Allergy proceedings : the official journal of regional and state allergy societies最新文献

Objective: To document that idiopathic anaphylaxis may have a fatal or near fatal outcome.

Design: Review of selected cases seen personally by authors during the past 16 years.

Setting: University faculty practice and private practices.

Patients: All cases of idiopathic anaphylaxis seen by the authors are not presented, but 10 cases were selected to demonstrate two fatalities and eight cases of near fatalities.

Results: Two fatal cases had expired before emergency service therapy. Eight near fatal cases responded to acute therapy and subsequently were controlled. Remission of idiopathic anaphylaxis was then induced. Idiopathic anaphylaxis may be fatal or potentially fatal and must be treated to prevent a fatal outcome.

Conclusions: The documentation of fatalities and near fatalities should help patients and their physicians accept intense management of idiopathic anaphylaxis that will result in control and induction of a remission in idiopathic anaphylaxis.

A patient with asthma related to his work in a greenhouse with Lathyrus odoratus was studied. Specific IgE against pollen of this cultivar of the Leguminosae family could be demonstrated, indicating a type I allergic mechanism. Monitoring of serial PEFR measurements and nonallergic bronchial responsiveness warrant diagnosis of occupational asthma.

Thirty-five patients age 9 to 67 were evaluated for chronic sinusitis by history, physical and laboratory examination, and imaging techniques (X-ray, magnetic resonance imaging (MRI) and flexible rhinoscopy). MRI was the most predictive. To establish the diagnosis of sinusitis, it was more sensitive than plain X-ray for intrasinus disease. Findings of edema, erythema, and drainage on flexible rhinoscopy were consistent with chronic sinusitis and were confirmed by MRI and sinus X-rays in 41% of the cases. Nasal smears for polymorphonuclear cells and eosinophils were suggestive of a diagnosis of chronic sinusitis, but other laboratory tests (CBC, sedimentation rate, quantitative immunoglobulins, total IgEs) were of very limited value in the diagnosis of chronic sinusitis.

Nonspecific bronchial hyperresponsiveness (BHR) is a hallmark of clinical asthma, but can be present in nonasthmatics as well. The diagnosis of asthma is based on clinical grounds, and no laboratory procedure can definitely establish its presence. This poses a problem in studies of asthma. If epidemiological studies are to provide valid information, the tools used must have a relative degree of predictive or diagnostic ability. This report determined whether the American Thoracic Society-Division of Lung Disease (ATS-DLD) respiratory questionnaire has the ability to predict different degrees of non-specific BHR. In the years 1983-1990, when the ATS-DLD questionnaire was used in our Natural History of Asthma study, 192 subjects completed the ATS-DLD questionnaire and underwent a standardized methacholine challenge. A recursive partitioning analysis of the ATS-DLD questionnaire was able to predict which questions would likely be answered if the subject had nonspecific bronchial reactivity to inhaled methacholine of 100 and 200 breath units. Positive responses for questions concerning treatment for asthma, wheezing, or shortness of breath, and emergency treatment for asthma predicted the presence of increased bronchial reactivity.

Serum tryptase (Tryp) and eosinophil cationic protein (ECP) and urine N-methylhistamine (N-MH) were quantitated in a group of 13 subjects who had experienced immediate allergic reactions to different drugs. Results indicated that both Tryp and N-MH were involved and the levels were related to the severity of the reaction. Results of serum ECP levels failed to provide relevant information concerning the participation of eosinophils in immediate reactions to drugs.

Nedocromil sodium is a novel anti-inflammatory agent that has been demonstrated to significantly improve pulmonary function and decrease bronchial hyperreactivity in asthmatic patients. Currently available only as an inhaled drug, nedocromil sodium has an excellent safety profile, the only adverse effect being a slightly unpleasant taste. Nedocromil sodium has been used as a replacement for sustained-release theophylline therapy; the overall efficacy of nedocromil sodium is at least equivalent to that of theophylline, with less adverse effects occurring in those patients treated with nedocromil sodium rather than with theophylline. Nedocromil sodium also appears to be equal in efficacy to low doses of beclomethasone when employed in patients with mild to moderate asthma. Addition of nedocromil sodium to an ongoing regimen of beclomethasone may also allow for reduction in the dosage of inhaled corticosteroid. The overall safety of therapy with nedocromil sodium suggests that it be considered as initial therapy for those patients having mild to moderate asthma.