[Therapeutic approach to the distal airways in asthma]. / Abordaje terapéutico de la vía aérea pequeña en el asma.

Bronchial asthma is a chronic inflammatory disease that affects both the large-caliber airways and the smaller-caliber bronchioles. In the last few years, a major therapeutic advance has been made with the development of new systems of inhalation solutions, which produce extra-fine particles, achieving better lung deposition throughout the airways and reducing oropharyngeal deposition. These formulations have improved the effectiveness of bronchodilation and particularly the antiinflammatory effect. The use of long-acting b2-adrenergic steroids in extra-fine formulation, whether alone or in combinations of fixed doses, improves drug distribution throughout the bronchial tree, enhancing the therapeutic effect with lower doses of drugs. Leukotriene receptor antagonists have shown their effect on the small airways in asthmatic patients, both in studies of pulmonary resistance and pulmonary volumes and in imaging studies.

Abordaje terapéutico de la vía aérea pequeña en el asma / Therapeutic approach to the distal airways in asthma

El asma bronquial es una enfermedad inflamatoria crónica que afecta tanto a las vías respiratorias de mayorcalibre como a los bronquiolos de menor calibre. En los últimos años se ha producido un avance importanteen la terapéutica con la aparición de nuevos sistemas de inhaladores en solución, que producen partículasextrafinas, consiguiendo un mejor depósito pulmonar en toda la vía aérea y disminuyendo el depósito orofaríngeo.Estas formulaciones han permitido una mayor eficacia en la broncodilatación pero, sobre todo, unmayor efecto antiinflamatorio. La utilización de esteroides y b2-adrenérgicos de acción prolongada en formulaciónextrafina, bien sea de forma aislada o en combinaciones de dosis fijas, mejora la distribución de losfármacos por todo el árbol bronquial, consiguiendo un mayor efecto terapéutico con menores dosis de fármacos.Los antagonistas de los receptores de los leucotrienos han demostrado su efecto sobre las vías aéreaspequeñas de los asmáticos, tanto en estudios de resistencia pulmonar y volúmenes pulmonares como utilizandotécnicas de imagen(AU)

Bronchial asthma is a chronic inflammatory disease that affects both the large-caliber airways and thesmaller-caliber bronchioles. In the last few years, a major therapeutic advance has been made with thedevelopment of new systems of inhalation solutions, which produce extra-fine particles, achieving betterlung deposition throughout the airways and reducing oropharyngeal deposition. These formulations haveimproved the effectiveness of bronchodilation and particularly the antiinflammatory effect. The use oflong-acting b2-adrenergic steroids in extra-fine formulation, whether alone or in combinations of fixed doses,improves drug distribution throughout the bronchial tree, enhancing the therapeutic effect with lower dosesof drugs. Leukotriene receptor antagonists have shown their effect on the small airways in asthmatic patients,both in studies of pulmonary resistance and pulmonary volumes and in imaging studies(AU)

Occupational rhinoconjunctivitis and food allergy because of aniseed sensitization.

BACKGROUND: Aniseed is a spice frequently used in Mediterranean cooking and, as with other Umbelliferae, it has been involved in clinical allergy. OBJECTIVE: This investigation was undertaken to study the allergens implicated in a case of occupational allergy to aniseed associated with rhinoconjunctivitis and gastrointestinal symptoms. METHODS: Skin prick tests were performed to inhalant allergens, spices used in the patient's workplace (aniseed and cinnamon), and 12 other Umbelliferae spices, birch, and mugwort. A nasal challenge test to aniseed and cinnamon and a double-blind placebo-controlled oral food challenge test to aniseed were also performed. The molecular weights of the allergens were studied by sodium dodecyl sulfate-polyacrylamide gel electrophoresis immunoblotting and cross-reactivity among Umbelliferae species by enzyme immunoassay inhibition. RESULTS: Skin prick tests showed a positive immediate response to aniseed, asparagus, caraway, coriander, cumin, dill, and fennel extracts, and an intense late response to aniseed. Skin prick tests to celery, carrot, birch pollen, and mugwort pollen extracts were negative. Results of a nasal challenge test were positive to aniseed and negative to cinnamon; an aniseed oral food challenge test yielded a positive response. The molecular weights of the main immunoglobulin (Ig)E-binding proteins in aniseed extracts were approximately 48, 42, 39, 37, 34, 33, and 20 kD. Caraway, fennel, cumin, and coriander extracts showed similar IgE-binding patterns. Enzyme immunoassay inhibition studies with the patient's serum revealed cross-reactivity among the IgE components from aniseed, caraway, coriander, fennel, and dill extracts. CONCLUSIONS: We demonstrate the presence of aniseed allergens in a case of occupational rhinoconjunctivitis and food allergy, with molecular weights for this spice that differed from those previously reported.