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Cohn JR. More Tools for the Toolbox: Interpreting Coughing Patients' Clues. J Allergy Clin Immunol Pract 2021; 9:433-434. [PMID: 33429710 DOI: 10.1016/j.jaip.2020.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 10/06/2020] [Indexed: 11/24/2022]
Affiliation(s)
- John R Cohn
- Allergy & Immunology Section, Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Philadelphia, Pa; The Jane and Leonard Korman Respiratory Institute, Thomas Jefferson University, Philadelphia, Pa.
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Decuyper II, Green BJ, Sussman GL, Ebo DG, Silvers WS, Pacheco K, King BS, Cohn JR, Zeiger RS, Zeiger JS, Naimi DR, Beezhold DH, Nayak AP. Occupational Allergies to Cannabis. J Allergy Clin Immunol Pract 2021; 8:3331-3338. [PMID: 33161961 DOI: 10.1016/j.jaip.2020.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 09/02/2020] [Accepted: 09/02/2020] [Indexed: 10/23/2022]
Abstract
Within the last decade there has been a significant expansion in access to cannabis for medicinal and adult nonmedical use in the United States and abroad. This has resulted in a rapidly growing and diverse workforce that is involved with the growth, cultivation, handling, and dispensing of the cannabis plant and its products. The objective of this review was to educate physicians on the complexities associated with the health effects of cannabis exposure, the nature of these exposures, and the future practical challenges of managing these in the context of allergic disease. We will detail the biological hazards related to typical modern cannabis industry operations that may potentially drive allergic sensitization in workers. We will highlight the limitations that have hindered the development of objective diagnostic measures that are essential in separating "true" cannabis allergies from nonspecific reactions/irritations that "mimic" allergy-like symptoms. Finally, we will discuss recent advances in the basic and translational scientific research that will aid the development of diagnostic tools and therapeutic standards to serve optimal management of cannabis allergies across the occupational spectrum.
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Affiliation(s)
- Ine I Decuyper
- Department of Immunology-Allergology-Rheumatology, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium; Infla-Med Centre of Excellence University of Antwerp, Antwerp, Belgium
| | - Brett J Green
- Office of the Director, Health Effects Laboratory Division, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Morgantown, Wv
| | - Gordon L Sussman
- Division of Allergy and Clinical Immunology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Didier G Ebo
- Department of Immunology-Allergology-Rheumatology, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium; Infla-Med Centre of Excellence University of Antwerp, Antwerp, Belgium
| | | | - Karin Pacheco
- Division of Environmental and Occupational Health Sciences, Department of Medicine, National Jewish Health, Denver, Colo
| | - Bradley S King
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Western States Division, Denver, Colo
| | - John R Cohn
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Philadelphia, Pa; Jane & Leonard Korman Respiratory Institute, Thomas Jefferson University, Philadelphia, Pa
| | | | | | | | - Donald H Beezhold
- Office of the Director, Health Effects Laboratory Division, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Morgantown, Wv
| | - Ajay P Nayak
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Philadelphia, Pa; Jane & Leonard Korman Respiratory Institute, Thomas Jefferson University, Philadelphia, Pa; Center for Translational Medicine, Thomas Jefferson University, Philadelphia, Pa.
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Sussman GL, Beezhold DH, Cohn JR, Silvers WS, Zeiger JS, Nayak AP. Cannabis: An Emerging Occupational Allergen? Ann Work Expo Health 2021; 64:679-682. [PMID: 32322894 DOI: 10.1093/annweh/wxaa043] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 03/23/2020] [Accepted: 04/08/2020] [Indexed: 11/13/2022] Open
Abstract
Cannabis is the most commonly used psychoactive drug. In recent years, Cannabis access has expanded for both medicinal and non-medicinal has grown. This is also marked with an increasing number of individuals gaining employment in this emerging industry. In this article, we briefly discuss the health hazards associated with Cannabis exposure with an emphasis on the potential for allergic reactions in workers who handle and process Cannabis plant.
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Affiliation(s)
- Gordon L Sussman
- Division of Clinical Immunology and Allergy, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Donald H Beezhold
- Office of the Director, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA
| | - John R Cohn
- Department of Medicine, Division of Pulmonary Allergy and Critical Care Medicine, Jane and Leonard Korman Respiratory Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - William S Silvers
- Canna Research Group, Boulder, CO, USA.,University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Ajay P Nayak
- Department of Medicine, Center for Translational Medicine and Division of Pulmonary Allergy and Critical Care Medicine, Jane and Leonard Korman Respiratory Institute, Thomas Jefferson University, Philadelphia, PA, USA
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4
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Cohn JR. Cough Frequency and Asthma: What Counts? J Allergy Clin Immunol Pract 2020; 8:662-663. [PMID: 32037112 DOI: 10.1016/j.jaip.2019.10.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 10/28/2019] [Indexed: 10/25/2022]
Affiliation(s)
- John R Cohn
- Allergy & Immunology Section, Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, The Jane and Leonard Korman Respiratory Institute, Thomas Jefferson University, Philadelphia, Pa.
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Ford MK, Cohn JR. Clopidogrel Hypersensitivity: Pathogenesis, Presentation and Diagnosis. Curr Vasc Pharmacol 2020; 17:110-112. [PMID: 30381080 DOI: 10.2174/1570161116666181031143628] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 10/10/2018] [Accepted: 10/15/2018] [Indexed: 11/22/2022]
Abstract
This paper provides an overview of the pathogenesis, presentation and diagnosis of clopidogrel hypersensitivity. The majority of clopidogrel hypersensitivity cases are due to a T cell mediated Gell and Coombs Type IV reaction. History, histology, and patch testing have shown consistency with a T cell mediated mechanism. Clopidogrel reactions most commonly present as a mild delayed maculopapular erythematous rash 5 to 10 days after introduction of the drug, and do not always require discontinuation of the drug. Severe cutaneous, systemic, and immediate adverse reactions to clopidogrel are rare. For the diagnosis of clopidogrel hypersensitivity, drug causality can be determined using patch testing, or for mild reactions, recurrence of symptoms after drug reintroduction, although neither are required for diagnosis.
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Affiliation(s)
- Megan K Ford
- Jane and Leonard Korman Respiratory Institute, Division of Pulmonary, Allergy & Critical Care Medicine, Allergy & Immunology Section, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA 19107, United States
| | - John R Cohn
- Jane and Leonard Korman Respiratory Institute, Division of Pulmonary, Allergy & Critical Care Medicine, Allergy & Immunology Section, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA 19107, United States
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Cohn JR, Ford MK, Fung SM. Asthma Outcomes and Quality Metrics: Improving Health or Teaching to the Test? J Allergy Clin Immunol Pract 2020; 7:1330-1331. [PMID: 30961843 DOI: 10.1016/j.jaip.2018.12.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 12/10/2018] [Indexed: 11/26/2022]
Affiliation(s)
- John R Cohn
- Allergy and Immunology Section, Division of Pulmonary, Allergy and Critical Care Medicine, The Jane and Leonard Korman Respiratory Institute, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pa.
| | - Megan K Ford
- Allergy and Immunology Section, Division of Pulmonary, Allergy and Critical Care Medicine, The Jane and Leonard Korman Respiratory Institute, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pa
| | - Shirley M Fung
- Allergy and Immunology Section, Division of Pulmonary, Allergy and Critical Care Medicine, The Jane and Leonard Korman Respiratory Institute, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pa
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Cohn JR. Management of anaphylaxis and allergies in patients with long QT syndrome. Ann Allergy Asthma Immunol 2019; 122:434. [PMID: 30954128 DOI: 10.1016/j.anai.2019.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 01/23/2019] [Indexed: 11/29/2022]
Affiliation(s)
- John R Cohn
- Allergy and Immunology Section, Division of Pulmonary, Allergy and Critical Care Medicine, The Jane and Leonard Korman Respiratory Institute, Sidney Kimmel Medical College at Thomas Jefferson University Jefferson Asthma Allergy & Immunology, Philadelphia, Pennsylvania.
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Poole JA, Barnes CS, Demain JG, Bernstein JA, Padukudru MA, Sheehan WJ, Fogelbach GG, Wedner J, Codina R, Levetin E, Cohn JR, Kagen S, Portnoy JM, Nel AE. Impact of weather and climate change with indoor and outdoor air quality in asthma: A Work Group Report of the AAAAI Environmental Exposure and Respiratory Health Committee. J Allergy Clin Immunol 2019; 143:1702-1710. [PMID: 30826366 PMCID: PMC10907958 DOI: 10.1016/j.jaci.2019.02.018] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 02/08/2019] [Accepted: 02/20/2019] [Indexed: 12/14/2022]
Abstract
Weather and climate change are constant and ever-changing processes that affect allergy and asthma. The purpose of this report is to provide information since the last climate change review with a focus on asthmatic disease. PubMed and Internet searches for topics included climate and weather change, air pollution, particulates, greenhouse gasses, traffic, insect habitat, and mitigation in addition to references contributed by the individual authors. Changes in patterns of outdoor aeroallergens caused by increasing temperatures and amounts of carbon dioxide in the atmosphere are major factors linked to increased duration of pollen seasons, increased pollen production, and possibly increased allergenicity of pollen. Indoor air pollution threats anticipated from climate changes include microbial and mold growth secondary to flooding, resulting in displacement of persons and need for respiratory protection of exposed workers. Air pollution from indoor burning of mosquito repellants is a potential anticipatory result of an increase in habitat regions. Air pollution from fossil fuel burning and traffic-related emissions can alter respiratory defense mechanisms and work synergistically with specific allergens to enhance immunogenicity to worsen asthma in susceptible subjects. Community efforts can significantly reduce air pollution, thereby reducing greenhouse gas emission and improving air quality. The allergist's approach to weather pattern changes should be integrated and anticipatory to protect at-risk patients.
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Affiliation(s)
- Jill A Poole
- Pulmonary, Critical Care, Sleep & Allergy Division, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Neb.
| | - Charles S Barnes
- Division of Allergy, Asthma and Immunology, Children's Mercy Hospital, University of Missouri-Kansas City School of Medicine, Kansas City, Mo
| | - Jeffrey G Demain
- Allergy Asthma & Immunology Center of Alaska, the Department of Pediatrics, University of Washington, and the WWAMI School of Medical Education, University of Alaska, Anchorage, Alaska
| | - Jonathan A Bernstein
- Division of Immunology, Allergy Section, Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Mahesh A Padukudru
- Department of Respiratory Medicine, JSS Medical College, JSSAHER, Mysore, India
| | - William J Sheehan
- Division of Allergy, Children's National Medicine Center, Department of Pediatrics, George Washington School of Medicine and Health Sciences, Washington, DC
| | | | - James Wedner
- Division of Allergy & Immunology, John T. Milliken Department of Internal Medicine, Washington University, St Louis, Mo
| | - Rosa Codina
- Allergen Science & Consulting, Lenoir, NC; Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, Fla
| | - Estelle Levetin
- Department of Biological Science, University of Tulsa, Tulsa, Okla
| | - John R Cohn
- Korman Respiratory Institute, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pa
| | - Steve Kagen
- Division of Allergy & Clinical Immunology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wis
| | - Jay M Portnoy
- Division of Allergy, Asthma, & Immunology, Children's Mercy Hospital, University of Missouri-Kansas City, Kansas City, Mo
| | - Andre E Nel
- University of California Los Angeles, David Geffen School of Medicine and California NanoSystems Institute, Los Angeles, Calif
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Lim C, Cohn JR, Cohn JA. Can a diagnosis of bladder cancer motivate positive lifestyle changes-and prevent recurrent disease? Transl Androl Urol 2018; 7:S242-S245. [PMID: 29928624 PMCID: PMC5989117 DOI: 10.21037/tau.2018.04.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Affiliation(s)
- Caitlin Lim
- Department of Urology, Einstein Healthcare Network, Philadelphia, PA, USA
| | - John R Cohn
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Korman Respiratory Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Joshua A Cohn
- Department of Urology, Einstein Healthcare Network, Philadelphia, PA, USA.,Department of Surgical Oncology, Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
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Ford MK, Grillo JA, Cohn JR. Safety of graded challenge in allergic patients. J Allergy Clin Immunol Pract 2015; 3:826. [PMID: 26122429 DOI: 10.1016/j.jaip.2015.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Accepted: 05/12/2015] [Indexed: 06/04/2023]
Affiliation(s)
- Megan K Ford
- Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, Pa.
| | - Joseph A Grillo
- Division of Allergy and Immunology, Department of Pediatrics, Thomas Jefferson University Hospital, Philadelphia, Pa
| | - John R Cohn
- Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, Pa
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Cohn JR. Elevation of the Head of Bed to Treat Supraesophageal Reflux: Controlling the Trigger and Reducing the “Drip”. The Journal of Allergy and Clinical Immunology: In Practice 2015; 3:362-4. [DOI: 10.1016/j.jaip.2015.03.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 03/16/2015] [Accepted: 03/18/2015] [Indexed: 01/01/2023]
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12
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Barne C, Alexis NE, Bernstein JA, Cohn JR, Demain JG, Horner E, Levetin E, Nei A, Phipatanakul W. Climate change and our environment: the effect on respiratory and allergic disease. J Allergy Clin Immunol Pract 2014; 1:137-41. [PMID: 23687635 DOI: 10.1016/j.jaip.2012.07.002] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Climate change is a constant and ongoing process. It is postulated that human activities have reached a point at which we are producing global climate change. It provides suggestions to help the allergist/environmental physician integrate recommendations about improvements in outdoor and indoor air quality and the likely response to predicted alterations in the earth's environment into his or her patient's treatment plan. It incorporates references retrieved from Pub Med searches for topics, including:climate change, global warming, global climate change, greenhouse gasses, air pollution, particulates, black carbon, soot and sea level, as well as references contributed by the individual authors. Many changes that affect respiratory disease are anticipated.Examples of responses to climate change include energy reduction retrofits in homes that could potentially affect exposure to allergens and irritants, more hot sunny days that increase ozone-related difficulties, and rises in sea level or altered rainfall patterns that increase exposure to damp indoor environments.Climate changes can also affect ecosystems, manifested as the appearance of stinging and biting arthropods in new areas.Higher ambient carbon dioxide concentrations, warmer temperatures, and changes in floristic zones could potentially increase exposure to ragweed and other outdoor allergens,whereas green practices such as composting can increase allergen and irritant exposure. Finally, increased energy costs may resultin urban crowding and human source pollution, leading to changes in patterns of infectious respiratory illnesses. Improved governmental controls on airborne pollutants could lead to cleaner air and reduced respiratory diseases but will meet strong opposition because of their effect on business productivity. The allergy community must therefore adapt, as physician and research scientists always have, by anticipating the needs of patients and by adopting practices and research methods to meet changing environmental conditions.
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Campbell KL, Cohn JR, Savage MP. Clopidogrel hypersensitivity: clinical challenges and options for management. Expert Rev Clin Pharmacol 2014; 3:553-61. [DOI: 10.1586/ecp.10.30] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Pillay K, Fung SS, Cohn JR. The allergist and the intensivist: not such odd bedfellows. Ann Allergy Asthma Immunol 2013; 112:94-6. [PMID: 24468246 DOI: 10.1016/j.anai.2013.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 12/02/2013] [Accepted: 12/03/2013] [Indexed: 11/26/2022]
Affiliation(s)
- Kamana Pillay
- Division of Pulmonary Medicine, Allergy and Critical Care, Department of Medicine, Thomas Jefferson University, and Asthma Allergy & Pulmonary Associates, Philadelphia, Pennsylvania
| | - Shirley S Fung
- Division of Pulmonary Medicine, Allergy and Critical Care, Department of Medicine, Thomas Jefferson University, and Asthma Allergy & Pulmonary Associates, Philadelphia, Pennsylvania
| | - John R Cohn
- Division of Pulmonary Medicine, Allergy and Critical Care, Department of Medicine, Thomas Jefferson University, and Asthma Allergy & Pulmonary Associates, Philadelphia, Pennsylvania.
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Patel NS, Fung SM, Zanichelli A, Cicardi M, Cohn JR. Ecallantide for treatment of acute attacks of acquired C1 esterase inhibitor deficiency. Allergy Asthma Proc 2013; 34:72-7. [PMID: 23406939 DOI: 10.2500/aap.2013.34.3620] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Acquired C1 inhibitor (C1-INH) deficiency exposes patients to angioedema recurrences (acquired angioedema [AAE]) mediated by bradykinin pathway activation. C1-INH replacement and specific inhibition of plasma kallikrein with ecallantide have been successful in the treatment of hereditary angioedema (HAE), a more common related disorder. C1-INH replacement has also been used in the treatment of AAE, but because of the underlying mechanism of rapid catabolism, some patients may not respond. As part of preclinical investigation of ecallantide, a potent bradykinin pathway inhibitor, we evaluated three AAE patients treated successfully with that agent. This study was designed to assess ecallantide for treatment of attacks in AAE. Three patients with AAE were treated a total of 12 times with various dosing regimens of ecallantide based on the protocols established for the studies using ecallantide in HAE (Evaluation of DX-88's Effects in Mitigating Angioedema trials). Response to therapy was also based on outcome measures determined by these protocols. Ecallantide effectively relieved symptoms in three patients with various manifestations of AAE over 12 acute episodes. Kallikrein inhibition with ecallantide appears effective in the treatment of AAE and may be an alternative for patients with resistance to C1-INH replacement therapy.
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Affiliation(s)
- Nisha S. Patel
- Division of Allergy & Immunology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Cohn JR. Human Conflict: Beware Politicized Science. Science 2012; 337:290. [DOI: 10.1126/science.337.6092.290-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- John R. Cohn
- Department of Medicine and Pediatrics, Thomas Jefferson University and Hospitals, Philadelphia, PA 19107, USA
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Policha A, Hu C, Holmes P, Cohn JR, Martin ND. Acute perforated appendicitis secondary to sarcoidosis. Am Surg 2012; 78:616-619. [PMID: 22546139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Aleksandra Policha
- Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA
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Baghdanian A, Cohn JR, Mitchell DG, Adamo RD, Brown DB. Cardiac-gated bright blood MR imaging to determine retrieval feasibility of a chronic foreign body. J Vasc Interv Radiol 2012; 23:151-2. [PMID: 22221482 DOI: 10.1016/j.jvir.2011.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Revised: 09/06/2011] [Accepted: 09/09/2011] [Indexed: 10/14/2022] Open
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Abstract
Intradermal skin testing (IDST) is performed by most allergists, but its value remains controversial. In most previous studies assessing the value of IDST, a positive result was based on a 5- to 6-mm wheal and erythema. While a subject's immediate reaction upon allergen exposure is a common endpoint to determine "allergy," additional known allergic phenomena such as the delayed or late-phase response to allergen exposure suggest that correlation only with current history or acute challenge may result in an incorrect labeling of false-positive results when, in fact, there is a physiologic response to exposure, albeit a reaction not immediately evident. We conducted a retrospective study to determine if positive IDST reactions represent nonspecific irritation or if they correlate with atopy. We retrospectively reviewed the records of 100 patients who had undergone skin prick testing (SPT) and IDST and compiled data on their age, sex, diagnosis, and number of skin and intradermal reactions. Results were analyzed according to a general linear model to see if the development of a positive IDST result correlated with atopy (defined as SPT positivity). We found statistically significant differences between SPT-positive and -negative patients with regard to diagnoses of asthma, rhinitis, or both (p=0.008). Controlling for asthma and rhinitis, we also found a significant association between atopy and a positive IDST result; among atopic (SPT+) patients, a mean of 25.9% of IDST results were positive, compared with a rate of only 6.7% IDST positivity among the nonatopic (SPT-) patients (p<0.0001). We conclude that IDST is more commonly positive in atopic (SPT+) than nonatopic (SPT-) patients, suggesting that a positive IDST represents genuine atopy and bona fide sensitization rather than nonspecific irritation.
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Affiliation(s)
- John R Cohn
- Department of Medicine, Jefferson Medical College, Thomas Jefferson University, 1015 Chestnut St., Suite 1300, Philadelphia, PA 19107, USA.
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Campbell KL, Cohn JR, Fischman DL, Walinsky P, Mallya R, Jaffrani W, Savage MP. Management of clopidogrel hypersensitivity without drug interruption. Am J Cardiol 2011; 107:812-6. [PMID: 21247516 DOI: 10.1016/j.amjcard.2010.11.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2010] [Revised: 11/03/2010] [Accepted: 11/03/2010] [Indexed: 11/27/2022]
Abstract
Clopidogrel hypersensitivity affects up to 6% of treated patients, often leading to discontinuation of the drug. Conventional desensitization protocols incorporate a washout period off medication that may be problematic after percutaneous coronary intervention because premature discontinuation of dual antiplatelet therapy is a major risk factor for stent thrombosis. The purpose of this study was to evaluate a strategy for treating clopidogrel hypersensitivity without drug interruption using corticosteroids and antihistamines to facilitate development of physiologic tolerance. The study population consisted of 25 consecutive patients who developed clopidogrel hypersensitivity after percutaneous coronary intervention and were managed with suppressive therapy using corticosteroids and antihistamines. Treatment success (resolution of hypersensitivity symptoms without interrupting clopidogrel) was assessed, in addition to duration of clopidogrel therapy and adverse cardiac events during late follow-up (mean 670 ± 630 days). The cohort included 19 men and 6 women with a mean age of 62 ± 9 years. Drug-eluting stents were used in 16 patients (64%). Clopidogrel hypersensitivity occurred 6 ± 2 days after drug initiation. Treatment included corticosteroids (5 patients), antihistamines (5 patients), or corticosteroids and antihistamines (15 patients). Patients treated with corticosteroids received tapering courses for a mean of 10 ± 8 days. Treatment was successful with sustained symptom resolution in 22 of 25 patients (88%). Clopidogrel therapy was continued in successfully desensitized patients for 417 ± 369 days and in patients with drug-eluting stents for 529 ± 376 days. There were no deaths, myocardial infarctions, or stent thrombosis during extended follow-up. In conclusion, clopidogrel hypersensitivity can be successfully treated using short-course corticosteroids and antihistamines without interrupting drug therapy. This technique enables long-term continuation of clopidogrel and confers a low risk of adverse cardiac events.
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Cohn JR. Alphabet soup: ABAI, ABMS, and MOC vs EBM, VBM, and IRB. Ann Allergy Asthma Immunol 2011; 106:79-80. [PMID: 21277507 DOI: 10.1016/j.anai.2010.12.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Accepted: 12/11/2010] [Indexed: 11/27/2022]
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Williams AA, Fung SM, Cohn JR. The risk of long-acting beta-agonists revisited. Am J Med 2011; 124:e11; author reply e13. [PMID: 21396493 DOI: 10.1016/j.amjmed.2010.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2010] [Revised: 10/01/2010] [Accepted: 10/01/2010] [Indexed: 11/25/2022]
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Cohn JR, Albert SM, Appelbaum PS, Zoloth L. The Lancet-Palestinian Health Alliance. Lancet 2010; 376:771-2. [PMID: 20816542 DOI: 10.1016/s0140-6736(10)61377-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Cohn JR. Intimate-partner violence in Gaza and the West Bank. Lancet 2010; 375:1251-2; author reply 1252-3. [PMID: 20382319 DOI: 10.1016/s0140-6736(10)60536-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Cohn JR. Aspirin challenge and desensitization for aspirin-exacerbated respiratory disease: a practice paper. Ann Allergy Asthma Immunol 2007; 99:196; author reply 196-7. [PMID: 17718110 DOI: 10.1016/s1081-1206(10)60646-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Wallace DV, Bahna SL, Goldstein S, Hamilton RG, Cohn JR. American Academy of Allergy, Asthma & Immunology Work Group Report: allergy diagnosis in clinical practice. J Allergy Clin Immunol 2007; 120:967-9. [PMID: 17637470 DOI: 10.1016/j.jaci.2007.05.049] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2007] [Revised: 05/16/2007] [Accepted: 05/21/2007] [Indexed: 10/23/2022]
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Abstract
OBJECTIVES To investigate the duration of effective inhalant subcutaneous immunotherapy (SCIT) reported in the published literature and to determine if any specific biomarkers or clinical predictors exist that may identify patients who will remain in long-term remission after discontinuing treatment. DATA SOURCES Articles were selected from a search of the PubMed database from 1976 to 2006 using the search terms immunotherapy and allergen immunotherapy in combination with venom, allergic rhinitis, asthma, mechanism, efficacy, and duration, as well as articles known to the authors and referenced in review articles. STUDY SELECTION Articles were selected if evaluation of efficacy of the primary allergic disease treated after discontinuation of SCIT was stated as one of the objectives of the study. RESULTS The rate of relapse after discontinuing SCIT ranges from 0% to 55% of patients in the studies reviewed in this article. The length of the specific allergen immunotherapy and allergen type (ie, perennial vs seasonal) may be variables that affect the duration of clinical remission after cessation of SCIT. One study found the duration of SCIT efficacy after discontinuation depended on duration of treatment and correlated with decrease in skin test reactivity. CONCLUSION Until specific tests or clinical markers are identified that will clearly distinguish between patients who will relapse from those who will remain in long-term clinical remission after discontinuing effective allergen immunotherapy, the decision to continue or stop immunotherapy must be individualized.
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Affiliation(s)
- Linda Cox
- Allergy and Asthma Center, Ft Lauderdale, Florida 33334, USA.
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Cohn JA, Skorpinski E, Cohn JR. Prevention of pneumococcal infection in a patient with normal immunoglobulin levels but impaired polysaccharide antibody production. Ann Allergy Asthma Immunol 2007; 97:603-5. [PMID: 17165266 DOI: 10.1016/s1081-1206(10)61087-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Patients with normal immunoglobulin levels may have an impaired response to immunization with pneumococcal vaccine and increased susceptibility to infection with encapsulated organisms. In children, but not adults, immunoglobulin replacement has been shown to be effective in reducing the infection rate. OBJECTIVE To reduce the incidence of infection in an adult with impaired response to pneumococcal vaccine but normal serum IgG levels. METHODS Intravenous IgG, 350 mg/kg, was given every 4 weeks. RESULTS The patient, who was hospitalized 3 times in 3 years with respiratory tract infections and who had documented infection with Streptococcus pneumoniae and Haemophilus influenzae, did not require antibiotic therapy for more than 15 months while undergoing intravenous immunoglobulin replacement therapy. CONCLUSION Adults with impaired response to vaccination with polyvalent pneumococcal vaccine and normal IgG levels may benefit from replacement therapy.
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Affiliation(s)
- Joshua A Cohn
- University of Michigan Medical School, Ann Arbor, Michigan, USA.
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Kung SJ, Choudhary C, McGeady SJ, Cohn JR. Lack of cross-reactivity between 5-aminosalicylic acid-based drugs: a case report and review of the literature. Ann Allergy Asthma Immunol 2006; 97:284-7. [PMID: 17042131 DOI: 10.1016/s1081-1206(10)60790-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND 5-Aminosalicylic acid (5-ASA)-containing drugs are the mainstay of therapy in inflammatory bowel disease, but adverse reactions to these medications are relatively common. Because there may be a lack of cross-reactivity among the various 5-ASA formulations, treatment with alternative preparations is sometimes possible even after an apparent allergic reaction to a 5-ASA product. OBJECTIVE To describe a patient with a possible allergy to 2 different 5-ASA drugs who tolerated a third. METHODS A 27-year-old man with Crohn disease developed a rash while taking mesalamine (Pentasa and Asacol). Treatment with 5-ASA products was discontinued, and 6-mercaptopurine and prednisone were prescribed. He then experienced multiorgan failure secondary to herpes simplex infection, which required discontinuation of the immunosuppressive therapy. After recovery from the acute infection, he underwent successful graded challenge with balsalazide. RESULTS The patient continued treatment with balsalazide for 9 months, with good control of his inflammatory bowel disease and no adverse effects. CONCLUSIONS Adverse reactions to 1 or more 5-ASA medications do not necessarily preclude the use of others in the same class. A treatment algorithm for patients with adverse reactions to 5-ASA is outlined based on the case report and review of the literature.
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Affiliation(s)
- Shiang-Ju Kung
- Division of Allergy and Immunology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Cohn JR. Academic boycott would damage chances for peace. Nature 2005; 435:736. [PMID: 15944674 DOI: 10.1038/435736c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Cohn JR, Sataloff RT, Branton C. Response of asthma-related voice dysfunction to allergen immunotherapy: a case report of confirmation by methacholine challenge. J Voice 2001; 15:558-60. [PMID: 11792032 DOI: 10.1016/s0892-1997(01)00056-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Professional singers and other serious voice users are particularly susceptible to alterations in their vocal apparatus. As the support for vocalization, lung function is an essential element of the production of speech and song. Patients have been described who presented with voice complaints along with minimal or no abnormalities on spirometry, but responded to conventional bronchodilator and other asthma therapy. It was proposed that this represented an exercise-induced asthmalike condition, brought on by the hyperventilation associated with performing. The objective of this study was to establish whether improvement in vocalization while performing correlated with a decrease in non-specific bronchial reactivity. We concluded that resolution of vocal complaints in conjunction with a decrease in methacholine reactivity supports the hypothesis that these patients do have an exercise-induced asthmalike condition brought on by airway drying. As with other patients with asthma, it appears to respond to allergy-directed therapy.
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Affiliation(s)
- J R Cohn
- Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA.
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Cohn JR, Uhm T, Ramu S, Nam YW, Kim DJ, Penmetsa RV, Wood TC, Denny RL, Young ND, Cook DR, Stacey G. Differential regulation of a family of apyrase genes from Medicago truncatula. Plant Physiol 2001; 125:2104-19. [PMID: 11299390 PMCID: PMC88866 DOI: 10.1104/pp.125.4.2104] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2000] [Accepted: 12/04/2000] [Indexed: 05/18/2023]
Abstract
Four putative apyrase genes were identified from the model legume Medicago truncatula. Two of the genes identified from M. truncatula (Mtapy1 and Mtapy4) are expressed in roots and are inducible within 3 h after inoculation with Sinorhizobium meliloti. The level of mRNA expression of the other two putative apyrases, Mtapy2 and Mtapy3, was unaffected by rhizobial inoculation. Screening of a bacterial artificial chromosome library of M. truncatula genomic DNA showed that Mtapy1, Mtapy3, and Mtapy4 are present on a single bacterial artificial chromosome clone. This apyrase cluster was mapped to linkage group seven. A syntenic region on soybean linkage group J was found to contain at least two apyrase genes. Screening of nodulation deficient mutants of M. truncatula revealed that two such mutants do not express apyrases to any detectable level. The data suggest a role for apyrases early in the nodulation response before the involvement of root cortical cell division leading to the nodule structure.
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Affiliation(s)
- J R Cohn
- Center for Legume Research, Department of Microbiology, University of Tennessee, Knoxville, Tennessee 37996, USA
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Abstract
An accurate diagnosis of pulmonary embolism is essential to prevent excessive morbidity and mortality from either inappropriate therapy or failure to institute anticoagulation. The diagnosis of pulmonary embolism in tetraplegic spinal cord injury patients is complicated by frequent inability to perform the ventilation portion of the ventilation-perfusion scintiscan (V/Q scan) and by controversy regarding classification of defects on perfusion-only scans, as well as by coexisting pulmonary disease, systemic illness, related injuries, and the tendency for tetraplegic patients to have unexplained fever. This report describes three tetraplegic ventilator-dependent patients with hypoxic respiratory failure and normal chest radiographs who had large defects on perfusion-only lung scans. Ventilation scintiscans were not performed because the patients were ventilator-dependent with tracheostomies. Pulmonary angiography findings were normal in all patients, and all three responded to aggressive pulmonary toilet. Even large defects on perfusion-only scans despite normal chest radiographs should not be used to establish a diagnosis of pulmonary embolism in tetraplegic patients, and further diagnostic imaging is warranted.
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Affiliation(s)
- D J More O'Ferrall
- Department of Physical Medicine and Rehabilitation, Thomas Jefferson University Hospital, Philadelphia, PA, USA
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Abstract
As the power source for vocalization, the lower respiratory tract plays a key role in voice production. This is particularly true with sustained singing, where continued high ventilatory demands are present. Changes in pulmonary function that are insignificant with normal speech have been shown to lead to performance impairment. The purpose of this study was to examine and characterize this problem in a large group of singers. Systematic evaluation of a defined population, along with inhalational and singing challenge, was the design. The demographic characteristics, history, pulmonary function, and response to treatment were evaluated in 20 professional or serious amateur singers with voice problems, who did not have causal laryngeal pathology, whose history and evaluation suggested increased airway reactivity, and who responded to anti-asthma therapy. An additional patient was challenged by the exercise of singing in the office, with pulmonary function measurements before and after. This group of serious singers demonstrated vocalization complaints referable to bronchodilator responsive airway obstruction. They responded to treatment for asthma, with improvement in their performance-related difficulties. An additional subject demonstrated a small decline in expiratory flow rates with only 20 minutes of singing in the office. This was readily reversed by an inhaled bronchodilator. Singers who present with complaints of impaired vocalization, such as vocal fatigue, decreased control, and excessive muscular tension, should be evaluated for increased airway reactivity as a possible cause of their complaints.
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Affiliation(s)
- J R Cohn
- Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Minami E, Kouchi H, Carlson RW, Cohn JR, Kolli VK, Day RB, Ogawa T, Stacey G. Cooperative action of lipo-chitin nodulation signals on the induction of the early nodulin, ENOD2, in soybean roots. Mol Plant Microbe Interact 1996; 9:574-83. [PMID: 8810072 DOI: 10.1094/mpmi-9-0574] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Various lipo-chitin molecules were tested for their ability to induce the expression of the early nodulin, ENOD2, in Glycine soja roots. When inoculated separately onto G. soja roots, LCO-V (C18:1 delta 11,Mefuc), LCO-V (C18:1 delta 9,Mefuc), LCO-V (C16:0,Mefuc), and LCO-IV (C16:0) were unable to induce ENOD2 expression, even though these compounds had previously been shown to induce root hair curling, the formation of nodule-like primordia, and induction of the early nodulin, ENOD40. ENOD2 expression, however, was induced when any two of these molecules were inoculated in combination. Thus, the lipo-chitin nodulation signals appear to act cooperatively to induce ENOD2 expression. B. japonicum strains USDA110 and USDA135 and B. elkanii strain USDA61, all symbionts of soybean, were found to produce at least two distinct nod signals ([i.e., NodBj-V[C18:1,Mefuc] and NodBj-V[C16:0,Mefuc]). These two compounds were mixed in various ratios and tested for their ability to induce ENOD2 expression. The results indicate that the former compound must be present in equivalent or excess amount in order to obtain maximum ENOD2 expression. Additional nonspecific LCOs (e.g., LCO-IV[C16:2 delta 2,9; SO3]), incapable of inducing root hair curling or cortical cell division, were tested in combination with the four active LCOs listed above. It was found that any combination of one active LCO with a nonspecific LCO was sufficient to induce ENOD2 mRNA expression. The ENOD2 mRNA expression pattern detected by in situ hybridization closely resembled that found in bacterial-induced nodules with expression detected in cortical cells between primary and secondary meristems and around the vascular strands. These data demonstrate that the cooperative action of at least two LCO nodulation signals leads to a greater progression of nodule ontogeny as demonstrated by the expression of ENOD2, a marker gene for the differentiation of nodule parenchyma.
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Affiliation(s)
- E Minami
- Dept. of Microbiology, University of Tennessee, Knoxville 37996-0845, USA
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Minami E, Kouchi H, Cohn JR, Ogawa T, Stacey G. Expression of the early nodulin, ENOD40, in soybean roots in response to various lipo-chitin signal molecules. Plant J 1996; 10:23-32. [PMID: 8758977 DOI: 10.1046/j.1365-313x.1996.10010023.x] [Citation(s) in RCA: 77] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The lipo-chitin (LCO) nodulation signal (nod signal) purified from Bradyrhizobium japonicum induced nodule primordia on soybean (i.e. Glycine soja) roots. These primordia were characterized by a bifurcated vascular connection, cortical cell division, and the accumulation of mRNA of the early nodulin gene, ENOD40. A chemically synthesized LCO identical in structure to the Nod signal purified from B. japonicum cultures showed the same activity when inoculated on to soybean roots. Surprisingly, synthetic LCO or chitin pentamer, inactive in inducing root hair curling (HAD) or cortical cell division (NOI) in G. soja, induced the transient accumulation of ENOD40 mRNA. In roots inoculated with such LCO, ENOD40 mRNA was abundant at 40 h after inoculation but decreased to the background levels 6 days after inoculation. In contrast, nod signals active in inducing HAD and NOI induced high levels of ENOD40 accumulation at 40 h and 6 days after inoculation. In situ hybridization analysis showed that ENOD40 mRNA accumulated in the pericycle of the vascular bundle at 24 h after root inoculation with nod signal. At 6 days post-inoculation with nod signal, ENOD40 expression was seen in dividing subepidermal cortical cells. These results provide morphological and molecular evidence that nodule induction in soybean in response to purified or synthetic nod signal is similar, if not identical, to nodule formation induced by bacterial inoculation. Surprisingly, ENOD40 mRNA accumulation occurs in response to non-specific chitin signals. This suggests that, in the case of ENOD40, nodulation specificity is not determined at the level of initial gene expression.
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Affiliation(s)
- E Minami
- Department of Microbiology, University of Tennessee, Knoxville 37996-0845, USA
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40
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Abstract
Respiratory and glottal efficiency measures were collected from a pool of 40 classically trained singers with normal larynges. All singers had > or = 3 years of formal classical voice training and were active professional solo classical singers. Mean flow rates were obtained from all subjects to assess glottal efficiency. Additionally, maximum phonation times and phonation quotients were obtained from a subset of the singers. Pulmonary function test data on forced expiratory volume, forced vital capacity, and forced expiratory flow were obtained for all subjects. Results were compared with published normal values, not specifically derived from trained singers, used commonly in voice laboratories. Differences were found, suggesting the need for separate normative data to be used for evaluation of the vocal athlete.
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Affiliation(s)
- L M Carroll
- Department of Speech and Language Pathology, Teachers College, Columbia University, New York, New York, USA
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Steiner RM, Liu JB, Goldberg BB, Cohn JR. The value of ultrasound-guided fiberoptic bronchoscopy. Clin Chest Med 1995; 16:519-34. [PMID: 8521706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Flexible fiberoptic bronchoscopy is the procedure of choice for the diagnosis of endobronchial neoplasm. Because of technical limitations of fiberoptic bronchoscopy, the use of ultrasound assistance was initiated and evaluated. This article reviews the technique, study design, and clinical results of ultrasound-assisted fiberoptic bronchoscopy.
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Affiliation(s)
- R M Steiner
- Department of Radiology, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Cohn JR, Spiegel JR, Sataloff RT. Vocal disorders and the professional voice user: the allergist's role. Ann Allergy Asthma Immunol 1995; 74:363-73; quiz 373-6. [PMID: 7749966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND As the modulating and power source for the voice, the upper and lower respiratory tracts play a key role in management of voice production. Allergic respiratory disease can impair vocalization, which can be a particular problem in the professional voice user. OBJECTIVE The goal of this review is to facilitate the evaluation and management of professional voice users who have allergic respiratory problems contributing to their vocal dysfunction. This article discusses the anatomy and physiology of voice production, laryngeal pathology, and special diagnostic and therapeutic considerations relative to the allergist's role in treatment of these patients. METHODS Mechanisms of voice production are reviewed, as well as common laryngeal pathology effecting voice production. Allergic respiratory diseases are summarized, with particular attention to those aspects of management that are altered in professional voice users. RESULTS Professional voice users require modification in their management to optimize vocal function and minimize abnormalities of the vocal tract. This includes avoidance of medications that produce drying of the airway, as well as avoidance of inhaled corticosteroids. Subtle changes in respiratory function, which may be of no consequence to other individuals, may adversely affect performance ability, and need aggressive management. Allergen immunotherapy, because of its lack of adverse effects on the vocal apparatus, is particularly well suited for treatment of professional voice users. CONCLUSIONS Allergists have an important role to play in management of the professional voice user. With careful attention to the unique requirements of these highly trained individuals, the allergist can enhance their performance ability while minimizing side effects from treatment.
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Affiliation(s)
- J R Cohn
- Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Affiliation(s)
- J R Cohn
- Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA
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Cohn JR, Caliguiri LA, Gallagher PE, Schenkel EJ. Commentary: prevention and cost of asthma--a model for cost effective health care. Allergy Proc 1994; 15:39-41. [PMID: 8005455 DOI: 10.2500/108854194778816616] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Goldberg BB, Steiner RM, Liu JB, Merton DA, Articolo G, Cohn JR, Gottlieb J, McComb BL, Spirn PW. US-assisted bronchoscopy with use of miniature transducer-containing catheters. Radiology 1994; 190:233-7. [PMID: 8259411 DOI: 10.1148/radiology.190.1.8259411] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
PURPOSE To demonstrate the value of ultrasound (US) guidance during flexible bronchoscopic procedures in a series of patients with known or suspected pulmonary neoplasms. MATERIALS AND METHODS US-guided bronchoscopy was carried out as an adjunct to conventional bronchoscopy for the diagnosis of mediastinal, hilar, or parenchymal neoplasms in 25 patients with masses previously detected with chest radiography or computed tomography. Miniature transducer-containing catheters were inserted through the biopsy port of the flexible bronchoscope, and cross-sectional real-time US scans of tumors, lymph nodes, and blood vessels were obtained. RESULTS Among six cases of peripheral masses and 19 cases of central masses, additional information was provided in 18 cases (72%). This information was used to choose the optimal site for transmural biopsy. CONCLUSION These preliminary results suggest that this US procedure may become an important diagnostic tool during bronchoscopy, due to the ability to identify structures beyond the lumen of the tracheobronchial tree.
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Affiliation(s)
- B B Goldberg
- Department of Radiology, Thomas Jefferson University Hospital and Jefferson Medical School, Philadelphia, PA 19107
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Cohn JR, Cohn JB, Fellin F, Cantor R. Systemic anaphylaxis from low dose methotrexate. Ann Allergy 1993; 70:384-5. [PMID: 8498728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- J R Cohn
- Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
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Abstract
BACKGROUND Allergen immunotherapy (AIM) has been demonstrated to be safe and effective in the treatment of allergic respiratory disease. Although it requires considerable patient commitment, little attention has been paid to the factors that contribute to patient compliance. METHODS Patients in a practice based at an urban university hospital, who discontinued AIM, were contacted to determine their reasons for stopping treatment. Results were correlated with demographic and disease data obtained from the patient charts. RESULTS Review of practice records identified 217 patients on AIM. One hundred forty-eight had allergic rhinitis, (R), 66 had allergic rhinitis and asthma (RA), and 3 had allergic asthma without evidence of rhinitis (A). Seventy-four (50%) of the patients in the R group, 32 (48%) of the patients in the RA group, and three (100%) of those in the A group discontinued treatment. The groups differed in that 55% of the patients in the R group discontinued treatment because of inconvenience, compared with only 22% of the patients in the RA group (p < 0.01). By contrast, 25% of the patients in the RA group stopped because they thought that they were "better" with medication, compared with none of the patients in the R group (p < 0.001). All of the patients in the RA group who stopped because they were better completed at least the first four-vial treatment series. CONCLUSIONS Inconvenience is the major contributing factor in noncompliance with AIM. Regulations designed to protect patients from adverse reactions should balance the potential risk of reactions against the benefits of treatment and the effect of more stringent guidelines on patient compliance.
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Affiliation(s)
- J R Cohn
- Department of Medicine, Thomas Jefferson University, Philadelphia, PA
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Cohn JR. The intensive care unit--industrial complex. Arch Intern Med 1992; 152:417, 421. [PMID: 1739379 DOI: 10.1001/archinte.152.2.417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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