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

Continued growth of health care as a major sector of the U.S. economy has brought concern about whether health care services can be made more efficient and effective. Much of this concern is global in nature, relating to comprehensive issues in preventive and therapeutic services. Yet, examination of specific conditions provides insight into explicit approaches to achieving more effective care. The purpose of this report is to provide an overview of one health condition, asthma, and will 1) introduce the health economic concepts that define the costs of illness for asthma; 2) discuss the outcomes that are relevant to effective asthma management from a health systems perspective; 3) review the concepts underlying the study of cost-effectiveness of asthma care; and 4) examine the existing and emerging literature on the cost-effectiveness of asthma care.

Atopic dermatitis (AD) is a chronic and disabling condition that has a major impact on financial and social resources of the individual and the community. Its incidence is increasing dramatically, and no cure is available. Pharmacological treatment is only partially effective. The evidence that diet plays a role in children with atopic dermatitis is now irrefutable. Prophylactic measures can prevent or limit the development of AD, and partially restricted diets can modify the disease's course or severity. This study reports the reactions to various foods as perceived by parents of 112 children affected by AD. It demonstrates that many foods exacerbate AD and that reactions are caused by two distinct groups of food. The commonest triggers of cutaneous symptoms are tomatoes, oranges, sweets, pineapple, chocolate, and softdrinks preserved with sulfur dioxide. These foods result in symptoms in 30% to 49% of the children. The traditional IgE reaction type foods, namely egg, fish, milk, and peanut, resulted in reactions in 14% to 25% of the children, and with many non-cutaneous symptoms. The study further shows that allergen avoidance measures are not practiced in our community, and that sound advice is not often proffered. Practical advice on prophylactic dietary preventative measures and dietary management of children with atopic dermatitis is presented.

The entity of spontaneous cerebrospinal fluid rhinorrhea is a rare condition that presents a special challenge to the practicing allergist. Delayed diagnosis can be associated with significant morbidity and mortality. We describe two cases of this condition occurring in association with allergic rhinitis and sinusitis. The presentation and management of these cases is described. A high index of suspicion for this condition should be maintained in all patients who present with profuse and often unilateral rhinorrhea.

This report reviews approximately 35 years of patient care, teaching, and research an asthma in one academic unit at Northwestern University Medical School. Historical perspectives are summarized on the delivery of care for asthma, therapeutic regimens for asthma we believed in (and were wrong), and diagnosis and management in the last decade of this century. Particular problems, such as potentially fatal asthma and assessment and management of such problems, are discussed. Finally, certain aspects of our basic research programs and their relevance to asthma are briefly reviewed. Part One of this article appeared in the May-June issue of this journal.