Abstracts
Adenosine (Hay Fever)
Adenosine
Adenosine, a naturally occurring purine nucleoside, elicits dose-related bronchoconstriction in asthmatic subjects when administered by inhalation and it is recovered in increased amounts from the bronchial lavage fluid of subjects with active asthma when compared to normal controls.
Although the mechanism by which adenosine mediates bronchoconstriction in asthmatic subjects is not clear, recent data indicate an important role for mast cell mediator release.
Adenosine provocation may gain increasing acceptance as an additional measure of disease activity in asthma and rhinitis.
Crimi N et al., Purine derivatives in the study of allergic inflammation in respiratory diseases. Allergy, 1997, 52:34 Suppl, 48-54.
Allergen (Hay Fever)
Allergen
"Enzyme" potentiated desensitization (EPD) involves mixing an "allergen" with beta-glucuronidase and applying it to the "skin" in very low doses. This has been claimed to be effective for hay "fever" and identifying food allergens in "ulcerative colitis".
One carefully conducted double-blind study found the solution of grass pollen diluted to the point where no molecules remained (1 in 1060) was significantly more active than placebo in controlling hay fever.
Anonymous: Other Treatments Used by Practitioners of Alternative "Allergy". Clinical and Experimental Allergy, October, 1992;22(3):34-35.
Allergic Rhinitis (1)
Allergic Rhinitis (1)
Dysfunction of the upper and lower airways frequently coexist, and they appear to share key elements of pathogenesis. Data from epidemiologic studies indicate that nasal symptoms are experienced by as many as 78% of patients with asthma and that asthma is experienced by as many as 38% of patients with allergic rhinitis.
Studies also have identified a temporal relation between the onset of rhinitis and asthma, with rhinitis frequently preceding the development of asthma. Patients with allergic rhinitis and no clinical evidence of asthma commonly exhibit nonspecific bronchial hyperresponsiveness.
The observation that management of allergic rhinitis also relieves symptoms of asthma has heightened interest in the link between these diseases.
Nasal allergen challenge results in increases in lower airway reactivity within 30 minutes, suggesting a neural reflex. Improvements in asthma associated with increased nasal breathing may be the result of superior humidification, warming of inspired air, and decreased inhalation of airborne allergens.
Postnasal drainage of inflammatory cells during sleep also may affect lower airway responsiveness. A link between allergic rhinitis and asthma is evident from epidemiologic, pathophysiologic, and clinical studies. Future research, however, is needed to determine whether nasal therapy can alter the natural history of asthma.
Corren J: Allergic rhinitis and asthma: how important is the link? J Allergy Clin Immunol, 1997 Feb, 99:2, S781-6.
Allergic Rhinitis (2)
Allergic Rhinitis (2)
Allergic rhinitis affects approximately 20% of the U.S. population. An association between allergic rhinitis and conditions including asthma, sinusitis, otitis media, nasal polyposis, respiratory infections, and even orthodontic malocclusions has been observed.
The positive response of patients afflicted with these conditions to antiallergic treatment further enhances the association between allergic rhinitis and other airway diseases.
Three techniques for the treatment of allergic rhinitis are used, including avoidance of offending allergens, selection of appropriate pharmaceuticals, and allergy immunotherapy.
Spector SL: Overview of comorbid associations of allergic rhinitis. J Allergy Clin Immunol, 1997 Feb, 99:2, S773-80.
Allergic Rhinitis (3)
Allergic Rhinitis (3)
A sodium, potassium adenosine triphosphatase (Na+,K+ ATPase) enzyme inhibitor is bound to the platelet membrane, displaced from the platelet membrane by freezing, and present in the plasma of subjects with allergic rhinitis. Others have shown that stimulation of Na+,K+ ATPase is an important early event in mitogen-induced activation of peripheral blood mononuclear cells.
Determined whether the Na+,K+ ATPase enzyme inhibition observed in the platelets of subjects with allergic rhinitis also extends to peripheral blood mononuclear cells.
Data demonstrate that peripheral blood mononuclear cells from subjects with allergic rhinitis, like platelets, possess a membrane-bound Na+,K+ ATPase inhibitor that is displaced from the membrane by freezing. In vivo Na+,K+ ATPase inhibition could have significant effects on the activation and function of peripheral blood mononuclear cells in subjects with allergic rhinitis.
Van Deusen MA et al., Inhibition of the sodium, potassium adenosine triphosphatase enzyme in peripheral blood mononuclear cells of subjects with allergic rhinitis. Ann Allergy Asthma Immunol, 1997 Mar, 78:3, 259-64.
Allergic Rhinitis (4)
Allergic Rhinitis (4)
Olfactory dysfunction is a common finding in patients suffering from allergic rhinitis. However, little is known about the pathophysiology underlying this phenomenon and about the time course of hyposmia in seasonal allergy.
Patients with grass pollen allergy develop olfactory dysfunction during natural allergen exposure that might be related to allergic inflammatory mechanisms.
Klimek L & Eggers G: Olfactory dysfunction in allergic rhinitis is related to nasal eosinophilic inflammation. J Allergy Clin Immunol, 1997 Aug, 100:2, 158-64.
Epidemiology (Hay Fever)
Epidemiology
The escalation of allergic diseases (hay fever, asthma, atopic eczema) over recent decades has been linked to an increase in environmental pollutants. The prevalence of hay fever is associated with genetic predisposition, and some reports show an association with urban areas, socioeconomic status, and combined high allergen and automobile exhaust exposure.
In asthma, there is also some evidence for geographical variations in prevalence; exercise challenge tests prove positive more often in urban areas than in rural areas.
Schäfer T & Ring J: Epidemiology of allergic diseases. Allergy, 1997, 52:38 Suppl, 14-22; discussion 35-6.
Nasal Immunotherapy
Nasal Immunotherapy
When a patient is affected by specific vasomotor rhinopathy (allergic rhinitis), both perennial and seasonal, all the nasal functions are altered to various degrees.
To evaluate the efficacy of an antiallergic therapy:
1) anterior rhinoscopy;
2) active anterior rhinomanometry;
3) positioned acoustic rhinometry;
4) determination of mucociliary transport time; and
5) specific nasal provocation test.
The specific nasal provocation test is one of the most important tests in this field: it is more sensitive than skin tests and RAST in the asymptomatic phase and it is able to show organ allergies.
Passali D & Bellussi L: Monitoring methods for local nasal immunotherapy. Allergy, 1997, 52:33 Suppl, 22-5.
Otitis Media (1) (Hay Fever)
Otitis Media (1)
Otitis media and otitis media with effusion are among the most common childhood illnesses and contribute a great deal to health care costs. The cause of otitis media is multifactorial. Eustachian tube dysfunction, bacterial or viral infection of the middle ear, and nasal inflammation resulting from allergic rhinitis or upper respiratory infection are acknowledged contributing factors.
Studies indicate that 25% to 40% of upper respiratory infections in children younger than 3 years are accompanied by an episode of otitis media, 40% to 50% of children older than 3 years with chronic otitis media have confirmed allergic rhinitis.
Studies of the pathogenesis of otitis media have identified interactions among infection, allergic reactions, and eustachian tube dysfunction.
Both viral upper respiratory infection and nasal allergic reaction provoke nasal inflammation, eustachian tube dysfunction, and enhanced nasal protein transudation and secretion, which is likely to be sustained and modulated by inflammatory mediators and cytokines.
Viral upper respiratory infections may promote secondary bacterial infections by altering bacterial adherence, modulating host immune and inflammatory responses, and impairing eustachian tube function.
In acute otitis media, bacteria are cultured from approximately 70% of middle ear effusions with Streptococcus pneumoniae being the most common organism. Initial management of otitis media consists of appropriate antimicrobial therapy. In the presence of allergic rhinitis, antiallergic therapies may be used to augment symptom resolution and therapeutic response. Surgical insertion of tympanostomy or ventilation tubes to promote drainage of unresolved effusions has become common.
Further delineation of the pathogenesis of otitis media and otitis media with effusion will guide appropriate medical management and may decrease the need and frequency of surgical procedures.
Fireman P: Otitis media and eustachian tube dysfunction: connection to allergic rhinitis. J Allergy Clin Immunol, 1997 Feb, 99:2, S787-97.
Otitis Media (2) (Hay Fever)
Otitis Media (2)
Otitis media is a multifactorial illness that is the most common childhood disease that requires physician care, and its resultant health care costs are high. The established role of infection in the pathogenesis of otitis media has promoted aggressive antimicrobial therapy with specific antibiotic protocols for acute otitis and prophylactic antibiotic regimens for chronic or recurrent acute otitis media.
Even though these antibiotic regimens have been widely used, there has not been a decreased incidence of otitis media and its complications.
The possibility that allergy contributes to chronic or recurrent otitis media especially in children older than 3 years has been debated for years. If a causal relationship between allergic respiratory diseases and middle ear disease were to be established, then one would anticipate that anti-allergic therapy would reduce the morbidity and health care costs associated with otitis media.
Fireman P: Otitis media and its relation to allergic rhinitis. Allergy Asthma Proc, 1997 May-Jun, 18:3, 135-43.
Provocation Testing
Provocation Testing
In vivo challenge procedures can be very useful in the analysis of allergic symptoms. Skin testing has a high degree of sensitivity and specificity for determining antigens that cause allergic disease. However, positive skin tests do not necessarily indicate that a specific allergen causes symptoms specific for a certain organ.
Nasal and whole lung provocation testing can help define relevant allergens that cause rhinitis or asthma symptoms. These tests are safe when performed properly under close medical supervision and have predictive values that make them useful diagnostic tools.
Peebles RS & Hartert TV: In vivo diagnostic procedures: skin testing, nasal provocation, and bronchial provocation. Methods, 1997 Sep, 13:1, 14-24.
Quality of Life (Hay Fever)
Quality of Life
Allergic rhinitis has been conservatively estimated to affect 35 million Americans, with an annual US expenditure of more than $2 billion for treatment.
Immunotherapy is generally administered to patients with allergic rhinitis when avoidance is impossible or impractical, when pharmacotherapy provides insufficient relief, and/or symptoms span more than one season.
Changes in physical, social and emotional well-being were determined. Also investigated were changes in productivity and medication usage.
The majority of patients noted significant improvement in all areas within four to six months of initiating immunotherapy, and an overwhelming majority felt that such treatment represented a worthwhile investment of their time and money.
Fell WR et al., Quality of life analysis of patients undergoing immunotherapy for allergic rhinitis. Ear Nose Throat J, 1997 Aug, 76:8, 528-32, 534-6.
Teenagers
Teenagers
Assessed the proportion of 17-year-old students who consider themselves to have allergic rhinoconjunctivitis and to find out how they treat themselves.
A total of 1,458 students (24%) claimed that they suffered from allergic rhinoconjunctivitis after being given a description of the disease. Sixty-five percent had had symptoms for 3 or more years and most of the sufferers, 71%, had had symptoms during the spring and/or summer. In 32% of the sufferers the causative agent was unknown.
Seventy-six percent (# 1,103) of the sufferers treated themselves with drugs. The most commonly used drugs for a systemic effect were nonsedating "antihistamines" and for a local effect, sodium cromoglycate.
The reasons for not using nasal sprays daily were inconvenience and embarrassment. Twenty-five percent had bought the drug over the counter in 1992, the first year when allergy drugs could be purchased without a prescription. The use of over-the-counter treatment increased in the following year to 33%.
Many young people perceive themselves as having allergic rhinoconjunctivitis and that the treatment can be much improved for the group as a whole.
Borres MP et al., How many teenagers think they have allergic rhinoconjunctivitis and what they do about it. Ann Allergy Asthma Immunol, 1997 Jan, 78:1, 29-34.
10th Century
10th Century
Seasonal allergic rhinitis (hay fever) is considered a disease of the postindustrial revolution era. Clinical reports of patients are readily available from the 19th century starting with John Bostock's description of his own summer symptoms. Also patients with "rose catarrh' are described in the 16th and 17th century. Although asthma is well described by Maimonides, clear descriptions of diagnosis, prevention and treatment of hay fever are rare in the first millennium.
This report by Razi (prior to 925 AD) is perhaps the earliest such report yet. It is contained in a compendium written by Ibn Sharabeyun ben Ibrahim in the 13th or 14th century AD. The volume also contains work by Avicenna (Abo Ali-Sina; a friend of Razi) and other contemporary writers. Some of the treatments suggested in this early report may not be so acceptable to modern sufferers.
Bungy GA et al., Razi's report about seasonal allergic rhinitis (hay fever) from the 10th century AD. Int Arch Allergy Immunol, 1996 Jul, 110:3, 219-24.
Thunderstorms
Thunderstorms
An account of an epidemic of thunderstorm associated asthma on the night of 24/25 June 1994 involving a large area of the south and east of England.
Extrapolation suggests about 1500 extra patients were likely to have requested a visit from a GP that night because of epidemic asthma.
Higham J et al., Asthma and thunderstorms: description of an epidemic in general practice in Britain using data from a doctors' deputising service in the UK. J Epidemiol Community Health, 1997 Jun, 51:3, 233-8.
Treatment With Air
Treatment With Air
Ten subjects with asymptomatic seasonal allergy, outside of their allergy season, underwent allergen provocation following 1 hour of exposure to air at either 20 degrees C and 30% relative humidity (RH) or air at 37 degrees C, 90% RH.
Thus air at 37 degrees C and 90% RH partially reduces the early response to antigen. Its effects are greatest on histamine release, the vascular response, and neural responses, with no effect on the glandular response. The mechanisms underlying these effects are unknown.
Desrosiers M et al., Treatment with hot, humid air reduces the nasal response to allergen challenge. J Allergy Clin Immunol, 1997 Jan, 99:1 Pt 1, 77-86.
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