August 10, 2012 Fadlullah Aksoy, MD; Yavuz Selim Yıldırım, MD; Bayram Veyseller, MD; Hasan Demirhan, MD; Orhan Özturan, MD
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Abstract
Patients with asthma, allergic rhinitis, or atopic dermatitis experience increased oxidative stress. We conducted a prospective study to examine the levels of advanced oxidation protein products (AOPPs) as an indicator of oxidative stress in 97 patients with allergic rhinitis who were followed in our clinic during a 3.5-month period. Of these 97 patients, 51 were treated with subcutaneous immunotherapy (SCIT), and 46 did not receive any treatment until the study was concluded. In each patient, allergic rhinitis and allergic sensitization were documented by the history, the findings on clinical examination, and the results of blood and skin-prick tests. Blood samples from each patient were analyzed to determine AOPP levels. We found that the mean serum AOPP level was significantly higher in the SCIT group than in the non-SCIT group (258.55 vs. 163.83 µmol/L; p = 0.0015). We conclude that as a known indicator of protein oxidation, the serum AOPP level is a marker of increased oxidative stress in response to allergen exposure in allergic rhinitis.
March 1, 2012 Akefeh Ahmadiafshar, MD, Daryoosh Taghiloo, MD, Abdolreza Esmailzadeh, PhD, and Behnaz Falakaflaki, MD
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Abstract
Eosinophils are the principal effector cells involved in the pathogenesis of allergic inflammation. We conducted a study to investigate the validity of the nasal smear examination for detecting eosinophilia in patients with allergic rhinitis. Our study group was made up of 50 patients with allergic rhinitis and 50 age- and sex-matched controls without allergic rhinitis. Smears were obtained from nasal secretions in both groups and then fixed, stained, and studied under light microscopy. Statistical analysis revealed that the odds ratio for eosinophilia positivity in nasal smears in the rhinitis group was 25.61 with a 95% confidence interval of 8 to 78. The sensitivity, specificity, positive predictive value, and negative predictive value of this test were 74, 90, 88, and 77%, respectively. We conclude that the nasal eosinophilia test is highly specific and moderately sensitive in diagnosing allergic rhinitis, and that it therefore can be used as an easy, noninvasive, and inexpensive procedure for screening patients and for conducting epidemiologic studies of this disorder.
Additional information: This study was part of Dr. Taghiloo's graduate thesis, and it was supported by the Research Council of the Zanjan University of Medical Sciences.
September 20, 2011 Jamie Woody, PA-C, MSPAS, Sarah K. Wise, MD, Sarah Koepp, PA-C, MSPAS, and Rodney J. Schlosser, MD
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Abstract
Sublingual immunotherapy (SLIT) permits rapid antigen escalation with an improved safety profile over that of subcutaneous immunotherapy. Outcomes for SLIT in terms of the timing of clinical improvement were investigated in a retrospective review of patients undergoing SLIT who completed quality of life (QOL) and medication-use questionnaires at baseline and immediately after antigen escalation was performed. A subset of patients (n = 24) also completed maintenance-phase questionnaires. Paired post-escalation data (mean 5.5 weeks; N = 38) demonstrated improvement (p< 0.05) in overall QOL scores and in 6 of 14 symptom domains. Maintenance phase data (n = 24) revealed significant improvements in total QOL scores and in 5 symptom domains. A significant reduction in nasal steroid use was also demonstrated during the maintenance phase of treatment (p < 0.05). Significant improvement is seen immediately post-escalation in SLIT patients. This improved QOL appears to be maintained, and perhaps even increases, during the maintenance phase, with decreased nasal steroid use.
August 15, 2011 Yaser Khalil, MD, Adel Tharwat, MD, Asmaa Gaber Abdou, MD, Enas Essa, MD, Abdel Hamid Elsawy, MD, Osama Elnakib, MD, and Nada Farag Elnaidany, PhD
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Abstract
Allergic fungal rhinosinusitis (AFRS) is the most common form of fungal sinus disease. Its recurrence rate is high despite numerous strategies to prevent it. We conducted a study to assess the effect of systemic and topical antifungal agents-both separately and in combination-in preventing recurrence of AFRS following functional endoscopic sinus surgery (FESS). Our initial study population was made up of 50 adults who were diagnosed with AFRS by clinical, radiologic, histopathologic, and laboratory workup and who subsequently underwent FESS. Postoperatively, these patients were randomized into 5 different treatment groups matched for sex, age, and socioeconomic status. Four of the groups received a different antifungal regimen in addition to convenient medical treatment (CMT), while a fifth group served as a control. The antifungal regimens included oral itraconazole (group A), fluconazole nasal spray (group B), combined oral itraconazole and nasal fluconazole (group C), and irrigation with a fluconazole solution through the nasal fossa (group D); the group of 10 controls (group E) received CMT only. A total of 41 patients were available for follow-up (9 mo maximum). Recurrence rates in the 5 groups were 66.7, 10.0, 14.3, 28.6, and 75.0%, respectively. Based on our findings, we conclude that treatment with topical fluconazole as either a nasal spray or an irrigation solution can significantly reduce the rate of recurrence of AFRS after FESS.
June 13, 2011 John R. Cohn, MD
March 31, 2011 Ravi Vaswani, BS, Yi-Chun Carol Liu, MD, Leena Parikh, MD, and Surender Vaswani, MD
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Abstract
We conducted a study of 155 patients with allergic rhinitis who prematurely discontinued subcutaneous allergen immunotherapy to determine the reasons for their discontinuation. The most commonly cited factor, which was cited by 62 patients (40.0%), was the issue of cost-specifically, inadequate or nonexistent insurance coverage. Studies have shown that subcutaneous allergen immunotherapy is more cost-effective than pharmacologic treatment for patients with allergic rhinitis. Therefore, improved insurance coverage for this treatment of proven efficacy would not only improve quality of life, it would also be economically beneficial to the health care system in general.
March 31, 2011 John R. Cohn, MD, FACAAI, Patricia Padams, BSN, RN, and Jeremy Zwillenberg, BA
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Abstract
Intradermal skin testing (IDST) is performed by most allergists, but its value remains controversial. In most previous studies assessing the value of IDST, a positive result was based on a 5- to 6-mm wheal and erythema. While a subject's immediate reaction upon allergen exposure is a common endpoint to determine “allergy,” additional known allergic phenomena such as the delayed or late-phase response to allergen exposure suggest that correlation only with current history or acute challenge may result in an incorrect labeling of false-positive results when, in fact, there is a physiologic response to exposure, albeit a reaction not immediately evident. We conducted a retrospective study to determine if positive IDST reactions represent nonspecific irritation or if they correlate with atopy. We retrospectively reviewed the records of 100 patients who had undergone skin prick testing (SPT) and IDST and compiled data on their age, sex, diagnosis, and number of skin and intradermal reactions. Results were analyzed according to a general linear model to see if the development of a positive IDST result correlated with atopy (defined as SPT positivity). We found statistically significant differences between SPT-positive and -negative patients with regard to diagnoses of asthma, rhinitis, or both (p = 0.008). Controlling for asthma and rhinitis, we also found a significant association between atopy and a positive IDST result; among atopic (SPT+) patients, a mean of 25.9% of IDST results were positive, compared with a rate of only 6.7% IDST positivity among the nonatopic (SPT-) patients (p < 0.0001). We conclude that IDST is more commonly positive in atopic (SPT+) than nonatopic (SPT-) patients, suggesting that a positive IDST represents genuine atopy and bona fide sensitization rather than nonspecific irritation.
March 31, 2011 John H. Boyles Jr., MD
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Abstract
Skin prick testing remains the most popular way to confirm an IgE-mediated allergic response. This study was performed to compare the accuracy and sensitivity of two skin testing modalities (serial endpoint titration and skin prick testing with 2 different in vitro assays.) In 52 atopic patients serial endpoint titration showed a higher degree of sensitivity in evaluating skin response in less sensitive reactors. At higher degrees of reactivity in individual patients there was good correlation between the 3 modalities. Identifying patients who are less sensitive reactors is important, so that they can be started on immunotherapy. In fact, an informal survey of low-reacting patients treated with immunotherapy showed a high degree of success.
March 1, 2011 Lester D.R. Thompson, MD
March 31, 2010 Sezgin Sarikaya, MD, Can Aktaş, MD, Didem Ay, MD, Asli Çetin, MD, and Ferudun Celikmen, MD
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Abstract
Acute pharyngitis in adults is primarily a viral infection; only about 10% of cases are of bacterial etiology. Most cases of bacterial pharyngitis are caused by group A beta-hemolytic streptococci (GABHS). One laboratory method for the diagnosis of GABHS is rapid antigen diagnostic testing (RADT), which can be processed during an emergency department visit and which has become a popular alternative to throat swab cultures. We conducted a study to define the sensitivity and specificity of RADT, using throat culture results as the gold standard, in 100 emergency department patients who presented with symptoms consistent with streptococcal pharyngitis. We found that RADT had a sensitivity of 68.2% (15 of 22), a specificity of 89.7% (70 of 78), a positive predictive value of 65.2% (15 of 23), and a negative predictive value of 90.9% (70 of 77). We conclude that RADT is useful in the emergency department when the clinical suspicion is GABHS, but results should be confirmed with a throat culture in patients whose RADT results are negative.
March 31, 2009 Ioannis Vlastos, MD, Ioannis Athanasopoulos, MD, PhD, Nicholas S. Mastronikolis, MD, PhD, Theodora Panogeorgou, MD, Vassilios Margaritis, MD, Stefanos Naxakis, MD, PhD, and Panos D. Goumas, MD
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Abstract
Although mucociliary clearance has been shown to be impaired in patients with allergic rhinitis and chronic rhinosinusitis, its exact role in relation to a predisposition to rhinosinusitis is unknown. To investigate this possible association, we conducted a prospective study of 125 patients with allergic rhinitis. Of this group, 23 patients were classified as being sinusitis-prone based on their history of antibiotic consumption for the treatment of rhinosinusitis; the remaining 102 patients were deemed to be not sinusitis-prone. The saccharine test was used to evaluate mucociliary clearance in all patients. Several variables-age, sex, smoking habits, rhinitis severity, and medication history-were examined. We found that the sinusitis-prone patients had a significantly greater mucociliary clearance time than did those who were not prone (median: 15 and 12 min, respectively; p = 0.02). No other statistically significant differences were seen between the 2 groups with respect to any other variables that might have affected mucociliary clearance. We conclude that impaired mucociliary clearance in allergic rhinitis patients is associated with a predisposition to rhinosinusitis.
March 31, 2009 Mubasher Ikram, FCPS, Akbar Abbas, FCPS, Anwar Suhail, FRCS, Maisam Abbas Onali, MBBS, Shabbir Akhtar, FCPS, and Moghira Iqbal, FCPS
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Abstract
In patients with allergic fungal sinusitis, the mainstay of treatment remains surgical removal of allergic mucin and fungal debris. But as a single modality, surgery is associated with high rates of recurrence, so a number of adjunctive medical modalities have been tried, including postoperative corticosteroid therapy. We conducted a study of 63 patients with allergic fungal sinusitis who underwent endoscopic sinus surgery with or without postoperative steroid therapy. A group of 30 patients who had been treated prior to January 2000 had undergone surgery only; their cases were reviewed retrospectively, and they served as historical controls. Another 33 patients who were treated after June 2000 underwent surgery plus oral and nasal steroid therapy. All patients were followed for a minimum of 2 years. Recurrences were seen in 50.0% (15/30) of the no-steroid group and 15.2% (5/33) of the steroid group-a statistically significant difference (p = 0.008). The results of our study strongly support the use of steroids to control allergic fungal sinusitis and prevent its recurrence, and we recommend further study to identify the optimal dosage and duration of therapy.
