Asthma

PHILADELPHIA -- Rodent allergies, particularly sensitivity to mouse allergens, are common among inner city children, and may be the primary triggers for moderate-to-severe asthma, reported researchers here.

PHILADELPHIA -- Rush immunotherapy, also called rapid allergen vaccination, can cram into a few days some six to 12 months worth of allergy shots, safely and with low risk of serious systemic reactions or anaphylaxis, reported investigators here.

PHILADELPHIA -- When a patient with an orthopedic implant develops a rash or inflammatory symptoms, think metal allergy, suggested researchers here.

PHILADELPHIA -- Adding the long-acting beta2-agonist Serevent (salmeterol) to an inhaled corticosteroid reduces the rate of asthma exacerbations and asthma-related hospitalizations, said researchers from Servent's maker.

PHILADELPHIA -- Infants who are put on food-elimination diets to avoid allergens could be inadvertently robbed of the proteins and nutrients they need to grow, researchers warned here.

Invasive aspergillosis is a common and often deadly infection in immunocompromised patients, such as neutropenic patients who are being treated for malignancies. Does it have similar features and outcomes in nonneutropenic patients? This study by Cornillet and colleagues provides some interesting answers.

Abstract: Allergic drug reactions are mediated by IgE. Other immunologic drug reactions are mediated by IgG and complement, T cells, systemic cytokine release, and mast cell activation. True drug allergies, which are IgE-mediated, account for less than 10% of all adverse drug reactions. IgE-mediated reactions are commonly seen with penicillins, but also occur with some other antibiotics, chemotherapeutic agents, therapeutic proteins, and neuromuscular blockers. They are often limited to urticaria but also include life-threatening anaphylaxis. Skin testing to identify patients who are allergic is available for many agents associated with IgE-mediated reactions. Protocols for desensitization permit the use of some culprit agents when indicated. (J Respir Dis. 2006;27(11):463-471)

Although the overall rates of asthma-related hospitalization and death are about 2.5 to 5 times higher among black than white patients, it has not been known whether hospital deaths also are increased in black patients with asthma exacerbations. Investigators from Johns Hopkins who studied this issue found there were no significant race differences in hospital deaths.

SALT LAKE CITY -- Smokers and ex-smokers treated with statins for cardiovascular disease had less of a decline in lung function than comparable patients not taking statin, researchers reported here.

SALT LAKE CITY -- Incorrect use of home nebulizers may contribute to the deaths of some asthma patients, researchers reported here.

DENVER -- The trivalent influenza vaccine appears to be safe in children between the ages of six and 23 months, according to researchers here who reviewed more than 69,000 vaccinations among more than 45,000 children.

SALT LAKE CIY -- A deficiency in the enzyme alpha-1 antitrypsin (A1AT) may help explain why some people exposed to the toxic dust from the collapse of the World Trade Center towers developed respiratory disease and others didn't.

DUNDEE, Scotland -- A smoking ban in enclosed places here had a quick effect on bar workers -- significant improvements in respiratory function and lower systemic inflammation.

LONDON -- The TNF-alpha inhibitor Remicade (infliximab) decreased the number of asthma exacerbations in a small clinical trial, but the drug had no significant effect on peak expiratory flow, the study's primary efficacy endpoint.

A pressurized metered-dose inhaler (MDI), the most common asthma-medication delivery system, does not indicate the quantity of medication remaining in the canister after use. Are patients with asthma using their MDIs beyond the indicated number of doses or, alternatively, disposing of them before they are empty? That is the question researchers investigated in a random sample of 500 respondents with asthma.

Although the cause of chronic cough can often be identified (with asthma and postnasal drip being 2 of the most common culprits), it sometimes eludes diagnosis. Bastian and associates studied a group of patients with idiopathic chronic cough that was diagnosed clinically as sensory neuropathic cough. They found that this type of cough responded well to the tricyclic antidepressant amitriptyline.

Abstract: Because of recent advances, more patients may potentially benefit from a variety of interventional bronchoscopic techniques. Nd:YAG laser phototherapy is the most widely used modality and is the treatment of choice for patients with endobronchial malignancies who have large-central airway obstruction. Cryotherapy may be superior to Nd:YAG phototherapy for more distal airways lesions because of the lower risk of airway perforation, but it may be suboptimal for bulky airways disease that requires quick relief of obstruction. Brachytherapy relieves symptoms, such as cough, dyspnea, and hemoptysis, in many patients who have locally invasive airway malignancies. Endobronchial ultrasonography appears to be a safe and sensitive method for staging lung cancer. In select patients with emphysema, a 1-way endobronchial valve can be used to reduce lung volumes. Bronchial thermoplasty is being studied as a potential treatment for asthma. (J Respir Dis. 2006;27(10):415-428)

As with any potential exposure, the initial approach should be to establish the patient's diagnosis before attempting to determine the effect of a potential exposure. The main differential diagnoses to consider for a patient who has cough and wheezing that may be associated with an exposure are asthma, chronic obstructive pulmonary disease, allergic rhinitis, and vocal cord dysfunction.

Abstract: There is solid evidence that a positive association exists between nasal allergy and acute or chronic sinusitis in both adults and children. Patients with perennial allergic rhinitis--especially those with significant sensitivity to molds and/or house dust mites--are particularly susceptible to acute sinusitis. It therefore seems reasonable to assume that controlling rhinitis by controlling allergens in the home environment will minimize recurrences of acute sinusitis. Conversely, many patients with chronic sinusitis also have nasal allergy. Thus, management of nasal allergy should be included in the treatment strategy for chronic sinusitis. (J Respir Dis. 2006; 27(10):435-440)

ABSTRACT: There is solid evidence that a positive association exists between nasal allergy and acute or chronic sinusitis in both adults and children. Patients with perennial allergic rhinitis--especially those with significant sensitivity to molds and/or house dust mites--are particularly susceptible to acute sinusitis. It therefore seems reasonable to assume that controlling rhinitis by controlling the home environment will minimize recurrences of acute sinusitis. Conversely, many patients with chronic sinusitis also have nasal allergy. Thus, management of nasal allergy should be included in the treatment strategy for chronic sinusitis.

If left untreated, sinusitis can cause significant physical symptoms and can negatively affect quality of life by substantially impairing the daily functioning of sufferers. For children, this can mean learning difficulties at school and for adults, a loss of efficiency at work.

Can early intervention with inhaled corticosteroids help prevent irreversible lung function decline in patients with asthma? Yes, according to results of the international Inhaled Steroid Treatment as Regular Therapy in Early Asthma (START) study.

Perhaps surprisingly, limited published data exist on the effects of smoking cessation on symptoms, lung function, and corticosteroid responsiveness in smokers who have asthma. However, in a prospective controlled study, Scottish researchers found that 6 weeks af-ter smoking cessation, patients with asthma had significant improvement in lung function and a decrease in sputum neutrophil count compared with patients who continued to smoke.

MUNICH -- A simple breath test accurately predicts which patients with a chronic cough will benefit from inhaled corticosteroid treatment, according to a study presented here.

ABERDEEN, Scotland -- Children whose mothers consume more foods containing vitamin E during pregnancy are less likely to develop wheeze or asthma by the age of five, according to researchers here.