Management of acute rhinosinusitis.

Acute rhinosinusitis (ARS) is one of the most common reasons for physician visits and for significant school absenteeism, although precise data on its prevalence and incidence are still lacking. RS is defined as acute if there are symptoms lasting <12 wk with complete resolution. Superinfection by bacteria following a viral infection is the most important mechanism of ARS. Diagnosis of ARS should be made on clinical grounds alone. Typically, acute bacterial RS is self-limited and goes through spontaneous recovery within 4 wk. Recognizing the occurrence of bacterial superinfections of the sinuses during a common viral respiratory infection is fundamental to making the decision to start an appropriate antibiotic treatment. Topical treatments such as saline irrigation, nasal decongestants, steroids, antihistamines, and fungicides are all in widespread pediatric use, but analyzing the literature gives poor evidence of efficacy, except for topical steroids. RS is a multifactorial condition that poses a diagnostic and management challenge to infectivologist and ear-nose-throat specialists as well as to pediatricians.

Correlation of anti-Pru p 3 IgE levels with severity of peach allergy reactions in children.

BACKGROUND: Peach allergy is regarded as one of the most important fresh fruit allergies. Data are available on the state-of-the-art diagnosis, including food challenges, and a component-resolved diagnosis. However, the roles played by different peach allergens with respect to symptom severity are not completely understood. OBJECTIVE: To evaluate the role of serum specific IgE to peach and recombinant allergens in the diagnosis of peach allergies in Italian children. METHODS: Forty-four children with peach allergy confirmed by a placebo-controlled food challenge were divided into 2 groups based on their symptom severity: patients with mild oral allergy syndrome (OAS) and patients with systemic symptoms (SS). The presence of specific IgE to peach and rPru p 1, rPru p 3, and rPru p 4 was determined. RESULTS: The presence of specific IgE to Pru p 4 and Pru p 1 was found significantly more frequently in patients with OAS, whereas specific IgE to Pru p 3 was not found significantly more frequently in patients with SS. Only anti-rPru p 4 IgE levels were significantly higher in patients with OAS, whereas no significant differences were found in anti-rPru p 1 and anti-rPru p 3 IgE levels between patients with OAS compared with patients with SS. CONCLUSION: In Italian children with peach allergies, the presence of specific IgE to Pru p 3 is not associated with SS, and the levels of specific IgE to Pru p 3 do not correlate with the severity of the reactions.

Thyroid autoimmunity in chronic idiopathic urticaria: implications for therapy.

The association between thyroid autoimmunity and chronic idiopathic urticaria has long been recognized, although prevalence rates differ in the studies reported to date (from 12 to 29%). There is, therefore, a strong indication to screen patients affected by chronic urticaria of unknown origin for thyroid antibodies (antithyroperoxidase and antithyroglobulin) and, when positive, for serum thyrotropin to assess thyroid functional status. Less clear is the implication of thyroid autoimmunity for therapy, as most patients with urticaria who have associated thyroid autoimmunity are euthyroid. There is no doubt that cases with clinical or subclinical thyroid dysfunction should undergo treatment with either levothyroxine or antithyroid drugs for hypo- or hyper-function, respectively. Although the best remission rates for symptoms of urticaria have so far been obtained with levothyroxine in patients who are euthyroid, monitoring of thyroid function through serum thyrotropin determination is highly recommended because of the risk of hyperthyroidism, especially in the elderly.