RESUMO
BACKGROUND: Pollen food allergy syndrome (PFAS), also called oral allergy syndrome, is a form of food allergy in which uncooked foods cause allergic symptoms generally limited to the oral mucosa. It occurs in a subset of patients with pollen allergy, although not all patients have prominent rhinitis symptoms. PFAS is related to antigenic similarity between the pollen and food allergen. OBJECTIVE: The size of skin test reactions in a group of subjects with pollen sensitivity with PFAS was compared with a group of subjects who were pollen sensitive and without PFAS. Self-reported rhinitis symptoms between the two groups were compared to identify if symptom severity differed. METHODS: Twenty subjects with PFAS and 20 subjects with seasonal allergic rhinitis without PFAS were enrolled in the study. All the subjects underwent standard skin-prick testing to a panel of common allergens, including select fresh fruits and vegetables. The subjects completed a Mini Rhinoconjunctivitis Quality of Life Questionnaire as part of their clinical evaluation. The subjects with PFAS and those without PFAS were compared statistically. RESULTS: The subjects with PFAS had significantly larger-sized skin-prick test results specific to pollens (p < 0.05). Despite the larger-sized skin-prick test results, the subjects with allergic rhinitis and PFAS reported milder nasal symptoms in relation to pollen skin test result size when compared with allergic rhinitis controls without PFAS. CONCLUSIONS: Our study outlined basic differences between two seemingly similar patient groups with a particularly striking discordance between skin test result sizes and rhinitis symptoms. This discordance should be explored further to increase mechanistic understanding of allergen cross-reactivity in PFAS.
Assuntos
Hipersensibilidade Alimentar/diagnóstico , Pólen/imunologia , Rinite Alérgica Sazonal/diagnóstico , Rinite Alérgica/diagnóstico , Testes Cutâneos , Adolescente , Adulto , Idoso , Alérgenos/imunologia , Reações Cruzadas , Diagnóstico Diferencial , Feminino , Hipersensibilidade Alimentar/complicações , Hipersensibilidade Alimentar/imunologia , Humanos , Imunização , Masculino , Pessoa de Meia-Idade , Rinite Alérgica/imunologia , Rinite Alérgica Sazonal/complicações , Rinite Alérgica Sazonal/imunologia , Síndrome , Adulto JovemAssuntos
Alérgenos/imunologia , Enterocolite/diagnóstico , Hipersensibilidade Alimentar/diagnóstico , Mangifera/imunologia , Alérgenos/administração & dosagem , Diagnóstico Tardio , Enterocolite/tratamento farmacológico , Enterocolite/etiologia , Enterocolite/fisiopatologia , Hipersensibilidade Alimentar/tratamento farmacológico , Hipersensibilidade Alimentar/etiologia , Hipersensibilidade Alimentar/fisiopatologia , Humanos , Lactente , Masculino , Mangifera/química , Ondansetron/uso terapêuticoRESUMO
BACKGROUND: Aspirin-exacerbated respiratory disease (AERD) is a chronic illness of progressive recurrent sinus disease with nasal polyps and asthma. No population-based comprehensive surveys of patients with AERD have been carried out to assess specific quality-of-life impact or perceptions of treatment benefit. OBJECTIVE: This survey analyzed perceptions and quality of life in those living with AERD and queried patient observations of treatment effectiveness. The survey assessed whether dietary and nutritional support was used to manage AERD, and if so, whether there was a perceived benefit. METHODS: This survey was publicized through clinics that treat patients with AERD, Web sites, and online blogs. RESULTS: Results are reported for 190 patients. Most subjects reported an adverse effect of AERD on quality of life. Chronic nasal symptoms followed by decreased sense of smell were reported to have the greatest impact on quality of lifein 81 (43%) and 74 (39%), respectively. Those who lost their ability to smell (n = 65; 34%) reported that they missed the enjoyment of food and eating the most. A minority indicated that a combination of medications (aspirin, leukotriene receptor antagonist, zileuton, or omalizumab) was more effective than 1 alone. Of those surveyed, 120 (63%) respondents felt that components of their diet contributed to their disease and 147 (77%) respondents reported having reactions after alcohol consumption. CONCLUSIONS: Patients with AERD live with frustration and report a poor quality of life in spite of several pharmacologic treatments including aspirin desensitization followed by daily aspirin. Despite ongoing medical therapy, the burden of disease in AERD remains high.
Assuntos
Asma Induzida por Aspirina/diagnóstico , Quimioterapia Combinada , Imunoterapia , Pólipos Nasais/diagnóstico , Adulto , Consumo de Bebidas Alcoólicas/efeitos adversos , Alérgenos/imunologia , Aspirina/administração & dosagem , Aspirina/efeitos adversos , Aspirina/imunologia , Asma Induzida por Aspirina/terapia , Doença Crônica , Interações Medicamentosas , Feminino , Humanos , Hidroxiureia/administração & dosagem , Hidroxiureia/efeitos adversos , Hidroxiureia/análogos & derivados , Masculino , Pessoa de Meia-Idade , Pólipos Nasais/etiologia , Pólipos Nasais/terapia , Omalizumab/administração & dosagem , Omalizumab/efeitos adversos , Qualidade de Vida , Inquéritos e QuestionáriosRESUMO
Aspirin exacerbated respiratory disease (AERD) is characterized as adult onset asthma, nasal polyps, chronic rhinosinusitis, and hypersensitivity to a cyclooxygenase-1 (COX-1) inhibitor, viz aspirin or nonsteroidal antiinflammatory drugs (NSAIDs). The method for diagnosing AERD is with aspirin challenge, and treatment includes aspirin desensitization followed by continued daily aspirin. Although oral challenge has been the mainstay in the United States, lysyl-aspirin has been validated as a diagnostic tool for aspirin-sensitive asthma and will be discussed further in this article. The challenges with aspirin therapy surrounding endoscopy and perioperative aspirin therapy will be discussed. Additionally, daily aspirin therapy is not for everyone. Aspirin is relatively contraindicated in those with a history of gastrointestinal bleed and an absolute contraindication in pregnancy. Aspirin desensitization and subsequent treatment has been shown to be highly effective for AERD.
Assuntos
Aspirina/efeitos adversos , Doenças Respiratórias/induzido quimicamente , Colonoscopia , Inibidores de Ciclo-Oxigenase/uso terapêutico , Dessensibilização Imunológica , Humanos , Doenças Respiratórias/terapiaAssuntos
Androgênios/efeitos adversos , Dermatite Alérgica de Contato/etiologia , Estradiol/efeitos adversos , Terapia de Reposição de Estrogênios/efeitos adversos , Estrogênios/efeitos adversos , Testosterona/efeitos adversos , Adulto , Idoso , Feminino , Terapia de Reposição Hormonal/efeitos adversos , Humanos , Masculino , Adesivo TransdérmicoAssuntos
Alérgenos/uso terapêutico , Hipersensibilidade Tardia/terapia , Imunoterapia/métodos , Urticária/terapia , Adulto , Alérgenos/imunologia , Protocolos Clínicos , Feminino , Humanos , Hipersensibilidade Tardia/diagnóstico , Hipersensibilidade Tardia/imunologia , Recidiva , Testes Cutâneos , Urticária/diagnóstico , Urticária/imunologiaAssuntos
Cateteres de Demora/efeitos adversos , Hematúria/etiologia , Fístula da Bexiga Urinária/diagnóstico , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Cateteres de Demora/microbiologia , Feminino , Hematúria/diagnóstico , Hematúria/tratamento farmacológico , Hematúria/microbiologia , Humanos , Fístula da Bexiga Urinária/microbiologia , Urina/microbiologiaRESUMO
AIMS: To determine whether specific IgE and skin prick test correlate better in predicting reaction severity during a double-blinded placebo controlled food challenge (DBPCFC) for egg, milk, and multiple tree nut allergens. STUDY DESIGN: Prospective study. PLACE AND DURATION OF STUDY: Department of Pediatrics, Stanford University School of Medicine, August 2009 and ongoing. METHODOLOGY: We examined the reaction severity of twenty-four subjects to nine possible food allergens: milk, egg, almond, cashew, hazelnut, peanut, sesame, pecan and walnut. Specific IgE and SPT were performed before each DBPCFC. DBPCFC results were classified into mild (1), moderate (2), or severe (3) reactions using a modified Bock's criteria. RESULTS: Twenty four subjects underwent a total of 80 DBPCFC. Eighty percent of all DBPCFCs resulted in a positive reaction. A majority, 71%, were classified as mild. No reactions occurred with a SPT of zero mm while three reactions occurred with a negative specific IgE. All reactions were reversible with medication. CONCLUSION: These data suggest that SPT and specific IgE levels are not associated with reaction severity (p<0.64 and 0.27, respectively). We also found that combining specific IgE and SPT improved specificity but did not help to achieve clinically useful sensitivity. For instance, an SPT > 5mm had a sensitivity of 91% and specificity of 50%. Combining SPT > 5mm and IgE > 7 resulted in a reduced sensitivity of 64%. Unexpectedly, a history of anaphylaxis 70% (n=17) was not predictive of anaphylaxis on challenge 4% (n=2).