Critical Points on the Use of Biologicals in Allergic Diseases and Asthma

Improved understanding of the contribution of immune-inflammatory mechanisms in allergic diseases and asthma has encouraged development of biologicals and small molecules specifically targeting the innate and adaptive immune response. There are several critical points impacting the efficacy of this stratified approach, from the complexity of disease endotypes to the effectiveness in real-world settings. We discuss here how these barriers can be overcome to facilitate the development of implementation science for allergic diseases and asthma.

Asthma Biomarkers: Do They Bring Precision Medicine Closer to the Clinic?

Measurement of biomarkers has been incorporated within clinical research of asthma to characterize the population and to associate the disease with environmental and therapeutic effects. Regrettably, at present, there are no specific biomarkers, none is validated or qualified, and endotype-driven choices overlap. Biomarkers have not yet reached clinical practice and are not included in current asthma guidelines. Last but not least, the choice of the outcome upholding the value of the biomarkers is extremely difficult, since it has to reflect the mechanistic intervention while being relevant to both the disease and the particular person. On the verge of a new age of asthma healthcare standard, we must embrace and adapt to the key drivers of change. Disease endotypes, biomarkers, and precision medicine represent an emerging model of patient care building on large-scale biologic databases, omics and diverse cellular assays, health information technology, and computational tools for analyzing sizable sets of data. A profound transformation of clinical and research pattern from population to individual risk and from investigator-imposed subjective disease clustering (hypothesis driven) to unbiased, data-driven models is facilitated by the endotype/biomarker-driven approach.

Electrodiagnostic approach in entrapment neuropathies of the median and ulnar nerves

Objective: The present study's aim was to analyze the late responses' parameters in order to determine the utility of each one. Methods: The study, conducted on a total of 325 patients with entrapment neuropathy of the median nerve and 36 with entrapment neuropathy of the ulnar nerve, included the bilateral evaluation of the median and the ulnar nerve and analysis of 20 F-wave and 4 A-wave parameters. Results: The authors emphasize the necessity of bilateral examination and that of examining the ipsilateral ulnar/median nerve, such as to calculate the difference in F-wave average latency of the median/ulnar and the ipsilateral ulnar/median nerve. This was the most sensitive parameter studied, altered in more than 70% of cases, significantly in more cases than when using only the M-wave distal latency. Also there was a statistically significant correlation between patient age and F-wave latency. Conclusions: The completed research yielded the recommendation for F-wave parameter studies to include the difference in F-wave average latency of the median/ulnar and the ipsilateral ulnar/median nerve. This parameter was also included in the composite score, along with the recommendations of the American Academy of Emergency Medicine [AAEM]