Eosinophilic esophagitis is characterized by a non-IgE-mediated food hypersensitivity.

Eosinophilic esophagitis (EoE) is a chronic disease characterized clinically by symptoms of esophageal dysfunction and histologically by eosinophil-predominant inflammation. EoE is frequently associated with concomitant atopic diseases and immunoglobulin E (IgE) sensitization to food allergens in children as well as to aeroallergens and cross-reactive plant allergen components in adults. Patients with EoE respond well to elemental and empirical food elimination diets. Recent research has, however, indicated that the pathogenesis of EoE is distinct from IgE-mediated food allergy. In this review, we discuss the individual roles of epithelial barrier defects, dysregulated innate and adaptive immune responses, and of microbiota in the pathogenesis of EoE. Although food has been recognized as a trigger factor of EoE, the mechanism by which it initiates or facilitates eosinophilic inflammation appears to be largely independent of IgE and needs to be further investigated. Understanding the pathogenic role of food in EoE is a prerequisite for the development of specific diagnostic tools and targeted therapeutic procedures.

Asthma and other allergic disorders in pregnancy.

About 1 percent of pregnancies are complicated by asthma. Morbidity and mortality, both maternal and fetal, are significantly increased in cases of severe asthma. In selecting therapy, the physician must weigh the potential risks and benefits of any medication. Theophylline and beta-adrenergic agonists are the drugs of choice. Carefully selected antihistamines, decongestants and immunotherapy are safe and effective in the management of most other allergic problems. A few commonly used medications are teratogenic.

Exercise-induced bronchospasm in children.

Exercise-induced bronchospasm (EIB) is common among asthmatic children. After vigorous exercise, about 80 percent of childhood asthmatics develop significant bronchoconstriction. The mechanism is probably related to heat loss from the respiratory tract during exercise. Jogging, soccer and basketball are the activities most often implicated. Adequate bronchodilator therapy can prevent most EIB episodes. Recognition and treatment of EIB will allow full participation in sports.

Champ Camp: the Colorado Children's Asthma Camp experience.

To encourage children with asthma to enjoy outdoor activities without physical or psychosocial impairment, children's asthma camps are established throughout the country sponsored by organizations including local and state allergy societies. We wish to describe our Colorado "Champ Camp" experience as a model and reference for future similar efforts and to encourage networking by medical leadership for information sharing and guidelines development nationally. Statistics from parents' satisfaction surveys over 8 years demonstrate a positive influence on attitudes toward asthma and confidence to enter activities and sports with children without asthma.

Effect of tree and grass pollens and fungal spores on spring allergic rhinitis: a comparative study.

BACKGROUND: Current literature indicates tree pollen is less important than grass pollen as the cause of spring allergic rhinitis. The role of fungal spores is secondary and uncertain. OBJECTIVE: To assess the relative allergenicity of tree and grass pollen and fungal spores as the cause of spring allergic rhinitis in central Indiana. METHODS: (1) Chart review of 189 Indiana natives with seasonal allergic rhinitis to ascertain clinical sensitivity to tree or grass pollens. (2) A prospective study conducted in the spring of 1997 in 51 patients, correlating patients' symptom and medication scores with daily pollen and spore counts, obtained with a Burkard spore trap. RESULTS: One hundred thirty of 189 patients (69%) reported symptoms before May with positive prick test to at least one tree pollen. One hundred thirty-four patients (71%) had symptoms in May and June with positive test to grass pollen. The ratio between the two groups is 1:1, in contrast to a ratio of 1:4 derived from the literature. The prospective study revealed a symptom score increase parallel to the rise of tree pollen counts beginning in mid-March and reaching a plateau in early May prior to the onset of grass season. Medication use continued to increase and peaked at the height of grass pollination. Spore counts increased in late May and stayed at high levels throughout June, yet symptom and medication scores steadily declined following the peak of grass pollination in early June. CONCLUSIONS: This study suggests that in central Indiana, tree pollen is more important as the cause of spring allergic rhinitis than that suggested by the literature. This study confirmed previous observations that fungal spores are substantially less allergenic than pollens.