Clinical Presentation

The most consistent feature distinguishing acute bacterial from a viral upper respiratory infection is persistence of symptoms beyond 7-10 d (Table 2). Cough and nasal discharge are the two most common complaints in children, whereas headache and facial pain are unusual in children younger than age 10. Adult patients with acute sinusitis most often complain of discolored nasal discharge, unilateral facial pain, headache, and cough. Although reported in only a minority of patients, upper tooth...

Definitions and Epidemiology

Sinusitis is a clinical condition characterized by mucosal inflammation of the paranasal sinuses. Acute bacterial sinusitis is a rapid-onset infection that most commonly develops following a viral upper respiratory infection. it is defined by symptom duration of less than 1 mo and most commonly affects the maxillary sinuses. Recurrent acute siinusitis is defined by episodes of bacterial infection of the paranasal sinuses, each lasting less than 30 d and separated by intervals of at least 10 d,...

Rhinitis Associated With Systemic Diseases or Anatomical Defects

The presence of systemic findings or the persistence of nasal symptoms despite treatment should prompt consideration of systemic diseases or anatomical problems resulting in nasal symptoms. Structural problems typically will present with a predominance of unilateral symptoms or initially unilateral symptoms. Nasopharyngoscopy, paranasal computed tomography, and or otolaryngological consultation are major considerations with lateralizing nasal complaints or bleeding noted from one nasal airway...

Rhinitis Induced by Drugs or Hormones Rhinitis Medicamentosa

Topical use of a-adrenergic decongestant sprays for more than 5-7 d in succession may result in a rebound nasal congestion upon discontinuation of treatment or after the immediate effects have waned. Continued use of the decongestant to control withdrawal congestion can lead to an erythematous, congested nasal mucosa termed rhinitis medicamentosa. Regular intranasal cocaine use will have the same effect and should be considered in the differential diagnosis. Other systemic medications or...

Clinical Asthma Symptoms

The classic symptoms of asthma include intermittent, reversible episodes of airflow obstruction manifested by cough, wheezing, chest tightness, and dyspnea (Table 10). When the clinical situation permits, a detailed history (Table 11) should be taken that includes the following (l) family and personal history of atopic disease (2) age of onset of asthma, frequency and severity of attacks (3) times (including seasons) and places of occurrence of asthmatic attacks (4) known provocative stimuli...

Perennial Nonallergic Rhinitis

Perennial nonallergic rhinitis (PNAR) is a term used to designate a heterogeneous group of disorders that share clinical features. The pathophysiology is not completely defined, and nasal histology does not correlate with symptoms. PNAR is common, representing 30-60 of subjects referred to an allergy immunology or otolaryngology clinic for evaluation. PNAR coexists with allergic rhinitis in more than 50 of adults with allergic rhinitis, a condition referred to as mixed rhinitis. Mucosal...

Suggested Reading Sinusitis

Gwaltney JM, Jr, Phillips CD, Miller RD, Riker DK. Computed tomographic study of the common cold. N Engl J Med 1994 330(1) 25-30. Hickner JM, Bartlett JG, Besser RE, Gonzales R, Hoffman JR, Sande MA American Academy of Family Physicians American College of Physicians-American Society of Internal Medicine Centers for Disease Control Infectious Diseases Society of America. Principles of appropriate antibiotic use for acute rhinosinusitis in adults background. Ann Intern Med. 2001 134(6) 498-505....

Evaluaton of Patients With Recurrent or Persistent Sinusitis

Fifty percent of children and 30-40 of adults with recurrent or chronic sinusitis are sensitized to common aeroallergens such as plant pollens, house dust mite, and animal danders. Assessment of IgE-mediated hypersensitivities by allergy skin testing or in vitro blood assays should therefore be performed in all patients because they may benefit from a comprehensive program of allergen avoidance, anti-allergic drug therapy, and, in selected cases, immunotherapy. Patients with severe, recurrent...

Treatment Of Urticaria And Angioedema

In the primary care setting, the common encounter is with that patient who develops acute urticaria following the ingestion of a food or medicine to which he or she is allergic. The patient with an acute allergic reaction often develops urticaria with or without an-gioedema. If the allergic response extends beyond the skin, bronchospasm, laryngeal edema, or hypotension from cardiovascular collapse might occur. However, in the case of urticaria and angioedema, the patient is treated first by...

P Lactam Antibiotics

In patients with a history of an allergic reaction to penicillin or other p -lactam antibiotics, penicillin skin testing should be done electively. Only 20 of adults and 10 of children with this diagnosis turn out to be actually allergic based on allergy skin testing (the positive penicillin allergy skin test rate is higher in the first year after labeled allergic to penicillin). 1. In many cases, the original reaction, usually a rash, is a result of an infection (usually viral) rather than the...

Other Food Intolerance Reactions That May Be Confused With Allergy

Reactions, such as anaphylactoid events following ingestion of scromboid fish protein, are described under Mechanisms. Urticaria may occasionally occur following ingestion of certain foods containing histamine or as histamine reactors as listed in Table 3. Examples include cheese, alcohol, red wine, or strawberries. One of the most common gastrointestinal problems that is confused with milk allergy is primary (and secondary) lactose intolerance. The pathogenesis of this reaction is described...

Reasons For Lack Of Benefit From Immunotherapy

The reasons for lack of benefit from allergen immunotherapy include (1) inappropriate treatment with such therapy of non-IgE-mediated disease, such as chronic nonallergic rhinitis or vasomotor rhinitis (2) utilization of low-potency allergen vaccines (3) administration of inadequate doses of allergen (4) ineffective environmental control resulting in continued excessive exposure, for example, to cat or dog dander (5) a coexistent medical problem, such as sinusitis and nasal polyps, which...

Therapeutic Drug Monitoring

The rationale for therapeutic monitoring of theophylline serum concentration is that it is a major determinant of both efficacy and toxicity. Theophylline has a narrow therapeutic index, which makes it imperative for the physician to understand that serum concentration may be affected by many factors that affect liver microsomal enzyme function and alter elimination kinetics. During the treatment of an acute exacerbation of asthma, a serum theophylline level should be determined before...

Cessation of Venom Immunotherapy

Definitive criteria for safe cessation of VIT are still evolving. These include immuno-logical criteria and a specific period of treatment unrelated to the persistence of IgE antibody (Table 4). In my opinion, conversion to a negative skin test is an absolute criterion for stopping therapy, indicating that the IgE antibody, the immune mediator of this reaction, is no longer present. In my experience approx 20 of individuals will convert to a negative skin test after 3-5 yr of VIT. Three to five...

Antileukotrienes Where Do They Fit In Your Practice

In the 2002 NAEPP guidelines, antileukotrienes are recommended for therapy in patients who have mild or moderate persistent asthma. In the 2002 Global Initiative for Asthma guidelines, antileukotrienes are recommended for therapy in patients who have mild, moderate, or severe persistent asthma. Montelukast is indicated for use in patients aged 12 mo and older, and zafirlukast is indicated for use in patients aged 5 yr and older with chronic asthma. Montelukast is also indicated for use in...

Dust Mite Allergen

Exposure to house dust in sensitized individuals is a common trigger of allergic symptoms. House dust is a complex mixture of materials and contains many different allergens, including products derived from household animals, bacteria, fungi, and insects. One of the major allergen components of house dust is produced by dust mites. Dust mites are microscopic arthropods related to spiders. There are two major dust mite species Dermatophagoidespteronyssinus and Dermatophagoides farinae. Dust...

Pharmacokinetics Absorption

Theophylline is rapidly absorbed from orally administered liquid and uncoated tablets and from rectally administered (as an aminophylline) solutions. The absorption profile of rectally administered theophylline looks very much like that seen after intravenous (i.v.) administration. Theophylline suppositories (erratically absorbed) are no longer manufactured in the United States. The speed, but not the extent, of absorption is affected to a clinically insignificant degree by concurrent ingestion...

Morgan Knight Mary E Paul md and William T Shearer md phd

Introduction Presentation Family History The Immunodeficiency Disorders Antibody Disorders T-Cell and Combined Disorders Phagocytic Defects Complement Defects Diagnostic Tests Treatment Suggested Reading Perhaps the most common complaints in the primary care physician's office are related to the common cold. The miseries induced by the common cold virus prompt patients afflicted to seek medical care with expectations of relief prompted by the fact that physicians can successfully transplant...

Approach to the Allergic Patient

Esinophil Allergic Disease

Physical Examination Allergy Testing Diagnostic Studies Conference Suggested Reading Allergic disease is protean in its manifestations, affecting single or multiple organ systems. It may also mimic other conditions. The clinician must be prepared to take an in-depth history, make a comprehensive physical examamination, and seek appropriate objective measures in order to adequately consider the differential diagnosis and arrive at a proper diagnosis. No less important is the conference with the...

Tcell And Combined Disorders

Primary disorders of T-cell function and combined T-cell defects come in many forms. One combined immunodeficiency, Wiskott-Aldrich syndrome (WAS), results from defects in the gene for the WAS protein (WASP), encoded on the X chromosome. WASP is a complex protein that functions in phagocytosis of microorganisms and apoptotic cells and regulation of cytoskeletal architecture in T-cells and platelets. WAS results in to profound humoral and cellular deficiency hallmarked by eczema, excessive...

Physical Findings

In the completely asymptomatic patient, results of chest examination will be normal, although head, eye, ear, nose, and throat examination may disclose concomitant serous otitis media, allergic conjunctivitis, rhinitis, nasal polyps, paranasal sinus tenderness, signs of postnasal drip, or pharyngeal mucosal lymphoid hyperplasia. Clubbing of the fingers is extremely rare in uncomplicated asthma, and this finding should direct the physician's attention toward diseases such as bronchiectasis,...

Pathogenesis Role of Allergens

There is a strong correlation of atopic dermatitis with other atopic conditions such as asthma and allergic rhinitis. The term atopic march has been coined to define the natural history of atopic diseaases characterized by a sequence of progression in the clinical signs of atopic disease with some manifestations becoming more prominent while others subside. Typically, the cutaneous manifestations represented by AD represent the beginning of the atopic march, with approx 50 of patients with AD...

Pathophysiology Of Urticaria And Angioedema

Mast cells and basophils have high-affinity receptors for IgE on their surfaces. If an individual develops a specific IgE response to an antigen, re-exposure to that antigen has the potential of crosslinking IgE on the mast cell or basophil, causing cellular degranulation. Degranulation of mast cells and basophils results in histamine release as well as prostaglandin D2 and leukotriene C4 from mast cells, plus other mediators of inflammation. If the mast cells are located in the skin, the...

Antibody Disorders

Immunodeficiencies primarily affecting IgG antibody production usually do not result in recurrent infection until after maternal antibody wanes at 6-12 mo of age. Bruton's disease or X-linked agammaglobulinemia (XLA) is a primary immunodeficiency that is characterized by an inability to produce antibody because of the absence of mature B-cells. The defect resides in a gene, labeled the btk gene for Bruton tyrosine kinase, which is located on the X chromosome. Bruton tyrosine kinase is necessary...

Airway Inflammation

The mucosa of patients who have died in status asthmaticus contains mixed cellular infiltrates consisting of eosinophils, neutrophils, macrophages, lymphocytes, mast cells, and plasma cells. In the airway lumen, admixed in the abundant secretions are eosinophils and eosinophil-derived Charcot-Leyden crystals, neutrophils, and desquamated clumps of epithelial cells (Creola bodies). The same pathological changes are found in the lungs of allergic or nonallergic asthmatics, suggesting that there...

Allergic Asthma Overview

More than 50 controlled immunotherapy trials have been performed with a variety of allergens for seasonal, perennial and animal-induced asthma. Vaccines of rye grass, mixed grasses, ragweed, birch, mountain cedar, Alternar a spp, Cladospor um spp, house dust mites, cat, dog, and cockroach have been used in these trials. Collective analysis of these studies provides important insight, but comparisons among studies are difficult because of varied study designs. Of these studies, 42 demonstrated...

Antileukotrienes In Chronic Asthma Studies

The CysLT1 receptor antagonists montelukast and zafirlukast have been shown to improve asthma control in adult and pediatric asthmatics when given alone and in combination with inhaled steroids*. These studies are described here. The efficacy of montelukast and zafirlukast were demonstrated in placebo-controlled trials submitted to the US Food and Drug Administration for the approval for use in chronic asthma. Compared to placebo, montelukast has been shown to improve pulmonary function (forced...

Classification of Asthma

Asthma may be divided into four clinical phases, based on symptoms and pulmonary function testing. These stages allow physicians to communicate about asthma severity and provide general guidelines on treatment. The four categories include mild intermittent asthma, mild persistent asthma, moderate persistent asthma, and severe persistent Table 13 Classification of Asthma Severity Table 13 Classification of Asthma Severity Normal between attacks Attacks brief and usually mild less than daily...

Dietary Restriction

In patients with food hypersensitivity, food-allergen avoidance results in improvement of AD. Sampson and coworkers have shown that following a strict avoidance diet of relevant food allergens patients experience symptomatic relief of pruritus and clearing of skin rash. Because of the high false-positive rate of prick skin testing and standard RAST for food allergens, an elimination diet followed by a blinded (single- or doubleblind) or open food challenge should be performed to confirm...

Environmental Allergens

Eggleston, md Introduction Outdoor Allergens Indoor Allergens Suggested Reading Airborne allergens in the outdoor environment are associated primarily with pollen grains and mold spores and usually induce seasonal symptoms. Exposure varies according to geographic location, season, and weather conditions. Indoors, allergenic proteins derived from house dust mites, furred pets, mold, and pests, such as mice and cockroaches, may induce perennial symptoms. A...

Allergic Disease

The Allergic Reaction A Scenario Aspects of IgE Production The Mast Cell Effects of Mast Cell Mediators on Target Organs Allergic Inflammation A TH2-Mediated Response The incidence of asthma and allergic disease is rising. However, primary care physicians have dealt with allergic conditions far more often than they may expect even before the development of these recent epidemiological trends. Some examples of immunological disease that the primary care physician has encountered include asthma,...

IgE Food Allergy Skin Testing or In Vitro Food Allergen Specific Antibody Testing

Confirming the Diagnosis of an Adverse Food Reaction DBPCFC is the gold standard for the diagnosis of an adverse reaction to food. A positive DBPCFC does not identify the mechanism of reaction. In most cases of systemic (life-threatening) anaphylaxis, a DBPCFC is not clinically necessary since it is risky the presence of IgE allergen-specific antibody can help establish a presumptive diagnosis. Food diaries and short-term elimination diets at home may be helpful tools, but in themselves do not...

Differential Diagnosis Of Asthma

Not all that wheezes is asthma Diseases in which wheezing is a component are listed in Table 7. Asthma, chronic bronchitis, and emphysema affect the airways diffusely, cause airway obstruction, and may coexist in the same patient. Generally, chronic bronchitis occurs in cigarette smokers who develop chronic cough that persists for years before airflow becomes symptomatically obstructed. The bronchorrhea may vary in intensity in relation to infectious or irritant exposure, for example. Chronic...

Efficacy of Oral Glucocorticoid Therapy in Asthma

Effect on Bronchial Hyperresponsiveness Bronchial hyperresponsiveness (BHR), or airway twitchiness, is an essential feature of asthma. BHR has been shown to correlate with disease severity, frequency of symptoms, and need for treatment. Although the precise relationship remains elusive, airway inflammation is thought to contribute to BHR. High-dose prednisone therapy has been shown to improve pulmonary function and BHR in both adults and children with asthma. Reductions in bronchoalveolar...

Coclusion Of Allergic Diseases

Both nedocromil sodium and cromolyn sodium are useful anti-inflammatory drugs in the therapy of allergic diseases. These diseases include asthma, allergic rhinitis, and allergic ocular disorders. Additional therapeutic uses have been proposed. Nedocromil and cromolyn are both available in the United States for asthma therapy, but only cromolyn is available for the treatment of the other conditions. Recent publications in the evidence-based literature have upheld the safety profile of the...

Uses of Antihistamines

It is quite clear that nonsedating second-generation antihistamines are the recommended first line of therapy for patients with allergic rhinitis (Table 5). They are usually sufficient to treat symptoms of sneezing, rhinorrhea, and itching associated with mild to moderate allergic rhinitis. They are also helpful for ocular symptoms. However, with the exception of azelastine, little effect on nasal congestion is seen. There is no distinct difference in the efficacy between first- and...

Treatment of Concomitant Diseases and Conditions

Many asthmatics will only respond once their concomitant sinusitis, GERD, thyroiditis, emotional stress, or pregnancy is under control. Moreover, the treatment of asthma requires close attention to concomitant colds, flu, bronchitis, environmental irritant or pollutant inhalation, recreational drug use, and emotional changes. Compliance is a significant problem, both with medication use and allergen avoidance and inhaler techniques. Thus, the physician who treats asthma needs to keep the whole...

Differential Diagnosis Allergic Rhinitis

Allergic rhinitis is the most prevalent form of rhinitis and should be considered in any individual presenting with nasal complaints. Other possible diagnoses are listed in Table 1. The principal factors utilized in distinguishing allergic rhinitis from the other conditions are summarized in Tables 5 and 6, with history being the most important. The diagnosis of allergic rhinitis is presumptive until specific allergic sensitivity is identified by epicutaneous or percutaneous testing or in vitro...

Differential Diagnosis

The differential diagnosis of anaphylaxis and anaphylactoid events is listed in Table 6. The most common condition mimicking anaphylaxis is the vasodepressor (vasovagal) reaction. Most of these events precede emotional trauma or a threatening event. Hypotension, pallor, diaphoresis, weakness, nausea, vomiting, and bradycardia are classically seen in these reactions. Patients lack the urticaria, pruritus, angioedema, tachycardia, and bronchospasm that are commonly seen in anaphylaxis. The...

Suggested Reading

Casaburi R, Mahler DA, Jones PW, et al. A long-term evaluation of once daily inhaled tiotropium in chronic obstructive pulmonary disease. Eur Respir J 2002 19 217-224. Ducharme F, Davis GM. Randomized controlled trial of ipratropium bromide and frequent low doses of salbutamol in the management of mild and moderate acute pediatric asthma. J Pediatr 1998 133 479-485. Garrett JE, Town GI, Rodwell P, Kelly A. Nebulized salbutamol with and without ipratropium bromide in the treatment of acute...

Conditions Associated With Exacerbations Of Asthma

Several clinical conditions are closely associated with and may worsen asthma by diverse mechanisms. An association between asthma and concomitant sinus disease has been recognized since the early part of the century and has been reconfirmed repeatedly both in children and adults. It is estimated that 60-75 of severe asthmatics have concomitant sinusitis and that 20-30 of sinusitis patients have asthma. Slavin treated 33 adults with asthma and concomitant sinusitis medically or surgically....

Targeting BCells Expressing IgE

IgE-expressing B-cells are the crucial targets for blocking off the IgE-related pathways and include (1) IgE-expressing lymphoblasts on their way of maturation to become plasma cells and memory cells and (2) IgE-expressing memory B-cells. There are two ways to inhibit, downregulate, and or eliminate those cells. One is to target the B-cells directly, and the other is to reduce the generation of those cells. Since mIgE is a part of the B-cell receptor and the gate for receiving antigens and...

The Hands

Hand eczema is a very special problem because there is commonly more than one cause for the eruption. Contact dermatitis of the hands is often irritant with dry scaly patches, which in some atopics are converted to a discoid eczema. Dermatitis under a ring is usually an irritation from soap. Occupational factors are important because persons handling raw meat (e.g., slaughterhouse, chicken processing and fishery workers, butchers and chefs), those engaged in wet work, and mothers with small...

Unconventional Theories Of Allergy

The principal theories on which most of the unproven allergy practices are based are listed in Table 1. So-called allergic toxemia is the basis for a number of these practices. It is comprised of two mistaken components. It postulates that allergens are inherently toxic and that virtually any subjective symptom in the absence of objective evidence of pathology can be attributed to allergy. In fact, most allergens are nontoxic in the usual dosage and manner of exposure necessary to either induce...

Future Therapeutic Options for Allergic Rhinitis

Future therapies for allergic rhinitis may include immunomodulators such as monoclonal anti-IgE (omalizumab), inhibitors of inflammatory cell immigration into the nasal mucosa, and anti-inflammatory therapies. Omalizumab binds to soluble IgE and also results in a reduction in the high-affinity receptor for IgE on mast cells and basophils and possibly on select dendritic cells. If dosed according to the recommendation of 0.16 mg kg U IgE, the free plasma IgE concentration is reduced to approx 15...

Patch Testing

The most important confirmatory test in allergic contact dermatitis (and in establishing a diagnosis of irritant dermatitis) is the patch test. Here one attempts to prove the presence of allergy by reproducing the disease in a controlled situation. Usually standard commercial allergens (Table 3) are used for screening examinations. There are two commercially available sources of patch test materials in Canada or the United States. One set, available from Chemotechnique or Trolab as the European...

Emergency Treatment

For first aid management, it is advised to use epinephrine (0.2-0.5 mg in adults 0.1 mg per kg to a maximum of 0.3 mg in children ) im as soon as possible after the symptoms begin, even though these early signs of anaphylaxis may be mild. Although the reaction to food may remain mild (e.g., symptoms confined to the skin) and an antihistamine would relieve symptoms, rapid progression to a life-threatening situation can also occur. Therefore epinephrine is advised (with or without...

Systemic Glucocorticoid Therapy Pharmacokinetics

The pharmacokinetics of GCs can influence dosing strategies however, in general, GC dosing regimens are not dependent on pharmacokinetic parameters. Rather, dosing is either empirical or based on the patient's history of prior response. Exceptions to this Mechanisms of Glucocorticoid Action in Asthma Inhibition of leukocyte adhesion migration Inhibition of leukocyte activation, function, and survival T-lymphocytes Eosinophils Monocyte macrophages Inhibition of the production of cytokines...

Jonathan Corren md and Gary Rachelefsky md

Sinusitis Otitis Media Suggested Reading Sinusitis occurs in both acute and chronic forms. The acute form is usually a result of bacterial complications secondary to a viral upper respiratory tract event. Approximately 1 in 200 viral upper respiratory tract events results in a secondary bacterial infection of the sinuses, with the ethmoids and maxillary deemed the most frequently involved. Chronic sinusitis may be a complication of repeated bacterial infections but more often than not appears...

Other Therapeutic Uses for Cromolyn or Nedocromil

Atopic dermatitis is an inflammatory, IgE-mediated skin disease characterized by intense pruritus, xerosis, and scaly, licheniform rash with a characteristic anatomical distribution. Therapy is directed at avoidance of inciting stimuli, moisture retention, emollients, antipruritics, and topical corticosteroids. One report of a placebo-controlled, randomized, crossover study suggests that topical cromolyn may potentially benefit patients for whom the above therapeutic modalities have failed....

Allergic Like Food Intolerance Reactions

The mechanisms for most food intolerance reactions are not known. Most infants who develop isolated gastrointestinal symptoms (vomiting, diarrhea, blood in stool) resulting from formula intolerance do not demonstrate IgE antibody reactions. This condition can occur while the child is ingesting cow's-milk-based conventional formula, breast milk from mothers eating a normal diet, or soy protein-based infant formulas. Approximately one-half of the individuals with documented eosinophilic...

Pharmacological Management

Asthma pharmacotherapy can be divided into categories long-term control medications and quick-relief medications. Long-term control medications are used on a daily basis to lessen airway inflammation and or maintain control of asthma. Inhaled Corticosteroids. Inhaled corticosteroids (ICSs) are the most effective anti-inflammatory medications for the treatment of chronic, persistent asthma and are the cornerstone of asthma treatment. Numerous studies have shown that regular use of ICSs reduces...

Clinical Use Of Theophylline In Asthma

Although intravenous aminophylline has been standard treatment for status asthmaticus since the early 1940s, the value of aminophylline in the emergency room setting for acute asthma has been questioned recently. Various authors have suggested that theophylline adds little in terms of bronchodilator activity while increasing adverse effects when optimal therapy with aerosolized p-agonists have been given. In an early study of the use of intranenous theophylline in the treatment of acute asthma,...

How Does One Manage A Patient With Suspected Contact Dermatitis

The principal rules for complex cases of suspected contact dermatitis involve the following procedures 1. Remove the patient from all possible contact sources in the involved area. Of course, in some situations (e.g., clothing dermatitis), this is not possible. However, all white polyester textiles are seldom a problem, and such materials are a good substitute. Many women are reluctant to omit wearing makeup, but they are much more receptive when shown the potential for developing additional...

Special Forms Of Eczema And Contact Reactions Protein Contact Dermatitis

In 1976, a group of Danish investigators described eczematous reactions to foods in food service workers, with irregular results on patch testing but positive immediate sensitivity. Not all of these individuals were atopic according to the report. These reactions appear as early as 30 min, which is much earlier than ordinary contact dermatitis. The first report found that most reactions to food were to meats, but a few were to vegetables. The published antigens causing protein contact...

How Does One Recognize Contact Dermatitis

Poison Ivy Streaking

The first step in recognizing contact dermatitis is to suspect it. One should always consider the possibility of a contact reaction in anyone with an eczema. Even noneczematous conditions may have a contact reaction superimposed upon the pre-existing condition. 2. The eruption is typically eczematous, and as such it will normally show spongiosis histologically. Acute lesions demonstrate weeping, oozing, crusting, and scaling, and chronic lesions tend to show thickening, hyperkeratosis,...

What Is Contact Dermatitis

Contact dermatitis typically is an eczematous reaction, usually to a substance applied to the skin surface. It may have an allergic cause, or it may be irritant (nonallergic). The archetype of the allergic form is poison ivy dermatitis, whereas soap dermatitis is a typical From Current Clinical Practice Allergic Diseases Diagnosis and Treatment, Third Edition Edited by P. Lieberman and J. A. Anderson Humana Press, Totowa, NJ example of irritant contact dermatitis. Of course, there are many...

Contact Dermatitis of the Eyelids

In contradistinction to ocular allergy, which is predominantly associated with the activation of mast cells, contact dermatitis is predominantly a lymphocytic delayed type of hypersensitivity reaction involving the eyelids. Because the eyelid skin is soft, pliable, and thin, contact dermatitis of the eyelids frequently causes the patient to seek medical attention for a cutaneous reaction that elsewhere on the skin normally would be of less concern. The eyelid skin is capable of developing...

Theophylline Toxicity

Theophylline Toxicity Signs

Like its bronchodilator activity, adverse effects are related to the logarithm of the serum concentration. Hendeles and associates demonstrated a relationship between serum concentration and symptoms of theophylline toxicity. Few toxic symptoms were noted when the steady-state serum concentration was less than 14.6 g mL. Adverse effects appeared as the serum concentration rose beyond 20 g mL. These included gastrointestinal, CNS, and cardiovascular effects (Fig. 1). Of all adverse effects,...

Huamin Henry Li md phd and Michael A Kaliner md

Conditions Associated With Exacerbations of Asthma Asthma affects more than 15 million adults in the United States. The incidence of asthma has risen in the past few decades. It is a significant health concern and a tremendous economic burden in modern societies. In this chapter we discuss the etiologies and pathogenesis of asthma. We also describe the current concepts and guidelines of asthma intervention and treatment. Key Words Asthma allergy asthma treatment inhaled steroids...

Causes Of Bronchial Asthma Allergic Asthma

About 90 of asthmatics between the ages of 2 and 16 yr are allergic, 70 less than 30 yr are allergic, and about 50 of patients older than 30 yr are concomitantly allergic (Table 2). Thus, coincidental allergies are far and away the most common underlying condition associated with the development of asthma. One should suspect allergy as a contributing factor when (1) there is a family history of allergic diseases, (2) the clinical presentation includes seasonal exacerbations or exacerbations...