Biomedical subjects
M S Blaiss
Publications and source records attributed to M S Blaiss.
Outcomes analysis in asthma.
Physicians, patients, employers, managed care organizations, insurance companies, and government all want to know how different approaches to management of asthma are improving care. To this end, the field of outcomes analysis in asthma is playing a major role. Clinical, physiologic, humanistic, and economic outcomes are being assessed using different types of general and asthma-specific instruments. Historically, clinical and physiologic outcomes have been of most concern to clinicians. However, humanistic outcomes, such as health-related quality of life and patient satisfaction, shift the focus to the patient. Economic outcomes, especially cost-effectiveness, evaluate how to achieve the best outcomes at the lowest cost. These outcomes have been used to evaluate asthma intervention programs. Several large asthma outcomes research projects, which should define the future of outcomes analysis in asthma, are under way.
Airway fluoroscopic diagnosis of vocal cord dysfunction syndrome.
BACKGROUND: Vocal cord dysfunction syndrome is often misdiagnosed as refractory asthma. Airway fluoroscopy has recently been proposed as an alternative to laryngoscopy in the initial evaluation of certain cases of suspected vocal cord dysfunction. OBJECTIVE: To evaluate the use of airway radiographs and fluoroscopy in a patient with suspected vocal cord dysfunction. METHODS: We used soft tissue technique airway radiographs and fluoroscopy to evaluate the glottic function during inspiration and expiration in a 9-year-old boy with refractory asthma and suspected vocal cord dysfunction. RESULTS: The study confirmed paradoxical vocal cord motion. CONCLUSIONS: Airway radiographs and fluoroscopy provide a rapid and noninvasive means of diagnosing vocal cord dysfunction. Patients should still have laryngoscopy performed at the earliest possible moment to rule out the possibility of other laryngeal abnormalities.
Aerosols and delivery devices in asthma management.
Explore the source record for details and available documents.
Cell-mediated immune status of children with recurrent infection.
OBJECTIVE: To evaluate the cell-mediated immune status of children with recurrent respiratory tract infections. DESIGN: We evaluated the cell-mediated immune status of 76 patients referred because of recurrent infection. Patients were divided into those with serologic abnormalities and those without such findings. Twenty-three healthy children served as control subjects. Studies of lymphocyte phenotype included CD4+ CD29+ cells (an immunologically mature phenotype), lymphocyte proliferation studies, cytokine production including interleukin-2 (IL-2), IL-4, IL-6, and interferon gamma), and measurement of in vitro IgM and IgG synthesis. RESULTS: Lymphocyte proliferation and T-cell phenotype were similar in both patient groups as well as in control subjects. The proportions of CD4+ CD29+ cells at different ages were similar in all groups. Patients with serologic abnormalities (e.g., partial IgA deficiency, partial IgG subclass deficiency) produced more IL-2 and IL-4 than did other patients. The control population had greater spontaneous IgM and IgG synthesis than the patient groups. CONCLUSION: Routine studies of T-cell function of patients with recurrent infection provide little information useful in making clinical decisions.
Exercise-induced asthma and the athlete.
Explore the source record for details and available documents.
A seven-year-old boy with sinusitis, otitis media, and asthma.
A 7-year-old boy with recurrent otitis media, bronchitis, pneumonia, asthma, and sinusitis was found to have primary ciliary dyskinesia. It was important to rule out other systemic diseases such as immune deficiency and cystic fibrosis. Electron microscopy of a properly obtained and prepared biopsy of the mucosal surface of the nose, trachea, or bronchus is essential.
A 4-year-old girl with chronic pruritic rash.
Explore the source record for details and available documents.
Role of immunoglobulin subclasses and specific antibody determinations in the evaluation of recurrent infection in children.
We studied humoral immune function in 267 children with recurrent respiratory infections referred to our immunology clinic to determine the most appropriate immunologic studies for evaluating recurrent infections in children. Of this highly selected population, 58% had a partial deficiency in one or more of the major immunoglobulin isotypes or IgG subclasses (defined as at least 2 SD below the normal age-adjusted mean). In none of the patients was there a total absence of an immunoglobulin isotype. The most common abnormality was partial IgA deficiency, which was found in one third of the patients. Twenty-six patients had only partial IgG subclass deficiencies, of which 20 were deficiencies of a single subclass. IgG1 was an isolated partial defect in three patients, IgG3 in five patients, and IgG2 and IgG4 were selective partial defects in six patients each. Tetanus toxoid and pneumopolysaccharide type 3 were the most immunogenic of the immunogens tested; hyporesponsiveness to pneumococcal polysaccharide types 7, 9, and 14 was common. Nineteen percent of the patients with normal immunoglobulin concentrations who were tested had lower-than-expected antibody titers; 42% of those tested with partial isotype deficiencies had deficient antibody responses. Of 25 patients with selective partial IgG subclass deficiencies or combined IgG subclass deficiencies, eight had antibody deficiencies. Our findings indicate that a high proportion of children referred to immunology clinics for recurrent infection have a demonstrable immunologic abnormality. Selective IgG subclass deficiency or a combined IgG subclass deficiency without an associated deficiency in a major immunoglobulin isotype is unusual. Identification of such patients is not predictive of the capacity to form antibodies to the antigens tested in this study and, in our opinion, adds little to the initial evaluation of immune function in such children.
Proving penicillin allergy.
Allergic reactions to penicillin are usually short-lived and reversible, but they can be fatal. What causes these reactions? Can they be avoided? How is the risk of penicillin allergy evaluated? Drs Erffmeyer and Blaiss describe the full spectrum of allergic, immune, and nonimmune reactions to penicillin and discuss how to assess and treat patients with suspected penicillin allergy.
Drug allergy.
Adverse reaction to drugs is a common problem in the pediatric population. This article discusses the different types of adverse drug reactions and their mechanisms. Also included are representative clinical syndromes of drug hypersensitivity reactions, as well as certain organ systems syndromes. Finally, diagnosis and management of allergic reactions to particular drugs such as penicillin, iodinated contrast dye, insulin, and others are discussed.
Anaphylaxis to cabbage: detection of allergens.
Allergy to cabbage and other foods in the Brassica family has rarely been observed in man. We report a case of facial and throat swelling in an atopic female after she ingested coleslaw on two separate occasions. She had 4+ reactions to cabbage, mustard plant, cauliflower, and broccoli by skin testing. A RAST using cabbage extract was positive for specific IgE antibody. Analysis of cabbage extract by gel filtration showed five peaks of ultraviolet-absorbing material at 280 nm. Allergenic activity was demonstrated by RAST inhibition in two fractions of the cabbage extract. This report confirms IgE sensitivity can occur to foods in the Brassica family.
How helpful is the radioallergosorbent test in the diagnosis of allergic disease?
We compared the results of clinical history, skin testing, and radioallergosorbent test (RAST) scores on 274 patients seen in an allergy clinic, using nine different allergens, namely ragweed, oak, Bermuda grass, redtop, Timothy, Alternaria, cat hair, house dust, and dust mite. More than 90% of patients who reported clinical allergy to pollens had a positive skin test to the respective allergen. Only two thirds of these patients also had a positive RAST, while only one patient in this group had a positive RAST and a negative skin test. Of the patients reporting allergy to cat hair, 60% had a positive RAST but only 46% had a positive skin test. For the case of dust allergy, there was poor agreement between test results and history, since more than half of the patients who reported symptoms from dust exposure had a negative RAST and negative skin test results.
Occipital headache as a manifestation of giant cell arteritis.
Explore the source record for details and available documents.
Beclomethasone dipropionate aerosol: hematologic and immunologic effects.
Inhaled beclomethasone dipropionate aerosol is a topically active corticosteroid that has proved to be of great value in treating asthma. The authors have examined the effect of inhaled beclomethasone dipropionate aerosol on circulating leukocytes and on immunological measurements in normal adult subjects. Subjects inhaled either 400 micrograms or 1600 micrograms as a single dose. White blood cell counts, total neutrophil counts, total eosinophil counts and total lymphocyte counts were determined at 0, 2, 4 and 6 hours following an 8:00 a.m. inhalation. Among the 11 subjects who inhaled 400 micrograms, the total white blood cell count increased significantly at six hours (p less than 0.05). The total neutrophil count was increased significantly at 2, 4 and 6 hours (p less than 0.05). Total eosinophil counts and total lymphocyte counts were diminished but not significantly. Among the five subjects inhaling 1600 micrograms similar findings were observed. Seventeen volunteers inhaled 200 micrograms of beclomethasone dipropionate qid for 24 hours. In addition to the above studies, T and B cell numbers were determined and lymphocyte transformation studies were performed. Although trends similar to those observed with single larger dose inhalations were seen, the changes were not statistically significant. The results of these studies indicate that inhaled beclomethasone dipropionate does have the potential to affect circulating leukocytes.
Prevalence of latex sensitivity in children evaluated for inhalant allergy.
We prospectively examined 80 children referred to a university allergy/immunology clinic for evaluation for inhalant allergies to determine the prevalence of latex hypersensitivity in this group. All children were skin tested with a Multi-test device to 35 inhalant allergens and a latex glove extract. Only one child gave a questionable history of latex sensitivity, but her skin test was negative. Three of 44 (6.8%) atopic children had a positive latex skin test (wheal greater than 4 mm); none of the 36 nonatopic children had a positive latex skin test. Two of the three children had a history of two or more surgical procedures but denied any clinical hypersensitivity reactions during surgery. Previous reports have demonstrated a personal history of atopy and of surgical procedures as risk factors for the development of latex hypersensitivity. This study helps verify these risk factors and should increase the awareness of this possible health hazard in this select group of children.