Fatal asthma in adolescents.
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Biomedical subjects
Publications and source records attributed to F Speer.
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This paper represents a 17-year prospective study of the clinical characteristics of patients with a history of having had allergic reactions to aspirin. The following points are especially important. (1) The most common manifestation is urticarica/angioedema; the second most common, asthma. (2) Women of child-bearing age are especially prone to develop aspirin sensitivity, otherwise the age of onset is approximately equal in the two sexes, varying from one year to 60 years. (3) Although an immunologic basis of aspirin sensitivity has not been demonstrated, 90% of its victims are also sensitive to inhalants (76%), foods (74%) or drugs (43%). (4) The authors could not confirm the widely held view that aspirin cross-reacts with tartrazine. (5) They were also unable to confirm another widely held view that asthmatic patients who are sensitive to aspirin have a strong tendency to develop nasal polyps. (6) The prognosis of asthma in patients sensitive to aspirin does not differ from that of patients who are not. These findings underline the importance of giving every aspirin-sensitive patient the benefit of a complete allergic work-up.
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Foods which are ingested frequently, and cow's milk in particular, are a common cause of delayed-in-onset allergy. Difficulty in diagnosing milk allergy is encountered because: (1) skin tests are unreliable; (2) the symptoms of milk allergy are frequently delayed in appearing, thereby obscuring their connection with the previously ingested food; (3) when such symptoms do appear, they often fail to suggest allergy as etiologic; and (4) the offending antigen may be present in a milk product not obviously associated with milk per se such as sherbet or cheese. Contrary to common belief, most milk (and other food) allergy is not reagin (IgE) mediated. Milk allergy is not confined to infancy, but is frequently seen in children and adults, often persisting as an allergy which had supposedly been "outgrown." Since milk allergy is often a familial disorder, its presence in a patient can assist the physician in possibly discovering it in other members of the family. A two or three-week trial elimination of milk, in conjunction with written dietary instructions for the patient, is presently the only reliable diagnostic procedure.
Urticaria is not by any means the most serious clinical problem with which the physician must deal but it is certainly the most tedious and capricious. Its management therefore calls for patience on the part of both the patient and the physician and for a plan of management that is thorough and detailed. In this paper the authors present a plan which has proved capable of fulfilling these criteria.
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The 10 chief offenders among food allergens are cow's milk, chocolate and cola (the kola nut family), corn, eggs, the pea family (chiefly peanut, which is not a nut), citrus fruits, tomato, wheat and other small grains, cinnamon and artificial food colors. Food allergy results in a remarkable variety of clinical syndromes. Diagnois rests on an elimination and challenge process. Treatment is avoidance. Desensitization does not work.
The efficacy of hyposensitization in the control of ragweed hay fever has been demonstrated in both the clinic and the laboratory. In this paper evidence is presented that it also is important in preventing ragweed asthma. This is based on an experience with seven untreated patients who developed severe asthma in the 1975 season. The results of a 15-year study of constitutional reactions resulting from hyposensitization is summarized and means of their prevention is discussed.
The following beliefs about aspirin sensitivity are widely held: (1) it usually is accompanied by nasal polyps. (2) It occurs primarily in nonallergic patients. (3) Its most common manifestation is asthma. (4) When it is combined with polyps and asthma (the so-called "aspirin triad"), the prognosis is unfavorable. (5) Polypectomy may precipitate asthma in aspirin sensitive patients. This paper, based on a study of 112 private patients, presents clinical evidence to refute these beliefs. It shows the following: (1) Aspirin allergy is accompanied by polyps in less than 5% of cases (13% of asthma patients). (2) In most cases, patients show well-defined allergy to an inhalant, food, or other drug. (3) Its most common manifestations are urticaria and angiodema, not asthma. (4) The prognosis is favorable, whether or not polyps are present. (5) Polypectomy does not precipitate asthma in aspirin-sensitive patients.