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J P Corey

Publications and source records attributed to J P Corey.

At least 37 records · Page 2Linked to original sources
PubMed1997

Prevalence of mold-specific immunoglobulins in a Midwestern allergy practice.

Mold allergy surveys are an important part of the correct identification and treatment of mold allergies. This study included 100 patients who were referred to a Midwestern allergy clinic for the evaluation of rhinitis, suspected to be of allergic origin. An in vitro screening test for allergen-specific IgE (ImmunoCAP) comprised of 10 allergens, including Candida, Aspergillus, Helminthosporium, and Alternaria, was used. To assess the seasonal distribution of mold allergies, we randomly selected 8 patients out of the 100 from each season during which the clinical contact occurred, and we tested them for 14 varieties of mold. The overall incidence of mold allergy in atopic subjects was 44%. The most common molds were (in descending order of frequency) Alternaria, Helminthosporium, Aspergillus, Candida, and Curvularia. Mold allergy was diagnosed most frequently in the winter; the second highest period was the fall. Population surveys of IgE antibody sensitization by in vitro techniques can provide useful information about fungal allergy.

Adolescent↗
PubMed1997

Evaluation of the nasal cavity by acoustic rhinometry in normal and allergic subjects.

With acoustic rhinometry, one can detect a difference in response to a topical decongestant between normal and allergic subjects at the minimal cross-sectional area. The minimal cross-sectional area corresponds in most cases to the anterior end of the inferior turbinate or the first valley, which occurs after the nose piece of the acoustic rhinometer on the acoustic rhinometry graph. Allergic patients typically have an increase in nasal mucosal swelling, which leads to a decrease in the nasal volume and area and, subsequently, to an increase in congestion. In this study acoustic rhinometry was used to test normal and allergic subjects before and after the application of a topical decongestant (1% phenylephrine (Neo-Synephrine)). Symptoms were measured by a five-point scale. Results showed that increasing symptom scores demonstrated a trend toward being related to decreasing area as measured at the minimal cross-sectional area or nasal valve. The average total percent change at the minimal cross-sectional area was calculated for both groups and compared. The normal subjects had an average total percent area change at the minimal cross-sectional area of 15.6% +/- 14.8%, and the allergic subjects had a percent change of 24.6% +/- 20.8%. This represents a significant difference between the normal and allergic subjects in response to the topical decongestant at the minimal cross-sectional area (p = 0.04). However, the average total percent change was not significantly different between the two groups at the second and third valleys. At the second valley, the normal subjects had a percent change of 40% +/- 17.5%, and the allergic subjects had a percent change of 36% +/- 18.5%. At the third valley, the normal subjects had a percent change of 35% +/- 15.4%, and the allergic subjects had a percent change of 32% +/- 20.6% (p = 0.4 and 0.5, respectively). The total area was calculated by adding measurements from both right and left nasal cavities for each subject in an attempt to control the effect of the nasal cycle. Acoustic rhinometry makes it possible to detect a trend in the relationship between either a decrease in area at the minimal cross-sectional area or a decrease in the total volume from 0 to 7 cm into the nasal cavity and congestion. A statistically significant difference between normal and allergic subjects in their response to a topical decongestant at the minimal cross-sectional area was detected by acoustic rhinometry at the nasal valve.

Acoustics↗
PubMed1997

Pediatric sinusitis: a literature review with emphasis on the role of allergy.

Evaluation and treatment of pediatric sinusitis is a challenging area that has been subject to many different opinions and options during the past decade. Sinusitis is among the most commonly encountered diseases of childhood and has been the major area of interest for many otolaryngologists, allergists, and pediatricians. We have searched the medical literature to review the many aspects of the problem and the opinions of various authors. The increasing importance of allergic diseases and their relationship to sinus disease have been evaluated through a review of relevant literature. The poorly understood variations of the presentation of sinusitis and its signs and symptoms in the pediatric age group have been reviewed. Recommendations concerning the method, duration, and timing of the therapeutic intervention or interventions are summarized. The natural course of pediatric sinusitis in association with related respiratory tract diseases is discussed. Allergies and viral upper respiratory infections are among the most common predisposing factors of sinus disease. Every child with sinusitis is a candidate for an allergy evaluation.

Child↗
PubMed1996

In vitro testing for immunoglobulin E-mediated food allergies.

The role of immunoglobulin E-mediated food allergy in subjects with allergic disorders, especially in patients with rhinitis and sinusitis, is underestimated by clinicians because of the initial attribution of these disorders to immediate-type hypersensitivity reactions. The difficulties of diagnosing food-related reactions have caused further delay in their recognition and incorporation into the daily practice of diagnosing food allergy. Two of the diagnostic methods for food allergy are the in vitro assay of total immunoglobulin E and the measurement of food-specific immunoglobulin E levels in serum with the radioallergosorbent test. Measurement of specific immunoglobulin E level is the most commonly used but also one of the most controversial techniques. We examined 123 patients with rhinitis who were referred to our otolaryngology/allergy clinic between January and April 1995. All patients received an initial radioallergosorbent test screen, which included milk. We determined the positive predictive value of this positive screen and, in particular, of a positive test for milk in the diagnosis of immunoglobulin E-mediated food allergies in these patients. Conclusions were based on comparison with the result of an additional radioallergosorbent test food panel consisting of eight common and two investigational food allergens.

Adolescent↗
PubMed1995

Allergic fungal sinusitis: allergic, infectious, or both?

Allergic fungal sinusitis is a benign noninvasive sinus disease related to a hypersensitivity reaction to fungal antigens. A wide variety of fungal agents has been implicated, with the vast majority belonging to the Dematiaceae family. Allergic fungal sinusitis should be suspected in any atopic patient with refractory nasal polyps. Sinus computed tomograms and magnetic resonance imaging findings can be quite distinctive, but not diagnostic. Diagnosis requires histopathologic examination, which shows characteristic allergic mucin. Hyphae can be demonstrated on special fungal stains or confirmed by a positive fungal culture. At surgery, the diagnosis should be considered if thick, tenacious allergic mucin is encountered in the atopic patient with nasal polyps. Fungal cultures should then be obtained, and the pathologist alerted to the possible diagnosis of allergic fungal sinusitis. Current recommendations for therapy include conservative but complete exenteration of all allergic mucin. This can often be accomplished endoscopically. Adjunctive short-term systemic steroids are often helpful, and nasal steroid sprays should be continued long term. The length and dose of steroid therapy is controversial. Persistence of allergic fungal sinusitis with recurrence of sinonasal symptoms is common, particularly when there has been incomplete eradication of allergic fungal mucin. Even when the patient is clinically disease free, recurrence can occur, presumably from reexposure to fungal antigens. Therefore close clinical, endoscopic, and radiographic follow-up is important.

Humans↗
PubMed1995

Comparison of modified PhadezymRAST, ImmunoCAP, and serial dilution titration skin testing by receiver operating curve analysis.

Improved technology in in vitro tests for allergen-specific immunoglobulin E has led to increased efficiency and faster turnaround times. ImmunoCAP (Pharmacia Diagnostics, Clayton, N.C.) is an in vitro-specific immunoglobulin E test that uses a three-dimensional cellulose solid allergen phase, which allows quick results in 6 hours. In comparison, modified Phadezym-RAST (Pharmacia Diagnostics) uses a two-dimensional solid phase, and results take 3 days to obtain. This study compares the sensitivity and specificity of CAP with that of modified RAST in the detection of specific immunoglobulin E, and it assesses the correlation of the individual class scores of CAP and modified RAST with end points obtained from skin-dilutional end-point titration. The reproducibility of CAP was also assessed. Patients evaluated at the University of Chicago Allergy Clinic who had a history and physical examination consistent with immunoglobulin E-mediated allergy and in whom skin testing was clinically indicated as part of their allergy management, were asked to donate some blood for simultaneous in vitro testing by PhadezymRAST and ImmunoCAP. Testing was performed in batches. Random samples from the CAP batches were chosen for duplicate runs under conditions blinded to the technician. Receiver operating curve analysis was used for comparison of the sensitivity and specificity of RAST vs. that of CAP. We used Pearson product-moment correlation coefficients to compare the correlation of RAST and CAP classes with the end points from skin testing. Our results indicate that the sensitivity and specificity of RAST and CAP are similar, that the classes of these two tests correlate well with the end points from skin testing, and that duplicate samples of CAP also correlate well.

Adolescent↗
PubMed1994

Malbranchea pulchella fungal sinusitis.

Fungal sinus disease is being reported with increasing frequency. We could find no previously reported cases of sinonasal infections with Malbranchea pulchella and only two previously reported cases of human infection of any kind. We now report on a case of suspected sinonasal Malbranchea pulchella in a patient with aspirin-sensitive triad asthma.

Adult↗
PubMed1994

Mucosal allergy in the absence of systemic allergy in nasal polyposis and rhinitis: a meta-analysis.

To better determine the role of allergy in rhinitis and nasal polyposis, we assessed the prevalence of nasal mucosal allergy in the absence of systemic allergy. After a thorough literature search we compiled and analyzed data from nine studies (287 patients) that tested for specific immunoglobulin E both intranasally and systemically. When meta-analysis was applied to the different populations, 19% of those who demonstrated specific immunoglobulin E manifested nasal mucosal allergy but no systemic allergy. We suggest that there is an important segment of rhinitis and nasal polyp patients who have nasal mucosal allergy.

Humans↗
PubMed1994

Environmental control of allergens.

Allergy therapy properly consists of three possible treatment methods that can be used singly or in combination: environmental control (avoidance), pharmacotherapy, and immunotherapy. What allergens are effectively treated by environmental control? There are several broad groups of allergens with which we are concerned: indoor allergens such as dust, animal dander, molds (indoor), and cockroach; and outdoor allergens such as trees, grasses, weeds, and molds (outdoor); and, lastly, foods. The largest body of work has been collected regarding the effectiveness of indoor allergens, especially dust mites and cat. Scientifically proven measures exist for dust mites, cats, and infant formulas. Practical advice for controlling the environment for other furred animals, cockroaches, molds, and pollens are summarized. More research on effective avoidance measures for these other allergens is needed to help our patients control their environment effectively.

Air Pollution, Indoor↗
PubMed1993

Hypersensitivity to latex in health care workers: report of five cases.

Concern about transmission of acquired immunodeficiency syndrome and hepatitis has greatly increased the use of latex gloves. Latex allergy is a newly emerging problem with potential life-threatening sequelae among health care personnel. Patients are also at risk. We report on five cases of latex allergy in health care workers who were using latex gloves for variable lengths of time before their allergic reaction. All workers had a significant history of reactions to other allergens, including inhalants and food. Each individual had at least one systemic symptom that was directly attributed to latex exposure. Reactions to latex ranged from severe contact urticaria (all cases), bronchospasm (three cases), angioedema (two cases), and rhinorrhea (one case) to anaphylactic reactions that required immediate attention in three cases. Levels of specific IgE to latex (as measured by in vitro enzyme immunoassay) and total IgE were elevated in all five patients (total IgE > 100 kU/L). Long-term treatment included avoidance of latex, administration of antihistamines, and desensitization to other, nonlatex allergens. Health care workers should have increased awareness of latex allergy. At risk are health care workers with a history of other allergies and those with atopic dermatitis or eczema. In vitro testing may be useful, especially in persons with skin conditions such as eczema or urticaria or for persons with a history of systemic reactions to the latex allergen as reported in these five cases.

Adult↗
PubMed1993

Orbital complications in functional endoscopic sinus surgery.

Endoscopic sinus surgery can result in both minor and major complications. Among these, orbital complications--including retroorbital hematoma--are among the most feared. Injuries can be direct or indirect from pulling on diseased structures. A retrospective chart review of 616 endoscopic sinus procedures revealed eight orbital complications in seven patients. These included two medial rectus injuries, five orbital hemorrhages, and one nasolacrimal duct injury. Predisposing factors may include hypertension, lamina papyracia dehiscences, extensive polypoid disease, previous surgery, inability to visualize the maxillary ostia, violent coughing or sneezing, and chronic steroid use. Suggested management in the literature includes lateral canthotomy, steroids, and mannitol with ophthalmologic consultation. Opening of the wound by means of an external ethmoidectomy incision has also been suggested. We suggest that adding orbital decompression by means of multiple incisions into the periorbita should be added for fully effective relief. A "management" tree of decision parameters relevant to orbital complications is presented.

Adolescent↗
PubMed1993

Advances in the pharmacotherapy of allergic rhinitis: second-generation H1-receptor antagonists.

Allergic rhinitis, whether seasonal or perennial, potentially affects up to 30% of the population. Pharmacotherapy for allergic rhinitis that is directed at symptomatic relief traditionally includes antihistamines as one of the first lines of therapy. All antihistamines are H1-receptor antagonists, or H1 blockers; they are reversible, competitive inhibitors of the actions of histamine, a critical mediator in the pathophysiology of the allergic response. Nearly all antihistamines (with the exception of the second-generation antihistamine cetirizine) are metabolized by the hepatic cytochrome P-450 system. Potentially fatal adverse effects of antihistamines may include heart arrhythmias from overdosage. Hepatic or cardiac dysfunction also predisposes to heart arrhythmias in patients who take antihistamines. Concomitant administration of macrolide antibiotics or antifungal agents with antihistamines may also predispose patients to potentially fatal heart arrhythmias. First-generation H1 blockers (e.g., the ethanolamines, ethylenediamines, alkylamines, piperazines, and phenothiazines) offer rapid relief of symptoms (usually within 15 or 30 minutes) but have the potential for significant sedation and for adverse reactions and drug interactions, as previously described. In contrast, however, the second-generation H1-antagonists (e.g., clemastine, terfenadine, astemizole, acrivastine, loratadine, and cetirizine) offer equal or superior relief but have markedly decreased sedation potential. This article compares first- and second-generation H1 blockers to provide clinicians with a better understanding of each agent's actions, potential side effects, and efficacy as antihistamine therapy.

Histamine H1 Antagonists↗
PubMed1992

Allergic fungal sinusitis.

In summary, AFS is a newly recognized form of sinusitis, appearing in otherwise healthy young adults with a history of chronic bacterial or polypoid rhinosinusitis refractory to conventional therapy. Radiologic study may show patchy opacification or calcifications of the sinuses on CT. The patients have an elevated total IgE, peripheral eosinophilia, and positive skin tests for fungal antigens. They may also have elevated serum fungal allergen-specific IgE and IgG and precipitating antibodies to Aspergillus, Curvularia, or other fungi. Diagnostic and therapeutic surgical drainage of the sinuses will establish a definitive diagnosis by identifying the typical allergic mucin with eosinophils, Charcot-Leyden crystals, few fungal hyphae on silver stain, and a lack of tissue invasion. Treatment, other than surgical drainage, consists of systemic corticosteroids to prevent recurrence of disease.

Aspergillosis↗
PubMed1991

Otolaryngology problems in the immune compromised patient--an evolving natural history.

As the human immunodeficiency virus is being detected in increasing numbers of asymptomatic individuals at risk, newer earlier patterns of disease have become apparent--including cranial and cervical herpes zoster, oral hairy leukoplakia, and oral candidiasis--thus linking viral and other disease to the development of acquired immunodeficiency disease (AIDS). Many similarities between patients with AIDS and other immunosuppressed patients have emerged. As immunosuppressed patients survive longer, they begin to manifest cancers such as lymphomas and squamous cell cancers in addition to Kaposi's sarcoma. Otolaryngologists can learn to identify and treat otitis and sinusitis in the immunosuppressed patient, to identify predictive early signs such as oral hairy leukoplakia, herpes simplex virus, and oral candidiasis, and to diagnose and treat Kaposi's sarcomas of the head and neck, lymphomas, squamous cell cancers, and opportunistic infections as the immunodeficiency disease progresses.

Acquired Immunodeficiency Syndrome↗