Why subtle gene changes mean every child is different – the example of allergy and asthma

Answer 1

ICS = inhaled corticosteroid

LABA = long-acting beta 2 agonist

LTRA = leukotriene receptor antagonist

SABA (i.e Salbutamol)

Question 2

7 years old Jamie

Recurrent wheeze, 2 hospital admissions and 2 further A&E visits over 12 months, managed with inhaled salbutamol plus intravenous prednisolone

Low lung function with 15% response to bronchodilator

On Seretide 125 inhaler plus aerochamber 1 puff twice daily plus regular oral montelukast

still uses the blue inhaler several times daily

Answer 2

• with 15% response to bronchodilator- A low response to bronchodilator means that he has asthma.
• Seretide is a combination of a LABA AND ICS.
• oral montelukast = Leukotriene receptor antagonists (LTRA)
• Jamie has a poorly controlled asthma due to persistent wheezr, increased hospital admission, using the blue inhaler more.
• Proper inhaler technique, he is taking it well
• Very organised family, you don’t think there is a problem with not taking medicines regularly

Question 3

Jamies Asthma is uncontrolled due to genetic differences

Answer 3

-At position 16 of the Beta 2 receptor, you can have Arginine- Arginine or Arginine-Glycine or you can have Glycine-Glycine. These are the 3 possibilities.

1. If you have Arginine, Arginine. You respond less well to LABA.

2. If you have glycine-glycine, you show a good response to LABA.

3. if you have Arginine-Glycine , you are somewhere in between.

Question 4

Montelukast

Answer 4

Montelukast is in the leukotriene receptor antagonist family of medications. It works by blocking the action of leukotriene D4 in the lungs resulting in decreased inflammation and relaxation of smooth muscle.