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Biomedical subjects

P Fireman

Publications and source records attributed to P Fireman.

At least 127 records · Page 7Linked to original sources
PubMed1967

Passive transfer of tuberculin reactivity in vitro.

A factor capable of effecting passive transfer in vivo of delayed hypersensitivity to tuberculin to recipients that are tuberculin negative was isolated from the dialyzate of disrupted leukocytes of tuberculin-positive individuals. After this factor was incubated with cultures of peripheral leukocytes from tuberculin-negative individuals, the addition of purified protein derivative of tubercle bacilli resulted in leukocyte stimulation similar to that observed after addition of purified protein derivative to leukocytes from tuberculin-positive individuals.

Bacterial Proteins↗
PubMedDate not supplied

Development of IgE antibodies to human (recombinant DNA), porcine, and bovine insulins in diabetic subjects.

Thirty-one previously untreated diabetic individuals received only human insulin (recombinant DNA) for 1 yr with no adverse reactions. The development of serum IgE antibodies to human, porcine, and bovine insulins was assessed by a sepharose radioallergoabsorbent test (RAST). Immunoglobulin (total Ig antibody) binding was assessed by a nonabsorbed species-specific radioimmunoassay. During therapy 2 patients developed IgE antibodies to human insulin as well as increased total Ig binding. The IgE antibodies to human insulin cross-reacted with porcine and bovine insulins, were transient, and were not accompanied by insulin allergy. Ig binding to insulin developed and persisted in 11 of the human insulin-treated diabetics. In comparison, 62 previously untreated diabetic persons received only purified porcine insulin (PPI, less than 5 ppm proinsulin, N = 40) or a mixed bovine-porcine insulin (proinsulin less than 50 ppm, N = 21). Increased Ig antibody developed in 16 of 21 patients receiving mixed bovine-porcine insulin and 25 of 41 PPI-treated patients (P less than 0.05). Seven of 41 PPI-treated patients and 4 of 21 mixed bovine-porcine-treated patients developed anti-insulin IgE antibodies, which were transient in 4 and persisted in 6 diabetic patients. IgE antibody levels did not correlate with total Ig antibody. These data suggest that IgE and total Ig antibodies develop less often after human insulin treatment. Also, the immunoregulation mechanisms responsible for anti-insulin IgE antibody synthesis differ from those regulating other Ig that bind to insulins. Since none of the patients in this study have developed clinical manifestations of insulin allergy or resistance, the clinical relevance of the antibody data must remain speculative.

Adult↗
PubMedDate not supplied

Treatment strategies designed to minimize medical complications of allergic rhinitis.

Perennial and seasonal allergic rhinitis affect many million Americans and account for close to $2 billion annually in medical costs and lost productivity. The symptoms of allergic rhinitis, including sneezing, rhinorrhea, nasal congestion, and pruritus are, at best, very annoying and may be quite debilitating in some patients, causing irritability, insomnia, and fatigue. Moreover, allergic rhinitis is often not self-limiting and can contribute to serious medical complications such as sinusitis and otitis. Aggressive medical management of allergic rhinitis is important in the therapy for chronic sinusitis and otitis media and may prevent progression to more serious disease. Accurate diagnosis and initiation of environmental control measures to reduce exposure to causative factors should accompany initiation of pharmacotherapy. Antihistamines form the cornerstone of pharmacologic therapy, and use of the newer nonsedating antihistamines such as loratadine, terfenadine, and astemizole is not associated with the sedation produced by the classic antihistamines. Both loratadine and terfenadine are available in combination with a decongestant. Topical intranasal corticosteroids are another important component of pharmacologic management of allergic rhinitis. Allergen immunotherapy (hyposensitization) is used in those patients not adequately managed with pharmacotherapy. The relative safety and convenient dosing schedule of the newer medications should be accompanied by enhanced patient compliance and, hence, better control of allergic symptoms, halting progression of allergic rhinitis to serious medical complications.

Adult↗
PubMedDate not supplied

Combination of inhaled corticosteroids plus other medications in the management of moderate to severe persistent asthma.

Severe persistent asthma accounts for a small percentage, probably less than 5% of all patients with asthma, but is responsible for the major portion of health care costs associated with the illness. According to the National Institutes of Health (National Asthma Education and Prevention Program) guidelines for the management of asthma, patients with severe asthma should be treated with high dosages of inhaled corticosteroids. These inhaled corticosteroids can be given in conjunction with a brief course of oral or parenteral systemic steroids, but it is best to decrease or eliminate systemic corticosteroid therapy whenever possible to prevent the side effects of long-term oral prednisone therapy. If inhaled corticosteroids do not control the asthma, then one or perhaps two, and even three, other long-term control medications can be added to the therapy regimen. Current guidelines recommend adding a long-acting beta 2-agonist such as salmeterol to the inhaled corticosteroid. Recent evidence suggests that leukotriene receptor antagonists can also be used in conjunction with inhaled steroids. Theophylline is also recommended as another controller agent to be considered. Unfortunately, no studies have comparatively evaluated all of these different classes of agents, even in moderate asthma, in head-to-head trials. This manuscript will review the current literature and provide the author's perspective on the combination of these medications in the pharmacologic management of moderate to severe persistent asthma.

Administration, Inhalation↗
PubMedDate not supplied

Rhinitis and asthma connection: management of coexisting upper airway allergic diseases and asthma.

Asthma is a chronic inflammatory disease of the lower airways. Epidemiologic surveys and clinical reports have documented that allergic rhinitis coexists with asthma in many patients. Provocative bronchial challenge with allergens responsible for allergic rhinitis in susceptible asthma patients can elicit asthma, and these responses have been linked to bronchial airway hyperreactivity. Provocative bronchial methacholine challenge in allergic rhinitis patients will demonstrate increased airway responsiveness to the bronchial challenge in 30% of those allergic rhinitis patients who had no past history of asthma. These data suggest that subclinical asthma may be present in certain patients with allergic rhinitis. The focus of the National Heart, Lung, and Blood Institute (NHLBI) guidelines for the pharmacologic treatment of asthma focuses on medications to relieve the symptoms of asthma, i.e., bronchodilators and anti-inflammatory agents (i.e., inhaled corticosteroids, cromolyn, and leukotriene modifiers) to control asthma. Avoidance of allergens such as house dust mite are also recommended. Although not emphasized in these NHLBI guidelines, recent studies have observed that treatments, including intranasal steroid, cromolyn, antihistamines, and decongestants, which provide relief of nasal symptoms in patients with both allergic rhinitis and asthma, will also improve the pulmonary symptoms of allergic asthma. This article will review the recent literature.

Adrenal Cortex Hormones↗
PubMedDate not supplied

Allergy induced eustachian tube and middle ear pathophysiology.

While these studies have provided evidence to support the contention that nasal allergy contributes to OME, they have not confirmed the hypothesis in its entirety. The provocative intranasal antigen or histamine challenges have induced eustachian tube obstruction but have not resulted in OME. Because we wanted to minimize the possible risk of creating middle ear pathology following a provocative intranasal challenge, the absence of a resultant OME was anticipated for two reasons: the relatively brief duration of eustachian tube obstruction after challenge and the use of adult study subjects. Following intranasal provocative challenge, the developed tubal obstruction persisted only for several hours to a few days. In monkeys OME does not develop until 1 to 4 weeks after creating a surgical functional eustachian tube obstruction. Thus, eustachian tube obstruction must be sustained for a week or more for OME to develop. Further, a number of studies have suggested that eustachian tube function improves with age and has been related to the fact that OME is more prevalent in younger children. If the younger child has some degree of functional eustachian tube obstruction, then the development of an antigen provoked, histamine mediated eustachian tube obstruction might be expected to have more severe and prolonged effects at a lesser antigen dosage. It is our hypothesis that allergy and other pathophysiologic events that release or generate mediators of inflammation in the nasopharynx play a role in the pathogenesis of middle ear diseases.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

B2 agonists and their safety in the treatment of asthma.

Increasing prevalence and severity of asthma has prompted the development and promulgation of various national and international guidelines for asthma management in adults and children. All of these guidelines agree that short-acting inhaled B2-agonists on demand represent the most appropriate initial bronchodilator therapy. However, there has been considerable debate as to the merit of maintenance bronchodilator therapy with regular inhaled B2-agonists, either the short acting agents, or the newer long-acting inhaled B2-agonist, salmeterol. Of concern is the possibility that there are detrimental effects of chronic B2-agonist bronchodilator treatment. Do these B2-agonists have the potential to worsen asthma control and thereby have an adverse impact by contributing to the increased prevalence and severity of asthma? This article will review the pertinent literature with regard to the safety of the B2-agonists, which are appropriate but not perfect medications for asthmatics. It will also put this information in perspective for the clinician and provide this author's recommendations for their use in managing the manifestations of chronic and recurrent asthma.

Adrenergic beta-Agonists↗
PubMedDate not supplied

Cytokines and allergic rhinitis.

Cytokines that are important in the pathophysiology of allergic diseases are summarized in Table II. The role of certain of these cytokines, especially IL-4 as well as IL-1, IL-2, IL-6, GM-CSF, and TNF-alpha have been documented in nasal biopsies and/or nasal secretions of patients with allergic rhinitis. The improvement of symptoms of allergen rhinitis induced by corticosteroid therapy or immunotherapy were associated with differences in cytokine expression, whereas, steroids decreased IL-4 expression and immunotherapy increased expression of IL-2 and IFN-gamma. These data indicate that these proven therapies most probably are mediated by different mechanisms with different cytokine expression.

Adrenal Cortex Hormones↗
PubMedDate not supplied

Treatment of allergic rhinitis: effect on occupation productivity and work force costs.

Allergic rhinitis, one of the most common chronic illnesses, can have a negative impact on occupational productivity in the work-place. Allergic rhinitis affects over 13 million workers (6.15 million men and 6.11 million women) of the United States work force. Work place productivity can be reduced in the several ways: (1) Employee works at suboptimal efficiency because of the disease or its treatment; (2) employee takes a sick day away from work because of allergic rhinitis or its complications; (3) employee takes time off from work to care for or transport a child or dependent who needs care for allergic rhinitis or its complications, and (4) worker takes time off because of a work-related injury related to the disease or the medication used to treat the illness. Although nonsedating antihistamines and intranasal anti-inflammatory medications have been developed as effective therapies and are available as prescription drugs, many workers (50%) indicate that they manage their allergic rhinitis with over-the-counter medications. Most of these over-the-counter medicines contain sedating antihistamines which are known to alter cognitive and motor function. To determine whether the medications used by 3394 members of a health maintenance organization were associated with incident work-related injury, they were compared to two control groups selected from the membership and matched for age, gender, and Standard Industrial Classification Code of their employer. Medication use was determined from pharmacy data. The injuries included 496 fractures on dislocations, 2728 open, crushing, or superficial injuries, 176 burns, and 63 internal injuries. The risk of injury was statistically significantly elevated among users of sedating antihistamines. Utilizing demographic data the annual cost of last productivity to employers and society as the result of allergic rhinitis and its therapy with the over-the-counter sedating antihistamines is estimated to be greater than $4 billion.

Cost of Illness↗
PubMedDate not supplied

Otitis media and its relation to allergic rhinitis.

Otitis media is a multifactorial illness that is the most common childhood disease that requires physician care, and its resultant health care costs are high. The established role of infection in the pathogenesis of otitis media has promoted aggressive antimicrobial therapy with specific antibiotic protocols for acute otitis and prophylactic antibiotic regimens for chronic or recurrent acute otitis media. Even though these antibiotic regimens have been widely used, there has not been a decreased incidence of otitis media and its complications. The possibility that allergy contributes to chronic or recurrent otitis media especially in children older than 3 years has been debated for years. If a causal relationship between allergic respiratory diseases and middle ear disease were to be established, then one would anticipate that anti-allergic therapy would reduce the morbidity and health care costs associated with otitis media.

Animals↗
PubMedDate not supplied

Intranasal budesonide aqueous pump spray (Rhinocort Aqua) for the treatment of seasonal allergic rhinitis. Rhinocort Aqua Study Group.

To determine the relative efficacy, compare the incidence of adverse events, and ascertain the systemic glucocorticoid effect of the nasal application of several doses of budesonide, 406 patients with seasonal ragweed-induced allergic rhinitis were randomized in a double-blind, parallel group design to receive intranasal budesonide aqueous pump spray (Rhinocort Aqua) 32 micrograms, 64 micrograms, 128 micrograms, 256 micrograms, or placebo once daily for 4 weeks. A total of 231 adults and 175 children participated in the study conducted at 14 centers in two geographic regions, the Midwest and the Northeast United States, during the 1994 ragweed season. Pollen counts were collected at each site by the Rotorod method. The primary efficacy parameter was the change from baseline nasal index score (NIS) for the overall study population--defined as the sum of scores for nasal congestion, runny nose, and sneezing. The study was powered only to evaluate the overall study population for statistical significance. Significant differences in NIS were observed in each active treatment group compared with placebo (p < or = 0.003). Compared with placebo, budesonide aqueous spray significantly reduced individual symptoms of runny nose and sneezing at all doses (p < or = 0.008), and nasal congestion and nasal itching at all doses except 64 micrograms (p < or = 0.022). In the Midwest pollen belt where the 1994 ragweed season was representative of a typical pollen season, it was possible to establish a dose-response relationship for comparison of budesonide aqueous spray 256 micrograms versus 32 micrograms (p = 0.017). The incidence of adverse events was similar between budesonide aqueous-treated and placebo-treated patients. Importantly, there was no effect of budesonide aqueous spray on basal or ACTH-stimulated plasma cortisol levels in either adults or children at the end of 4 weeks of treatment. Intranasal budesonide aqueous pump spray, administered once daily, was efficacious and was generally well tolerated in both adults and children with seasonal allergic rhinitis.

Administration, Intranasal↗
PubMedDate not supplied

Asthma. A role for IVIG therapy?

Asthma is a multifactorial, reversible, obstructive lung disease that manifests airway inflammation as well as airway hyperreactivity. In addition to IgE-mediated respiratory reactions, the pathophysiology of asthma can be triggered by both viral respiratory and bacterial sinopulmonary infections. Even though most asthma patients do not manifest undue susceptibility to infection, a subset of asthma patients with recurrent sinopulmonary as well as upper-respiratory infections may have an associated immune deficiency syndrome. In a subset of these patients, deficiencies of serum IgG subclasses have also been described in the presence of low-normal or normal serum IgG and also deficient serum IgA. In addition to the usual asthma therapy with beta 2 agonist and theophylline bronchodilators as well as cromolyn and steroids, many of these immunodeficiency patients will benefit from iv gamma-globulin therapy. However, we suggest that an inability to synthesize specific serum antibody to injected vaccines or immunogens be a prerequisite before initiating iv gamma-globulin therapy. The clinician should not rely on serum IgG subclass levels alone as a criterion for initiation of passive immune globulin therapy. There may be another cohort of asthma patients who could benefit from iv gamma-globulin therapy. In a small open-label pilot study severe steroid-dependent asthma patients who were not immunodeficient and did not have undue susceptibility to infection were treated with iv gamma-globulin with a very large dosage protocol of 2000 mg/kg monthly.(ABSTRACT TRUNCATED AT 250 WORDS)

Asthma↗