Annals of allergy最新文献

Background: The proper duration of venom immunotherapy remains uncertain.

Objective: We report our experience with a cohort of patients who started venom immunotherapy from 1978 to 1986.

Methods: In a midwestern allergy practice, the cohort of 204 stinging insect-allergic patients who commenced venom immunotherapy from 1978 to 1986 were identified and evaluated by retrospective chart analysis and patient telephone inquiry.

Results: Only 12 patients remain on venom treatment. The majority of patients have discontinued venom immunotherapy either by self-determination (35 patients) or upon physician advice (80 patients). There was no relationship between the severity of the initial sting reaction and the length of time patients received therapy. After cessation of venom treatment, there were 148 re-stings in 117 patients with only two re-sting reactions, both of which occurred in patients with severe initial sting reactions.

Conclusions: Most patients who have received four to 6 years of venom immunotherapy continue to tolerate insect stings after cessation of treatment.

Background: Budesonide and disodium cromoglycate (DSCG) are commonly used agents for the treatment of seasonal allergic rhinitis. The comparative efficacy, however, of these agents in the pediatric population has not been reported.

Objective: The efficacy of nasally administered budesonide (400 micrograms/day, administered twice daily) was compared with that of DSCG (31.2 mg/day, administered six times per day) for the treatment of seasonal allergic rhinitis in children.

Methods: A single-blind parallel group study was carried out in 56 children (mean age 12 years) with seasonal allergic rhinitis. Treatment was for 3 weeks, during which patients assessed nasal symptoms, eye symptoms, and overall efficacy.

Results: Over the 3-week period, mean scores for the nasal symptoms of blocked nose, itchy nose, and sneezing were significantly lower with budesonide therapy than with DSCG. P values were .021, .0032, and .0016, respectively. Both treatment groups reported reduced scores for runny nose and eye symptoms; no statistically significant difference was observed between budesonide and DSCG. The global efficacy assessment scores show significantly more patients benefited from budesonide therapy than from DSCG treatment.

Conclusions: The results suggest that nasally administered budesonide has greater efficacy than DSCG in the treatment of seasonal allergic rhinitis in children.

Background: Self-management protocols and home peak expiratory flow rate monitoring are thought to improve asthma care.

Objective: Compliance and accuracy of patients' record keeping were measured during a guided self-management protocol. Video, face-to-face instruction, and written protocols were part of the educational program.

Methods: Twenty patients participated in a 5-week study using memory capable peak expiratory flow rate meters and inhalers. During the baseline week all patients followed their customary approach to treatment and kept written diaries of peak expiratory flow rate and inhaler usage results; thereafter, they followed an individually designed self-management protocol.

Results: Good technique and knowledge were found during the baseline visit and improved by the last visit. Compliance with the protocol during the fifth week occurred in 40% of patients with underusage of inhalers in 50% and overusage in 10% despite allowing for a 10% inaccuracy in recording. Patients keeping inaccurate records early in care tend not to improve. Errors in recording inhaler usage increased from 47% to 58% of days during the final week. Patients inflated peak expiratory flow rate scores (P < .01) over time. Slight improvement in the peak expiratory flow rate was found for the entire group (baseline week 371 L/min versus final week 386 L/min P < .05).

Conclusions: Despite an extensive educational program in the self-management of asthma, compliance with recommended treatment was only 40%. Electronic monitoring of peak expiratory flow rate and inhaler usage can provide early identification of patients who do not comply.

Background: The limpet, phylum Mollusca, is one of the most frequent sea mollusks in the Canary Islands. Limpet IgE hypersensitivity reactions have been described.

Objective: To describe six patients with anaphylactic reactions due to limpet ingestion and to demonstrate by in vivo methods and by in vitro techniques specific IgE responses.

Methods: Six subjects who developed severe bronchospasm 30 to 120 minutes after eating limpets were included in the present study. The antigenic material for the in vivo and in vitro studies was an extract of cooked limpet prepared in our laboratory. Skin prick tests were performed in all patients using commercially available aeroallergens, mollusk, and crustacean extracts; the same skin tests were performed using the extracts prepared in our laboratory. Specific IgE by CAP and RAST and CAP inhibition studies were also performed. Limpet contamination by mites was excluded through a commercial ELISA using monoclonal antibodies.

Results: All patients had positive skin prick tests to D. pteronyssinus and cooked limpet extract and weak reactivity to cockroach and raw limpet extract. Specific IgE to mites and cooked limpet extract was also found using CAP and RAST techniques, respectively. The possible existence of common epitopes between limpet and D. pteronyssinus was excluded by CAP inhibition studies. Finally, no significant mite concentration was detected in the cooked limpet extract analyzed by a commercially available ELISA.

Conclusions: Limpet is a potentially dangerous allergen specially in patients sensitized to D. pteronyssinus.

Background: Chronic sinusitis, in contrast to acute sinusitis, often presents with nonspecific symptoms that may be confused with other disease entities. Due to the cost of computerized tomography and the difficulty in interpreting sinus radiographs in certain children, a search for a simpler screening tool for chronic sinusitis in children was undertaken.

Objective: This study was undertaken to provide a quantitative comparison between the methods of wax paper blow and Rhinoprobe scraping for nasal cytology in screening for chronic sinusitis while minimizing selection bias.

Methods: Twenty serially selected patients (13 males and seven females) with a mean age of 11 years (range 6-16) were enrolled. Nasal cytology was obtained via two methods: scraping of the turbinate with a Rhinoprobe (Synbiotics Inc.,) and wax paper blow.

Results: The results showed that > or = 5 neutrophils per high power field on Rhinoprobe cytology significantly correlated with radiographic sinusitis (P < .05 by Chi-square and P < .056 by Fisher's exact test). The sensitivity and specificity for > or = 5 neutrophils per high power field were 100% and 53%, respectively. Counts of other nasal cells, such as eosinophils, bacteria, and epithelial cells, did not yield significant correlations with radiographic sinusitis.

Conclusions: We feel that the Rhinoprobe, with criteria of > or = 5 neutrophils per high power field, may be useful as a screen for occult chronic sinusitis in childhood asthma. Confirmation of sinusitis via X-ray is still necessary if neutrophils are present on Rhinoprobe nasal cytology.

Background: While hay fever is a very common experience, its treatment in primary care setting has been little reported in controlled studies.

Objective: This study sought to evaluate the patient's assessment of efficacy of an intranasal steroid spray (budesonide) alone or in combination with an antihistamine (terfenadine) against terfenadine alone or placebo alone.

Methods: A double-blind parallel group, placebo-controlled trial design was used, comparing the four groups. Each group used an active or placebo spray and active or placebo tablets. Symptom scores were recorded daily in diaries over a 21-day period.

Results: Overall assessment of efficacy by the 106 patients was significantly greater (P < .05) for budesonide versus terfenadine or placebo alone. There was a 40% placebo response. Budesonide was more effective than terfenadine for all individual symptom scores, particularly nasal blockage, against which terfenadine was ineffective. Adverse effects were mild and transient for all groups.

Conclusions: Budesonide alone is a highly effective treatment for hay fever with few side effects.

Background: Increasing rates of death from asthma in the United States have stabilized somewhat since 1988. Case-control studies have suggested possible adverse effects of inhaled beta-adrenergic agonists that may have contributed to mortality.

Objective: To examine possible relationships between changing asthma mortality and sales of inhaled antiasthmatic drugs.

Methods: The National Center for Health Statistics supplied numbers and rates of death from asthma (ICD 493) by year. The Bureau of the Census supplied population data. IMS America provided estimates of total hospital and drugstore sales of inhaled beta-adrenergic agonists, cromolyn sodium, and inhaled corticosteroids by year and annual sales of AeroChambers and InspirEase kits. I calculated sales of the antiasthmatic drugs as puffs per person in the general population or doses per person for cromolyn sodium, defining a dose as a 20-mg capsule or vial or 2 mg by metered dose inhaler.

Results: Rates of death from asthma in the United States increased from 0.8 per 100,000 general population in 1977 and 1978 to 2.0 in 1989, then decreased to 1.9 in 1990 before increasing again to 2.0 in 1991. Rates of death for blacks 5 through 34 years of age increased from 0.9 in 1980 to 1.3 in 1990 and decreased to 1.2 in 1991. Estimated total hospital and drugstore sales of beta-adrenergic metered dose inhalers increased from 10.3 puffs per person in the general population in 1976 to 31.0 in 1991; those for inhaled corticosteroids, from 0.44 puffs per person in 1976 to 5.44 in 1991. Sales of cromolyn increased from 0.047 doses per person in 1978 to 0.91 in 1991. Sales of AeroChambers and InspirEase kits have also increased.

Conclusions: Since 1988 there has been some moderation in increases in rates of death from asthma while progressive increases in sales of inhaled antiasthmatic drugs have continued. These data are consistent with the likelihood that previous increases in rates of death from asthma were partly due to undertreatment.

Background: A 15-year-old young man with a history of recurrent streptococcal pharyngitis and hereditary angioedema presented for tonsillectomy. Preoperative physical examination was normal with the exception of enlarged pharyngeal tonsils with crypts and pustules; there was no evidence of angioedema. Laboratory studies were remarkable for a C4 level of 8 mg/dL (normal 20-50 mg/dL) and C1 inhibitor (C1 INH) level of 4 mg/dL (normal 11-26 mg/dL).

Objective: To report the use of C1 INH concentrate as prophylactic treatment for a patient with hereditary angioedema who required tonsillectomy.

Methods: The patient was treated with stanozolol 4 mg po quid and clindamycin 150 mg po tid during the week before the procedure. Two hours prior to surgery, he received 2300 plasma units of intravenous C1-inhibitor (Human) Vapor Heated, IMMUNO (IMMUNO Clinical Research Corporation, New York, NY).

Results: Approximately eight hours after an uncomplicated tonsillectomy, the patient began to experience crampy abdominal pain, typical of his hereditary angioedema. Beginning 22 hours after surgery, he had facial swelling and complained of difficulty swallowing and the sensation of throat swelling. The symptoms resolved over the next eight hours. Serial laboratory examinations revealed: [table: see text]

Conclusions: We believe that the occurrence of abdominal pain, facial swelling, and difficulty swallowing suggests that this patient may have experienced a mild, generalized flare of hereditary angioedema during the postoperative period in spite of prophylactic therapy with both anabolic steroids and C1 INH concentrate. This serves as a reminder that patients with hereditary angioedema require close observation following invasive procedures even after premedication with stanozolol and C1 INH concentrate.