pulmicort and Food-Hypersensitivity

Eosinophilic esophagitis (EoE) is a chronic immune-mediated inflammatory disease of the esophagus that affects an estimated 34.4/100 000 people in Europe and North America. EoE affects both children and adults, and causes dysphagia, food impaction of the esophagus, and esophageal strictures.. EoE is defined by symptoms of esophageal dysfunction, such as vomiting, dysphagia, or feeding difficulties, in a patient with an esophageal biopsy demonstrating at least 15 eosinophils per high-power field in the absence of other conditions associated with esophageal eosinophilia such as gastroesophageal reflux disease or achalasia. Genetic factors and environmental factors, such as exposure to antibiotics early in life, are associated with EoE. Current therapies include proton pump inhibitors; topical steroid preparations, such as fluticasone and budesonide; dietary therapy with amino acid formula or empirical food elimination; and endoscopic dilation. In a systematic review of observational studies that included 1051 patients with EoE, proton pump inhibitor therapy was associated with a histologic response, defined as less than 15 eosinophils per high-power field on endoscopic biopsy, in 41.7% of patients, while placebo was associated with a 13.3% response rate. In a systematic review of 8 randomized trials of 437 patients with EoE, topical corticosteroid treatment was associated with histologic remission in 64.9% of patients compared with 13.3% for placebo. Patients with esophageal narrowing may require dilation. Objective assessment of therapeutic response typically requires endoscopy with biopsy.. EoE has a prevalence of approximately 34.4/100 000 worldwide. Treatments consist of proton pump inhibitors, topical steroids, elemental diet, and empirical food elimination, with esophageal dilation reserved for patients with symptomatic esophageal narrowing.

Topics: Adrenal Cortex Hormones; Adult; Amino Acids; Budesonide; Capsules; Combined Modality Therapy; Deglutition Disorders; Dilatation; Eosinophilic Esophagitis; Eosinophils; Esophagoscopy; Esophagus; Fluticasone; Food Hypersensitivity; Gene-Environment Interaction; Humans; Proton Pump Inhibitors

Topics: Adolescent; Anti-Inflammatory Agents; Budesonide; Enterocolitis; Eosinophilia; Food Hypersensitivity; Humans; Male

Eosinophilic esophagitis (EoE) is a chronic immune-mediated relapsing disease caused by eosinophilic infiltration of the esophageal mucosa which is normally lacking these cells. EoE belongs to the group of the so called Eosinophilic Gastrointestinal Disorders (EGIDs). From a rare and unusual disease, EoE has become an emerging entity and in recent years its incidence and prevalence have increased all over the world, also in children. The pathogenesis is very complex and still not completely clear. Esophageal disfunction symptoms (e.g. dysphagia and food impaction) represent the typical manifestation of EoE and this condition could be difficult to recognize, more in pediatric age than in adults. Moreover, symptoms can often overlap with those of gastro-esophageal reflux disease (GERD), leading to a delayed diagnosis. EoE is often related to atopy and an allergological evaluation is recommended. Untreated EoE could provoke complications such as strictures, esophageal rings, narrowing of the esophagus. Diagnosis is confirmed by the demonstration in biopsy specimens obtained through upper endoscopy of eosinophilic inflammation (>15 for high powered field) of the esophageal mucosa and other histological features. Other tests could be useful not specifically for the diagnosis, but for the characterization of the subtype of EoE. Since EoE incidence and knowledge about physiopathology and natural history have increased, the goal of the review is to provide some helpful tools for the correct management in pediatric age together with an overview about epidemiology, pathogenesis, clinical, diagnosis and treatment of the disease.

Topics: Adolescent; Adrenal Cortex Hormones; Age of Onset; Budesonide; Cell Movement; Child; Child, Preschool; Cytokines; Dilatation; Eosinophilic Esophagitis; Eosinophils; Esophagoscopy; Feeding Behavior; Food Hypersensitivity; Food, Formulated; Gastroesophageal Reflux; Humans; Immunosuppressive Agents; Proton Pump Inhibitors

Eosinophilic esophagitis is a clinicopathologic disease that can present with a constellation of upper gastrointestinal symptoms and endoscopic findings in conjunction with significant infiltration of the esophageal tissue with eosinophils. Clinical and histologic resolution of the disease can be seen with dietary restriction therapies and systemic and topical corticosteroids. Because most patients have an atopic background and the disease seems to have an underlying T-helper type 2 pathogenesis, allergists and gastroenterologists need to be familiar with the diagnosis and management of this disease. In this review, clinical characteristics, endoscopic and histologic findings, and available therapy options are discussed.

Topics: Age Factors; Androstadienes; Budesonide; Eosinophilic Esophagitis; Eosinophils; Esophagus; Fluticasone; Food; Food Hypersensitivity; Humans; Sex Factors

Vitamin D is hypothesized to have some roles in innate and adaptive immunity, inflammation reduction, and remodeling; therefore, it is supposed to affect the asthma phenotype, severity, and response to inhaled corticosteroid (ICS).. To explore the synergistic effects of vitamin D supplementation in addition to asthma controllers (ICS or ICS plus long-acting β-agonist) on airway functions.. A randomized clinical trial was conducted in 130 individuals aged 10 to 50 years who lived in Tehran during a 24-week period. Data on age, sex, body mass index, stage of asthma, serum total IgE, history of allergic rhinitis, atopic dermatitis, food allergy, and urticaria were collected. Spirometric parameters (forced expiratory volume in 1 second [FEV1] and ratio of FEV1 to forced vital capacity) and serum vitamin D measurement were obtained before and 8 and 24 weeks after the intervention. Patients were divided in 2 groups randomly. Both groups received asthma controllers (budesonide or budesonide plus formoterol) according to their stage, but the intervention group received vitamin D supplementation (100,000-U bolus intramuscularly plus 50,000 U orally weekly) in addition to asthma controllers.. FEV1 improved significantly in both groups after 8 weeks, but no significant difference was found between the 2 groups at baseline (P = .20) or after 8 weeks (P = .99); however, a significant improvement was seen in the intervention group in the last 16 weeks, and FEV1 was significantly better in the intervention group than the other group after 24 weeks (P < .001).. Vitamin D supplementation associated with asthma controllers could significantly improve FEV1 in mild to moderate persistent asthma after 24 weeks.. irct.ir Identifier: IRCT201302079608N1.

Topics: Adolescent; Adult; Anti-Inflammatory Agents; Asthma; Bronchodilator Agents; Budesonide; Child; Dermatitis, Atopic; Dietary Supplements; Drug Synergism; Ethanolamines; Female; Food Hypersensitivity; Forced Expiratory Volume; Formoterol Fumarate; Humans; Immunoglobulin E; Iran; Male; Middle Aged; Prospective Studies; Rhinitis, Allergic; Urticaria; Vital Capacity; Vitamin D; Young Adult

To evaluate the influence of early antiinflammatory therapy in the development of asthma 3 years after hospitalization for wheezing in infancy. In addition, the effects of allergic sensitization and respiratory syncytial virus (RSV) infection on the development of asthma were investigated.. A randomized, controlled follow-up study in a university hospital that provides primary hospital care for all pediatric patients in a defined area.. Eighty-nine infants under 2 years of age who had been hospitalized for infection associated with wheezing and followed up for 3 years.. Early antiinflammatory therapy was given for 16 weeks; 29 patients received cromolyn sodium and 31 received budesonide. Twenty-nine control patients received no therapy.. Clinical diagnosis of current asthma, defined as having at least 3 episodes of physician-diagnosed wheezing and either a wheezing episode during the preceding year or ongoing antiinflammatory medication for asthma.. Fourteen (48%) patients in the former cromolyn group, 15 (48%) in the former budesonide group, and 16 (55%) in the control group had current asthma. The significant predictors of asthma were age over 12 months (risk ratio [RR] 4.1; 95% confidence interval [CI] = 1.59-10.35), history of wheezing (RR 6.8; CI = 1.35-34.43), and atopic dermatitis on study entry (RR 3.4; CI = 1.17-9.39). Skin prick test positivity at the age of 16 months significantly predicted asthma (RR 9.5; CI = 2.45-36.72). In addition, all of the 18 (20%) children sensitized with furred pet developed asthma. RSV identification (RR 0.3; CI = 0.08-0.80) and early furred pet contact at home (RR 0.3; CI 0.10-0.79) were associated with the decreased occurrence of asthma.. Antiinflammatory therapy for 4 months has no influence on the occurrence of asthma 3 years after wheezing in infancy. Early sensitization to indoor allergens, especially to pets, and atopic dermatitis predict subsequent development of asthma. RSV infection in wheezing infants may have a better outcome than other infections.

Topics: Administration, Inhalation; Anti-Inflammatory Agents; Asthma; Budesonide; Comorbidity; Cromolyn Sodium; Dermatitis, Atopic; Disease Progression; Female; Finland; Follow-Up Studies; Food Hypersensitivity; Hospitalization; Humans; Infant; Male; Prospective Studies; Respiratory Hypersensitivity; Respiratory Sounds; Respiratory Syncytial Virus Infections; Risk Factors

Topics: Adult; Allergens; Arachis; Bone Marrow Transplantation; Budesonide; Colic; Diarrhea; Eosinophils; Food Hypersensitivity; Humans; Intestinal Mucosa; Male; Postoperative Complications; Transplantation, Homologous; Weight Loss

Topics: Budesonide; Child; Crocus; Food Hypersensitivity; Humans; Male; Rhinitis, Allergic; Rhinitis, Allergic, Perennial; Spices

Topics: Allergens; Anti-Inflammatory Agents; Budesonide; Cottonseed Oil; Eosinophilic Esophagitis; Eosinophils; Food Hypersensitivity; Garlic; Humans; Immunoglobulin E; Male; Middle Aged

Topics: Adolescent; Adult; Aged; Allergens; Anti-Inflammatory Agents; Budesonide; Child; Colitis; Female; Food Hypersensitivity; Gastroesophageal Reflux; Gastrointestinal Diseases; Histamine Antagonists; Humans; Male; Middle Aged; Recurrence; Skin Tests; Time Factors