(completed to #305/1,053.  To be continued...)

<>HIGHLIGHTS….MAY, 2009 – PAGE 2
 

• As is the case with adults with chronic bronchitis, children with chronic cough and wheezing have been found to have their lower airways colonized with bacteria.  This lowers the threshold for the use of appropriate antibiotics when they develop superimposed URI. 
• Laryngopharyngeal reflux, a distinct form of GERD, causes dysphonia, globus pharyngeus, non-productive throat clearing, cough, dysphagia, and recurrent sore throats.  It is under-diagnosed and undertreated, as is Obstructive Sleep Apnea…which can also cause these conditions, and much more serious results. 
• Homes with moldy walls  are also found to harbor dust mites.  More reasons to remediate.
• The role of endotoxins in immune response is controvercial…although I have long considered them as the mechanism for the clinical effectiveness of bacterial vaccines…once widely used in clinical allergy practice.  They have been found to be present in many allergenic extracts.  And they may form the basis for the Hygiene Theory…and future treatment…once more. 
• A wide variety of prodromal symptoms are reported to preceed, in nearly 50% of cases, episodes of Hereditary Angioedema.  (see # 377, 391).
• Evidence of thyroid autoimmunity is commonly found (over 30%) in chronic urticaria.  This may be treatable with thyroid hormone.
• IgG anti-IgE autoantibodies have been found in a variety of disease states, including rarely in chronic urticaria.  One of my patients was diagnosed at Yale this year with this condition.  She declined immunosuppressive treatment and is so far doing well with doxepin. 
• Children with food allergies and consequent food avoidances can have poorer health and poorer growth.  Every effort should be made to eliminate these food avoidances where possible.  These children also have a higher incidence of asthma.
• Sensitization to inhalant allergens is common in children less than 3 years old with food allergies, atopic dermatitis and a history of respiratory illnesses.  Most of these children can be treated with good environmental control and reasonable medications. 
• Allergy immunotherapy has been found to  “restore dendritic cell innate immune function previously reported to be impaired at baseline in allergic subjects.”
• Allergic conjunctivitis is under-diagnosed and under-treated.  It may or may not respond to a variety of available eye drops…and may at times require steroid eye drops, which I leave to Eye MD’s to prescribe and follow.  It is also somewhat responsive to nasal steroid spray use. 
• Here is something that I have suspected for many years: allergic patients seem to have a reduced incidence of cancer.  One abstract (#509) reports that the documented use of antihistamines for over one year “may be associated with decreased cancer risk”.  ??
• Administered 100% CO2 was found to inhibit mast cell degranulation and histamine release (# 516).  Maybe “don’t inhale” is really a treatment. 
• Here is an oldie and goodie: diesel fumes worsen airway inflammation and promote airway infections…in addition to promoting IgE.  Have cockroaches in urban environments been getting a bad rap?

(completed to 520/1,053).  To be continued…

<>HIGHLIGHTS….MAY, 2009 – PAGE 3
 

• “Cigarette smoke induces profound disturbances in epithelial cell biology, such as inflammation and metaplasia”.
• This is interesting, if confirmed: long-term anti-IgE (Xolair) treatment was found to reduce IgE production to normal non-atopic levels.  The related question is what happens when Xolair use is discontinued.  This all has a bearing on its relative effectiveness in desensitization vis a vis allergy immunotherapy (#583).
• If you want to do “original” research, read the research done 40 to 70 years ago…and do it again.  See #588, 612.
• Does obesity affect steroid responsiveness?  This study says “No” (#595).
• Probiotics may play a role in reducing airway inflammation in children.
• One of the toxic molds, capable of inducing a variety of systemic effects, is Stachybotrys Chartarum, a “black mold”.  #658 describes an assay for this agent. 
• #668 describes a protocol for graded dose administration of Flu vaccine in egg sensitive children.
• In one study, 50% of soy allergic children outgrew their allergy to soy by age 8.
• Some women have severe uterine cramping as part of an anaphylactic reaction.  Inhaled or injected terbutaline is useful in such cases. 
• #720 describes the relative safety of doing allergy testing on patients on beta- blockers. 
• Epinephrine digital auto-injection occurs and can produce severe digital ischemia, which may require amputation.  #723 describes the effectiveness of hyperbaric oxygen in such patients. 
• #912 describes desensitization for Bactrim sensitivity, in both HIV + and – patients. 
• Iodinated contrast media can produce Type 4 delayed hypersensitivity reactions, delayed between 3-72 hours, according to this study (923).
• #943 notes that just 3 years of venom immunotherapy (instead of the usually recommended 5 years) can infer lasting immunity for up to 10 years.  I repeat the venom skin tests after three years.  A substantial reduction in reaction (ie. 100-fold) is usually found and results in cessation of venom immunotherapy. 
• The presence of allergic rhinitis as a co-morbid condition in bronchial asthma can have a distinct effect on asthma severity and control.  It must also be treated aggressively. 

That’s all, folks…until next year.    GS