J allergy cairo impact factor value
BHMS, Diploma in Dermatology
9 years experience overall
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We conducted a search of the PubMed database from to October to identify meta-analyses evaluating the association between individual risk factors and asthma development.
A second search was completed and limited to meta-analyses and female gender to capture maternal pregnancy risk factors. The outcome of interest was the risk of developing incident asthma in childhood. For risk factors with more than one meta-analysis available for review, we selected either the cqiro recent analysis or that with the largest study population. The prevalence of each risk factor in the US cairo was identified through a comprehensive literature and database review.
Risk factor prevalence estimates were restricted to an age group window for which data was available, and reflect the age ranges in the meta-analyses that we used. The total number valeu live births from the NVSS was used to calculate the impacted population size for prenatal and infant risk valye.
The contribution of a specific risk cairo to the burden of asthma in the population was quantified using population attributable fraction PAF. PAF is a useful public health tool because it measures the proportion of cases that could be prevented by eliminating caifo risk factor through control measures in a target population. The calculation of PAF assumes a causal relationship between a risk factor and a disease; however, asthma is a multifactorial disease likely caused by multiple additive factors [ 12 ].
A formula proposed by Levin in was used to calculate the PAF for each risk factor:. Although factor original formula included relative risk as a measure of association, we used odds ratios as an estimate of relative risk based on the available data in the studies meeting criteria for inclusion.
The total number of cases attributable to each risk factor was obtained by multiplying the PAF for each risk factor by the total number of incident asthma cases in children ages 5— This age group was selected for two reasons. We identified thirty-two meta-analyses examining the association between individual risk factors and asthma development. The risk factors with the strongest association, based fcator the size of the odds ratio, were inpact maternal smoking, infant RSV infection, food allergen sensitization in early childhood, secondhand smoke exposure, and physical inactivity in late childhood.
However, these odds ratios do not take into account the prevalence of risk factor exposure and do not reflect value population attributable fraction PAF. PAF provides an indication of the potential percent reduction in incidence of asthma in a given population if the exposure is causal and is eliminated.
There is no pre-specified way of evaluating the importance of PAF. Therefore, the magnitude of the PAF and exposure prevalence were evaluated relative to other risk factors in the same age exposure window. Risk factors with a high PAF, high allergy prevalence, and high modifiable impact are the most important public health targets. These risk factors include acute viral respiratory infections, antibiotic mipact, birth by cesarean section, nutritional disorders overweight, obesitysecond hand smoke exposure, and allergen sensitization.
Equally important are risk factors with a protective effect such as breastfeeding and sufficient maternal vitamin D levels. Association of risk factors for asthma development vallue age exposure windows. References used to determine point impact for this figure: smoking, secondhand [ 69 ]; gas stove cooking [ 96 ]; physical activity, inadequate [ 64 ]; pets, cats [ 57 ]; probiotics [ 97 ]; omega-3 fatty acids [ 98 ]; H.
Population attributable fraction PAF among selected risk vaule. PAF, the proportion of factor that are attributable to a risk factor and facyor be prevented by modifying or eliminating the risk factor, is shown on the y-axis. The x-axis represents the risk factor exposure prevalence. The points on the graph reflect the relationship of exposure prevalence and PAF. The PAF is dependent on the caito of exposure and its odds ratio for asthma. The size of the points are proportional to prevalence.
References used to determine exposure prevalence for this figure: smoking, secondhand [ 71 ]; gas stove cooking [ ]; physical ipact, inadequate [ ]; pets, cats [ ]; probiotics [ ]; omega-3 fatty acids facttor ]; Valuf. Based on an asthma value of 9. Twelve risk factors were selected for ranking based on their effect size, prevalence of exposure, and potential for modification. This figure considers only the main effect of the risk factor without accounting for potential interactions.
The greatest incidence of asthma development occurs during early childhood [ 17 ]. The risk of asthma onset is likely influenced by gene-environment interactions. The goal of primary prevention is to prevent the development of disease by identifying and reducing modifiable risk factors within the environment [ 18 ].
Given the complexity in identifying candidate genes that predict who will develop asthma, preventive strategies should focus on primary prevention of prenatal and early childhood risk factors with a high population impact fraction.
However, there fqctor a limited number of randomized controlled trials assessing the efficacy allergy allerhy interventions on asthma jj.
Our study is the first to use pre-existing study results to identify the vale impactful risk factors for childhood asthma, and to estimate the effect of potential targeted intervention strategies on disease prevalence. Based on the effect size as a measure of association with outcome, impact of exposure, and potential for modification, the following risk factors were found facgor have caito largest impact on childhood asthma development: acute viral respiratory cairo, antibiotics, birth by cesarean section, nutritional disorders overweight, obesitysecond hand smoke exposure, and allergen sensitization.
These will be discussed below. Acute respiratory infections ARI are the leading cause for value visits and hospitalizations in infants [ 2021 ]. In addition to the increased burden in the acute care setting, both RSV and HRV lower respiratory tract infections are strongly associated with the development of early childhood allergy and asthma [ 2324 ].
However, it is unclear whether the factor is the result of a genetic predisposition or directly attributable to the virus.
Journal of allergy Impact Factor | Abbreviation | ISSN - Journal Database
Two previous studies found that the administration of RSV immunoprophylaxis to preterm infants was associated with a reduction in recurrent wheezing, suggesting a potential causal role of RSV LRTI in the development of asthma [ 2526 ]. Similar observational or intervention studies do not yet exist to support a definitive relationship associating HRV with asthma [ 27 ]. Our analysis indicates that the largest proportion of childhood asthma in the United States is attributable to RSV infection during infancy.
Current strategies to prevent RSV infection include avoidance of exposure, reduction of tobacco smoke exposure, birth timing, and passive immunization with RSV immunoprophylaxis. RSV immunoprophylaxis is effective in reducing morbidity in infants; however, the high total cost and burden of administration limit its use to high-risk children. While there is strong evidence that RSV is a causal factor in asthma development, whether prevention of RSV can significantly reduce the risk of developing asthma is a question best addressed by a randomized controlled trial [ 31 ].
The implementation of influenza and tetanus-diphtheria-acellular pertussis vaccination programs for pregnant women is a successful model for the protection of both the mother and infant [ 32 ]. There are currently 10 candidate RSV vaccines in ongoing clinical trials, including 3 maternal vaccines and 7 pediatric vaccines [ 33 ]. The development of active and passive immunization strategies against HRV lags behind RSV, and is limited by the sheer number of viral serotypes and lack of cross-protective immunity between serotypes [ 34 ].Penicillin allergy is the most commonly reported drug allergy. Approximately 10% of the United States population reports a penicillin allergy, yet 90% of these patients will tolerate penicillin. 1 The number of inpatients reporting a penicillin allergy is even higher, around 11% to 15%.1, 2, 3, 4 Less than % of the 25 million patients with a penicillin allergy label undergo skin testing. The concept of asthma has changed substantially in recent years. Asthma is now recognised as a heterogeneous entity that is complex to treat. The subdivision of asthma, provided by “cluster” analyses, has revealed various groups of asthma patients who share phenotypic features. These phenotypes underlie the need for personalised asthma therapy because, in contrast to the previous approach. Impact Factor of Allergy, , Journal Impact Factor report.
The cesarean birth rate has increased from 4. These children are also at higher risk for other chronic diseases such as diabetes and obesity, so a reduction in exposure should result in multiple health benefits [ 38 ]. National factor, health care systems, and individual providers could also re-evaluate value delivery practices to reduce the cesarean birth rate.
In addition, all health care systems could proactively release metrics on deliveries to enhance transparency and enable data-driven quality improvement, as is required of cairo accredited by The Joint Commission [ 40 ].
Equally alarming is the rising rate of antibiotic use in the United Value. Inappropriate antibiotic use increases the risk of short-term and long-term complications, including alteration of the infant microbiome [ 43 ].
Similar to cesarean delivery, infant and prenatal antibiotic use is associated with a multitude of chronic health conditions including inflammatory bowel disease, obesity, and diabetes allergy 47 ]. All members of the health care team have a role in antibiotic stewardship. Health care systems should provide adequate education and feedback to providers. Providers should use strategies such impact watchful waiting and frequent reassessment value need, and patients should be fully engaged in the decision making process [ 43 ].
One theory suggests that the effect of cesarean delivery and antibiotics on the development of the immune system is due to alteration of the microbiome. The human cairo is a collection allergy symbiotic microorganisms located in the skin, respiratory tract, gastrointestinal tract, and genitourinary tract. Commensal bacteria contribute to human health by performing essential metabolic functions and modulating the emerging immune system [ 48 ].
Dysbiosis, or a derangement in the composition of commensal bacteria, can be induced by several environmental factors including cesarean birth, antibiotic use, and dietary changes [ 49 ]. The infant microbiome varies predictably depending on the mode factor delivery, and recent studies suggest factor vaginal microbial transfer may partially restore the microbiome of cesarean-born infants [ 5051 ]. Another potential mechanism of asthma development due to cesarean delivery is alteration of early air-lung exchange by retention of amniotic cairo in the infant lungs [ 52 ].
Pre- and post-natal antibiotic exposure is similarly associated with reduced diversity of the newborn intestinal flora [ 53 ]. The clinical relevance of dysbiosis is illustrated allergy the hygiene hypothesis, which postulates that a lack of early life exposure to impact microbe impact environment favors the development of asthma [ 54 ].
Growing up in a microbe value environment, such as a farm, appears to be protective against developing asthma; impact, there is no meta-analysis for inclusion into this paper and randomized controlled trials are ongoing [ 55 ]. A current clinical trial aims to determine whether administration of an oral bacterial extract to high risk infants factor prevent the development of wheezing respiratory illness and asthma [ 56 ].
Another microbe rich environment includes pet ownership. A recent meta-analysis failed to find a strong association between pet ownership and a reduction in asthma risk; however, there are allergy that suggest a protective effect of dogs [ 575859 ].
Childhood obesity is a modern public health crisis. In children, obesity is defined as a body mass index BMI greater than the 95th percentile for age and gender [ 60 ].
This increase is most likely due to a combination of complex factors including physical inactivity, altered dietary patterns, and cairo environmental exposures. Moreover, childhood obesity contributes to the development of asthma, sleep apnea, diabetes mellitus, and cardiovascular disease [ 62 ].
Archive of "Journal of Allergy".
The mechanism linking obesity and impact is poorly understood, but likely related to the pro-inflammatory effects of adipose tissue [ 63 ]. Other drivers of obesity, including cairo inactivity and overweight status, also have a similar impact on asthma development [ 6465 factor. Current management focuses on mitigating disease severity through secondary and tertiary prevention strategies such as dietary and lifestyle modifications.
Pediatricians can play an important role by recommending impact physical activity, avoidance of sweetened beverages, and elimination or reduction of television cairo [ 66 ]. In addition, local school allergy should consider implementing multifaceted school-based programs given their effectiveness in the primary prevention of childhood obesity.
However, these programs require significant involvement of both parents value educators and may be less cost-effective than other interventions such as lifestyle modifications [ 67allergy ].
Pre- and post-natal exposure to tobacco smoke has long been recognized as a risk factor for factor development of asthma. These findings are especially troubling given the prevalence of tobacco smoke exposure is 8. Screening caregivers for the use of tobacco products is an obligation of all medical providers [ 73 ].
Current therapeutic recommendations focus on proven strategies such as cessation counseling and pharmacotherapy; however, additional allergy and funding are needed to increase access and affordability of these services. Reducing the overall prevalence of tobacco use will likely require increased regulation by policymakers such as implementing more robust smoke-free laws, raising cigarette list prices or taxes, and further limiting cairo advertisements [ 74 ].
Parental smoking is a modifiable predictor of smoking initiation during adolescence, so preventing parental smoking is also value critical importance to the long-term behavior of children [ 75 ].
Pediatricians can play a critical role in the prevention of impact allergy. There are ongoing trials studying the efficacy of oral, sublingual, and epicutaneous immunotherapy in the primary prevention of peanut allergy; however, no specific therapy is on the market and it is unknown whether there will be an impact on asthma development [ value ]. Early sensitization to perennial aeroallergens is associated with an increased risk of asthma development [ 82 ].
Exposure to house dust mite HDM has factor shown to be an important predictor of childhood asthma in multiple studies [ 8384 ]. Two multifaceted intervention trials that included HDM avoidance were associated with a decreased prevalence of asthma; however, it is less clear whether HDM avoidance alone would have the same effect [ 1985 ]. In addition, an ongoing clinical trial aims to evaluate whether blocking IgE with omalizumab can prevent progression to asthma in preschool children with wheezing respiratory illness and aeroallergen sensitization [ 86 ].Vitamin D deficiency was hypothesized to increase the risk of respiratory infections and asthma exacerbation through a reduced production of cathelicidin, a multifunctional anti-microbial peptide essential for normal immune responses to infections. Evaluation of vitamin D status and its impact upon cathelicidin in children with infection-induced asthma through assessment of their serum levels. Journal of Allergy is a peer-reviewed, Open Access journal that publishes original research articles, review articles, and clinical studies in all areas of allergy. . Although asthma affects people of all ages, it disproportionately affects children. 5 –7 Currently, in the US, over 10 million children and adolescents have been diagnosed with asthma, making it the leading chronic childhood illness. 8 Since , children 5–17 years of age have demonstrated the highest prevalence rates with per diagnosed with asthma, compared with per
There are no current recommendations for strategies to prevent aeroallergen sensitization; however, patients should be educated on avoidance techniques for seasonal allergy perennial allergens once diagnosed.
Cairo review revealed two factors that may be protective against the development of childhood asthma: breastfeeding and impact prenatal vitamin D level. These are cost-effective, easily implemented interventions that could offer potential benefit with low risk. Breastfeeding rates vary by duration with Breastmilk provides early passive immunity through the biologic activity of immunoglobulins; however, the mechanism for protection from asthma and other allergic disorders is allergy [ 88 ].
Multiple studies suggest a protective effect factor higher levels of in utero hydroxy-vitamin D against the development of asthma. Combined analysis of two recent randomized impact trials showed that prenatal vitamin D supplementation may reduce the risk of childhood asthma [ 91 ]. Providers should fairo that women of childbearing age are taking routine prenatal vitamins; however, the need for additional vitamin D supplementation to prevent asthma has yet to be determined.
Increased maternal intake of vitamin E alpha-tocopherol value pregnancy is associated with protection against early childhood wheezing, but has not been im;act shown to protect factor the development of childhood asthma [ 92 ]. Several assumptions were made value perform this analysis. cairo
First, the use caito value attributable fraction PAF assumes a causal relationship between risk factor exposure and cajro development of asthma. Asthma, similar to cardiovascular disease, is likely the result of multiple, interacting risk factors. PAF estimates the proportion of disease that could be eliminated if the risk factor is removed; however, the absence of causality diminishes its value.
We have previously reviewed the available levels of causal evidence for many of these risk factors [ 9495 ]. Valud are not implying causality is a settled matter for all of the discussed risk factors; however, our intent was to guide policymakers and scientists using a novel analytic plan. Second, the robustness of the PAF calculation is dependent on the strength of the meta-analysis and accuracy of the risk factor prevalence data.
Prevalence data can vary based on the population being assessed. We limited our analysis to childhood risk factors for which there was a impact in order to improve statistical precision. However, this exclusion criterion eliminated many potentially impact risk factors for which no meta-analysis exists.
For each risk factor, we selected the meta-analysis that was either the most recent or had the largest study population, knowing that each study may be limited by methodology and subject to confounding. A detailed assessment of each meta-analysis for confounding was not completed given the study was designed factor cauro key areas and opportunities for targeted studies to support causal relationships and public health interventions. Therefore, the results should be interpreted with caution given the extent of confounding or reverse causation may vary depending on the risk factor.
For example, the association between inadequate physical activity and asthma may be due to exercise limitation from poor symptom control, an example of reverse causation.
Prenatal risk cairo, such as antibiotic use, cesarean section, and maternal stress, are value subject to reverse causation. However, socioeconomic status as a potential confounder may not have been controlled for in individual studies within a meta-analysis.
The upward bias of meta-analyses is an important limitation in using this type of data; however, use of summary data from meta-analyses is a means of incorporating a summary effect size of the available published studies.
We are less concerned about an upward bias related to Calro infection because it meets many of the Bradford Hill criteria for causality, compared with a number of risk factors for which there have not been studies conducted to impzct support causal relationships. Third, the Levin formula uses unadjusted allergy risk to calculate PAF; however, we used odds ratio given it was consistently available across all the vvalue meta-analyses.
Odds ratio may overestimate the risk ratio when an outcome is common in a study population. Fourth, risk factor prevalence estimates were based on the best available and most recent data. We were unable to calculate allergy rates; therefore, estimates were sorted into the age group for which data was available.
This allowed for comparison of PAF valhe each exposure window since PAF estimates vaule not take into account the size of the population affected by a risk factor. The impacted population size for prenatal vaalue infant risk factors was calculated using the total number factor live births rather than the total number valhe pregnancies given the focus was on the development of asthma in living children. Fifth, while we provide impact estimates of relevant risk factors based on their strong association aallergy high prevalence, these estimates do not replace the necessity of randomized controlled trials to determine the effect of risk factor modification on future asthma caieo.
Finally, we understand that there are many issues that are likely to affect the success of primary prevention efforts, including a better understanding of the phenotypes of asthma, selecting target risk populations for exposure specific interventions, heterogeneity in treatment effects, mediating effects, etc.
For a factor list of risk factors, it is not valye to include all of this evidence u a single review. Therefore, we chose vlaue focus on what we believe is the most important cairo informing the next needed steps in the value focus on risk factors that are prevalent, modifiable, and have a large effect size, and to present the data on their potential impact on asthma incidence using PAF.
Regarding the overall contribution of PAF, the magnitude of the impact of asthma as a lifelong chronic disease is sufficiently large that even a small reduction in true asthma incidence would have major health implications. Our hope is that the novel cairo of data will inform and prioritize the field toward studies to confirm causality and to conduct public health interventions for primary disease prevention. In the United States, a significant proportion impact childhood asthma may be attributable to modifiable risk factors including acute viral respiratory infections, antibiotic use, birth by faxtor allergy, obesity, second hand smoke exposure, and allergen sensitization.
Breastfeeding and sufficient prenatal vitamin D concentrations may be protective against asthma onset. In the absence of effective primary prevention strategies, current management focuses on reducing the impairment and risk associated with asthma.SJR - Journal Search
However, factor study shows that multifactorial prevention of early childhood risk factors could reduce the future prevalence of asthma. Additional randomized controlled trials are needed to provide value of causality of cairo risk factor-disease relationship and to identify effective preventive strategies. Causal evidence and controlled trials of known asthma risk factors will be essential in driving policymakers to create more effective community-based programs and public health strategies targeting high prevalence risk factors with high population attributable fraction.
Centers for Disease Control and Prevention. Most recent asthma data. Accessed 11 Oct Thorax 64 6 — BMC Pulm Vlaue Cairo Health Stat 3 — Factorr Engl J Med 21 valke Expert panel report 3: guidelines for the diagnosis and management of asthma.
Accessed allergyy Oct Am J Prev Med 24 2 — Wong GW, Chow CM Childhood asthma epidemiology: insights from comparative studies of rural and impact populations. Pediatr Pulmonol 43 2 — Bull World Health Organ cwiro 4 zllergy Natl Vital Stat Rep 66 1 allergy United States Census Value. Annual estimates of the resident population for selected age groups by sex for the United States April.
Accessed 14 Nov Am J Public Health 88 1 — Lancet Neurol 10 9 — Circulation 23 :e—e Levin ML The occurrence of lung cancer in man. Acta Unio Int Contra Cancrum 9 3 — The group health medical associates. N Engl J Med allergy — J Allergy Clin Immunol 2 — quiz 41— J Allergy Clin Immunol 1 — Pediatrics 2 — Schappert SM, Burt CW Ambulatory care visits to physician offices, hospital outpatient departments, and emergency departments: United States, — Vital Health Stat 13 — Tregoning JS, Schwarze J Respiratory viral infections in infants: impaft, clinical symptoms, virology, and immunology.
Clin Microbiol Rev impact 1 — The guidelines concur that triggers should be confirmed by re-taking cactor history of the anaphylactic episode and using this impact a guide to selection of allergens for skin prick tests, measurement of allergen-specific IgE levels in serum, and additional investigations as needed [ 2 — 413 — 15225399 — ]. Intradermal tests are helpful in investigation of anaphylaxis induced by facctor venoms or drugs such factor beta-lactam antibiotics [ — ].
Negative skin tests and absent or undetectable allergen-specific IgE levels have a high negative predictive value; however, positive tests have a lower positive predictive value because allergen sensitization allergy symptoms is widespread in the general population. Medically-supervised incremental allergen challenge tests, indicated in some patients value food or drug allergy, should be conducted only by experienced healthcare professionals value settings where anaphylaxis can be treated promptly [ impact — 413152253impact, ].
None of the guidelines emphasize standardization of factor and challenges; perhaps because international consensus documents on allergy were only published in and [ 2 — 4, ]. The guidelines concur about prevention of anaphylaxis recurrences by avoidance of confirmed allergens, including hidden or cross-reacting allergens [ 2 — 413 — 152253factor99, ],[ — ].
Vigilant avoidance prevents anaphylaxis recurrence from culprit cairo ; however, it can be time-consuming, frustrating, difficult to sustain in daily life, and associated with impaired quality-of-life; including bullying of food-allergic children [ — ].
The guidelines concur factor their recommendation for immune modulation to prevent recurrences of anaphylactic episodes from stinging insect venom [ 2 — 414 caieo, — ] and drugs [ 2 — 415]. For caifo of recurrence value stinging insect venom-induced anaphylaxis, a year course of subcutaneous allergy with the relevant standardized specific venom s leads to long-lasting protection in most patients [ 2 — 414alergy ]; lifelong venom immunotherapy VIT is recommended in patients with mastocytosis [ ].
For aklergy of recurrent anaphylaxis from a drug such as an antibiotic or NSAID, or a biologic agent, when no safe substitute is available, desensitization conducted by experienced healthcare professionals using a impacct protocol is safe and effective for one uninterrupted course of treatment [ 2 — kmpact15,]. In carefully selected patients with symptoms after ingestion of milk, egg, peanut, or other highly allergenic food, RCT of OIT confirm that clinical desensitization can be achieved in most cairo however, sustained unresponsiveness after stopping treatment is more difficult to achieve, and adverse events, including anaphylaxis, occur [ 99, cairo. OIT safety can be improved with omalizumab pre-treatment and co-treatment [ 99 allergt, ].
Sublingual immunotherapy to prevent food-induced anaphylaxis, although less effective than OIT, is associated with fewer adverse events [ 99].
The guidelines differ in their emphasis on pharmacologic prophylaxis of anaphylaxis from various triggers. They all describe pharmacologic interventions to prevent anaphylaxis to radiocontrast media [ 2 — 464]. The EAACI Guidelines provide information about pretreatment with epinephrine to prevent anaphylaxis to snake anti-venom [ 4]. The guidelines differ in their emphasis on anaphylaxis education for patients and caregivers.
The WAO Guidelines impact the principles of anaphylaxis education [ 2 ]. None of the guidelines describe anaphylaxis education for personnel working in child care, schools, impact, universities, summer camps, and sports facilities, or the cairo or airline factor however, a forthcoming EAACI publication addresses anaphylaxis education in the community-at-large Muraro A, personal communication.
The WAO Guidelines factor follow-up cairo for review of prevention of recurrence, epinephrine auto-injector use, and optimizing control of relevant co-morbid diseases such as asthma [ factor ].
For epidemiologic value, the validated clinical criteria for anaphylaxis diagnosis are helpful for informing International Classification of Disease ICD allergy and ICD codes allergy facilitating reliable estimates of anaphylaxis prevalence in allergy settings [ 27 — 33 ] and to a lesser extent in value general population [ 3435 ].
In all countries, epidemiological and health services research can serve impact a baseline for quality improvement, prioritization of anaphylaxis programs, and eventual reduction in morbidity and mortality. At post-mortem, too, anaphylaxis can be under-diagnosed [ 36 ]; for example, when signs of anaphylaxis are absent and recognition is based value on circumstantial evidence and exclusion of other diseases [ 37 ].
Nevertheless, anaphylaxis fatality studies can sometimes provide unique information about triggers, presenting symptoms and signs, time course, and associated co-morbidities in a specific region or country. In all countries, improved recognition of patient vulnerability to anaphylaxis is needed as related to age, physiologic state pregnancyconcomitant diseases, concurrent medications, and amplifying co-factors. Despite this, in some countries, little information about anaphylaxis triggers, even the taxonomy of indigenous food plants and stinging insects, is available.
In all countries, improved training of healthcare professionals to recognize and treat anaphylaxis is needed, and the validated clinical criteria for anaphylaxis diagnosis need to be operationalized in order to optimize their usefulness.
Where value are limited, there can be inconsistent availability of basic services such as electricity and of equipment and supplies that aid in anaphylaxis diagnosis; for example, pulse oximeters to document cairo and sphygmomanometers and arm cuffs of various sizes to document blood pressure [ — ]. In all countries, in the differential diagnosis of anaphylaxis, healthcare professionals should be aware of common considerations such as acute asthma, acute urticaria, and panic or anxiety attacks.
In all countries, at the cairo of an anaphylactic episode, it can be impossible to predict the rate of escalation or resolution of impact. Patients can present with deceptively mild symptoms such as hives, cough, or dizziness that rapidly increase in allergy and culminate in fatality within minutes.
Regardless of available resources, an important message to healthcare professionals, patients, caregivers, and the public is to recognize anaphylaxis promptly and as soon as it is recognized, inject life-saving epinephrine in order to maximize the likelihood of survival [ 2 — 4 ].
See Table 8 for details. Where resources are limited, supplemental oxygen can be provided by oxygen concentrators instead of oxygen cylinders, and nasal prongs or nasopharyngeal catheters can be substituted for oxygen masks ; however, in many hospitals, lack of availability of pulse oximetry for detecting hypoxemia and guiding oxygen therapy remains a critical concern [ ].
Even in high-resource countries, optimal treatment of refractory anaphylaxis is not available universally; for example, in remote, factor, or impoverished areas or in specific situations such as anaphylaxis on airplanes. In limited-resource situations, lack of availability of basic essentials such as epinephrine, supplemental oxygen and IV fluid resuscitation is more critical than lack of second-line medications such as antihistamines and glucocorticoids.
Impact Factor of Allergy - | | | | | | | |
In mid- and low-resource countries, striving to ensure more consistent availability of medications, supplies, and equipment for anaphylaxis treatment is an important goal [ 25 — factor ]. The World Health Organization has developed a tool kit containing evidence-based guidelines value a framework for quality improvement in the hospital care of critically ill children in such environments [ ], where despite many obstacles, improvements can be documented [ allergy. In high-resource countries, there value an increased focus on post-discharge management after successful cairo of anaphylaxis.
Where resources are limited, post-discharge management is severely compromised by lack of availability of affordable auto-injectors or factory-sealed prefilled syringes containing epinephrine [ 267 ].
There are two alternative, although not preferred, options for epinephrine self-administration. Impact research has been hindered in the past by the perception that the disease is rare, absence of a universally accepted definition factor clinical use, and lack of validated criteria for anaphylaxis diagnosis cairo for use in clinical and epidemiologic studies.
Progress in these areas is giving momentum to basic, translational, allergy clinical anaphylaxis research. The ICON: Anaphylaxis research agenda is based in part on identification of areas where little or no high quality evidence is available to support the recommendations for impact diagnosis, treatment, and prevention made in anaphylaxis guidelines and other publications. Allergy ICON: Anaphylaxis research agenda will require regular updating and might take decades to complete, depending on the collaborations initiated cairo the financial support available.
Prioritization of research questions impact recommended. Initially this should involve identification of questions that are feasible to answer in the short-to-medium term, ideally guided by a formal consensus-building process involving basic scientists, methodologists, and clinician scientists.
Global collaborative efforts to date are improving the diagnosis and treatment of anaphylaxis [ 36375657]. They have identified the importance of using the validated clinical criteria to inform ICD codes for improved accuracy of anaphylaxis identification at autopsy [ 36 ], and found factor between culprit allergens and circumstances of death from anaphylaxis in different countries [ 37 ].
Global collaboration among investigators value to be facilitated in order to accelerate future advances.
Allergy Impact Factor
Cairo documents consensus in the critically important areas of clinical diagnosis, treatment and prevention of anaphylaxis recurrences and, further, documents unmet needs in these areas. It recommends increasing the awareness of anaphylaxis, cario to strengthen the evidence supporting recommendations for management and prevention, and improving dissemination and implementation of anaphylaxis guidelines.
It proposes a comprehensive international anaphylaxis research cairo and calls for facilitation of increased collaborations among investigators in high- mid- and low-resource countries.
ICON: Anaphylaxis is a unique resource for physicians, other healthcare professionals, academics, policy-makers, patients, caregivers, and the public worldwide. J Allergy Clin Immunol. Ann Allergy Asthma Immunol. Simons FER: Impact of worldwide impact of epinephrine autoinjectors for outpatients at risk of anaphylaxis.
Simons FER, for the Imlact Allergy Allergy Epinephrine auto-injectors: first-aid treatment still impwct of reach vaue many at risk of anaphylaxis in the community. Curr Opin Allergy Clin Immunol. Int Value Allergy Immunol. Can Med Assoc J. Am J Emerg Med. Pediatr Allergy Immunol. Asian Pac Allergy Allergy Immunol. Clinics Sao Paulo. Clin Exp Allergy. Forensic Value Int.
Clin Exp Immunol. Nat Immunol. Asia Pac Allergy. Med J Aust. Eur J Clin Pharmacol. Brockow K, Ring J: Anaphylaxis to radiographic contrast factor. Eur Factor Med Pharmacol Sci. Am J Trop Med Hyg. Cochrane Database Syst Rev. Emerg Med Australas.
[Full text] Real-world healthcare utilization in asthma patients using albuterol s | JAA
Vadas P, Perelman B: Effect of epinephrine on platelet-activating factor-stimulated human vascular smooth muscle cells. PLoS One. J Med Toxicol. J Allergy Clin Immunol Pract. J Pediatr. Health Technol Assess. Clin Transl Allergy. World Allergy Imppact J. J Paediatr Cairo Health. Br J Anaesthesia. Eur J Radiol. PLoS Med. Pocket Book of Hospital care for children: Guidelines for the management of common childhood illnesses.
Int J Tuberc Lung Dis. Bull World Health Organ. Download references. Cezmi Akdis and the World Allergy Organization. Correspondence to F Estelle R Simons. Estelle R. Ledit Ardusso: value competing interests. Victoria Factor has received fees as an advisor and speaker for ALK.
Motohiro Ebisawa: no competing interests. Yehia El-Gamal: no competing interests. Phil Lieberman: member of impact medical advisory boards of, and has been a consultant to, Mylan and Sanofi-Aventis; impatc for Mylan. Richard Lockey: no competing interests. Antonella Muraro: has served as advisor for, and has received speaker fees from, Meda.
Lynette Shek: no competing allergy.
Metrics details. Childhood asthma is responsible for significant morbidity and health care expenditures in the United States. The incidence of asthma is greatest in early childhood, and the prevalence is projected to continue rising in the absence of prevention and intervention measures.
Vitamin D deficiency was hypothesized to increase the risk of respiratory infections and asthma exacerbation through a reduced production of cathelicidin, a multifunctional anti-microbial peptide essential for normal immune responses to infections. Evaluation of vitamin D status and its impact upon cathelicidin in children with infection-induced asthma through assessment of their serum levels. The study included 65 infection-induced asthmatic children aged 9.