Middleton’s Allergy Essentials E-Book

Front Cover......Page 1 Inside Front Cover......Page 2 Middleton's Allergy Essentials......Page 3 Copyright Page......Page 6 Table Of Contents......Page 7 Foreword......Page 8 Preface......Page 9 Contributors......Page 10 Dedication......Page 12 Summary of Important Concepts......Page 13 Pattern Recognition Receptors......Page 14 Cellular Responses of Innate Immunity......Page 15 Adaptive Immune Response in Allergic Disease......Page 16 Features of the Adaptive Immune Response......Page 17 B Lymphocytes and the Humoral Immune Response......Page 18 Immunoglobulins and Human Disease......Page 19 Central Tolerance......Page 21 Interleukin-10 (IL-10)......Page 23 Interleukin-4 (IL-4)......Page 24 Interleukin-9 (IL-9)......Page 25 Thymic Stromal Lymphopoietin (TSLP)......Page 26 Asthma......Page 27 Atopic Dermatitis......Page 28 T Lymphocytes......Page 30 Type 2 Innate Lymphoid Cells......Page 31 Eosinophils......Page 32 Airway Epithelial Cells......Page 34 Neuronal Control of Airway Function......Page 35 Cytokine Networks in Allergic Inflammation......Page 36 References......Page 38 Summary of Important Concepts......Page 41 Introduction......Page 42 Heritability Studies......Page 43 Genome-wide Association Studies (GWAS).......Page 44 Atopy......Page 45 Genetic Studies Increase the Understanding of Asthma Pathogenesis......Page 46 Early Life Development and Asthma......Page 47 Food Allergy and Anaphylaxis......Page 48 Gene–Environment Interaction......Page 49 Pharmacogenetics of Allergic Disease......Page 50 Epigenetics and Allergic Disease......Page 51 Potential for Clinical Application of Genetics in Allergic Disease......Page 52 Developmental Origins of Allergic Disease......Page 53 Evidence for Developmental Programming......Page 54 Maternal Environmental Exposures during Pregnancy and Allergic Disease Risk in Offspring......Page 55 Postnatal Immune Development and Allergic Disease......Page 58 T Regulatory Cells......Page 59 Gut Microbiome and Postnatal Immune Development......Page 60 References......Page 61 Introduction......Page 63 Asthma......Page 64 Allergic Rhinitis......Page 65 Atopy and Atopic Sensitization......Page 66 Estimates of Worldwide Prevalence of Asthma, Rhinitis, Atopic Sensitization, and Food Allergy......Page 67 Asthma......Page 68 Childhood Asthma......Page 69 Food Allergy......Page 72 Asthma, Allergic Rhinitis and Atopic Sensitization......Page 73 Risk Factors for Asthma and Allergic Diseases......Page 75 Protective Exposures in Rural Areas......Page 76 Allergens......Page 77 The Interaction between Environmental Exposures and Genetic Predisposition......Page 78 ‘Team Science’ to Solve the Puzzle of Asthma and Allergies......Page 79 References......Page 80 Summary of Important Concepts......Page 85 Allergens and Allergenicity......Page 86 Indoor and Outdoor Allergen Sources......Page 87 Aerobiology of Indoor and Outdoor Allergen Sources......Page 88 Indoor Allergen Monitoring......Page 89 The Chemical Nature of Allergens......Page 90 Allergen Nomenclature and Allergen Databases......Page 92 Outdoor Allergen Sources – Pollen......Page 93 Pollen Structure and Allergen Release......Page 95 Pollen Allergens......Page 97 Allergens Involved in Defense......Page 98 Ligand Binding PR-10 Allergens......Page 101 Outdoor Allergen Sources – Fungi......Page 102 Alternaria, Aspergillus, and Cladosporium......Page 103 Indoor Allergens......Page 108 Acaridae......Page 109 Mite Allergens......Page 113 Cockroach Allergens......Page 114 Cats, Rabbits, and Dogs......Page 115 Cat and Dog Allergens......Page 116 Allergens and Allergenicity......Page 117 Avoidance Measures for Indoor Allergens......Page 118 House-dust Mites......Page 119 Air Pollution, Allergic Sensitization, and Disease......Page 120 Sources of Air Pollution......Page 121 Biomass......Page 122 Particulates......Page 123 Ozone (O3)......Page 125 References......Page 126 Summary of Important Concepts......Page 129 Historical Perspectives......Page 130 Pathogenesis and Etiology......Page 131 Skin Testing for a Specific Food......Page 132 Skin Tests Recommended in Clinical Practice......Page 133 Skin Reactivity......Page 134 Allergic Sensitization......Page 135 Drug Interference with Skin Testing......Page 136 Other Drugs......Page 137 Skin Test Risks......Page 138 Anti-histaminic Treatment......Page 139 Allergic Profile......Page 140 Component Resolved Diagnosis......Page 141 Conclusions......Page 142 References......Page 143 Summary of Important Concepts......Page 145 Indications for Specific Allergen Immunotherapy......Page 146 Cockroach......Page 148 Persistence of Clinical Improvement after Cessation of Immunotherapy......Page 149 End-Organ Changes......Page 150 Overview of the Immune Response to Immunotherapy......Page 151 Injection Schedules......Page 152 Adverse Reactions to SIT......Page 153 Sublingual Immunotherapy......Page 154 Side Effects of SLIT......Page 156 SLIT for Asthma......Page 157 Safety and Cost-Effectiveness of SLIT......Page 158 Modified Allergen Extracts and Adjuvants (Box 6-6)......Page 159 Unmodified Allergens......Page 160 Conclusions......Page 161 References......Page 162 Chapter Outline......Page 163 Background......Page 164 Prevalence and Impact of Asthma......Page 165 Prevalence......Page 166 Changing Trends......Page 167 Structural Changes and Airway Remodeling......Page 168 Immunologic Factors......Page 169 Genetics and Epigenetics......Page 170 Phenotypes of Adult Asthma......Page 176 Phenotypes in Children......Page 177 Lung Function......Page 178 Determination of the Allergic Status......Page 180 Occupational Asthma......Page 181 Asthma in the Elderly......Page 182 History and Examination......Page 183 Pulmonary Function Tests......Page 184 Monitoring Asthma......Page 185 Exacerbations......Page 187 Personal Asthma Action Plan......Page 188 Anticholinergics.......Page 189 Leukotriene Modifiers.......Page 191 Immunomodulation.......Page 192 Step 1 Care.......Page 193 Step 3 Care: Moderate Persistent Asthma.......Page 194 Steps 5 and 6 Care in Severe Persistent Asthma.......Page 195 Asthma Management in Infants and Children......Page 196 Environmental Control......Page 197 Asthma Education......Page 198 Long-acting Bronchodilators (LABAs).......Page 199 Introduction......Page 201 Evaluation......Page 202 Adults: Home Management of Asthma Exacerbation......Page 203 Oxygen.......Page 205 Inhaled Anticholinergic Agents.......Page 206 Systemic Corticosteroids.......Page 207 Office or Emergency Department Management in Children......Page 208 Asthma Diagnosis and Monitoring......Page 209 New Treatments......Page 210 Prevention......Page 211 References......Page 212 Summary of Important Concepts......Page 217 Incidence and Prevalence......Page 218 Associated Diseases......Page 219 Pathogenesis and Etiology......Page 220 Physical Examination......Page 221 Blood Eosinophils and Total Serum Immunoglobulin E......Page 222 Chronic Rhinosinusitis with and Without Nasal Polyps......Page 223 Rhinitis Associated with Drugs.......Page 224 Nasal and Pharyngeal Structural Abnormalities......Page 225 Toxic Conjunctivitis......Page 226 Allergen Avoidance......Page 227 Intranasal Corticosteroids......Page 228 Anticholinergics......Page 229 Allergen Immunotherapy......Page 230 Non-allergic Rhinitis......Page 231 Elderly......Page 232 References......Page 233 Introduction......Page 237 Historical Perspective......Page 239 Epidemiology......Page 241 Pathogenesis and Etiology......Page 242 Clinical Features (Phenotypes)......Page 244 Maculopapular Exanthem (MPE) (Delayed Type)......Page 245 Exfoliative Dermatitis (Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis) (Delayed Type)......Page 246 Systemic Drug Reactions: Severe Drug Hypersensitivity Syndromes (Delayed Type)......Page 250 Patient Evaluation, Diagnosis, and Differential Diagnosis......Page 251 Angiotensin Converting Enzyme Inhibitor (ACE-I)......Page 253 Beta-lactams......Page 254 Biologicals......Page 255 Treatment......Page 256 Referral......Page 257 References......Page 258 Summary of Important Concepts......Page 261 Urticaria......Page 262 Autoimmunity......Page 263 Skin Histopathologic Features......Page 264 Autoimmune Hypothesis......Page 265 Skin Mast Cells......Page 266 History......Page 267 Laboratory Assessments......Page 268 Mechanically Induced Urticaria.......Page 271 Systemic Diseases......Page 272 Leukotriene Pathway Inhibitors......Page 273 Third-line (Immunomodulatory) Drugs......Page 274 References......Page 275 Summary of Important Concepts......Page 277 Historical Perspective......Page 278 Epidemiology......Page 279 Atopic Diathesis......Page 280 Natural History......Page 282 Role of the Abnormal Epidermal Barrier......Page 283 Clinical Features (Phenotype)......Page 284 Infections......Page 285 Role of Allergens......Page 286 Microbial Agents......Page 287 Immunology......Page 288 Cytokine Expression......Page 289 Role of IgE in Cutaneous Inflammation......Page 291 Irritants......Page 292 Allergens......Page 293 Hydration......Page 294 Corticosteroids......Page 295 Topical Calcineurin Inhibitors......Page 298 Anti-Infective Therapy......Page 299 Cyclosporin A......Page 300 Methotrexate......Page 301 Allergen Immunotherapy......Page 302 Omalizumab......Page 303 Probiotics......Page 304 References......Page 305 Summary of Important Concepts......Page 313 Historical Perspective......Page 314 Children......Page 316 Prevalence of Food Allergy......Page 317 Natural History of Food Allergy......Page 318 Normal Immune Response to the Ingested Food Antigens......Page 320 Food Allergens......Page 321 IgE-Mediated Food Allergy......Page 322 Gastrointestinal IgE-Mediated Food Allergy......Page 323 Mixed IgE- and Non-IgE-Mediated Gastrointestinal Food Allergy......Page 325 Non-IgE-Mediated Gastrointestinal Food Allergy......Page 326 Cutaneous IgE-Mediated Food Allergy......Page 327 Mixed IgE- and Non-IgE-Mediated Cutaneous Food Allergy......Page 328 Respiratory Food Allergy......Page 329 Food-Dependent, Exercise-Induced Anaphylaxis......Page 331 Patient Evaluation, Diagnosis, and Differential Diagnosis......Page 332 Practical Management......Page 337 General Approach to Avoidance......Page 338 Labeling of Manufactured Products......Page 339 Manner of Exposure......Page 340 Avoidance for Schools and Camp......Page 341 Nutritional Issues......Page 342 Emergency Management......Page 343 Emergency Plans and Special Considerations for School......Page 344 Trials Using Oral Tolerance Induction to Prevent Food Allergies......Page 345 Oral Immunotherapy......Page 347 Sublingual Immunotherapy......Page 350 Conclusions......Page 351 References......Page 352 Introduction......Page 357 Epidemiology......Page 358 Triggering......Page 359 Biochemical Mediators and Effects......Page 360 Mechanisms of Anaphylactic Shock......Page 361 Clinical Features (Phenotypes)......Page 363 Patient Evaluation, Diagnosis, and Differential Diagnosis......Page 365 Laboratory Testing......Page 366 Epinephrine......Page 367 Intravenous Fluid (Volume) Resuscitation......Page 368 Ongoing Management and Referral......Page 369 References......Page 371 Occupational Asthma......Page 373 Occupational Rhinitis......Page 374 Pathophysiology......Page 375 Smoking and Exposure to Other Pollutants.......Page 377 Rhinitis.......Page 378 History......Page 379 Specific Inhalation Challenge Tests.......Page 381 Combination of Different Tests.......Page 382 Differential Diagnosis......Page 383 Prevention......Page 385 Work-Related Anaphylaxis......Page 386 References......Page 387 Summary of Important Concepts......Page 389 Etiology......Page 390 Vespidae......Page 391 Formicidae......Page 392 Clinical Features and Classification of Reactions......Page 393 Clinical History......Page 394 Sting Challenge Test......Page 395 Epinephrine Kits......Page 396 Natural History......Page 397 Markers of Risk for Sting Anaphylaxis......Page 398 Indications......Page 399 Effectiveness......Page 400 Maintenance......Page 401 Discontinuation......Page 402 Triatoma (Kissing Bug, Cone-Nose Bug)......Page 403 Conclusions......Page 404 References......Page 405 Appendix A Internet Resources......Page 407 A......Page 409 B......Page 411 D......Page 412 F......Page 413 I......Page 414 N......Page 416 P......Page 417 S......Page 418 T......Page 419 Y......Page 420 Inside Back Cover......Page 421 Annotation For decades, health care practitioners have relied on Middleton's Allergy as their go-to reference for comprehensive information on allergic disorders. Now Middleton's Allergy Essentials, by Drs. Robyn E. O'Hehir, Stephen T. Holgate, and Aziz Sheikh, offers a concise resource that's both easily accessible and highly authoritative. Perfect for clinicians in primary and secondary care settings, this practical volume covers what is most useful in your daily practice, with a strong emphasis on disease diagnosis and management. A practical approach to evaluation, differential diagnosis, and treatment of allergic disorders, focused specifically on what the non-specialist needs to know for everyday practice. Each chapter begins with a handy summary of key concepts to help you quickly identify important information. Coverage of today's hot topics includes asthma, drug allergies, food allergies and gastrointestinal disorders, anaphylaxis, atopic dermatitis, and allergic contact dermatitis. Concise sections on mechanisms are included where relevant, keeping you up to date with this rapidly evolving field. Authored by the same internationally recognized experts that produce Middleton's Allergy, the definitive text in the field. Ideal for physicians, residents, general and family practitioners, nurse practitioners, primary care doctors, hospitalists, general internists - anyone who is called upon to make effective diagnostic and treatment decisions regarding allergic disorders