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Biomedical subjects

Leonard Bielory

Publications and source records attributed to Leonard Bielory.

At least 37 records · Page 2Linked to original sources
PubMed2003

Inhaled corticosteroids: past lessons and future issues.

Inhaled corticosteroids play a pivotal role in the treatment of asthma. Inhalation permits effective delivery of the corticosteroid in high concentration to target sites within the lung while minimizing systemic exposure. Consequently, the safety profile of inhaled corticosteroids is markedly better than that of oral corticosteroid therapy. However, although it was first thought that direct delivery might eliminate systemic adverse effects, this has not been confirmed by clinical trials and experience. Inhaled corticosteroids are absorbed from the lungs into the systemic circulation, in which they can acutely decrease growth velocity in children, an effect that fortunately appears to be temporary and might have no effect on final adult height. In sufficient dosages, they also produce bone mineral loss leading to osteoporosis and might increase the risk of cataracts, glaucoma, skin atrophy, and vascular changes that increase the risk of ecchymoses. Effective evaluation of the severity and significance of these complications is challenging because highly sensitive tests do not reliably predict clinically significant events, and short-term observations do not predict long-term consequences. Also, compliance wanes with long-term treatment, and susceptibility to a particular adverse event can vary over time, even in the same individual, because of developmental or hormonal changes. This journal supplement will review what has been learned about the safety of inhaled cortico-steroids during the past decade, discussing some of the questions that remain and considering the characteristics of an "ideal" inhaled corticosteroid: one with high local activity in the lung and minimal or no adverse systemic effects.

Administration, Inhalation↗
PubMed2003

Sarcoidosis of the anterior visual pathway: 24 new cases.

OBJECTIVES: To describe the clinical spectrum and a rational approach to the diagnosis of anterior visual pathway sarcoidosis. METHODS: Retrospective chart review of all patients examined in neuro-ophthalmic consultation by 1 author from 1989 to 1998 with a diagnosis of sarcoidosis. RESULTS: There were 24 patients (17 female, 7 male, mean age 40 years) with anterior visual pathway sarcoidosis, 17 (71%) of whom were not previously known to have sarcoidosis. Visual acuity ranged from 20/20 to NLP. Normal fundi were observed in 15%. Among the 85% who had fundus abnormalities, pallor was present in 55%, disc edema in 26%, periphlebitis/sheathing in 14%, and optic disc granuloma in 10%. Ten patients (42%) had uveitis, active in only 3 (13%). An elevated angiotensin-converting enzyme (ACE) was present in 16 (76%) of 21 patients tested; evidence of sarcoidosis on chest radiograph was present in 13 (72%) of 18; gallium scanning was abnormal in 13 (93%) of 14; neuroimaging abnormalities of the optic nerves, chiasm, or tract were present in 16 (70%) of 23; lymphocytic pleocytosis or elevated cerebrospinal fluid protein was identified in 14 (88%) of 16 patients, with both values elevated in 7 (44%) patients. Histologic confirmation was obtained in 13 (81%) of 16 who underwent biopsy; in the remaining patients, diagnosis was based entirely on clinical and laboratory evidence. CONCLUSIONS: Anterior visual pathway disease may be underrecognized as a presentation of sarcoidosis. Classic fundus findings of periphlebitis and optic granuloma are typically absent. An aggressive diagnostic evaluation may help establish the diagnosis early in its course.

Adult↗
PubMed2003

Review of complementary and alternative medicine in treatment of ocular allergies.

PURPOSE OF REVIEW: Ocular allergy is a common complaint of allergy sufferers, many of whom may choose to use complementary and alternative medicine in the treatment of these symptoms. In this review major complementary and alternative medicine modalities including herbal therapies, acupuncture, homeopathy, alternative immunotherapy and behavior modification are assessed for evidence of their effectiveness in the treatment of ocular allergy symptoms. RECENT FINDINGS: Certain herbs including Euphrasia officinalis, Petasites hybridus and Argemone mexicana have been evaluated in control studies in the treatment of ocular allergy. Honey is no more effective than placebo in the treatment of ocular allergy. Acupuncture used regularly has demonstrated some positive trends in ocular allergy sufferers. Homeopathy has shown conflicting results in the treatment of ocular allergy, while alternative forms of immunotherapy have been shown to develop immunologic tolerogenic effects in the control of the condition. SUMMARY: Several forms of complementary and alternative medicine have been studied for their effectiveness in treatment of ocular allergy symptoms. Further research is needed to assess mechanisms of action and to establish practice guidelines for the use of these modalities

Acupuncture Therapy↗
PubMed2003

Alternative treatment for allergy and asthma.

Treatment of asthma remains complex. Patients who are considering alternative and complementary treatments for asthma should have a good understanding of what the treatment entails, and whether it has proven ability to make an impact in the disease. One should remember, however, these treatments are made to complement most traditional therapies and not to replace them.

Asthma↗
PubMed2002

Role of antihistamines in ocular allergy.

Although H(1) antihistamines are commonly used to treat allergic disorders and have demonstrated efficacy in allergic rhinoconjunctivitis, data on the effects of these agents specifically on ocular symptoms are limited. Oral H(1) antihistamines inhibit some symptoms of pruritus and erythema in laboratory models and have been shown to be superior to placebo for relief of symptoms in clinical trials. Eye drops typically provide faster relief of ocular symptoms than oral agents, and combination therapy with a topical agent and an oral agent has been found to be superior to the oral agent alone. In general, oral H(1) antihistamines have been considered superior to intranasal corticosteroids for relief of ocular symptoms, but some studies have shown equal efficacy for these agents, or even superior efficacy for intranasal corticosteroids.

Eye Diseases↗
PubMed2002

Complementary and alternative medicine herbal therapies for atopic disorders.

More than 42% of patients with atopic disorders use some type of complementary or alternative medicine, underscoring the importance of determining the scientific validity of such treatments. This review summarizes herbal therapies from China, Japan, Korea, and India, and provides an introduction to some Western preparations. Although well-controlled scientific studies of many of the Asian herbal therapies have been carried out, and some basic studies have been performed for various herbal components (active ingredients), additional research is needed to assess the composite effects of many of these remedies.

Complementary Therapies↗
PubMed2002

Concepts in developing health-based indicators for ozone.

OBJECTIVES: The traditional manner to evaluate whether regulatory controls meet their public health goals of reducing adverse health effects associated with exposure to environmental pollutants is to compare measured concentrations of the target pollutant in the environment with a standard. A complementary approach is also to measure health-based indicators, e.g., changes in the prevalence of adverse health outcomes attributed to the pollutant. This manuscript presents the concepts of using asthma emergency room (ER) visits and hospital admission as potential health-based indicators for ozone. METHODS: The frequency of ER visits and hospital admissions for asthma in New Jersey in 1995 was compared with daily ozone concentrations, to establish the consistency of the relationship and the presence of potential confounders, and to establish whether routinely documented adverse outcomes in asthmatics could serve as health-based indicators. RESULTS: A mathematical model relating ER visits and hospital admissions of asthmatics to ozone concentration was developed for 1995, which was to be used as a baseline year within a health-based indicator program. A coherent relationship was found between same-day ambient air ozone concentrations and ER visits and 2-day time-lagged ambient ozone and hospital admissions during 1995; pollen was identified as a confounder and the association between ER visits and ozone concentration was similar to that determined for 1986 to 1990. CONCLUSIONS: Sufficient databases exist for ER visits by asthmatics in Northern and Central New Jersey, and throughout the state for hospital admissions, for these health outcomes to be used as health-based indicators, complementing air-monitoring data in assessing whether improvements in public health are occurring because of reduction in emissions of precursors of ozone.

Air Pollutants↗
PubMed2002

Topical immunopharmacology of ocular allergies.

PURPOSE OF REVIEW: To review the histamine-1 receptor antagonists, mast cell blockers and natural agents with such actions that can be used for the topical treatment of ocular allergies. RECENT FINDINGS: Increasing evidence indicates that some histamine-1 receptor antagonists have additional actions to inhibit secretion of inflammatory mediators, especially cytokines, from ocular mast cells and other cell types. Emerging information suggests that such actions may be through regulation of intracellular calcium ion levels of NF-kappaB activation. SUMMARY: A number of available drugs and natural non-prescription agents may have anti-histaminic and anti-inflammatory actions.

Administration, Topical↗
PubMed2002

Current opinion of immunotherapy for ocular allergy.

PURPOSE OF REVIEW: Allergic conjunctivitis is common and may be the most prominent or the only feature of allergies. Immunotherapy has been used as a primary treatment for allergies since the early 1900s. Currently the use of immunotherapy for allergic rhinoconjunctivitis is well established and has been shown to decrease the development of bronchial hyperreactivity and asthma. However, the role of immunotherapy for primary treatment of allergic conjunctivitis is unclear. We reviewed the studies where immunotherapy was used with particular attention to the affects on ocular allergies. RECENT FINDINGS: There are many schedules and methods of delivering immunotherapy. Recent studies have started to assess ocular symptoms as one of the parameters to monitor efficacy of therapy. They follow the affects of immunotherapy on conjunctival provocation tests, ocular symptoms, or the use of eye drops. The literature suggests that using the various immunotherapy modalities at different schedules, ocular symptoms improved even when immunotherapy was used on a rush schedule. SUMMARY: The initiation of immunotherapy for allergic rhinoconjunctivitis has been shown to switch the immune response to T helper 1 and thus avoid the progression of other atopic conditions. Current literature shows that using many allergens with different forms of immunotherapy appear to have a significant improvement in ocular allergy symptoms and this can be achieved rapidly and safely in most patients. Whether using immunotherapy early in allergic conjunctivitis will alter the progression of other atopic conditions remains to be investigated.

Allergens↗
PubMed2002

Update on ocular allergy treatment.

Allergy affects > 15% of the world population with a higher prevalence of 30% in westernised industrialised countries, such as the US. Allergy commonly affects various target organs including the eyes, nose, sinuses, ears, lungs and skin. However, the ocular component may be the most common and initially the most prominent disabling feature. Some patients are affected for only a few weeks to months while others have symptoms that last throughout the year. The associated healthcare costs related to allergic conjunctivitis has been commonly nestled with allergic rhinitis and has been reported to be as high as US$5.9 billion in the US, with 25% (US$1.5 billion) of it related to medication use. The expenditures related to ocular prescription medication has only recently risen in the past decade from US$6 million in early 1990s to > US$200 million in the new millennium with a projected continuous expansion of 25% per year. This appears to be due to improved prescription medications and their clear benefit over the less efficacious over-the-counter products. The actual cost of the medications and their relative price increases over the past year have ranged from 0 - 49% with an average cost of < US$ day. The newer topical medications (multiple acting agents) are focusing on multiple actions that include an antihistaminic effect to provide an immediate relief and additional delayed effects to act on the mediators of the late phase reaction without steroid side effects (glaucoma, cataracts). The paradigm for the treatment of ocular allergy ranges from primary measures (avoidance measures, cold compresses and lubrication), to secondary measures (various combination of topical agents) and tertiary measures that would include topical steroids and immunotherapy. The increased interest in advancing ocular treatment will lead to the development of additional therapies, novel pharmacokinetic delivery systems and, thus, improved healthcare outcomes for patients with allergic conjunctivitis.

Administration, Topical↗
PubMed2002

Ocular allergy guidelines: a practical treatment algorithm.

The treatment of ocular allergy requires a better understanding of the spectrum of clinical disorders involving various components of the immune system, and of interactions at the conjunctival surface. The immune response focuses primarily on the different levels of activity of Th2 lymphocytes and various other immune cells associated with allergic disorders, including mast cells, eosinophils, fibroblasts, and epithelial and endothelial cells. Ocular allergic disorders include seasonal allergic conjunctivitis (SAC), perennial allergic conjunctivitis (PAC), vernal keratoconjunctivitis (VKC), giant papillary conjunctivitis (GPC) and atopic keratoconjunctivitis (AKC), which, through immunopathological and molecular immunological techniques, can all be better appreciated as being part of a larger spectrum of an atopic disease state. In SAC, pathological changes, such as increased mast-cell activation, the presence of migratory inflammatory cells, and early signs of cellular activation at the molecular level, are minimal. In PAC, these changes are more pronounced in line with the increased duration of allergenic stimulation. In more chronic forms of allergic conjunctivitis, such as VKC in children and AKC in adults, the following changes are evident: a persistent state of mast cell, eosinophil and lymphocyte activation; noted switching from connective-tissue to mucosal-type mast cells; increased involvement of corneal pathology; and follicular development and fibrosis. The treatment of acute and more chronic forms of allergic conjunctivitis has focused in the past on symptomatic relief of symptoms, but with a better understanding of the mechanisms involved we can now provide interventional therapeutic strategies and symptomatic relief. Our advances in the basic understanding of these conditions are providing the foundation for guidelines that improve the ocular health of patients with ocular allergies.

Anti-Allergic Agents↗
PubMedDate not supplied

United States pharmacopeia development of the Medicare model formulary guidelines.

Prescription drug formularies are a key element in prescription drug benefit management. The use of formularies can both increase the quality of prescribing and reduce the costs of prescription drug therapy. The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 specified that an external agency, the United States Pharmacopeial Convention, Inc. (USP) through the Secretary of the United States Department of Health and Human Services develop model formulary guidelines for prescription drug plans. The model formulary guidelines are to assist individual drug plans in developing formularies that would qualify for participation in the Medicare Part D prescription program. The guidelines were developed through a Model Guidelines Expert Committee assisted by USP staff and following input from patient advocate groups, health care organizations, and pharmaceutical organizations over a period of 8 months (April 2004 to December 2004). The USP Model Formulary Guidelines organize prescription medications into 41 therapeutic categories (32 with associated pharmacologic classes and nine with no associated pharmacologic classes), 137 pharmacologic classes, and 146 unique therapeutic categories and pharmacologic classes.

Aged↗
PubMedDate not supplied

Clinical efficacy, mechanisms of action, and adverse effects of complementary and alternative medicine therapies for asthma.

Complementary and Alternative Medicine (CAM) therapies such as herbal therapy, acupuncture, yoga, homeopathy, chiropractic medicine, and massage therapy, continue to gain popularity as modalities for the treatment of asthma. In the Chinese, Japanese, Korean, Indian, and Western cultures, herbal therapies appear to be commonly used for allergies. Although well-controlled scientific studies have not been performed on many of the Asian herbal therapies and some basic studies have been performed on various herbal components (active ingredients), more needs to be done to assess the composite effects of many herbal remedies. An important part of the assessment of CAM modalities is the therapeutic-toxicologic safety profile (risk-benefit ratio), and further research evaluating the clinical efficacy and mechanism of action of various CAM interventions for asthma is greatly needed. This paper focuses on clinical and laboratory research regarding various CAM therapies that have been used in the treatment of asthma. The references cited are confined to literature originally published or translated into English.

Asthma↗