Early interventional treatment with intranasal corticosteroids compared with postonset treatment in pollinosis.

BACKGROUND: The usefulness of early interventional treatment (EIT) with intranasal corticosteroids (INSs) compared with postonset treatment (POT) has not been clarified. OBJECTIVES: To study the efficacy and safety of EIT with INSs compared with POT and placebo in Japanese cedar/cypress pollinosis. METHODS: We designed a 3-armed, double-blinded, randomized, placebo-controlled trial. Patients received mometasone furoate nasal spray (EIT group: n = 25), placebo (n = 25), or 4 weeks of placebo followed by 8 weeks of mometasone (POT group: n = 25) for a 12-week period starting on February 1, 2011. The primary end point was the comparison of the total nasal symptom score (TNSS) among the 3 groups. Total ocular symptom score (TOSS), total naso-ocular symptom score (TSS), Allergic Rhinitis and Its Impact (ARIA) on Asthma classification, and safety were the main secondary end points. RESULTS: The placebo and POT groups, but not the EIT group, had a significant exacerbation of TNSS and TOSS soon after the start of pollen counts being high on consecutive days. The 12-week mean TSS in the EIT group (score, 2.3) was significantly lower than in the placebo (5.0; P < .01) and POT (3.9; P = .03) groups. All patients in the placebo and POT groups were classified as having persistent rhinitis, whereas 80% of the EIT group met the ARIA classification criteria (P = .03). The quality-of-life score and nasal eosinophil cationic protein levels were lower in the EIT and POT groups compared with the placebo group. Daytime sleepiness, smell disturbance, and the mean dose of loratadine taken as the rescue medication were similar. Treatment with mometasone was well tolerated. CONCLUSION: EIT with INSs is superior to POT in controlling pollinosis.

Contact dermatitis to topical medicaments: a retrospective chart review from the Ottawa Hospital Patch Test Clinic.

BACKGROUND: Topical medicaments are a common cause of allergic contact dermatitis. This study will evaluate the prevalence of contact allergy to a wide array of topical medicaments at the Ottawa Patch Test Clinic. OBJECTIVES: The objectives of this study are to report the results of positive patch testing to topical medicaments at the Ottawa Patch Test Clinic and identify common sensitizers in topical medicaments. METHODS: Patients were tested with the standard North American Contact Dermatitis screening series of 70 allergens plus supplementary allergens when indicated. A retrospective chart review of patients positive to topical medicaments between January 1, 2000, and September 30, 2010, was undertaken. RESULTS: The average age of patients was 49.5 years. Thirty-four percent were atopic. Common sensitizers included topical antibiotics (58%), steroids (30%), anesthetics (6%), and antifungals (6%). Patch testing showed that 61% of patients tested positive to antibiotics, 21% to topical steroids, 17% tested positive to topical anesthetics, and 1% tested positive to topical antifungals. The most common reactions were to bacitracin (44%) and neomycin (29%). The most common steroid screener was tixocortol-17-pivalate (group A) (19%), and the most common local anesthetic was lidocaine (12%). CONCLUSIONS: Topical medicaments of all kinds are common causes of allergic contact dermatitis. Those that are more readily available, in over-the-counter preparations, are the most frequent culprits.

Predator exposure-induced cerebral interleukins are modulated heterogeneously by behavioral asymmetry.

Predator exposure is a naturalistic stressor that is likely to elicit a stressful response pattern similar to those experienced in the real world. As a consequence of stress, HPA hormonal activity and the alteration of mediators such as cytokines may result. Behavioral asymmetry, as assessed by paw preference, exerted effects on immune responses and peripheral cytokine production, observed after exposure to the physical stimuli. Thus, we hypothesized that behavioral asymmetry can modulate mouse brain interleukins and HPA activity after exposure to an internally generated psychological stress source. To determine the impact of behavioral asymmetry, mice were divided into left- and right-pawed groups by paw preference. Then, the mice received either a single 60-min or a daily 60-min predator exposure (cat exposure) for 14 consecutive days. After receiving predator exposure, trunk blood was collected and brain tissues, including the cerebral cortex, hippocampus and hypothalamus, were separated. Plasma corticosterone (CS) was detected by EIA, and IL-1ß and IL-6 levels in the cortex, hippocampus and hypothalamus, were quantified by ELISA. The results revealed that predator stress, in particular chronic stress, could enhance plasma CS concentration and could alter IL-1ß and IL-6 concentrations in the cortex, hippocampus and hypothalamus. Simultaneously, predator stress-induced CS and brain interleukin levels were modulated by behavioral asymmetry. The left-pawed mice showed a decreased variation in CS, less than right-pawed mice, and both left-pawed and right-pawed mice displayed heterogeneous direction and intensity of changes for IL-1ß and IL-6 in the cortex, hippocampus and hypothalamus after predator exposure. From these results, it can be concluded that the alteration of cytokines depends on the characteristics of the stressor. Furthermore, the asymmetric cytokine responses within the brain to a natural, psychological stressor may be involved in the immunomodulation of behavioral asymmetry. These findings likely reflect the flexibility in reactivity patterns of a population in response to various insults.