Francis Thien

Maternal breast milk long‐chain n‐3 fatty acids are associated with increased risk of atopy in breastfed infants

Background Australia has one of the highest prevalence rates internationally of allergic conditions, such as asthma and eczema. Atopy is one hallmark for the development of allergic disease and predisposes to allergic inflammation in the target organs. ω‐3 (n‐3) fatty acids (FAs) are thought to act as precursors to the formation of less active inflammatory mediators, with the potential to reduce inflammation.

Induction of T ‘regulatory’ cells by standardized house dust mite immunotherapy: an increase in CD4+CD25+ interleukin‐10+ T cells expressing peripheral tissue trafficking markers

Background Clinically effective subcutaneous allergen‐specific immunotherapy (SIT) is associated with altered circulating T cell cytokine production and altered local cytokine responses with increased IL‐10 following allergen challenge in target organs.

Using discrete choice experiments to investigate subject preferences for preventive asthma medication

Background and objective:  Long‐term adherence to inhaled corticosteroids is poor despite the crucial role of preventer medications in achieving good asthma outcomes. This study was undertaken to explore patient preferences in relation to their current inhaled corticosteroid medication, a hypothetical preventer or no medication.

Associations between fatty acids in colostrum and breast milk and risk of allergic disease

Background Exposure to n‐3 polyunsaturated fatty acids (PUFA) in early life is hypothesized to offer protection against atopic disease. However, there is controversy in this area, and we have previously observed that high levels of n‐3 fatty acid (FA) in colostrum are associated with increased risk of allergic sensitization.

Do dairy products induce bronchoconstriction in adults with asthma

BACKGROUND Dairy products have often been implicated as a cause of exacerbation of asthma, but there is little scientific evidence to support this hypothesis. OBJECTIVE We sought to determine whether dairy products induce bronchoconstriction in a group of adults with asthma. METHODS Twenty subjects with asthma (13 women and 7 men) were recruited from respondents who had previously completed a food and asthma questionnaire. Ten subjects perceived that their asthma became worse with ingestion of dairy products (positive perceivers), whereas ten were negative perceivers. None of the subjects had positive skin prick test results with cows milk. The study was a randomized, cross-over, double-blind, placebo-controlled trial. Subjects complied with a dairy-free diet throughout the study. The active challenge was a single-dose drink equivalent to 300 ml of cows milk. A positive reaction was defined as a 15% reduction in both FEV1 and peak expiratory flow (PEF) on the active challenge day compared with results obtained at the same time on the placebo day. RESULTS For both FEV1 and PEF there were no statistically significantly differences in group means between active challenge and placebo challenge, between sequence of administration, or between perceptions. Nine subjects showed FEV1 or PEF changes that were greater than 15% of baseline values: four patients showed changes after both active and placebo treatment; two after treatment with placebo only; and three after active treatment alone. Of the latter group, two subjects showed changes only in PEF, and when one of these subjects underwent a further detailed study, no asthmatic reaction could be demonstrated. CONCLUSION It is unlikely that dairy products have a specific bronchoconstrictor effect in most patients with asthma, regardless of their perception.

Chlorhexidine anaphylaxis: a case report and review of the literature.

A 25-year-old man presented for assessment after an episode of anaphylaxis following insertion of a urethral catheter. He required intermittent dilatation of a urethral stricture after a previous pelvic fracture. Six months earlier he had developed an itchy rash minutes after urethral catheterization under local anaesthetic, which subsided over some hours. On this occasion, a catheter was inserted after infiltration of the urethra with lignocaine 2% with chlorhexidine 0.05% (Pharmacia, Bentley, WA, Australia). Within minutes, his blood pressure fell to 90/60 and he developed a generalized pruritic rash, wheeze and dizziness. He was treated with nebulized salbutamol, intravenous hydrocortisone and subcutaneous adrenaline. He recovered without further incident and was subsequently discharged from hospital.

A prospective open clinical trial of a proton pump inhibitor, elimination diet and/or budesonide for eosinophilic oesophagitis.

Elimination diets and high‐dose proton pump inhibitors (PPI) are advocated as first‐line treatments in patients with eosinophilic oesophagitis (EoE).

Systematic review of the effectiveness of breathing retraining in asthma management

In asthma management, complementary and alternative medicine is enjoying a growing popularity worldwide. This review synthesizes the literature on complementary and alternative medicine techniques that utilize breathing retraining as their primary component and compares evidence from controlled trials with before-and-after trials. Medline, PubMed, Cumulative Index to Nursing and Allied Health Literature and the Cochrane Library electronic databases were searched. Reference lists of all publications were manually checked to identify studies not found through electronic searching. The selection criteria were met by 41 articles. Most randomized controlled trials (RCTs) of the Buteyko breathing technique demonstrated a significant decrease in β2-agonist use while several found improvement in quality of life or decrease in inhaled corticosteroid use. Although few in number, RCTs of respiratory muscle training found a significant reduction in bronchodilator medication use. Where meta-analyses could be done, they provided evidence of benefit from yoga, Buteyko breathing technique and physiotherapist-led breathing training in improving asthma-related quality of life. However, considerable heterogeneity was noted in some RCTs of yoga. It is reasonable for clinicians to offer qualified support to patients with asthma undertaking these breathing retraining techniques.

Royal jelly-induced asthma and anaphylaxis: clinical characteristics and immunologic correlations.

temperature difference could be perceived either directly by elevated blood temperature affecting cells in the hypothalamic preoptic area, or indirectly by blood temperature first affecting peripheral neuronal receptors, which in turn stimulate the preoptic area. It would have been tempting to assume that direct heating of the blood could bypass peripheral neuronal receptors. However, because sequential skin temperatures were not recorded along with oral temperatures, this assumption cannot be established. Nevertheless, this case is a unique example of the temperature difference needed to be perceived by the central temperature regulation system in order to provoke the common efferent reflex leading to hives in CU.

Oral ginseng formulae for stable chronic obstructive pulmonary disease: A systematic review

Ginseng alone or combined with other herbs has been increasingly used for chronic obstructive pulmonary disease (COPD). This review aims to evaluate the effectiveness and safety of oral Ginseng formulae for stable COPD. Four English databases and three Chinese databases were searched to identify randomized controlled trials. Methodological quality was assessed by Cochrane risk of bias and Jadads scale. Data were analyzed using Review Manager 5.0. Twelve studies overall of low quality, involving 1560 participants were included. Results of three studies showed a mean difference (MD) of 0.30 (95%CI 0.02 to 0.58) for forced expiratory volume in 1 s (FEV(1)) improvement of Ginseng formulae versus placebo control. Findings of three studies revealed an MD of 9.43 (95%CI 3.64 to 15.21) of FEV(1) % predicted between Ginseng formulae and placebo control. Quality of life (Qol) measured by St. Georges Respiratory Questionnaire was improved (MD -10.32, 95%CI -14.99 to -5.65) with Ginseng formulae plus pharmacotherapy versus pharmacotherapy alone in one study. There were no severe adverse events reported. Ginseng formulae for stable COPD patients show promising evidence of lung functions and Qol improvement. However, the degree of benefit is uncertain due to potential risk of bias of the included studies.