Biomedical subjects
Publications and source records attributed to M S Blaiss.
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.
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.
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.
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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.
The goals of asthma treatment have broadened beyond managing traditional clinical markers of disease severity, and now include a focus on benefits of treatment in terms that are most meaningful to patients. Measurement of both generic and disease-specific health-related quality of life (HQL) is advocated because each provides complementary information about how the condition affects everyday functioning and well-being and whether treatments have their intended effects. The purpose of this study was to determine the impact of changes in asthma severity (defined using NHLBI/NAEPP severity staging) on patient-assessed HQL. Two hundred and thirty-three pediatric asthma patients and 269 adult asthma patients were evaluated in a one-year observational study. Analyses were performed to compare the generic and asthma-specific scores for patients whose asthma severity improved, stayed the same, or worsened over one year. The asthma-specific scales are sensitive to changes in disease severity. Of the generic scales, those tapping areas of physical health are more affected than the mental/emotional scales. This confirms that HQL measures are responsive to changes in asthma severity. They complement traditional clinical markers used to evaluate changes in a patient's disease state and thus give the physician another useful tool in following the clinical progress of the child with asthma.
Allergic rhinitis is a highly prevalent, chronic condition. In addition to physical discomfort, rhinitis symptoms have been associated with detrimental effects on the psychological and social aspects of patients' lives. In allergy-specific questionnaires, subjects with allergic rhinitis consistently report lower quality of life than nonallergic controls. Untreated patients are embarrassed and frustrated by their allergy symptoms. Atopic individuals consistently exhibit significant declines in cognitive processing, psychomotor speed, verbal learning, and memory during allergy season. The discomfort, cognitive impairment, and absenteeism associated with allergic rhinitis exact a significant economic toll on U.S. businesses through decreased productivity. When combined with direct medical expenditures, the economic burden of allergic rhinitis is considerable. The effect of treatment on the economics of allergic rhinitis is highly variable: relatively inexpensive medications (lower direct costs) have central nervous system side effects that can cause somnolence and impair learning, memory, and performance (higher indirect costs). Health outcomes data on the effects of allergic rhinitis and its treatments can help establish, monitor, and improve standards of care; as well as inform priority setting, direct resource allocation, and eliminate unnecessary practices.
The incidence and severity of pediatric asthma continues to increase in developed countries throughout the world. In determining what works best in the management of the asthmatic child, outcome measurements specific for this population have been developed. There are three major categories of outcomes that should be addressed in pediatric asthma. First are the clinical and physiologic measurements, which include lung functions, clinical symptoms, and number of emergency department and hospital visits. Measurement of both generic and disease-specific health-related quality of life (HQL) is advocated because each provides complementary information about how the condition affects everyday functioning and well-being, and whether treatments have their intended effects. Finally, economic outcomes should be considered, which include direct costs, such as physician and medication costs, and indirect costs, such as missing school or the parents missing work due to their child's asthma.
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.
This article will review four new medications for the treatment of asthma. Extensive studies have been undertaken with these medications to demonstrate their efficacy. All these agents, in use in other countries, are presently in different stages of review by the Food and Drug Administration. This review will give physicians an understanding of these medications, so when they are approved in the United States, the clinician will have an idea of their proper place in treatment of the asthmatic patient.
Outcomes research is becoming an integral part of the sweeping changes occurring in the U.S. health care system. By developing outcomes monitoring systems in allergic disorders, allergists will be able to collect information showing their commitment to excellent clinical care, which improves the patient's quality of life in a cost-effective way. Outcomes data is also important in determining the number of allergists that need to be trained, appropriate therapeutic regimens for allergic disorders, evaluating differences in practice styles of allergists throughout the country, and in revising practice parameters in allergic disorders. Through the Joint Council of Allergy, Asthma, and Immunology, a subcommittee on outcomes was formed. This subcommittee awarded a national asthma outcomes monitoring project to The Health Institute, New England Medical Center, Boston. This project, which will be in three phases, will generate information on outcomes of board-certified allergists in asthma care. Another goal of this project will be to produce standardized instruments and collection methods, which will be made available for use by all allergists to collect their own outcomes data.
Most clinical studies of inhaled nasal corticosteroids have established comparable safety and efficacy; therefore, there remains little to distinguish the various products from each other in the treatment of allergic rhinitis. However, patient preference is recognized increasingly as an important factor in selecting appropriate treatment. This review discusses the different methodologies that have been used to measure patient preference for intranasal corticosteroids. Patient questionnaires and other instruments for assessment that are used to measure such preferences are discussed as well as several different study designs. Now, the challenge is to implement more studies that show the reliability and consistency of instruments used to assess patient preference.