Plastic bronchitis is a rare disease characterized by the formation of bronchial casts that can cause partial or complete obstruction of the airway. In this case report, a patient aged four years, previously healthy, began a chronic cough and underwent repeated courses of antibiotic therapy, inhaled corticosteroids and imaging tests; until there was a spontaneous sputum of a bronchial tree-shaped cast with approximately five cm, making possible the diagnosis of plastic bronchitis, which in our case report has idiopathic etiology. Due to the rarity of the pathology, we believe in the importance of the case report that can help to: (i) better understand the clinical presentation of plastic bronchitis; (ii) understand the difficulty in diagnosing the disease and distinguishing associated pathologies; (iii) disseminate the disease to health professionals; (iv) better understand the available therapies; (v) evaluate the efficacy of the disease treatment.

Atopic dermatitis is one of the epidemically expanding non-infectious diseases in the 21 century. It poses immense challenges to both patients and physicians. With a steady growth in its incidence and prevalence, the disease carries a heavy social and economical burden. Herein we discuss the therapeutic algorithm for atopic dermatitis in accordance with the disease severity. We emphasize on the personalized approach in selecting the proper treatment method and regimen for each patient.

Atopic dermatitis and allergic asthma result from amplified immune response to environmental antigens, and allergic reactions from released IgE, histamine, leukotrienes and cytokines. Environmental antigens immune cells, of innate and adaptive immunity, to stimulate interleukin-4 (IL-4) mediated activation of Th2 cells and subsequent isotype switching of B cells to produce IgE antibodies, responsible for the clinical manifestation of atopic diseases. The IL-4 receptor alpha chain (IL4Ra), which mediates IL-4 signaling, is common to IL-4 and IL-13 receptors, with IL-13 being an associated cytokine in the allergic response. US Food and Drug Administration recently approved dupilumab, which blocks IL4Ra for the treatment of moderate to severe atopic dermatitis. In controlled trials, dupilumab counteracted the allergic response and the clinical symptoms of dermatitis and asthma, and dupilumab was more effective than other available treatments. The primary safety concern of dupilumab is conjunctivitis and its long-term safety, which is unknown.

Background: Cysteinyl leukotriene levels are elevated in patients with atopic dermatitis, which can lead to eosinophilic infiltration of the gastrointestinal tract. Objective: We examined the role that montelukast (a leukotriene receptor antagonist) might play in improving symptoms of atopic dermatitis induced by food allergies. Methods: We conducted a randomized, double-blind, placebo-controlled, parallel group study in 20 children, aged 1 to 8 years, with 4 study visits every 3 weeks for 9 weeks. Primary inclusion criteria consisted of: 1) positive reactivity to food (indicated by skin or RAST test); 2) 10–25 % body area affected with atopic dermatitis; and 3) gastrointestinal symptoms. Liquid cetirizine and 1% hydrocortisone cream were both given as rescue medications for atopic dermatitis flare-ups. Pruritis and atopic dermatitis flare-up scores were used to collect clinical data. Laboratory values for nerve growth factor were evaluated pre- and post-treatment.

Calendula officinalis is a plant belonging to the Asteraceae family. Herbal preparations from Calendula have been used topically as a natural anti-inflammatory medicine and for the healing of wounds and leg ulcers. Although data on dermal irritation and sensitization are available, the risk of subchronic systemic toxicity following dermal application of Calendula officinalis preparations has not been evaluated. The threshold of toxicological concern is only based on a pragmatic risk assessment approach that gained regulatory acceptance for food. Here we describe a case of a 12 year old girl forced to the hospital for an acute periocular erythema and eczema after use for two days of Calendula Officinalis compresses on the eyes.

Asthma-COPD overlap syndrome (ACOS), a clinical syndrome common in routine practice, is still not fully defined entity characterized by features of both asthma and chronic obstructive pulmonary disease (COPD). In the present article a case with clinical syndrome of chronic airways disease sharing characteristics of asthma and COPD is described. In a 57-year old man working in herbal tea manufacture the diagnosis of sensitizer-induced occupational asthma (OA) was established at the age of 45 by recommended diagnostic work-up. After the diagnosis was established he was removed from the offending workplace exposure, the pharmacological treatment with inhaled corticosteroid was started and he was advised to quit smoking. He stopped use of the recommended medications after about two years and did not quit smoking. We saw the patient about 10 years after his last visit and he reported cough with sputum production and exertional dyspnea in the past one to two years. The spirometric findings indicated persistent airflow obstruction with positive response to bronchodilator. The features of COPD in the previously diagnosed asthmatic suggested overlap between two chronic airways diseases, i.e. the diagnosis of ACOS. Pharmacological treatment with combined therapy (inhaled corticosteroid and long-acting ß2-agonist) was started and he was advised to attend the programme for smoking cessation.