Beta2-agonists and paresthesias in multiple sclerosis.
Explore the source record for details and available documents.
Adrenergic beta-Agonists↗
Biomedical subjects
Leonard Bielory
Publications and source records attributed to Leonard Bielory.
The relation of stroke admissions to recent weather, airborne allergens, air pollution, seasons, upper respiratory infections, and asthma incidence, September 11, 2001, and day of the week.
BACKGROUND AND PURPOSE: Some previous research links stroke incidence to weather, some links strokes to air pollution, and some report seasonal effects. Alveolar inflammation was proposed as the mechanistic link. We present a unified model of time, weather, pollution, and upper respiratory infection (URI) incidence. METHODS: We combined existing databases: US Environmental Protection Agency pollution levels, National Weather Service data, counts of airborne allergens, and New York City Health and Hospitals Corporation counts of stroke, asthma, and URI patients. We used autoregressive integrated moving average modeling (a statistical time series modeling technique) with stroke admissions as the response variable and day of week, holidays, September 11th, and other counts and levels as explanatory variables. RESULTS: Using a broad definition of stroke, there were 5.1+/-2.3 stroke admissions per day: narrowly defined, 4.2+/-2.1 strokes per day. There are relatively fewer strokes on Sundays (0.50 strokes; P=0.0011), Saturdays (0.62; P<0.0001), Fridays (0.38; P=0.0009) and holidays (0.875; P=0.0016). We found relatively small, independent exacerbating effects of higher air temperature (P=0.0211), dry air (P=0.0187), URIs, (P<0.0001), grass pollen (P=0.0341), sulfur dioxide (SO2; P=0.0471), and suspended particles <10 microm in size (P=0.0404). These effects are modest: < or =0.6, 0.6, 2.4, 1, 0.9, and 0.7 strokes per day, respectively. We did not find statistically significant exacerbating effects of other variables. CONCLUSIONS: We found statistically significant, independent exacerbating effects of warmer, drier air, URIs, grass pollen, SO2, and particulate air pollution. The model supports the theory that links pulmonary inflammation to stroke.
Air Pollution↗
Ocular toxicity of systemic asthma and allergy treatments.
Systemic medications, such as antihistaminic and anti-inflammatory agents used in the treatment of asthma and allergy, may have adverse effects on the eye. The major adverse effects on the eye have included cataracts, glaucoma, and tear-film dysfunction (dry-eye syndrome). The use of inhaled corticosteroids (bronchial and nasal) has been associated with mild systemic effects when compared with oral corticosteroids. The development of cataracts and glaucoma has been more commonly associated with earlier "hard" oral and inhaled steroids that affected individuals with an inherent high susceptibility or those who used them for several years. Whereas oral antihistamines commonly have an effect on allergies within hours, they also may exacerbate dry-eye complaints that commonly complicate symptoms with various forms of tear film dysfunction or conjunctival hyperreactivity. Clinicians should be aware that other systemic agents may complicate their attempts to maximize the treatment of ocular allergies.
Adrenal Cortex Hormones↗
Allergic diseases of the eye.
The prevalence of ocular allergy is clearly underappreciated; it has been an underdiagnosed and undertreated area in primary care medicine. The ocular symptoms associated with the most common ocular allergy conditions,such as seasonal and perennial AC, are twice as likely to affect the allergy sufferer as nasal symptoms alone. The emergence of new medications for the specific treatment of ocular symptoms over the course of the past 15 years offers a new field for improved patient care by the primary and sub-specialty health care providers.
Eye Diseases↗
Aeroallergen prevalence in the northern New Jersey-New York City metropolitan area: a 15-year summary.
BACKGROUND: Elevated environmental pollen levels result in allergic and asthmatic symptoms in sensitive individuals. OBJECTIVE: To present data collected during a 15-year period demonstrating the seasonal pollen variation in a metropolitan area. METHODS: Pollen was collected daily except for weekends. Pollen counts were counted using light microscopy and were used to calculate the average daily pollen count per month between March 1 and October 31 of each calendar year. The month in which each class of pollen reached the highest level (peak) was analyzed across the sampling period. Spearman p correlation coefficients were calculated to show changes in peak pollen levels across time. RESULTS: The average daily pollen level (tree, grasses, and weeds) for each month was analyzed (1987-2002). Tree pollen peaked in May and composed 98.7% of the measurable pollen between March and May. Grass pollen had a biphasic peak (June and September), representing 42.9% of measurable pollen in July and 6.4% in September. Weed and ragweed levels peaked in September. Total weed pollen constituted 93.5% of the measurable pollen between August and October. The combined total pollen levels peaked in May. The highest annual peak tree pollen count was observed between 1992 and 1997, with a linear relationship between tree and total pollen (R2 = 0.97); highest levels of grass pollen were observed between 1993 and 1997; and highest levels of weed pollen were observed between 1993 and 1995. A trend toward declining levels of total pollen was observed between 1993 and 2002. This declining trend was most pronounced for weed pollen. CONCLUSIONS: Aeroallergens pollinate sequentially, starting with trees in the spring, grass throughout the summer, and weeds in late summer to early fall. Pollen levels have declined from 1993 to the present. The most pronounced drop has been in weed pollen levels. Grass pollen demonstrates a biphasic pattern. Tree pollen composes most annual pollen measured in the northern New Jersey-New York City area.
Air Pollution↗
Concerns about intranasal corticosteroids for over-the-counter use: position statement of the Joint Task Force for the American Academy of Allergy, Asthma and Immunology and the American College of Allergy, Asthma and Immunology.
The Joint Task Force for the American Academy of Allergy, Asthma and Immunology and the American College of Allergy, Asthma and Immunology was charged with formulating a position paper regarding the potential release of intranasal corticosteroids for over-the-counter use. We took the position that safety issues regarding this proposal would be our sole concern. We reviewed the literature to evaluate the frequency and severity of potential adverse events related to the administration of intranasal corticosteroids. We limited this review to 5 areas: (1) effects on growth, (2) ocular effects, (3) effects on bone, (4) effects on the hypothalamic-pituitary-adrenal axis, and (5) local adverse effects. After review of the available data, we concluded that intranasal corticosteroids should remain prescription-only drugs. Patients receiving an intranasal corticosteroid should be instructed in its use and that use should be monitored by a physician or an appropriately trained medical provider (eg, nurse practitioner or physician assistant) under the direct supervision of a physician. This conclusion was reached based on the evidence that corticosteroids administered by any route, including the intranasal route, have the potential to cause adverse effects in all the areas noted herein. Our conclusion was strengthened by the fact that these adverse effects can be insidious and therefore not evident for many years; there is the potential for overuse; patients could also have access to other forms of topically administered corticosteroids, thus increasing their total dose; and individuals vary in their susceptibility to corticosteroid-induced adverse effects. We were also influenced to take this position knowing that generally reassuring data regarding the use of respiratory tract-administered corticosteroids are based on mean data and that all such studies have shown outliers in whom adverse effects were evident. Thus, as stated, we recommend that intranasal corticosteroids remain prescription-only drugs.
Administration, Inhalation↗
Vasomotor (perennial chronic) conjunctivitis.
PURPOSE OF REVIEW: To increase the awareness of nonimmunoglobulin E-mediated conjunctival disorders similar to those recognized to affect other organs that are targets in immunoglobulin E-mediated disorders. Such conditions may include 'vasomotor' instability, that is vasomotor conjunctivitis, which leads to a more common perennial chronic conjunctivitis. These conditions are not commonly included in the differential diagnosis of allergic conjunctivitis. RECENT FINDINGS: Although there have not been specific recent findings regarding the eye, it appears that evidence for such disorders in the rhinitis literature suggests that they can be involved in more than 25% of chronic conjunctivitis cases. The extrapolation of such conditions to the conjunctival surface clearly reflects these syndromes which have clearly been underappreciated and underdiagnosed. SUMMARY: A significant amount of work remains to be performed to understand perennial chronic conjunctivitis (vasomotor conjunctivitis or nonallergic noninfectious conjunctivitis) as well as other forms of chronic conjunctivitis that can mimic or exist in a comorbid state with ocular allergy. These disorders need to be better defined, categorized and classified to determine the best treatment modalities. Management guidelines and parameters of chronic noninfectious conjunctivitis need to be set on a national and international basis that will advance clinically applicable research results, pharmaceutical development and relief for patients.
Anti-Allergic Agents↗
Effects of glucocorticosteroids on the skin and eye.
The dermatologic anachronistic adage, "If wet--dry it, if dry--wet it!" has bee perhaps justifiably replaced by "Call the dermatologist to prescribe a steroid!" To say this without knowledge of the contents of this article and more importantly, to accept such cliches, is a disservice to the patient and a litigious liability to the prescriber. Recognizing the risk/benefit ratio of the most commonly used anti-inflammatory agents is essential. All therapies are most effective when used for their specific diagnosis. This article attempts to provide an update on the geometrically progressing knowledge regarding the uses and misuses of GCSs for the eye and skin.
Administration, Topical↗
Probiotics: a complementary approach in the treatment and prevention of pediatric atopic disease.
PURPOSE OF REVIEW: The goal of this article is to review recent primary research and developments in the area of probiotics and pediatric atopic disease. RECENT FINDINGS: Research developments in probiotics summarized in this article include the following: (1) the role of probiotics in primary prevention of atopic disease, (2) the effect of probiotics on cytokines involved in the allergic immune response, (3) the long-term effects of peri-natal probiotic use and (4) the relationship between the gut microflora and atopic dermatitis. SUMMARY: Probiotics continue to be an area of active investigation as our understanding evolves of the gut microbiota's role in the altered immune response of atopic patients. Physicians should be aware of these developments as probiotics may be an important complementary approach in the treatment and the natural and long-term course of various pediatric diseases. This article summarizes the research conducted over the past 10 years with a primary focus on the literature published since January 2003.
Child↗
Histamine receptors and the conjunctiva.
PURPOSE OF REVIEW: The purpose of this review is to evaluate the effect of histamine on various receptors in the conjunctiva. A Medline search from 1980 was performed on the histamine receptor subtypes H1, H2 and H3 in the human conjunctiva. RECENT FINDINGS: In the conjunctiva, histamine has been shown to induce various physiological and immunological changes through both H1 and H2 receptor stimulation. Histamine binding to conjunctival H1 receptors through the phospholipase C-dependent inositol phosphate pathway leads to the symptom of pruritus while histamine stimulation of the conjunctival H2 receptors has been indirectly shown to cause vasodilation. SUMMARY: The effect of histamine on conjunctival H1 receptors appears to be the primary target for ocular allergy treatment as it is primarily involved in ocular pruritus. The exact interaction of the conjunctival H2 receptors appears to work in a complementary fashion to the H1 receptor in controlling other features of ocular allergy such as vasodilation and injection. Thus, oral and topical antihistamines with multiple histamine receptor binding activities may provide an improved treatment paradigm for the various signs and symptoms of ocular allergy. The histamine H1, H2 and H3 receptor affinities of ketotifen, pyrilamine, and epinastine appear to have the strongest H1 and H2 affinities.
Animals↗
Efficacy and tolerability of newer antihistamines in the treatment of allergic conjunctivitis.
Treatment for allergic conjunctivitis has markedly expanded in recent years, providing opportunities for more focused therapy, but often leaving both physicians and patients confused over the variety of options. As monotherapy, oral antihistamines are an excellent choice when attempting to control multiple early-phase, and some late-phase, allergic symptoms in the eyes, nose and pharynx. Unfortunately, despite their efficacy in relief of allergic symptoms, systemic antihistamines may result in unwanted adverse effects, such as drowsiness and dry mouth. Newer second-generation antihistamines (cetirizine, fexofenadine, loratadine and desloratadine) are preferred over older first-generation antihistamines in order to avoid the sedative and anticholinergic effects that are associated with first-generation agents. When the allergic symptom or complaint, such as ocular pruritus, is isolated, focused therapy with topical (ophthalmic) antihistamines is often efficacious and clearly superior to systemic antihistamines, either as monotherapy or in conjunction with an oral or intranasal agent. Topical antihistaminic agents not only provide faster and superior relief than systemic antihistamines, but they may also possess a longer duration of action than other classes including vasoconstrictors, pure mast cell stabilisers, NSAIDs and corticosteroids. Many antihistamines have anti-inflammatory properties as well. Some of this anti-inflammatory effect seen with 'pure' antihistamines (levocabastine and emedastine) may be directly attributed to the blocking of the histamine receptor that has been shown to downregulate intercellular adhesion molecule-1 expression and, in turn, limit chemotaxis of inflammatory cells. Some topical multiple-action histamine H(1)-receptor antagonists (olopatadine, ketotifen, azelastine and epinastine) have been shown to prevent activation of neutrophils, eosinophils and macrophages, or inhibit release of leukotrienes, platelet-activating factors and other inflammatory mediators. Topical vasoconstrictor agents provide rapid relief, especially for redness; however, the relief is often short-lived, and overuse of vasoconstrictors may lead to rebound hyperaemia and irritation. Another class of topical agents, mast cell stabilisers (sodium cromoglicate [cromolyn sodium], nedocromil and lodoxamide), may be considered; however, they generally have a much slower onset of action. The efficacy of mast cell stabilisers may be attributed to anti-inflammatory properties in addition to mast cell stabilisation. In the class of topical NSAIDs, ketorolac has been promoted for ocular itching but has been found to be inferior for relief of allergic conjunctivitis when compared with olopatadine and emedastine. Lastly, topical corticosteroids may be considered for severe seasonal ocular allergy symptoms, although long-term use should be avoided because of risks of ocular adverse effects, including glaucoma and cataract formation.
Administration, Oral↗
Ocular allergy treatment comparisons: azelastine and olopatadine.
Azelastine hydrochloride 0.05% and olopatadine hydrochloride 0.1% are topical ocular allergy treatments that have demonstrated multiple pharmacologic actions, including antihistamine, mast cell stabilization, and inhibition of proinflammatory mediators. In this article, the mechanisms of action, efficacy, and tolerability of these two agents on ocular signs and symptoms are examined. By studying the various target sites of drug action, an enhanced clinical response algorithm of these topical ocular agents can be implemented to maximize the response for patients suffering from ocular allergy.
Administration, Topical↗
The science of complementary and alternative medicine: the plural of anecdote is not evidence.
Explore the source record for details and available documents.
Allergy and Immunology↗
Mast cells and mast cell mediators as targets of dietary supplements.
OBJECTIVE: To review the increasing amount of data that support or dispel the use of dietary supplements in the treatment of inflammatory conditions that involve mast cells, such as allergies, arthritis, and chronic pelvic pain syndrome. DATA SOURCES: A search was conducted in MEDLINE for natural substances, dietary supplements, flavonoids, and proteoglycans for their in vitro or in vivo effects on allergic and inflammatory conditions. STUDY SELECTION: Studies were selected for inclusion because of the impact factor of the journal, the definitive nature of the findings, the soundness of the study design, and the expert opinion of the authors. RESULTS: Dietary supplements include a large group of products, such as vitamins, minerals, plant, or animal extracts, as well as herbal preparations that are often called medicinal herbs. Many of the available dietary supplements contain a multitude of ingredients, the source and/or purity of which is seldom disclosed; some of these may have biologic effects of their own or may interact with other supplements or drugs, often leading to adverse effects. The most well-documented evidence published to date is on the inhibitory action of natural compounds, especially flavonoids, on mast cells and allergic symptoms. Some flavonoids have weak inhibitory activity, whereas others may have no benefit or may be detrimental. Sulfated proteoglycans could provide synergistic action but require formulations with increased absorption. CONCLUSIONS: Combining the most active flavonoids with proteoglycans could be helpful in atopic and inflammatory conditions. However, a complete list of active ingredients and their source, purity, and exact concentration should be a requirement for nutraceuticals to standardize, compare, and promote their safe use.
Anti-Inflammatory Agents↗
Complementary and alternative interventions in asthma, allergy, and immunology.
OBJECTIVE: To review which herbs are most commonly used as complementary and alternative medicine (CAM) for treatment of asthma, allergy, and immunologic conditions. DATA SOURCES: A review of the literature was performed using the PubMed and OVID databases searching the keywords asthma, allergy, and CAM to identify studies published between 1980 and 2003 that focused on Echinacea (Echinacea augustifolia, Echinacea pallida, and Echinacea purpurea); garlic (Allium); angelica; chamomile; ephedra; gingko; grape seed extract; licorice root (Glycyrrhiza); St. John's wort (Hypericum); kava kava (Piper); peppermint oil and leaf (Mentha); stinging nettle (Urtica); and ginseng (Panax) published in the English and German literature. STUDY SELECTION: Studies included in vitro and in vivo clinical trials and case reports selected according to the expert opinion of the author. RESULTS: Echinacea is one of the most common herbs used to treat symptoms of the "common cold" or upper respiratory tract allergies. Although no common drug interactions have been reported, there is a risk of hepatotoxicity, exacerbation of allergies and asthma, and anaphylactic reactions. Garlic is primarily used for cardiovascular health and relief of cough, colds, and rhinitis. Adverse effects commonly include gastrointestinal disturbances, change in body odor through the sweat and breath, and rarely allergic reactions or hypoglycemia. Other CAM agents, including angelica, German chamomile flower, ephedra, gingko, grape seed extract, licorice root, St. John's wort, kava kava rhizome, peppermint, stinging nettle, and ginseng, are also associated with significant adverse effects. CONCLUSION: The specialty of allergy and immunology has seen the second largest increase in the popularity of CAM (second only to practitioners who treat lower back pain). Almost all of the CAM interventions have displayed adverse effects, usually in the form of a hypersensitivity reaction. Allergists and clinical immunologists need to become more knowledgeable about CAM so that they can inform patients about the use and possible abuse of these modalities.
Asthma↗
Ocular allergy and dry eye syndrome.
PURPOSE OF REVIEW: Ocular allergy is a common clinical disorder that includes dry eye syndrome in its differential diagnosis. While ocular allergy treatments have continued to evolve since the early 1990s when the new prescription topical agents became available, there have been no major advances in the treatment of dry eye syndrome other than changes in the chemical structures of various artificial tear formulations. This review is timely and relevant due to the recent FDA approval of several new agents for the treatment of dry eye syndrome. RECENT FINDINGS: The literature reviewed brings the practicing allergist/clinical immunologist up to date on the recent understanding that T-cell activation plays a key role in dry eye syndrome immunopathophysiology. In addition, the parallel novel treatment developments are discussed, including new formulations for tear substitutes, topical cyclosporine A and purinergic receptor (P2Y2) agonists. SUMMARY: The recent developments bode well for patients who are referred for ocular allergy, including dry eye syndrome. A new formulation for a tear substitute that generates a 'soft gel' covering the ocular surface (in situ) is ideal for early forms of dry syndrome, while topical cyclosporine is the first new real prescription treatment for patients with moderate to severe forms of dry eye. Another potential agent to revolutionize the treatment of various disorders is based on the discovery of the purinergic receptor agonists. This is not only relevant for the production of mucin and the change in tear fluid content, but it may also have implications for other sinopulmonary disorders such as cystic fibrosis and chronic sinusitis.
Conjunctivitis, Allergic↗
Defining complementary and alternative medicine in allergies and asthma: benefits and risks.
In this review, the current literature discussing complementary/alternative medicine (CAM) interventions, the prevalence and pattern of use, examples of specific modalities and the risks of CAM for asthma and atopic disease are discussed. The specific risks of CAM interventions associated with the use of these modalities, omission of traditional therapeutic modalities, and the liability risk for physicians who either provide or counsel their patients regarding CAM interventions are also discussed.
Acupuncture Therapy↗
Autoimmune optic neuropathy with anticardiolipin antibody mimicking multiple sclerosis in a child.
PURPOSE: To demonstrate that autoimmune optic neuropathy (AON) may occur in the pediatric population. DESIGN: Interventional case report. METHODS: A 4-year-old developed four episodes of bilateral optic neuritis with mild concurrent weakness, ataxia, or dizziness; one episode of unilateral optic neuritis; and one episode of weakness over a period of 4 years. RESULTS: Autoimmune optic neuropathy was diagnosed because of the presence of anticardiolipin antibody and an abnormal skin biopsy with thrombin and immunoreactant deposition. She was treated with corticosteroids, aspirin, and gammaglobulin. This diminished the frequency and intensity of her attacks. CONCLUSION: This case represents the diagnosis and treatment of AON in a child.
Antibodies, Anticardiolipin↗