chronic infections of urinary system (USCI) including cystitis and pyelonephritis may be critical in disease pathogenisis.
T64 642825-642833 Sentence denotes Methods:
T65 642834-643177 Sentence denotes Levels of interleukin (IL)-1, -4, -6, -10, TNF-, TGF-1 in peripheral blood of 12 patients with chronic cystitis ( 1 st group) and 25 patients with chronic pyelonephritis (2 nd group) were assessed by ELISA methods using STAT FAX-303 PLUS ("Immunotech", "Diaclon", France; "DRG", Germany and "Hycult biotechnology" for Human SLPI (Netherlands).
T66 643178-643186 Sentence denotes Results:
T67 643187-643281 Sentence denotes Patients in both groups showed high levels of cytokines compared with normal persons (p<0.05).
T68 643282-643571 Sentence denotes Serum TNF-levels were greater in Group 1 99.6±6.5 versus Group 2 43.5±2.0 pg/ml (p<0,001) but the urine levels in Group 1 exceeded the levels in Group 2 by 3-fold (p<0.001); IL-1, IL-4, IL-6, IL-10, IL-17, IFN-γ, TGF-, though exceeding normal levels, did not differ between Groups 1 and 2.
T69 643572-643672 Sentence denotes The SLPI level in urine from Group 1 was greater (4171±225) than in Group 2 (1857±203 pg/ml; <0.05).
T70 643673-643824 Sentence denotes SLPI levels in serum of Group 1 (2052+378) and Group 2 (2240+178) were greater than normal but did not differ( 2240±178 versus 2052±316 pg/ml; P>0.05).
T71 643825-644001 Sentence denotes Conclusion: TNF-, that was greater in cystitis than in pyelonephritis, The elevated SLPI-levels were seen in urine with levels >3200 pg/ml typical for the presence of cystitis.
T72 644002-644121 Sentence denotes Cytokines and SLPI have an important role in immunity of the urinary bladder mucosa and antibacterial immunity in USCI.
T73 644122-644133 Sentence denotes Background:
T74 644134-644266 Sentence denotes Lipopolysaccharide (LPS) or endotoxin of Gram-negative enterobacteria may help to maintain autoimmune inflammatory responses in SLE.
T75 644267-644342 Sentence denotes One indicator of the strength of immunity is antiendotoxin CD14 expression.
T76 644343-644351 Sentence denotes Methods:
T77 644352-644381 Sentence denotes 48 SLE patients were studied.
T78 644382-644595 Sentence denotes Levels of potential of specific receptors to endotoxin (CD14) on granulocytes in peripheral blood were determined by laser double staining flow cytometry using monoclonal antibodies to anti-CD14-REIO-Test® (CD14).
T79 644596-644664 Sentence denotes Levels of general Ig, IgM and IgG antibodies were assessed by ELISA.
T80 644665-644786 Sentence denotes Circulating immune complexes (CIC) were determined spectrophotometrically by precipitation with polyethyleneglycol (PEG).
T81 644787-644795 Sentence denotes Results:
T82 644796-644899 Sentence denotes The levels of CD14 receptors in SLE patients on granulocytes was 18.57 ± 0.502 fluorescence units (UF).
T83 644900-645002 Sentence denotes The level of total IgA was 2.041 ± 0.059 g/l, IgM was 1.927 ± 0.087 g/l and IgG was 11.34 ± 0.171 g/l.
T84 645003-645056 Sentence denotes CIC level was 19.288 ± 1.546 conventional units (CU).
T85 645057-645266 Sentence denotes In studying the relations of these parameters an inverse relationship between CD14 receptor level and the level of total IgA was found with R= -0.404 (Pearson correlation) at a significance level of p = 0.004.
T86 645267-645307 Sentence denotes Dependence was described by the formula:
T87 645308-645334 Sentence denotes IgA = -1.734 * CD14+3.258.
T88 645335-645484 Sentence denotes There was also a direct significant correlation of receptors CD14 and CIC (R = +0.371; p = 0,009) expressed by the formula: CIC = 41.47 * CD14 -9.81.
T89 645485-645565 Sentence denotes Significant relationships between CD14 and IgM and IgG antibodies were detected.
T90 645566-645578 Sentence denotes Conclusions:
T91 645579-645729 Sentence denotes An association of cellular anti-endotoxin immunity as represented by the CD14 receptor with humoral immunity (IgA, CIC) was seen in patients with SLE.
T92 645730-645841 Sentence denotes This support s arole for LPS of Gram-negative intestinal flora in modulating the immune status of SLE patients.
T93 645842-645853 Sentence denotes Background:
T94 645854-645996 Sentence denotes Spermatozoa and leukocytes in semen may produce reactive oxygen species (ROS) which may have and importance in chronic abacterial prostatitis.
T95 645997-646005 Sentence denotes Methods:
T96 646006-646083 Sentence denotes Reactive Oxygen species can be assessed by using nitroblue tetrazolium (NBT).
T97 646084-646135 Sentence denotes Levels of ROS can be measured by chemiluminescence.
T98 646136-646208 Sentence denotes The NBT test was performed according to the method adapted to ejaculate.
T99 646209-646334 Sentence denotes In the light microscope with an increase in x 100 counted stained percentage of neutrophils and spermatozoa in the ejaculate.
T100 646335-646467 Sentence denotes To avoid additional procedures, determination of ROS in cells was performed using native ejaculate without using a density gradient.
T101 646468-646586 Sentence denotes Cells that had large and small dark blue deposits occupying more than 50% of the sperm cytoplasm were called positive.
T102 646587-646595 Sentence denotes Results:
T103 646596-646876 Sentence denotes Based on leukocyte concentrations in semen,patients samples were classified into 2 separate groups: leukocytic -sperm group (leukocytic count > 1 x 10 6 peroxidase-positive leukocytes[PPL]/mL semen; n = 20) and non-leukocytic sperm group(leukocytic count 1 x 10 6 PPL/mL; n = 63).
T104 646877-647153 Sentence denotes In Group 1 the NBTtest showed that the overwhelming number of patients (75%) had 60% of sperm producing reactive oxygen species (ROS), more than in healthy men with sperm ejaculate normally characterized by low ROS generation; percentage of NBT positive sperm is 15.5 ± 4.2%).
T105 647154-647250 Sentence denotes Antioxidant properties of ejaculate based upon NBT test in 75% of patients was decreased by 90%.
T106 647251-647350 Sentence denotes Group 2 had ROS production by sperm by NBT test in 75% of patients with 56% of sperm producing ROS.
T107 647351-647439 Sentence denotes Antioxidant properties of the ejaculate by NBT test in 75 patients was decreased by 70%.
T108 647440-647452 Sentence denotes Conclusions:
T109 647453-647585 Sentence denotes The NBT test can be used to assess the contribution of seminal leukocytes and defective spermatozoa towards ROS generation in semen.
T110 647586-647767 Sentence denotes In infertile patients with a chronic abacterial prostatitis production of ROS by seminal spermatozoa is increased and does not depend on the quantity of leukocytes in the ejaculate.
T111 647768-647779 Sentence denotes Background:
T112 647780-647925 Sentence denotes Obstruction of the upper urinary tracts results in the re-modulation of the tubulointerstitial tissue that is a precondition for nephrosclerosis.
T113 647926-648015 Sentence denotes TGF-β1 influences each stage of development of tubulointerstitial and glomerular lesions.
T114 648016-648144 Sentence denotes Levels of TGF-β1 in the urine of children with obstructive and refluxing megaureter (MU) may be critical in disease development.
T115 648145-648153 Sentence denotes Methods:
T116 648154-648306 Sentence denotes The TGF-β1 level in urine was assessed in 54 children (1 -9 years old) with obstructive (23) and refluxing (31) MU; with or without pyelonephritis (PN).
T117 648307-648358 Sentence denotes The control group consisted of 10 healthy children.
T118 648359-648459 Sentence denotes The TGF-β1 concentrations were assessed by the immuno-enzymatic method with "DRG" (USA) test system.
T119 648460-648665 Sentence denotes Results: TGF-β1 concentration in urine taken from the urinary bladder of children with obstructive and refluxing MU statistically exceeded the values in the control group being 15.3 ± 4.35 pg/ml (P<0.001).
T120 648666-648774 Sentence denotes The distribution of values in controls was 0 to 5.4 pg/ml, while in children with MU it was 8.8 -50,9 pg/ml.
T121 648775-649144 Sentence denotes There was an increase in MU when compared with the control of TGF-β1 excretion in the patients with obstructive (15.7 ± 2.1 pg/ml) and refluxing MU (16.9 ± 3.8 pg/ml) (P<0.001); no difference was noted between the groups and was similar to the TGF-β1 excretion in urine of groups of MU patients complicated by pyelonephritis (16.6 ± 1.6 pg/ml) (P<0.05 versus controls).
T122 649145-649156 Sentence denotes Conclusion:
T123 649157-649485 Sentence denotes Increase in the TGF-β1 level above normal at the first examination, or continuous increase during examination every 3 to 4 months in comparison with the values of the first examination, are considered evidence of aggravation of the functional state of the kidney due to the active fibrotic processed in patients with megaureter.
T124 649486-649584 Sentence denotes TGF-β1 plays a role in the pathogenesis of renal disease in these patients. ful treatment options.
T125 649585-649710 Sentence denotes We present a 9 month old patient with recurrent lung abscesses who was successfully treated with an interleukin-1 antagonist.
T126 649711-649810 Sentence denotes The case illustrates the importance of early diagnosis and treatment of autoinflammatory disorders.
T127 649811-649823 Sentence denotes Case Report:
T128 649824-649965 Sentence denotes A female patient presented in the newborn period with recurrent sterile skin abscesses that resolved after antifungal and antibiotic therapy.
T129 649966-650204 Sentence denotes She was then well until 9 months of age, when she developed recurrent sterile lung abscesses which were unresponsive to trials of antibacterial and antifungal treatment, but which resolved completely with Anakinra and Canakinumab therapy.
T130 650205-650213 Sentence denotes Results:
T131 650214-650341 Sentence denotes Laboratory testing revealed negative cultures with persistent leukocytosis, thrombocytosis, and elevated acute phase reactants.
T132 650342-650531 Sentence denotes Lung biopsy was sterile and without granulomas, and lung parenchyma showed reactive type 2 pneumocyte hyperplasia, chronic interstitial inflammation, and detached acute inflammatory debris.
T133 650532-650680 Sentence denotes The drained abscess showed evidence of acute inflammation and debris with 90% neutrophils, 12% macrophages, 4% eosinophils and 4% small lymphocytes.
T134 650681-650757 Sentence denotes Skin biopsy showed neutrophilic folliculitis with organizing dermal abscess.
T135 650758-650770 Sentence denotes Conclusions:
T136 650771-650851 Sentence denotes The spectrum of clinical presentations of autoinflammatory disorders is growing.
T137 650852-651065 Sentence denotes Low threshold for early treatment initiation with IL-1 antagonists is necessary in the setting of persistently elevated inflammatory markers and sterile neutrophilic biopsy without evidence of infectious etiology.
T138 651066-651068 Sentence denotes B.
T139 651069-651083 Sentence denotes Patel * , A.S.
T140 651084-651097 Sentence denotes Nickels, G.W.
T141 651098-651112 Sentence denotes Volcheck, A.Y.
T142 651113-651134 Sentence denotes Joshi, Rochester, MN.
T143 651135-651146 Sentence denotes Background:
T144 651147-651254 Sentence denotes Diagnosis of CVID presents a diagnostic challenge given variable interpretation of the diagnostic criteria.
T145 651255-651402 Sentence denotes Clinical findings are not included as part of the diagnostic criteria, however they can be helpful in further supporting or refuting the diagnosis.
T146 651403-651527 Sentence denotes CVID is associated with many other diseases including granulomatous disease, though the mechanism of association is unclear.
T147 651528-651546 Sentence denotes Case Presentation:
T148 651547-651694 Sentence denotes 47 year old female presented with a progressive rash for 2.5 years, lymphopenia and hypogammaglobulinemia, though she denied an infectious history.
T149 651695-651800 Sentence denotes Rash consisted of well circumscribed plaques with lichenification and mild scaling on the face and trunk.
T150 651801-651925 Sentence denotes Biopsy of her rash demonstrated eosinophilic spongiosis and noncaseating dermal granulomatous inflammation with eosinophils.
T151 651926-651975 Sentence denotes Staining for an infectious etiology was negative.
T152 651976-652185 Sentence denotes Exam demonstrated axillary lymphadenopathy and follow up PET/CT demonstrated mild uptake in areas of thickened skin overlying the right breast and left axilla and multiple prominent right axillary lymph nodes.
T153 652186-652290 Sentence denotes An excisional right axillary lymph node biopsy demonstrated non-necrotizing granulomatous lymphadenitis.
T154 652291-652366 Sentence denotes Bone marrow biopsy and peripheral flow for lymphoma/leukemia were negative.
T155 652367-652431 Sentence denotes An angiotensin-converting enzyme (ACE) level was elevated at 68.
T156 652432-652588 Sentence denotes Blood work demonstrated a low IgG of 587 (reference range 767-1590mg/dl) and a low IgA of 50 (reference range of 61-356mg/dl) but normal IgM and IgE levels.
T157 652589-652777 Sentence denotes She had a mildly reduced response to the pneumococcal vaccination as defined by the 2012 AAAAI working group statement, but she had protective titers to diphtheria and tetanus vaccination.
T158 652778-652876 Sentence denotes A lymphocyte flow report demonstrated a decrease in the class switched memory B cells (CD27+M-D-).
T159 652877-652888 Sentence denotes Conclusion:
T160 652889-652976 Sentence denotes This case describes granulomatous disease as the primary presentation of possible CVID.
T161 652977-653100 Sentence denotes This patient meets the least stringent diagnostic criteria for CVID, but interestingly does not have an infectious history.
T162 653101-653293 Sentence denotes However, recurrent infections can develop over time in patients who meet criteria for CVID and would not be uncommon in patients who initially present with granulomatous or autoimmune disease.
T163 653294-653401 Sentence denotes Therefore, this patient should be closely monitored for infection and consideration of treatment with IVIG.
T164 653402-653406 Sentence denotes S.E.
T165 653407-653425 Sentence denotes Henrickson *1 , S.
T166 653426-653442 Sentence denotes Jyonouchi 2 , 1.
T167 653443-653462 Sentence denotes Haddonfield, NJ; 2.
T168 653463-653480 Sentence denotes Philadelphia, PA.
T169 653481-653494 Sentence denotes Introduction:
T170 653495-653715 Sentence denotes Two toddlers presented with skin abscesses, recurrent acute otitis media (AOM) and neutropenia with both weakly positive anti-neutrophil antibodies and ELANE mutations consistent with severe congenital neutropenia (SCN).
T171 653716-653837 Sentence denotes Here we consider when it may be necessary to consider genetic testing even after anti-neutrophil antibodies are positive.
T172 653838-653853 Sentence denotes Clinical Cases:
T173 653854-653864 Sentence denotes Patient 1:
T174 653865-654018 Sentence denotes 17-month-old female presented with neutropenia, delayed umbilical cord separation, recurrent AOM, oral ulcers and progressive, refractory skin abscesses.
T175 654019-654180 Sentence denotes She was referred to Infectious Disease where an assessment yielded appropriate humoral immune responses, normal B and T cell flow cytometry and CBC with ANC 126.
T176 654181-654265 Sentence denotes With persistent skin abscesses, she was referred to Dermatology and then Immunology.
T177 654266-654397 Sentence denotes A repeat CBC with ANC of 0 led to urgent referral to hematology and BM biopsy with evidence of blockade in granulocyte development.
T178 654398-654527 Sentence denotes She was had weakly positive anti-neutrophil antibodies and an ELANE mutation consistent with severe congenital neutropenia (SCN).
T179 654528-654647 Sentence denotes Patient was started on G-CSF and required high dose G-CSF (15mcg/kg/day), with a full sibling match identified for BMT.
T180 654648-654658 Sentence denotes Patient 2:
T181 654659-654825 Sentence denotes 8-month-old male presented with a history of chronic AOM, perirectal abscess complicated by fistula formation and pneumonia requiring prolonged IV antibiotic therapy.
T182 654826-655065 Sentence denotes Based on recurrent infections, he was referred to Immunology and labs showed persistent neutropenia, with referral to Hematology and a bone marrow biopsy with decreased granulocyte maturation, consistent with severe congenital neutropenia.
T183 655066-655204 Sentence denotes He was found to have weakly positive anti-neutrophil antibodies and an ELANE mutation consistent with severe congenital neutropenia (SCN).
T184 655205-655318 Sentence denotes He was started on G-CSF, requiring high doses (10mcg/kg/day), with only modest increases in his neutrophil count.
T185 655319-655385 Sentence denotes He received an identically matched sibling bone marrow transplant.
T186 655386-655397 Sentence denotes Conclusion:
T187 655398-655508 Sentence denotes We have not identified any prior case reports of anti-neutrophil antibody positivity in patients who have SCN.
T188 655509-655605 Sentence denotes Patients with autoimmune neutropenia do not generally have difficulty with recurrent infections.
T189 655606-655779 Sentence denotes Therefore, In neutropenic patients with multiple, severe, recurrent infections at an early age and weakly positive anti-neutrophil antibodies, SCN should be fully evaluated.
T190 655780-655793 Sentence denotes Introduction:
T191 655794-656148 Sentence denotes Idiopathic CD4 Lymphopenia (ICL) is a disorder defined by persistently low CD4 T-lymphocyte count (CD4 < 300/mm 3 ) or CD4 count less than 20% of total lymphocytes on more than one occasion with no evidence of human immunodeficiency virus (HIV-1/2) or human T-cell lymphotropic 1/2 (HTLV-1/2) infection and no other secondary causes of immunosuppression.
T192 656149-656228 Sentence denotes Other features include high serum IL-7 levels, but poor signaling through IL-7.
T193 656229-656320 Sentence denotes ICL patients can present with autoimmune disease, malignancies or opportunistic infections.
T194 656321-656442 Sentence denotes The most common infections include Cryptococcus, nontuberculosis mycobacterial infection and human papilloma virus (HPV).
T195 656443-656651 Sentence denotes Very low CD4 counts (< 150/mm 3 ), low CD8 counts (< 180/mm 3 ; normal 212 -1007/mm 3 ) and low natural killer (NK) cell counts (< 100/mm 3 ; normal 97 -421/mm 3 ) are all associated with increased morbidity.
T196 656652-656775 Sentence denotes Treatment options considered were immunomodulators such as interleukin-2 (IL-2), interleukin-7 (IL-7) and interferon-gamma.
T197 656776-656859 Sentence denotes We describe a case of cutaneous HPV infection in ICL treated with interferon-gamma.
T198 656860-656868 Sentence denotes Methods:
T199 656869-656889 Sentence denotes Case Report Results:
T200 656890-657045 Sentence denotes A 34 year-old female with known ICL presented to Immunology clinic with digital warts and severe plantar warts on her left sole which were scraped monthly.
T201 657046-657095 Sentence denotes Her previous treatment with IL-7 was ineffective.
T202 657096-657150 Sentence denotes Warts were unresponsive to Imiquimod and Urea 40% gel.
T203 657151-657271 Sentence denotes Laboratory results were significant for a very low CD4 count at 18/mm 3 , low NK cells 86/mm 3 , low CD8 count 69/mm 3 .
T204 657272-657497 Sentence denotes Mitogen and antigen-induced lymphocyte proliferation profile was decreased to candida, tetanus toxoid, tuberculin purified protein derivative (PPD), phytohemagglutinin (PHA), pokeweed mitogen (PWM) and concanavalin A (Con A).
T205 657498-657587 Sentence denotes Serum immunoglobulins and mannose-binding lecithin (MBL) levels were within normal range.
T206 657588-657674 Sentence denotes We started treatment with Interferon-gamma-1b 100mcg three times a week for one month.
T207 657675-657812 Sentence denotes Our patient's digital warts resolved and the plantar warts significantly decreased after one month of treatment with Interferon-gamma-1b.
T208 657813-657892 Sentence denotes Conclusion: ICL is a rare immunodeficiency that can present with HPV infection.
T209 657893-658027 Sentence denotes Severe cases of cutaneous HPV infection with very depressed T-lymphocyte counts may be unresponsive to topical or destructive therapy.
T210 658028-658113 Sentence denotes However, treatment with immunomodulators such as Inteferon-gamma-1b may be promising.
T211 658114-658124 Sentence denotes Rationale:
T212 658125-658263 Sentence denotes The prevalence of lymphopenia, neutropenia and thrombocytopenia in children without HIV infection, malignancy, or aplastic anemia is rare.
T213 658264-658323 Sentence denotes Frequent infections are the primary clinical manifestation.
T214 658324-658332 Sentence denotes Methods:
T215 658333-658534 Sentence denotes An 8 year old (yo) African American female with recurrent infections since 1 yo was monitored with serial CBC's, immunoglobulins, lymphocyte subsets, specific antibody titers, and bone marrow biopsies.
T216 658535-658543 Sentence denotes Results:
T217 658544-658626 Sentence denotes From 1 yo, this patient had recurrent otitis media, pneumonia, and skin abscesses.
T218 658627-658679 Sentence denotes She had diffuse verrucae plana for the last 2 years.
T219 658680-658863 Sentence denotes Serial CBCs showed intermittent neutropenia (ANC ranging 570-6248 cells/uL), marked lymphopenia (ALC 272-943 cells/uL), and thrombocytopenia (platelet counts 54,000-120,000 cells/uL).
T220 658864-658999 Sentence denotes Lymphocyte subsets (CD3, CD4, CD8, CD19, and CD3-CD16+CD56+) were persistently very low, as well as low CD27+ B cells (memory B cells).
T221 659000-659065 Sentence denotes HIV PCR, HIV-1/2 antibody, and Parvovirus antibody were negative.
T222 659066-659110 Sentence denotes Neutrophil associated antibody was negative.
T223 659111-659265 Sentence denotes Specific antibody titers to Streptococcus pneumoniae and Haemophilus influenzae b normalized following booster vaccines, with fairly good amnestic titers.
T224 659266-659345 Sentence denotes Quantitative immunoglobulins were normal, until recent onset of low IgM levels.
T225 659346-659412 Sentence denotes Lymphocyte response to mitogens and specific antigens were normal.
T226 659413-659481 Sentence denotes Flow cytometry for paroxysmal nocturnal hemoglobinuria was negative.
T227 659482-659558 Sentence denotes 1,2:3,4-diepoxybutane (DEB) clastogen assay for Fanconi anemia was negative.
T228 659559-659619 Sentence denotes Chromosomal study showed 46, XX, with no clonal abnormality.
T229 659620-659734 Sentence denotes Fluorescent in situ hybridization (FISH) for Myelodysplasia panel and DiGeorge (22q11 and 10p13p14) were negative.
T230 659735-659949 Sentence denotes Bone marrow at 1 yo showed normocellular trilineage marrow with erythroid and megakaryocytic hyperplasia, and at 5 yo showed hypocellular marrow (60-80% cellularity) with trilineage maturation and mild 1+ fibrosis.
T231 659950-660002 Sentence denotes Megakaryocytes were normal in number and morphology.
T232 660003-660111 Sentence denotes Chromosomal microarray analysis showed duplication at 10q26.3, confirmed by FISH and a deletion at 11p11.12.
T233 660112-660229 Sentence denotes She began daily trimethoprim/sulfamethoxazole prophylaxis 3 years ago, with very few bacterial infections since then.
T234 660230-660242 Sentence denotes Conclusions:
T235 660243-660333 Sentence denotes Patients with lymphopenia and frequent infections may benefit from antibiotic prophylaxis.
T236 660334-660401 Sentence denotes Monitoring with appropriate lab tests can guide the treatment plan.
T237 660402-660505 Sentence denotes Given this patient's onset of verrucae plana, additional evaluation for WHIM syndrome may be warranted.
T238 660506-660508 Sentence denotes V.
T239 660509-660522 Sentence denotes Nayima * , P.
T240 660523-660548 Sentence denotes Atkinson, Birmingham, AL.
T241 660549-660559 Sentence denotes Rationale:
T242 660560-660703 Sentence denotes Nuclear factor-κB essential modulator (NEMO) deficiency is a combined immunodeficiency due to hypomorphic mutations in the X-linked IKBKG gene.
T243 660704-660814 Sentence denotes Symptoms include antibody deficiency, susceptibility to nontuberculous mycobacteria, and ectodermal dysplasia.
T244 660815-660924 Sentence denotes Female carriers of severe loss of function mutations in IKBKG have a condition called incontinentia pigmenti.
T245 660925-660942 Sentence denotes Case description:
T246 660943-661061 Sentence denotes A Caucasian male infant (36.5wga) presented to clinic at one week after circumcision with MRSA infection of the penis.
T247 661062-661196 Sentence denotes Five weeks later he again presented for evaluation with thrush, severe eczema, bloody stools, and a submandibular mass that grew MSSA.
T248 661197-661371 Sentence denotes At 12 weeks of age he was admitted for fever, diarrhea, and leukocytosis (WBC 40K) and was found to have significant eosinophilia ( 24%) and severe panhypoimmunoglobulinemia.
T249 661372-661421 Sentence denotes He was treated with empiric antibiotics and IVIG.
T250 661422-661589 Sentence denotes At 14 weeks the patient was admitted for weight loss and leukocytosis (WBC 45K) and was found to have a right inguinal abscess that grew MSSA and multiple bowel flora.
T251 661590-661686 Sentence denotes He was readmitted at 5 months for a planned bone marrow transplant after positive genetic tests.
T252 661687-661846 Sentence denotes He continued to have poor weight gain and experienced multiple infections during the pre-transplant interval with MSSA, MRSA, coagulase negative staphylococci.
T253 661847-661855 Sentence denotes Results:
T254 661856-662106 Sentence denotes Complement tests, CD11/CD18 protein expression, mitogen stimulation, neutrophil respiratory burst, FOXP3 protein expression, NK cell function, T and B cells and subsets including Th17 cells by flow, and HHV 6/7/8 PCR testing were all normal/negative.
T255 662107-662159 Sentence denotes CD45 RO (naïve) CD4+ T cells were decreased by flow.
T256 662160-662313 Sentence denotes During his evaluation it was discovered that his mother had an extensive patchy hyperpigmented birthmark that was consistent with incontinentia pigmenti.
T257 662314-662551 Sentence denotes Gene sequencing revealed a hemizygous IKBKG gene (H413D) variant which has not been published as mutation or benign polymorphism, not identified in 1200 individuals with European/African American ancestry, and predicted to be pathogenic.
T258 662552-662563 Sentence denotes Conclusion:
T259 662564-662802 Sentence denotes This early and severe presentation of NEMO/IKBKG deficiency suggests that this diagnosis should be considered in very young infants with severe infections and persistent leukocytosis even in the face of largely normal immunologic testing.
T260 662803-662805 Sentence denotes K.
T261 662806-662826 Sentence denotes Cook * , Orange, CA.
T262 662827-662840 Sentence denotes Introduction:
T263 662841-662935 Sentence denotes Spice allergy is relatively rare accounting for approximately 2% of all observed food allergy.
T264 662936-663060 Sentence denotes Cilantro has been implicated in IgE mediated hypersensitivity reactions varying from mild cases of urticaria to anaphylaxis.
T265 663061-663160 Sentence denotes To our knowledge this is the first reported case of eosinophilic esophagitis secondary to cilantro.
T266 663161-663178 Sentence denotes Case Description:
T267 663179-663343 Sentence denotes A 31 year old man with no prior medical history initially presented to gastroenterology clinic with episodic dysphagia and food impaction for approximately 7 years.
T268 663344-663426 Sentence denotes Five years prior, an EGD revealed a Schatzki ring which was treated with dilation.
T269 663427-663534 Sentence denotes He was maintained on Omeprazole daily but subsequently self discontinued as he was relatively asymptomatic.
T270 663535-663673 Sentence denotes The patient returned after experiencing 6 distinct episodes of dysphagia associated with increased mucous production over a 2 year period.
T271 663674-663803 Sentence denotes Repeat EGD with biopsy of the lower esophagus showed "strikingly abundant eosinophils, consistent with eosinophilic esophagitis".
T272 663804-663861 Sentence denotes He was started on Lansoprazole by his gastroenterologist.
T273 663862-663969 Sentence denotes The patient was asked to record a food diary of all foods he consumed in relation to episodes of dysphagia.
T274 663970-664131 Sentence denotes He underwent skin prick testing for corn, potato, soy, wheat, chicken, pork, egg, milk, almonds and peanuts with commercial extracts, all of which were negative.
T275 664132-664201 Sentence denotes Skin prick testing to aeroallergens was positive for dust mites only.
T276 664202-664361 Sentence denotes As he noted symptoms with intake of fresh salsa, the patient later underwent fresh food skin prick test to tomato and cilantro, which was positive to cilantro.
T277 664362-664428 Sentence denotes ImmunoCAP testing for cilantro/coriander was negative at <0.1kU/L.
T278 664429-664550 Sentence denotes Lansoprazole was changed to Omeprazole which has been shown to decrease IL-13 and eotaxin 3 levels as additional benefit.
T279 664551-664682 Sentence denotes With strict cilantro avoidance measures and omeprazole the patient noted no further episodes of dysphagia at three month follow up.
T280 664683-664694 Sentence denotes Conclusion:
T281 664695-664847 Sentence denotes This case illustrates the importance of fresh food skin prick testing in evaluating eosinophilic esophagitis associated with intake of foods and spices.
T282 664848-665053 Sentence denotes Although skin prick with commercial extracts and ImmunoCAP testing are used as first line in diagnostic work ups, fresh food skin prick testing with cilantro should be considered with a suggestive history.
T283 665054-665064 Sentence denotes Rationale:
T284 665065-665159 Sentence denotes Asparagus food allergy is rare and usually associated with positive skin or serum IgE testing.
T285 665160-665168 Sentence denotes Methods:
T286 665169-665253 Sentence denotes A 26 year-old male reported urticaria over 3 years associated with eating asparagus.
T287 665254-665281 Sentence denotes He had no history of atopy.
T288 665282-665329 Sentence denotes Skin testing with fresh asparagus was negative.
T289 665330-665414 Sentence denotes An open challenge resulted in a diffuse urticarial rash within minutes of ingestion.
T290 665415-665464 Sentence denotes Serum IgE via Immuno-CAP was less than 0.35 KU/L.
T291 665465-665504 Sentence denotes Serum was analyzed using ELISA testing.
T292 665505-665592 Sentence denotes Asparagus was lyophilized and protein content determined by a modified Lowry technique.
T293 665593-665684 Sentence denotes The food extract was added to ELISA plate wells, incubated, washed, blocked, and re-washed.
T294 665685-665781 Sentence denotes Serum was then added and the plate was incubated, washed, and anti-human IgE antibody was added.
T295 665782-665849 Sentence denotes After incubation, plate was washed and pNPP AP substrate was added.
T296 665850-665927 Sentence denotes Optical density readings were taken at 30 minutes and at 1,2,3, and 20 hours.
T297 665928-666008 Sentence denotes Inhibition ELISA testing was also performed, with asparagus inhibited by itself.
T298 666009-666078 Sentence denotes Controls included cord blood as well as serum from an atopic patient.
T299 666079-666117 Sentence denotes The assay was performed in triplicate.
T300 666118-666126 Sentence denotes Results:
T301 666127-666246 Sentence denotes The patient's serum exhibited IgE binding to asparagus antigens at a ratio of 2.5 times that of the cord blood control.
T302 666247-666329 Sentence denotes The binding was completely inhibited by preincubation of the serum with asparagus.
T303 666330-666417 Sentence denotes An atopic control exhibited binding to asparagus which was also inhibited by asparagus.
T304 666418-666460 Sentence denotes Immunoblot was performed and was negative.
T305 666461-666473 Sentence denotes Conclusions:
T306 666474-666740 Sentence denotes To our knowledge this is the first patient with asparagus allergy manifesting as systemic urticaria with negative fresh asparagus skin testing and negative commercial serum IgE testing demonstrated to have specific IgE to asparagus via an IgE-ELISA inhibition assay.
T307 666741-666811 Sentence denotes Further testing is needed to identify the specific allergens involved.
T308 666812-666816 Sentence denotes K.E.
T309 666817-666831 Sentence denotes Bruner *1 , R.
T310 666832-666844 Sentence denotes Gomez 2 , J.
T311 666845-666859 Sentence denotes Freiler 2 , K.
T312 666860-666872 Sentence denotes White 2 , A.
T313 666873-666885 Sentence denotes White 3 , 1.
T314 666886-666906 Sentence denotes Lackland AFB, TX; 2.
T315 666907-666926 Sentence denotes San Antonio, TX; 3.
T316 666927-666941 Sentence denotes San Diego, CA.
T317 666942-666955 Sentence denotes Introduction:
T318 666956-667006 Sentence denotes Pineapple is rarely reported to cause anaphylaxis.
T319 667007-667098 Sentence denotes We present two cases of pineapple anaphylaxis with evidence of IgE antibodies to pineapple.
T320 667099-667107 Sentence denotes Methods:
T321 667108-667267 Sentence denotes Two patients with histories consistent with pineapple anaphylaxis underwent ImmunoCAP and immunoblot testing to pineapple and one underwent skin prick testing.
T322 667268-667276 Sentence denotes Results:
T323 667277-667373 Sentence denotes Both patients reported regularly eating pineapple prior to their initial episode of anaphylaxis.
T324 667374-667538 Sentence denotes Pt 1 initially experienced a feeling of throat swelling, lip numbness and unsettled stomach after eating pineapple but did not associate it as an allergic reaction.
T325 667539-667714 Sentence denotes Three weeks later, he ate 4-5 pieces of pineapple and experienced generalized sweating, prolonged abdominal cramping and recurrent vomiting that lasted approximately one hour.
T326 667715-667744 Sentence denotes He had no rash or angioedema.
T327 667745-667846 Sentence denotes His skin testing revealed a 15x40mm wheal and flare to fresh pineapple, 15x50mm to pineapple extract.
T328 667847-667958 Sentence denotes He was skin test negative to bromelain, other fruits including fig, kiwi and papaya, and an aeroallergen panel.
T329 667959-668110 Sentence denotes An immunoblot was performed which revealed a faint band at 23 kD consistent with bromelain and correlated with a weak positive Immuno-CAP of 0.42 kU/L.
T330 668111-668251 Sentence denotes Patient 2 developed generalized hives, angioedema, throat closing, diarrhea and a sense of impending doom shortly after ingesting pineapple.
T331 668252-668373 Sentence denotes She received steroids, epinephrine and IV fluids in the emergency department with resolution of symptoms over 90 minutes.
T332 668374-668423 Sentence denotes Her initial ImmunoCAP to pineapple was 2.24 kU/L.
T333 668424-668500 Sentence denotes She deferred pineapple skin prick testing due to fear of recurrent reaction.
T334 668501-668577 Sentence denotes Repeat ImmunoCAP was obtained one year later and was negative at <0.35 kU/L.
T335 668578-668708 Sentence denotes Immunoblot performed at that time was also negative suggesting that her sensitivity may have waned over the intervening 12 months.
T336 668709-668750 Sentence denotes She was not interested in food challenge.
T337 668751-668762 Sentence denotes Conclusion:
T338 668763-668877 Sentence denotes Pineapple can cause anaphylaxis with presence of IgE demonstrated on skin prick testing, ImmunoCAP and immunoblot.
T339 668878-668943 Sentence denotes Bromelain was identified on immunoblot as the reactive substance.
T340 668944-669069 Sentence denotes One patient's ImmunoCAP converted to negative after one year indicating that sensitivity to pineapple may decrease over time.
T341 669070-669297 Sentence denotes Introduction: FPIES is a non-immunoglobulin E (IgE) mediated GI food hypersensitivity which presents with profuse, repetitive vomiting, often with diarrhea leading to dehydration and lethargy after ingestion of a food allergen.
T342 669298-669495 Sentence denotes The exact mechanism is unknown, however it is thought that the ingestion of an allergen causes local inflammation (mediated by T cells) leading to increased intestinal permeability and fluid shift.
T343 669496-669615 Sentence denotes The most common allergens are cow's milk or soy protein, however solid food proteins can also elucidate these symptoms.
T344 669616-669681 Sentence denotes The common solid food that has been known to cause FPIES is rice.
T345 669682-669690 Sentence denotes Methods:
T346 669691-669948 Sentence denotes An 8 month old female with a history of atopic dermatitis presented for initial consultation after she developed two episodes of profuse vomiting, listlessness and non-bloody diarrhea requiring ICU admission status post ingestion of homemade sweet potatoes.
T347 669949-670106 Sentence denotes The first instance occurred at 6.5 months of age for which she was diagnosed with a viral sepsis syndrome in the setting of a positive parainfluenza culture.
T348 670107-670238 Sentence denotes Symptoms then reoccurred at 7.5 months of age when she was fed sweet potato mixed with pear, and then she was diagnosed with FPIES.
T349 670239-670316 Sentence denotes She had already been consuming cheerios, oatmeal, banana, peas, and broccoli.
T350 670317-670400 Sentence denotes The patient's mom had questions regarding the proper timing to introduce new foods.
T351 670401-670409 Sentence denotes Results:
T352 670410-670508 Sentence denotes There are no specific recommendations regarding introduction of new foods for patients with FPIES.
T353 670509-670660 Sentence denotes Among infants with solid food FPIES in one study, 80% reacted to more than one food and 65% were previously diagnosed with cow's milk and/or soy FPIES.
T354 670661-670776 Sentence denotes Typically, if a patient is tolerating foods from one group then other foods of that group are considered OK to eat.
T355 670777-670928 Sentence denotes It is suggested that in children with solid food FPIES, the introduction of grains, legumes and poultry should be delayed until the first year of life.
T356 670929-670941 Sentence denotes Conclusions:
T357 670942-671036 Sentence denotes It was recommended to our patients mother that she continue foods she is currently tolerating.
T358 671037-671111 Sentence denotes It was also recommended that mom can introduce other fruits one at a time.
T359 671112-671196 Sentence denotes Since she was eating peas, it was suggested that she try lentils as her next legume.
T360 671197-671264 Sentence denotes Since she was eating oat, quinoa was recommended as her next grain.
T361 671265-671311 Sentence denotes Mom was instructed to continue breast feeding.
T362 671312-671388 Sentence denotes She was instructed to wait to until one year of age to consume soy and milk.
T363 671389-671496 Sentence denotes Approximately two weeks later she had tolerated lentils, quinoa and blueberries at home without any issues.
T364 671497-671536 Sentence denotes She still had not exposed her to dairy.
T365 671537-671550 Sentence denotes Introduction:
T366 671551-671645 Sentence denotes Pramoxine is a local anesthetic agent that has long been used in various surgical specialties.
T367 671646-671743 Sentence denotes A few cases of contact dermatitis have been described; however anaphylaxis has not been reported.
T368 671744-671837 Sentence denotes Though pramoxine has low sensitizing potential, it was implicated in our case of anaphylaxis.
T369 671838-671855 Sentence denotes Case Description:
T370 671856-672021 Sentence denotes A 47-year-old Caucasian man was brought to our emergency department with a widespread pruritic rash, generalized edema, chest pain, dyspnea, nausea, and diaphoresis.
T371 672022-672092 Sentence denotes An acute anaphylactic reaction was suspected, and treated immediately.
T372 672093-672230 Sentence denotes Serum laboratories revealed tryptase 2.6 (< 15.8 mcg/L), total IgE 44.5 (< 113 kU/L), and WBC 14.7 (4-11 x 1000/mcL) with no eosinophils.
T373 672231-672396 Sentence denotes He had applied Neosporin + Pain Relief® cream (active ingredients neomycin, polymyxin B, and pramoxine) to a cut on his hand minutes prior to his anaphylactic event.
T374 672397-672531 Sentence denotes He had applied topical Neosporin® ointment (without the Pain Relief component) numerous times previously without any adverse reaction.
T375 672532-672682 Sentence denotes At allergy clinic follow-up 5 weeks later, topical application of Neosporin + Pain Relief® cream to the patient's forearm produced a 30 x 30-mm wheal.
T376 672683-672758 Sentence denotes Skin prick testing revealed a 7 x 9-mm wheal to histamine and to pramoxine.
T377 672759-672809 Sentence denotes Testing of neomycin and polymyxin B were negative.
T378 672810-672904 Sentence denotes In vitro assays were performed (ImmunoCAP 1000 System, Thermo Fisher Scientific, Waltham, MA).
T379 672905-673042 Sentence denotes Direct coupling of pramoxine to the solid phase was not feasible as there was no free amine or hydroxyl group available on this compound.
T380 673043-673159 Sentence denotes Specific IgE against polymyxin B, neomycin, and bacitracin were not detected in the patient's serum (< 0.1 KU A /L).
T381 673160-673259 Sentence denotes Therefore, of the 3 active components in Neosporin + Pain Relief® cream, pramoxine was the culprit.
T382 673260-673271 Sentence denotes Discussion:
T383 673272-673398 Sentence denotes Pramoxine is used only for surface anesthesia; therefore sensitization should not entail any risk of future systemic reaction.
T384 673399-673539 Sentence denotes Low sensitization potential has been demonstrated, and patients sensitive to other topical anesthetics showed no sensitization to pramoxine.
T385 673540-673637 Sentence denotes To our knowledge, ours is the first report describing anaphylaxis to topically applied pramoxine.
T386 673638-673741 Sentence denotes Ready access to the systemic circulation seems to be a prerequisite for the development of anaphylaxis.
T387 673742-673827 Sentence denotes In contemplating topical therapy, patients should consider the integrity of the skin.
T388 673828-673901 Sentence denotes If the skin barrier is compromised, an anaphylactic reaction is possible.
T389 673902-673998 Sentence denotes Physicians should be aware that topical pramoxine may give rise to life-threatening anaphylaxis.
T390 673999-674001 Sentence denotes T.
T391 674002-674016 Sentence denotes Shankar * , A.
T392 674017-674027 Sentence denotes Petrov, M.
T393 674028-674049 Sentence denotes Fajt, Pittsburgh, PA.
T394 674050-674063 Sentence denotes Introduction:
T395 674064-674199 Sentence denotes Food allergies appear to be increasing in prevalence (Boyce, JACI 2010), and aside from physical effects, lead to poor quality of life.
T396 674200-674467 Sentence denotes Epidemiologic studies to date have focused on the pediatric population, and as a result, there is limited data on food allergies in adults, with available data suggesting differences in both presentation of allergy and underlying causative agents in these two groups.
T397 674468-674663 Sentence denotes This study aimed to evaluate the characteristics of patients presenting to an adult Allergy/Immunology clinic with food allergy as well as to determine the most prevalent food allergies reported.
T398 674664-674672 Sentence denotes Methods:
T399 674673-674916 Sentence denotes We conducted a retrospective analysis of demographic and clinical data from adult patients seen in an outpatient university Allergy/Immunology Clinic from June 2010-June 2014 for a complaint of food allergy as evidenced by ICD-9 code of 995.7.
T400 674917-674922 Sentence denotes Data:
T401 674923-675072 Sentence denotes Preliminary results from evaluation of 10 patients demonstrated a female predominance (90%) with onset of symptoms in adulthood (age >18 yrs) in 80%.
T402 675073-675213 Sentence denotes Concomitant environmental allergy was present in 80% of patients and drug allergy, most commonly penicillin, was present in 40% of patients.
T403 675214-675392 Sentence denotes Though nearly all of the patients (70%) had previously sought medical care for food allergy, only 1 patient had injectable epinephrine previously prescribed at the time of visit.
T404 675393-675463 Sentence denotes The most common food allergen reported and confirmed was shrimp (40%).
T405 675464-675537 Sentence denotes Other confirmed food allergies were fish (salmon), peanuts and tree nuts.
T406 675538-675649 Sentence denotes 80% of patients reported allergy to >3 foods, but only 30% had positive serum specific IgE testing to >3 foods.
T407 675650-675870 Sentence denotes Of the 10 patients evaluated, 40% opted to have no further testing beyond the initial visit and were discharged with injectable epinephrine prescription, training for use if needed, and an action plan for food avoidance.
T408 675871-675882 Sentence denotes Conclusion:
T409 675883-676029 Sentence denotes Our preliminary data suggests that onset of food allergy can occur in adulthood and is under-recognized and undertreated by the medical community.
T410 676030-676181 Sentence denotes Specific features such as female gender and coexistence of both environmental and drug allergies may help to identify adult patients with food allergy.
T411 676182-676267 Sentence denotes Additional analysis with larger sample sizes is needed to confirm these associations.
T412 676268-676272 Sentence denotes W.M.
T413 676273-676288 Sentence denotes Rassbach * , J.
T414 676289-676308 Sentence denotes Wang, New York, NY.
T415 676309-676493 Sentence denotes As a monoclonal antibody to CD20 on B lymphocytes, rituximab is used to treat a variety of lymphoproliferative disorders, including post-transplant lymphoproliferative disorder (PTLD).
T416 676494-676627 Sentence denotes It is unknown to what degree this rituximab-induced B cell depletion could affect pre-existing IgE-mediated food allergy in children.
T417 676628-676840 Sentence denotes We report a case of a three year-old patient who developed hives and lip swelling to peanut butter after receiving tacrolimus immunosuppression for a living-related liver transplant performed for biliary atresia.
T418 676841-676941 Sentence denotes She subsequently developed PTLD and underwent treatment with rituximab, leading to B cell depletion.
T419 676942-677102 Sentence denotes In the allergy evaluation that followed, her skin prick testing revealed a negative histamine control, and her serum food-specific IgE levels were undetectable.
T420 677103-677346 Sentence denotes As the patient had demonstrated clinical reactivity to peanut despite a negative serum peanut IgE, her case raises the question as to whether rituximab could have played a role in masking her IgE-mediated sensitivity to peanut and other foods.
T421 677347-677597 Sentence denotes Rituximab targets actively dividing B cells, particularly those present in the peripheral blood, and as such her case may indicate that the IgE active in food allergy is being produced by B cells in a body compartment other than the peripheral blood.
T422 677598-677609 Sentence denotes Background:
T423 677610-677655 Sentence denotes Food allergy affects many millions of people.
T424 677656-677787 Sentence denotes May develop allergy to almost any food, but in some cases it may be result of cross-reactivity between food and inhalant allergens.
T425 677788-677897 Sentence denotes Clinical manifestations can be included in the pollen-food syndrome sometimes leading to trigger anaphylaxis.
T426 677898-678050 Sentence denotes These syndromes are related to proteins like pathogenesis related protein family (PR-10), profilin, lipid transfer proteins (LTPs) and storage proteins.
T427 678051-678061 Sentence denotes Objective:
T428 678062-678236 Sentence denotes Determine the frequency of sensitization to food rich in LTPs and profilin in patients of the National Institute of Respiratory Diseases of Allergy and Immunology Department.
T429 678237-678245 Sentence denotes Methods:
T430 678246-678530 Sentence denotes Patients were seen at the Allergy and Immunology Department with suggestive symptoms of oral allergy syndrome or food anaphylaxis underwent questionnaire to determine functional gastrointestinal disorders with subsequent skin testing to aeroallergens and food with LTPs and profilins.
T431 678531-678539 Sentence denotes Results:
T432 678540-678693 Sentence denotes 42 patients were included, 75.6% were female and 26.1% male, mean of IgE levels were 506 IU / L, average eosinophils in peripheral blood 422 cells/mm 3 .
T433 678694-678890 Sentence denotes 71% of patients had symptoms of oral allergy syndrome, 19% anaphylaxis to food intake and 60% had functional gastroin-testinal disorders, the most frequent was esophageal and functional dyspepsia.
T434 678891-679090 Sentence denotes Positive test to aeroallergens were 76.19% Betulaceae (Birch 45.2%, Alnus 30.95%), 78.57% Oleaceae (42.5% Fraxinus, Olive 35.09%), 38.09% Asteraceae (Red Oak 38.09%), 38.9% Fagaceae (Thistle 38.09%).
T435 679091-679289 Sentence denotes For food were positive test were peach, orange and plum 38.09%, raw apple, 35.7% raw broccoli, celery, 33.3% raw carrot, strawberry, 30.95% raw onion, corn, banana, kiwi, hazelnut and almond 28.57%.
T436 679290-679352 Sentence denotes Positivity LTP extract 14% and 12% were positive to profilins.
T437 679353-679364 Sentence denotes Conclusion:
T438 679365-679444 Sentence denotes In our populations, 12% of patients were positive to profilins and 14% to LTPs.
T439 679445-679591 Sentence denotes 100% was positive to multiple pollens which is similar to the prevalence reported worldwide 10-30% patients with pollen allergy react to profilin.
T440 679592-679748 Sentence denotes This is of great importance since it is considered a risk factor for developing food allergies as well as most of these patients with oral allergy syndrome.
T441 679749-679851 Sentence denotes Also it has been reported that anaphylaxis is more common in patients with only sensitization to LTPs.
T442 679852-679854 Sentence denotes 1.
T443 679855-679870 Sentence denotes Chicago, IL; 2.
T444 679871-679885 Sentence denotes DeKalb, IL; 3.
T445 679886-679909 Sentence denotes Toronto, ON, Canada; 4.
T446 679910-679923 Sentence denotes New York, NY.
T447 679924-679937 Sentence denotes Introduction:
T448 679938-680046 Sentence denotes Food allergy prevalence is increasing globally in developed and developing countries especially in children.
T449 680047-680156 Sentence denotes Avoidance is still the best recommendation for management; however, strict avoidance impacts quality of life.
T450 680157-680276 Sentence denotes Recent research has focused on food allergen threshold levels, the lowest amount of an allergen that causes a reaction.
T451 680277-680390 Sentence denotes After years of recommendations to avoid allergens at any level, it is unknown how families feel about thresholds.
T452 680391-680575 Sentence denotes This would be the first international study of its kind to examine differences in food allergy types, severity, diagnosis, and opinions about food allergy thresholds between countries.
T453 680576-680743 Sentence denotes Methods:A survey prepared by FARE gathered consumer comments on allergen thresholds and was distributed by patient organizations in 16 countires to 10,225 respondents.
T454 680744-680855 Sentence denotes The survey was designed for people with food allergies, family members, and caregivers who purchase their food.
T455 680856-681027 Sentence denotes The public was asked to comment on opinions of food allergen thresholds, current approaches to managing food allergies through food selection, and knowledge of thresholds.
T456 681028-681097 Sentence denotes The results from these surveys were compiled and analyzed by country.
T457 681098-681106 Sentence denotes Results:
T458 681107-681420 Sentence denotes Differences were observed by country in percent of respondents with food allergy to each of the common food allergens, percent of respondents with history of severe reaction, source of diagnosis, knowledge of food allergy thresholds, and willingness to consume food that contains varying amounts of food allergen.
T459 681421-681722 Sentence denotes Overall, while 73% of respondents said they had some knowledge about allergen thresholds, only 21% said they would buy a product that contained levels of an allergen low enough that it would not trigger a reaction and 4% would purchase a product with levels only capable of triggering a mild reaction.
T460 681723-681786 Sentence denotes Responses to all threshold opinion questions varied by country.
T461 681787-681798 Sentence denotes Conclusion:
T462 681799-681896 Sentence denotes There are clear differences in food allergy in each of the countries participating in the survey.
T463 681897-682088 Sentence denotes This is the first study of its kind to analyze the breakdown of food allergy by common allergen and severity in each country and opinions about the emerging topic of food allergen thresholds.
T464 682089-682231 Sentence denotes It is apparent that if a food contains an allergen a family is avoiding, they may avoid the food regardless of thresholds and allergen levels.
T465 682232-682316 Sentence denotes As this topic develops, patient input is crucial as industry labeling policy shifts.
T1 682317-682319 Sentence denotes A.
T2 682320-682332 Sentence denotes Doshi * , S.
T3 682333-682356 Sentence denotes Leonard, San Diego, CA.
T4 682357-682519 Sentence denotes Introduction: FPIES is a non-IgE mediated gastrointestinal food hypersensitivity that is characterized by delayed profuse, repetitive vomiting and often diarrhea.
T5 682520-682625 Sentence denotes Severe cases can also lead to acute dehydration; weight loss and failure to thrive can result if chronic.
T6 682626-682721 Sentence denotes We present 2 cases of FPIES caused by avocado, a trigger that has not previously been reported.
T7 682722-682729 Sentence denotes Case 1:
T8 682730-682886 Sentence denotes A breastfed 10-month-old male presents with a history of reflux, failure to thrive, and intermittent vomiting, which improved with restricted maternal diet.
T9 682887-682953 Sentence denotes Solids were introduced at age 6 months, one new food every 3 days.
T10 682954-683141 Sentence denotes At age 7 months, 4 hours after the second introduction of peas, zucchini and avocado he experienced 2 episodes of emesis and appeared lethargic, returning to baseline by the next morning.
T11 683142-683304 Sentence denotes Shortly thereafter he developed repetitive vomiting, paleness, limpness and lethargy 3 hours after the second introduction of sweet potato and squash, separately.
T12 683305-683460 Sentence denotes He was treated in the emergency room with ondansetron and intravenous fluids for the sweet potato episode, but recovered at home after the squash reaction.
T13 683461-683527 Sentence denotes At this point he was diagnosed with sweet potato and squash FPIES.
T14 683528-683647 Sentence denotes At age 10 months, avocado was ingested again, and 3 hours later he developed vomiting, limpness, paleness and lethargy.
T15 683648-683683 Sentence denotes He recovered at home after 3 hours.
T16 683684-683691 Sentence denotes Case 2:
T17 683692-683891 Sentence denotes A 9-month-old female was diagnosed with rice and milk FPIES after presenting with a history of repetitive vomiting 2 hours after ingestion of rice and milk-based formula, separately, at age 7 months.
T18 683892-684020 Sentence denotes When avocado was introduced at age 12 months, she developed repetitive episodes of vomiting 5 hours after ingesting a few bites.
T19 684021-684064 Sentence denotes She was back to baseline a few hours later.
T20 684065-684076 Sentence denotes Discussion:
T21 684077-684141 Sentence denotes These cases highlight avocado as an unreported trigger of FPIES.
T22 684142-684282 Sentence denotes The most common causative foods are milk, soy, rice, and egg; reactions to meats, nuts, and other fruits/vegetables have also been reported.
T23 684283-684367 Sentence denotes To our knowledge, there have not been any other published accounts of avocado FPIES.
T24 684368-684535 Sentence denotes There is often a delay in FPIES diagnosis due to the lack of biomarkers and because symptoms overlap with other more common disease processes, such as gastroenteritis.
T25 684536-684651 Sentence denotes FPIES is a clinical diagnosis based on history and it is important to not overlook uncommon or unreported triggers.
T26 684652-684665 Sentence denotes Introduction:
T27 684666-684811 Sentence denotes Food protein-induced enterocolitis syndrome is a non-IgE mediated food allergy which usually presents in infancy as severe vomiting and diarrhea.
T28 684812-684888 Sentence denotes Onset of symptoms are delayed and occur 2-4 hours after ingestion of a food.
T29 684889-685044 Sentence denotes FPIES patients often experience delayed diagnosis due to the similarity of its presentation with gastroenteritis, surgical abdominal processes, and sepsis.
T30 685045-685236 Sentence denotes This case illustrates that acute FPIES can be accompanied by profound dehydration and a high clinical suspicion should be maintained for the potential clinical sequelae of severe dehydration.
T31 685237-685250 Sentence denotes Case Summary:
T32 685251-685457 Sentence denotes An exclusively breastfed 6 week old full-term male was transferred to our institution for the management of hyponatremia and severe dehydration in the setting of one week of worsening vomiting and diarrhea.
T33 685458-685551 Sentence denotes He had been breastfeeding and gaining weight appropriately until six days prior to admission.
T34 685552-685672 Sentence denotes He presented with 6 days of multiple episodes of nonbloody, nonbilious emesis and four days of loose nonbloody diarrhea.
T35 685673-685865 Sentence denotes He had 0.52 kg weight loss over one week's time, with exam notable for sunken fontanel, delayed capillary refill and dry mucous membranes and laboratory workup notable for hyponatremia to 128.
T36 685866-686051 Sentence denotes He required rehydration with IV fluids, and during the hospitalization he developed persistent rightward eye deviation which progressed to apnea and bradycardia requiring resuscitation.
T37 686052-686137 Sentence denotes Electrolytes were normal and brain MRI/MRV revealed thrombosis of the medullary vein.
T38 686138-686174 Sentence denotes Hypercoagulable workup was negative.
T39 686175-686403 Sentence denotes Workup of his vomiting and diarrhea was negative, including: LFTs, lipase, infectious stool studies, testing for neurometabolic disorders, anti-enterocyte and FoxP3 staining as well as normal IgA staining of intestinal biopsies.
T40 686404-686658 Sentence denotes His hospital course was significant for multiple attempts to restart breastmilk or alimentum complicated by recurrence of vomiting and diarrhea; he was eventually able to tolerate NeoCate with resolution of GI symptoms and was discharged home on NeoCate.
T41 686659-686866 Sentence denotes At followup visits he demonstrated normal growth pattern and stooling pattern on NeoCate, but at 28 months had accidental exposure to a small amount of milk and developed diarrhea secondary to this exposure.
T42 686867-687048 Sentence denotes Although FPIES is a diagnosis of exclusion given the severity of symptoms in this patient, and the reproducibility of his symptoms, FPIES to milk seems is the most likely diagnosis.
T43 687049-687062 Sentence denotes Introduction:
T44 687063-687179 Sentence denotes Two methods for treating Eosinophilic Esophagitis (EoE) are off-label use of swallowed steroids and dietary therapy.
T45 687180-687338 Sentence denotes For swallowed steroids, the two main options are swallowing MDI actuated inhaled corticosteroids or mixing budesonide into a slurry with sucralose (Splenda®).
T46 687339-687384 Sentence denotes However, some patients do not like sucralose.
T47 687385-687460 Sentence denotes We describe our treatment success with other agents used to mix budesonide.
T48 687461-687469 Sentence denotes Methods:
T49 687470-687574 Sentence denotes We retrospectively reviewed data from EoE patients treated with swallowed budesonide at our institution.
T50 687575-687725 Sentence denotes EoE was defined using the standard consensus criteria of > 15 eosinophils/hpf (eos/hpf) on esophageal biopsy after ruling out gastroesophageal reflux.
T51 687726-687786 Sentence denotes A value of < 15 eos/hpf was considered adequate improvement.
T52 687787-687852 Sentence denotes IRB approval and informed consent was obtained from all subjects.
T53 687853-687861 Sentence denotes Results:
T54 687862-688019 Sentence denotes Fifty-four children between ages 2 and 18 years (mean 6 years) were treated with swallowed budesonide over a 5 year period and had sufficient data to review.
T55 688020-688094 Sentence denotes The most common delivery vehicle for budesonide was sucralose (n=32, 59%).
T56 688095-688136 Sentence denotes A variety of other agents were also used:
T57 688137-688341 Sentence denotes 11 patients used apple sauce; 3-honey; 1-alternating apple sauce and ice cream; 1-banana puree; 1-pear sauce; 1-hot cocoa mix; 1-rice cereal; 1-tapioca starch; 1-xanthan gum; and 1-compounded formulation.
T58 688342-688464 Sentence denotes Of the patients using sucralose, 30 of 32 patients had improvement on their esophageal biopsy (down to mean 1.27 eos/hpf).
T59 688465-688672 Sentence denotes Of the 11 apple sauce patients, 7 had improvement (down to mean 2.86 eos/hpf); 2 had no repeat biopsy data, 1 did not respond adequately to budesonide, and 1 improved after switching to honey as the vehicle.
T60 688673-688761 Sentence denotes The patient on alternating apple sauce and ice cream went from 60 eos/hpf to 20 eos/hpf.
T61 688762-688827 Sentence denotes All 3 honey patients had improvement (down to mean 3.33 eos/hpf).
T62 688828-688979 Sentence denotes The patients using banana puree, pear sauce, hot cocoa mix, xanthan gum and the compounded formulation as the vehicle all had improvement to 0 eos/hpf.
T63 688980-689072 Sentence denotes The patients using rice cereal or tapioca starch did not have improvement on their biopsies.
T64 689073-689084 Sentence denotes Conclusion:
T65 689085-689190 Sentence denotes Splenda® (sucralose) is the most commonly used delivery vehicle for swallowed budesonide in EoE patients.
T66 689191-689350 Sentence denotes Various other vehicles can also be effective, including apple sauce, pear sauce, honey, banana puree, hot cocoa mix, xanthan gum, and a compounded formulation.
T67 689351-689395 Sentence denotes Certain other agents, however, may not work.
T68 689396-689414 Sentence denotes Case Presentation:
T69 689415-689503 Sentence denotes An 18-year-old female presented to the allergy clinic with concern for beer intolerance.
T70 689504-689577 Sentence denotes She drank beer for the first time at age 14 and did not develop symptoms.
T71 689578-689730 Sentence denotes Recently she has begun experiencing lip and mouth tingling and numbness within minutes of drinking beer, followed by nausea and vomiting within an hour.
T72 689731-689822 Sentence denotes She denied additional skin or mucosal symptoms, and never experienced respiratory symptoms.
T73 689823-689936 Sentence denotes Her symptoms occur with a single sip of beer and are present with every exposure, regardless of the type of beer.
T74 689937-690068 Sentence denotes She has consumed wine, champagne and distilled spirits without any adverse reactions, both before and since her symptoms with beer.
T75 690069-690158 Sentence denotes She also reports developing a localized, urticarial rash if beer is splashed on her skin.
T76 690159-690263 Sentence denotes Her past medical history is remarkable for migraine headaches for which she takes sumatriptan as needed.
T77 690264-690302 Sentence denotes She has no history of atopic diseases.
T78 690303-690335 Sentence denotes She has no known drug allergies.
T79 690336-690369 Sentence denotes Her mother has allergic rhinitis.
T80 690370-690431 Sentence denotes Review of systems and physical examination were unremarkable.
T81 690432-690550 Sentence denotes Skin prick test was adequate for interpretation with a histamine control of 10mm/34mm and a negative glycerin control.
T82 690551-690657 Sentence denotes She reacted to barley extract (5mm/17mm), malt extract (10mm/32mm) and Pabst Blue Ribbon beer (10mm/40mm).
T83 690658-690742 Sentence denotes She did not react to corn, hops, wheat or yeast (Saccharomyces cerevisiae) extracts.
T84 690743-690824 Sentence denotes She was instructed to avoid beer and food or beverages containing barley or malt.
T85 690825-690988 Sentence denotes Follow up was arranged to perform oral food challenges to barley and malt, in order to determine whether she can safely consume foods containing these ingredients.
T86 690989-691000 Sentence denotes Conclusion:
T87 691001-691158 Sentence denotes Although uncommon, beer allergy should be suspected in a patient who reacts adversely to beer and whose presentation is consistent with an allergic reaction.
T88 691159-691307 Sentence denotes Several beer components have the potential to cause IgE-mediated reactions, including barley, hops and yeast, in addition to various other starches.
T89 691308-691450 Sentence denotes [3] Identifying a specific allergen, although often difficult, will assist in allergen avoidance and prevent unnecessary dietary restrictions.
T90 691451-691453 Sentence denotes A.
T91 691454-691465 Sentence denotes Kaur 1 , G.
T92 691466-691477 Sentence denotes Koch 2 , S.
T93 691478-691493 Sentence denotes Durham 3 , J.M.
T94 691494-691508 Sentence denotes Portnoy 4 , Z.
T95 691509-691518 Sentence denotes Li 1 , J.
T96 691519-691533 Sentence denotes Maloney 1 , H.
T97 691534-691547 Sentence denotes Nolte *1 , 1.
T98 691548-691574 Sentence denotes Whitehouse Station, NJ; 2.
T99 691575-691594 Sentence denotes Chapel Hill, NC; 3.
T100 691595-691621 Sentence denotes London, United Kingdom; 4.
T101 691622-691638 Sentence denotes Kansas City, MO.
T102 691639-691652 Sentence denotes Introduction:
T103 691653-691788 Sentence denotes Number needed to treat (NNT) and needed to harm (NNH) is a quantitative approach to assess relative efficacy and safety of a treatment.
T104 691789-691876 Sentence denotes Lower NNT indicates more effective treatment, and higher NNH indicates safer treatment.
T105 691877-692067 Sentence denotes NNTs for allergic rhinitis (AR) treatments depend on the clinical response definition and range from 3-34.5; NNHs depend on the frequencies and types of adverse events and range from 13-167.
T106 692068-692252 Sentence denotes We determined the NNT and NNH to quantify benefit-risk for 2 sublingual immunotherapy tablets (SLIT-T) approved for Timothy grass-(and related grasses) or short ragweed (RW)induced AR.
T107 692253-692261 Sentence denotes Methods:
T108 692262-692438 Sentence denotes For grass SLIT-T 2800 BAU (MK-7243; Merck/ALK-Abelló), efficacy data vs placebo from 3094 subjects was used for NNT; safety data from 4195 subjects was used for NNH evaluation.
T109 692439-692615 Sentence denotes For RW SLIT-T 12 Amb a 1-U (MK-3641; Merck/ALK-Abelló), efficacy data vs placebo from 644 subjects was used for NNT; safety data from 1814 subjects was used for NNH evaluation.
T110 692616-692733 Sentence denotes In the absence of an established responder definition, NNT was based on 2 exploratory post-hoc responder definitions.
T111 692734-692855 Sentence denotes Definition 1 required the subject to achieve ≥50% well days during the pollen season (grass full season, RW peak season).
T112 692856-692984 Sentence denotes Well days were days with no rescue medication use, and with the worst score as none or mild for each of the 6 symptoms measured.
T113 692985-693028 Sentence denotes Missing data were considered non-well days.
T114 693029-693191 Sentence denotes Definition 2 required the subject's total combined symptom and medication score (TCS) to be ≤3 (~10% of the observed endpoint range to be considered a responder).
T115 693192-693344 Sentence denotes NNH was based on the adverse event rate for epinephrine use and treatment-related systemic allergic reactions, the safety endpoints of clinical concern.
T116 693345-693410 Sentence denotes IRB approval and informed consent was obtained from all subjects.
T117 693411-693419 Sentence denotes Results:
T118 693420-693525 Sentence denotes For grass SLIT-T, the NNT was 7.9 using the ≥50% well days definition and 9.4 using the TCS ≤3 threshold.
T119 693526-693608 Sentence denotes NNH was 305 based on epinephrine use and 303 based on systemic allergic reactions.
T120 693609-693712 Sentence denotes For RW SLIT-T the NNT was 10.3 using the ≥50% well days definition and 16.4 using the TCS ≤3 threshold.
T121 693713-693829 Sentence denotes NNH was 230 based on epinephrine use and no harmful effect could be determined based on systemic allergic reactions.
T122 693830-693891 Sentence denotes Additional sensitivity analysis corroborated the NNT results.
T123 693892-693904 Sentence denotes Conclusions:
T124 693905-693988 Sentence denotes Grass SLIT-T and RW SLIT-T have favorable benefit-risk ratios based on NNT and NNH.
T125 693989-694002 Sentence denotes Introduction:
T126 694003-694130 Sentence denotes This study investigated the percentage of patients who achieved their pre-set dust mite immunotherapy maintenance goal within 1
T127 694131-694136 Sentence denotes year.
T128 694137-694236 Sentence denotes Patient demographics were analyzed to see if specific populations were less likely to achieve goal.
T129 694237-694245 Sentence denotes Methods:
T130 694246-694363 Sentence denotes An IRB approved retrospective chart review of all current immunotherapy patients at one allergy clinic was conducted.
T131 694364-694456 Sentence denotes Only patients on standardized dust mite mix immunotherapy for at least 1 year were included.
T132 694457-694778 Sentence denotes One year was chosen as the inclusion time because it would take 32-43 weekly incremental dosage steps to achieve maintenance goal if there were no gaps or skipped doses, assuming a starting dose of 0.05cc of 0.001AU-0.1AU and a goal maintenance dose of 0.20cc of 10,000AU using our standard protocol for dose advancement.
T133 694779-694919 Sentence denotes Patients were excluded if they received combination shots with other allergens in the same extract vial or were on house dust immunotherapy.
T134 694920-694994 Sentence denotes Chi-square analysis was used to determine if differences were significant.
T135 694995-695003 Sentence denotes Results:
T136 695004-695071 Sentence denotes There were 36 females and 46 males that met criteria for the study.
T137 695072-695158 Sentence denotes Of the 82 patients, 41 (50%) achieved their pre-set maintenance goal target in 1 year.
T138 695159-695229 Sentence denotes 41.7% of females achieved goal maintenance compared to 56.5% of males.
T139 695230-695326 Sentence denotes However, chi-square analysis found no significant gender difference in achieving goal (p=0.182).
T140 695327-695479 Sentence denotes Participants were also stratified into 3 different age groups: young (0-39 years), n=35, middle aged (40-59 years), n=32, and elderly (60+ years), n=15.
T141 695480-695547 Sentence denotes The age group differences were statistically significant (p=0.003).
T142 695548-695693 Sentence denotes Odds ratio showed middle aged patients were 3.2 times and elderly patients 6.0 times more likely to achieve goal when compared to young patients.
T143 695694-695842 Sentence denotes Also, patients with no reactions to immunotherapy were significantly more likely to achieve maintenance goal than those who had reactions (p=0.027).
T144 695843-695991 Sentence denotes Patients who consistently visited clinic for immunotherapy treatments were more likely to achieve goal than those who missed appointments (p≤0.000).
T145 695992-696003 Sentence denotes Conclusion:
T146 696004-696189 Sentence denotes Patients who consistently visit clinic for immunotherapy treatments, have no major reactions to treatments, and are older are more likely to achieve maintenance goal in a timely manner.
T147 696190-696256 Sentence denotes Patients younger than age 40 are at high risk of not meeting goal.
T148 696257-696424 Sentence denotes Improving success for this population may indicate a need for more resources for them such as special adherence counseling on each injection visit and visit reminders.
T149 696425-696427 Sentence denotes 1.
T150 696428-696454 Sentence denotes Whitehouse Station, NJ; 2.
T151 696455-696473 Sentence denotes Pittsburgh, PA; 3.
T152 696474-696493 Sentence denotes Minneapolis, MN; 4.
T153 696494-696509 Sentence denotes Fort Worth, TX.
T154 696510-696523 Sentence denotes Introduction:
T155 696524-696736 Sentence denotes Saliva may carry concentrated allergen extract to areas of the gastrointestinal (GI) tract distal to the mouth and throat when swallowed after administration of sublingual immunotherapy tablet (SLIT-T) or liquid.
T156 696737-696962 Sentence denotes Unabsorbed contents of a rapidly dissolving SLIT-T may be swallowed fewer times than that of a SLIT-T that takes minutes to dissolve or liquid extracts, minimizing allergen exposure contact with the non-mouth/throat GI tract.
T157 696963-697085 Sentence denotes Therefore, it is important to characterize the non-mouth/throat GI adverse events (AEs) associated with each SLIT product.
T158 697086-697307 Sentence denotes We report the GI AEs associated with 2 SLIT-T products approved for the treatment of Timothy grass (and crossreactive grasses) or short ragweed (RW)-induced allergic rhinitis that dissolve within seconds under the tongue.
T159 697308-697523 Sentence denotes Methods: AE data from 8 randomized, double-blind, placebo-controlled trials (24-week to 1-year) of daily Timothy grass SLIT-T 2800 BAU (MK-7243; Merck/ALK-Abelló) were combined into adult and pediatric safety pools.
T160 697524-697732 Sentence denotes AE data from 4 randomized, double-blind, placebocontrolled trials (two 52-week trials and two 28-day trials) of daily RW SLIT-T 12 Amb a 1-U (MK-3641; Merck/ALK-Abelló) were combined into a 28day safety pool.
T161 697733-697741 Sentence denotes Results:
T162 697742-697839 Sentence denotes A total of 3173 subjects received grass or RW SLIT-T and 2836 subjects received placebo (Table) .
T163 697840-697927 Sentence denotes The majority of treatment-related GI AEs were associated with the oral mucosa (Table) .
T164 697928-698086 Sentence denotes Dysphagia and dyspepsia did not affect a large number of subjects but did occur at a numerically higher rate than in the placebo group for each pool (Table) .
T165 698087-698202 Sentence denotes Abdominal pain and gastroesophageal reflux disease (GERD) occurred in ≤1% of subjects receiving grass or RW SLIT-T.
T166 698203-698445 Sentence denotes Only 1/2116 (0.05%) subjects receiving grass SLIT-T (none for RW SLIT-T) reported eosinophilic esophagitis; this AE was mild in intensity, did not result in study discontinuation, and was not assessed as treatment-related by the investigator.
T167 698446-698522 Sentence denotes No serious GI AEs were reported in any subject receiving grass or RW SLIT-T.
T168 698523-698668 Sentence denotes Only 2/2116 (0.09%) subjects receiving grass and 1/1057 (0.09%) receiving RW SLIT-T discontinued due to treatment-related abdominal pain or GERD.
T169 698669-698781 Sentence denotes Conclusions: GI AEs associated with grass SLIT-T and RW SLIT-T treatment predominately affected the oral mucosa.
T170 698782-698894 Sentence denotes Non-mouth/throat GI AEs were infrequent and rarely resulted in study discontinuation. (Figure 1) , were studied.
T171 698895-698992 Sentence denotes Immunologic assessment of all patients revealed normal humoral and cell-mediated immune function.
T172 698993-699350 Sentence denotes The warts had failed to respond to multiple courses of destructive modes of treatment, including cryotherapy, salicylic acid 6%, imiquimod 5%, and electrodessication These patients were started on immunotherapy consisting of intralesional injections of 0.4 mL of a Candida albicans antigen preparation (Hollister-Stier) with a concentration of 1,000 PNU/mL.
T173 699351-699428 Sentence denotes This treatment was given at 3-week intervals with an average of 3.5 sessions.
T174 699429-699437 Sentence denotes Results:
T175 699438-699632 Sentence denotes The patients' plantar warts achieved complete and striking resolution without scarring (Figure 2a, 2b) following immunotherapy with multiple intralesional injections of Candida albicans antigen.
T176 699633-699703 Sentence denotes No relapses have been reported to date (average follow-up ~2.3 years).
T177 699704-699909 Sentence denotes The mechanism of action is still uncertain, but most likely due to the stimulation of a T-helper type 1 (Th1) cell cytokine response leading to induction of local and distal cell-mediated immune responses.
T178 699910-699979 Sentence denotes The most common side effect was pain during intralesional injections.
T179 699980-699991 Sentence denotes Conclusion:
T180 699992-700300 Sentence denotes The striking favorable response to multiple stratified intralesional immunotherapeutic injections of Candida albicans antigen in these 4 patients with recalcitrant warts unresponsive to usual destructive forms of treatment, provides support for a promising effective and safe mode of immunomodulator therapy.
T181 700301-700314 Sentence denotes Introduction:
T182 700315-700389 Sentence denotes Controversy exists about the efficacy of self-administered SCIT protocols.
T183 700390-700536 Sentence denotes We previously reported the safety study results of the United Allergy Service (UAS) self-administered SCIT protocol (WAO J 2014, 7 (Suppl 1), 24).
T184 700537-700585 Sentence denotes We now report the results of the efficacy trial.
T185 700586-700594 Sentence denotes Methods:
T186 700595-700676 Sentence denotes An IRB/HAC approval and informed consent was obtained from all research subjects.
T187 700677-700805 Sentence denotes A retrospective efficacy study was completed for 56 control patients and 60 SCIT patients (in accordance with the UAS protocol).
T188 700806-701043 Sentence denotes Enrollment criteria in part included only patients: who demonstrated positive SPTs to at least 3 of 6 common study site geographic allergens (Timothy, Bermuda, Cedar, Oak, Ragweed, and Cocklebur) and had associated seasonal symptomology.
T189 701044-701168 Sentence denotes The study contrasted statistical assessment of pretreatment and ongoing symptom scores (SS), medication scores ( Background:
T190 701169-701336 Sentence denotes Subcutaneous specific allergic immunotherapy (SSAI), in conjunction with drug therapy and patient education, is the cornerstone for the treatment of allergic diseases.
T191 701337-701464 Sentence denotes So far SSAI is the only treatment able to modify the allergic disease in addition to helping prevent the development of asthma.
T192 701465-701509 Sentence denotes Complications of SSAI are rare but possible.
T193 701510-701628 Sentence denotes Currently there is insufficient information to describe the incidence of adverse reactions in daily clinical practice.
T194 701629-701831 Sentence denotes Collecting information that assesses SSAI's safety could help us to identify allergens, dose, time of administration, and other factors in order to reduce the incidence of potentially serious reactions.
T195 701832-701842 Sentence denotes Objective:
T196 701843-701922 Sentence denotes To assess the safety of SSAI in patients with allergic rhinitis from 2005-2014.
T197 701923-701931 Sentence denotes Methods:
T198 701932-702014 Sentence denotes Patients with Allergic rhinitis who received SSAI between 2005-2014 were included.
T199 702015-702138 Sentence denotes SSAI was performed using Alk-Abello® allergens with monthly applications according to Mexican guidelines for immunotherapy.
T200 702139-702301 Sentence denotes An adverse reaction to SSAI (AR) was considered as the presence of any clinical manifestation proposed by the European Academy of Allergy and Clinical Immunology.
T201 702302-702381 Sentence denotes Frequency analysis and survival curve were performed using the software SPSS v.
T202 702382-702385 Sentence denotes 21.
T203 702386-702394 Sentence denotes Results:
T204 702395-702561 Sentence denotes 1,923 patients were included, 3.7% (72) had AR, the average age of the patients was 19 years, 63% were female and 37% male, 67%(48) were children and 33% (24) adults.
T205 702562-702675 Sentence denotes The most frequent allergens detected by skin test and reported as managed with SSAI were Dpt (94%) and Ash (25%).
T206 702676-702863 Sentence denotes Of the 72 patients with AR, 66% were polisensitized (POL) and 34% monosensitized (MONO); 39% received SSAI with standardized allergens (E), 25% with non-standard () and 26% a combination.
T207 702864-703016 Sentence denotes The average duration of the SSAI treatment was 15 months, and the AR was presented during the build up phase at 1:1 concentration in E and 1:200000 in .
T208 703017-703128 Sentence denotes POL patients developed AR earlier than MONO patients, and the same phenomenon was observed when comparing vs E.
T209 703129-703211 Sentence denotes Of those with AR 65% of the cases had mild reactions, 24% moderate and 11% severe.
T210 703212-703223 Sentence denotes Conclusion:
T211 703224-703384 Sentence denotes The polisensitized pediatric patients who received SSAI with non-standardized allergen had mild adverse reactions that were presented earlier in our population.
T212 703385-703389 Sentence denotes R.K.
T213 703390-703404 Sentence denotes Zeldin *1 , Y.
T214 703405-703420 Sentence denotes Amistani 1 , L.
T215 703421-703436 Sentence denotes Paolozzi 1 , U.
T216 703437-703448 Sentence denotes Wahn 2 , 1.
T217 703449-703467 Sentence denotes Antony, France; 2.
T218 703468-703484 Sentence denotes Berlin, Germany.
T219 703485-703496 Sentence denotes Background:
T220 703497-703650 Sentence denotes The efficacy and safety of the 5-grass pollen sublingual tablet has been demonstrated in patients with grass pollen-induced allergic rhinoconjunctivitis.
T221 703651-703743 Sentence denotes Using pooled data from across the development program, we evaluated the safety by age group.
T222 703744-703752 Sentence denotes Methods:
T223 703753-703767 Sentence denotes Patients (age:
T224 703768-703967 Sentence denotes 5-65 years) with medically confirmed grass pollen-induced allergic rhinoconjunctivitis for at least 2 years were included in one of eight double-blind, placebo-controlled studies conducted worldwide.
T225 703968-704036 Sentence denotes IRB/EC approval and informed consent was obtained from all patients.
T226 704037-704229 Sentence denotes Those who received 300IR (9,000 BAU) 5-grass pollen sublingual tablet or placebo were considered for the age subgroup (i.e., children/adolescents [5-17 years] and adults [≥18 years]) analysis.
T227 704230-704283 Sentence denotes Adverse events were monitored throughout the studies.
T228 704284-704354 Sentence denotes Treatment-emergent adverse events (TEAEs) were analyzed descriptively.
T229 704355-704363 Sentence denotes Results:
T230 704364-704488 Sentence denotes 1,878 adults (300IR=1,038; placebo=840) and 312 children/adolescents (300IR=154; placebo=158) were included in the analysis.
T231 704489-704628 Sentence denotes TEAEs were reported by 78% of adults and 84% of children/adolescents receiving active treatment and 66% and 79% of those receiving placebo.
T232 704629-704808 Sentence denotes The most commonly reported TEAEs by both actively-treated subgroups were application site reactions (e.g., oral pruritus, throat irritation, mouth edema), with similar incidences.
T233 704809-704947 Sentence denotes The incidence of severe TEAEs was similar in actively-treated adults (102 patients [9.8%]) and children/adolescents (17 patients [11.0%]).
T234 704948-705184 Sentence denotes Similar percentages of adults and children/adolescents receiving the 300IR sublingual tablets withdrew from the studies due to TEAEs (49 [4.7%] adults and 7 [4.5%] children/adolescents), mainly as a result of application site reactions.
T235 705185-705374 Sentence denotes Three serious TEAEs (hypersensitivity, angioedema and diarrhea) considered related to the study drug by the investigator were reported in adults; none were reported in children/adolescents.
T236 705375-705457 Sentence denotes No activelytreated patients received epinephrine and there were no ICU admissions.
T237 705458-705471 Sentence denotes Con-clusions:
T238 705472-705666 Sentence denotes The incidence, nature and severity of adverse reactions reported during treatment with the 300IR (9,000 BAU) 5-grass pollen sublingual tablet were similar in the adult and pediatric populations.
T239 705667-705671 Sentence denotes D.B.
T240 705672-705686 Sentence denotes Golden *1 , K.
T241 705687-705705 Sentence denotes Abiteboul 2 , R.K.
T242 705706-705719 Sentence denotes Zeldin 2 , 1.
T243 705720-705737 Sentence denotes Baltimore, MD; 2.
T244 705738-705753 Sentence denotes Antony, France.
T245 705754-705765 Sentence denotes Background:
T246 705766-705937 Sentence denotes The efficacy of the 5-grass pollen sublingual tablet has been demonstrated in both mono-and poly-sensitized patients with grass polleninduced allergic rhinoconjunctivitis.
T247 705938-706087 Sentence denotes Using pooled data from across the development program, we report the safety profile according to the sensitization status of patients at study entry.
T248 706088-706096 Sentence denotes Methods:
T249 706097-706169 Sentence denotes Eight double-blind, placebo-controlled studies were conducted worldwide.
T250 706170-706306 Sentence denotes Patients (age 5-65 years) with medically confirmed grass pollen-induced allergic rhinoconjunctivitis for at least 2 years were enrolled.
T251 706307-706375 Sentence denotes IRB/EC approval and informed consent was obtained from all patients.
T252 706376-706501 Sentence denotes At entry, all patients underwent skin testing to 5-grass mix or timothy and a panel of geographically relevant aeroallergens.
T253 706502-706676 Sentence denotes Mono-sensitized patients had a positive test to 5-grass mix/timothy alone and poly-sensitized ones had a positive test to 5-grass/timothy and at least one other aeroallergen.
T254 706677-706805 Sentence denotes Of note, these other sensitizations were not to cause potential confounding symptoms of allergy during the period of evaluation.
T255 706806-706857 Sentence denotes Adverse events were monitored throughout the study.
T256 706858-706928 Sentence denotes Treatment-emergent adverse events (TEAEs) were analyzed descriptively.
T257 706929-706937 Sentence denotes Results:
T258 706938-707066 Sentence denotes A total of 951 patients were mono-sensitized (active=587; placebo=364) and 1,560 were poly-sensitized (active=927; placebo=633).
T259 707067-707450 Sentence denotes Similar incidences of TEAEs were reported in active and placebo groups, whether patients were mono-sensitized (77.2% vs. 67.9%) or poly-sensitized (76.7% vs. 70.9%) and the most frequently reported TEAEs (i.e., application site reactions such as oral pruritus, throat irritation, mouth edema) were reported at similar incidences in actively-treated mono-and poly-sensitized patients.
T260 707451-707590 Sentence denotes Mono-and poly-sensitized patients receiving active treatment reported serious TEAEs with similar frequencies (1.5% and 1.4%, respectively).
T261 707591-707747 Sentence denotes Activelytreated patients withdrew due to TEAEs with similar frequencies whether monosensitized (31 patients [5.3%]) or poly-sensitized (46 patients [5.0%]).
T262 707748-707760 Sentence denotes Conclusions:
T263 707761-707890 Sentence denotes Treatment with the 5-grass pollen sublingual tablet was similarly well tolerated in mono-sensitized and poly-sensitized patients.
T264 707891-707901 Sentence denotes Rationale:
T265 707902-708040 Sentence denotes Allergic rhinitis is frequently associated with ocular symptoms which can have a significant impact on quality of life and daily activity.
T266 708041-708331 Sentence denotes The effect of house dust mite (HDM) sublingual immunotherapy tablet (SLIT-T) on ocular symptoms is unknown; therefore, the efficacy on ocular symptoms of MK-8237 (Merck/ALK-Abelló), a HDM SLIT-T currently under clinical development, was evaluated in an environmental exposure chamber trial.
T267 708332-708340 Sentence denotes Methods:
T268 708341-708565 Sentence denotes Adults with HDM-induced allergic rhinitis with/without conjunctivitis and/or asthma (n=124) received daily MK-8237 12 DU, 6 DU, or placebo for 24 weeks in this randomized, placebo-controlled, double-blind, single-site trial.
T269 708566-708662 Sentence denotes HDM exposure challenges of 6 hours duration were conducted at screening and weeks 8, 16, and 24.
T270 708663-708825 Sentence denotes The total ocular symptom score (TOSS) was assessed and was the sum of 2 scores: gritty/red/itchy eyes and watery eyes, scored on a 0 to 3 point scale (maximum=6).
T271 708826-709003 Sentence denotes Total nasal symptom score (TNSS) was also assessed and was the sum of scores for runny nose, blocked nose, sneezing, and itchy nose, scored on a 0 to 3 point scale (maximum=12).
T272 709004-709069 Sentence denotes IEC approval and informed consent was obtained from all subjects.
T273 709070-709078 Sentence denotes Results:
T274 709079-709163 Sentence denotes Overall 83% of subjects reported ocular symptoms at the screening chamber challenge.
T275 709164-709183 Sentence denotes Improvements of 34.
T276 709184-709198 Sentence denotes 1% Background:
T277 709199-709424 Sentence denotes The efficacy and safety of a sublingual tablet of house dust mite (HDM) allergen extracts was tested in an environmental exposure chamber (EEC) study, in which patients were exposed to a stable concentration of HDM allergens.
T278 709425-709467 Sentence denotes Here, we focus on asthma-related symptoms.
T279 709468-709476 Sentence denotes Methods:
T280 709477-709722 Sentence denotes Adults (18-55 years) with medically confirmed HDM-associated allergic rhinitis were randomized in this double-blind study to receive either placebo or active treatment at the doses of 500IR, 300IR or 100IR with daily administration for 6 months.
T281 709723-709839 Sentence denotes Patients with intermittent asthma controlled with therapies consistent with GINA treatment step 1 could be enrolled.
T282 709840-709905 Sentence denotes IRB approval and informed consent was obtained from all patients.
T283 709906-710019 Sentence denotes During the study, patients participated in five 4-hour allergen challenges in the environmental exposure chamber.
T284 710020-710332 Sentence denotes Analyses were performed to evaluate the incidence of bronchospasm, asthma and asthma-related symptoms, such as dyspnea, cough, wheezing, occurring in relation to the EEC challenges (i.e., peri-EEC periods defined as the day of and the day after an allergen challenge) and that occurring outside of these periods.
T285 710333-710341 Sentence denotes Results:
T286 710342-710501 Sentence denotes 355 patients received at least 1 dose of the investigational product and comprised the safety set (500IR=93; 300IR=86; 100IR=89; placebo=87); 12.7% had asthma.
T287 710502-710640 Sentence denotes During the peri-EEC periods, the incidence of bronchospasm, asthma and asthma-related symptoms was similar across treatment groups (range:
T288 710641-710654 Sentence denotes 36.6%-44.9%).
T289 710655-710778 Sentence denotes The incidence of these symptoms outside of the peri-EEC periods was approximately half of that during these periods (range:
T290 710779-710792 Sentence denotes 16.1%-21.3%).
T291 710793-710879 Sentence denotes The majority of patients experiencing these events did not have asthma at study entry.
T292 710880-711000 Sentence denotes Seven patients in the 3 active treatment groups (none with asthma at baseline) withdrew due to peri-EEC asthma symptoms.
T293 711001-711047 Sentence denotes No Patients withdrew outside of these periods.
T294 711048-711182 Sentence denotes All events were of mild or moderate intensity; 2 resolved without treatment, 4 with inhaled β 2 -agonist, and 1 with an OTC treatment.
T295 711183-711195 Sentence denotes Conclusions:
T296 711196-711391 Sentence denotes Treatment with sublingual tablet of house dust mite allergen extracts tested in an environmental exposure chamber was generally well tolerated and without adverse effects on respiratory function.
T297 711392-711529 Sentence denotes During the challenges, asthma-related symptoms of mild-moderate severity were reported in patients receiving placebo or active treatment.
T298 711530-711668 Sentence denotes Traditionally, immunotherapy consisted of regular (weekly/bi-weekly) injections over several months until a maintenance stage was reached.
T299 711669-711788 Sentence denotes Rush immunotherapy (RIT) allows the patient to achieve a maintenance stage much quicker than traditional immunotherapy.
T300 711789-711918 Sentence denotes The purpose of the current study was to identify whether patients were more or less adherent to treatment when they received RIT.
T301 711919-712013 Sentence denotes A systematic chart review was conducted on all new patients who started immunotherapy in 2011.
T302 712014-712226 Sentence denotes Variables of interest included demographic factors (age, gender, etc.), potential control variables (systemic reactions, prick test results, and asthma diagnosis), RIT (hours), and duration of treatment (months).
T303 712227-712299 Sentence denotes Overall, 199 patients began allergy immunotherapy at the clinic in 2011.
T304 712300-712376 Sentence denotes The average patient was 33 years old, female (65.3%), and Caucasian (81.9%).
T305 712377-712505 Sentence denotes The majority of patients had systemic reactions during their initial screening (92.4%) and was also prick test positive (96.0%).
T306 712506-712708 Sentence denotes The patients were almost evenly divided by asthma diagnosis (yes=59.1%; no=40.9%), but analyses showed no significant differences between these two groups in regards to RIT hours and treatment duration.
T307 712709-712893 Sentence denotes Patients were classified into one of three groups at the time of chart review -(1) still on treatment, (2) stopped treatment without restart, and (3) stopped treatment with restart(s).
T308 712894-713033 Sentence denotes Of the 199 patients who started treatment in 2011, 97 (48.7%) were still receiving treatment with an average therapy duration of 14 months.
T309 713034-713203 Sentence denotes Eighty patients (42.2%) had stopped treatment and had not restarted while 18 patients (9.0%) had stopped treatment and subsequently restarted, some on several occasions.
T310 713204-713418 Sentence denotes The average number of RIT hours for patients still on treatment (M=13.37) was significantly higher than for patients who had stopped treatment (M=8.20) even if they restarted (M=2.64) [F(2, 196) = 15.57, p = .000].
T311 713419-713545 Sentence denotes Further analyses were conducted classifying patients into groups dependent upon the number of RIT hours they received, if any.
T312 713546-713759 Sentence denotes Patients receiving 1-10 RIT hours had significantly lower treatment duration (M=8.3) than patients receiving no RIT (M=14.4), 11-20 RIT hours (17.2), or more than 20 RIT hours (18.77) [F(3,195) = 14.17, p = .000].
T313 713760-713968 Sentence denotes While RIT hours do play a role in treatment duration, results of these analyses suggest that another variable, possibly related to commitment to treatment, may also be involved in the prediction of adherence.
T314 713969-713980 Sentence denotes Background:
T315 713981-714322 Sentence denotes The World Health Organization estimates that 40% of the world population suffers any type of allergic disease lilke allergic rhinitis (AR), currently the mainstay of treatment of AR is the use of topical steroids, however the specific allergy immunotherapy (SAIT) is the only treatment capable of modifying the natural course of the disease.
T316 714323-714632 Sentence denotes Currently the studies that evaluate the SAIT in patients with AR describes a favorable clinical efficacy, however the are performed in monosensitized patients, the results of these investigations have traspolated to polysensitized, without having assessed the same clinical consistency and biological support.
T317 714633-714643 Sentence denotes Objective:
T318 714644-714795 Sentence denotes To evaluate the efficacy of subcutaneous immunotherapy in patients polysensitized (POL) versus monosensitized (MONO) with allergic rhinitis and asthma.
T319 714796-714804 Sentence denotes Methods:
T320 714805-715022 Sentence denotes We enrolled asthmatic patients with AR; skin prick test were developed with ALKbello allergens classifying the groups of study in POL if there are two or more allegens positives in the test and MONO if only has a one.
T321 715023-715088 Sentence denotes SAIT was developed according Mexican guideline for immunotherapy.
T322 715089-715328 Sentence denotes All participants realized spirometry, Asthma Control Test, control of AR symptoms with statement of ARIA in each phase of build up and measure of eosinophils, levels of Ig E and inhaled steroids dosage at the begging and end of this phase.
T323 715329-715462 Sentence denotes Statics was developed using Wilcoxon test compared 0 time vs 4 time in each grupo and U Mann Whitney between the groups with SPSSv21.
T324 715463-715471 Sentence denotes Results:
T325 715472-715963 Sentence denotes 23 patients participated, were xx female and xx male, the average of age was xx years old, 12 patients integrated monosensitized group and 11 polysensitized, the principal allergen was Dpt in both groups, the average of allergens in POL group were 5; FEV1 increases in each group (p = 0.006), there were decrease of 32 % in the dosage of inhaled steroid (p = 0.001) and increased of ACT questionnaire score (p = 0.001),there were not differences in these variable when comparing POL vs MONO.
T326 715964-716079 Sentence denotes The levels of IgE,eosinophils and evaluation of symptoms of AR were similar in 0 vs 4 time in each and both groups.
T327 716080-716092 Sentence denotes Conclusions:
T328 716093-716188 Sentence denotes Immunotherapy has the same efficacy in polysensitized patients as in monosensitized Background:
T329 716189-716356 Sentence denotes Subcutaneous specific allergic immunotherapy (SSAI), in conjunction with drug therapy and patient education, is the cornerstone for the treatment of allergic diseases.
T330 716357-716484 Sentence denotes So far SSAI is the only treatment able to modify the allergic disease in addition to helping prevent the development of asthma.
T331 716485-716529 Sentence denotes Complications of SSAI are rare but possible.
T332 716530-716648 Sentence denotes Currently there is insufficient information to describe the incidence of adverse reactions in daily clinical practice.
T333 716649-716851 Sentence denotes Collecting information that assesses SSAI's safety could help us to identify allergens, dose, time of administration, and other factors in order to reduce the incidence of potentially serious reactions.
T334 716852-716862 Sentence denotes Objective:
T335 716863-716942 Sentence denotes To assess the safety of SSAI in patients with allergic rhinitis from 2005-2014.
T336 716943-716951 Sentence denotes Methods:
T337 716952-717034 Sentence denotes Patients with Allergic rhinitis who received SSAI between 2005-2014 were included.
T338 717035-717158 Sentence denotes SSAI was performed using Alk-Abello® allergens with monthly applications according to Mexican guidelines for immunotherapy.
T339 717159-717322 Sentence denotes An adverse reaction to SSAI (AR) was considered as the presence of any clinical manifestation pro-posed by the European Academy of Allergy and Clinical Immunology.
T340 717323-717402 Sentence denotes Frequency analysis and survival curve were performed using the software SPSS v.
T341 717403-717406 Sentence denotes 21.
T342 717407-717415 Sentence denotes Results:
T343 717416-717582 Sentence denotes 1,923 patients were included, 3.7% (72) had AR, the average age of the patients was 19 years, 63% were female and 37% male, 67%(48) were children and 33% (24) adults.
T344 717583-717696 Sentence denotes The most frequent allergens detected by skin test and reported as managed with SSAI were Dpt (94%) and Ash (25%).
T345 717697-717884 Sentence denotes Of the 72 patients with AR, 66% were polisensitized (POL) and 34% monosensitized (MONO); 39% received SSAI with standardized allergens (E), 25% with non-standard () and 26% a combination.
T346 717885-718037 Sentence denotes The average duration of the SSAI treatment was 15 months, and the AR was presented during the build up phase at 1:1 concentration in E and 1:200000 in .
T347 718038-718149 Sentence denotes POL patients developed AR earlier than MONO patients, and the same phenomenon was observed when comparing vs E.
T348 718150-718232 Sentence denotes Of those with AR 65% of the cases had mild reactions, 24% moderate and 11% severe.
T349 718233-718244 Sentence denotes Conclusion:
T350 718245-718405 Sentence denotes The polisensitized pediatric patients who received SSAI with non-standardized allergen had mild adverse reactions that were presented earlier in our population.
T351 718406-718416 Sentence denotes Rationale:
T352 718417-718528 Sentence denotes Gastroesophageal reflux disease (GERD) is a chronic disease and very common in the evaluation of chronic cough.
T353 718529-718615 Sentence denotes Oftentimes, GERD is silent and patients do not realize they are experiencing symptoms.
T354 718616-718736 Sentence denotes When treated, the dosing of medication is often a significant component in ensuring improvement and efficacy in therapy.
T355 718737-718837 Sentence denotes Yet, under-dosing seems to be a common problem that is not meeting the needs of appropriate therapy.
T356 718838-718846 Sentence denotes Methods:
T357 718847-718933 Sentence denotes 28 patients with GERD (diagnosed by EGD or classic symptoms) were evaluated in clinic.
T358 718934-719033 Sentence denotes The patients had failed conventional proton-pump inhibitor therapy with omeprazole 20mg once daily.
T359 719034-719073 Sentence denotes Patients were randomized to two groups.
T360 719074-719198 Sentence denotes 14 patients were placed on omeprazole 20mg twice daily; the remaining 14 patients were placed on omeprazole 40mg once daily.
T361 719199-719337 Sentence denotes 12 weeks of therapy were performed and the REFLUX-QUAL (RQS) quality of life (QoL) questionnaire was used to evaluate symptom improvement.
T362 719338-719346 Sentence denotes Results:
T363 719347-719488 Sentence denotes The REFLUX-QUAL (RQS) questionnaire is a validated and simple tool consisting of 8 items covering the principal domains of the patients' QoL.
T364 719489-719581 Sentence denotes A score is rapidly obtained ranging from 0 to 100; the higher the score, the better the QoL.
T365 719582-719636 Sentence denotes The median score amongst both groups at Week 0 was 36.
T366 719637-719874 Sentence denotes Patients in the Omeprazole 20mg twice daily group had RQS scores improve by an average of 16 points at Week 12 whereas the 40mg once daily group RQS scores improved by an average of 44 points at Week 12, an almost three-fold improvement.
T367 719875-719965 Sentence denotes Conclusions: GERD is a common diagnostic consideration in the Allergy and Asthma practice.
T368 719966-720093 Sentence denotes It has been my finding that increased frequency (qday vs. BID) of failed omeprazole doses do not alleviate or improve symptoms.
T369 720094-720237 Sentence denotes Rather, it appears that an increased dose of omeprazole is associated with much improved REFLUX-QUAL symptoms scores and quality of life (QoL).
T370 720238-720316 Sentence denotes A steady state of the same failed dose is not appropriate to control symptoms.
T371 720317-720411 Sentence denotes It is likely that this might be a class finding and relatable to other proton pump inhibitors.
T372 720412-720423 Sentence denotes Background:
T373 720424-720537 Sentence denotes There is a paucity of data examining patterns for inpatient pediatric Allergy and Immunology (A/I) consultations.
T374 720538-720548 Sentence denotes Objective:
T375 720549-720683 Sentence denotes This analysis was to determine the reasons for inpatient consultation to the A/I service at a tertiary care pediatric referral center.
T376 720684-720785 Sentence denotes Patient demographics and patterns for establishing A/I follow-up (if recommended) were also examined.
T377 720786-720794 Sentence denotes Methods:
T378 720795-720909 Sentence denotes We performed a retrospective chart review of all inpatient A/I consults from January 1, 2013 to December 31, 2013.
T379 720910-720918 Sentence denotes Results:
T380 720919-721006 Sentence denotes In 2013, 82 inpatient consults were placed to the A/I service, with 76 unique patients.
T381 721007-721120 Sentence denotes Of these, 55 represented patients who had not previously been evaluated by the Section of Allergy and Immunology.
T382 721121-721416 Sentence denotes Fifty-six percent (31/55) of new patient consults were to assess for possible immunodeficiency, 16% (9/55) for angioedema/anaphylaxis, 13% (7/55) for possible food allergy, 7% (4/55) for adverse drug reactions, 5% (3/55) to assist with immunoglobulin replacement therapy, and 2% (1/55) for rash.
T383 721417-721527 Sentence denotes Of the consultations placed for possible immunodeficiency, 71% (22/31) were for patients under 2 years of age.
T384 721528-721689 Sentence denotes The majority of new inpatient consults were requested by Infectious Disease (ID) (23%, 13/55), Hospital Pediatrics (14%, 8/55), and Gastroenterology (13%, 7/55).
T385 721690-721766 Sentence denotes The remaining 50% of consults were placed by 11 other subspecialty services.
T386 721767-721870 Sentence denotes Outpatient A/I follow up was recommended for 31 (56%) of the 55 new patients evaluated in the hospital.
T387 721871-721964 Sentence denotes Of these 31 patients, 55% (17/31) presented to our clinic for scheduled follow up evaluation.
T388 721965-722063 Sentence denotes Established patients of the A/I service accounted for 27 inpatient consults on 22 unique patients.
T389 722064-722182 Sentence denotes Fifty-two percent (14/27) of these consults were for co-management related to a previously diagnosed immunodeficiency.
T390 722183-722317 Sentence denotes The majority (67%, 18/27) of consults for established A/I patients were placed by ID (20%, 11/55) and Hospital Pediatrics (13%, 7/55).
T391 722318-722330 Sentence denotes Conclusions:
T392 722331-722485 Sentence denotes Our review of inpatient A/I consultations demonstrates the need for expert evaluation of both allergic and immunologic disorders in the inpatient setting.
T393 722486-722629 Sentence denotes Additionally, inpatient evaluation by the A/I service is helpful for establishing outpatient A/I follow-up for patients new to the A/I service.
T394 722630-722786 Sentence denotes Understanding the inpatient consultation patterns has implications for A/I fellow training, resident and medical student education, as well as patient care.
T395 722787-722800 Sentence denotes Introduction:
T396 722801-722879 Sentence denotes Many clinicians under-utilize and incorrectly dose epinephrine in anaphylaxis.
T397 722880-723028 Sentence denotes Residents report being confident in diagnosing and managing anaphylaxis despite limited clinical experience with this relatively uncommon condition.
T398 723029-723213 Sentence denotes We designed a simple training module to teach interns how to use an EpiPen®, as well as developed and validated a scoring tool to reliably measure an intern's autoinjector proficiency.
T399 723214-723222 Sentence denotes Methods:
T400 723223-723431 Sentence denotes We developed the EpiPen® proficiency assessment tool (E-PAT), a two-part tool including a checklist that outlines 8 steps of proper autoinjector use and questions about a clinician's prior EpiPen® experience.
T401 723432-723601 Sentence denotes We recruited 58 interns from an ACGMEaccredited internal medicine training program at an academic medical center during orientation where they underwent skills training.
T402 723602-723630 Sentence denotes This study was IRB approved.
T403 723631-723714 Sentence denotes Each intern participated in a 30-minute training module, followed by an assessment.
T404 723715-723791 Sentence denotes First, the interns watched a part of the manufacturer's instructional video.
T405 723792-723875 Sentence denotes Second, an allergist recapped the key points in the video and encouraged questions.
T406 723876-724035 Sentence denotes Third, the interns used EpiPen® trainers to practice on themselves and their colleagues, with the opportunity to receive feedback from the observing allergist.
T407 724036-724199 Sentence denotes Finally, two independent coders (an allergist and a senior resident with allergy training) used the E-PAT to individually assess each intern's EpiPen® proficiency.
T408 724200-724208 Sentence denotes Results:
T409 724209-724250 Sentence denotes All 58 interns participated in the study.
T410 724251-724417 Sentence denotes Prior to this activity, 74% of the interns reported having never used an EpiPen® trainer, none have used an EpiPen® in the past year and 7% have ever used an EpiPen®.
T411 724418-724504 Sentence denotes Over one-third (37%) of the interns knew someone who uses an epinephrine autoinjector.
T412 724505-724666 Sentence denotes After the training, the interns' mean EpiPen® proficiency score was 7.5±0.85 out of a maximum of 8 points (range 6-8), suggesting that this module was effective.
T413 724667-724764 Sentence denotes Inter-rater reliability for each item on E-PAT was high and the overall kappa was 0.63, p<0.0001.
T414 724765-724776 Sentence denotes Conclusion:
T415 724777-724872 Sentence denotes Interns reported limited experience with epinephrine autoinjectors prior to starting residency.
T416 724873-724960 Sentence denotes Our brief training module resulted in high, measurable EpiPen® proficiency immediately.
T417 724961-725016 Sentence denotes E-PAT demonstrated substantial inter-rater reliability.
T418 725017-725163 Sentence denotes Future studies will assess whether residents retain proficiency longitudinally and if E-PAT is equally reliable when used by non-clinician coders.
T419 725164-725175 Sentence denotes Background:
T420 725176-725351 Sentence denotes Several treatment options exist for the treatment of hereditary angioedema (HAE), a rare genetic disease that manifests in episodes of swelling in different parts of the body.
T421 725352-725500 Sentence denotes Attenuated androgens, including danazol, are well established for long-term use but are associated with multiple side effects and contraindications.
T422 725501-725662 Sentence denotes C1 esterase inhibitor concentrate (C1-INH) replaces the missing or dysfunctional protein and is recommended as a firstline treatment by international guidelines.
T423 725663-725680 Sentence denotes Case Description:
T424 725681-725786 Sentence denotes A 51-year-old male patient with HAE had his first symptoms of HAE (abdominal pain) at an age of 13 years.
T425 725787-725848 Sentence denotes He was initially misdiagnosed with indigestion and allergies.
T426 725849-725907 Sentence denotes His first laryngeal attack occurred at an age of 23 years.
T427 725908-726009 Sentence denotes Upon diagnosis of HAE, the patient received a daily dose of 200 mg danazol for long-term prophylaxis.
T428 726010-726122 Sentence denotes During danazol therapy, he experienced side effects, including increased transaminases, and arterial hypertonia.
T429 726123-726211 Sentence denotes Reduction to a daily dose of 100 mg danazol triggered HAE attacks (≥ 1 attack per week).
T430 726212-726385 Sentence denotes When the patient expressed the wish to switch from danazol to C1-INH, he was trained in intravenous self-infusion and learned how to recognize early symptoms of HAE attacks.
T431 726386-726455 Sentence denotes Danazol was then reduced stepwise (tapering down over several weeks).
T432 726456-726677 Sentence denotes During this period, recurrent attacks occurred approximately every 8 days and were successfully treated with self-infusion of human pasteurized nanofiltered C1-INH (pnf-C1-INH, Berinert ® ; CSL Behring, Marburg, Germany).
T433 726678-726738 Sentence denotes Currently, the patient experiences HAE attacks every 5 days.
T434 726739-726808 Sentence denotes All attacks are treated successfully with self-infusion of pnfC1-INH.
T435 726809-726883 Sentence denotes The patient has no side effects and transaminases have returned to normal.
T436 726884-726957 Sentence denotes Arterial hypertonia is ongoing but is well-controlled with lercanidipine.
T437 726958-726970 Sentence denotes Conclusions:
T438 726971-727141 Sentence denotes Self-infusion of pnfC1-INH is an effective and safe alternative for patients with severe HAE who experience side effects or show lack of response to attenuated androgens.
T439 727142-727370 Sentence denotes Before switching from long-term prophylaxis with danazol to acute treatment with pnfC1-INH, we inform the patient about a possible increase of attack frequency and train the patient in intravenous self-administration techniques.
T440 727371-727450 Sentence denotes We do not stop androgens immediately and taper down danazol over several weeks.
T441 727451-727453 Sentence denotes G.
T442 727454-727479 Sentence denotes Steven * , Milwaukee, WI.
T443 727480-727491 Sentence denotes Objectives:
T444 727492-727669 Sentence denotes Health decision-makers involved with treatment, coverage and payment policies are increasingly developing policies that seek information on "real-world" (RW) data base outcomes.
T445 727670-727875 Sentence denotes Motivated by these initiatives, we have begun to develop a framework to assist health-care decision-makers in dealing with RW clinical data, especially related to treatment, coverage and payment decisions.
T446 727876-727884 Sentence denotes Methods:
T447 727885-728078 Sentence denotes Since 2008, a relational database has been developed and refined to complement the EHR by providing clinical decision support in ways that are not currently possible in most certified software.
T448 728079-728333 Sentence denotes Data from skin testing, spirometry, eNO analysis, impulse oscillometry are combined with medication lists, immunotherapy formularies and injection administration records, smoking history, demographics, quality of life assessments and immunization status.
T449 728334-728342 Sentence denotes Results:
T450 728343-728982 Sentence denotes We defined RW clinical information (P4P) as data used for decision-making in day-to-day clinical care that are more practical than the low-level paradigms formulated by data collected in conventional randomized controlled trials (RCTs) "evidence-based medicine." We considered several characterizations: by type of outcome (clinical, economic, and patient-reported), by hierarchies of evidence (which rank evidence according to the strength of research design), and by type of data source (supplementary data collection alongside RCTs, large simple trials, patient registries, administrative claims database, surveys, and medical records).
T451 728983-729008 Sentence denotes P4P data base key issues:
T452 729009-729368 Sentence denotes 1) the importance of RW data; 2) limitations of RW data; 3) data depends on the circumstance; 4) good practices for collecting and reporting RW data; 5)good process in using RW data in coverage and reimbursement decisions; 6) the need to consider costs and benefits of data collection; 7) need for modeling; and 8) the need for continued stakeholder dialogue.
T453 729369-729381 Sentence denotes Conclusions:
T454 729382-729463 Sentence denotes Realworld databases are essential for sound coverage and reimbursement decisions.
T455 729464-729577 Sentence denotes Of greatest utility is our use of clinical data to provide high-level treatment decisions that maximize outcomes.
T456 729578-729793 Sentence denotes It is critical that policymakers recognize the benefits, limitations, and methodological challenges in using RW data from private practice data bases (P4P), and the need to consider carefully the costs and benefits.
T457 729794-729805 Sentence denotes Background:
T458 729806-729960 Sentence denotes Medication errors are a very common problem, which can lead to a range of sequela, including disclosure with no harm to a substantial degree of morbidity.
T459 729961-730059 Sentence denotes As a result, medication reconciliation is being implemented as a formal process in many hospitals.
T460 730060-730282 Sentence denotes Similarly, inaccurate medication allergy lists can lead to increased cost to the system, unnecessary repeat allergy testing, inappropriate or inferior antibiotics being prescribed on readmission or even allergic reactions.
T461 730283-730490 Sentence denotes We hypothesized that the majority of inpatients tested for penicillin allergy were not allergic and that this information was not adequately documented in the EMR or communicated to the general practitioner.
T462 730491-730499 Sentence denotes Methods:
T463 730500-730643 Sentence denotes We retrospectively reviewed the charts of all inpatients at a teaching hospital that were seen by a consultant allergist over the year of 2012.
T464 730644-730830 Sentence denotes Data col-lected included basic demographics, penicillin allergy test results, current allergy status on the EMR, readmission rates, prescribed antibiotics and discharge summary contents.
T465 730831-730839 Sentence denotes Results:
T466 730840-730896 Sentence denotes 146 patients were tested for penicillin allergy in 2012.
T467 730897-730951 Sentence denotes Of these, 144 (98.6%) were not allergic to penicillin.
T468 730952-731170 Sentence denotes Although orders were written in the charts of 145 (99.3%) patients to update their allergy status after testing, 32 (22.23%) of these patients with negative tests were still listed as allergic to penicillin in the EMR.
T469 731171-731324 Sentence denotes Only 19 (15.2%) discharge summaries notified family physicians of the allergy testing results and discharge summaries were missing for 25 (20%) patients.
T470 731325-731489 Sentence denotes Further assessment of 50% of the charts revealed that in 41% of cases the negative allergy test resulted in a change of antibiotics to penicillin or its derivative.
T471 731490-731689 Sentence denotes Of the 60 readmitted patients, 20 (33%) were still listed as allergic to penicillin in the EMR (only one patient tested positive on skin testing) and 14 (70%) of the 20 patients required antibiotics.
T472 731690-731809 Sentence denotes 12 of the 14 patients (86%) were prescribed antibiotics in the penicillin family despite their positive allergy status.
T473 731810-731822 Sentence denotes Conclusions:
T474 731823-732044 Sentence denotes A significant proportion of health records were not amended following antibiotic allergy testing and the patient's new allergy status was not communicated to the majority of general practitioners in the discharge summary.
T475 732045-732197 Sentence denotes A more efficient and reliable system needs to be implemented to ensure changes to allergy status are communicated to all members of the healthcare team.
T476 732198-732200 Sentence denotes G.
T477 732201-732227 Sentence denotes Steven * , Greenfield, WI.
T1 732228-732348 Sentence denotes Clinical and demographic data have been entered in a diagnosis-related administrative database (P4P) at AASC since 2008.
T2 732349-732516 Sentence denotes This database was used to estimate the prevalence of ragweed seasonal allergic rhinitis and to examine the capture of data in P4P, considered in different time frames.
T3 732517-732525 Sentence denotes Methods:
T4 732526-732774 Sentence denotes A case-finding algorithm identified patients with a positive skin test to ragweed among those who had had skin testing done since 1996 and healthcare contact at AASC within the last six years for whom we had current and correct contact information.
T5 732775-732915 Sentence denotes Prevalence rates were calculated as the ratio of the number of identified patients to the total number of allergic rhinitis patients tested.
T6 732916-732924 Sentence denotes Results:
T7 732925-733328 Sentence denotes Of the 6877 skin test records in the database, 534 patients were identified who had at least a moderate SPT to short ragweed (approximately an 8mm wheal or greater), had a diagnosis of allergic rhinitis, were not already on SCIT, had a current email address on file and, based on the prescribing information of the recently approved sublingual ragweed extract tablet, were between the ages of 18 and 65.
T8 733329-733425 Sentence denotes Only 42 of these patients called in to request more information about this new treatment option.
T9 733426-733596 Sentence denotes Since this medication had been only recently approved, we found lack of formulary coverage to be a significant obstacle to getting patients treated with this new therapy.
T10 733597-733863 Sentence denotes Nonetheless, although there was only about 2 weeks' time between the drug appearing in pharmacies and the last day to start therapy this year (12 weeks prior to the start of the RW season, per the package insert), we were able to initiate treatment with 12 patients.
T11 733864-733876 Sentence denotes Conclusions:
T12 733877-734268 Sentence denotes Clinical and administrative healthcare databases in private practice today can be important tools in identifying populations that may benefit from new therapies, notifying patients of new information (e.g., boxed warnings) regarding medications they are currently taking, as well as identify potentially eligible patients for clinical research trials as part of the drug development process.
T13 734269-734404 Sentence denotes However, data collection needs to be judicious, relevant and used on a daily basis in order to have a positive impact on clinical care.
T14 734405-734416 Sentence denotes Background:
T15 734417-734494 Sentence denotes Allergic diseases affect 40% of the population with an increasing prevalence.
T16 734495-734696 Sentence denotes In the SIDRIA study, prevalence of allergic diseases changed with the age: asthma and rhinitis raised (respectively from 9.3% to 10.3% and 12.3% to 20.9%), while eczema decreased (from 15.9% to 11.9%).
T17 734697-734743 Sentence denotes However, data on younger children are lacking.
T18 734744-734925 Sentence denotes The aim of the present study is to assess the prevalence of allergic and respiratory diseases as well as related risk factors in a population of 3 to 5 years old preschool children.
T19 734926-734934 Sentence denotes Methods:
T20 734935-735020 Sentence denotes The study includes children attending 4 Nursery Schools in an urban district of Rome.
T21 735021-735151 Sentence denotes Data on the allergic diseases were collected using standardized questionnaire (SIDRIA-2) and Skin prick tests (SPT) was performed.
T22 735152-735363 Sentence denotes We investigated the association of atopy, rhinitis, wheezing and asthma with a list of potential deter-minants, calculating the Odds Ratios (OR) and 95% Confidence Limits (95%CI) from logistic regression models.
T23 735364-735372 Sentence denotes Results:
T24 735373-735425 Sentence denotes 494 children (46% male) aged 3-6 years were studied.
T25 735426-735517 Sentence denotes More than 75% were breastfed (> 2 months) and 87% were weaned after the 5 th month of life.
T26 735518-735619 Sentence denotes Most of them started attending school after the 11 th months and 64% had previously attended daycare.
T27 735620-735834 Sentence denotes Sixty-seven percent of children had at least 1 sibling; 72.3% lived at home with at least other 3 persons; 42% reported to live in a street with heavy traffic; 20.6% had a pet at home, and 22.9% had smoking parent.
T28 735835-735871 Sentence denotes SPT was positive in 12% of children.
T29 735872-735938 Sentence denotes Asthma was positively associated with nationality not Italian (OR:
T30 735939-735951 Sentence denotes 2.54, 95%CI:
T31 735952-735991 Sentence denotes 1.09-5.92), breastfeeding >1 month (OR:
T32 735992-736004 Sentence denotes 2.78, 95%CI:
T33 736005-736040 Sentence denotes 0.97-7.97), daycare attendance (OR:
T34 736041-736053 Sentence denotes 2.26, 95%CI:
T35 736054-736085 Sentence denotes 1.14-4.52), mother's atopy (OR:
T36 736086-736098 Sentence denotes 2.04, 95%CI:
T37 736099-736130 Sentence denotes 1.13-3.66), and dermatitis (OR:
T38 736131-736143 Sentence denotes 2.02, 95%CI:
T39 736144-736155 Sentence denotes 1.13-3.61).
T40 736156-736224 Sentence denotes Allergic rhinitis was positively associated with father's atopy (OR:
T41 736225-736237 Sentence denotes 3.11, 95%CI:
T42 736238-736269 Sentence denotes 1.30-7.44), and dermatitis (OR:
T43 736270-736282 Sentence denotes 11.6, 95%CI:
T44 736283-736294 Sentence denotes 4.52-29.6).
T45 736295-736359 Sentence denotes Atopic status was positively associated with mother's atopy (OR:
T46 736360-736372 Sentence denotes 2.09, 95%CI:
T47 736373-736384 Sentence denotes 1.15-3.77).
T48 736385-736396 Sentence denotes Conclusion:
T49 736397-736592 Sentence denotes Our study found a high prevalence of atopic sensitization in children under five years, and confirms the high prevalence of allergic diseases, to an extent comparable to those seen later in life.
T50 736593-736805 Sentence denotes The mother's atopy increases the risk of developing asthma, father's atopy increases the risk of allergic rhinitis while pollutants (smoke and vehicular traffic) are not significant risk factors in these setting.
T51 736806-736819 Sentence denotes Introduction:
T52 736820-736902 Sentence denotes Breastfeeding and vaginal delivery are known to be beneficial to a child's health.
T53 736903-737101 Sentence denotes This study investigates the prevalence of atopic disorders in children who are breastfed versus bottle fed and method of delivery, spontaneous vaginal delivery (SVD) or cesarean section (C-section).
T54 737102-737110 Sentence denotes Methods:
T55 737111-737226 Sentence denotes A retrospective chart review was conducted on 100 patients 0.5 to 17 years of age (average 6.3 years of age ± 4.3).
T56 737227-737317 Sentence denotes Patients were separated by duration of breastfeeding or formula fed with no breastfeeding.
T57 737318-737480 Sentence denotes Breastfed infants and toddlers were subdivided into 5 groups based on length of feeding, <3 months, 3-<6 months, 6-<9 months, 9-<12 months, and 12 or more months.
T58 737481-737739 Sentence denotes Prevalence of atopic skin disorders, such as eczema and atopic dermatitis (AD), Immunoglobulin E (IgE) disorders, such as food allergies, asthma, allergic rhinitis (AR), and a family history of pertinent atopic diseases (FHX) were identified in each patient.
T59 737740-737771 Sentence denotes Student's t test was performed.
T60 737772-737780 Sentence denotes Results:
T61 737781-737840 Sentence denotes Out of the 100 children, 52 were males and 48 were females.
T62 737841-737960 Sentence denotes The children breastfed for 9-<12 months and born via SVD group had the lowest atopic skin disorders, but had a low FHX.
T63 737961-738104 Sentence denotes The 6-<9 months breastfed and born via C-section group had the lowest amount of IgE disorders, but the highest amount of atopic skin disorders.
T64 738105-738161 Sentence denotes The 6-<9 months breastfed SVD group had the highest FHX.
T65 738162-738237 Sentence denotes The 12+ months breastfed SVD group had the highest number of IgE disorders.
T66 738238-738332 Sentence denotes All breastfed children had a lower occurrence of atopic skin disorders with a p value of 0.02.
T67 738333-738485 Sentence denotes With regards to breast fed versus formula fed, the 9-<12 months breastfed group had the lowest atopic skin disorders, IgE disorders, and FHX prevalence.
T68 738486-738564 Sentence denotes The 6-<9 months breastfed group had the highest atopic skin disorders and FHX.
T69 738565-738639 Sentence denotes The <3 months breastfed group had the highest occurrence of IgE disorders.
T70 738640-738651 Sentence denotes Conclusion:
T71 738652-738833 Sentence denotes Breastfeeding for 9-<12 months seemed to reduce the amount of atopic skin disorders and IgE disorders; however, the genetic lack of prevalence of atopy may explain this observation.
T72 738834-738897 Sentence denotes Children breastfed for <3 months had higher incidence of atopy.
T73 738898-739095 Sentence denotes Patients that were born via SVD were shown to have a less likely occurrence of atopic skin disorders and FHX and a higher occurrence of an IgE disorder when compared to patients born via C-section.
T74 739096-739176 Sentence denotes A future study with a larger population size is needed to confirm these results.
T75 739177-739345 Sentence denotes Rationale: TMJ, or temporo-mandibular joint disease, is a common disorder with significant morbidity affecting the quality of life for many people in the United States.
T76 739346-739476 Sentence denotes TMJ is more common in non-hispanic Caucasian women and has been attributed to pain threshold, behavioral factors, and past trauma.
T77 739477-739574 Sentence denotes However, to date no clear etiology has been identified and this disease is likely multifactorial.
T78 739575-739726 Sentence denotes Characterized primarily by pain, headache, and ear pain, TMJ is very difficult to treat given the complex nerve root anatomy of the skull and foramina.
T79 739727-739954 Sentence denotes Given the significant morbidity TMJ carries on patients, we hypoth-esize a correlation between the presence of TMJ symptoms and the Epworth sleep score which measures degree of daytime drowsiness during a variety of activities.
T80 739955-739963 Sentence denotes Methods:
T81 739964-740152 Sentence denotes After informed consent and IRB approval, 44 subjects were identified to have doctor diagnosed TMJ consisting of a constellation of tenderness to palpation over the TMJ with joint movement.
T82 740153-740255 Sentence denotes 763 subjects did not have clinically diagnosed TMJ in a university academic allergy/immunology clinic.
T83 740256-740264 Sentence denotes Results:
T84 740265-740407 Sentence denotes The average Epworth Sleepiness Scale (ESS) score amongst subjects with TMJ was 7.8 in comparison to controls with an average ESS score of 7.1.
T85 740408-740420 Sentence denotes Conclusions:
T86 740421-740522 Sentence denotes Our results show a positive correlation between the presence of TMJ symptoms and Epworth sleep score.
T87 740523-740725 Sentence denotes Our findings indicate a need to further evaluate the relationship between TMJ symptoms, day time sleepiness, and the role of sleep hygiene in symptomatic TMJ patients to improve patient quality of life.
T88 740726-740728 Sentence denotes Q.
T89 740729-740741 Sentence denotes Meng *1 , S.
T90 740742-740758 Sentence denotes Nagarajan 1 , L.
T91 740759-740773 Sentence denotes Bielory 2 , 1.
T92 740774-740792 Sentence denotes Piscataway, NJ; 2.
T93 740793-740809 Sentence denotes Springfield, NJ.
T94 740810-740821 Sentence denotes Background:
T95 740822-740947 Sentence denotes The prevalence of allergy skin test (IST), ocular and nasal symptoms (ONS), and asthma has been reported from N-II and N-III.
T96 740948-741020 Sentence denotes However, the associations of among these symptoms over time are unknown.
T97 741021-741131 Sentence denotes Methods: N-II (1976 -1980 and N-III (1988 N-III ( -1994 collected allergy IST data, ONS and asthma prevalence.
T98 741132-741288 Sentence denotes IST, ONS and asthma results were assessed for 6 common allergens (Ags) to N-II and N-III: cat, ragweed, perennial rye, oak, Bermuda grass, and A. alternata.
T99 741289-741387 Sentence denotes The IST+ (sensitized for 1 or more Ags) populations were then assessed for ONS, and asthma status.
T100 741388-741495 Sentence denotes ONS was identified using survey responses and asthmatics based on having a history and still having asthma.
T101 741496-741607 Sentence denotes The associations among IST, ONS and asthma were characterized with contingency tables and correlation analyses.
T102 741608-741703 Sentence denotes Results: IST+, ONS, and asthma status were collected from N-II (n=11,044) and N-III (n=10,833).
T103 741704-741833 Sentence denotes The number of IST+(n=2144), ONS(n=991), and asthma(n=275) from N-II; and IST+(n=4538), ONS(n=3242), and asthma(n=547) from N-III.
T104 741834-741933 Sentence denotes Comparing N-II to N-III, the prevalence increased: asthma 2.0 times, IST+ 2.2 times, ONS 3.3 times.
T105 741934-742031 Sentence denotes The concurrent prevalence of asthma, ONS, and +IST increased 5.3 times (all p< 0.0001; Χ 2 test).
T106 742032-742105 Sentence denotes From N-II to N-III, sensitivity increased to an increasing number of Ags.
T107 742106-742194 Sentence denotes ONS prevalence in N-III was 2-3 times > N-II (p< 0.0001, except for all 6 Ags, p=0.069).
T108 742195-742355 Sentence denotes Within each NHANES survey, the associations among +IST, ONS and asthma were all statistically significant with stronger associations observed in N-III vs. N-II.
T109 742356-742489 Sentence denotes Correlation coefficients between asthma and positive skin tests doubled or tripled in N-III (r=0.04 in N-II & 0.12 in N-III for oak).
T110 742490-742638 Sentence denotes A linear association (p< 0.0001) between the cumulative number of IST+ (ranging from 0-6) and the prevalence of ONS or asthma was stronger in N-III.
T111 742639-742650 Sentence denotes Conclusion:
T112 742651-742772 Sentence denotes From N-II to N-III, the prevalence of asthma, ONS, and IST increased with greatest associated with more than one symptom.
T113 742773-742846 Sentence denotes From N-II to N-III, sensitivity increased to an increasing number of Ags.
T114 742847-742929 Sentence denotes The associations among IST, ONS, and asthma became stronger during N-III vs. N-II.
T115 742930-743094 Sentence denotes Supported in part by US EPA STAR Grant #: RD834547; Observational, Laboratory, and Modeling Studies of the Impacts of Climate Change on Allergic Airway Disease; PI:
T116 743095-743116 Sentence denotes Leonard Bielory, M.D.
T117 743117-743119 Sentence denotes M.
T118 743120-743132 Sentence denotes Hogan 1 , A.
T119 743133-743152 Sentence denotes Wonnaparhown 2 , R.
T120 743153-743167 Sentence denotes Scherr *2 , N.
T121 743168-743181 Sentence denotes Wilson 2 , 1.
T122 743182-743194 Sentence denotes Reno, NV; 2.
T123 743195-743209 Sentence denotes Las Vegas, NV.
T124 743210-743223 Sentence denotes Introduction:
T125 743224-743358 Sentence denotes Eosinophilic esophagitis (EE) is an inflammatory esophagitis which can be associated with IgE sensitization to food and aeroallergens.
T126 743359-743494 Sentence denotes Food avoidance, swallowed glucocorticosteriods, and proton pump inhibitors have been utilized therapeutically in pediatric EE patients.
T127 743495-743554 Sentence denotes Information regarding pediatric follow-up of EE is limited.
T128 743555-743563 Sentence denotes Methods:
T129 743564-743819 Sentence denotes Patients (1-18 years) with biopsy proven EE co-managed with pediatric GI from 2010-2013 in the UNSOM A/I clinic and having at least one follow-up visit were evaluated retrospectively for skin test IgE sensitization to food, aeroallergens, and EE symptoms.
T130 743820-743890 Sentence denotes Statistics were performed with Fischer's exact test with graphpad.com.
T131 743891-743918 Sentence denotes IRB exclusion was obtained.
T132 743919-743927 Sentence denotes Results:
T133 743928-743987 Sentence denotes 23 children with EE meeting study criteria were identified.
T134 743988-744095 Sentence denotes IgE sensitization occurred to food in 87%, aeroallergens 96% and 87% of children had sensitization to both.
T135 744096-744366 Sentence denotes A/I and GI therapy for EE and AR increased after the first A/I visit with 9/23 swallowing GCS, 3/23 on proton pump inhibitors, 8/23 avoiding most likely contributing foods and 16/23 with prescribed aeroallergen avoidance or immunotherapy for allergic rhinitis or/asthma.
T136 744367-744452 Sentence denotes Most common food sensitizations identified were legumes (14/23) and tree nuts (8/20).
T137 744453-744498 Sentence denotes Other foods were noted at lesser frequencies.
T138 744499-744659 Sentence denotes Common aeroallergens identified in the population in order of frequency were cat 69%, sagebrush 63%, maple 61%, dog 57% and timothy 54% of the study population.
T139 744660-744786 Sentence denotes Eosinophilic esophagitis symptoms of stomachache (p<0.037) and GERD/heartburn (p<0.033) improved with this comprehensive care.
T140 744787-744798 Sentence denotes Conclusion:
T141 744799-744940 Sentence denotes Pediatric EE is a complex inflammatory disease with multiple possible triggers and follow-up information after initial evaluation is limited.
T142 744941-745013 Sentence denotes Aeroallergens and food IgE sensitization was notable in this population.
T143 745014-745172 Sentence denotes Comprehensive care in this population resulted in decreased GI symptoms of pain and should be studied further as a working model to improve pediatric EE care.
T144 745173-745186 Sentence denotes Introduction:
T145 745187-745321 Sentence denotes National training programs answer to the Accreditation Council for Graduate Medical Education (ACGME) to meet competency requirements.
T146 745322-745430 Sentence denotes Allergy and Immunology (AI) requirements include core competency achievements in allergy (hypersensitivity).
T147 745431-745629 Sentence denotes Methods that empower learners to take ownership in their own course curriculum are not standard, yet can maximize content retention important for accreditation, exam scores and practice performance.
T148 745630-745735 Sentence denotes Our objective was to develop an innovative and effective Hypersensitivity Course (HSC) by/for AI fellows.
T149 745736-745744 Sentence denotes Methods:
T150 745745-745982 Sentence denotes Needs assessment was performed for actual competence and perceived efficacy in aeroallergen diagnostics, allergic disorders and procedures, based on in-training exam results, patient/procedure logs and confidence/experience/satisfaction.
T151 745983-746170 Sentence denotes Gaps in allergy knowledge, practice and self-efficacy were identified and fellows became partners in creating an allergy-focused and shared-group interactive course with expert oversight.
T152 746171-746279 Sentence denotes Modified flipped design with project-based learning and reallife applications to master allergy was applied.
T153 746280-746625 Sentence denotes Results: AI fellows successfully designed (2008-2009) and implemented (2009-2014) their own HSC course to master ACGME AI competencies in allergic diseases/procedures, aeroallergen identification and desensitizations, and continue to modulate it (by practice parameters/literature updates and learner needs) and teach it (weekly-10 months/year).
T154 746626-746934 Sentence denotes All HSC AI fellows (2008-2014) reached increased in-training exam scores and board pass rates (100%), met log requirements to 50%ile (2013-2014), ranked it highest among courses, achieved increased allergy selfefficacy and, in 2013, earned the ACGME David Leach Award for a traineedriven educational program.
T155 746935-747106 Sentence denotes Conclusion: HSC AI fellows conquered comprehension-performance in allergic diseases and procedures with confidence and competence through becoming teachers while learners.
T156 747107-747215 Sentence denotes They became empowered as leaders in their own sustainable curriculum for themselves and their clinical team.
T157 747216-747393 Sentence denotes Their HSC methods may serve as a feasible and effective model not only for meeting AI training requirements but also for those seeking mastery in allergy practice and knowledge.
T158 747394-747396 Sentence denotes K.
T159 747397-747410 Sentence denotes Kulich 1 , B.
T160 747411-747426 Sentence denotes Tiplady *2 , D.
T161 747427-747441 Sentence denotes Banerji 3 , 1.
T162 747442-747464 Sentence denotes Basel, Switzerland; 2.
T163 747465-747497 Sentence denotes Peterborough, United Kingdom; 3.
T164 747498-747528 Sentence denotes East Hanover, NJ Introduction:
T165 747529-747695 Sentence denotes Patient-reported outcomes are increasingly important in evaluating the severity and impact of chronic conditions such as chronic obstructive pulmonary disease (COPD).
T166 747696-747818 Sentence denotes Electronic patient diaries (eDiaries) have been found to be highly acceptable to patients, who often prefer them to paper.
T167 747819-747952 Sentence denotes Also, eDiaries allow time-stamping of entries, automatic tailoring of entries to the time of day, and limit entries to valid options.
T168 747953-747961 Sentence denotes Methods:
T169 747962-748138 Sentence denotes Qualitative patient interviews have been used in the development of a new COPD eDiary, which includes five symptom items and two impact items rating bother and difficulty (BD).
T170 748139-748262 Sentence denotes Two morning assessments (since awakening, M1; since last assessment, M2) and one evening assessment (E) were made each day.
T171 748263-748372 Sentence denotes The eDiary was completed by a subset of 209 patients (140 males, aged 44 -86) in a 26week QVA149 SHINE study.
T172 748373-748381 Sentence denotes Results:
T173 748382-748480 Sentence denotes Patient compliance with the eDiary was 90.1% over the 7-day baseline period, and 80.0% at Week 26.
T174 748481-748728 Sentence denotes The frequencies of reporting of each of the 5 symptoms were ≥60% of baseline, with shortness of breath, mucus/phlegm and cough occurring in ≥70% entries while chest tightness and wheezing occurring in ≥60% of entries over the 26-week study period.
T175 748729-748820 Sentence denotes Exploratory factor analysis gave a single factor, including both symptoms and the BD items.
T176 748821-748954 Sentence denotes Internal consistency was extremely high, being >0.95 for all three assessment points (M1, M2 and E) at baseline, Week 12 and Week 26.
T177 748955-749074 Sentence denotes Thus the scale is unidimensional, so that the overall mean of the seven items (OM7) could be used as a summary measure.
T178 749075-749194 Sentence denotes Test-retest reliability was assessed in 44 patients who showed no change in their symptoms between baseline and Week 1.
T179 749195-749288 Sentence denotes The intraclass correlation coefficients (ICC) for OM7 were 0.97 for M1 and M2 and 0.96 for E.
T180 749289-749343 Sentence denotes The lower 95% confidence limit was >0.92 in all cases.
T181 749344-749611 Sentence denotes The eDiary was sensitive to change: the effect size for change over 26 weeks in patients identified as having improved on both clinical and patient global measures, was large (0.79) as compared to a minimal change in patients classified as uncertain/no change (0.16).
T182 749612-749755 Sentence denotes Anchor-based comparison suggests that a change of 0.6 on the OM7 Score of the eDiary (range 0-10) represented a meaningful change for patients.
T183 749756-749767 Sentence denotes Conclusion:
T184 749768-749894 Sentence denotes The new COPD eDiary showed good measurement properties, being valid, reliable, internally consistent, and sensitive to change.
T185 749895-750153 Sentence denotes Eosinophilic esophagitis (EoE) is a chronic, immune/food antigen-mediated disease characterized clinically by esophageal dysfunction and histologically by eosinophil-predominant inflammation with overexpression of cytokines, including interleukin 13 (IL-13).
T186 750154-750303 Sentence denotes RPC4046 (previously known as ABT-308) is a humanized, high-affinity, neutralizing antibody that prevents IL-13 binding to both IL-13Rα1 and IL-13Rα2.
T187 750304-750446 Sentence denotes The first-in-human (FIH) study (NCT00986037) was a single center, randomized, double-blind, placebo-controlled, 3-part, dose escalation study.
T188 750447-750686 Sentence denotes RPC4046 was administered to healthy volunteers (HV) and patients with mild to moderate, controlled asthma to assess the safety, tolerability and PK of single escalating intravenous (IV) doses or multiple escalating subcutaneous (SC) doses.
T189 750687-750789 Sentence denotes Twenty HV and 15 asthma patients received single IV infusions of RPC4046 (0.3 to 10 mg/kg) or placebo.
T190 750790-750891 Sentence denotes Subsequently, 12 asthma patients received 3 weekly SC doses of RPC4046 (0.3 or 3.0 mg/kg) or placebo.
T191 750892-750966 Sentence denotes IRB approval and informed consent was obtained from all research subjects.
T192 750967-751078 Sentence denotes RPC4046 pharmacokinetic (PK) parameters were similar after a single IV infusion between HV and asthma patients.
T193 751079-751209 Sentence denotes Following multiple SC administration, T max was ~4 days, exposure was dose-proportional and the absolute bioavailability was ~70%.
T194 751210-751353 Sentence denotes In 27.8% of subjects receiving RPC4046, measurable anti-drug antibodies were detected transiently, which did not appear to affect PK or safety.
T195 751354-751448 Sentence denotes The AE profile was similar in HV and asthma patients and with different administration routes.
T196 751449-751567 Sentence denotes For RPC4046 subjects, all AEs were mild to moderate in severity, with none reported as probably related to study drug.
T197 751568-751647 Sentence denotes There were no dose-related increases in AEs and no discontinuations due to AEs.
T198 751648-751784 Sentence denotes The proportion of subjects reporting an upper respiratory tract infection was greater among those receiving RPC4046 compared to placebo.
T199 751785-751911 Sentence denotes A single SAE of worsening foot bunion was reported in Group 1 HV and considered not related to study drug by the investigator.
T200 751912-752010 Sentence denotes There were no study drug related infusion-related reactions and no suggestion of worsening asthma.
T201 752011-752196 Sentence denotes These results support further investigation of RPC4046 for allergic/inflammatory diseases involving IL-13, including the ongoing phase 2 clinical trial in adults with EoE (NCT02098473).
T202 752197-752631 Sentence denotes PK Parameters (Mean ± SD) of RPC4046 Following a Single IV Infusion in Healthy and Asthma Subjects a N = 4 for Cmax and Cmax/Dose for Groups 2 and 3 b Mean ± SD c Harmonic mean ± pseudo-standard deviation Previously, we have shown the efficacy of Omalizumab, a recombinant, humanized, chimeric anti-IgE monoclonal antibody, for the treatment of Severe Chronic Idiopathic Urticaria (CIU) patients not controlled on oral antihistamines.
T203 752632-752965 Sentence denotes Clinical observations have led us to believe that sulfasalazine, an antiinflammatory agent, composed of a sulfapyridine covalently linked to 5-aminosalicylic acid, may provide additional efficacy in sub optimally controlled Chronic Idiopathic Urticaria (CIU) patients that remain symptomatic on an H1-Receptor Antagonist, Cetirizine.
T204 752966-753466 Sentence denotes In this open labeled 16 week trial, 60 adult patients with symptomatic Severe Chronic Idiopathic Urticaria using Cetirizine, 10 mg orally QD, were randomized to continue the existing therapy Cetirizine or to add on Sulfasalazine 500 mg oral tablets (increased by 500mg weekly) until control of clinical symptoms occurred or until reaching a maintenance dose according to patient's weight, 30 to 50 mg/kg per day, in 2 evenly divided doses, not to exceed 2g per day to the existing therapy Cetirizine.
T205 753467-753542 Sentence denotes The end points of the trial include: weekly itch severity score on a scale.
T206 753543-753773 Sentence denotes The mean of measurements at the end of the 16-week trial revealed a significant improvement in all parameters examined in the treatment group receiving Sulfasalazine (as addon to the existing therapy), compared to the other group.
T207 753774-753953 Sentence denotes In conclusion, the addition of Sulfasalazine to the combination of Cetirizine is more effective than Cetirizine, for the treatment of Severe Chronic Idiopathic Urticaria patients.
T208 753954-754114 Sentence denotes It appears that when Sulfasalazine is added to the combination H1-receptor antagonist, Cetirizine, the end points and symptom scores are significantly improved.
T209 754115-754117 Sentence denotes R.
T210 754118-754131 Sentence denotes Furcha 1 , A.
T211 754132-754144 Sentence denotes Amin *2 , 1.
T212 754145-754166 Sentence denotes Nyon, Switzerland; 2.
T213 754167-754182 Sentence denotes Parsippany, NJ.
T214 754183-754196 Sentence denotes Introduction:
T215 754197-754429 Sentence denotes An over-the-counter (OTC) cough and cold syrup containing paracetamol, phenylephrine, and guiafenesin was reformulated with flavour agent 316282, which has been shown to cause a warming sensation in the mouth and back of the throat.
T216 754430-754549 Sentence denotes This agent is included for the taste of the product, but also may have a soothing effect appropriate to the indication.
T217 754550-754676 Sentence denotes The ability of a warming sensation to help patients suffering from cough, cold, and flu feel better is well known anecdotally.
T218 754677-754844 Sentence denotes However, there are no studies to date that have evaluated the warming sensation of liquids, rubs, or drug ingredients in terms of patient acceptability and preference.
T219 754845-754855 Sentence denotes Objective:
T220 754856-754973 Sentence denotes We sought to assess the warming sensation associated with the flavour agent 316282 in terms of patient acceptability.
T221 754974-754982 Sentence denotes Methods:
T222 754983-755061 Sentence denotes This was a single dose, single cohort, single treatment arm, open-label study.
T223 755062-755228 Sentence denotes Subjects received one 30 mL dose of syrup containing paracetamol (500 mg), phenylephrine (10 mg), guaifenesin (200 mg) and flavour agent 316282 (0.15% weight/volume).
T224 755229-755457 Sentence denotes Onset and duration of the warming sensation in the mouth/throat were recorded, and subjective assessments of strength and appeal of the sensation and overall acceptability of the product as a cough and cold remedy were surveyed.
T225 755458-755565 Sentence denotes IRB/HAC approval and informed consent was obtained from all research subjects (or parents for adolescents).
T226 755566-755574 Sentence denotes Results:
T227 755575-755674 Sentence denotes Of 51 subjects included, 47 (92.1%) experienced a warming sensation within 60 seconds of ingestion.
T228 755675-755753 Sentence denotes The median duration of the sensation was 100 seconds (95% Confidence Interval:
T229 755754-755771 Sentence denotes 82, 112 seconds).
T230 755772-755917 Sentence denotes Most subjects (71%) liked the warming sensation; no subjects expressed significant dislike (i.e., very much or extreme dislike) of the sensation.
T231 755918-756099 Sentence denotes About 67% thought the strength of warming was "just about right." There were no safety concerns, and the syrup was well tolerated and effective for treating cough and cold symptoms.
T232 756100-756112 Sentence denotes Conclusions:
T233 756113-756260 Sentence denotes The flavour agent 316282 is associated with a warming sensation, which may be a desirable attribute for a cough and cold product for some patients.
T234 756261-756348 Sentence denotes Lack of a control group -i.e., unflavored syrup -limits interpretation of the findings.
T235 756349-756447 Sentence denotes More data are needed to overcome the challenge of appropriate controls for these types of studies.
T236 756448-756454 Sentence denotes MO; 2.
T237 756455-756471 Sentence denotes New York, NY; 3.
T238 756472-756488 Sentence denotes Stockton, CA; 4.
T239 756489-756505 Sentence denotes Bellevue, NE; 5.
T240 756506-756537 Sentence denotes Ingelheim am Rhein, Germany; 6.
T241 756538-756561 Sentence denotes Groningen, Netherlands.
T242 756562-756573 Sentence denotes Background:
T243 756574-756709 Sentence denotes In many patients (pts) current asthma control is inadequate, resulting in impaired quality of life and increased risk of exacerbations.
T244 756710-756872 Sentence denotes T helper 2 (T H 2) immune response mediates allergic airway inflammation, may influence individual asthma expression, and is the target of many asthma treatments.
T245 756873-757097 Sentence denotes Once-daily tiotropium Respimat ® add-on to at least medium-dose inhaled corticosteroid (ICS) ± long-acting β 2 -agonist (LABA) maintenance therapy provides sustained lung function improvements in pts with symptomatic asthma.
T246 757098-757347 Sentence denotes Pre-specified analyses of pooled data from replicate Phase III, randomized, double-blind, placebo-controlled, parallel-group trials were performed to assess whether tiotropium Respimat ® treatment response was dependent on T H 2 inflammatory status.
T247 757348-757356 Sentence denotes Methods:
T248 757357-757768 Sentence denotes Pts with severe symptomatic asthma (PrimoTinAasthma ® , n=912) from two 48-week trials of tiotropium Respimat ® 5 mg addon to high-dose ICS (≥800 mg budesonide or equivalent) + LABA, and pts with moderate symptomatic asthma (MezzoTinA-asthma ® , n=2100) from two 24week trials of tiotropium Respimat ® 5 mg or 2.5 mg or salmeterol add-on to medium-dose ICS (400-800 mg budesonide or equivalent), were evaluated.
T249 757769-758050 Sentence denotes Peak and trough forced expiratory volume in 1 second (FEV 1 ) were assessed (pooled data) in the T H 2-low and T H 2-high subgroups according to baseline total serum IgE ≤ or >430 mg/L, blood eosinophils ≤ or >0.6×10 9 /L, and clinical judgment of allergic asthma as "no" or "yes".
T250 758051-758069 Sentence denotes COPD was excluded.
T251 758070-758078 Sentence denotes Results:
T252 758079-758227 Sentence denotes 3012 pts were included in the treated set, with baseline demographics and disease characteristics balanced between treatment regimens and subgroups.
T253 758228-758429 Sentence denotes Peak and trough FEV 1 responses were improved with tiotropium Respimat ® versus placebo, independent of total serum IgE level, blood eosinophil count, and clinical judgment of allergic asthma (Table) .
T254 758430-758515 Sentence denotes Safety and tolerability of tiotropium Respimat ® were balanced compared with placebo.
T255 758516-758527 Sentence denotes Conclusion:
T256 758528-758765 Sentence denotes Once-daily tiotropium Respimat ® add-on to at least medium-dose ICS ± LABA maintenance therapy provides sustained improvements in lung function, independent of T H 2 inflammatory status, in pts with moderate or severe symptomatic asthma.
T257 758766-758871 Sentence denotes Tiotropium Respimat ® add-on therapy may therefore be beneficial in both allergic and nonallergic asthma.
T258 758872-759000 Sentence denotes Adjusted mean difference for tiotropium Respimat® versus placebo at Week 24 (mL) aValues for active and placebo groups combined.
T259 759001-759294 Sentence denotes Pts may be included in more than one subanalysis; bFor treatment × subgroup interaction BID, twice-daily; QD, once-daily DX-2930 is a fully human monoclonal antibody inhibitor of plasma kallikrein (pKal) under investigation for prophylaxis against acute attacks of hereditary angioedema (HAE).
T260 759295-759451 Sentence denotes It is well established that pKal plays a critical role in HAE pathogenesis but the minimum level of pKal inhibition necessary to prevent attacks is unknown.
T261 759452-759678 Sentence denotes We hypothesize that continuously maintaining levels of pKal inhibition associated with peak plasma drug levels (80 nM) of ecallantide (approved in the US to treat acute HAE attacks) would prevent attacks (mid-dose hypothesis).
T262 759679-759734 Sentence denotes Alternatively, lower or higher levels may be necessary.
T263 759735-759849 Sentence denotes To inform future clinical trial design we performed analyses to evaluate these low, mid, and high-dose hypotheses.
T264 759850-760001 Sentence denotes Publicly available data from OPuS-1, a clinical study of the pKal inhibitor BCX-4161 for HAE prophylaxis (BioCryst Pharmaceuticals Inc.), was reviewed.
T265 760002-760104 Sentence denotes In vitro inhibition of pKal by ecallantide and DX-2930 was assessed using a synthetic substrate assay.
T266 760105-760239 Sentence denotes Modeling was conducted using pharmacokinetic (PK) data from a single ascending dose study of subcutaneous DX-2930 in healthy subjects.
T267 760240-760305 Sentence denotes IRB approval and informed consent was obtained from all subjects.
T268 760306-760609 Sentence denotes Review of the OPuS-1 data suggested that therapeutic response correlated with higher plasma drug concentrations of BCX-4161 and that pKal inhibitor levels below 80 nM might offer only partial prophylactic effect, lending further credence to the mid-and high-dose hypotheses over the low-dose hypothesis.
T269 760610-760731 Sentence denotes In an in vitro pKal assay, DX-2930 and ecallantide displayed comparable pharmacodynamic activity at 80 nM concentrations.
T270 760732-760874 Sentence denotes Thus, continually maintaining DX-2930 drug levels above 80 nM should attain the level of pKal inhibition delineated by the middose hypothesis.
T271 760875-761082 Sentence denotes PK modeling predicts that chronic DX-2930 dosing will yield steady state plasma drug concentrations above 80 nM with 100 mg every 2 weeks (or 300 mg every 4 weeks) and above 200 nM with 300 mg every 2 weeks.
T272 761083-761185 Sentence denotes Available data support the mid-and high-dose hypotheses for long-term prophylaxis of HAE with DX-2930.
T273 761186-761354 Sentence denotes Chronic dosing with 100 mg and 300 mg is estimated to provide therapeutic coverage relevant to testing the mid and high-dose hypotheses in an efficacy and safety study.
T274 761355-761491 Sentence denotes Plans for future clinical trial efforts will further be refined by PK and biomarker data from an ongoing Phase 1b study in HAE subjects.
T275 761492-761494 Sentence denotes J.
T276 761495-761507 Sentence denotes Maik *1 , L.
T277 761508-761522 Sentence denotes Bielory 2 , 1.
T278 761523-761539 Sentence denotes New York, NY; 2.
T279 761540-761552 Sentence denotes Springfield.
T280 761553-761566 Sentence denotes Introduction:
T281 761567-761693 Sentence denotes Histamine receptor antagonists bind to several types of receptors causing various wanted and unwanted physiological responses.
T282 761694-762010 Sentence denotes By identifying the affinity levels (Ki) of ligands to three Histamine receptors (H1, H2, H3), one could utilize a given antagonist by identifying low Ki values to unwanted ligand-receptor binding (H3 which is consider to be an itch agonist), and high Ki values for wanted ligand-receptor binding (H1, H2) Background:
T283 762011-762166 Sentence denotes Hereditary angioedema (HAE) due to deficiency in C1 inhibitor is characterized by recurrent attacks of tissue swelling affecting multiple anatomic regions.
T284 762167-762344 Sentence denotes Recombinant human C1 esterase inhibitor (rhC1INH) was previously shown effective for treatment of angioedema attacks in patients with HAE by reducing the time to symptom relief.
T285 762345-762459 Sentence denotes In addition to onset of relief, the duration of attack symptoms is recognized as a clinically meaningful endpoint.
T286 762460-762581 Sentence denotes The current analysis reviews the time to reach minimal symptoms after treatment with rhC1INH across six clinical studies.
T287 762582-762746 Sentence denotes Methods: HAE patients treated with rhC1INH for acute angioedema attacks in three randomized-controlled trials (RCT) and three open-label (OL) studies were reviewed.
T288 762747-762844 Sentence denotes Patients treated in the RCTs received rhC1INH or placebo (saline) for a single angioedema attack.
T289 762845-762939 Sentence denotes In the OL studies, patients could be treated with rhC1INH multiple times for repeated attacks.
T290 762940-763148 Sentence denotes Severity of attack symptoms at each affected anatomical location was assessed using a 100 mm visual analog scale (VAS) prior to treatment and at regular intervals following administration of study medication.
T291 763149-763251 Sentence denotes Time to minimal symptoms was defined as occurring when VAS scores were <20 mm at all attack locations.
T292 763252-763280 Sentence denotes Data were analyzed by study.
T293 763281-763354 Sentence denotes IRB approval and written informed consent was obtained from all patients.
T294 763355-763363 Sentence denotes Results:
T295 763364-763484 Sentence denotes In the three RCTs, a total of 145 patients were randomized to receive either rhC1INH at doses of 50-100 IU/kg or saline.
T296 763485-763740 Sentence denotes The median time to minimal symptoms for patients in rhC1INH 50 IU/kg groups (240, 247 min) and 100 IU/kg groups (245, 480 min) was significantly shorter than for patients in the saline groups (362, 1101, 1440 min), p<0.05 for all within study comparisons.
T297 763741-763858 Sentence denotes In the OL studies patients were treated with an initial dose of 2100 IU or 50 IU/kg with an option for a second dose.
T298 763859-763938 Sentence denotes Data were available on 171 patients who received rhC1INH for 449 acute attacks.
T299 763939-764093 Sentence denotes Across the three studies, the median time to minimal symptoms was 241 minutes for the 2100 IU dose group, and 240 and 243 minutes for the 50 IU/kg groups.
T300 764094-764106 Sentence denotes Conclusions:
T301 764107-764332 Sentence denotes In addition to providing rapid onset of relief, as previously shown, treatment with rhC1INH resulted in consistently short duration of attack symptoms in HAE patients with acute angioedema attacks across six clinical studies.
T302 764333-764343 Sentence denotes Rationale:
T303 764344-764475 Sentence denotes Hereditary Angioedema (HAE) is a rare autosomal dominant disease that is caused by a deficiency in C1, a serine protease inhibitor.
T304 764476-764550 Sentence denotes It is currently estimated that the prevalence of HAE worldwide is 1:50000.
T305 764551-764628 Sentence denotes There are several drugs that have been developed to prevent and/or treat HAE.
T306 764629-764924 Sentence denotes We report on most of these drugs in order to highlight the challenges of treating HAE in some parts of the world and to provide awareness of this condition, especially to help assess travel risks for patients with diagnosed HAE and to advocate for patients in areas without sufficient HAE drugs.
T307 764925-764933 Sentence denotes Methods:
T308 764934-765055 Sentence denotes The study was conducted by literature reviews, case reports and by obtaining relevant information from the manufacturers.
T309 765056-765064 Sentence denotes Results:
T310 765065-765174 Sentence denotes We identified the main categories of drugs that are in current use in the treatment of hereditary angioedema.
T311 765175-765346 Sentence denotes The therapies used to treat HAE focus: on either replacing the deficient or dysfunctional C1 protein; or, on blocking the activation of specific pro-inflammatory proteins.
T312 765347-765451 Sentence denotes These include: recombinant human C1 inhibitors (INH), bradykinin antagonists, and kallekrein inhibitors.
T313 765452-765532 Sentence denotes Bradykinin B2 antagonists were widely available in most of Europe and in the US.
T314 765533-765605 Sentence denotes Plasma kallekrein inhibitors are only available in Israel and in the US.
T315 765606-765762 Sentence denotes Plasma derived C1-INH products are available in the US for HAE prophylaxis; but are approved for both propylaxis and treatment in eleven European countries.
T316 765763-765896 Sentence denotes The most widely available drug was a human C1-esterase inhibitor; which was found in the US, Europe, parts of South America and Asia.
T317 765897-766018 Sentence denotes A recombinant human C1 inhibitor is available in all 27 European Union countries, plus Norway, Iceland and Liechtenstein.
T318 766019-766031 Sentence denotes Conclusions:
T319 766032-766129 Sentence denotes Overall, there is a distribution differential in the availability of hereditary angioedema drugs.
T320 766130-766210 Sentence denotes These drugs are mostly available in the European Union and in the United States.
T321 766211-766353 Sentence denotes Most other countries outside these zones have either one or none of the therapies that are available for the prophylaxis and treatment of HAE.
T322 766354-766498 Sentence denotes Patients should take precautions when traveling to countries without HAE therapies and have a plan of care available in case of an exacerbation.
T323 766499-766701 Sentence denotes Also, since ill-health seems to be a trigger for HAE, patients should ensure that vaccinations and preventive medications are up to date, in addition to having their HAE medications available with them.
T324 766702-766715 Sentence denotes Introduction:
T325 766716-766882 Sentence denotes The objective of this study was to evaluate the safety of a new topical ocular anti-allergic formulation, Olopatadine HCl, 0.77% in subjects 2 years of age and older.
T326 766883-766891 Sentence denotes Methods:
T327 766892-766979 Sentence denotes This was a multicenter, double-masked, vehicle-controlled, parallel-group safety study.
T328 766980-767129 Sentence denotes Asymptomatic adult and pediatric subjects were randomized in a 2:1 ratio to receive Olopatadine 0.77% or vehicle once daily in both eyes for 6 weeks.
T329 767130-767191 Sentence denotes Safety assessments were conducted at Day 0, weeks 1, 3 and 6.
T330 767192-767401 Sentence denotes Safety assessments and parameters included adverse events (AEs), best-corrected visual acuity (BCVA), ocular signs, intraocular pressure (IOP), dilated fundus exam and vital signs (blood pressure, heart rate).
T331 767402-767410 Sentence denotes Results:
T332 767411-767593 Sentence denotes The safety population included a total of 499 subjects ranging from 2 to 74 years of age; 330 subjects were in the Olopatadine 0.77% group and 169 subjects were in the vehicle group.
T333 767594-767863 Sentence denotes Treatment-related adverse events occurring in ≥ 1% subjects included blurred vision (4.5% vs 4.1%), abnormal sensation in eye (2.1% vs 4.1%), dry eye (2.4% vs 3%), eye irritation (0.3% vs 3%), and dysgeusia (2.4% vs 0%), in olopatadine and vehicle groups, respectively.
T334 767864-767931 Sentence denotes No deaths or serious adverse events were reported during the study.
T335 767932-768036 Sentence denotes No subjects with exposure to Olopatadine 0.77% discontinued study participation due to an adverse event.
T336 768037-768206 Sentence denotes Based upon analysis and review of safety parameters measured over the course of this trial, no clinically meaningful differences were noted between the treatment groups.
T337 768207-768218 Sentence denotes Conclusion:
T338 768219-768370 Sentence denotes Olopatadine 0.77% was welltolerated in the overall safety population and no safety concerns were observed with the higher concentration of Olopatadine.
T339 768371-768382 Sentence denotes Background:
T340 768383-768459 Sentence denotes The goal of asthma treatment is to achieve control and minimize future risk.
T341 768460-768725 Sentence denotes Here we assess the efficacy of once-daily tiotropium Respimat ® add-on to inhaled corticosteroid (ICS) ± long-acting β 2 -agonist (LABA) maintenance therapy in patients with symptomatic asthma: lung function, asthma control, and asthma worsening data are presented.
T342 768726-768734 Sentence denotes Methods:
T343 768735-769220 Sentence denotes Four Phase III, randomized, double-blind, placebo-controlled, parallel-group trials were evaluated: two 48-week trials of tiotropium Respimat ® 5 mg add-on to high-dose ICS (≥800 mg budesonide or equivalent) + LABA (PrimoTinA-asthma ® ) in patients with severe symptomatic asthma; two 24-week trials of tiotropium Respimat ® 5 mg or 2.5 mg or salmeterol add-on to medium-dose ICS (400-800 mg budesonide or equivalent) in patients with moderate symptomatic asthma (MezzoTinA-asthma ® ).
T344 769221-769354 Sentence denotes Lung function was assessed as peak forced expiratory volume in 1 second (FEV 1 ) within 3 hours post-dosing (0-3h) and trough FEV 1 .
T345 769355-769542 Sentence denotes Asthma symptoms and control were assessed as responder rate (percentage of patients with minimally important change of ≥0.5) using the seven-question Asthma Control Questionnaire (ACQ-7).
T346 769543-769635 Sentence denotes Time to first episode of asthma worsening (pre-specified as exacerbation) was also assessed.
T347 769636-769644 Sentence denotes Results:
T348 769645-769772 Sentence denotes Tiotropium Respimat ® provided statistically significant and sustained improvements in both peak FEV 1(0-3h) and trough FEV 1 .
T349 769773-769890 Sentence denotes A higher proportion of patients achieved an ACQ-7 response with tiotropium Respimat ® compared with placebo (Table) .
T350 769891-769977 Sentence denotes Risk of asthma worsening was reduced with tiotropium Respimat ® compared with placebo:
T351 769978-770270 Sentence denotes 31% risk reduction [RR] with 5 mg (hazard ratio [HR] 0.69; 95% confidence interval [CI] 0.58, 0.82; p<0.001) in PrimoTinA-asthma ® at Week 48; 13% RR with 5 mg (HR 0.87; 95% CI 0.69, 1.08; p=0.211) and 34% RR with 2.5 mg (HR 0.66; 95% CI 0.52, 0.84; p<0.001) in MezzoTinA-asthma ® at Week 24.
T352 770271-770356 Sentence denotes Safety and tolerability of tiotropium Respimat ® were balanced compared with placebo.
T353 770357-770368 Sentence denotes Conclusion:
T354 770369-770625 Sentence denotes Once-daily tiotropium Respimat ® add-on to at least medium-dose ICS ± LABA provided significant and sustained improvements in lung function, improved asthma control, and reduced risk of asthma worsening in adults with moderate or severe symptomatic asthma.
T355 770626-770769 Sentence denotes ACQ-7 response with tiotropium Respimat® compared with placebo gic rhinitis (PAR).This is a double-blind, placebo controlled, cross-over study.
T356 770770-770914 Sentence denotes Fifteen subjects with symptomatic PAR (Total Nasal Symptom Score, TNSS≥5 out of 12) received VitD (4,000 I.U./day) and placebo each for 6 weeks.
T357 770915-771096 Sentence denotes TNSS (reflective and in the previous 3 weeks) and Rhinitis Related Quality of Life Questionnaire (RQLQ) were evaluated at 5 study visits (baseline, and 3, 6, 9, and 12 weeks later).
T358 771097-771244 Sentence denotes This study was performed in the period November 1, 2013 to March 20, 2014, to try to avoid seasonal fluctuations of serum VitD due to sun exposure.
T359 771245-771373 Sentence denotes All study subjects signed an informed consent and this study was approved by the Main Line Hospitals Institutional Review Board.
T360 771374-771474 Sentence denotes Data were analyzed by the two-tail t test for unpaired data and the Pearson correlation coefficient.
T361 771475-771658 Sentence denotes The study subjects' average age was 77.5±7.3 years, the Body Mass Index (BMI) was 26.5±4.9, the duration of rhinitis was 57.9±17.8 years, the total medication score (TMS) was 1.9±1.1.
T362 771659-771739 Sentence denotes Baseline serum vitamin D was 29.7±10.6 I.U. and serum calcium was 9.6±0.5 mg/dl.
T363 771740-771789 Sentence denotes TNSS was 7.3±2.2 (reflective) and 8±2.6 (3 week).
T364 771790-771815 Sentence denotes RQLQ score was 58.3±30.9.
T365 771816-771965 Sentence denotes After the 6 week VitD supplementation, its serum levels increased significantly (to 39.7±8.9 I.U., p<0.01), whereas serum calcium remained unchanged.
T366 771966-772154 Sentence denotes Reflective TNSS (4.6±2.7 and 4.3±3.4 for placebo and VitD at 3 weeks, respectively), 3 week TNSS, and RQLQ (including its individual values) remained unchanged compared to placebo (p>0.4).
T367 772155-772251 Sentence denotes There was no association between serum VitD and age, BMI, duration of rhinitis, or TMS (p≥0.57).
T368 772252-772486 Sentence denotes However, in subjects with poorly controlled symptoms (TNSS ≥8 of 12, RQLQ for nasal symptoms ≥16 of 24), there was an inverse association with serum vitamin D (r>-0.55) that was significant for the 3 week TNSS (r=-0.81, p=0.008, n=8).
T369 772487-772600 Sentence denotes In summary, VitD supplementation for 6 weeks did not improve nasal symptoms or RQLQ in elderly subjects with PAR.
T370 772601-772719 Sentence denotes These results and the inverse association between VitD and nasal symptoms will require confirmation in larger studies.
T371 772720-772733 Sentence denotes Introduction:
T372 772734-772895 Sentence denotes Intranasal antihistamines or steroids must be delivered in a volume and with a technique that allows optimal deposition and distribution within the nasal cavity.
T373 772896-773066 Sentence denotes Too little spray volume may not cover the entire nasal cavity, whereas excess volume may result in outflow from the front of the nasal cavity or backflow into the throat.
T374 773067-773271 Sentence denotes In the case of Dymista (AZ/FP) Nasal Spray, it has been suggested that two generic sprays of the components is equivalent to the single AZ/FP product, although no evidence exists to support that approach.
T375 773272-773431 Sentence denotes This in vitro evaluation simulated nasal deposition and distribution of AZ/FP compared to sequential sprays of the commercially available AZ and FP components.
T376 773432-773440 Sentence denotes Methods:
T377 773441-773560 Sentence denotes A model of a normal adult human nasal cavity was used to visualize deposition and distribution of nasal spray products.
T378 773561-773840 Sentence denotes A single spray of Dymista (0.137 mL [137 mg of azelastine/50 mg of fluticasone propionate]) or single sequential sprays of azelastine nasal spray (0.137 mL) followed by either Flonase or generic fluticasone propionate nasal spray (0.100 mL) were manually actuated into the model.
T379 773841-773966 Sentence denotes The interior of the cast was coated with a water-sensitive dye that changes color when exposed to aqueous-based formulations.
T380 773967-774051 Sentence denotes A slight vacuum (15 L/min) was applied during spray delivery to simulate inhalation.
T381 774052-774111 Sentence denotes Results were photographed using anterior and lateral views.
T382 774112-774120 Sentence denotes Results:
T383 774121-774203 Sentence denotes Three replicates of Dymista showed no dripping or back flow from the nasal cavity.
T384 774204-774300 Sentence denotes Visually, the turbinates in the anterior third of the nasal cavity were coated with nasal spray.
T385 774301-774516 Sentence denotes In contrast, three replicates of azelastine nasal spray followed in 1 minute by either Flonase or generic fluticasone nasal spray showed significant dripping from the nostril and toward the back of the nasal cavity.
T386 774517-774613 Sentence denotes Visually, the turbinates were coated with nasal spray as was the top portion of the nasopharynx.
T387 774614-774626 Sentence denotes Conclusions:
T388 774627-774847 Sentence denotes A single spray of Dymista resulted in retention in the nasal cavity compared to sequential administration of the two component products, which caused dripping from the front of the nostril and run-off to the nasopharynx.
T389 774848-775060 Sentence denotes The two components of AZ/FP Nasal Spray delivered sequentially provide a spray volume that exceeds the volume of the nasal cavity and therefore may negatively impact therapeutic efficacy and patient tolerability.
T390 775061-775074 Sentence denotes Introduction:
T391 775075-775235 Sentence denotes Astepro 0.10% and 0.15% are currently approved for use in patients 6 years and older with seasonal allergic rhinitis (SAR) or perennial allergic rhinitis (PAR).
T392 775236-775502 Sentence denotes The objective of this clinical trial was to evaluate the safety and efficacy of the 0.10% and 0.15% azelastine formulations compared to placebo at a dosage of 1 spray per nostril twice daily in pediatric patients ≥6 to <12 yrs with perennial allergic rhinitis (PAR).
T393 775503-775585 Sentence denotes The results of this study were the basis of approval for the pediatric indication.
T394 775586-775594 Sentence denotes Methods:
T395 775595-775724 Sentence denotes This was a 4-week, randomized, double-blind, parallel-group study in patients ≥6 to <12 years of age with moderate-to-severe PAR.
T396 775725-775839 Sentence denotes The studies were IRB-approved and all patients or guardians signed written, informed consent before participation.
T397 775840-776004 Sentence denotes The 12-hour reflective Total Nasal Symptom Score (rTNSS), consisting of nasal congestion, runny nose, sneezing and nasal itching, was the primary efficacy variable.
T398 776005-776136 Sentence denotes Symptoms were scored twice daily on a 0 to 3 scale (0=none, 1=mild, 2=moderate, 3=severe) such that the maximum daily rTNSS was 24.
T399 776137-776210 Sentence denotes Treatment group comparisons were made by analysis of covariance (ANCOVA).
T400 776211-776219 Sentence denotes Results:
T401 776220-776338 Sentence denotes A total of 489 patients were randomized to treatment and >90% of patients in each treatment group completed the study.
T402 776339-776483 Sentence denotes The change from baseline in rTNSS was statistically significant compared to placebo for both formulations (0.15%; P = .005 and 0.10%; P = .015).
T403 776484-776600 Sentence denotes Treatment with the 0.15% formulation resulted in a mean change of -3.45 rTNSS points from a baseline value of 16.60.
T404 776601-776696 Sentence denotes The 0.10% formulation resulted in a mean change of -3.37 points from a baseline value of 16.35.
T405 776697-776767 Sentence denotes The mean change with placebo was -2.48 from a baseline value of 16.09.
T406 776768-776925 Sentence denotes The most frequently reported adverse events with the 0.15% formulation were epistaxis (4.3%), nasal discomfort (4.3%), dysgeusia (3.7%), and sneezing (2.5%).
T407 776926-777070 Sentence denotes The most frequently reported adverse events with the 0.10% formulation were epistaxis (4.8%), dysgeusia (2.4%), URI (2.4%), and sneezing (1.8%).
T408 777071-777122 Sentence denotes There were no serious or unexpected adverse events.
T409 777123-777135 Sentence denotes Conclusions:
T410 777136-777251 Sentence denotes Both the 0.10% and 0.15% Astepro formulations were effective and well tolerated in this pediatric study population.
T411 777252-777265 Sentence denotes Introduction:
T412 777266-777463 Sentence denotes Azelastine hydrochloride (AZ) with fluticasone propionate (FP) in a single nasal spray (Dymista) is approved for the treatment of patients 12 years of age and older with seasonal allergic rhinitis.
T413 777464-777688 Sentence denotes The objective of this study was to evaluate the safety of AZ/FP Nasal Spray compared to FP Nasal Spray, administered as 1 spray per nostril twice daily in pediatric subjects ≥4 years to <12 years with allergic rhinitis (AR).
T414 777689-777697 Sentence denotes Methods:
T415 777698-777792 Sentence denotes This randomized, openlabel, 3-month study was conducted at 42 investigational sites in the US.
T416 777793-777970 Sentence denotes The study was approved by a central IRB and informed consent (from caregiver) and pediatric informed assent (from subjects 7 years and older) were obtained before participation.
T417 777971-778155 Sentence denotes Qualified subjects had a history of AR, were in good health, and had no evidence of nasal mucosal erosion, nasal ulceration, nasal septum perforation, or any significant nasal disease.
T418 778156-778266 Sentence denotes Subjects were randomized in a 3:1 ratio to AZ/FP (n=304) and FP (n=101) and were stratified by age as follows:
T419 778267-778349 Sentence denotes (1) ≥4 years to <6 years; (2) ≥6 years to <9 years; and (3) ≥9 years to <12 years.
T420 778350-778489 Sentence denotes Safety was assessed by subject and/or caregiver-reported adverse events (AEs), nasal examinations, vital signs, and laboratory assessments.
T421 778490-778498 Sentence denotes Results:
T422 778499-778587 Sentence denotes Overall, 94% of subjects treated with AZ/FP and 92% treated with FP completed the study.
T423 778588-778637 Sentence denotes Completion rates were similar in each age strata.
T424 778638-778740 Sentence denotes The percentage of subjects with AEs was comparable between treatment groups and across the age strata.
T425 778741-778901 Sentence denotes The most frequently reported AEs with AZ/FP and FP, respectively, were: epistaxis (10% and 9%), headache (7% and 3%), cough (4% and 3%) and pyrexia (3% and 2%).
T426 778902-778971 Sentence denotes The discontinuation rate due to AEs was 2% with AZ/FP and 4% with FP.
T427 778972-779075 Sentence denotes Laboratory parameters showed no meaningful increase in mean or median values in either treatment group.
T428 779076-779260 Sentence denotes Improvements in nasal examination findings were observed in both treatment groups and in each age stratum and there were no findings of nasal mucosal ulcera-tion or septal perforation.
T429 779261-779379 Sentence denotes The two treatment groups were comparable for mean changes in vital sign measurements regardless of age stratification.
T430 779380-779557 Sentence denotes Conclusions: AZ/FP and FP were well-tolerated during this 3-month study when administered as 1 spray per nostril twice daily in pediatric subjects ≥4 years to <12 years with AR.
T1 779558-779560 Sentence denotes B.
T2 779561-779578 Sentence denotes Stanaland *1 , R.
T3 779579-779595 Sentence denotes Settipane 2 , S.
T4 779596-779610 Sentence denotes Gawchik 3 , N.
T5 779611-779622 Sentence denotes Ruiz 4 , F.
T6 779623-779636 Sentence denotes Hampel 5 , 1.
T7 779637-779651 Sentence denotes Naples, FL; 2.
T8 779652-779670 Sentence denotes Providence, RI; 3.
T9 779671-779685 Sentence denotes Upland, PA; 4.
T10 779686-779702 Sentence denotes Somerset, NJ; 5.
T11 779703-779721 Sentence denotes New Braunfels, TX.
T12 779722-779735 Sentence denotes Introduction:
T13 779736-779991 Sentence denotes The efficacy of azelastine HCL (AZ) and fluticasone propionate (FP) in a single nasal spray (Dymista [AZ/FP]) for treating nasal symptoms of seasonal allergic rhinitis (SAR) has been demonstrated in four wellcontrolled clinical trials of 2 weeks duration.
T14 779992-780135 Sentence denotes 1,2,3 The reflective total ocular symptom score (rTOSS), consisting of itching, watering, and redness, was a secondary variable in the studies.
T15 780136-780274 Sentence denotes This post-hoc analysis compared the efficacy of AZ/FP to monotherapy with AZ, FP, and placebo for the treatment of ocular symptoms of SAR.
T16 780275-780283 Sentence denotes Methods:
T17 780284-780393 Sentence denotes A total of 3996 patients 12 years of age and older with moderate-to-severe SAR were included in the analyses.
T18 780394-780495 Sentence denotes The studies were IRB-approved and all patients signed written, informed consent before participation.
T19 780496-780644 Sentence denotes Patients were randomized to AZ/FP, AZ, FP or placebo nasal spray administered 1 spray/nostril twice daily (total daily doses: AZ=548 mg; FP=200 mg).
T20 780645-780801 Sentence denotes The three ocular symptoms were scored twice daily on a 4-point scale (0=no symptoms; 1=mild, 2=moderate, 3=severe) such that the maximum daily score was 18.
T21 780802-780908 Sentence denotes Treatment group comparisons of change from baseline in rTOSS were made by analysis of covariance (ANCOVA).
T22 780909-780998 Sentence denotes Time to response (defined as a ≥50% change from baseline) was evaluated by log-rank test.
T23 780999-781007 Sentence denotes Results:
T24 781008-781169 Sentence denotes Overall, patients treated with AZ/FP had a significantly greater improvement from baseline in rTOSS compared to AZ (P=.048), FP (P<.0001), and placebo (P<.0001).
T25 781170-781321 Sentence denotes Patients treated with AZ/FP achieved at least a 50% reduction in rTOSS significantly sooner than patients treated with FP (P=.02) or placebo (P≤.0001).
T26 781322-781379 Sentence denotes The difference approached significance versus AZ (P=.08).
T27 781380-781586 Sentence denotes When patients with baseline rTOSS ≥8 were analyzed (n=3341; representing 84% of the total population), significant differences were seen compared to AZ (P=.04) as well as to FP (P<.01) and placebo (P<.001).
T28 781587-781599 Sentence denotes Conclusions:
T29 781600-781745 Sentence denotes In this population of patients with moderate-to-severe SAR, AZ/FP improved ocular symptoms to a significantly greater extent than AZ or FP alone.
T30 781746-781772 Sentence denotes Background and Objectives:
T31 781773-781912 Sentence denotes To assess the symptom severities of allergic rhinitis patients sensitive to multiple allergens compared to single house dust mite allergen.
T32 781913-781933 Sentence denotes Subjects and Method:
T33 781934-782000 Sentence denotes Total 56 allergic rhinitis patients were classified into 2 groups.
T34 782001-782120 Sentence denotes The multiple allergens group was defined as patients sensitive to multiple allergens including house dust mite in MAST.
T35 782121-782205 Sentence denotes The single allergen group was defined as patients sensitive only to house dust mite.
T36 782206-782397 Sentence denotes Symptom severity was evaluated with visual analogue scale (VAS) for following symptoms: postnasal drip, anosmia, sneezing, itching, nasal obstruction, cough, sputum, headache, and rhinorrhea.
T37 782398-782473 Sentence denotes For in vitro test, total IgE and blood eosinophil count were also analysed.
T38 782474-782548 Sentence denotes IRB approval and informed consent was obtained from all research subjects.
T39 782549-782557 Sentence denotes Results:
T40 782558-782698 Sentence denotes Among 56 patients, 32 patients were classified to the multiple allergens group and 24 patients were classified to the single allergen group.
T41 782699-782959 Sentence denotes The mean symptom scores of multiple allergens group for postnasal drip, anosmia, sneezing, itching, nasal obstruction, cough, sputum, headache, rhinorrhea were 4.56±3.4, 1.25±2.40, 1.25±3.40, 4.25±3.11, 3.44±3.56, 5.75±3.30, 3.87±3.25, 3.50±3.45 and 5.21±3.17.
T42 782960-783237 Sentence denotes On the other hand, the mean symptom scores of single allergen group for postnasal drip, anosmia, sneezing, itching, nasal obstruction, cough, sputum, headache, rhinorrhea were 2.75±2.77, 1.29±3.01, 1.29±3.01, 4.46±3.60, 3.41±3.67, 5.75±3.13, 2.88±3.03, 2.75±3.57 and 3.70±3.22.
T43 783238-783324 Sentence denotes Total summation of symptom scores for two groups was 33.75±22.24 and 37.75±16.89 each.
T44 783325-783448 Sentence denotes Statistically these scores showed no differences between two groups as in vitro test, total IgE and blood eosinophil count.
T45 783449-783460 Sentence denotes Conclusion:
T46 783461-783621 Sentence denotes Symptom severities of allergic rhinitis patients sensitive to multiple allergens showed no differences with those of patients sensitive only to house dust mite.
T47 783622-783624 Sentence denotes S.
T48 783625-783649 Sentence denotes Nsouli * , Danville, CA.
T49 783650-784012 Sentence denotes Since chronic inflammation is the histopathologic landmark of otitis media with effusion, clinical observations have led us to believe that the combination of a nasal antihistamine Azelastine and corticosteroid Fluticasone propionate, with an oral antibiotic may be more effective than monotherapy with an oral antibiotic in the treatment of serous otitis media.
T50 784013-784362 Sentence denotes We studied forty adult patients in a randomized open labeled 2-week trial to compare the efficacy of the combination nasal Azelastine and Fluticasone propionate (137mcg/50 mcg), one spray per nostril twice daily, with an oral antibiotic Amoxicillin/Clavulanate potassium (875mg/125mg) every 12 hours, for the treatment of otitis media with effusion.
T51 784363-784562 Sentence denotes The efficacy of the treatment options was assessed using pneumatic otoscopy, impedance tympanometry, and audiometry to monitor the clinical course of the middle ear effusion in both treatment groups.
T52 784563-784711 Sentence denotes In the combination group nasal Azelastine and Fluticasone with oral antibiotic, a resolution of otitis media with effusion occurred at the 8 th day.
T53 784712-784859 Sentence denotes In contrast in the group treated with monotherapy with the oral antibiotic, the resolution of otitis media with effusion occurred on the 14 th day.
T54 784860-785135 Sentence denotes In conclusion, the combination of nasal Azelastine and Fluticasone plus an oral antibiotic may be a safer and shorter therapy than monotherapy with an oral antibiotic in the treatment of serous otitis media, given the safety issues with long-term use of systemic antibiotics.
T55 785136-785149 Sentence denotes Introduction:
T56 785150-785318 Sentence denotes Beclomethasone dipropionate (BDP) nasal aerosol (nonaqueous) is approved for management of seasonal and perennial allergic rhinitis (SAR/PAR) in adolescents and adults.
T57 785319-785414 Sentence denotes This study evaluated the efficacy and safety of 80 mg/d BDP nasal aerosol in children with PAR.
T58 785415-785423 Sentence denotes Methods:
T59 785424-785647 Sentence denotes A 12-wk, phase 3, randomized, double-blind, placebo-controlled, parallel-group, clinical trial was conducted at 62 US centers to investigate the efficacy and safety of BDP nasal aerosol in children (4-11 y of age) with PAR.
T60 785648-785814 Sentence denotes A total of 547 patients were randomized (2:1) to receive 2 actuations of BDP nasal aerosol (1 actuation/nostril; 40 mg/actuation) or placebo nasal aerosol once daily.
T61 785815-786007 Sentence denotes The primary end point was change from baseline in average morning (am) and evening (pm) reflective total nasal symptom score (rTNSS) over the first 6 wk of treatment in patients 6-11 y of age.
T62 786008-786222 Sentence denotes Additional efficacy end points included change from baseline in average am and pm instantaneous TNSS (iTNSS) in children 6-11 y of age, and change from baseline in average rTNSS and iTNSS in children 4-11 y of age.
T63 786223-786231 Sentence denotes Results:
T64 786232-786539 Sentence denotes Improvement was significantly greater with BDP nasal aerosol (80 mg/day) than with placebo over the first 6 wk of treatment in children 6-11 y of age in average am and pm rTNSS and iTNSS (mean [95% CI] treatment difference: -0.66 [-1.08, -0.24], P = 0.002 and -0.58 [-0.99, -0.18], P = 0.004, respectively).
T65 786540-786774 Sentence denotes Improvement in average am and pm rTNSS and iTNSS was significantly greater in patients 4-11 y of age receiving BDP nasal aerosol than in those receiving placebo over the first 6 wk of treatment (P = 0.002 and P = 0.004, respectively).
T66 786775-786841 Sentence denotes Similar results were observed over 12 wk of treatment (P < 0.001).
T67 786842-787110 Sentence denotes Improvement in average am and pm reflective individual nasal symptoms over the first 6 wk of treatment in 6-11 y olds was significantly greater for rhinorrhea (P = 0.004), nasal congestion (P = 0.001), and sneezing (P = 0.002) with BDP nasal aerosol than with placebo.
T68 787111-787205 Sentence denotes BDP nasal aerosol was well-tolerated in children, with a safety profile comparable to placebo.
T69 787206-787218 Sentence denotes Conclusions:
T70 787219-787474 Sentence denotes This study showed that once-daily treatment with 80 mg BDP nasal aerosol (nonaqueous) in children 4-11 y of age was safe and effective in controlling nasal symptoms associated with PAR, suggesting that BDP nasal aerosol is effective for children with PAR.
T71 787475-787477 Sentence denotes J.
T72 787478-787490 Sentence denotes Kern *1 , L.
T73 787491-787505 Sentence denotes Bielory 2 , S.
T74 787506-787519 Sentence denotes Luster 2 , 1.
T75 787520-787534 Sentence denotes Newark, NJ; 2.
T76 787535-787551 Sentence denotes Springfield, NJ.
T77 787552-787565 Sentence denotes Introduction:
T78 787566-787658 Sentence denotes Allergic rhinitis is a prevalent condition impacting approximately 20% of the US population.
T79 787659-787818 Sentence denotes There is a growing section of the population, up to 50% in some surveys, who are turning to alternative therapies for the treatment of their allergic rhinitis.
T80 787819-787827 Sentence denotes Methods:
T81 787828-787981 Sentence denotes A literature search was performed utilizing keywords rhinitis acupuncture, rhinitis traditional Chinese medicine (TCM), and rhinitis alternative therapy.
T82 787982-788122 Sentence denotes Randomized control trials were reviewed in regards to their impact on symptom scores and objective equivalents and are displayed in table 1.
T83 788123-788131 Sentence denotes Results:
T84 788132-788154 Sentence denotes Decrease in total IgE:
T85 788155-788244 Sentence denotes 39% from Yang et al. correlating with symptom improvement using various TCM formulations.
T86 788245-788276 Sentence denotes 13.7% reduction in Zhang et al.
T87 788277-788351 Sentence denotes Jung et al. showed a 3% increase in IgE levels in the group receiving TCM.
T88 788352-788431 Sentence denotes Yang et al. demonstrated a 15% reduction in specific IgE to dust mites (p<.05).
T89 788432-788527 Sentence denotes Acupuncture has been shown to have an impact on patient symptom scores as evidenced in table 1.
T90 788528-788726 Sentence denotes In a randomized control trial by Brinkhaus et al. there was a minimal, however statistically significant, improvement in symptom score with acupuncture compared to sham therapy and medication alone.
T91 788727-788905 Sentence denotes A follow up study comparing the combination of acupuncture with medication versus sham therapy with medication showed a reduction of 9% in the utilization of medication [p=0.01].
T92 788906-789064 Sentence denotes A large portion of studies were poorly constructed with significant bias given the operators' awareness of real versus sham therapy when applying acupuncture.
T93 789065-789197 Sentence denotes Homeopathic therapy has been evaluated in several studies demonstrating mixed results in regards to its impact on allergic rhinitis.
T94 789198-789241 Sentence denotes Several have found significant improvement.
T95 789242-789443 Sentence denotes Taylor et al. demonstrated nasal airflow mean difference 19.8 L/min [p=0.0001], visual analogue score showed a symptom reduction of 28% in homeopathic group vs 3% reduction in placebo group [p=0.0007].
T96 789444-789536 Sentence denotes A larger study conducted by Aabel et al found no difference in symptom scoring from placebo.
T97 789537-789548 Sentence denotes Conclusion:
T98 789549-789629 Sentence denotes The evidence regarding the utilization of traditional Chinese medicine is mixed.
T99 789630-789760 Sentence denotes Complementary therapy for allergic rhinitis demonstrates a potential benefit to patients in addition to current medical therapies.
T100 789761-789937 Sentence denotes Alternative therapy studies revealed mixed results, however safety studies have shown minimal to no risk making them a safe addition to the treatment regime in select patients.
T101 789938-789949 Sentence denotes Background:
T102 789950-790113 Sentence denotes Mold sensitization is a risk factor for development and deterioration of upper airway allergy, especially chronic rhinosinusitis including those requiring surgery.
T103 790114-790122 Sentence denotes Methods:
T104 790123-790196 Sentence denotes 38 chronic sinusitis patients after surgery were included into the study.
T105 790197-790595 Sentence denotes Routine medical examination, skin prick tests with common inhaled allergens an extended mold panel (Alternaria alternate, Cladosporium herbarium, Aspergilus fumigatus, Candida albicans, Mucor mucedo, Botrytis cinerea, Rhisopus nigricans, Penicilliumi notatum, Fusarum moniliforme Pullularia pullulans (Allergopharma, Germany) was done and IgE and allergen specific IgE measurement (Phadia, Sweden).
T106 790596-790684 Sentence denotes All subjects were seen by an otolaryngologist and mycological examination was performed.
T107 790685-790693 Sentence denotes Results:
T108 790694-790784 Sentence denotes Sensitization to at least one allergen was present in 44.7% (17/38) of sinusitis patients.
T109 790785-790896 Sentence denotes The most prevalent was sensitization to house dust mite Der-matophagoides pt., found in 21.0 % (8/38) patients.
T110 790897-791147 Sentence denotes Positive skin prick tests with Candida albicans occurred in 18.4% (7/38), with Alternaria alternata in 18.4% (7/38), with Cladosporium herbarium in 10.52% (4/38), with Aspergilus fumigatus in 5.26 % (2/38), and with Botrytis cinerea in 2.63 % (1/38).
T111 791148-791213 Sentence denotes None of these patients had sensitization to other mold allergens.
T112 791214-791364 Sentence denotes Elevated allergen specific IgE was seen for Candida in 24% (9/38) patients, Alternaria alternata 26% (10/38), and Cladosporium herbarium in 8% (3/38).
T113 791365-791376 Sentence denotes Conclusion:
T114 791377-791462 Sentence denotes Nearly half of chronic sinusitis patients had sensitization to at least one allergen.
T115 791463-791601 Sentence denotes Mold allergy was commonly seen in chronic sinusitis patients requiring surgery, being comparable in occurrence to dust mite sensitization.
T116 791602-791613 Sentence denotes Background:
T117 791614-791682 Sentence denotes The onset allergic diseases by age and gender may vary in childhood.
T118 791683-791890 Sentence denotes The prevalence of various allergic diseases in patients stratified by gender into age groups who presented at the Allergy Outpatient Clinic of Western Hungary from 2002-2005 and from 2006-2009 were assessed.
T119 791891-791899 Sentence denotes Methods:
T120 791900-792092 Sentence denotes Only patients with newly diagnosed allergic diseases confirmed by skin prick tests and/or allergen specific IgE were assessed, being stratified by age into groups from newborn to 20 years old.
T121 792093-792226 Sentence denotes From 2002 to 2005, there were 10,018 patients and from 2006 to 2009, there were 13,125 patients included in this epidemiologic study.
T122 792227-792235 Sentence denotes Results:
T123 792236-792374 Sentence denotes The total number of allergic patients increased from 0 through 5 years of age, then declined until adulthood in both investigated periods.
T124 792375-792506 Sentence denotes There were more male patients under the age of 15, especially in the 5 year old age group in every year of the investigated period.
T125 792507-792577 Sentence denotes After 15 years of age the female/male patient ratio increases rapidly.
T126 792578-792660 Sentence denotes At 20 years of age, females are twice as likely to present with allergic diseases.
T127 792661-792799 Sentence denotes Both the female and male patients in the age group analysis of various allergic diseases demonstrated the pattern of the "allergic march".
T128 792800-792811 Sentence denotes Conclusion:
T129 792812-792894 Sentence denotes Peak incidence of various allergic diseases occurred in the 5 years old age group.
T130 792895-793016 Sentence denotes In early childhood the male/female ratio among allergic patients is high, this ratio being reversed in later adolescence.
T131 793017-793219 Sentence denotes Patterns of prevalence of various childhood and adolescent allergic disease in Western Hungary demonstrated the progression from dermatologic to respiratory allergy characteristic of the allergic march.
T132 793220-793231 Sentence denotes Background:
T133 793232-793353 Sentence denotes The time interval from diagnosis of pseudotumor cerebri to development of CSF rhinorrhea is quite variable in literature.
T134 793354-793440 Sentence denotes It can be intermittent and undetected for many years or may be the presenting symptom.
T135 793441-793541 Sentence denotes We report a case of CSF rhinorrhea presenting three years after head trauma and pseudotumor cerebri.
T136 793542-793550 Sentence denotes Methods:
T137 793551-793816 Sentence denotes A 35-year-old woman with a five-year history of perennial allergic rhinitis to cat and mouse and moderate persistent asthma complained of intermittent persistent unilateral clear rhinorrhea, without any nasal congestion, sneezing or pruritus of six months duration.
T138 793817-793864 Sentence denotes She denied any associated headache or wheezing.
T139 793865-793873 Sentence denotes Results:
T140 793874-794076 Sentence denotes Further review of systems was notable for history of head trauma three years prior to presentation, with development of pseudotumor cerebri, sinovenous thrombosis, papilledema, and macular degeneration.
T141 794077-794114 Sentence denotes However, there was no skull fracture.
T142 794115-794190 Sentence denotes Nasal examination was remarkable for swollen bilateral inferior turbinates.
T143 794191-794268 Sentence denotes She was able to produce left sided nasal clear rhinorrhea by leaning forward.
T144 794269-794328 Sentence denotes Fluid was tested for glucose and was found to be 307 mg/dL.
T145 794329-794371 Sentence denotes She was promptly referred to neurosurgery.
T146 794372-794477 Sentence denotes Confirmatory tests for new onset diabetes were performed given the degree of elevated glucose in the CSF.
T147 794478-794489 Sentence denotes Discussion:
T148 794490-794574 Sentence denotes Etiology of CSF rhinorrhea is classified as traumatic (>90%) or nontraumatic (<10%).
T149 794575-794716 Sentence denotes Accidental head injury accounts for most traumatic cases, followed by iatrogenic etiology secondary to neurosurgical or rhinologic procedure.
T150 794717-794892 Sentence denotes Nontraumatic causes are typically due to high intracranial pressure, tumors, erosive diseases, congenital defects of base of skull, or spontaneous without a specific etiology.
T151 794893-795035 Sentence denotes Though our patient had no history of skull fracture to account for a CSF leak, she did have a history of pseudotumor cerebri after the trauma.
T152 795036-795415 Sentence denotes While CSF rhinorrhea is a relatively rare entity in comparison to other common sinonasal inflammatory conditions such as the allergic rhinitis in our patient, this case illustrates the importance of maintaining a high index of clinical suspicion when encoun-tering a complaint of unilateral clear rhinorrhea with a remote history of trauma and/or increased intracranial pressure.
T153 795416-795606 Sentence denotes This will ensure timely diagnosis and proper neurosurgical management that can ultimately prevent further complications such as bacterial meningitis or other serious intracranial infections.
T154 795607-795635 Sentence denotes CHALLENGES OF CHRONIC COUGH.
T155 795636-795638 Sentence denotes V.
T156 795639-795649 Sentence denotes Ta *1 , K.
T157 795650-795665 Sentence denotes Woessner 2 , 1.
T158 795666-795687 Sentence denotes Redondo Beach, CA; 2.
T159 795688-795702 Sentence denotes San Diego, CA.
T160 795703-795716 Sentence denotes Introduction:
T161 795717-795928 Sentence denotes Establishing gastroesophageal reflux disease (GERD) as the cause of chronic cough is challenging despite a careful history and initial evaluation because not all patients present with the usual symptoms of GERD.
T162 795929-796103 Sentence denotes The term supraesophageal reflux disease (SERD) has been used to describe GERD with additional symptoms such as sore throat, hoarseness, globus, and excessive throat clearing.
T163 796104-796328 Sentence denotes It should be emphasized that these laryngeal findings are not specific for SERD as a causative factor and the precise pathophysiologic mechanism responsible for the production of supraesophageal symptoms remains contentious.
T164 796329-796334 Sentence denotes Case:
T165 796335-796457 Sentence denotes The patient is a 60 year old male who presented with throat clearing and nonproductive chronic cough of one year duration.
T166 796458-796579 Sentence denotes The cough occurs daily and is associated with the sensation of postnasal drip although he is unable to expectorate mucus.
T167 796580-796646 Sentence denotes His symptoms are not positional or triggered by fumes or exercise.
T168 796647-796694 Sentence denotes He denies food impaction or heartburn symptoms.
T169 796695-796877 Sentence denotes The patient has tried various nasal corticosteroids, antihistamines, systemic corticosteroids and proton pump inhibitors (PPI) but these interventions failed to control his symptoms.
T170 796878-796980 Sentence denotes His workup included negative skin prick, intradermal, and serum specific IgE testing to aeroallergens.
T171 796981-797029 Sentence denotes His nasal cytology was negative for eosinophils.
T172 797030-797085 Sentence denotes His CT sinus showed maxillary sinus mucosal thickening.
T173 797086-797185 Sentence denotes He underwent an upper esophagogastro-duodenoscopy that showed no furrows, white patches, or ulcers.
T174 797186-797280 Sentence denotes However, mid/proximal esophagus biopsy showed greater than 50 eosinophils on high power field.
T175 797281-797359 Sentence denotes He also underwent a 24 hour pH probe which showed a supine pH average of 4.75.
T176 797360-797371 Sentence denotes Discussion:
T177 797372-797534 Sentence denotes Initial treatments include PPI and head of bed elevation even though acid suppressing medications have been shown to be only partially effective in treating SERD.
T178 797535-797618 Sentence denotes Other options include surgery such as the Nissen fundoplication or the LINX System.
T179 797619-797770 Sentence denotes Although 50 eosinophils/HPF was observed histologically, the patient denied any EoE symptoms and on these grounds the possibility of EoE was dismissed.
T180 797771-797874 Sentence denotes The more likely explanation for this patient's cough is SERD, evident by his positive 24 hour pH probe.
T181 797875-797974 Sentence denotes The patient tried and failed a short course of PPIs, however, a longer trial of a PPI is warranted.
T182 797975-798018 Sentence denotes If ineffective, surgery will be considered.
T183 798019-798162 Sentence denotes Spontaneous Chronic Urticaria (SCU ) is a common condition in adults and mainly among women, which coincides this phenomenon with autoimmunity.
T184 798163-798271 Sentence denotes Our objective was assessed through laboratory studies whether patients with CUS presented autoimmunity data.
T185 798272-798293 Sentence denotes Material and Methods:
T186 798294-798611 Sentence denotes Cross-sectional study that 35 patients from the Allergy and Immunology at Juarez Hospital of Mexico diagnosed with CUS included, to which complete blood count CBC, thyroid antibodies (anti peroxidase and thyroglobulin), nuclear antibodies, rheumatoid factor, lupus anticoagulant and autologous serum skin test (ASST).
T187 798612-798620 Sentence denotes Results:
T188 798621-798943 Sentence denotes We evaluated 35 adult patients, 77.1% female and 22.9% male, ASST was positive in 11.4% patients, negative antinuclear antibodies in all cases but the antibodies anti thyroid (AAT) positive in 11.4% of LE cells, lupic anticoagulant and D dimer were negative in all patients and rheumatoid factor was positive in 1 patient.
T189 798944-799015 Sentence denotes Positive patients AAT 100% were women and 75% of them had negative PSA.
T190 799016-799086 Sentence denotes Tests of correlation between ASST and antibodies, was not significant.
T191 799087-799098 Sentence denotes Conclusion:
T192 799099-799274 Sentence denotes Patients with UCE most are women and only 11% had positive ASST but this does not correlate with anti thyroid antibodies or other common parameters of autoimmunity Background:
T193 799275-799394 Sentence denotes Chronic urticaria (CU) is a benign, idiopathic and disturbing condition affecting a significant proportion of patients.
T194 799395-799466 Sentence denotes A state of obesity has been linked with atopic diseases such as asthma.
T195 799467-799526 Sentence denotes The association of obesity and CU has not been established.
T196 799527-799535 Sentence denotes Methods:
T197 799536-799691 Sentence denotes We performed a retrospective analysis of 86 Hispanic patients with CU visiting an Allergy and Immunology Clinic from June 2012 -August 2013 in Puerto Rico.
T198 799692-799777 Sentence denotes Cases were stratified between physical urticaria (PU) and idiopathic urticaria (CIU).
T199 799778-799864 Sentence denotes Demographic characteristics, comorbid diseases, and associated symptoms were compared.
T200 799865-799898 Sentence denotes Data was analyzed using SPSS v19.
T201 799899-799907 Sentence denotes Results:
T202 799908-799961 Sentence denotes Subjects mean age was 32 ± 20 years, 77% were female.
T203 799962-800038 Sentence denotes Concurrent atopic diseases were reported in 48% of patients, 31% had asthma.
T204 800039-800093 Sentence denotes Most commonly associated symptom was angioedema (38%).
T205 800094-800151 Sentence denotes Forty-four (51%) patients had CIU, while 41 (48%) had PU.
T206 800152-800220 Sentence denotes 56% of the patients with PU reported more than one physical trigger.
T207 800221-800349 Sentence denotes No significant associations were found between gender, thyroid disease, allergic rhinitis or food allergy and type of urticaria.
T208 800350-800502 Sentence denotes Thyroid disease was more prevalent in adult participants (16/66; 24%), while allergic rhinitis was more common in adolescents and children (19/27; 70%).
T209 800503-800695 Sentence denotes Patients with BMI > 25 were significantly more likely to have PU (20/31 (65%); p = 0.025), while subjects with a BMI <25 were two times more likely to suffer from CIU (29/49 (59%); p = 0.039).
T210 800696-800708 Sentence denotes Conclusions:
T211 800709-800790 Sentence denotes A significant association was found between increased BMI and PU compared to CIU.
T212 800791-800896 Sentence denotes Studies are needed to evaluate the modulation of adipose tissue on mast cells and basophil degranulation.
T213 800897-800901 Sentence denotes M.I.
T214 800902-800925 Sentence denotes Rojo-Gutierrez * , C.N.
T215 800926-800946 Sentence denotes Flores Ruvalcaba, J.
T216 800947-800965 Sentence denotes Mellado Abrego, G.
T217 800966-800986 Sentence denotes Castillo Narvaez, M.
T218 800987-801028 Sentence denotes Gonzalez ibarra, Mexico City, DF, Mexico.
T219 801029-801138 Sentence denotes Urticaria is a very common disease of skin, characterized by rapid onset of hives with or without angioedema.
T220 801139-801245 Sentence denotes It is classified by etiology ; in spontaneous and inducible urticaria, and evolution in acute and chronic.
T221 801246-801250 Sentence denotes IgE.
T222 801251-801466 Sentence denotes CSU is more common in women and international management guidelines recommend 2nd generation antihistamines regulate dose or higher doses and in cases of failure suggest the use of monoclonal antibodies against IgE.
T223 801467-801627 Sentence denotes Monoclonal antibodies are effective at doses of 150 and 300 mg so our aim was to determine their effectiveness at doses of 150mg and 300mg in patients with CSU.
T224 801628-801650 Sentence denotes Materials and methods:
T225 801651-801879 Sentence denotes We evaluated 35 patients who failed UCE in conventional antihistamine therapy .Two groups were randomly performed where the group : A) 20 patients received 150 mg single subcutaneous dose of omalizumab and B) 300mg 20 patients .
T226 801880-802114 Sentence denotes Evaluate effectiveness by measuring frequency and intensity of the lesions with a baseline measurement UAS7 (Urticaria activity score 7 days) and weekly reviews and quality of life questionnaire (CUQ2oL) on arriving a week 1, 2 and 3.
T227 802115-802194 Sentence denotes Results: we evaluated 40 patients 22.5 % (9) were male and 78.5 % (31) females.
T228 802195-802293 Sentence denotes The mean was 226.93 CUQ2oL at baseline, 93.7 at the first week, 57 the second and the third 44.33.
T229 802294-802522 Sentence denotes Hives/ pruritus in stockings 2.2/2.5 at startup, the first week 1.35/1.45, 0.9/1.1 second and 0.98 / 1.08 the third, we find highly significant differences when comparing home against 1st week, 2nd week and 3rd week p < 0.0001 .
T230 802523-802535 Sentence denotes Conclusions:
T231 802536-802624 Sentence denotes Omalizumab is highly effective in controlling symptoms of chronic spontaneous urticaria.
T232 802625-802627 Sentence denotes V.
T233 802628-802647 Sentence denotes Bozoghlanian * , D.
T234 802648-802656 Sentence denotes Levy, R.
T235 802657-802675 Sentence denotes Gutta, Irvine, CA.
T236 802676-802689 Sentence denotes Introduction:
T237 802690-802825 Sentence denotes Staphylococcus aureus is known to exacerbate atopic dermatitis with production of bacterial enterotoxins and superinfection of lesions.
T238 802826-803006 Sentence denotes We report the first case of severe atopic dermatitis in a human exacerbated by Staphylococcus intermedius, which has been associated with exacerbation of atopic dermatitis in dogs.
T239 803007-803024 Sentence denotes Case Description:
T240 803025-803153 Sentence denotes A 26 year old Hispanic man presented with a 6-year history of extremely pruritic diffuse rash consistent with atopic dermatitis.
T241 803154-803313 Sentence denotes He was referred for total IgE >16,000 IU/ml and failure to respond to high-dose topical and oral corticosteroids, methotrexate, cyclosporine, and phototherapy.
T242 803314-803371 Sentence denotes In our clinic, an immunodeficiency evaluation was normal.
T243 803372-803458 Sentence denotes Workup for hyper-IgE syndrome, including STAT-3 and Dock-8 gene mutations, was normal.
T244 803459-803631 Sentence denotes Skin biopsies were negative for malignancy, fungal staining, or vasculitis, and suggestive of severe atopic dermatitis with normal immunofluorescence and immunophenotyping.
T245 803632-803832 Sentence denotes Workup for a 70-pound unintentional weight loss was performed, with negative SPEP, UPEP, HIV, HTLV, bone marrow biopsy, flow cytometry, CT chest/abdomen/pelvis, endoscopies, and autoimmune evaluation.
T246 803833-803914 Sentence denotes The patient had multiple severe exacerbations requiring several hospitalizations.
T247 803915-804119 Sentence denotes Aggressive skin care measures (including wet/dry wraps), high-dose antihistamines, gabapentin, oral antibiotics, a onemonth trial of terbinafine, and a five-month trial of omalizumab were not efficacious.
T248 804120-804198 Sentence denotes Multiple skin cultures identified highly-resistant Staphylococcus intermedius.
T249 804199-804284 Sentence denotes The patient developed malignant otitis externa treated with daptomycin and meropenem.
T250 804285-804344 Sentence denotes Cultures from the ear also grew Staphylococcus intermedius.
T251 804345-804484 Sentence denotes His skin lesions improved on the IV antibiotics, but he continued to have a relapsing-remitting course when the antibiotics were withdrawn.
T252 804485-804496 Sentence denotes Discussion:
T253 804497-804591 Sentence denotes Staphyloccocus intermedius has been associated with exacerbation of atopic dermatitis in dogs.
T254 804592-804651 Sentence denotes It may be transmitted to humans with close contact to dogs.
T255 804652-804932 Sentence denotes In patients with severe atopic dermatitis refractory to first and second line therapies, it may be prudent to investigate for Staphyloccocus intermedius colonization and/or infection, and if identified, should be treated with tailored antibiotic therapy based on drug sensitivity.
T256 804933-804935 Sentence denotes A.
T257 804936-804966 Sentence denotes Hamad * , Madison Heights, MI.
T258 804967-804980 Sentence denotes Introduction:
T259 804981-805058 Sentence denotes Sweet syndrome has a presentation that is not uncommon; acute skin eruptions.
T260 805059-805255 Sentence denotes It could be mistaken for many other conditions and expose patients to unnecessary medications and stress for months before reaching a diagnosis or worse delay a diagnosis of underlying malignancy.
T261 805256-805273 Sentence denotes Case Description:
T262 805274-805473 Sentence denotes Patient was a 52 year old female with past medical history of hypertension who was in her usual state of health until July 2013.She started having raised, painful, edematous and erythematous lesions.
T263 805474-805574 Sentence denotes The tended to appear first in her hands and feet then rapidly spread to her forearms, legs and face.
T264 805575-805614 Sentence denotes She occasionally had them in her chest.
T265 805615-805657 Sentence denotes These lesions would appear every 7-8 days.
T266 805658-805724 Sentence denotes They would last for 3-4 days then disappear, mostly spontaneously.
T267 805725-805784 Sentence denotes She noticed that they were preceded almost always by fever.
T268 805785-805867 Sentence denotes The patient initially went to the emergency room after the lesions first appeared.
T269 805868-805989 Sentence denotes She was told that the lesions were likely hives and she was discharged home to follow up with her primary care physician.
T270 805990-806109 Sentence denotes Her primary care physician switched her medication for hypertension (lisinopril) to another drug but that did not help.
T271 806110-806187 Sentence denotes Later she was started on a short course of prednisone 40mg daily for 10 days.
T272 806188-806257 Sentence denotes She also was prescribed topical corticosteroid and anesthetic creams.
T273 806258-806322 Sentence denotes Patient did not have any relief with any of these interventions.
T274 806323-806371 Sentence denotes Lesions continued to be a major concern for her.
T275 806372-806462 Sentence denotes So, she was referred to a dermatologist and biopsy was performed for one of these lesions.
T276 806463-806520 Sentence denotes The biopsy was consistent with "neutrophilic dermatitis".
T277 806521-806611 Sentence denotes Patient later was referred to a hematologist/oncologist to rule out underlying malignancy.
T278 806612-806701 Sentence denotes She was also referred to an Allergy-Immunology clinic where we had the chance to see her.
T279 806702-806847 Sentence denotes She did not have active lesions at the time we saw her in the clinic but she showed us pictures she took for them at different sites of her skin.
T280 806848-806958 Sentence denotes Our plan was to start the patient on colchicines as prednisone failed to show any improvement in her symptoms.
T281 806959-806970 Sentence denotes Conclusion:
T282 806971-807103 Sentence denotes It is crucial for general practitioners and allergists to keep sweet syndrome in the differential diagnosis of acute skin eruptions.
T283 807104-807193 Sentence denotes As long as it is in the differential, the diagnosis can be confirmed with a skins biopsy.
T284 807194-807326 Sentence denotes However, management can be as easy as discontinuing a causative drug or gets more complicated if there was an underlying malignancy.
T285 807327-807399 Sentence denotes That's why it is important to increase awareness of this rare condition.
T286 807400-807402 Sentence denotes T.
T287 807403-807423 Sentence denotes Slavyanskaya *1 , V.
T288 807424-807438 Sentence denotes Derkach 2 , B.
T289 807439-807455 Sentence denotes Sangidorj 1 , 1.
T290 807456-807486 Sentence denotes Moscow, Russian Federation; 2.
T291 807487-807519 Sentence denotes Vladivostok, Russian Federation.
T292 807520-807687 Sentence denotes The study was aimed at conducting a comparative cost-effectiveness (CE) analysis of various immunotropic therapy (IT) programmes of atopic dermatitis (AD) in children.
T293 807688-807778 Sentence denotes 94 children at the age of from 3 to 18 with AD having lasted for 1-15 years were examined.
T294 807779-807861 Sentence denotes All the patients received routine clinical and immuno-allergological examinations.
T295 807862-807936 Sentence denotes The treatment was conducted in two stages: background therapy (BT) and IT.
T296 807937-808273 Sentence denotes The patients were divided into three groups: the 1st group (n=30) received immunomodulator (IM) on a stepby-step basis in the course dose of 20 mg; the 2nd group (n=31) received an accelerated course of parenteral allergen-specific IT (PASIT); in the 3rd group (n=33) a combination IT (CIT) -IM+PASIT at an accelerated pace was applied.
T297 808274-808423 Sentence denotes The CE comparative estimation of IT in the treatment of children with AD has shown the most optimal ratio in the 3rd group of patients receiving CIT.
T298 808424-808593 Sentence denotes However, in the 1st and the 2nd groups in which IM and PASIT were applied, AD was not monitored well enough, that resulting from considerable expenses for hospital care.
T299 808594-808812 Sentence denotes The ratio of costs for treating children with AD in hospital environment who received IM (the 1st group) was 42.95% of the total cost of AD treatment per year within direct expenses; the medicinal treatment was 48.12%.
T300 808813-808946 Sentence denotes Among expenses for medications, 30.6% were for IM, and the other ones were associated with conducting BT for improving AD monitoring.
T301 808947-809112 Sentence denotes In the 2nd group of children receiving PASIT, the principal item of direct expenses was the amount spent for visiting the allergologist for administering injections.
T302 809113-809155 Sentence denotes The expenses for hospital care were 15.1%.
T303 809156-809263 Sentence denotes In the 2nd group, the principal costs were associated with medicinal treatment of infectious complications.
T304 809264-809397 Sentence denotes In the 3rd group of children receiving CIT, the percentage of direct expenses for hospital care was 8.92%, thus, being insignificant.
T305 809398-809589 Sentence denotes Expenses for outpatient care (5.95%) and BT (8.95%) in this group were much lower than in the 1st and the 2nd groups due to the absence of infectious complications and reduction of BT volume.
T306 809590-809839 Sentence denotes Inclusion of CIT in the integrated programme of therapy of children with AD resulted in reduction of BT volume, less admissions to hospital, prevention of secondary infection overlay; moreover, the disease was monitored efficiently at the same time.
T307 809840-809894 Sentence denotes Thus, the CE ratio of the treatment was more rational.
T308 809895-809908 Sentence denotes Introduction:
T309 809909-810048 Sentence denotes Chronic idiopathic (spontaneous) urticaria (CIU) is a rare and symptomatic skin condition affecting patient health-related quality of life.
T310 810049-810108 Sentence denotes Data on CIU-related healthcare resource use (HCRU) are old.
T311 810109-810187 Sentence denotes We examined HCRU and costs in CIU patients using a healthcare claims database.
T312 810188-810196 Sentence denotes Methods:
T313 810197-810327 Sentence denotes We used a HIPAA-compliant fully de-identified commercial healthcare claims database from 2012 for this retrospective cohort study.
T314 810328-810409 Sentence denotes We identified CIU patients with a previously validated ICD-9-CM coding algorithm.
T315 810410-810463 Sentence denotes We examined patient characteristics, HCRU, and costs.
T316 810464-810505 Sentence denotes Outcomes were stratified by demographics.
T317 810506-810573 Sentence denotes We used chi-square tests and F-tests to conduct bivariate analyses.
T318 810574-810650 Sentence denotes Because the study did not involve human subjects, IRB review was not needed.
T319 810651-810659 Sentence denotes Results:
T320 810660-810732 Sentence denotes The prevalence of CIU was 0.1% among all continuously enrolled patients.
T321 810733-810845 Sentence denotes We identified 6,350 CIU patients with mean age 42.4 years, 68.3% women, and mean Charlson Comorbidity Index 0.9.
T322 810846-810947 Sentence denotes CIU-related comorbidities included allergic rhinitis (43.2%), angioedema (23.5%), and asthma (18.3%).
T323 810948-811099 Sentence denotes The most commonly prescribed drug classes were oral corticosteroids (OCS; 54.7%), antihistamines (24.0%), and leukotriene receptor antagonists (17.5%).
T324 811100-811226 Sentence denotes Mean allcause total annual healthcare costs were $9,142 per CIU patient; outpatient services accounted for 43.0% of the costs.
T325 811227-811396 Sentence denotes Per year, CIU patients averaged 15.1 physician office visits, 7.3% of patients had at least one hospitalization, and 15.9% -at least one emergency department (ED) visit.
T326 811397-811451 Sentence denotes Total costs and HCRU increased significantly with age.
T327 811452-811532 Sentence denotes Women accrued higher costs and had more hospitalizations and ED visits than men.
T328 811533-811642 Sentence denotes CIU-specific annual costs totaled $997 per patient, and outpatient services accounted for about 2/3 of costs.
T329 811643-811815 Sentence denotes Patients averaged 3.4 office visits for CIU-specific claims; 0.1% of CIU patients had at least one CIU-specific hospitalization and 1.9% at least one CIU-specific ED visit.
T330 811816-811960 Sentence denotes Costs associated with CIU-based claims increased with age and were higher in women than in men; otherwise few consistent trends in HCRU emerged.
T331 811961-811973 Sentence denotes Conclusions:
T332 811974-812095 Sentence denotes Despite being otherwise relatively healthy, CIU patients had frequent HCRU, the majority of which were outpatient visits.
T333 812096-812198 Sentence denotes CIU-specific HCRU was small compared with the total use, which also primarily comprised office visits.
T334 812199-812305 Sentence denotes This indicates that CIU patients often see physicians for reasons not directly related to their urticaria.
T335 812306-812319 Sentence denotes Introduction:
T336 812320-812367 Sentence denotes Chronic urticaria (CU) has a prevalence of 30%.
T337 812368-812458 Sentence denotes It is a condition that does not endanger life but has great impact on the quality of life.
T338 812459-812498 Sentence denotes Sometimes, its management is difficult.
T339 812499-812506 Sentence denotes Case 1:
T340 812507-812806 Sentence denotes 33 year old female with urticaria for 1 year, and 2 months ago she has an exacerbation with the presence of edematous-erythematous, pruritic plaques, positive dermatographism and insomnia; eyelid edema and arms, she was treated with multiple antihistamines without success, we initiate methotrexate.
T341 812807-812845 Sentence denotes We achieve a good control of symptoms.
T342 812846-812853 Sentence denotes Case 2:
T343 812854-813114 Sentence denotes 60 years old female, with urticaria for 3 years, which exacerbates in the past 3 months without responding to the multiple tratments, predominantly generalized pruritus and rash on both arms and abdomen; we indicate methotrexate with an good clinical response.
T344 813115-813126 Sentence denotes Discussion:
T345 813127-813195 Sentence denotes Urticaria management includes H1 antihistamines as the first option.
T346 813196-813425 Sentence denotes Recent studies have reported the usefulness of methotrexate at a dose of 10-15mg per week, due to its anti-inflammatory effect rather than immunosuppression, proving to be effective in chronic idiopathic and autoimmune urticaria.
T347 813426-813577 Sentence denotes Its mechanism of action is unclear, it increases adenosine levels, inducing apoptosis of activated CD4 lymphocytes and decreases neutrophil chemotaxis.
T348 813578-813635 Sentence denotes It has an estimated response time of 3 weeks to 6 months.
T349 813636-813718 Sentence denotes We report two cases of patients with urticaria with good response to methotrexate.
T350 813719-813807 Sentence denotes It is a good option for patients with no response to antihistamines and other therapies.
T351 813808-813810 Sentence denotes R.
T352 813811-813824 Sentence denotes Patel *1 , G.
T353 813825-813843 Sentence denotes Jyothirmayi 2 , E.
T354 813844-813858 Sentence denotes Capitle 2 , 1.
T355 813859-813883 Sentence denotes Long Island City, NY; 2.
T356 813884-813895 Sentence denotes Newark, NJ.
T357 813896-813909 Sentence denotes Introduction:
T358 813910-814034 Sentence denotes Toxic Epidermal Necrolysis (TEN) is a dermatologic disorder characterized by diffuse erythema and necrosis of the epidermis.
T359 814035-814108 Sentence denotes TEN can occur secondary to drugs, infections or autoimmune disorders (1).
T360 814109-814117 Sentence denotes Methods:
T361 814118-814358 Sentence denotes This is a 43 year old female,with a history of SLE maintained on hydroxychloroquine and azathioprine, hypertension and hypothyroidism, who presented with a progressively worsening erythematous and tender skin rash affecting her entire body.
T362 814359-814510 Sentence denotes She was seen prior for a similar skin rash under the breast and discharged on cephalexin and fluconazole for possible cellulitis vs a fungal infection.
T363 814511-814632 Sentence denotes She reported myalgias but denied any fever, vision changes, chest pain, shortness of breath, or genitourinary complaints.
T364 814633-814874 Sentence denotes On physical examination, the patient was afebrile, with a blood pressure of 81/57, heart rate of 106, and a diffuse, erythematous, exudative, desquamating rash over 70 percent of her body including mucous membranes but no ocular involvement.
T365 814875-814883 Sentence denotes Results:
T366 814884-814928 Sentence denotes Further work up revealed leucocytois on CBC.
T367 814929-815021 Sentence denotes The severity of illness score for TEN (SCORTEN) was 5 out 7 indicating a 90% mortality rate.
T368 815022-815114 Sentence denotes Her acute symptoms were managed with intravenous (IV) fluids and broad spectrum antibiotics.
T369 815115-815147 Sentence denotes Infectious work up was negative.
T370 815148-815238 Sentence denotes Skin biopsy was indicative of TEN and she was treated with IV Immunoglobulin and steroids.
T371 815239-815318 Sentence denotes Discussion: TEN is a life threatening skin disease and must be managed rapidly.
T372 815319-815458 Sentence denotes This disorder belongs on a spectrum of skin diseases, which also involve Erythema Multiforme Major and Minor and Steven's Johnson Syndrome.
T373 815459-815525 Sentence denotes History is an important aspect in the diagnosis of this condition.
T374 815526-815646 Sentence denotes Details involving medication history, recent infections, and underlying autoimmune diseases must be thoroughly reviewed.
T375 815647-815808 Sentence denotes In this patient, the rash was present prior to the start of antibiotic therapy, thus her underlying autoimmune disease of lupus most likely was the cause of TEN.
T376 815809-815817 Sentence denotes Image 1:
T377 815818-815941 Sentence denotes Our patient with a diffuse erythematous, exudative, and desquamating rash involving more than 70% of her body surface area.
T378 815942-815955 Sentence denotes Introduction:
T379 815956-816045 Sentence denotes Chronic idiopathic/spontaneous urticaria (CIU/CSU) symptoms interfere with patient sleep.
T380 816046-816124 Sentence denotes Omalizumab has been shown to reduce disease activity in patients with CIU/CSU.
T381 816125-816248 Sentence denotes We describe patient-reported data on sleep from GLACIAL -a large randomized double-blind placebo-controlled clinical trial.
T382 816249-816257 Sentence denotes Methods:
T383 816258-816321 Sentence denotes Subjects were randomized 1:3 and received placebo Introduction:
T384 816322-816421 Sentence denotes Henna, derived from the plant Lawsonia inermis, has been used for centuries in India as a hair dye.
T385 816422-816555 Sentence denotes In recent years, it has experienced resurgence, as consumers are increasingly drawn to natural products, including natural hair dyes.
T386 816556-816636 Sentence denotes Interest in henna has also arisen as it is an exceedingly rare cause of allergy.
T387 816637-816716 Sentence denotes Traditional hair dyes, on the other hand, make use of pphenylenediamine (PPDA).
T388 816717-816876 Sentence denotes This is a common cause of allergic contact dermatitis, and is found in almost all permanent, semi-permanent, and demi-permanent hair dyes in the United States.
T389 816877-817037 Sentence denotes Because of the extremely low risk of allergy, henna hair dyes are often recommended by physicians as appropriate alternate hair dyes for those allergic to PPDA.
T390 817038-817043 Sentence denotes Case:
T391 817044-817157 Sentence denotes A 50 year old male presented to dermatology clinic with a rash of the frontal hairline, eyebrows, and beard area.
T392 817158-817294 Sentence denotes He reported that months earlier he had experienced an allergic reaction several days following the use of a drugstore brand of hair dye.
T393 817295-817401 Sentence denotes His physician had diagnosed allergic contact dermatitis, likely due to p-phenylenediamine in the hair dye.
T394 817402-817462 Sentence denotes He was instructed to use only henna hair dyes in the future.
T395 817463-817582 Sentence denotes He then purchased a henna hair dye at an ethnic grocery store and applied it to his hair, eyebrows, and the beard area.
T396 817583-817668 Sentence denotes Within three days he developed erythema, itching and swelling in each of these areas.
T397 817669-817761 Sentence denotes A review of the ingredient list on the henna hair dye package revealed the presence of PPDA.
T398 817762-817807 Sentence denotes Given his history, he declined patch testing.
T399 817808-817819 Sentence denotes Conclusion:
T400 817820-817902 Sentence denotes Henna is often recommended as an alternate hair dye in patients with PPDA allergy.
T401 817903-818047 Sentence denotes For patients reporting PPDA allergy, henna has been recommended by physicians and hairstylists, as well as via multiple outlets on the internet.
T402 818048-818111 Sentence denotes This case demonstrates that this is not always a safe strategy.
T403 818112-818192 Sentence denotes Patients must be informed that some henna hair dyes may contain additional PPDA.
T404 818193-818278 Sentence denotes This may be due to the fact that henna naturally produces a reddish tint to the hair.
T405 818279-818412 Sentence denotes In order to produce a darker color, additional ingredients may be added in commercially available henna hair dyes; in this case PPDA.
T406 818413-818581 Sentence denotes Patients must also be advised that packaging may not include dis-claimers, and therefore a review of the full ingredient list of any hair dyes is required prior to use.
T407 818582-818697 Sentence denotes We report a case of a patiente with atopic dermatitis and allergic rhinitis with bad control with standard therapy.
T408 818698-818773 Sentence denotes We added mycophenolate mofetil with good results, assessed by SCORAD scale.
T409 818774-818792 Sentence denotes Case Presentation:
T410 818793-818835 Sentence denotes Twenty-eight years old male from Veracruz.
T411 818836-819092 Sentence denotes Since childhood, he has had pruritic erythematous scaly lesions scattered across the whole body surface, especially in the flexurar folds of the elbows, popliteal and ankle regions, creases of the neck and on the face; he also has extremely dry scaly skin.
T412 819093-819145 Sentence denotes Symptoms have periods of remission and exacerbation.
T413 819146-819234 Sentence denotes He also has hyaline anterior rhinorrhea, nasal obstruction, nasal pruritus and sneezing.
T414 819235-819338 Sentence denotes He received moisturizers, topical and systemic steroids and calcineurin inhibitors without improvement.
T415 819339-819383 Sentence denotes At initial assessment he has a SCORAD of 60.
T416 819384-819449 Sentence denotes He has pruritic erythematous scaly papules with impetiginization.
T417 819450-819570 Sentence denotes Studies show 9400 leukocytes, 3500 (38%) neutrophils, 2500 (27%) lymphocytes, 2400 (26%) eosinophils, 90 (1%) basophils.
T418 819571-819678 Sentence denotes Blood chemistry, stool test, acute phase reactants (CRP and ESR), IgG, IgM, IgA and complement were normal.
T419 819679-819707 Sentence denotes Total serum IgE 7830 IU /ml.
T420 819708-819735 Sentence denotes Positive nasal eosinophils.
T421 819736-819807 Sentence denotes Skin prick test was positive for Fraxinus and Dermatophagoides farinae.
T422 819808-819941 Sentence denotes The diagnosis of severe atopic dermatitis and mild intermittent allergic rhinitis is confirmed by clinical and complementary studies.
T423 819942-820186 Sentence denotes We started treatment for allergic rhinitis and atopic dermatitis based on intranasal saline solution, intranasal steroids, oral antihistamines, skin hydration, specific immunotherapy and added mycophenolate mofetil 1 g orally daily for 60 days.
T424 820187-820280 Sentence denotes Clinical response of both allergic rhinitis and skin pathology was successful (SCORAD of 10).
T425 820281-820292 Sentence denotes Discussion:
T426 820293-820393 Sentence denotes Atopic dermatitis is a chronic inflammatory skin disease commonly associated with allergic rhinitis.
T427 820394-820530 Sentence denotes The goals of treatment are to improve pruritus, papules, erythema, edema, vesicles and prevent impetigo and lichenification of the skin.
T428 820531-820660 Sentence denotes Treatment was established with skin hydration, topical steroids, antihistamines and mycophenolate mofetil 1 g orally for 60 days.
T429 820661-820769 Sentence denotes We conclude that mycophenolate mofetil is an effective treatment for difficult to control atopic dermatitis.
T430 820770-820855 Sentence denotes Inflammatory skin diseases manifest via reactive physiological pathways to pathogens.
T431 820856-820919 Sentence denotes Epidermal keratinocytes play a major role in skin inflammation.
T432 820920-821100 Sentence denotes In acute eczematous dermatitis, activated dermis-infiltrating T cells secrete proinflammatory cytokines that direct epidermal keratinocytes to undergo either apoptosis or survival.
T433 821101-821305 Sentence denotes Tumor necrosis factor may promote keratinocyte apoptosis and limit the spread of keratinocyte damage, leading to the formation of spongiosis, the histopathological hallmark of acute eczematous dermatitis.
T434 821306-821413 Sentence denotes A 76 year old female presented to the allergy clinic with intermittent lesions in her left lower extremity.
T435 821414-821520 Sentence denotes The patient had similar lesions in her chest and upper extremity in the past which resolved spontaneously.
T436 821521-821786 Sentence denotes Her medical history is significant for rheumatoid arthritis, Sjogren's disease, fibromyalgia, breast cancer with bilateral mastectomy, gastroesophageal disease, myocardial infarction, neuropathy, depression, anxiety disorder, COPD, dyslipidemia, and hypothyroidism.
T437 821787-821870 Sentence denotes Physical examination was significant for a 6.4cm discoid ulcer near the left ankle.
T438 821871-822055 Sentence denotes RF, CCP, B cell markers, CD19, CD29, CD23, CD10, surface immunoglobulin, myeloid, platelet and natural killer cell, stem cell, erythroid cell markers and NBT were within normal limits.
T439 822056-822092 Sentence denotes Allergen testing by sIgE was normal.
T440 822093-822206 Sentence denotes Immunoglobulin A and M, as well as complement levels were normal; however immunoglobulin G levels were decreased.
T441 822207-822353 Sentence denotes Biopsy of the area revealed spongiosis, epidermal hyperplasia, and a superficial perivascular and interstitial mixed inflammatory cell infiltrate.
T442 822354-822464 Sentence denotes Sjögren's syndrome is a systemic autoimmune disease characterized by dry oral mucosa, dry eyes, and arthritis.
T443 822465-822546 Sentence denotes Skin manifestations in Sjögren's syndrome occur in half of the affected patients.
T444 822547-822701 Sentence denotes There are reports of atopic dermatitis complicated by Sjögren's syndrome and these patients present with persistent itchy dry skin and eczematous lesions.
T445 822702-822839 Sentence denotes Perivascular infiltrates of lymphocytes, histiocytes, and occasional eosinophils can occur in dyshidrotic eczema in rheumatoid arthritis.
T446 822840-822980 Sentence denotes Drug eruptions may present in virtually all patterns of cutaneous inflammation including spongiotic, lichenoid, and psoriasiform dermatitis.
T447 822981-823197 Sentence denotes In psoriasiform dermatitis, the microenvironment of interacting inflammatory cells, antigen presenting cells, and epithelial cells is disturbed, leading to stereotyped reaction patterns in inflammatory skin diseases.
T448 823198-823211 Sentence denotes Introduction:
T449 823212-823342 Sentence denotes The chemical p-phenylenediamine (PPDA), found in almost all permanent hair dyes, is a common cause of allergic contact dermatitis.
T450 823343-823459 Sentence denotes As the treatment of PPDA allergy centers on avoidance, the identification of a safe alternate hair dye is important.
T451 823460-823549 Sentence denotes Henna is frequently recommended as an alternate, as allergy to henna is exceedingly rare.
T452 823550-823625 Sentence denotes Derived from the plant Lawsonia inermis, henna has been used for centuries.
T453 823626-823773 Sentence denotes This study was undertaken to evaluate commercially available henna hair dyes to determine their suitability as hair dyes in PPDA-allergic patients.
T454 823774-823782 Sentence denotes Methods:
T455 823783-823904 Sentence denotes A cross-section of local stores, including ethnic grocery stores, were surveyed in order to evaluate any henna hair dyes.
T456 823905-823993 Sentence denotes Products were included if they contained the word "henna" in the name or on the package.
T457 823994-824045 Sentence denotes The ingredient lists of all products were reviewed.
T458 824046-824111 Sentence denotes Packaging was reviewed for any other indicators of PPDA presence.
T459 824112-824120 Sentence denotes Results:
T460 824121-824200 Sentence denotes A total of 6 stores were surveyed, and 25 brands of henna hair dyes identified.
T461 824201-824365 Sentence denotes Of these, 21 contained the word "henna" in the name of the product, 2 used alternate words such as "mehandi" and 2 used the word "henna" elsewhere on the packaging.
T462 824366-824417 Sentence denotes Eight of the 25 products lacked an ingredient list.
T463 824418-824507 Sentence denotes Of the remaining 17 dyes, 7 listed PPDA as an ingredient and one contained disperse dyes.
T464 824508-824662 Sentence denotes Only 3 of the 7 dyes containing PPDA provided disclaimers; the remainder displayed no notification of the presence of PPDA apart from the ingredient list.
T465 824663-824674 Sentence denotes Conclusion:
T466 824675-824800 Sentence denotes This analysis finds that multiple commercially available henna hair dyes could prove hazardous to patients with PPDA allergy.
T467 824801-824970 Sentence denotes Almost half of labeled henna hair dyes in local stores contained PPDA, and the majority contained no notification of the presence of PPDA apart from the ingredient list.
T468 824971-825053 Sentence denotes One additional product contained disperse dyes, a potential cross-reactor to PPDA.
T469 825054-825160 Sentence denotes Another notable hazard was our finding that almost 1/3 of products contained no ingredient listing at all.
T470 825161-825269 Sentence denotes This analysis makes clear that recommending henna hair dyes to patients with PPDA allergy is not sufficient.
T471 825270-825384 Sentence denotes Many of the commercially available products would result in allergic reactions if used by those with PPDA allergy.
T472 825385-825543 Sentence denotes Patients must therefore be advised to purchase only products that contain a full listing of ingredients, and to review the ingredients carefully prior to use.
T473 825544-825546 Sentence denotes A.
T474 825547-825569 Sentence denotes Kim * , San Diego, CA.
T1 825570-825583 Sentence denotes Introduction:
T2 825584-825758 Sentence denotes Acute generalized exanthematous pustulosis (AGEP) is a rare self-limiting drug eruption that classically presents with sterile pustules on an edematous and erythematous base.
T3 825759-825966 Sentence denotes Diagnosing AGEP can be challenging due to potentially overlapping clinical features shared with septic shock, chronic blistering diseases, Stevens Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN).
T4 825967-825975 Sentence denotes Methods:
T5 825976-826003 Sentence denotes Clinical case presentation.
T6 826004-826012 Sentence denotes Results:
T7 826013-826142 Sentence denotes A 49 year old woman was admitted to the intensive care unit for multi-organism urosepsis and started on vancomycin and ertapenem.
T8 826143-826318 Sentence denotes Due to preexisting drug allergies, antimicrobial resistance and ertapenem-induced thrombocytopenia, Allergy/Immunology was consulted to facilitate Ceftriaxone desensitization.
T9 826319-826487 Sentence denotes Prior to desensitization, the patient had stable hemodynamics and absent history of AGEP, DRESS, SJS/TEN, and visceral involvement from prior antibiotic administration.
T10 826488-826566 Sentence denotes 2 hours following desensitization, the patient became febrile and tachycardic.
T11 826567-826676 Sentence denotes Clinical deterioration progressed to profound hypotension overnight requiring initiation of two vasopressors.
T12 826677-826775 Sentence denotes Infectious Disease evaluated the patient for urosepsis recurrence, but cultures were unremarkable.
T13 826776-826966 Sentence denotes 96 hours following desensitization the patient developed erythema, edema, blistering, and desquamation on the dorsal feet with progression to her neck, perioral region, chest and upper back.
T14 826967-827036 Sentence denotes Flaccid bullae and Nikolsky sign were present on the anterior thighs.
T15 827037-827140 Sentence denotes Dermatology and Burn teams were emergently consulted and IVIG was initiated due to concerns of SJS/TEN.
T16 827141-827239 Sentence denotes Skin biopsy revealed subcorneal neutrophilic pustular dermatitis with negative immunofluorescence.
T17 827240-827370 Sentence denotes Blood analysis did not reveal eosinophilia or liver abnormalities and diagnosis of presumed AGEP secondary to Vancomycin was made.
T18 827371-827494 Sentence denotes Conclusion: AGEP is a self-limiting and acute cutaneous eruption that typically presents with fever, pustules and erythema.
T19 827495-827663 Sentence denotes Although AGEP generally has a clinical presentation distinct from SJS/TEN, there can be considerable clinical overlap necessitating care-ful histopathologic evaluation.
T20 827664-827799 Sentence denotes As in our patient, AGEP can manifest with skin desquamation and positive Nikolsky sign, as well as profound disruption in hemodynamics.
T21 827800-827971 Sentence denotes Given that the prognosis and management of AGEP is notably different from SJS/TEN, it is vital that physicians are aware of the diagnosis and its myriad clinical features.
T22 827972-827985 Sentence denotes Introduction:
T23 827986-828140 Sentence denotes It is important to evaluate the nutritional deficiencies in severely atopic infants in order to treat possible non-atopic causes of persistent dermatitis.
T24 828141-828239 Sentence denotes We describe a case of acquired acrodermatitis enteropathica and endocrinopathy in an atopic child.
T25 828240-828257 Sentence denotes Case Description:
T26 828258-828424 Sentence denotes A full term 11 month old male with history of failure to thrive, GERD, and atopic dermatitis presented to our hospital with fever, dehydration, edema, and dermatitis.
T27 828425-828569 Sentence denotes At 6 months of age, the patient's mother elected to feed with rice milk exclusively due to positive serum specific IgE testing to various foods.
T28 828570-828669 Sentence denotes Our initial laboratory evaluation revealed anemia, lymphopenia, hypoalbuminemia, and transaminitis.
T29 828670-828748 Sentence denotes His growth parameters were less than the 3 rd percentile, and he had anasarca.
T30 828749-828901 Sentence denotes Skin exam revealed denuded, scaly, well demarcated erythematous plaques over the diaper area and erythematous crusted lesions around the mouth and eyes.
T31 828902-828991 Sentence denotes The rash appeared 1 month prior to admission, and was not responsive to topical steroids.
T32 828992-829053 Sentence denotes Skin biopsy was consistent with acrodermatitis enteropathica.
T33 829054-829178 Sentence denotes Inpatient evaluation of his malnutrition further revealed markedly elevated thyroid stimulating hormone, and low serum zinc.
T34 829179-829265 Sentence denotes An elemental diet and levothyroxine were started, and the patient's symptoms improved.
T35 829266-829379 Sentence denotes Appropriate re-evaluation of his food hypersensitivity was performed and reintroduction of solids was successful.
T36 829380-829391 Sentence denotes Discussion:
T37 829392-829509 Sentence denotes This report highlights the potential morbidity of overly restrictive diets in children with severe atopic dermatitis.
T38 829510-829628 Sentence denotes Patients with atopic dermatitis may have positive sensitization to various foods without history of clinical reaction.
T39 829629-829737 Sentence denotes Foods used in lieu of infant formula may have varying levels of carbohydrates, fats, proteins, and minerals.
T40 829738-829811 Sentence denotes These differences must be considered when dietary counseling takes place.
T41 829812-829823 Sentence denotes Conclusion:
T42 829824-829941 Sentence denotes Acquired acrodermatitis enteropathica should be considered in malnourished infants with steroid resistant dermatitis.
T43 829942-830011 Sentence denotes Minerals are important co-factors in hormone production and function.
T44 830012-830106 Sentence denotes Nutritionally appropriate alternatives should be recommended when discussing food elimination.
T45 830107-830255 Sentence denotes Introduction:Treatment for urticarial rash could be frustrating if the conventional treatment fails but the side effect of medication seems to rise.
T46 830256-830384 Sentence denotes We report a case of urticaria secondary to food allergy along with concomitant undiagnosed gluten-sensitive enteropathy.Methods:
T47 830385-830504 Sentence denotes A 23 year old oriental female presented with 1 week history of the generalized urticaria including face and both palms.
T48 830505-830559 Sentence denotes There were no GI symptoms at the initial presentation.
T49 830560-830679 Sentence denotes She took a chitosan pill which is a product of shrimp and shell fishes as a food supplement prior to onset of the rash.
T50 830680-830756 Sentence denotes There was a history of premenstrual pain which required high doses of advil.
T51 830757-830824 Sentence denotes She had a frequent indigestion with unknown origin during chidhood.
T52 830825-830943 Sentence denotes Initially,her urticarial rash responded well to IM steroid with IM Benadryl, followed by oral prednisone, hydroxyzine.
T53 830944-831325 Sentence denotes But few days later, the patient started to have severe intermittent colicky abdominal pain with recurrent urticaria in spite of the treatment.The patient was seen at ER, started on hydrocodone-acetaminophen for pain without relief.Oral steroid was discontinued after the onset of the abdominal pain and changed to IM steroid which controlled urticaria but abdominal pain persisted.
T54 831326-831389 Sentence denotes The patient was evaluated by two different gastroenterologists.
T55 831390-831431 Sentence denotes The gastroendoscopy finding was negative.
T56 831432-831487 Sentence denotes The blood test was positive for t-transglutaminase IgA:
T57 831488-831739 Sentence denotes 5u/ml (0-3).The percutaneous skin test revealed multiple hypersensitivities to clam, shrimp, oyster, barley, celery, coconut, sweet potato, salmon, squash, strawberry, string bean, tomato, dust mites and chinese elm tree pollen but negative for wheat.
T58 831740-831837 Sentence denotes Result:The gluten-free diet resulted in prompt remission of the recurrent colicky abdominal pain.
T59 831838-831974 Sentence denotes The urticaria was under control with antihistamine along with elimination diets, allowing complete discontinuation of systemic steroids.
T60 831975-832262 Sentence denotes Urticaria came back twice over 2 months in spite of gluten-free diet but subsided with antihistamines alone.Conclusion:The urticaria started with food supplemental pill which contained shrimp and shell fish proteins but undiagnosed gluten enteropathy became obvious during the treatment.
T61 832263-832375 Sentence denotes The urticaria also can be a cutaneous manifestation of gluten-sensitive enteropathy aside from the food allergy.
T62 832376-832514 Sentence denotes Therefore, the clinician should be aware of the role of concomitant underlying gluten-sensitive enteropathy in the treatment of urticaria.
T63 832515-832528 Sentence denotes Introduction:
T64 832529-832669 Sentence denotes Skin health, especially in atopic dermatitis (AD), relies on an intact skin barrier, a critical component of which is the protein filaggrin.
T65 832670-832827 Sentence denotes If filaggrin production is impaired, skin barrier function is also dysfunctional and can lead to xerosis, infection, inflammation and allergic sensitization.
T66 832828-832924 Sentence denotes Commensals may help support a healthy skin barrier by helping support normal filaggrin function.
T67 832925-833097 Sentence denotes Using a patent-pending bio-extract from a novel probiotic human commensal organism, we examined whether the extract could be used to increase skin filaggrin protein levels.
T68 833098-833106 Sentence denotes Methods:
T69 833107-833330 Sentence denotes Using an ex vivo skin explant culture model with normal excised skin from plastic surgery patients, filaggrin induction by the proprietary bio-extract was tested via filaggrin antibody immunohistochemistry, rtPCR and ELISA.
T70 833331-833536 Sentence denotes Normal skin explants were also used in a dry skin model induced by SDS treatment, with skin barrier integrity/hydration assessed via skin conductance; bio-extract effect was compared against dexamethasone.
T71 833537-833545 Sentence denotes Results:
T72 833546-833660 Sentence denotes Filaggrin immunohistochemistry: proprietary bio-extract at 0.05% and 0.1% increased filaggrin staining vs control.
T73 833661-833776 Sentence denotes Filaggrin mRNA: filaggrin mRNA expression did not increase with bio-extract treatment at 0.25% and 0.1% vs control.
T74 833777-833897 Sentence denotes Filaggrin ELISA: proprietary bioextracts at 0.05% and 0.1% increased filaggrin protein levels by over 2-fold vs control.
T75 833898-834140 Sentence denotes Skin barrier function: after SDS treatment, 30 minute proprietary bioextract treatment increased skin conductance to or above normal levels; this improvement lasted for all time points measured and performed at least as well as dexamethasone.
T76 834141-834152 Sentence denotes Conclusion:
T77 834153-834248 Sentence denotes Patients look for "natural" disease treatment options but often fail to find effective choices.
T78 834249-834348 Sentence denotes Even small increases in filaggrin have the potential to significantly improve AD clinical symptoms.
T79 834349-834675 Sentence denotes The 2-fold increase in filaggrin protein levels accompanied by normalization of skin barrier function in human skin explants induced by a novel humanprobiotic derived bio-extract hold significant clinical promise in the treatment of skin diseases characterized by low filaggrin expression and skin barrier defects, such as AD.
T80 834676-834689 Sentence denotes Introduction:
T81 834690-834886 Sentence denotes It is increasingly recognized that maintenance of skin health, particularly in patients with atopic dermatitis (AD), requires homeostasis among the microbes comprising the dermatologic microbiome.
T82 834887-834998 Sentence denotes Biofilms are the communal phenotype preferred by most microbes, including pathogens, and form on most surfaces.
T83 834999-835097 Sentence denotes Commensals may help support a healthy skin barrier by inhibiting pathogenic biofilms such as MRSA.
T84 835098-835300 Sentence denotes Using a patent-pending bioextract from a novel probiotic human commensal organism, we defined MRSA anti-biofilm activities of potential clinical utility in the prevention and treatment of MRSA biofilms.
T85 835301-835309 Sentence denotes Methods:
T86 835310-835503 Sentence denotes Using a 96-well biofilm microplate assay, proprietary bio-extracts were tested against clinical MRSA isolates for 2 antibiofilm activities: anti-biofilm adhesion and detachment of MRSA biofilm.
T87 835504-835559 Sentence denotes Results were compared against vancomycin and meropenem.
T88 835560-835568 Sentence denotes Results:
T89 835569-835582 Sentence denotes Antiadhesion:
T90 835583-835807 Sentence denotes The bio-extract was 2-3x more effective than antibiotic controls, with 35% anti-adhesion at 0.01 mg/ml, 50% at 0.05 mg/ml, 58% at 0.1 mg/ml, 85% at 0.5 mg/ml and 90% at 1 mg/ml when compared against untreated growth control.
T91 835808-835827 Sentence denotes Biofilm detachment:
T92 835828-835903 Sentence denotes The bio-extract was up to 10 times more effective than antibiotic controls:
T93 835904-836006 Sentence denotes 0.05 mg/ml detached 50% of MRSA biofilm; vancomycin and meropenem both detached only approximately 5%.
T94 836007-836148 Sentence denotes Unlike the anti-adhesive assay, there was no apparent dose-dependence, as percent detachment declined as bio-extract concentration increased.
T95 836149-836250 Sentence denotes Lack of dose dependence may reflect non-metabolic mechanisms of action and/or brief application time.
T96 836251-836262 Sentence denotes Conclusion:
T97 836263-836364 Sentence denotes We have discovered a novel human-derived probiotic extract with anti-MRSA biofilm therapeutic effect.
T98 836365-836447 Sentence denotes Skin of patients with AD is diffusely colonized by Staphylococcus aureus and MRSA.
T99 836448-836639 Sentence denotes Increased microbial burden is associated with acute exacerbations, and chronically, these microbes are associated with inflammation, decreased skin immune defense and a weakened skin barrier.
T100 836640-836723 Sentence denotes MRSA biofilms are a key factor in the persistence of these microbes in AD patients.
T101 836724-836992 Sentence denotes This human probiotic-derived bio-extract with the dual antibiofilm activities of inhibition of biofilm adhesion as well as detachment of already formed pathogenic biofilm, could synergistically both treat and prevent MRSA biofilms in chronic skin diseases, such as AD.
T102 836993-837003 Sentence denotes Rationale:
T103 837004-837148 Sentence denotes Angioedema is a self-limited, localized swelling of the skin or mucosal tissues resulting from the extravasation of fluid into the interstitium.
T104 837149-837453 Sentence denotes Although angioedema is a common condition in allergy practices, solar induced angioedema has a narrower differential diagnosis, including phototoxic drug reactions, solar urticaria, contact dermatitis, autoimmune inflammatory disorders and in rare cases metabolic disorders, such as cutaneous porphyrias.
T105 837454-837576 Sentence denotes We present a case of erythropoietic protoporphyria (EPP) presenting as sun-induced angioedema in a 36 y/o Hispanic female.
T106 837577-837585 Sentence denotes Methods:
T107 837586-837598 Sentence denotes Case Report.
T108 837599-837607 Sentence denotes Results:
T109 837608-837747 Sentence denotes A 36 y/o female G1P1A0 presents to the clinic with burning, itching and swelling within minutes upon sun-exposed areas since her childhood.
T110 837748-837874 Sentence denotes These episodes last several days, do not leave residual hyperpigmentation, but interfere significantly in her quality of life.
T111 837875-837955 Sentence denotes Neither antihistamines nor sunscreens have been helpful to control her symptoms.
T112 837956-838166 Sentence denotes Denies associated blisters, hives, hypertrichosis, anemia, exacerbation or provocation by any other physical stimuli, anemia, concomitant liver disease, family history of sun induced angioedema, nor NSAIDs use.
T113 838167-838248 Sentence denotes Also denies gastrointestinal or respiratory complains or any comorbid conditions.
T114 838249-838321 Sentence denotes Her family emigrated from Cuba and there is no history of intermarriage.
T115 838322-838367 Sentence denotes Her only medication is vitamin D replacement.
T116 838368-838526 Sentence denotes Past medical history was remarkable for chemical hepatitis after surgery for an ovarian cyst at 12 y/o and cholecystectomy for gallstones when she was 27 y/o.
T117 838527-838638 Sentence denotes On physical exam a pale short size woman was noted without any visible eczema, hives, blisters or organomegaly.
T118 838639-838780 Sentence denotes Initial laboratories were significant for mildly elevated liver function tests as well as elevated coproporphyrin and heptacarboxyl in urine.
T119 838781-838804 Sentence denotes Anemia was not present.
T120 838805-838956 Sentence denotes A preliminary diagnosis of EPP was made awaiting confirmatory porphyrin and protoporphyrin levels in RBC, which will be available for the presentation.
T121 838957-838968 Sentence denotes Conclusion:
T122 838969-839305 Sentence denotes Although EPP is a rare cause of sun-induced angioedema, it is important for allergists to consider it in the differential diagnosis in order to diagnose at an early age and prevent life-threatening complications such as hepatitis and hepatic failure requiring liver transplant, and to initiate appropriate sun avoidance recommendations.
T123 839306-839308 Sentence denotes K.
T124 839309-839320 Sentence denotes Dass * , A.
T125 839321-839340 Sentence denotes Ditto, Chicago, IL.
T126 839341-839440 Sentence denotes Elephantiasis nostras (EN) occurs secondary to a recurrent lymphangitis often introduced by trauma.
T127 839441-839517 Sentence denotes Rarely, EN can affect the lips, with only four reported cases in literature.
T128 839518-839686 Sentence denotes A 27 year old female presented to our allergyimmunology outpatient office with complaints of painful edema, erythema, peeling, and scabbing of her upper and lower lips.
T129 839687-839734 Sentence denotes Her symptoms began 6 months prior to her visit.
T130 839735-839803 Sentence denotes There was no history of drug allergy or prior history of angioedema.
T131 839804-839843 Sentence denotes She denied any constitutional symptoms.
T132 839844-839917 Sentence denotes Her symptoms were worse in the morning or when any food touched her lips.
T133 839918-839966 Sentence denotes She denied any globus, tongue swelling, dyspnea.
T134 839967-840052 Sentence denotes She denied any new medications or exposure to any new detergents or bathing products.
T135 840053-840158 Sentence denotes Examination was notable for erythematous, edematous, painful lips with fissures at the vermillion border.
T136 840159-840215 Sentence denotes There was no cervical or post-auricular lymphadenopathy.
T137 840216-840294 Sentence denotes She was concerned about her appearance and lack of resolution of her symptoms.
T138 840295-840347 Sentence denotes Elephantiasis nostras was considered as a diagnosis.
T139 840348-840489 Sentence denotes The patient was treated with five days of prednisone and twenty-one days of amoxicillin clavulanate with complete resolution of her symptoms.
T140 840490-840531 Sentence denotes Unfortunately, she was lost to follow up.
T141 840532-840603 Sentence denotes With recurrence of symptoms, the patient followed with a dermatologist.
T142 840604-840715 Sentence denotes She was treated for contact dermatitis despite avoiding all makeup or other skin products in the affected area.
T143 840716-840797 Sentence denotes After testing positive for a nickel allergy, she also followed a low nickel diet.
T144 840798-840844 Sentence denotes Despite her efforts, her symptoms persisted. .
T145 840845-841034 Sentence denotes The patient returned to the allergy and immunology outpatient office, where she was successfully treated with a second course of 5 days of prednisone and 21 days of amoxicillin-clavulanate.
T146 841035-841159 Sentence denotes Elephantiasis nostras can lead to permanent swelling, hypertrophic fibrosis, and facial disfigurement with repeated attacks.
T147 841160-841230 Sentence denotes Suspicion of EN as a clinical entity may arise with unrelenting edema.
T148 841231-841418 Sentence denotes Other disorders that should be considered include angioedema, contact dermatitis, erysipelas, granulomatous cheilitis, Melkersson's syndrome, superior vena cava syndrome, and scleroderma.
T149 841419-841519 Sentence denotes Treatment focuses on long-term antibiotic administration with plastic surgery occasionally required.
T150 841520-841662 Sentence denotes This case illustrates the importance of maintaining elephantiasis nostras as a differential diagnosis in patients with chronic edematous lips.