Auranofin in the treatment of steroid dependent asthma: a double blind study.

BACKGROUND: Long term administration of oral corticosteroids in patients with asthma may be associated with serious side effects. Non-steroidal anti-inflammatory drugs, including gold salts, have been shown to reduce the need for systemic corticosteroid treatment in uncontrolled studies. The effect of oral gold (auranofin) on asthma symptoms, lung function, and the need for oral prednisone treatment was investigated. METHODS: A 26 week randomised, double blind, placebo controlled, parallel group trial of auranofin was performed in 32 patients with moderately severe chronic asthma who required an oral corticosteroid dose of at least 5 mg prednisone a day (or equivalent) or 2.5 mg/day prednisone plus more than 800 micrograms/day inhaled corticosteroids. Auranofin was given orally in a dose of 3 mg twice daily. Asthma symptoms, lung function, and adverse effects were assessed at regular intervals. After 12 weeks of treatment prednisone dosage was tapered down by 2.5 mg every two weeks if the patient was clinically stable. Asthma exacerbations were treated with short courses of high doses of oral steroids. RESULTS: Twenty eight of the 32 patients, 13 in the placebo group and 15 in the auranofin group, completed the study. The total corticosteroid reduction achieved after 26 weeks of treatment was significantly greater (4 mg) in the auranofin group than in the placebo group (0.3 mg). The number of exacerbations requiring an increase of steroids was greater in the placebo group (2.1) than in the active group (0.9). A significant increase in FEV1 of 6.4% predicted occurred in the auranofin group during the study and there was a reduction of asthma symptoms such as wheezing and cough. There was no difference between the groups in peak flow measurements or in the number of asthma attacks. The incidence of side effects of auranofin was low, but exacerbations of constitutional eczema were noticeable. CONCLUSION: Auranofin provides an effective adjunct to treatment for steroid dependent asthma, leading to a reduction of oral steroid dose.

A case of seminal fluid allergy successfully treated with immunotherapy in a one-day rush procedure.

A 28-year-old woman was treated for seminal fluid allergy with immunotherapy using a one-day 'rush' procedure. Apart from minor anaphylactic symptoms, no serious side effects were noted during or after hyposensitization or boostering. Five weeks after the start of the hyposensitization, she was free of symptoms after unprotected coitus.

Prophylactic treatment of grass pollen-induced asthma with cetirizine.

In a double-blind randomized parallel-group study, six investigators enrolled 43 subjects to study the prophylactic effect of 10 mg cetirizine b.i.d. on grass pollen-induced asthma. The control group received 60 mg b.i.d. terfenadine, given to avoid withdrawals from the trial because of hay fever symptoms. Subjects were included in the study between the appearance of the first symptoms of hay fever and those of pollen-induced asthma. The hay fever and asthma symptoms, visual analogue scores (VAS), FEV1 and self-assessment data on complaints, salvage treatment and peak-flow values were statistically analysed. Both treatments were well tolerated, with a low and similar incidence of side-effects. During the last 3 weeks of treatment, six (32%) of the 19 subjects on cetirizine who were evaluable for efficacy remained free of asthma complaints, and another two (10%) had only a single minor attack. None had a grade 3 (incapacitating) attack. Conversely, only one (5%) of the 20 evaluable subjects on terfenadine remained complaint free, and all others (95%) had multiple attacks, which incapacitated three (15%) of them. Nasal obstruction, dyspnoea, morning peak flow, consumption of beta 2-mimetics and an efficacy index on asthma, combining complaints and rescue drug consumption, were significantly better on cetirizine (P less than 0.05). It is concluded that cetirizine is able to prevent the exacerbation of asthma induced by grass pollen.

Is diaphragmatic elevation a serious complication of open-heart surgery?

Diaphragmatic elevation or paralysis after open-heart surgery was retrospectively analyzed in 370 consecutive operations performed on 365 adult patients. The incidence of the complication was 7.2%. It was significantly correlated with ipsilateral pleural effusion and lower-lobe atelectasis, but no predisposing or causal factors could be identified. Diaphragmatic elevation did not prolong the hospital stay. Actuarial analysis of data from follow-up chest radiograms showed normalization of the diaphragmatic position within 6 months in 44% and within a year in 90% of the patients.

Atopic skin test re-evaluated. X. Comparison of a perfected technique of intracutaneous skin testing and the prick test performed with a modified Morrow Brown Needle.

With a modified Morrow Brown needle it proved possible to obtain duplicate skin-test values with almost the same reliability as those obtained with the intracutaneous method described in one of the preceding papers of this series. The results of the present study also showed that 50% glycerin has a distinct inhibitory effect when added to the extracts, whereas 0.0005% Tween 80 produces a distinct enhancement of the skin reaction.