Reactive airways dysfunction syndrome following inhalation of hydrogen chloride vapor

Hydrogen chloride is available commercially as an anhydrous gas or an aqueous solution, hydrochloric acid. Exposure to this gas has been associated with the development of reactive airways dysfunction syndrome. However, there are few published reports. A 37-year-old woman developed progressive bronchospasm and acute respiratory failure after cleaning an enclosed space with an unknown concentration of hydrochloric acid gas from a cleaning substance. She had no prior history of asthma or atopy. Severe bronchospasm developed, leading to hypoxemia and diffuse interstitial infiltrates, necessitating orotracheal intubation and admission to the intensive care unit. Asthma-like symptoms such as cough, wheezing, and dyspnea; requiring bronchodilators, and repeated hospitalizations are persistent a year after the accident. Pulmonary function testing showed mild airflow obstruction.

IL-12-STAT4-IFN-gamma axis is a key downstream pathway in the development of IL-13-mediated asthma phenotypes in a Th2 type asthma model

IL-4 and IL-13 are closely related cytokines that are produced by Th2 cells. However, IL-4 and IL-13 have different effects on the development of asthma phenotypes. Here, we evaluated downstream molecular mechanisms involved in the development of Th2 type asthma phenotypes. A murine model of Th2 asthma was used that involved intraperitoneal sensitization with an allergen (ovalbumin) plus alum and then challenge with ovalbumin alone. Asthma phenotypes, including airway-hyperresponsiveness (AHR), lung inflammation, and immunologic parameters were evaluated after allergen challenge in mice deficient in candidate genes. The present study showed that methacholine AHR and lung inflammation developed in allergen-challenged IL-4-deficient mice but not in allergen-challenged IL-13-deficient mice. In addition, the production of OVA-specific IgG2a and IFN-gamma-inducible protein (IP)-10 was also impaired in the absence of IL-13, but not of IL-4. Lung-targeted IFN-gamma over-expression in the airways enhanced methacholine AHR and non-eosinophilic inflammation; in addition, these asthma phenotypes were impaired in allergen-challenged IFN-gamma-deficient mice. Moreover, AHR, non-eosinophilic inflammation, and IFN-gamma expression were impaired in allergen-challenged IL-12Rbeta2- and STAT4-deficient mice; however, AHR and non-eosinophilic inflammation were not impaired in allergen-challenged IL-4Ralpha-deficient mice, and these phenomena were accompanied by the enhanced expression of IL-12 and IFN-gamma. The present data suggest that IL-13-mediated asthma phenotypes, such as AHR and non-eosinophilic inflammation, in the Th2 type asthma are dependent on the IL-12-STAT4-IFN-gamma axis, and that these asthma phenotypes are independent of IL-4Ralpha-mediated signaling.

Efectos de la inmunoterapia sobre la hiperreactividad bronquial de pacientes con rinitis alérgica / Effects of immunotherapy on bronchial hyperresponsiveness in patients with allergic rhinitis

La rinitis Alérgica es una enfermedad respiratoria crónica, inducida por una inflamación mediada por IgE en las membranas que recubren la nariz; con una prevalencia importante entre el 10% y el 25% de la población y una morbilidad con deterioro de la calidad de vida. Asma y rinitis son enfermedades comórbidas que surgieren el concerpto de una vía única, ya que comparten el mismo mecanismo inmunológico y una característica clínica que es la presencia de HRB; aunque en la rinitis es menos frecuentes, su presencia es considerada un factor de riesgo para el futuro desarrollo de Asma Bronquial. El tratamiento de la Rinitis Alérgica contempla: - la evitación del alérgeno - farmacoterapia - inmunoterapia específica, siendo considerada como la única terapia capaz de cambiar el curso de la enfermedad. Los Objetivos de este estudio fueron: 1) Evaluar los efectos de la inmunoterapia sobre la HRB de pacientes con rinitis alérgica, luego de un año de tratamiento. 2) Valorar la respuesta al tratamiento, mediante variables inmunológicas. 3) Evaluar la respuesta al tratamiento mediante escala de síntomas y consumo de medicación. 4) Determinar dosis alergénicas mínimas seguras y efecaces para el control de los síntomas...

The Allergic Rhinitis is a chronic respiratory disease, induced by a half-full inflammation by IgE in the mucosa that covers the nose; It has an important prevalence of between 10%y 25% of the population and a morbidity with deterioration of the quality of life. Asthma and rhinitis are comorbid diseases that suggest the concept of aunique route, since they share the same immunological mechanism and clinicalcharacteristics that is the HRB presence; although in the rhinitis this is less frequent, its presence is considered a risk factor for the future development of bronchial Asthma. The treatment of Allergic Rhinitis contemplates: Allergen avoidance Pharmacotherapy, specific Immunotherapy, being considered the only therapy able to change the course of the disease. Objetives: 1) To evaluate the effects of the immunotherapy on the HRB of patients with Allergic Rhinitis, after a year of treatment. 2) To value the response to the treatment, by means immunological variables 3) Evaluate the response to the treatment, by clinical variables: Registry medication consumption and score of symptoms. 4) Determinate dose security and efficacity for symptoms control. Randomized design double blind placebo control studied 20 adult patients who presented displayed compatible symptoms with allergic rhinitis, confirmed by skin pricktest (Alergo Pharma). The group placebo control was 8 patients (4 male, 4 female) and the group that received treatment with antigens I include 12 patients (9 m, 3 F) of whom 10 receivedtreatment with Dermatophagoides mixes and 2 patients treated with grass pollen (Alergo Pharma) All the patients were valued at the beginning and the year of treatment with subcutaneous Immunotherapy, considering the following variables: Bronchial measurement of HRB by methacolin challenge. (Chemical Sigma Co)continuous method aerosolization considering positive response a PC20=<16mg/ml...

The Validity of the ISAAC Written Questionnaire and the ISAAC Video Questionnaire (AVQ 3.0)for Predicting Asthma Associated with Bronchial Hyperreactivity in a Group of 13-14 Year Old Korean Schoolchildren

To validate the prevalence rate of symptoms of asthma produced by the phase I ISAAC (International Study of Asthma and Allergies in Childhood) study, hypertonic saline challenge test was carried out during the phase II study at a year after the phase I study. For the phase II study, six middle schools from three cities in the phase I study were selected. Finally, 499 children who responded to both studies were analyzed. All subjects were asked to complete the written questionnaire (WQ) first, followed by a video questionnaire (AVQ 3.0) during the phase I study. Of the 499 children, only 19 (3.8%) were positive to the hypertonic saline bronchial challenge test. The degree of agreement between responses to the two corresponding questions "wheezing at rest" and "nocturnal wheeze" in the AVQ 3.0 and WQ were moderate and weak with a Kappa indices of 0.45 and 0.23, respectively. The question on "severe wheeze" in the AVQ 3.0 had the highest Youden's index among the five questions related to asthma symptoms in the previous 12 months, but its specificity was low whereas it 's sensitivity was 1.0. There was no consistency of priority between the two questionnaires in predicting bronchial hyperreactivity in a group of Korean schoolchildren. Therefore we need to develop more appropriate WQ or AVQ to compare the prevalences of asthma to other countries.

Riscos relativos de gotejamento pós-nasal, hiper-reatividade brônquica e refluxo gastroesofágico em tosse crônica / Chronic cough

Neste artigo abordam-se os mecanismos etiopatogênicos implicdos nos pacientes com tosse crônica, sendo assim considerados aqueles cujos sintomas tenham duração superior a três semanas. Discutem-se os mais recentes avanços que permitiram chegar ao conceito de tríade patogênica da tosse crônica e que estão relacionados ao emprego da tomografia computadorizada de seios paranasais, à monitorização prolongada do pH intraesofagiano e ao teste de broncoprovocação com agentes químicos. O uso do termo tríade patogênica da tosse crônica deve-se à análise de vários estudos na literatura internacional confirmados definitivamente pelo grupo do Pavilhão Pereira Filho, segundo os quais na maioria das vezes ocorre a presença simultânea de duas ou três das seguintes causas: síndrome do gotejamento pós-nasal, hiper-reatividade brônquica e refluxo gastroesofágico. Especulam-se os mecanismos pelos quais os componentes desta tríade estão associados