Editorial
Wheels within wheals: The burden of urticaria and angioedema ‘Wheels within Wheels’ Ezekiel 1,15–16. The appearance of the wheels and their workings was like the color of beryl, and all four had the same likeness. The appearance of their workings was, as it were, A WHEEL WITHIN A WHEEL.
A
s in the vision described in Ezekiel, the English sea captain, John Serson in 1743, introduced the concept and complexity of “whirling wheels” when he invented the precursor to the modern day gyroscope to locate the horizon in foggy or misty conditions. In today’s medical usage the metaphor can also be applied to the complexity of issues surrounding the “evanescent wheals” of urticaria and angioedema. Previous issues of the Proceedings have addressed the burden of disease and barriers to treatment associated with these clinical entities.1–10 Within the pages of the current issue, appear five novel articles that focus on the heterogeneous expressions and complexity of issues associated with urticaria and angioedema.11–15 Guidelines for treatment of hereditary angioedema (HAE), established by international consensus, emphasize home-based therapy as a preferred managed strategy.16 In this issue, Bernstein et al11 review the medical literature relating to home-based treatment of HAE and present new strategies for implementing homebased care. They report that home-based treatment of HAE has been shown to reduce the time to initiation of treatment, reduce the duration and severity of attacks, and improve patients’ quality of life. In recent years the availability of on-demand therapies for HAE has been transformative for patients who suffer from this potentially life threatening disorder. Christiansen et al12 examine the perceptions of HAE patients, focusing on the impact that the introduction of these therapies have had on their lives. Subjects were surveyed to assess the current burden of HAE in comparison to prior to 2009. The authors report that although the availability of the current treatments has substantially improved the quality of life for HAE patients in the US, a substantial burden of illness remains. The availability of on-demand home based infusion services has also provided an opportunity to capture data regarding characteristics associated with HAE attacks. Trachdjian et al13 report their analysis of these characteristics in 158 HAE patients. Factors associated
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with a severe attack included an overall severe rating of HAE attacks in the previous year, an abdominal attack alone or a combination of peripheral and abdominal attacks versus a peripheral attack alone, and the use of 2 doses rather than one for treatment of the current attack. Average time to relief onset was 43.5 minutes. Despite the high prevalence of an autoimmune pathophysiology underlying many cases of chronic idiopathic urticaria (CIU), the prevalence of autoimmune comorbidities in this population is poorly defined. To evaluate this possible concordance, Magen et al14 performed a study that evaluated clinical and laboratory manifestations associated with antinuclear antibody (ANA)-positive CIU patients. They report that ANApositive CIU is characterized by a higher prevalence of SS-A 52, SS-A 60, SS-B antibodies and poorer clinical response to antihistamine medications. Bringing further clinical applicability to this collection of urticaria and angioedema articles is the most recent installment of the Patient-Oriented Problem Solving “POPS” series, which, as per tradition, is written by an allergy-immunology fellow-in-training from one of the 73 US allergy-immunology training programs. The purpose of the POPS series is to provide an innovative and practical learning experience for the allergist-immunologist using a format of clinical presentation and deductive reasoning. Speck et al15 lead the reader through this process, describing the evaluation of a 31-year old woman presenting with newonset angioedema in the setting of her first pregnancy. This case report illustrates the complexity of the differential diagnostic process for this presentation and the importance of a detailed history, physical exam and appropriate laboratory assessment in arriving at a correct diagnosis. This issue also features two articles which address new treatment options for environmentally induced allergic rhinitis and for asthma. Subcutaneous immunotherapy (SCIT) has been used to help alleviate symptoms of allergic diseases since its discovery over 100 years ago. With the 2014 approval of sublingual immunotherapy (SLIT) by the US Food and Drug Administration (FDA), allergists now have the choice of deciding which therapeutic route of administration to select for their patients in whom allergy immunotherapy is appropriate. Tabatabaian and Casale17 provide an in-
O C
Allergy and Asthma Proceedings Delivered by Ingenta to: Guest User IP: 146.185.204.196 On: Sun, 26 Jun 2016 01:57:08 Copyright (c) Oceanside Publications, Inc. All rights reserved. For permission to copy go to https://www.oceansidepubl.com/permission.htm
89
formative review which focuses on how to choose between SLIT vs. SCIT. Flunisolide hydrofluoroalkane (HFA) with integrated spacer is the most recent reformulated inhaled corticosteroid for asthma which has become available in the United States. Berger and Tashkin18 performed a comprehensive review of the published literature to provide an overview of the important clinical characteristics of this extrafine aerosol. They report that flunisolide HFA is a safe and effective maintenance therapy for asthma patients. Additionally, the integrated spacer may provide additional advantages for patients, especially for those who may be more likely to experience adverse effects of inhaled corticosteroids, both local and systemic, including children who are susceptible to adverse effects on growth. Topics related to asthma prevention and lifestyle changes are the focus of two papers in this issue. The protective effect of breastfeeding on asthma remains controversial. Kim et al19 surveyed 555 asthmatic children and determined that longer duration of breastfeeding has a favorable effect on lung function, especially in non-atopics. Because of the significant clinical implications regarding the identification of modifiable risk factors, the article by Kim and coworkers is featured in this issue’s “For the Patient” section. This segment, found in the back of the print version of this issue and also available online, consists of a one page synopsis of a selected article, that is written in a readily comprehensible fashion to help patients better understand the content of the full article and its diagnostic and therapeutic implications. It is printed in a format to allow reproduction on the practitioner’s letterhead for distribution to patients. If breastfeeding can improve the health of children with asthma, perhaps other lifestyle changes can have beneficial effects as well. To this end, Sybilski et al20 investigated the effects of disease awareness on lifestyle changes and the use of preventive measures in asthma patients. In an exclusively online article these authors report that higher rates of prevention-oriented behavior were observed in groups characterized by higher levels of education and higher household income Continuing with the asthma prevention theme, exposure to indoor allergens is a significant risk factor for the development of allergies and asthma. To evaluate the main environmental and residential predictors of high prenatal allergen levels and multiple allergen exposure, Hernandez-Cadena et al21 studied a Mexico City birth cohort of 1094 infants, recruited during pregnancy and followed until delivery. Dust samples were collected in a subset of 264 homes and environmental factors were evaluated. The predictors of a high multiple allergen index were mainly related to sociodemographic factors and household cleaning.
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90
In two additional exclusively online articles, new information is reported on asthma biomarkers and associated gene mutations. Shimoda et al22 studied serum high sensitivity C-reactive protein (hs-CRP) to determine whether it is a useful indicator of airway inflammation in bronchial asthma. They conclude that serum hs-CRP may be a useful predictive marker of airway inflammation in nonsmoking asthmatic patients without complications such as heart disease, hypertension, hyperlipidemia, chronic obstructive pulmonary disease, or infection. Chen et al23 studied TRPV1 gene mutation and expression of cytokines in children with acute bronchial asthma before and after treatment. They report that TRPV1 expression level, IL-4 level for rs4790522 site mutation were the main risk factors inducing bronchial asthma in children. Adding further diversity to this issue is an article which relates to corticosteroid safety. Published case reports have associated central serous chorioretinopathy with the use of various formulations of corticosteroids. In this condition, vision loss results from fluid leakage and serous detachment in the macula. Most patients experience resolution within a few months; however permanent loss of vision may result. Ricketti et al24 present three atopic patients who present with this form of retinopathy after oral, inhaled, intranasal, and topical corticosteroid therapy. In summary, the collection of articles found within the pages of this issue provides another insight into important allergic, cutaneous and respiratory disorders afflicting patients whom the allergist-immunologist serves. In keeping with the overall mission of the Proceedings, which is to distribute timely information regarding advancements in the knowledge and practice of allergy, asthma, and immunology to clinicians entrusted with the care of patients, it is our hope that the articles found within this issue achieve this goal and will help foster enhanced patient management through efficient workup and optimal therapy for a great diversity of clinical problems. On behalf of the editorial board, we hope you will enjoy the diversity of literature offered in this issue of the Proceedings.
Y P
O N
T
O C
Joseph A. Bellanti, M.D., Russell A. Settipane, M.D. REFERENCES 1.
2.
3.
Tuong LA, Olivieri K, Craig TJ. Barriers to self-administered therapy for hereditary angioedema. Allergy Asthma Proc. 35: 250 –254, 2014. Weldon D. Quality of life in patients with urticaria and angioedema: assessing burden of disease. Allergy Asthma Proc. 35: 4 –9, 2014. Nordenfelt P, Dawson S, Wahlgren CF, et al. Quantifying the burden of disease and perceived health state in patients with hereditary angioedema in Sweden. Allergy Asthma Proc. 35: 185–190, 2014.
March–April 2015, Vol. 36, No. 2 Delivered by Ingenta to: Guest User IP: 146.185.204.196 On: Sun, 26 Jun 2016 01:57:08 Copyright (c) Oceanside Publications, Inc. All rights reserved. For permission to copy go to https://www.oceansidepubl.com/permission.htm
4.
5. 6.
7.
8.
9. 10.
11.
12.
13.
14.
Caballero T, Aygo¨ren-Pu¨rsu¨n E, Bygum A, et al. The humanistic burden of hereditary angioedema: results from the Burden of Illness Study in Europe. Allergy Asthma Proc. 35:47–53, 2014. Kalaria S and Craig T. Assessment of hereditary angioedema treatment risks. Allergy Asthma Proc. 34:519 –22, 2013. Gang C, Lindsell CJ, Moellman J, et al. Factors associated with hospitalization of patients with angiotensin-converting enzyme inhibitorinduced angioedema. Allergy Asthma Proc. 34:267–273, 2013. Kelly M, Donnelly JP, McAnnally JR and Wang HE. National estimates of emergency department visits for angioedema and allergic reactions in the United States. Allergy Asthma Proc. 34:150 –154, 2013. Lin RY, Levine RJ and Lin H. Adverse drug effects and angioedema hospitalizations in the United States from 2000 to 2009. Allergy Asthma Proc. 34:65–71, 2013. Bernstein JA. HAE update: epidemiology and burden of disease. Allergy Asthma Proc. 34:3– 6, 2013. Lumry WR, Miller DP, Newcomer S, et al. Quality of life in patients with hereditary angioedema receiving therapy for routine prevention of attacks. Allergy Asthma Proc. 35:371–376, 2014. Bernstein JA, Riedl M, Zacek L and Shapiro RS. Facilitating home-based treatment of hereditary angioedema. Allergy Asthma Proc 36:92–99, 2015. Christiansen SC, Bygum A, Banerji A, et al. Before and after, the impact of available on-demand treatment for HAE. Allergy Asthma Proc 36:145–150, 2015. Tachdjian R, Banerji A, Guyer A and Morphew T. Current characteristics associated with hereditary angioedema attacks and treatment: The home infusion based patient experience. Allergy Asthma Proc 36:151–159, 2015. Magen E, Waitman D-A, Dickstein Y, et al. Clinical-laboratory characteristics of ANA-positive chronic idiopathic urticarial. Allergy Asthma Proc 36:138 –144, 2015.
O D
15.
16.
17.
18.
19.
20.
21.
22.
Speck AL, Killen PD and Greenhawt MJ. A 31-year-old pregnant woman with angioedema. Allergy Asthma Proc 36:160 – 165, 2015. Longhurst HJ, Farkas H, Craig T, et al. HAE international home therapy consensus document. Allergy Asthma Clin Immunol 6:22, 2010. Tabatabaian F and Casale TB. Selection of patients for sublingual immunotherapy (SLIT) versus subcutaneous immunotherapy (SCIT). Allergy Asthma Proc 36:100 –104, 2015. Berger WE and Tashkin DP. Flunisolide hydrofluoroalkane with integrated spacer for treating asthma: An updated review. Allergy Asthma Proc 36:105–115, 2015. Kim HS, Kim YH, Kim MJ, et al. Effect of breastfeeding on lung function in asthmatic children. Allergy Asthma Proc 36:116 – 122, 2015. Sybilski AJ, Lusawa A, Lipiec A, et al. The effects of disease awareness on lifestyle changes and the use of preventive measures in asthma patients. Allergy Asthma Proc 36:e14 – e22, 2015. Herna´ndez-Cadena L, Zeldin DC, Barraza-Villarreal A, et al. Indoor determinants of dustborne allergens in Mexican homes. Allergy Asthma Proc 36:130 –137, 2015. Shimoda T, Obase Y, Kishikawa R and Iwanaga T. Serum high-sensitivity C-reactive protein can be an airway inflammation predictor in bronchial asthma. Allergy Asthma Proc 36: e23– e28, 2015. Chen C-L, Li H, Xing X-H, et al. Effect of TRPV1 gene mutation on bronchial asthma in children before and after treatment. Allergy Asthma Proc 36:e29 – e36, 2015. Ricketti PA, Unkle DW, Cleri DJ, et al. Central serous chorioretinopathy secondary to corticosteroids in patients with atopic disease. Allergy Asthma Proc 36:123–129, 2015. e
O N
T 23.
24.
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O C
Allergy and Asthma Proceedings Delivered by Ingenta to: Guest User IP: 146.185.204.196 On: Sun, 26 Jun 2016 01:57:08 Copyright (c) Oceanside Publications, Inc. All rights reserved. For permission to copy go to https://www.oceansidepubl.com/permission.htm
91
Wheels within wheals: The burden of urticaria and angioedema ‘Wheels within Wheels’ Ezekiel 1,15–16. The appearance of the wheels and their workings was like the color of beryl, and all four had the same likeness. The appearance of their workings was, as it were, A WHEEL WITHIN A WHEEL.
A
s in the vision described in Ezekiel, the English sea captain, John Serson in 1743, introduced the concept and complexity of “whirling wheels” when he invented the precursor to the modern day gyroscope to locate the horizon in foggy or misty conditions. In today’s medical usage the metaphor can also be applied to the complexity of issues surrounding the “evanescent wheals” of urticaria and angioedema. Previous issues of the Proceedings have addressed the burden of disease and barriers to treatment associated with these clinical entities.1–10 Within the pages of the current issue, appear five novel articles that focus on the heterogeneous expressions and complexity of issues associated with urticaria and angioedema.11–15 Guidelines for treatment of hereditary angioedema (HAE), established by international consensus, emphasize home-based therapy as a preferred managed strategy.16 In this issue, Bernstein et al11 review the medical literature relating to home-based treatment of HAE and present new strategies for implementing homebased care. They report that home-based treatment of HAE has been shown to reduce the time to initiation of treatment, reduce the duration and severity of attacks, and improve patients’ quality of life. In recent years the availability of on-demand therapies for HAE has been transformative for patients who suffer from this potentially life threatening disorder. Christiansen et al12 examine the perceptions of HAE patients, focusing on the impact that the introduction of these therapies have had on their lives. Subjects were surveyed to assess the current burden of HAE in comparison to prior to 2009. The authors report that although the availability of the current treatments has substantially improved the quality of life for HAE patients in the US, a substantial burden of illness remains. The availability of on-demand home based infusion services has also provided an opportunity to capture data regarding characteristics associated with HAE attacks. Trachdjian et al13 report their analysis of these characteristics in 158 HAE patients. Factors associated
O D
T
O N
Y P
with a severe attack included an overall severe rating of HAE attacks in the previous year, an abdominal attack alone or a combination of peripheral and abdominal attacks versus a peripheral attack alone, and the use of 2 doses rather than one for treatment of the current attack. Average time to relief onset was 43.5 minutes. Despite the high prevalence of an autoimmune pathophysiology underlying many cases of chronic idiopathic urticaria (CIU), the prevalence of autoimmune comorbidities in this population is poorly defined. To evaluate this possible concordance, Magen et al14 performed a study that evaluated clinical and laboratory manifestations associated with antinuclear antibody (ANA)-positive CIU patients. They report that ANApositive CIU is characterized by a higher prevalence of SS-A 52, SS-A 60, SS-B antibodies and poorer clinical response to antihistamine medications. Bringing further clinical applicability to this collection of urticaria and angioedema articles is the most recent installment of the Patient-Oriented Problem Solving “POPS” series, which, as per tradition, is written by an allergy-immunology fellow-in-training from one of the 73 US allergy-immunology training programs. The purpose of the POPS series is to provide an innovative and practical learning experience for the allergist-immunologist using a format of clinical presentation and deductive reasoning. Speck et al15 lead the reader through this process, describing the evaluation of a 31-year old woman presenting with newonset angioedema in the setting of her first pregnancy. This case report illustrates the complexity of the differential diagnostic process for this presentation and the importance of a detailed history, physical exam and appropriate laboratory assessment in arriving at a correct diagnosis. This issue also features two articles which address new treatment options for environmentally induced allergic rhinitis and for asthma. Subcutaneous immunotherapy (SCIT) has been used to help alleviate symptoms of allergic diseases since its discovery over 100 years ago. With the 2014 approval of sublingual immunotherapy (SLIT) by the US Food and Drug Administration (FDA), allergists now have the choice of deciding which therapeutic route of administration to select for their patients in whom allergy immunotherapy is appropriate. Tabatabaian and Casale17 provide an in-
O C
Allergy and Asthma Proceedings Delivered by Ingenta to: Guest User IP: 146.185.204.196 On: Sun, 26 Jun 2016 01:57:08 Copyright (c) Oceanside Publications, Inc. All rights reserved. For permission to copy go to https://www.oceansidepubl.com/permission.htm
89
formative review which focuses on how to choose between SLIT vs. SCIT. Flunisolide hydrofluoroalkane (HFA) with integrated spacer is the most recent reformulated inhaled corticosteroid for asthma which has become available in the United States. Berger and Tashkin18 performed a comprehensive review of the published literature to provide an overview of the important clinical characteristics of this extrafine aerosol. They report that flunisolide HFA is a safe and effective maintenance therapy for asthma patients. Additionally, the integrated spacer may provide additional advantages for patients, especially for those who may be more likely to experience adverse effects of inhaled corticosteroids, both local and systemic, including children who are susceptible to adverse effects on growth. Topics related to asthma prevention and lifestyle changes are the focus of two papers in this issue. The protective effect of breastfeeding on asthma remains controversial. Kim et al19 surveyed 555 asthmatic children and determined that longer duration of breastfeeding has a favorable effect on lung function, especially in non-atopics. Because of the significant clinical implications regarding the identification of modifiable risk factors, the article by Kim and coworkers is featured in this issue’s “For the Patient” section. This segment, found in the back of the print version of this issue and also available online, consists of a one page synopsis of a selected article, that is written in a readily comprehensible fashion to help patients better understand the content of the full article and its diagnostic and therapeutic implications. It is printed in a format to allow reproduction on the practitioner’s letterhead for distribution to patients. If breastfeeding can improve the health of children with asthma, perhaps other lifestyle changes can have beneficial effects as well. To this end, Sybilski et al20 investigated the effects of disease awareness on lifestyle changes and the use of preventive measures in asthma patients. In an exclusively online article these authors report that higher rates of prevention-oriented behavior were observed in groups characterized by higher levels of education and higher household income Continuing with the asthma prevention theme, exposure to indoor allergens is a significant risk factor for the development of allergies and asthma. To evaluate the main environmental and residential predictors of high prenatal allergen levels and multiple allergen exposure, Hernandez-Cadena et al21 studied a Mexico City birth cohort of 1094 infants, recruited during pregnancy and followed until delivery. Dust samples were collected in a subset of 264 homes and environmental factors were evaluated. The predictors of a high multiple allergen index were mainly related to sociodemographic factors and household cleaning.
O D
90
In two additional exclusively online articles, new information is reported on asthma biomarkers and associated gene mutations. Shimoda et al22 studied serum high sensitivity C-reactive protein (hs-CRP) to determine whether it is a useful indicator of airway inflammation in bronchial asthma. They conclude that serum hs-CRP may be a useful predictive marker of airway inflammation in nonsmoking asthmatic patients without complications such as heart disease, hypertension, hyperlipidemia, chronic obstructive pulmonary disease, or infection. Chen et al23 studied TRPV1 gene mutation and expression of cytokines in children with acute bronchial asthma before and after treatment. They report that TRPV1 expression level, IL-4 level for rs4790522 site mutation were the main risk factors inducing bronchial asthma in children. Adding further diversity to this issue is an article which relates to corticosteroid safety. Published case reports have associated central serous chorioretinopathy with the use of various formulations of corticosteroids. In this condition, vision loss results from fluid leakage and serous detachment in the macula. Most patients experience resolution within a few months; however permanent loss of vision may result. Ricketti et al24 present three atopic patients who present with this form of retinopathy after oral, inhaled, intranasal, and topical corticosteroid therapy. In summary, the collection of articles found within the pages of this issue provides another insight into important allergic, cutaneous and respiratory disorders afflicting patients whom the allergist-immunologist serves. In keeping with the overall mission of the Proceedings, which is to distribute timely information regarding advancements in the knowledge and practice of allergy, asthma, and immunology to clinicians entrusted with the care of patients, it is our hope that the articles found within this issue achieve this goal and will help foster enhanced patient management through efficient workup and optimal therapy for a great diversity of clinical problems. On behalf of the editorial board, we hope you will enjoy the diversity of literature offered in this issue of the Proceedings.
Y P
O N
T
O C
Joseph A. Bellanti, M.D., Russell A. Settipane, M.D. REFERENCES 1.
2.
3.
Tuong LA, Olivieri K, Craig TJ. Barriers to self-administered therapy for hereditary angioedema. Allergy Asthma Proc. 35: 250 –254, 2014. Weldon D. Quality of life in patients with urticaria and angioedema: assessing burden of disease. Allergy Asthma Proc. 35: 4 –9, 2014. Nordenfelt P, Dawson S, Wahlgren CF, et al. Quantifying the burden of disease and perceived health state in patients with hereditary angioedema in Sweden. Allergy Asthma Proc. 35: 185–190, 2014.
March–April 2015, Vol. 36, No. 2 Delivered by Ingenta to: Guest User IP: 146.185.204.196 On: Sun, 26 Jun 2016 01:57:08 Copyright (c) Oceanside Publications, Inc. All rights reserved. For permission to copy go to https://www.oceansidepubl.com/permission.htm
4.
5. 6.
7.
8.
9. 10.
11.
12.
13.
14.
Caballero T, Aygo¨ren-Pu¨rsu¨n E, Bygum A, et al. The humanistic burden of hereditary angioedema: results from the Burden of Illness Study in Europe. Allergy Asthma Proc. 35:47–53, 2014. Kalaria S and Craig T. Assessment of hereditary angioedema treatment risks. Allergy Asthma Proc. 34:519 –22, 2013. Gang C, Lindsell CJ, Moellman J, et al. Factors associated with hospitalization of patients with angiotensin-converting enzyme inhibitorinduced angioedema. Allergy Asthma Proc. 34:267–273, 2013. Kelly M, Donnelly JP, McAnnally JR and Wang HE. National estimates of emergency department visits for angioedema and allergic reactions in the United States. Allergy Asthma Proc. 34:150 –154, 2013. Lin RY, Levine RJ and Lin H. Adverse drug effects and angioedema hospitalizations in the United States from 2000 to 2009. Allergy Asthma Proc. 34:65–71, 2013. Bernstein JA. HAE update: epidemiology and burden of disease. Allergy Asthma Proc. 34:3– 6, 2013. Lumry WR, Miller DP, Newcomer S, et al. Quality of life in patients with hereditary angioedema receiving therapy for routine prevention of attacks. Allergy Asthma Proc. 35:371–376, 2014. Bernstein JA, Riedl M, Zacek L and Shapiro RS. Facilitating home-based treatment of hereditary angioedema. Allergy Asthma Proc 36:92–99, 2015. Christiansen SC, Bygum A, Banerji A, et al. Before and after, the impact of available on-demand treatment for HAE. Allergy Asthma Proc 36:145–150, 2015. Tachdjian R, Banerji A, Guyer A and Morphew T. Current characteristics associated with hereditary angioedema attacks and treatment: The home infusion based patient experience. Allergy Asthma Proc 36:151–159, 2015. Magen E, Waitman D-A, Dickstein Y, et al. Clinical-laboratory characteristics of ANA-positive chronic idiopathic urticarial. Allergy Asthma Proc 36:138 –144, 2015.
O D
15.
16.
17.
18.
19.
20.
21.
22.
Speck AL, Killen PD and Greenhawt MJ. A 31-year-old pregnant woman with angioedema. Allergy Asthma Proc 36:160 – 165, 2015. Longhurst HJ, Farkas H, Craig T, et al. HAE international home therapy consensus document. Allergy Asthma Clin Immunol 6:22, 2010. Tabatabaian F and Casale TB. Selection of patients for sublingual immunotherapy (SLIT) versus subcutaneous immunotherapy (SCIT). Allergy Asthma Proc 36:100 –104, 2015. Berger WE and Tashkin DP. Flunisolide hydrofluoroalkane with integrated spacer for treating asthma: An updated review. Allergy Asthma Proc 36:105–115, 2015. Kim HS, Kim YH, Kim MJ, et al. Effect of breastfeeding on lung function in asthmatic children. Allergy Asthma Proc 36:116 – 122, 2015. Sybilski AJ, Lusawa A, Lipiec A, et al. The effects of disease awareness on lifestyle changes and the use of preventive measures in asthma patients. Allergy Asthma Proc 36:e14 – e22, 2015. Herna´ndez-Cadena L, Zeldin DC, Barraza-Villarreal A, et al. Indoor determinants of dustborne allergens in Mexican homes. Allergy Asthma Proc 36:130 –137, 2015. Shimoda T, Obase Y, Kishikawa R and Iwanaga T. Serum high-sensitivity C-reactive protein can be an airway inflammation predictor in bronchial asthma. Allergy Asthma Proc 36: e23– e28, 2015. Chen C-L, Li H, Xing X-H, et al. Effect of TRPV1 gene mutation on bronchial asthma in children before and after treatment. Allergy Asthma Proc 36:e29 – e36, 2015. Ricketti PA, Unkle DW, Cleri DJ, et al. Central serous chorioretinopathy secondary to corticosteroids in patients with atopic disease. Allergy Asthma Proc 36:123–129, 2015. e
O N
T 23.
24.
Y P
O C
Allergy and Asthma Proceedings Delivered by Ingenta to: Guest User IP: 146.185.204.196 On: Sun, 26 Jun 2016 01:57:08 Copyright (c) Oceanside Publications, Inc. All rights reserved. For permission to copy go to https://www.oceansidepubl.com/permission.htm
91
