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Abstract: The accurate assessment and communication of the severity of acute allergic reactions are important to patients, clinicians, researchers, the food industry, and public health and regulatory authorities. Severity has different meanings to different stakeholders with patients and clinicians rating the significance of particular symptoms very differently. Many severity scoring systems have been generated, most focusing on the severity of reactions following exposure to a limited group of allergens. They are heterogeneous in format, none has used an accepted developmental approach, and none has been validated. Their wide range of outcome formats has led to difficulties with interpretation and application. Therefore, there is a persisting need for an appropriately developed and validated severity scoring system for allergic reactions that work across the range of allergenic triggers and address the needs of different stakeholder groups. We propose a novel approach to develop and then validate a harmonized scoring system for acute allergic reactions, based on a data‐driven method that is informed by clinical and patient experience and other stakeholders’ perspectives. We envisage two formats: (i) a numerical score giving a continuum from mild to severe reactions that are clinically meaningful and are useful for allergy healthcare professionals and researchers, and (ii) a three‐grade‐based ordinal format that is simple enough to be used and understood by other professionals and patients. Testing of reliability and validity of the new approach in a range of settings and populations will allow eventual implementation of a standardized scoring system in clinical studies and routine practice. [ABSTRACT FROM AUTHOR]

The article discusses effects of nasopharyngeal CCL5 in infants depicting severe bronchiolitis with risk of recurrent wheezing. Also included are analyzing infants with respiratory syncytial virus (RSV) bronchiolitis and irregular chemokine chemoattractant causing risk of developing childhood asthma and nasopharyngeal CCL5 levels increasing risks of developing recurrent wheezing.

Abstract: Low circulating 25‐hydroxyvitamin D (25OHD) levels are a risk factor for acute respiratory infection (eg, bronchiolitis) in children. However, little is known about the relation of circulating 25OHD with the many downstream functional molecules in target organs—such as the airway—and with clinical outcomes. In this prospective multicenter study of infants (age <1 year) hospitalized with bronchiolitis, we measured serum 25OHD levels and profiled the metabolome of 144 nasopharyngeal airway samples. Among 254 metabolites identified, we defined a set of 20 metabolites that are related to lower serum 25OHD and higher vitamin D‐binding protein levels. Of these metabolites, 9 metabolites were associated with a significantly higher risk of positive pressure ventilation use. These metabolites were glycerophosphocholines esterified with proinflammatory fatty acids (palmitate, arachidonate, linoleate, and stearate), sphingomyelins, alpha‐hydroxyisovalerate, 2‐hydroxybutyrate, and 3‐(4‐hydroxyphenyl)lactate (all FDR<0.05). Based on the multicenter data, vitamin D‐related airway metabolites were associated with risks of bronchiolitis severity. [ABSTRACT FROM AUTHOR]

Objectives: Occupational exposure to disinfectants is associated with work-related asthma, especially in healthcare workers. However, little is known about the specific products involved. To evaluate disinfectant exposures, we designed job-exposure (JEM) and job-task-exposure (JTEM) matrices, which are thought to be less prone to differential misclassification bias than self-reported exposure. We then compared the three assessment methods: self-reported exposure, JEM and JTEM.Methods: Disinfectant use was assessed by an occupational questionnaire in 9073 US female registered nurses without asthma, aged 49-68 years, drawn from the Nurses' Health Study II. A JEM was created based on self-reported frequency of use (1-3, 4-7 days/week) of 7 disinfectants and sprays in 8 nursing jobs. We then created a JTEM combining jobs and disinfection tasks to further reduce misclassification. Exposure was evaluated in 3 classes (low, medium, high) using product-specific cut-offs (eg, <30%, 30-49.9%, ≥50%, respectively, for alcohol); the cut-offs were defined from the distribution of self-reported exposure per job/task.Results: The most frequently reported disinfectants were alcohol (weekly use: 39%), bleach (22%) and sprays (20%). More nurses were classified as highly exposed by JTEM (alcohol 41%, sprays 41%, bleach 34%) than by JEM (21%, 30%, 26%, respectively). Agreement between JEM and JTEM was fair-to-moderate (κ 0.3-0.5) for most disinfectants. JEM and JTEM exposure estimates were heterogeneous in most nursing jobs, except in emergency room and education/administration.Conclusions: The JTEM may provide more accurate estimates than the JEM, especially for nursing jobs with heterogeneous tasks. Use of the JTEM is likely to reduce exposure misclassification. [ABSTRACT FROM AUTHOR]

Epidemiological studies first demonstrated the association between obesity and asthma and they have begun to provide additional evidence to support causality: a dose-effect relationship, consistency across studies (especially among women) and the correct temporal order (ie, obesity before asthma). To date, relatively few studies have addressed reversibility, an important but less frequently demonstrated epidemiological criterion of causality. Reversibility suggests that if excessive weight is a risk factor for asthma, then reducing body weight should decrease the prevalence of asthma, or at least decrease asthma related symptoms or health care utilisation. We performed a systematic review on weight loss and asthma, based on searches between January 1966 and January 2007 of both PubMed and the Cochrane Clinical Trial Database. Of the 15 relevant studies, asthma was the primary outcome in only five. Only one study was conducted in children. Regardless of the type of intervention (surgical vs medical), all 15 studies noted an improvement in at least one asthma outcome after weight loss. The improvement was noted across studies that differed in sample age, gender or country of origin. The heterogeneity of the interventions and outcomes precluded quantitative synthesis. We briefly review the role of specific factors (eg, gastro-oesophageal reflux) in the weight loss-asthma association, and potential directions for future research. [ABSTRACT FROM AUTHOR]

Background: Leptin, a pro-inflammatory cytokine produced by adipose tissue, has previously been shown to be associated with asthma in children. We hypothesised that high serum leptin concentrations would also be associated with asthma in adults.Methods: The Third National Health and Nutrition Examination Survey is a cross sectional study that included fasting serum leptin concentrations and self-report of doctor diagnosed asthma. Data were analysed using multivariable logistic regression analysis.Results: Of 5876 participants, those with current asthma had a higher mean unadjusted leptin concentration than those who had never had asthma (geometric mean (SE) 9.2 (0.6) microg/l v 7.6 (0.2) microg/l; p = 0.02). After adjustment for triceps skinfold thickness and other covariates, the association between leptin and asthma appeared stronger in women than in men, and in premenopausal women than in postmenopausal women. Body mass index (BMI) was also associated with current asthma in women, but this association was not significantly affected by adjustment for leptin concentrations.Conclusions: The results of this large population based study support the hypothesis that leptin is associated with asthma in women. In addition, while BMI also is related to asthma in women, this study does not support the suggestion that leptin contributes significantly to this association. [ABSTRACT FROM AUTHOR]

Background: The phase of the menstrual cycle is thought to influence the course of asthma in women. One recent study reported a large increase in exacerbations during the perimenstrual phase, while another found a preovulatory increase. A study was undertaken to determine the relation between phase of the menstrual cycle and acute asthma in patients presenting to the emergency department (ED).Methods: All women aged 18-54 years presenting with a diagnosis of acute asthma exacerbation were considered for enrollment in the study. Women who were pregnant, postmenopausal, following hysterectomy, with a >28 day menstrual cycle or incomplete reproductive history were excluded. The 792 eligible women were classified by menstrual phase based on both date of symptom onset and date of ED visit.Results: When classified by date of symptom onset, 28% were preovulatory (days 5 to 11), 25% were periovulatory (days 12 to 18), 21% were postovulatory (days 19 to 25), and 27% were perimenstrual (days 26 to 4; p = 0.03). When classified by date of ED visit, 28% were preovulatory, 22% were periovulatory, 22% were postovulatory, and 27% were perimenstrual (p = 0.004). Using either approach, there were no significant differences in demographic factors or in asthma severity of women in the various menstrual phase groups.Conclusion: Acute asthma exacerbations do not markedly increase during the perimenstrual phase. The results support the suggestion that both preovulatory and perimenstrual phases are actual triggers of asthma exacerbation in some women, or that these two phases serve as "co-factors" that worsen other recognised triggers of acute asthma. [ABSTRACT FROM AUTHOR]

The article discusses the study regarding the venom immunotherapy (VIT) in Great Britain by Noorani L. Diwakar and his colleagues. It mentions that the researchers conducted surveys to know the percentage of people who are willing to go under VIT with or without being stung by insects. In addition, they state that the medical practice of VIT in Great Britain is different from other countries due to lack of specialists and knowledge of the process.

A letter to the editor is presented about the article on atopic dermatitis, which appeared within the issue.

The article discusses the effectiveness of the addition of methylxanthines to standard treatments on patients with acute exacerbations of chronic obtrusive pulmonary disease (COPD). A study of randomized controlled trials compared methylaxnthines with placebo for acute exacerbations of COPD; the treatment occurred in the emergency department or immediately after admission to the hospital. In patients with acute exacerbations of chronic obstructive pulmonary disease, methylxanthines do not improve lung function after 2 hours and increase vomiting.

PURPOSE: A longstanding goal of ACE is to develop and maintain a vital membership base representing all aspects of epidemiology, and anecdotal evidence suggests progress. The objective of this study was to quantify possible changes in the diversity of the ACE membership.METHODS: Members were divided into two groups: a) member as of 1/1/01, and b) new member between 1/2/01 and 3/15/02. The two groups were compared using descriptive statistics. Proportions are reported with 95% confidence intervals (CI).RESULTS: As of 1/1/01, there were 859 active members. Over the next 15 months, an additional 93 members joined the College. Compared with members on 1/1/01, new members were younger (54 vs. 42 years, respectively; p < 0.001). However, the two groups did not differ by gender (66% vs. 66% male) or by race/ethnicity (86% vs. 81% white; p = 0.42). The majority of both groups reside in the US (92% vs. 87%; p = 0.63). Existing members'' top areas of research expertise (up to 5 choices per member) were cancer (29%; 95% CI, 26–32%), methods (22%; 95% CI, 20–25%), environmental (21%; 95% CI, 18–24%), and infectious disease (19%; 95% CI, 16–21). New members were less likely to report expertise in cancer (29% vs. 18%; p = 0.03) and environmental (21% vs 10%; p = 0.01) epidemiology, but did not differ in methods or infectious disease; new members were more likely to report expertise in cardiovascular, dental, drug, eye, geriatric, and hospital areas of research expertise (all p < 0.05). University or academic position was the most commonly reported current place of employment but was less common among new members (45% vs. 31%; p = 0.009); new members were more likely to hold consulting positions (4% vs. 11%; p = 0.001).CONCLUSION: Although long-term trends may be favorable, we observed no increase in gender and race/ethnic diversity in 2001. The College is attracting younger epidemiologists, however, and has become more diverse in its range of research expertise and employment settings. [Copyright &y& Elsevier]

The article discusses a study on the effectiveness of ultrasonography and computed tomography as the initial imaging method for patients with suspected nephrolithiasis. It mentions the administration of either point-of-care ultrasonography, radiology ultrasonography and abdominal computed tomography (CT), primary outcomes of high-risk diagnosis with complications, cumulative radiation exposure and total costs, and finding that ultrasonography results to lower cumulative radiation exposure.

Vitamin D deficiency is associated with cardiovascular disease, the most common cause of mortality in hemodialysis patients. To investigate the relation between blood levels of 25-hydroxyvitamin D (25D) and 1,25-dihydroxyvitamin D (1,25D) with hemodialysis outcomes, we measured baseline vitamin D levels in a cross-sectional analysis of 825 consecutive patients from within a prospective cohort of incident US hemodialysis patients. Of these patients, 78% were considered vitamin D deficient with 18% considered severely deficient. Calcium, phosphorus, and parathyroid hormone levels correlated poorly with 25D and 1,25D concentrations. To test the association between baseline vitamin D levels and 90-day mortality, we selected the next 175 consecutive participants who died within 90 days and compared them to the 750 patients who survived in a nested case–control analysis. While low vitamin D levels were associated with increased mortality, significant interaction was noted between vitamin D levels, subsequent active vitamin D therapy, and survival. Compared to patients with the highest 25D or 1,25D levels who received therapy, untreated deficient patients were at significantly increased risk for early mortality. Our study shows that among incident hemodialysis patients, vitamin D deficiency is common, correlates poorly with other components of mineral metabolism and is associated with increased early mortality.Kidney International (2007) 72, 1004–1013; doi:10.1038/sj.ki.5002451; published online 8 August 2007 [ABSTRACT FROM AUTHOR]