February 1, 2009 James P. Dworkin, PhD, Patrick M. Reidy, MD, Robert J. Stachler, MD, and John H. Krouse, MD, PhD
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Abstract
The goal of this investigation was to study the effects of sequential dust mite antigen stimulation on the appearance and function of the larynx. To that end, we designed a randomized, placebo-controlled, double-blind, prospective analysis of adults who had tested positive for perennial dust mite allergy. The larynx of patients who received the active antigen was challenged directly with a low (1:100) and a high (1:40) concentration of the dust mite allergen via an oral nebulizer. Voice laboratory assessment tools included voice and allergy questionnaires, videostroboscopic examination of the larynx, acoustic and speech aerodynamic analyses, and digital audio voice recordings. The study was prematurely terminated after 2 patients had been treated with the highest concentration of the antigenic suspension because of adverse effects, including chest tightness, coughing, and voice difficulties. Both of these patients had demonstrated viscous endolaryngeal secretions and vocal fold edema on videostroboscopy. No reactions were noted at the lower concentration of antigen exposure or in 1 control patient who completed the study. We believe that our findings, as preliminary as they are, may serve as an initial template for the differential diagnosis and treatment of other patients with inhalant allergies who present with chief complaints suggestive of allergic laryngitis.
December 1, 2008 Rauf Tahamiler, MD, Salih Canakcioglu, MD, Suleyman Yilmaz, MD, and Huseyin Isildak, MD
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Abstract
We studied 63 adults with perennial allergic rhinitis and positive skin-prick tests for Dermatophagoides pteronyssinus (Dp) and Dermatophagoides farinae (Df) who had not previously received any type of immunotherapy or pharmacotherapy for their condition. We injected these patients with a 50% Dp/50% Df modified allergen intradermally in accordance with the classic immunotherapy scheme once a week for 30 months. Specific immunotherapy (SIT) was administered until the specific IgG (sIgG) concentration reached level IV (≥81% absorbance). We measured specific IgE and sIgG levels, obtained skin-prick test results, and evaluated clinical symptoms and signs before immunotherapy, at 6 months into therapy, at the completion of therapy (30 mo), and 1 year after the completion of therapy. In the group as a whole, differences between mean sIgG values and mean skin-prick test results before and after SIT were statistically significant (p < 0.05). At the 1-year follow-up, there was a negative correlation between sIgG levels and clinical symptom and sign scores, a positive correlation between skin-prick test results and clinical improvement, and a negative correlation between sIgG levels and skin-prick test results. Individually, at the 1-year follow-up, 50 of the 63 patients (79%) had experienced a resolution of clinical symptoms and/or signs and were thus deemed to have achieved clinical recovery.
August 31, 2008 William R. Reisacher, MD, FACS, FAAOA
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Abstract
A retrospective, controlled study was undertaken to determine the prevalence of autoimmune thyroid disease in 111 adult patients with allergic (77) and nonallergic (34) rhinitis seen in a private ENT/allergy practice in the lower Hudson Valley, New York. The control group consisted of 101 patients with no history of chronic rhinitis. Autoimmune thyroid disease was found in 10.4% of the allergic rhinitis group, 14.7% of the nonallergic rhinitis group, and 9.9% of controls, with a trend toward higher prevalence in the nonallergic rhinitis group compared with controls. No statistically significant association was noted between the 3 groups. The female-to-male ratio in the nonallergic rhinitis group was approximately twice as high as in the control group.
May 31, 2008 Piyush Patel, MD, Deepen Patel, MD, Sudeesha Kunjibettu, PhD, Nancy Hall, MS, and Mark A. Wingertzahn, PhD
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Abstract
Ciclesonide is an intranasal corticosteroid approved for the treatment of allergic rhinitis. We conducted a randomized, double-blind, parallel-group, placebo-controlled study to evaluate the time to onset of action of ciclesonide 200 μg once daily in 502 adults with seasonal allergic rhinitis of at least 2 years' duration. To trigger immunologic priming, patients underwent between one and five priming sessions with exposure to 3,500 grains/m3 (±500) of ragweed pollen in an environmental exposure chamber. The criteria for a successful priming session were a patient-assessed instantaneous total nasal symptom score of at least 6 (of a possible 12) and a nasal congestion or rhinorrhea score of at least 2 (of a possible 3) 90 minutes after allergen exposure during at least two consecutive priming sessions. Patients were then randomly assigned to receive either a single dose of ciclesonide 200 μg (n = 251) or placebo (n = 251) administered intranasally. The difference in the change from baseline total nasal symptom scores in the two groups was assessed hourly for 12 hours after administration. Onset of action was determined to have taken place the first time that the effects of ciclesonide, as reflected in the total nasal symptom score, were significantly greater than those of placebo at a particular hourly assessment, provided that the subsequent hourly assessment also showed a statistically significant difference. The onset of action of ciclesonide occurred within 1 hour of administration (p = 0.01 vs. placebo), and the significant difference in total nasal symptom scores between ciclesonide and placebo was maintained through post-treatment hour 12 (p = 0.018).
July 31, 2007 Diego Saporta, MD, FACS, FAAOA; Alan B. McDaniel, MD, FACS, FAAOA
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Abstract
We performed an observational study to determine whether allergen-specific sublingual immunotherapy (SLIT) is as effective as allergen-specific subcutaneous injection immunotherapy (SCIT). Our study population was comprised of 66 patients who had been taking SLIT. Of this group, 36 patients had switched to SLIT after having been treated with SCIT (group I), while the remaining 30 patients had received SLIT only (group II). A questionnaire was used to evaluate the results of treatment. In group I, 33 patients (92%) gave SLIT a favorable rating; 27 of these patients (75%) said it was just as effective as SCIT, and 6 (17%) said it was actually superior (the remaining 3 patients [8%] said that SCIT was better). In group II, 27 of 30 patients (90%) said they had attained symptom relief with SLIT; 21 (70%) said that the relief had been very significant. Overall, 60 of the 66 patients (91%) expressed various degrees of satisfaction with SLIT. We believe that our SLIT protocol, which is based on established guidelines for SCIT administration, is an effective, safe, well-tolerated, and easy-to-use regimen. Future prospective studies of larger groups are clearly indicated.
June 30, 2007 Christos Spiliotopoulos, MD; Nicholas S. Mastronikolis, MD, PhD; Ioannis K. Petropoulos, MD; Ephigenia K. Mela, MD, PhD; Panos D. Goumas, MD, PhD; Sotirios P. Gartaganis, MD, PhD
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Abstract
The effect of systemic steroid administration on intraocular pressure (IOP) is well established. However, less attention has been paid to the effect of steroids when administered in a nasal spray. We conducted a study to investigate a possible association between nasal steroids and elevated IOP in 54 patients who were being treated for allergic rhinitis. IOP was measured before the patients started therapy and thereafter every 5 days during that therapy. Follow-up ranged from 27 to 35 days (mean: 31). Statistical analysis revealed no significant elevation in IOP after nasal steroid administration. It seems that short-term administration of nasal steroids does not cause significant IOP elevation. Nevertheless, their long-term effects on this pressure should be investigated.
April 30, 2007 Hsien Teik Wong, MS; Tengku A. Shahrizal, MS; Narayanan Prepageran, FRCS; Wye Keat Lim, FRCS; Rajagopalan Raman, MS
April 30, 2007 Eric P. Wilkinson, MD; Jose N. Fayad, MD
March 31, 2007 Sharon E. Jacob, MD; Tace Steele, BA
February 1, 2007 Joseph P. Mirante, MD; Dewey A. Christmas, Jr., MD; Eiji Yanagisawa, MD
June 30, 2005 Scott Cordray, DO, FAOCO; Jim B. Harjo, DO; Linda Miner, PhD
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Abstract
Intranasal corticosteroids are well known to be efficacious in the treatment of allergic rhinitis. Nasal irrigation with saline, including hypertonic saline, has long been recommended for the treatment of sinonasal disease, and it has been shown to have a positive effect on the physiology of the nasal mucosa. Until now, no study of the clinical efficacy of intranasal hypertonic Dead Sea saline as a monotherapy for seasonal allergic rhinitis has been reported. We conducted a prospective, randomized, single-blind, placebo-controlled comparison of intranasal hypertonic Dead Sea saline spray and intranasal aqueous triamcinolone spray in 15 patients with seasonal allergic rhinitis. Results were based on a 7-day regimen. Based on Rhinoconjunctivitis Quality of Life Questionnaire scores, clinically and statistically significant (p < 0.0001) improvements were seen in both active-treatment groups; as expected, the corticosteroid spray was the more effective of the two treatments. No significant improvement occurred in the control group. Our preliminary results not only confirm the efficacy of intranasal corticosteroid therapy in moderate-to-severe allergic rhinitis, they also suggest that the Dead Sea saline solution can be an effective alternative in mild-to-moderate allergic rhinitis, particularly with respect to nasal and eye symptoms. The hypertonicity of the Dead Sea solution may have a positive effect on the physiology of the nasal mucosa by improving mucociliary clearance. In addition, the dominant cation in the Dead Sea solution''magnesium''probably exerts anti-inflammatory effects on the nasal mucosa and on the systemic immune response.
April 1, 2005 Rakesh K. Chandra, MD; Collin E. Lee, RPh; Harold Pelzer, MD
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Abstract
We noticed a seemingly high prevalence of penicillin allergy in patients who had been diagnosed with peritonsillar abscess (PTA) at our institution. To formally investigate this observation, we reviewed the emergency room (ER) records of 118 patients who had presented between Jan. 1, 1995, and Dec. 31, 1999, with suspected PTA. A diagnosis of PTA was confirmed by the presence of pus on incision and drainage in 78 of these patients (66.1%). The remaining 40 patients (33.9%) were diagnosed with peritonsillar cellulitis (PTC). Of the 78 patients with confirmed PTA, 13 (16.7%) self-reported an allergy to an antibiotic, including 11 (14.1%) who claimed to be allergic to penicillin. In the 40 patients with PTC, the corresponding figures were only 3 (7.5%) and 1 (2.5%). The difference between the PTA and PTC groups with respect to the prevalence of self-reported penicillin allergy was statistically significant (p < 0.05). We also compared the prevalence of antibiotic allergies in our patients with that of 1,893 consecutively presenting patients whose records had been entered into a pharmacy database at our institution. We found that the overall prevalence of patient-reported penicillin allergy in our PTA group was similar to that of the database population, although penicillin allergy did account for a greater percentage of all antibiotic allergies (84.6%) in our PTA group than in the larger population (62.8%). In our series, patients with PTA were more likely to have reported an allergy to penicillin than were patients without an abscess. Additionally, the prevalence of patient-reported antibiotic allergy is high at our institution. Although self-reported penicillin allergy may not represent a true hypersensitivity reaction, it can influence antibiotic selection and/or compliance. Prospective studies are needed to determine what influence allergic status and antibiotic choice has on abscess development.
