Biologic targeted therapy in allergic asthma.

OBJECTIVE: To review the structure, function, clinical utility, and safety of current biologic targeted therapies being used for the treatment of asthma. DATA SOURCES: Medical literature obtained from PubMed and OVID searches from June to November 2013. STUDY SELECTIONS: Studies were selected based on article impact, relevance, and clinical significance. Particular emphasis was placed on articles discussing therapies targeted at IgE, interleukin (IL)-4, IL-4 receptor, IL-5, IL-13, tumor necrosis factor-α, CRTh2, and toll-like receptors 7 and 9. RESULTS: Since the approval of omalizumab in 2003, the development of biologic asthma therapies has grown at a remarkable pace. With approximately 30 drugs currently in clinical trials and dozens more in development, the future of asthma biologic therapies is promising. Despite several well-publicized setbacks, researchers remain focused on elucidating the complex pathophysiology of asthma. The hope is that asthma biologic therapies will eventually be tailored to an individual's asthma phenotype. With more than 300 million people worldwide affected by asthma and with roughly 5% to 10% of this population living with severe, uncontrolled asthma, the need for new biologic therapies is great. CONCLUSION: The introduction of each new biologic therapy into clinical trials has been associated with great anticipation, but the outcome of these trials, in many cases, has led to disappointment. Given the lack of overwhelming positive responses, these results have emphasized that asthma is a complex clinical syndrome with multiple underlying genotypes and clinical phenotypes. It has become abundantly clear that it is very unlikely that there is one "magic bullet" to cure all patients with asthma.

Lymphoma complicating primary immunodeficiency syndromes.

PURPOSE OF REVIEW: One of the strongest arguments for the immune surveillance network of antibodies and sensitized cytotoxic T cells is the extraordinary incidence of lymphoid malignancy in the many types of primary immunodeficiency. RECENT FINDINGS: This review updates the literature that seems to wax and wane on the importance of specific immunity to malignant cell antigens by previous authors. This new survey strongly supports the tenet that immune responses protect from malignant cell growth and development, much like it protects against a hostile microbial world. As more genetic lesions are discovered that cause various forms of immune deficiency, each with their consequent type of infection or malignancy, the notion that certain devastating infections or malignancies develop by chance is becoming less likely. The predominance of B-cell lymphoma in immune-deficient patients is both interesting and vexing. One might reasonably ask why the entire spectrum of malignancies is not seen in primary immunodeficiency. SUMMARY: Regardless of continuing debate on immune surveillance of malignancy, the evidence presented in this review strongly supports that it has a key role in preventing lymphoid malignancy.

Role of drowsy driving in traffic accidents: a questionnaire survey of Thai commercial bus/truck drivers.

OBJECTIVE: The authors assessed the relationship between traffic accidents and drowsiness. MATERIAL AND METHOD: A self-answered questionnaire survey of 4331 commercial bus/truck drivers was done. RESULT: Sixty-nine percent of the drivers reported accidents and one third of these accidents was attributable to drowsiness. Drowsy driving and microsleeps were experienced by 75% and 28% of drivers respectively. Forty-five percent of drivers had excessive daytime sleepiness based on the Epworth Sleepiness Scale (ESS score > or =11). This excessive daytime sleepiness was strongly associated with feeling drowsy, microsleeps, and accidents. The major causes of drowsiness were sleep deprivation (90%), medications that caused sleepiness (78%), drinking alcohol the previous night (23%), and chronic loud snoring with or without obesity (17%). 61% of drivers worked longer than 12 hours with no days off The feeling of drowsiness at the wheel was also closely related to long hours of driving (>4 hours). Countermeasures that drivers used to keep them awake were talking to someone, drinking coffee or caffeinated-energy drinks, chewing snacks or gum and pulling over to have a nap. CONCLUSION: There is a strong relationship between accidents and drowsiness in commercial bus/truck drivers. The main cause of drowsiness was sleep deprivation. The authors hope that this information will help the public authority develop a policy to reduce the traffic accidents attributable to drowsy driving in commercial bus/truck drivers.