il-2 FAQ

As a biomarker of atopy, a blood eosinophil count of at least 150/mm 3 is associated with asthma symptoms and exacerbations. Specific Immunoglobulin E (IgE) indicates allergic sensitization associated with asthma. Finally, elevated fractional concentration of exhaled nitric oxide (> 20-25 parts per billion depending on age) is associated with wheezing, corticosteroid use, and persistent asthma. The combination of atopy markers — including maternal allergy, eczema, wheezing, positive specific IgE levels, and eosinophilia — significantly increases the likelihood of asthma. “However, when diagnostic uncertainty persists in a child younger than 5 years (absence of atopy; normal PFTs — which is common), a trial of treatment based on initial symptoms may be recommended according to GINA 2025 (Box 10-2) ,” explained Bourgoin-Heck. In the presence of mild and intermittent symptoms, a short-acting bronchodilator challenge test on demand is indicated for a maximum duration of 2-3 months. This strategy applies to infrequent wheezing episodes, without the need for emergency care and therefore without any severe exacerbations, with symptoms occurring twice or less per week. Treatment consists of administering two puffs when symptoms occur (to be repeated as needed), with an assessment of improvement within 20-60 minutes. In cases of a history of a severe wheezing episode within the past year (systemic corticosteroids, emergency department visit, and hospitalization) or symptoms more than twice a week, the therapeutic trial involves long-term inhaled corticosteroids (eg, fluticasone 100 µg/d to 250 µg/d) combined with a short-acting bronchodilator as needed for 2-3 months. If the response is favorable, treatment is adjusted to the minimum effective dose. Monitoring of clinical progress relies on asthma control scores such as the Asthma Control Test , considering both parental perception and the child’s self-assessment. Because the goal in mild asthma is indeed to achieve complete control.

Clinically, asthma most often presents with wheezing, cough, shortness of breath, and chest tightness, with symptoms that fluctuate in frequency and severity. Nighttime symptoms are common. Symptoms often start or worsen with viral infections, physical exertion (including after exercise), laughter, or exposure to allergens or cold air. “Symptoms are often dismissed as minor and intermittent,” the pediatrician said, “which leads to delayed diagnosis.” That’s why recognizing risk factors is important because they help guide diagnosis: male sex, a first-degree family history of asthma, exposure to secondhand smoke, prematurity , maternal obesity , living in group settings or having school-aged siblings which raise the risk for early infections, a history of severe bronchiolitis , and an atopic tendency, demonstrated by atopic dermatitis , allergic rhinitis , or sensitization to food and respiratory allergens.

Pulmonary function tests (PFTs) may be normal and do not rule out asthma. Spirometry can be performed around age 6 and is often normal. “The reversibility test is a diagnostic indicator but may be negative in cases of normal forced expiratory volume in 1 second (FEV 1 ),” warned the specialist. Provocation tests are useful in cases of doubt. In children unable to perform a forced exhalation, spirometry is impossible or unreliable, which justifies the use of respiratory resistance measurements (starting at age 3). Several methods are then used: flow-interruption resistance (FIR) identifies bronchial obstruction with an expiratory FIR > 2 Z scores (how many SDs a result is from the predicted value for a child’s age/height/sex). Oscillometry, suitable for young children, is considered pathologic for values exceeding 150% of the predicted value. Plethysmography indicates obstruction with a Raw value > 150% of the predicted value or an sRaw value > 180%. Interpretation is based on standards adapted to the technique and the study population, with thresholds varying by method ( threshold values for PFTs, page e4).

Several clinical scores for predicting asthma exist, notably the Asthma Predictive Index , the modified Asthma Predictive Index , and the Pediatric Asthma Risk Score ; the latter demonstrates better overall discrimination, making it useful for children at low-to-moderate risk. “These scores place significant emphasis on the atopic predisposition,” noted Bourgoin-Heck, “including allergic sensitivities, allergic rhinitis, and atopic dermatitis. Their performance varies by age and clinical phenotype. They are highly specific for the diagnosis of allergic asthma , with a positive score associated with a high risk of asthma. However, their sensitivity is not up to par: A negative score does not rule out the diagnosis, leading to a risk of overlooking nonallergic forms.” A chest x-ray is used to rule out differential diagnoses. It may be normal or reveal chest distension or bronchial signs. During follow-up, it is only recommended in cases of fever or severe illness to look for complications such as bronchopulmonary superinfection, pneumothorax , pneumomediastinum , subcutaneous emphysema and ventilation disorders/ atelectasis .

Current data show that complications are rare, about 2%-3%. At 10 years, nearly 90% of implants are still intact, according to Sofcep data. Deterioration is slow and gradual, and even in the event of a rupture, it is often asymptomatic and poses no immediate serious risk. There is generally no urgency to replace an implant, the surgeon explained. “Routine replacement is not warranted. I have no reason to operate and replace the implants if everything is medically fine. The most common reason for replacing implants is the patient’s desire to do so for aesthetic reasons,” emphasized the speaker, who noted that weight fluctuations, pregnancies, and natural aging play a significant role in how the aesthetic outcome evolves.

To assess the effectiveness and safety of these creams, American researchers set out to evaluate 189 homemade sunscreen recipes available on the social media platform Pinterest. The results found that 95.2% of the recipes claimed to be effective. SPF claims appeared in 33.3% of the recipes, with reported values ranging from SPF 20 to SPF 50. However, 68.3% of the recommended recipes provided insufficient protection against UV rays. The authors noted that in this sample of posts, 41.8% had been saved by other users between one and more than 21,000 times, indicating significant interest in “health” information from this social media platform. “This study revealed widespread interest in and acceptance of inadequate information regarding sun protection,” the authors noted. More recently, the authors of an Australian study tested the effectiveness of a natural, homemade sunscreen posted online by a wellness blogger to determine its photoprotective properties — beyond its ability to protect against erythema — compared with a commercially available SPF 50+ sunscreen. The DIY cream contained almond oil, coconut oil, shea butter, beeswax, red raspberry seed oil, carrot seed oil, and zinc oxide. Skin explants were treated with either a commercial SPF 50+ sunscreen or the homemade sunscreen before being exposed to UV rays. Analysis of these skin explants showed that the homemade cream reduced UV-induced damage to DNA and epidermal thickness but did not effectively protect against the formation of sunburn cells. In comparison, the SPF 50+ sunscreen provided effective protection against all parameters studied. The researchers concluded that there is currently no evidence supporting the effectiveness of homemade sunscreen in preventing skin carcinogenesis. They explained that enhanced DNA repair in the first few hours after irradiation does not necessarily mean that apoptosis is prevented 24 hours after UV exposure. They therefore recommended the continued use of approved commercial sunscreens. Finally, in practice, errors in preparing homemade sunscreen formulations cannot be ruled out, particularly when using approximate measurements such as cups, teaspoons, or tablespoons, which can result in formulations that vary from person to person. Without rigorous testing and regulation, as is the case with commercial sunscreens, DIY sunscreens can result in highly variable levels of photoprotection and thus potentially increase the risk for skin cancer. Additionally, the absence of so-called chemical preservatives requires very strict hygiene conditions and increases the risk for bacterial contamination or mold growth. Giordano-Labadie disclosed having no relevant financial relationships. This story was translated from Medscape’s French edition.

At steps 4 and 5, treatment escalation primarily relies on a medium dose of ICS, always combined with a LABA. Before considering a high dose or further escalation, the addition of a second long-acting bronchodilator, a long-acting muscarinic antagonist (LAMA), may be proposed ( moderate-dose ICS-LABA-LAMA ). The goal is to limit the use of high doses of ICS as much as possible by maintaining treatment around an effective moderate dose.

The consequences of TAVI with less favorable hemodynamic parameters generally result in an increase in clinical events starting at 3 years, he explained. Compared to patients receiving a prosthesis with better hemodynamic outcomes, the mortality curve begins to diverge after 3 years. We should therefore see a clinical difference within the next 2 years. We must now await the results of the planned 5-year follow-up for this trial to confirm an effect on the primary endpoint, which is the primary composite endpoint of all-cause mortality, disabling stroke , or rehospitalization for heart failure . When asked to comment on the results following the presentation, Anna Petronio , cardiologist, University of Pisa, Pisa, Italy, noted that the latest generation of balloon-expandable valves was not included in the study. “We now have a fifth generation of balloon-expandable valves. It has a larger valve surface area and a lower aortic gradient than previous models. Would the results be different with these new-generation valves?” the cardiologist wondered.