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While some allergies that affect the pediatric population resolve over time, peanut allergy tends to persist.Food allergens as triggers in different age groups (n=665, children and adolescents aged 0–17 years, adults from 18 years). Cases from the anaphylaxis register (1 January 2006 to 31 March 2013) [1]Accidental ingestion of the allergen (peanuts) is one of the most common causes of fatal/near-fatal anaphylactic reactions. Most patients with peanut allergy face the fear of anaphylactic reactions throughout their life. The current available treatment is strict avoidance of peanuts, and self-injectable Epinephrine, in the case of accidental exposure. I.e. this is huge unmet need from the perspective of the biotech industry [2].Aimmune’s AR101 for Peanut Allergy is based on oral immunotherapy (OIT) . OIT is a not a new concept, and has been studied for decades.What is OIT?In patients with peanut allergy, the allergen binds to Immunoglobulin E (among others), releasing pre-formed Histamine and other inflammatory molecules that generate the inflammatory immune response. This is augmented by a series of different reactions that lead to the production of additional inflammatory mediators ( cytokines interleukin-4 (IL-4), IL-5 etc).OIT, is a process by which the food allergen is administered slowly, in small but steadily increasing doses, to effectively reduce the sensitivity to food antigens (Ag) in patients. There is decades of work demonstrating safety of OIT, given that it is properly administered in a controlled setting. However, it is not yet clear the extent to which patients develop desensitization(DS) as opposed to sustained unresponsiveness (SU). DS, defined as a lack of clinical reactivity to Ag, and requires regular exposure to antigens for maintenance. DS is distinct from SU. In SU, patients exhibit a long-term or permanent loss of reactivity to Ag, which is independent of continued Ag exposure.In a typical OIT study, participants ingest small but gradually increasing doses of food Ag over a period of several months. The goal is to progressively retrain the immune response to establish DS and maybe, SU to the Ag.Example of an OIT study [3]So, what’s new?One must determine the most effective dosage and time frame for treatment. Further, we must learn whether or not OIT can desensitize large numbers of patients, and finally, if it can lead to tolerance. The clinical value of AR101 will be to allow the initiation of peanut immunotherapy with tiny initial quantities of peanut proteins that are required to safely launch oral desensitization.Footnotes[1] Guidelines on the management of IgE-mediated food allergies: S2k-Guidelines of the German Society for Allergology and Clinical Immunology (DGAKI) in collaboration with the German Medical Association of Allergologists (AeDA), the German Professional Association of Pediatricians (BVKJ), the German Allergy and Asthma Association (DAAB), German Dermatological Society (DDG), the German Society for Nutrition (DGE), the German Society for Gastroenterology, Digestive and Metabolic Diseases (DGVS), the German Society for Oto-Rhino-Laryngology, Head and Neck Surgery, the German Society for Pediatric and Adolescent Medicine (DGKJ), the German Society for Pediatric Allergology and Environmental Medicine (GPA), the German Society for Pneumology (DGP), the German Society for Pediatric Gastroenterology and Nutrition (GPGE), German Contact Allergy Group (DKG), the Austrian Society for Allergology and Immunology (Æ-GAI), German Professional Association of Nutritional Sciences (VDOE) and the Association of the Scientific Medical Societies Germany (AWMF)[2] Peanut allergy market set for remarkable growth to 2027[3] ScienceDirect

I had plastic surgery at the age of 18 months old. I was born with a genetic disorder that caused the growth plates in my skull not to form correctly. Basically every baby has a soft spot on their heads that eventually closes, but my head didn’t form correctly so as I grew, my face and head were deformed. It also affected one of my eyes.“Craniosynistosis, defined as the premature fusion of the cranial sutures, presents many challenges in classification and treatment. At least 20% of cases are caused by specific single gene mutations or chromosome abnormalities…In severe cases, initial care should be directed towards maintenance of the airway, support of feeding, eye protection and treatment of raised intracranial pressure.“—European Journal of Genetics(Example involving the eye above)“In cases in which the compensation does not effectively provide enough space for the growing brain, craniosynostosis results in increased intracranial pressure leading possibly to visual impairment, sleeping impairment, eating difficulties, or an impairment of mental development combined with a significant reduction in IQ”—WikipediaLuckily for me, there was a doctor one state away who was skilled in neurosurgery and plastic surgery. He would be performing a surgery that had just been developed. He knew that without intervention, that as I grew, my face would become more noticeably unsymmetrical (all faces are, but I would be noticeably disfigured).He wanted to try a surgery that would leave me with a normal face. He brought in another doctor and his team from France. When I was18 months old, my family traveled with me to one of the larger teaching hospitals in that state.“The first reported surgical procedure for correction of craniosynostosis was performed in 1890 by Lannelongue who advocated releasing, but not resecting, the fused suture. Craniofacial surgery has developed its own identity in the last 3 decades, with the Frenchman Tessier seen as the founding father.” —Annuls of Plastic Surgery“What we now consider to be the “routine treatment” of cranio- synostosis and other craniofacial pathologies is based in the many principles and methods pioneered by Tessier. To date, Tessier’s impact on neurosurgery from his work on craniosynostosis and facial trauma has not been discussed. In fact, multiple disciplines, including plastic surgery, head and neck surgery, oral-maxillofacial surgery, ophthalmology, and neurosurgery, have been deeply influenced by Paul Tessier’s work. Craniosynostosis is most frequently nonsyndromic and monosutural but may be associated with a known genetic disorder, such as Crouzon or Apert syndrome. The latter may involve multiple synostoses and often require more extensive and staged reconstruction. Nasal and oral airway functions are often affected in these cases.In his inaugural address to the International Society of Craniofacial Surgery in 1985, he credited his training (and collaborators) in pediatric orthopedics (G. Huc),43 facial trauma (M. Virenique), facial reconstruction (H. Gillies, A. McIndoe), ophthalmology (G. Sourdille, P. Francois), cleft palate surgery (P. Petit), and neurosurgery (G. Guiot, J. Rougerie).24”—Craniosynostosis Surgery: The Legacy of Paul Tessier“While others before him had managed some treatment of craniosynostosis and other craniofacial deformities, what made Tessier stand out most was his stubbornness that “If it’s not normal it’s not enough.”—Craniosynostosis Surgery: The Legacy of Paul TessierDr. Tessier was the doctor who came to the U.S. from France. The surgery took place over several hours with the American team and the French team working together. Unfortunately, during surgery I ended up needing a blood transfusion, and I had an anaphylactic reaction to one of the medications I was given. How all of that played out, I don’t know.“Surgery for craniosynostosis is often associated with significant perioperative hemorrhage so multiple strategies are often used to minimize blood loss…Additionally, the initiation of surgery should be delayed until blood products are physically present in the operating room.”—WikipediaThankfully, both doctors did an excellent job, and the surgery was successful. Part of my skull had been reinforced with titanium plating and screwed in place. They made sure that my face was as symmetrical as possible.Now, the only evidence of surgery is a scar from one ear to the other, covered by my hair style. The surgery became the standard treatment for subsequent children born with the condition.Both doctors followed up with me once a year throughout my childhood where they measured and photographed and studied my face to be sure that as I grew my face would remain appropriately formed. And just like the picture above, I would spend many years sitting with him and his team as they studied the development of my head and face. It developed well! So if my face isn’t beautiful, you’ll just have to blame them! Lol. But I think they did a great job, and I am so glad that other children have been able to have the same procedure.How do I feel? Incredibly blessed. Very thankful. Dr. Tessier was a kind man. I remember sitting on his knee around the age of three or four years old while he lectured the other doctors. I’m thankful he came all the way to the U.S. for me.It should be noted that titanium is no longer used for this procedure. I am at risk for complications even now if one of my screws comes in contact with my brain.“Another general agreement is the avoidance of the use of titanium plates in the fixation of the skull.[51][52] One potential complication following this procedure involves the gradual movement of the titanium plates towards the brain, induced by resorption of the innermost bone layer of the skull with deposition of new bone on the outermost layer, thereby integrating the titanium plates.[51][52] In some cases, the plates have been observed to come into direct contact with the brain.[51][52] Absorbable plates are now used instead.[51][52]“—Wikipedia

Ritalin Vs. Adderall?Ritalin and Adderall are helpful in the treatment of attention deficit hyperactivity disorder. Health care providers also prescribe these medications to people having narcolepsy, a sleep disorder.Ritalin and Adderall are the brand name versions of two types of central nervous system stimulant medications. Research shows that both medicines are useful in the treatment of ADHD by increasing attention and memory.In this article, we will see all the similarities and differences between Ritalin and Adderall.In what form are they available?Ritalin and Adderall are both available in immediate-release and extended-release forms. However, the extended-release version of Adderall comes as Adderall XR. At the same time, Ritalin extended-release pills come as Ritalin LA (long-acting capsules), and it also comes as SR or sustained-release form.Adderall is available in the strengths of 5 mg, 7.5 mg, 10 mg, 12.5 mg, 15 mg, 20 mg, and 30 mg of amphetamine salts as immediate-release forms and 5 mg, 10 mg, 15 mg, 20 mg, 25 mg, and 30 mg of amphetamine salts as extended-release formulations.Ritalin is available in the strengths of 5 mg, 10 mg, and 20 mg of methylphenidate as immediate-release forms, 20 mg of methylphenidate as a sustained-release form, and 10 mg, 20 mg, 30 mg, and 40 mg of methylphenidate as long-acting formulations.How do they work?Ritalin contains methylphenidate, which works as a norepinephrine-dopamine reuptake inhibitor. It is a derivate of Benzylpiperidine and phenethylamine, which also shares some part of its structure with catecholamines. Ritalin is a psychostimulant that increases the activity of the CNS by inhibiting the reuptake of neurotransmitters dopamine and norepinephrine.Ritalin is effective in treating ADHD as it increases neurotransmitter activity in the systems that lack action due to the disorder. By increasing the effects of dopamine and norepinephrine, Ritalin improves the activity of the central nervous system and produces effects such as improved attention, increased alertness, and combated fatigue.Adderall, on the other hand, contains amphetamine, which also acts primarily by increasing the activity of dopamine and norepinephrine neurotransmitters in the brain. It also triggers the release of some other hormones such as epinephrine and neurotransmitters such as histamine and serotonin as well as the synthesis of some neuropeptides such as cocaine and amphetamine-regulated transcript (CART) peptides.While Ritalin contains the only methylphenidate, Adderall contains two different salts of amphetamine, dextroamphetamine, and levoamphetamine. Both these salts bind to the same biological targets, differing in their binding affinities.Adderall helps alleviate the symptoms of attention deficit hyperactivity disorder and narcolepsy by increasing the activity of dopamine and norepinephrine neurotransmitters in the brain, which results due to the interactions in neurons with vesicular monoamine transporter 2 (VMAT2) and human trace amine-associated receptor 1 (hTAAR1).Who needs them?A health care provider may prescribe you Ritalin or Adderall when you are diagnosed with attention deficit hyperactivity disorder as a part of a complete treatment plan that includes behavioral therapies and counseling.According to the Children and Adults with Attention Deficit Hyperactivity Disorder (CHADD) charity, a complete treatment plan for ADHD include:Education about the disorder and its causesLearning about treatment and diagnosisMedications such as Adderall and RitalinBehavioral therapy to teach how to manage ADHD symptomsChanges to a person’s knowledge to account for ADHDGeneral mental health counseling for the family and individualThe AAP (American Academy of Pediatrics) recommends a combination of behavioral therapy and medicine for children above six years.For children under the age of six years of age, doctors only recommend behavioral therapies as it can be as effective as medications.Cost, availability, and insurance?Cost:Prices of the medications can vary widely, so it’s easy to get Adderall or Ritalin at online pharmaceuticals or local pharmacies. In general, the extended-release formulations of both medicines are usually more expensive than immediate-release ones.Per pill cost of the Adderall, immediate-release pills is about $5-$7 while that of Ritalin is $3-$7 in the United States. Comparatively, you can get Ritalin at lesser costs than Adderall.Availability:Ritalin and Adderall both are available in the immediate-release and extended-release formulations. Ritalin also comes in a suspended release tablet form. Both medications are readily available in the local market or at online pharmacies.Insurance:Insurance plans vary from place to place. Do check your insurance plan to know whether your medication gets covered under it. Generally, most of the insurance plan includes both Adderall and Ritalin. But your plan may have different policies.Drug features: similarity or difference?Adderall is the brand version for amphetamine, while Ritalin is the brand version for methylphenidate.The FDA (Food and Drug Administration) classifies both Adderall and Ritalin as schedule-II controlled substances under the Controlled Substance Act of America.As both medications are stimulants, they have similar effectiveness and side effects.A meta-analysis of 2018 demonstrates that Ritalin is best for the treatment of children or adolescents with ADHD.Being stimulants, they both help improve attention and focus and reduce impulsivity and hyperactivity.Although they both have similar effects and work in the same way, the primary difference is that Ritalin works more quickly than Adderall, and it reaches its peak performance earlier, having a shorter half-life.Can people use them together?A health care provider would generally not advise you to take Ritalin and Adderall together.No clinical research shows any relevant data on how these two medicines interact with each other. As both of them are stimulants and work similarly, taking them together can have additive effects and could increase the chances of developing significant complications and side effects.What should the medical conditions or symptoms be for taking Adderall or Ritalin?Health care providers prescribe central nervous system stimulants like Adderall or Ritalin only to people who have been diagnosed with attention deficit hyperactivity disorder or narcolepsy.Attention-deficit hyperactivity disorder is a medical condition in which you have differences in brain development and activity that affects attention, self-control, impulsivity, and hyperactivity. A person should take Ritalin or Adderall if they have the following symptoms of ADHD:ImpulsivenessPoor management skillsDisorganizationPrioritizing problemsLack of focus or concentrationTrouble multitaskingExcessive restlessnessLow frustration toleranceHot temperFrequent mood swingsAbove are some of the most common symptoms of ADHD, which may require medications like Ritalin or Adderall. However, there may be other symptoms of the disorder depending upon different individuals.Is it dangerous to use them together?It can be dangerous to use Adderall and Ritalin together as they both are central nervous system stimulants, and their concomitant use can cause additive effects of a stimulant, thus, causing unwanted severe side effects.Drug interactions?Ritalin and Adderall both contain similar ingredients and act in the same way in the brain. They also interact with the same drugs to produce similar kinds of effects. Frequent interactions of Adderall include:Acidifying agentsAdrenergic blockersAlkalinizing agentsTricyclic antidepressantsCYP2D6 inhibitorsSerotonergic drugsMAO inhibitorsAntihistaminesAntihypertensivesProton pump inhibitorsVeratrum alkaloidsFrequent interactions of Ritalin include:MAO inhibitorsAntihypertensive drugsHalogenated anestheticsRitalin has lesser interactions when compared to Adderall, as the medication has quick absorption and elimination cycle.Are these drugs safe to take if I am pregnant or breastfeeding?Adderall and Ritalin are not safe to take during pregnancy. Taking Adderall during pregnancy includes the risks of premature birth, low birth weight, and withdrawal symptoms in the infant. Taking Ritalin during pregnancy, especially in the first trimester, has a higher risk of heart defects in the infants.No clinical studies suggest the adverse effects of Adderall while breastfeeding. It does not affect the nursing infant. However, the mother actively abusing Adderall should not breastfeed as it can have several unwanted effects on the baby. Ritalin also passes through the breastmilk but at a shallow level. Mothers taking the medication at recommended dosages can breastfeed. However, like Adderall, higher doses or abuse of Ritalin by the mothers is not advisable.Stages of dose?Childhood:Adderall and Ritalin are not for children below three years of age.Children 3-12:Give 2.5 mg of Adderall per day.Give 5 mg of Ritalin per day.Teenage:Children 13-19:Give 5 mg of Adderall per day.Give 5-10 mg of Ritalin per day.Young age:Aged 20-60:Give 10-20 mg of Adderall per day.Give 20-30 mg of Ritalin per day.Old age:Above 65:Ritalin and Adderall are not recommendable for people above 65 years as the medication can produce severe side effects in geriatric patients.Side effects of Ritalin vs. Adderall?Ritalin and Adderall have similar side effects, including:HeadacheIrritabilityFast heartbeatsAnxietyLoss of appetiteStomach upsetHigh blood pressureTrouble sleepingSkin rashTremorsRestlessnessMood swingsTicsDiarrheaConstipationNervousnessHivesNauseaStomach painDizzinessBoth the medicines also contain warnings related to risks of heart problems, mental health issues, seizures, vision problems, and circulatory problems in the toes and fingers.Adderall may have some effects on men like impotence, change in sex drive, longer erections, or frequent erections. Some people taking it might also have rhabdomyolysis and hair loss, while Ritalin has very little or no risk of these effects.Precautions of Ritalin vs. Adderall?The general precautions for using Adderall and Ritalin include:The medications have a high potential for addiction and abuse. However, younger people and adults abuse Adderall more than Ritalin as the former has a more significant high and also helps students with improved memory and concentration.People with heart problems should not use Adderall or Ritalin as they both have a risk of stroke, myocardial infarction, or sudden death.CNS stimulants like Ritalin and Adderall can cause an increase in the blood pressure and heart rate, causing hypertension or tachycardia.They may exacerbate the symptoms of thought disorder and behavior disturbances.Adderall and Ritalin impair the ability to engage in potentially hazardous activities like driving or operating machinery.Stimulants like Ritalin and Adderall have been associated with the risk of long-term suppression of growth in younger people.What is better, Ritalin vs. Adderall?As we have been discussing above, both Adderall and Ritalin are central nervous system stimulants that work similarly in the brain for producing the effects of increased alertness and improved concentration.It is not easy to say which one is better when comparing Ritalin vs. Adderall as different people have different effects on the same medication. However, if you want a medicine that has more prolonged effects and you need not take the doses every four to six hours, Adderall extended-release form is the best for you as its effects last for more than 12 hours while the effects of Ritalin long-acting pills last for 6-10 hours.Some people want a medication with lesser side effects and a low risk of abuse and addiction. In that case, Ritalin is the best medicine for you as its half-life and elimination period is less than that of Adderall.The most prescribed medicine in Ritalin vs. Adderall by doctors is Adderall, as it was the 45th most prescribed medication in the United States, leaving Ritalin behind at 47th position in the year 2016. Doctors consider several factors while making a decision for prescribing stimulant medication to people with ADHD