Of 158 asthmatic patients who were placed on inhaled beclomethasone, 15 (9.5%) developed either hoarseness (8), oral thrush (6), or both (1). When their adverse reactions subsided, seven of these 15 patients were rechallenged with inhaled beclomethasone. These included five cases who developed hoarseness and three who developed Candidiasis. One patient had both. Oral thrush did not recur, but 60% (3/5) of patients with hoarseness had recurrence. We conclude that patients may be restarted on inhaled beclomethasone when clinically indicated; however, because of the high recurrence rate, patients who develop hoarseness should not be re-challenged. Concomitant use of oral prednisone and topical beclomethasone may increase the risk of developing hoarseness or candidiasis.

Administration, Inhalation↗

PubMedDate not supplied

Anaphylaxis to peanuts: clinical correlation to skin tests.

To determine the prevalence of peanut sensitivity in a group of patients referred for routine allergy evaluation, we skin tested 365 consecutive patients with a battery of extracts that included pollens, danders, mold, dust and peanuts. These patients were seen either in private practice or in the Allergy Clinic (Rhode Island Hospital). Of these 365 patients, 248 were found to be atopic. Eight patients had a positive scratch test to peanut extract, and four of these had a positive history of peanut sensitivity. One asymptomatic patient to peanut by history reacted to open challenge with 2 oz of peanut on two occasions. We, therefore, found that 3.2% (8 of 248) of our atopic patients had a positive skin test to peanuts and of these at least 62.5% (5 of 8) had clinical sensitivity to peanuts. No nonatopic patient reacted to peanut skin testing.

Adult↗

PubMedDate not supplied

Delayed nasal mucociliary clearance in patients with nonallergic rhinitis and nasal eosinophilia.

This study investigated nasal mucociliary clearance as related to nasal eosinophilia in nonallergic rhinitis patients using the technique of nasal saccharin challenge. Fifty-six consecutive patients with nonallergic rhinitis were evaluated with nasal cytology and saccharin challenge. A saccharin challenge time of greater than 25 minutes was considered abnormal. Twelve of 56 patients (21.4%) had nasal eosinophilia. Fifteen of 56 patients (26.8%) had prolonged nasal circulation times greater than 25 minutes, indicating delayed mucociliary clearance. Although 7 of 12 patients (58.3%) with nasal eosinophilia had delayed mucociliary clearance, only 8 of 44 patients (18.2%) without eosinophilia had circulation times longer than 25 minutes. The correlation of nasal eosinophilia with prolongation of the nasal circulation time is statistically significant (chi square 5.84, P = .0156). We postulate that damage to the nasal mucociliary system may be an etiologic factor for a subset of patients with nonallergic rhinitis and that this damage may be mediated by eosinophils.

Adult↗

PubMedDate not supplied

Latex hypersensitivity: two case reports.

For persons hypersensitive to latex, continued exposure may result in a life-threatening situation. Since 1979 reports appeared supporting evidence of urticaria, rhinitis, asthma, and anaphylaxis in association with latex exposure. We present two cases of latex hypersensitivity, patients who reacted to latex on skin-prick and radioallergosorbent tests (RAST). A 30-year-old surgeon developed reactions to latex gloves. On skin-prick testing to latex extract in saline, he was 4+. RAST latex antigen-specific IgE was 50.75 times control. The second case is that of a 24-year-old nurse who underwent multiple corrective surgeries for congenital birth defects and experienced reactions to latex. On skin-prick testing to an extract of latex in saline, she was 2+. RAST latex antigen-specific IgE was 23.37 times control. Both patients were given epinephrine and diphenhydramine and advised to use latex-free gloves and to avoid latex products. As health care personnel contact with latex products increases because of new guidelines for the prevention of sexually transmitted diseases, more adverse reactions in this subpopulation will occur.

Adult↗

PubMedDate not supplied

Follow-up of hymenoptera-sensitive patients without active immunotherapy.

Presently there is no definitive guideline for the treatment of adult patients suffering from generalized insect sting reactions limited to skin manifestations or purely respiratory compromise who have not been treated with immunotherapy. Previous studies in adults demonstrate that the majority of patients with insect sting anaphylaxis have a decreased reactivity to re-sting with time, suggesting the insect allergy itself may be self-limiting. In this study, we evaluated 63 patients with initial insect sting manifestations limited to the skin and the respiratory system and noted the incidence and degree of natural re-sting reactions to these patients who had not undergone venom immunotherapy. In those patients with mild systemic reactions limited to the skin, none experienced an increase in severity. A local reaction was found on repeat sting in three of five patients in this group, and two of five had an equivalent cutaneous response (i.e., urticaria/angioedema). In five patients who had an initial respiratory reaction, four of the patients had a local reaction while one patient repeated the same respiratory manifestations. None of the patients with cutaneous or respiratory symptoms demonstrated a more severe reaction upon re-sting. This demonstrates that there is a natural progression of tolerance to insect stings in the adult population.

Adolescent↗

PubMedDate not supplied

Asthma, polyps, and aspirin intolerance beginning in childhood.

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Adrenal Glands↗