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Atopic dermatitis may be food allergy

In the past, positive blood and skin tests would often be mistaken for a food allergy because they would indicate the presence of immunoglobulin E antibodies, but it is important to remember that these are typically higher in patients with atopic dermatitis, according to a speaker at the 69th Annual American Academy of Dermatology Meeting conducted in New Orleans this week. “Those antibodies are not diagnostic, and the only way to diagnose food allergy is with a strong history of reactions or a challenge,” Jon M. Hanifin, MD, of Oregon Health & Science University, said in a press release. “This is done in a doctor’s office, using small increments of the food in question and increasing the amount until an allergic reaction occurs or does not occur. Usually a parent can pinpoint if a child has a true food allergy because the allergic reaction will appear so quickly with lip swelling or hives, quite distinct from simply food intolerance.”

Between 6% and 10% of children have atopic dermatitis, and about one-third of these children have food allergy. Recent research examining the genetic basis of atopic dermatitis has shown that this chronic skin condition is likely related to a defect in the epidermal barrier, which allows irritants, microbes and allergens (such as food) to penetrate the skin and cause adverse reactions. Because the skin barrier in patients with atopic dermatitis is compromised and open to absorb proteins, it allows sensitization to certain foods, leading to a positive skin or blood test.

New guidelines recently issued by the National Institute of Allergy and Infectious Diseases established a protocol for the proper evaluation and management of food allergy. The guidelines recommend that children who are younger than aged 5 years with moderate to severe atopic dermatitis be considered for food allergy evaluation if they have persistent atopic dermatitis despite optimized management or if the child has a reliable history of an immediate reaction after eating a specific food.

Hanifin said research is also ongoing into whether withholding foods is leading to more allergies than an unrestricted diet in young children. This may provide future insight in potential ways to prevent food allergies. He said children in Israel seldom get peanut allergy, which may potentially be attributed to the use of peanut proteins in pacifiers in that country. In the United States and Europe, where peanut allergies are more common, infants are not usually exposed to this food until they are toddlers – the time when most peanut allergies are noticed.

“There is some thinking that withholding foods might actually be causing more allergies, and that an unrestricted diet may help tolerize babies to foods that could potentially cause a problem later in life,” Hanifin said. “Ongoing studies in this country using oral immunotherapy appear promising, and physicians hope that we may discover how to prevent food allergies in the future while continuing to provide successful treatment for children with atopic dermatitis.”

Source: Hanifin J. Food allergy and dermatology. Presented at: The American Academy of Dermatology 69th Annual Meeting; Feb. 4-8, 2011; New Orleans

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Ten major advances in heart disease in 2010

The American Heart Association has compiled its annual list of the top 10 major advances in heart disease. “We have come far in the past decade, reducing heart disease deaths by more than 27 per cent,” said Ralph Sacco of the University of Miami. “But we know there is still much to be done in improving the lives of heart disease and stroke patients – and more importantly, in preventing these devastating diseases in the first place. Scientific research will help us lead the way,” said Sacco.

The highlights of the top ten advances in cardiovascular research in 2010:

1. Tailoring treatment for people with diabetes to reduce their risk of cardiovascular disease
New research from the ACCORD Study Group offered insight into specific treatments that can reduce their risk of cardiovascular disease (CVD). The first study found that aggressive blood pressure control does not reduce CVD risk in people with type 2 diabetes at high risk for CVD. In a second study, a combination therapy with a statin plus a fibrate was no better at reducing risk than a statin alone in patients with type 2 diabetes at high risk for CVD.

2. New advances for patients who aren't candidates for conventional valve surgery
Two new studies have supported evidence that Transcatheter aortic valve implantation (TAVI) can improve symptoms and outcomes – including quality of life – even over the course of several years. While there are some risks associated with TAVI, including strokes and other major cardiovascular events, the catheter-based procedure offers significant progress in this area.

3. Improving the way we reverse sudden cardiac arrest
Significant studies reported that chest compression only, or ''Hands Only CPR'' for adults by bystander lay rescuers improves survival outcome. Public awareness campaigns resulted in increased use of hands only CPR, as well as improved survival rates. While the new procedure appeared successful in adults, it is important to note that using conventional chest compressions with rescue breathing is still important for children stricken with sudden cardiac arrest.

4. More options for reducing stroke risk in atrial fibrillation
For the first time in more than 20 years there are viable alternatives to the primary prevention of stroke for patients with atrial fibrillation (AF). Warfarin (Coumadin) has long been the standard anti-clotting drug used to reduce the risk of stroke for these patients. But it carries its own complications from bleeding, and managing the dose requires regular blood tests, making it difficult to manage for both patients and doctors. Now, several new drugs have been found to work as well as warfarin – and are simpler for patients to take – offering an important advance in this field.

5. Adjusting pacing therapies can improve outcomes for heart failure patients
New studies showed that adding additional resynchronization pacing to ICD therapy could lead to improved outcomes in an expanded group of heart failure patients. In addition, new types of ICDs (defibrillators without leads, for example) can offer options that reduce some of the risks associated with traditional devices.

6. Hopeful new procedure for infants with congenital heart disease
The Pediatric Heart Network's randomized trial of Norwood shunt types in infants with single-ventricle lesions showed that the type of shunt used makes a difference in outcomes. Better transplantation-free survival at 12 months is a possibility with this new understanding of the better shunt choice for these patients. This was the first large-scale randomized trial in congenital heart surgery, offering an approach that should provide answers to other questions in the future.

7. Finding the right anti-clotting (anti-platelet) therapy
New research from the PLATO investigators has found that ticagrelor may improve outcomes and reduce adverse events better than the current standard, clopidogrel. The CURRENT-OASIS 7 Trial is exploring the optimal dosing of clopidogrel and aspirin in patient undergoing invasive surgery. These studies will help providers better understand the situations where new choices and dosages may improve results for the patient.

8. Basic science findings offer insight into future progress
Several studies this year brought the future of medicine closer to the present with new insight into emerging technologies. Findings from stem cell therapy have shown improved quality of life and survival in several early studies of patients with chronic heart failure and support the development of future cell-based therapeutics. A large animal study defined the basic mechanisms for heart muscle regeneration initiated by specific types of stem cells. The results demonstrated that these stem cells repair scarred myocardium through promotion of the generation of new heart muscle and blood vessel).

9. Using science to support healthy lifestyle behaviours
New science examining lifestyle behaviours in adults and children, with particular emphasis on physical activity and consumption pattern, show that such conditions as obesity and hypertension are positively influenced by a change in diet with decreasing sodium levels. Results from the school setting suggest that the earlier one starts to adopt healthy behaviours the better the effect on health outcomes.

10. Get With The Guidelines participation eliminates disparity gaps in care
Racial and ethnic disparities have been found in the quality of care delivered to patients with cardiovascular disease and achieving equity and addressing disparities has implications for quality, cost, risk management, and community benefit. These findings are the first to show that participating in a quality improvement program, such as Get With The Guidelines-Coronary Artery Disease, can eliminate racial and ethnic disparities of care while increasing the overall use of evidence-based care for heart attack patients.

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