International consensus on (ICON) pediatric asthma

Asthma is the most common chronic lower respiratory disease in childhood throughout the world. Several guidelines and/or consensus documents are available to support medical decisions on pediatric asthma. Although there is no doubt that the use of common systematic approaches for management can considerably improve outcomes, dissemination and implementation of these are still major challenges. Consequently, the International Collaboration in Asthma, Allergy and Immunology (iCAALL), recently formed by the EAACI, AAAAI, ACAAI, and WAO, has decided to propose an International Consensus on (ICON) Pediatric Asthma. The purpose of this document is to highlight the key messages that are common to many of the existing guidelines, while critically reviewing and commenting on any differences, thus providing a concise reference. The principles of pediatric asthma management are generally accepted. Overall, the treatment goal is disease control. To achieve this, patients and their parents should be educated to optimally manage the disease, in collaboration with healthcare professionals. Identification and avoidance of triggers is also of significant importance. Assessment and monitoring should be performed regularly to re-evaluate and fine-tune treatment. Pharmacotherapy is the cornerstone of treatment. The optimal use of medication can, in most cases, help patients control symptoms and reduce the risk for future morbidity. The management of exacerbations is a major consideration, independent of chronic treatment. There is a trend toward considering phenotype-specific treatment choices; however, this goal has not yet been achieved.

Inflammatory responses to mast cell granules

Mast cell degranulation leads to classic allergic reactions appearing within minutes and abating in 30-60 min. It is now appreciated that this is but the first stage of a multisequenced reaction that includes late phase allergic reactions that are apparent within 4-8 h and persisting up to 24 h. These late phase reactions (LPR) are clinically experienced as burning, ill-defined erythema, and edema and are thought to participate in airway and nasal hyperreactivity. A rodent model has been developed that permits analyses of the pathogenesis of LPR: LPR may be elicited by isolated inflammatory factors released from mast cell granules, are complement independent, require an influx of neutrophils for full expression, and may be inhibited by combinations of H-1 and H-2 antihistamines as well as corticosteroids. The appreciation of the late phase of allergic reactions broadens our understanding of the pathologic features of immunologically induced inflammation as well as provides new approaches to the treatment of allergy and asthma.