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Biomedical subjects

J W Georgitis

Publications and source records attributed to J W Georgitis.

At least 37 records · Page 2Linked to original sources
PubMed1994

Measles, mumps, rubella vaccine administration in egg-sensitive children: systemic reactions during vaccine desensitization.

In egg-sensitive children, measles-mumps-rubella (MMR) vaccination may cause acute allergic reactions; therefore, current recommendations are to perform skin testing with the commercial vaccine before administration to egg-allergic children. In children with positive skin tests, desensitization with the measles-mumps-rubella vaccine should be done in order to administer a full dose of the vaccine. Twelve egg-allergic children, aged 12 months to 5 years of age, were referred to our pediatric allergy clinic for MMR administration over a 20-month period. Three children had positive skin prick or intradermal tests to the MMR vaccine. Two of these three patients experienced systemic hypersensitivity reactions while undergoing desensitization to the MMR. All reactions occurred with injections of the undiluted vaccine. Based upon this experience, we recommend that egg-allergic children should continue to have cutaneous tests done to the MMR vaccine and careful observation during desensitization in those children with positive skin tests.

Child, Preschool↗
PubMed1993

Local hyperthermia and nasal irrigation for perennial allergic rhinitis: effect on symptoms and nasal airflow.

Local hyperthermia or inhalation of heated water vapor is often recommended as a home remedy for various nasal disorders such as the common cold and allergic rhinitis. With technical advances in vapor generation, water can be heated to a range of 41 degrees C to 43 degrees C with variation in particle size. The effect of inhaled heated vapor treatments was studied in patients with perennial rhinitis for changes in nasal airflow and patient perception of symptoms. Thirty symptomatic patients underwent three treatments at weekly intervals: (1) a large particle heated water vapor at 43 degrees C for 20 minutes with a particle size of 4 to 8 microns, (2) a molecular water vapor at 41 degrees C for 20 minutes which is a vapor phase, and (3) nasal irrigation. Nasal airflow increased after both vapor treatments at four and six hours (P < .05) whereas airflow decreased after simple nasal irrigation treatment. Rhinitis symptoms improved after vapor treatments but not with nasal irrigation. Patients preferred the molecular water vapor treatment over the large particle vapor treatment and nasal irrigation by 2:1 margin. This study demonstrated the usefulness of heated vapor treatments in improving rhinitis symptoms and nasal airflow.

Adolescent↗
PubMed1992

Ipratropium bromide aqueous nasal spray for patients with perennial allergic rhinitis: a study of its effect on their symptoms, quality of life, and nasal cytology.

Ipratropium bromide is an anticholinergic agent with topical activity that has been studied as a freon-propelled aerosol spray for therapy of nonallergic rhinitis. This is the first report of its use both as an aqueous nasal spray and in perennial allergic rhinitis. In this study 123 patients who had symptoms of perennial allergic rhinitis were randomized to receive ipratropium bromide 21 micrograms or 42 micrograms or placebo, one spray per nostril three times a day for 4 weeks. Patients maintained daily diaries of duration and severity of nasal symptoms and were evaluated weekly. Mean duration and severity of rhinorrhea was decreased in both ipratropium bromide treatment groups by comparison with placebo, with consistently greatest improvement in the group treated with ipratropium bromide 42 micrograms per nostril three times a day. No statistically significant differences occurred among treatment groups in duration or severity of postnasal drip, congestion, or sneezing. Seventy percent of patients treated with 42 micrograms of ipratropium bromide thought it had good or excellent effect on rhinorrhea (p less than 0.05 vs placebo); significantly more patients thought that it had improved the quality of life (p = 0.02). No changes occurred in nasal cytology, and no significant local or systemic adverse events occurred. These data indicate that ipratropium bromide significantly decreases the rhinorrhea of perennial allergic rhinitis.

Administration, Intranasal↗
PubMed1992

The anticholinergic treatment of allergic perennial rhinitis.

Anticholinergic agents have been used for nonallergic rhinitis expressly to control rhinorrhea. In allergic rhinitis, rhinorrhea can be extremely troublesome and unresponsive to traditional pharmacotherapeutic rhinitis treatments. Anticholinergic agents, through their specific ability to decrease nasal secretory response, should have beneficial effects for allergic rhinitis. In a recent trial ipratropium bromide at concentrations of 0.03% and 0.06% reduced rhinorrhea in allergic subjects without any demonstrable rebound effect. Therefore anticholinergic therapies may be a useful adjunct in controlling the rhinorrhea associated with allergic rhinitis.

Adolescent↗
PubMed1992

Inflammatory cells and mediator release during ragweed challenge: correlation between histamine content in nasal secretions and appearance of inflammatory cells.

The early and late phase responses in the nasal tissues exhibit release of inflammatory mediators and a mixed cellular influx in separate nasal challenges. To explore this phenomenon further, histamine concentration was determined along with characterization of cell influx during dose-dependent ragweed challenges. Ten subjects with allergic rhinitis underwent two unilateral nasal lavages using incremental 3-fold concentrations of short ragweed. Low doses of ragweed (0.016 to 0.114 units Amb a I) rarely induced cell influx (1/18 challenges), whereas moderate doses (0.432 to 1.3 units Amb a I) caused cell influxes in 7/18 and high doses (3.39 to 11.7 units Amb a I) resulted in cell influxes in 8/17. The eluent contained greater than 50% neutrophils in seven challenges; greater than 50% eosinophils in three; and a mixed pattern in six. There was a significant association between the dose of antigen and the level of histamine. Challenges with an eosinophilic influx tended to be associated with higher concentrations of histamine than neutrophilic influxes. Similar to the immediate skin response, the early allergic response in the nose demonstrated a cell influx with release of histamine. Nasal cellular inflammation therefore can occur within minutes of allergen exposure.

Adult↗
PubMed1991

Nasal inflammatory mediator release in ragweed allergic rhinitis: correlation with cellular influx into nasal secretions.

Lipid-derived mediators are found in nasal secretions during the early and late phase of allergic responses. To explore this early response further, concentrations of inflammatory mediators were measured along with characterization of specific cell influx during dose-dependent ragweed challenges. Ten allergic rhinitis subjects underwent two unilateral nasal lavages using 3-fold concentrations of short ragweed antigen. Low doses of ragweed (0.016-0.114 units Amb a I) did not provoke cell influx (1 of 18 challenges), whereas moderate doses (0.432-1.3 units Amb a I) induced cell influxes in 7 of 18 and at high doses in 8 of 17 challenges (3.39-11.7 units Amb a I). The differential of the cellular influx was greater than 50% neutrophils in 7 challenges; greater than 50% eosinophils in 3, and a mixed pattern in 6. There was a significant association between the dose of antigen and the level of prostaglandin D2 (PGD2), leukotrienes (LTs) C4, D4 and E4. Challenges with an eosinophilic influx tended to be associated with higher concentrations of mediators than neutrophilic influxes. Similar to the immediate skin response, the early allergic response in the nose demonstrated a cell influx with release of PGD2, LTsC4, D4 and E4. Nasal cellular inflammation therefore can occur within minutes of allergen exposure.

Allergens↗
PubMed1991

Anaphylaxis and desensitization to the murine monoclonal antibody used for renal graft rejection.

The murine monoclonal antibody muromonab CD3 is currently used to reverse acute renal graft rejection. We report a case of systemic anaphylaxis during a muromonab CD3 infusion despite pretreatment with systemic antihistamines and corticosteroids. Rapid intravenous desensitization was performed the following day without untoward reactions and daily muromonab CD3 infusions were successful in reversing renal graft rejection. A second rapid desensitization to CD3 was performed 1 month later without any complications. Serum muromonab CD3-specific IgG and IgE antibodies were detected in serum samples obtained after the anaphylactic reaction. The anaphylactic reaction to muromonoab CD3 monoclonal antibody could have been due to allergen-specific antibodies noted in postreaction serum or a cross-reactive antibody to mouse antigens or both. More importantly, this case illustrates that rapid desensitization can be performed successfully without serious complications; therefore, systemic anaphylaxis can develop in susceptible atopic individuals receiving muromonab CD3 monoclonal antibody for renal graft rejection.

Adolescent↗
PubMed1990

A double-blind study of the effectiveness of a high-efficiency particulate air (HEPA) filter in the treatment of patients with perennial allergic rhinitis and asthma.

This study was designed to assess the effectiveness of a high-efficiency particulate air (HEPA) filter in alleviating allergic respiratory symptoms. Thirty-two patients were studied who had symptomatic perennial rhinitis and/or asthma during the fall and winter months and had a positive skin test with house dust or house dust--mite extract. An ENVIRACAIRE room air cleaner was placed in the bedroom for 8 weeks. In a random manner, the active filter was used for 4 weeks and a blank filter for 4 weeks. There was an average 70% reduction in the particulate matter greater than or equal to 0.3 micron with the HEPA filter. In a double-blind design, results were assessed by analysis of the patients' symptom/medication scores and subjective evaluation. For the total study, there was no difference in the total symptom/medication scores or individual symptom scores during the placebo and active-filter periods. Analysis of the last 2 weeks of each filter period in which respiratory infection was absent demonstrated definite differences in total and individual symptoms, suggesting active-filter benefit. Patients' subjective responses also suggested benefit from the filter. The overall impression is that the HEPA filter can reduce allergic respiratory symptoms.

Adolescent↗
PubMed1989

Magnetic resonance imaging of the paranasal sinuses: frequency and type of abnormalities.

This retrospective study reports on sinus abnormalities detected in patients having magnetic resonance imaging (MRI) scans. Over a 12-month period, 1120 patients (aged 2-87 years) had MRI scans done for suspected intracranial pathology. Scans were reviewed independently for abnormal sinuses using four criteria: increased signal of the epithelial lining, cloudy or opacified sinus cavity, air-fluid levels, and intrasinus polyps. Thirteen percent of the 1120 patients had abnormal sinus images with the maxillary being the most involved cavity. A cloudy or opacified sinus was found in 43% of these cases. An increased signal to the epithelial lining was present in 44%. Intrasinus polyps were found in 27 paranasal sinus cavities (27 subjects). Furthermore, a seasonal pattern was evident for abnormal sinus scans. The months of July, August, September, and December had the highest frequency of abnormalities noted (greater than 16% of total scans done) whereas there was a low percentage (less than 8%) found during February and November. In summary, abnormalities of the paranasal sinuses occur frequently and vary with the time of year.

Adolescent↗
PubMed1988

Nasal pharmacodynamics of brompheniramine in perennial rhinitis.

This study evaluated the relationship between brompheniramine maleate and changes in nasal reactivity. Ten subjects with moderate-to-severe perennial rhinitis took brompheniramine for seven days using either a standard formulation or sustained-release preparation. Nasal aerodynamics and response to histamine were assessed at the end of the week. Despite varying doses of brompheniramine maleate (12 to 32 mg/d), there was no significant difference in nasal reactivity to histamine or in changes of nasal airflow, indicating that low doses of brompheniramine are highly effective in blocking histamine, receptors in the nasal mucosa.

Adolescent↗
PubMed1988

Adverse reactions to protamine sulfate during cardiac surgery in diabetic and non-diabetic patients.

The incidence of adverse reactions to protamine sulfate range from 0.06% to 27% and vary from mild urticaria to anaphylactic shock and death. In a retrospective analysis of 2996 patients, only four subjects experienced an adverse reaction due to protamine. Two individuals were NPH-insulin-dependent diabetics and two patients had exposure to protamine only during cardiac catheterization. Skin test titrations to protamine were done in three of four patients. One patient had a positive reaction at a 100-micrograms/mL dilution whereas the other two patients had positive reactions at 1000 micrograms/mL. In a comparable number of normal subjects, the threshold for a positive immediate skin response was 1000 micrograms/mL. Since the observed incidence of adverse reactions was 2.9% in NPH-insulin-dependent diabetics and 0.07% in non-diabetics, this represents a nearly 40-fold increased risk for diabetic patients (P less than .005). Skin testing appears to have limited applicability in the assessment of protamine sensitivity.

Anaphylaxis↗
PubMed1988

Eustachian tube function associated with histamine-induced and ragweed-induced rhinitis.

Nasal allergies may contribute to Eustachian tube dysfunction and chronic middle ear problems. In exploring this association further, Eustachian tube function was measured in ten ragweed-allergic and eight non-allergic patients undergoing repetitive nasal provocation. Anterior nasal provocation was done using paper disks impregnated with either histamine or aqueous ragweed allergen. Increasing concentrations of the provocative agent were placed on both inferior nasal turbinates until moderate symptoms of rhinitis developed. Eustachian tube function was evaluated using the 9-step inflation-deflation tympanometric test before and immediately after each nasal challenge. Eustachian obstruction developed in 4 of 38 non-allergic ears during histamine nasal provocation. With ragweed nasal challenge, 9 of 42 allergic ears developed Eustachian tube obstruction. Four allergic ears gained Eustachian tube function despite being obstructed before the challenge. The observed changes in ear function for both groups were not significant due to variability in Eustachian response. At the concentrations which initiated symptoms of rhinitis, nasal provocation with histamine or ragweed did not consistently obstruct the Eustachian tube. We conclude that mild symptoms of allergic rhinitis may not cause significant Eustachian tube obstruction.

Airway Resistance↗
PubMed1987

Practical diagnosis and treatment of allergic and nonallergic rhinitis.

Allergic and nonallergic rhinitis is a common chronic disorder affecting children and adults. Effective treatment includes a variety of pharmacologic agents: antihistamines, sympathomimetics, cromolyn, corticosteroids or parenteral immunotherapy. Correct diagnosis is crucial for selecting appropriate and beneficial therapy.

Adrenal Cortex Hormones↗
PubMed1986

Methylprednisolone versus prednisolone pharmacokinetics in relation to dose in adults.

The disposition and plasma binding of methylprednisolone were examined in seven normal volunteers following the administration of 5, 20 and 40 mg of intravenous methylprednisolone sodium succinate. Methylprednisolone exhibits linear plasma protein binding averaging 77%. The mean plasma methylprednisolone clearance of 337 ml X h-1 X kg-1 was independent of dose. The steroid appears to moderately distribute into tissue spaces with a mean volume of distribution of 1.41 X kg-1. Methylprednisolone disposition parameters were compared with the non-transcortin bound parameters for prednisolone. The prednisolone plasma clearance based on the transcortin free-drug is similar to methylprednisolone total plasma clearance. However, the corrected volume of distribution of prednisolone is only one-half that of methylprednisolone. The disposition rate of these two steroids is thus similar, in spite of their metabolic control by different enzymatic pathways and major influence of saturable transcortin binding on prednisolone elimination.

Adult↗
PubMed1986

Lack of correlation between titers of serum allergen-specific IgE and symptoms in untreated patients with seasonal allergic rhinitis.

In five ragweed seasons and three grass pollen seasons, preseason and postseason ragweed-specific serum IgE and nasal secretory-specific IgE and IgA have been measured in untreated patients with seasonal allergic rhinitis. There was no consistent correlation between severity of rhinitis, as measured by symptom/medication scores during the season, and either absolute or changes in antibody titers. These findings suggest that antibody levels are only one of the factors that determine symptom severity.

Adolescent↗
PubMed1986

Local intranasal immunotherapy with high-dose polymerized ragweed extract.

Thirty-one ragweed-allergic patients received preseasonal local intranasal immunotherapy (LNIT) with high doses of gluteraldehyde-polymerized ragweed extract (average total dose 544 micrograms antigen E). Minimal side effects were reported during treatment and did not interfere with the dosing schedule. During the ragweed pollen season, LNIT-treated patients had lower symptom scores for sneezing, rhinorrhea and nasal congestion than a comparable group of untreated ragweed-allergic patients. There was no difference in ragweed-induced eye symptoms between the two groups. Secretory ragweed-specific IgA and IgG rose following LNIT treatment. Absolute antibody titers and changes in titers did not correlate with clinical improvement. LNIT with the polymerized ragweed did not block the seasonal rise in serum ragweed-specific IgE. These results suggest that LNIT with high-dose polymerized ragweed extract is a safe, simple and effective form of immunotherapy.

Adult↗
PubMed1985

The applicability of rhinomanometry in nonatopic children: comparison of three techniques.

Three techniques for rhinomanometry were evaluated in 10 nonatopic children. Each child performed anterior, posterior, and forced oscillation rhinomanometry during 2 to 5 hr. Nasal airflow and transnasal driving pressure were measured continuously over several breaths. From the nasal airflow-pressure tracings, nasal airway resistance (Rn) was determined at a linear and a turbulent airflow. Individual average Rn values at linear airflow ranged from 1.0 to 5.4 cm H2O sec/L and at turbulent airflow from 1.5 to 7.6 cm H2O sec/L. There was no significant difference between the means on the log, scale of the individual average Rn measurements obtained by the conventional rhinomanometric techniques. Posterior and forced oscillation rhinomanometry exhibited a higher intrasubject variation in Rn than anterior rhinomanometry. In assessing performance, anterior rhinomanometry was the easiest method for the children to do. Two children despite multiple training sessions were unable to perform posterior or forced oscillation rhinomanometry. These findings indicate that anterior rhinomanometry is the easiest method for use in children.

Adolescent↗