Asthma

abstract: Subcutaneous allergen immunotherapy is clearly beneficial in the treatment of select patients with allergic rhinitis or asthma. However, this therapy is underused, partly because it requires administration in a medical facility. Sublingual immunotherapy (SLIT) may be a promising alternative; it appears to be associated with fewer adverse effects, which suggests that it might be administered at home. Currently, there is no FDA-approved formulation for SLIT in the United States. However, allergists are showing increased interest in this therapy, and an approved formulation may be available in the near future. A number of studies have shown the clinical efficacy of SLIT, but many questions remain unanswered, including the effective dose, optimal treatment schedules, and overall duration of treatment. (J Respir Dis. 2007;28(4):162-168)

A pruritic rash around the elbows; a soft, doughy papule; a slightlytender nodule with a keratotic core-do you recognize the disorderspictured here?

A middle-aged man hospitalized for intensive pulmonary toilet and topical and systemic treatment of a refractory skin disorder. Cough and moderate dyspnea with even mild exertion. Complains of scaling, uncomfortable dermopathy that he finds deeply cosmetically disfiguring and emotionally distressing.

LONDON -- On the eastern Mediterranean island of Crete, where olive oil is the primary source of fat, children with allergic rhinitis are uncommon, found a British team.

SOUTHAMPTON, England -- The research focus in asthma should shift back to conventional T-cells and away from the newly discovered invariant natural killer cells, according to investigators here.

DENVER, April 2 -- The occurrence rate of asthma increases by 50% in adults who are overweight or obese, according to a small meta-analysis.

A 65-year-old woman seeks evaluation of a tender, pruritic patchy rash on the trunk and extremities, as well as tender lips. Her symptoms began after she started taking a new NSAID for osteoarthritis. She has no known drug allergies and has not changed any other medications. The photographs were taken 2 days apart.

Allergic disorders are becoming more common. For example, about 20% of Americans have allergic rhinitis, which accounts for more than 10 million office visits each year. Most of these visits are to primary care clinicians.

UTRECHT, The Netherlands -- Lifeguards, swimming instructors, and other pool rats are likely to wind up with respiratory symptoms, according to researchers here.

HAMILTON, Ontario -- Adults with severe persistent asthma refractory to high-doses of drugs reacted well to radiofrequency warming, a procedure for opening airways called bronchial thermoplasty.

CLEVELAND -- Concerns that morphine or other opioids will cause respiratory depression when given to cancer patients for pain appear to be unfounded, investigators here found.

ROCHESTER, N.Y. -- Inadequate asthma control remains common among children, researchers here said.

CINCINNATI -- African-American children are particularly susceptible to exposure to second-hand tobacco smoke, according to researchers here.

SAN DIEGO -- Severe acute abdominal pain, which may recur with no obvious clinical explanation, could be due to hereditary angioedema, reported investigators here.

Managing Managed Care: Health Literacy, HIV, and Outcomes

Prompt recognition of poorly controlled asthma is one of the keys to avoiding asthma-related hospitalizations. Yet symptoms appear to be an unreliable indicator of the degree of airway obstruction. Even more sobering news comes from a pharmacy-based survey, which found that almost 70% of patients with poorly controlled asthma considered their asthma to be well controlled.

abstract: The mainstay of therapy for acute severe asthma includes ß2-agonists, anticholinergics, and corticosteroids. Other agents, such as leukotriene modifiers and magnesium sulfate, can be used in patients who have responded poorly to conventional therapy. Noninvasive positive pressure ventilation (NPPV) should be tried before intubation in alert, cooperative patients who have not improved with aggressive medical therapy. However, NPPV should not be attempted in patients who are rapidly deteriorating or in those who are somnolent or confused. Endotracheal intubation is recommended for airway protection or for patients who present with altered mental status or circulatory shock. Patients should be admitted to the ICU if they have difficulty in talking because of breathlessness, altered mental status, a forced expiratory volume in 1 second or peak expiratory flow rate of less than 25% of predicted, or a PaCO2 greater than 40 mm Hg after aggressive treatment in the emergency department. (J Respir Dis. 2007;28(3):113-117)

A 45-year-old man presented with food impactionof 3 hours' duration. He also complainedof dysphagia and chest pain. His historyincluded asthma during childhood and intermittentdysphagia for the past 3 years. Anupper endoscopy performed 2 years earlier showed noesophageal lesions.

SAN DIEGO -- For controlling asthma, an investigational oral anti-inflammatory drug with multiple actions, called MN-001, appears to be safe and effective, researchers reported here.

SAN DIEGO -- Allergic fungal sinusitis deserves a place of its own at the table of nasty chronic rhinosinusitis infections, researchers asserted here.

SAN DIEGO -- Public schools can be challenged learners in protecting children with severe food allergies, University of Michigan researchers reported here.

SAN DIEGO -- Children with allergies to eggs can lose their sensitivity with the help of a little powdered egg and an oral desensitization regimen, according to Japanese researchers.

SAN DIEGO -- City-dwelling children with asthma may miss out on allergy screening or education about avoidance of household allergens, reported New York investigators.

SAN DIEGO -- Five of seven children with severe peanut allergy were able, after two years of oral immunotherapy, to tolerate a dose of 7.8 grams of peanut flour, equivalent to eating more than 13 peanuts.

SAN DIEGO -- It may be possible to predict which children with peanut allergies will eventually outgrow them and become goober tolerant, according to Australian investigators.

SAN DIEGO -- A wheezing illness before the age of three years signals the likelihood of asthma by age six, and frequent rhinoviral infections in infancy may have something to do with it, according to investigators here.

NASHVILLE, Tenn. -- In a year-long study, more than one in four children admitted to the hospital with acute respiratory symptoms had a rhinovirus infection, according to researchers here.

ROCKVILLE, Md. -- Anaphylaxis reports associated with the asthma drug omalizumab (Xolair) led the FDA today to order Genentech to add a black box warning to the agent's label.

MELBOURNE, Australia -- For children with intermittent asthma, a short course of Singulair (montelukast), a leukotriene antagonist, given at the first sign of an episode may reduce acute care visits, reported Australian investigators.

ST. LOUIS -- A live attenuated flu vaccine -- administered in a nasal spray -- outperformed the traditional inactivated vaccine in a large study of children from six months to five years old.