Publications by authors named "David Weldon"

22 Publications

  • Page 1 of 1

TSLP or IL-7 provide an IL-7Rα signal that is critical for human B lymphopoiesis.

Eur J Immunol 2016 09 12;46(9):2155-61. Epub 2016 Jul 12.

School of Medicine, Loma Linda University, Loma Linda, CA, USA.

Thymic stromal lymphopoietin (TSLP) and IL-7 are cytokines that signal via the IL-7 receptor alpha (IL-7Rα) to exert both overlapping and unique functions during early stages of mouse B-cell development. In human B lymphopoiesis, the requirement for IL-7Rα signaling is controversial and the roles of IL-7 and TSLP are less clear. Here, we evaluated human B-cell production using novel in vitro and xenograft models of human B-cell development that provide selective IL-7 and human TSLP (hTSLP) stimulation. We show that in vitro human B-cell production is almost completely blocked in the absence of IL-7Rα stimulation, and that either TSLP or IL-7 can provide a signal critical for the production and proliferation of human CD19(+) PAX5(+) pro-B cells. Analysis of primary human bone marrow stromal cells shows that they express both IL-7 and TSLP, providing an in vivo source of these cytokines. We further show that the in vivo production of human pro-B cells under the influence of mouse IL-7 in a xenograft scenario is reduced by anti-IL-7 neutralizing antibodies, and that this loss can be restored by hTSLP at physiological levels. These data establish the importance of IL-7Rα mediated signals for normal human B-cell production.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5056642PMC
http://dx.doi.org/10.1002/eji.201646307DOI Listing
September 2016

High Pressure Phase-Transformation Induced Texture Evolution and Strengthening in Zirconium Metal: Experiment and Modeling.

Sci Rep 2015 Jul 28;5:12552. Epub 2015 Jul 28.

1] Beijing National Laboratory for Condensed Matter Physics and Institute of Physics, Chinese Academy of Sciences, Beijing 100190, China [2] HiPSEC and Department of Physics and Astronomy, University of Nevada, Las Vegas, Nevada, USA.

We studied the phase-transition induced texture changes and strengthening mechanism for zirconium metal under quasi-hydrostatic compression and uni-axial deformation under confined high pressure using the deformation-DIA (D-DIA) apparatus. It is shown that the experimentally obtained texture for ω-phase Zr can be qualitatively described by combining a subset of orientation variants previously proposed in two different models. The determined flow stress for the high-pressure ω-phase is 0.5-1.2 GPa, more than three times higher than that of the α-phase. Using first-principles calculations, we investigated the mechanical and electronic properties of the two Zr polymorphs. We find that the observed strengthening can be attributed to the relatively strong directional bonding in the ω phase, which significantly increases its shear plastic resistance over the α-phase Zr. The present findings provide an alternate route for Zr metal strengthening by high-pressure phase transformation.
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http://dx.doi.org/10.1038/srep12552DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4517392PMC
July 2015

One-pot synthesis of cinnamylideneacetophenones and their in vitro cytotoxicity in breast cancer cells.

Bioorg Med Chem Lett 2014 Aug 4;24(15):3381-4. Epub 2014 Jun 4.

Department of Pharmaceutical and Administrative Sciences, School of Pharmacy, Loma Linda University, Loma Linda, CA, United States; Department of Basic Sciences, School of Medicine, Loma Linda University, Loma Linda, CA, United States; Department of Chemistry, University of California, Riverside, CA 92521, United States. Electronic address:

A series of cinnamylideneacetophenones were synthesized via a modified Claisen-Schmidt condensation reaction and evaluated for cytotoxicity against breast cancer cells using the Alamar Blue™ assay. Derivatives 17 and 18 bearing a 2-nitro group on the B ring, exhibited sub-micromolar cytotoxicity in MCF-7 cells (IC50=71 and 1.9 nM), respectively. Derivative 17 also displayed sub-micromolar (IC50=780 nM) cytotoxicity in MDA-MB-468 cells. Additionally, 17 and 18 displayed significantly less cytotoxicity than the chemotherapeutic doxorubicin in non-tumorigenic MCF-10A cells. This study provides evidence supporting the continued development of nitro-substituted cinnamylideneacetophenones as small molecules to treat breast cancer.
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http://dx.doi.org/10.1016/j.bmcl.2014.05.089DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4145842PMC
August 2014

The diagnosis and management of acute and chronic urticaria: 2014 update.

J Allergy Clin Immunol 2014 May;133(5):1270-7

These parameters were developed by the Joint Task Force on Practice Parameters (JTFPP), representing the American Academy of Allergy, Asthma & Immunology (AAAAI); the American College of Allergy, Asthma & Immunology (ACAAI); and the Joint Council of Allergy, Asthma & Immunology. The AAAAI and ACAAI have jointly accepted responsibility for establishing "The diagnosis and management of acute and chronic urticaria: 2014 update." This is a complete and comprehensive document at the current time. The medical environment is a changing environment, and not all recommendations will be appropriate for all patients. Because this document incorporated the efforts of many participants, no single individual, including those who served on the JTFPP, is authorized to provide an official AAAAI or ACAAI interpretation of these practice parameters. Any request for information about or an interpretation of these practice parameters by the AAAAI or ACAAI should be directed to the Executive Offices of the AAAAI, the ACAAI, and the Joint Council of Allergy, Asthma & Immunology. The JTFPP understands that the cost of diagnostic tests and therapeutic agents is an important concern that might appropriately influence the work-up and treatment chosen for a given patient. The JTFPP recognizes that the emphasis of our primary recommendations regarding a medication might vary, for example, depending on third-party payer issues and product patent expiration dates. However, because a given test or agent's cost is so widely variable and there is a paucity of pharmacoeconomic data, the JTFPP generally does not consider cost when formulating practice parameter recommendations. In extraordinary circumstances, when the cost/benefit ratio of an intervention is prohibitive, as supported by pharmacoeconomic data, commentary might be provided. These parameters are not designed for use by pharmaceutical companies in drug promotion. The JTFPP is committed to ensuring that the practice parameters are based on the best scientific evidence that is free of commercial bias. To this end, the parameter development process includes multiple layers of rigorous review. These layers include the workgroup convened to draft the parameter, the task force reviewers, and peer review by members of each sponsoring society. Although the task force has the final responsibility for the content of the documents submitted for publication, each reviewer comment will be discussed, and reviewers will receive written responses to comments, when appropriate. To preserve the greatest transparency regarding potential conflicts of interest, all members of the JTFPP and the practice parameter workgroups will complete a standard potential conflict of interest disclosure form, which will be available for external review by the sponsoring organization and any other interested individual. In addition, before confirming the selection of a Work Group chairperson, the Joint Task Force will discuss and resolve all relevant potential conflicts of interest associated with this selection. Finally, all members of parameter workgroups will be provided a written statement regarding the importance of ensuring that the parameter development process is free of commercial bias. Practice parameters are available online at www.jcaai.org and www.allergyparameters.org.
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http://dx.doi.org/10.1016/j.jaci.2014.02.036DOI Listing
May 2014

Synthesis, biological evaluation, hydration site thermodynamics, and chemical reactivity analysis of α-keto substituted peptidomimetics for the inhibition of Plasmodium falciparum.

Bioorg Med Chem Lett 2014 Mar 31;24(5):1274-9. Epub 2014 Jan 31.

School of Pharmacy, Department of Medicinal Chemistry, University of Mississippi, University, MS 38677, United States; National Center for Natural Products Research, University of Mississippi, University, MS 38677, United States. Electronic address:

A new series of peptidomimetic pseudo-prolyl-homophenylalanylketones were designed, synthesized and evaluated for inhibition of the Plasmodium falciparum cysteine proteases falcipain-2 (FP-2) and falcipain-3 (FP-3). In addition, the parasite killing activity of these compounds in human blood-cultured P. falciparum was examined. Of twenty-two (22) compounds synthesized, one peptidomimetic comprising a homophenylalanine-based α-hydroxyketone linked Cbz-protected hydroxyproline (39) showed the most potency (IC50 80 nM against FP-2 and 60 nM against FP-3). In silico analysis of these peptidomimetic analogs offered important protein-ligand structural insights including the role, by WaterMap, of water molecules in the active sites of these protease isoforms. The pseudo-dipeptide 39 and related compounds may serve as a promising direction forward in the design of competitive inhibitors of falcipains for the effective treatment of malaria.
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http://dx.doi.org/10.1016/j.bmcl.2014.01.062DOI Listing
March 2014

Quality of life in patients with urticaria and angioedema: assessing burden of disease.

Authors:
David Weldon

Allergy Asthma Proc 2014 Jan-Feb;35(1):4-9

Scott & White Clinic, College Station, Texas, USA.

Patients with urticaria and/or angioedema have several reasons to have a poor quality of life (QoL). The intensity of pruritus and density of involvement compromise a patient's lifestyle as well as aggravate stressors that affect physical and psychiatric conditions. The burden of illness is significant in not only costs for emergent practitioner visits, but, often, unnecessary laboratory testing and medication expenses. Questionnaires that assess a patient's QoL serve to document benefit to therapies. Objectively documenting changes that are important to patients with urticaria and/or angioedema allows the patients and clinician to accurately assess effectiveness of therapies over long periods of time. Specific surveys that address urticaria (CU-Q2oL and UAS) and angioedema (AE-QoL questionnaire) allow simplified and sensitive assessments for patients with the corresponding condition. Common components of appropriate surveys assess not only intensity of pruritus and wheals but also impact on sleep, interpersonal relationships, and appearances. In considering the most important aspects of several surveys, an example of a survey is provided that focuses on the patient's perception of how their urticaria and/or angioedema impacts their QoL.
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http://dx.doi.org/10.2500/aap.2014.35.3713DOI Listing
September 2014

A focused parameter update: hereditary angioedema, acquired C1 inhibitor deficiency, and angiotensin-converting enzyme inhibitor-associated angioedema.

J Allergy Clin Immunol 2013 Jun;131(6):1491-3

Joint Council of Allergy, Asthma&Immunology, 50 N BrockwaySt, #304, Palatine, IL 60067, USA.

These parameters were developed by the Joint Task Force on Practice Parameters (JTFPP), representing the American Academy of Allergy, Asthma & Immunology (AAAAI); the American College of Allergy, Asthma & Immunology (ACAAI); and the Joint Council of Allergy, Asthma and Immunology. The AAAAI and the ACAAI have jointly accepted responsibility for establishing "A focused parameter update: Hereditary angioedema, acquired C1 inhibitor deficiency, and angiotensin-converting enzyme inhibitor-associated angioedema." This is a complete and comprehensive document at the current time. The medical environment is a changing environment, and not all recommendations will be appropriate for all patients. Because this document incorporated the efforts of many participants, no single individual, including those who served on the JTFPP, is authorized to provide an official AAAAI or ACAAI interpretation of these practice parameters. Any request for information about or an interpretation of these practice parameters by the AAAAI or ACAAI should be directed to the Executive Offices of the AAAAI, the ACAAI, and the Joint Council of Allergy, Asthma and Immunology. The Joint Task Force on Practice Parameters understands that the cost of diagnostic tests and therapeutic agents is an important concern that might appropriately influence the work-up and treatment chosen for a given patient. The JTFPP recognizes that the emphasis of our primary recommendations regarding a medication might vary, for example, depending on third-party payer issues and product patent expiration dates. However, because the cost of a given test or agent is so widely variable and there is a paucity of pharmacoeconomic data, the JTFPP generally does not consider cost when formulating practice parameter recommendations. In some instances the cost benefit of an intervention is considered relevant, and commentary might be provided. These parameters are not designed for use by pharmaceutical companies in drug promotion. The Joint Task Force is committed to ensuring that the practice parameters are based on the best scientific evidence that is free of commercial bias. To this end, the parameter development process includes multiple layers of rigorous review. These layers include the Workgroup convened to draft the parameter, the Task Force Reviewers, and peer review by members of each sponsoring society. Although the Task Force has the final responsibility for the content of the documents submitted for publication, each reviewer comment will be discussed, and reviewers will receive written responses to comments when appropriate. To preserve the greatest transparency regarding potential conflicts of interest, all members of the Joint Task Force and the Practice Parameters Workgroups will complete a standard potential conflict of interest disclosure form, which will be available for external review by the sponsoring organization and any other interested individual. In addition, before confirming the selection of a Workgroup chairperson, the Joint Task Force will discuss and resolve all relevant potential conflicts of interest associated with this selection. Finally, all members of parameter workgroups will be provided a written statement regarding the importance of ensuring that the parameter development process is free of commercial bias.
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http://dx.doi.org/10.1016/j.jaci.2013.03.034DOI Listing
June 2013

The effects of corticosteroids on bone: osteonecrosis (avascular necrosis of the bone).

Authors:
David Weldon

Ann Allergy Asthma Immunol 2009 Aug;103(2):91-7; quiz 97-100, 133

Department of Internal Medicine, Texas A&M University Health Sciences Center, College Station, Texas, USA.

Objective: To provide information about risk factors for, diagnosis of, and potential treatments and prevention of avascular necrosis (AVN) in patients frequently given systemic corticosteroid therapy for the management of allergic and/or inflammatory diseases.

Data Sources: Articles on AVN cited in PubMed from 1975 through 2008.

Study Selection: Publications consisted of case reports, reviews of osteonecrosis, and animal and human studies (mostly open, nonrandomized, and observational).

Results: Case reports of rare and infrequent use of corticosteroids and the development of osteonecrosis are of great concern to physicians, but most patients affected may also be at risk of developing osteonecrosis because of repetitive systemic corticosteroid use with underlying hyperlipidemia, alcoholism, smoking, connective tissue disorders, and/or previous trauma to the affected area. The use of statins for patients with hyperlipidemias may be useful in decreasing the risk of osteonecrosis but is considered investigational. Enhanced magnetic resonance imaging is the most sensitive tool for diagnosing AVN early. Prophylaxis with bisphosphonates may be worthwhile in certain patients for the early management of pain due to AVN, but eventually surgical intervention is warranted in the treatment of osteonecrosis.

Conclusions: Recognition of risk factors and educating (enabling) the patient remain the most effective ways of preventing AVN caused by corticosteroid use.
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http://dx.doi.org/10.1016/S1081-1206(10)60159-7DOI Listing
August 2009

The effects of corticosteroids on bone growth and bone density.

Authors:
David Weldon

Ann Allergy Asthma Immunol 2009 Jul;103(1):3-11; quiz 11-3, 50

Department of Internal Medicine, Texas A&M University Health Sciences Center, College Station, Texas 77840, USA.

Objective: To define the effects of both parenteral and inhaled corticosteroids on bone growth in children and the development of osteopenia and osteoporosis in children and adults.

Data Resources: Articles in PubMed and MEDLINE published from 1983 to 2008 were searched. Keywords used included corticosteroids and bone growth, osteopenia, osteoporosis, and bisphosphonates.

Study Selection: Publications reviewed include randomized, placebo-controlled studies of both children and adults.

Results: Because systemic and high-dose inhaled corticosteroids affect bone growth of children taking these medications, stadiometry should be used to measure the growth of children. Osteoporosis due to repetitive courses of oral or parenteral corticosteroids and inhaled corticosteroids can develop gradually in the aging adult. Prophylaxis against osteoporosis requires an index of suspicion, assessment of bone density, supplemental calcium and vitamin D, and use of bisphosphonates to prevent bone fractures that could compromise the patient's quality of life.

Conclusion: Preventing corticosteroid-induced effects on bone metabolism can allow effective treatment of allergic disease without long-term adverse effects.
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http://dx.doi.org/10.1016/S1081-1206(10)60135-4DOI Listing
July 2009

Your patients are itching for answers.

Authors:
David Weldon

Ann Allergy Asthma Immunol 2008 Mar;100(3):191-2

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http://dx.doi.org/10.1016/S1081-1206(10)60440-1DOI Listing
March 2008

What lies beneath the surface of the itch in adults?

Authors:
David Weldon

Allergy Asthma Proc 2007 Mar-Apr;28(2):153-62

Allergy and Pulmonary Services, Scott & White Clinic, College Station, Texas 77840, USA.

Pruritus is synonymous with itching. Many medical conditions are complicated by chronic pruritus compromising the patient's quality of life. The majority of pruritic stimuli are transmitted through C fibers into the lateral spinothalamic tract and then into the somatic sensory cortex where the itching is detected. Histamine, substance P, and tumor necrosis factor a play significant roles in the perception of pruritus. Medical conditions in adults with significant pruritus will be defined in this review.
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http://dx.doi.org/10.2500/aap.2007.28.2942DOI Listing
July 2007

Laryngopharyngeal reflux and chronic sinusitis.

Authors:
David Weldon

Curr Allergy Asthma Rep 2007 Jun;7(3):197-201

Scott and White Clinic, 1600 University Drive East, College Station, TX 77845, USA.

In patients with chronic and recurrent sinusitis, laryngopharyngeal reflux disease may play a significant role. Laryngopharyngeal reflux disease differs from gastroesophageal reflux disease in the extent of reflux (into the hypopharynx and above) as well as timing (occurring more often when the patient is upright). Most patients are unaware of the extent of their symptoms, and diagnostic tools such as pH probe, multichannel intraluminal impedance, and manometry are required for adequate diagnosis. Although therapy with lifestyle modification and acid-suppressive agents may improve reflux in the majority of patients, for many with persistent symptoms, endoscopic or surgical intervention is required to reduce reflux successfully.
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http://dx.doi.org/10.1007/s11882-007-0072-5DOI Listing
June 2007

What drives the inflammatory response in rhinosinusitis.

Authors:
David R Weldon

Allergy Asthma Proc 2006 Nov-Dec;27(6):441-6

Department of Allergy and Pulmonary Services, Scott & White Clinic, College Station, Texas 77840, USA.

The dilemma of treating chronic sinusitis continues to confuse clinicians. When mucosal thickening does not respond to aggressive antibiotic therapy, other etiologies should be considered. Perhaps the most likely is the inflammatory response. In comparison with asthma, chronic sinusitis exhibits amazing similarities. Atopic dermatitis also exhibits similar inflammatory responses that lead to thickening of the skin in a manner not dissimilar to mucosal thickening. The interactions amid eosinophils, lymphocytes, leukotrienes, interleukins, and epithelial cells serve as a reminder that there is one immune response and similarities exist in the pathophysiology of these conditions.
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http://dx.doi.org/10.2500/aap.2006.27.2925DOI Listing
February 2007

Differential diagnosis of angioedema.

Authors:
David Weldon

Immunol Allergy Clin North Am 2006 Nov;26(4):603-13

Texas A&M University Health Sciences Center, College Station, TX 77840, USA.

There are many conditions that may present with swelling that mimics angioedema. When swelling persists for greater than a few days or is unresponsive to treatment for urticaria/angioedema, other etiologies should be considered. In most instances, a thorough history and physical examination will define other etiologies. However, for more persistent conditions, further laboratory evaluation and a biopsy may be required to define the diagnosis. Rarely is a more aggressive approach required to make the diagnosis. Clinicians should remember that if the swelling does not act like angioedema, it more than likely is not angioedema.
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http://dx.doi.org/10.1016/j.iac.2006.09.006DOI Listing
November 2006

Quality of life in patients with urticaria.

Authors:
David R Weldon

Allergy Asthma Proc 2006 Mar-Apr;27(2):96-9

Department of Allergy and Pulmonary Services, Scott & White Clinic, College Station, Texas A&M University Health Sciences Center, TX 77840, USA.

Patients with chronic urticaria have a poor quality of life (QOL). Chronic pruritus with variable appearance of urticaria and/or angioedema are typical of the uncertainty that compromise their QOL. Other issues such as fatigue, cost of therapy, and social isolation further contribute to the frustration that patients experience. Various instruments are available to measure the quality of life of patients with urticaria and can be adjunctive in the continued assessment of patients with this variable condition. In comparison with other dermatological and medical conditions, patients with chronic urticaria have a significantly worse QOL.
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August 2006

Sublingual immunotherapy: a comprehensive review.

J Allergy Clin Immunol 2006 May;117(5):1021-35

Nova Southeastern University School of Osteopathic Medicine, Davie, Florida, USA.

Sublingual immunotherapy (SLIT) has been used with increasing frequency in Europe and is viewed with increasing interest by allergists in the United States. To address this interest, a Joint Task Force of the American College of Allergy, Asthma and Immunology and the American Academy of Allergy, Asthma and Immunology's Immunotherapy and Allergy Diagnostic Committees reviewed the available literature on SLIT and prepared this report. The task force concluded that despite clear evidence that SLIT is an effective treatment, many questions remained unanswered, including effective dose, treatment schedules, and overall duration of treatment. Until these have been determined, an assessment of the cost/benefit ratio of the treatment cannot be made. SLIT does appear to be associated with few serious side effects, but it has not been administered in high-risk asthmatic patients, nor in the studies reviewed has it been administered as a mixture of non-cross-reacting allergens. Furthermore, there is currently no allergy extract approved for this use in the United States, nor is there a Current Procedural Terminology code for billing purposes. All of these factors should be given careful consideration by anyone contemplating initiating SLIT treatment for their allergic patients.
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http://dx.doi.org/10.1016/j.jaci.2006.02.040DOI Listing
May 2006

Gastroesophageal reflux disease and sinusitis: their role in patients with chronic cough.

Authors:
David R Weldon

Allergy Asthma Proc 2006 Jan-Feb;27(1):36-44

Department of Allergy and Pulmonary Services, Scott & White Clinic and Texas A & M University Health Sciences Center, College Station, Texas 77840, USA.

The causes of coughing are multiple. Research into the physiology of coughing has established that interactions amid C-fibers and rapidly activating receptors in humans have the most significant effect on stimulation of coughing. Precipitants of coughing include gastroesophageal reflux and sinusitis. Stimulation of vagal afferents by esophageal irritation and aspiration of acidic gastric contents or vapors are the most frequently cited causes of cough associated with gastroesophageal reflux or laryngopharyngeal reflux. Sinusitis may precipitate coughing from other mechanisms including aspiration of postnasal drainage and sinopulmonary reflex. Taking a lesson on how these conditions affect asthmatic patients, this article will review how these two conditions may also influence cough in normal patients.
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September 2006

Chronic cough: an interactive case discussion.

Allergy Asthma Proc 2006 Jan-Feb;27(1):17-20

Division of Allergy & Pulmonary Medicine, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, MO 63141, USA.

The following case was presented at the Eastern Allergy Conference May 2005 to each of four small group sessions in an attempt to incorporate problem-based learning (PBL) into the curriculum of the conference for the first time in its 18-year history. Before this, the format had always been non-stop lectures for four days. The attempt to use PBL in breakout sessions was due to the well-documented improved learning experience with PBL demonstrated by multiple studies in the literature of PBL for CME. This PBL case on an adult who presents with a "chronic cough" was linked to a series of three didactic lectures to reinforce the differential diagnoses in this patient. The three lectures followed the PBL breakout sessions (during the morning of the conference) and were entitled Laryngeal Pharyngeal Reflux (LPR), Chronic Sinusitis: A Surgical Perspective and Chronic Cough. Although the best learning scenario for this case occurs when there is interaction with one's peers, review of this case and answering the questions that were posed by the facilitators can still provide a great learning experience.
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September 2006

Endocrinological masqueraders of allergy.

Authors:
David Weldon

Allergy Asthma Proc 2005 Nov-Dec;26(6):440-4

Department of Allergy and Pulmonary Laboratory Services, Scott & White Clinic, College Station, Texas 77840, USA.

There are many endocrine conditions that can present with allergic symptoms and signs. Thyroid conditions ranging from fatigue to orbitopathy associated with Grave's disease can be confused with allergic conjunctivitis and angioedema. Autoimmune thyroid disease is commonly associated with idiopathic urticaria. Symptoms of orthostatic hypotension and intolerance often present when least expected and should be considered ahead of time to avoid confusion in treating possible systemic allergic reactions. Flushing is a frequent sign and differentiating from complaints commonly associated with allergic reactions, rosacea, and endocrinopathies is helpful in sorting out some of the more complex conditions associated with this symptom.
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August 2006

Differential diagnosis of chronic cough.

Authors:
David R Weldon

Allergy Asthma Proc 2005 Sep-Oct;26(5):345-51

Department of Internal Medicine, Texas A & M University Health Sciences Center, 1600 University Drive East, College Station, TX 77840, USA.

Coughing that lasts >3 weeks is generally considered chronic. The causes of chronic cough are many. Most often, chronic cough is due to postnasal drainage, asthma, and/or gastroesophageal disease. However, other causes such as laryngopharyngeal reflux, vocal cord dysfunction, occult sinusitis, pertussis, and angiotensin-converting enzyme inhibitor should be considered. Even rarer entities will be discussed as well as some of the pathophysiology associated with the cough reflex.
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April 2006

When your patients are itching to see you: not all hives are urticaria.

Authors:
David Weldon

Allergy Asthma Proc 2005 Jan-Feb;26(1):1-7

Department of Allergy, Scott & White Clinic, Texas 77804, USA.

When patients present with itching and the perception that they have hives, what other processes can mimic urticaria? With the exception of urticarial vasculitis, urticaria typically lasts less than 24 to 36 hours at one site. A rash that persists longer should raise the suspicion of another inflammatory process. When the hive-like rash does not respond to antihistamines, a biopsy may reveal an alternative diagnosis. All biopsies should also be submitted for immunofluorescence to exclude atypical presentations of inflammatory bullous disease presenting with urticaria. However, even biopsies can be subject to misinterpretation and if the clinical picture does not support the biopsy, an alternative consultation with a dermatopathologist may be required. The extent of the laboratory and radiologic evaluation should be dictated by the clinician's suspicion of alternative causes for the hive(s) because rarely malignancies may present with urticaria. Common things are indeed common with urticaria and the more urticaria does not appear to be typical, the more often the clinician should consider alternative diagnoses.
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June 2005