Browsing by Author "Potter, Paul"

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    A therapeutic approach to atopic eczema
    (2010) Potter, Paul
    Atopic eczema is a common problem in general practice. The underlying disorder is a barrier dysfunction of the skin, but exacerbations of eczema can be triggered by a range of external and internal factors. In young children, dietary factors are important triggers of exacerbations and specific IgE sensitivity to common allergens may be confirmed by skin prick testing or ImmunoCap® RAST tests. True sensitivity to foods is best confirmed by a controlled food challenge, and cut off values have been published which indicate the predictive values of blood or skin tests for true food sensitivity to guide the clinician. Elimination of identifiable triggers, the use of emollients and topical corticosteroids remain the mainstay of treatments. Calcineurin inhibitors have a place for treatment of selected cases. The use of systemic corticosteroids is discouraged and patients who do not respond to emollients, specific food avoidance and corticosteroids topically should be referred to a dermatologist. The role of maternal diet in preventing the development of eczema in the offspring remains controversial.
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    Diagnosis and treatment of urticaria and angioedema: a worldwide perspective
    (BioMed Central Ltd, 2012) Sánchez-Borges, Mario; Asero, Riccardo; Ansotegui, Ignacio; Baiardini, Ilaria; Bernstein, Jonathan; Canonica, G Walter; Gower, Richard; Kahn, David; Kaplan, Allen; Katelaris, Connie; Maurer, Marcus; Park, Hae; Potter, Paul; Saini, Sarbjit; Tassinari
    Urticaria and angioedema are common clinical conditions representing a major concern for physicians and patients alike. The World Allergy Organization (WAO), recognizing the importance of these diseases, has contributed to previous guidelines for the diagnosis and management of urticaria. The Scientific and Clinical Issues Council of WAO proposed the development of this global Position Paper to further enhance the clinical management of these disorders through the participation of renowned experts from all WAO regions of the world. Sections on definition and classification, prevalence, etiology and pathogenesis, diagnosis, treatment, and prognosis are based on the best scientific evidence presently available. Additional sections devoted to urticaria and angioedema in children and pregnant women, quality of life and patient-reported outcomes, and physical urticarias have been incorporated into this document. It is expected that this article will supplement recent international guidelines with the contribution of an expert panel designated by the WAO, increasing awareness of the importance of urticaria and angioedema in medical practice and will become a useful source of information for optimum patient management worldwide.
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    Indications, Efficacy, and Safety of Intranasal Corticosteriods in Rhinosinusitis
    (BioMed Central Ltd, 2012) Potter, Paul; Pawankar, Ruby
    Rhinosinusitis is a significant health problem, causing significant morbidity and resulting in considerable financial cost. Some patients suffer persistent or recurrent symptoms despite receiving optimal medical and surgical treatment. Rhinosinusitis can be acute or chronic, acute often due to viral or bacterial infections and chronic which is classified into chronic with nasal polyposids or chronic rhinosinusitis without nasal polyposis. The disease affects the quality of life significantly and presents a significant burden on health costs globally. The anatomical linkage of the nose with the paranasal sinuses facilitates a common pathology in both organs. Chronic rhinosinusitis (CRS) has heterogeneous origins, including viruses, bacteria, fungal infections, anatomical abnormalities, polyposis, and aspirin sensitivity. Other conditions such as human immunodeficiency virus acquired immunodeficiency and cystic fibrosis may also be predisposing factors. Nasal polyposis is often associated with increased numbers of Th2 lymphocytes, fibroblasts, goblet cells, mast cells, and eosinophils, with upregulation of IL-13 and the release of specific IgE to staphylococcal enterotoxins. There is recent evidence that antibiotic treatment may not be as effective as higher doses of intranasal steroids in acute uncomplicated rhinosinusitis, especially in those with allergic disease. The broad inflammatory basis of the pathology of CRS also reveals a cellular infiltrate theoretically suppressed by intranasal corticosteroids. This has been confirmed in recent clinical studies of CRS with or without polyps. A treatment approach based on such studies reported in the European Position Paper on Rhinosinusitis guidelines and a guideline summary are presented. The current review represents the proceedings of a session (3 talks) by the authors at the first Middle East-Asia Allergy, Asthma, Immunology Congress in 2009.
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    The international WAO/EAACI guideline for the management of hereditary angioedema – the 2017 revision and update
    (BioMed Central, 2018-02-27) Maurer, Marcus; Magerl, Markus; Ansotegui, Ignacio; Aygören-Pürsün, Emel; Betschel, Stephen; Bork, Konrad; Bowen, Tom; Boysen, Henrik B; Farkas, Henriette; Grumach, Anete S; Hide, Michihiro; Katelaris, Constance; Lockey, Richard; Longhurst, Hilary; Lumry, William R.; Martinez-Saguer, Inmaculada; Moldovan, Dumitru; Nast, Alexander; Pawankar, Ruby; Potter, Paul; Riedl, Marc; Ritchie, Bruce; Rosenwasser, Lanny; Sánchez-Borges, Mario; Zhi, Yuxiang; Zuraw, Bruce; Craig, Timothy
    Hereditary Angioedema (HAE) is a rare and disabling disease. Early diagnosis and appropriate therapy are essential. This update and revision of the global guideline for HAE provides up-to-date consensus recommendations for the management of HAE. In the development of this update and revision of the guideline, an international expert panel reviewed the existing evidence and developed 20 recommendations that were discussed, finalized and consented during the guideline consensus conference in June 2016 in Vienna. The final version of this update and revision of the guideline incorporates the contributions of a board of expert reviewers and the endorsing societies. The goal of this guideline update and revision is to provide clinicians and their patients with guidance that will assist them in making rational decisions in the management of HAE with deficient C1-inhibitor (type 1) and HAE with dysfunctional C1-inhibitor (type 2). The key clinical questions covered by these recommendations are: 1) How should HAE-1/2 be defined and classified?, 2) How should HAE-1/2 be diagnosed?, 3) Should HAE-1/2 patients receive prophylactic and/or on-demand treatment and what treatment options should be used?, 4) Should HAE-1/2 management be different for special HAE-1/2 patient groups such as pregnant/lactating women or children?, and 5) Should HAE-1/2 management incorporate self-administration of therapies and patient support measures? This article is co-published with permission in Allergy and the World Allergy Organization Journal.
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    Variations in pollen and fungal spore air spora: an analysis of 30 years of monitoring for the clinical assessment of patients in the Western Cape
    (2018) Berman, Dilys Melanie; Potter, Paul; Peter, Jonathan
    Background and aims: Pollen and fungal spore concentrations in the atmosphere of Cape Town have been monitored since 1984 in two areas of Cape Town. Volumetric spore traps were used to monitor the air spora that trigger allergic disease in susceptible individuals. A pollen count was produced for the diagnosis and treatment of patients attending respiratory clinics at the academic hospitals but the findings of the different aerobiological monitoring areas have never been compared. We considered that more than one aerobiological area should be monitored to produce a representative pollen count for the most densely populated areas of Cape Town. Methods: The pollen taxa and fungal spore genera collected from the two aerobiological zones, now named the West Coast and Valkenberg Aerobiomes were defined. Eight of the air spora were selected for detailed comparison. The relative abundance and seasons of Poaceae, or grasses, the tree pollen taxa Cupressaceae, Platanus and Quercus and the fungal spores: Alternaria, Cladosporium, Epicoccum and Pleospora were evaluated and compared in each aerobiome. Differences in the annual distribution and seasonal limits of the air spora in the two aerobiomes were found using statistical techniques. Results: Significant differences were found between the tree pollen loads in the different aerobiomes. Spring pollinating trees were the most prevalent pollen taxa in the Valkenberg Aerobiome with short flowering seasons that spanned six weeks (August-September) for Platanus and Quercus but eight weeks (July-September) for Cupressaceae. The grass season was longer (September- March) in both aerobiomes and grasses flowered earlier at the inland site. Poaceae dominated the annual pollen catch at the coastal aerobiological zone. Parietaria was the only weed taxon with significant concentrations. Pleospora showed a seasonal trend peaking in mid to late winter at the West Coast. No comparable peaks for Pleospora were seen from the Valkenberg sites. Cladosporium concentrations were low and seldom breached the significant threshold of 3,000 spores/m-3 in either of the aerobiomes. The influence of meteorological parameters on Cladosporium and temperature on Poaceae was explored. A table was designed that clarified the ranges for Cladosporium and a formula was adapted for predicting the start of the grass season. Significant decreases in the Poaceae concentrations in both aerobiomes were observed and discussed with reference to Global Warming. Conclusions: The differences in the pollen spectra and seasonality of the selected allergenic air spora indicate that both aerobiomes should be monitored concurrently for patients who live and work in these different microclimates. Pollen profiles for skin, blood and specific IgE testing panels should be reassessed to include Cupressaceae, Parietaria, Myrica, Pleospora and basidiospores. When patients are recruited for clinical drug trials, their place of residence or work should be within the realm of the aerobiome that is being monitored. Current pollen monitoring programmes should be consulted for immunisation regimes to grass and tree pollen. These findings will be applied to the diagnosis and prescription of immunotherapy in clinical practice.