Coblation turbinate reduction in childhood allergic rhinitis.

INTRODUCTION: Nasal obstruction is the allergic rhinitis symptom least amenable to medical treatment, and inferior turbinectomy may be required. Coblation is a minimally invasive technique that is effective in obstruction secondary to inferior turbinate hypertrophy. The present study assessed efficacy in children presenting with obstructive allergic rhinitis after failure of medical management. PATIENT AND METHODS: This prospective study included nine children with allergic rhinitis. Coblation was performed after assessment of rhinitis. Obstruction was assessed on rhinomanometry and a visual analog scale; other rhinologic functional signs were assessed on interview, and functional impact was assessed on the PRQLQ quality of life questionnaire. RESULTS: After the procedure, all nine children showed reduced nasal obstruction and improved rhinologic function signs, confirmed by the favorable evolution of PRQLQ scores. CONCLUSIONS: The study demonstrated the interest of coblation in controlling nasal obstruction in children with allergic rhinitis refractory to medical treatment, with conserved nasal function. Larger-scale studies with longer follow-up will be needed to confirm these results.

Anaphylaxis to the 23-valent pneumococcal vaccine in child: a case-control study based on immediate responses in skin tests and specific IgE determination.

Injections of the 23-valent pneumococcal vaccine are usually well tolerated. Skin tests (prick and intradermal) and a self-made RAST with pneumococcal vaccine and phenol were performed in a child reporting a severe anaphylactic reaction induced by a 23-valent pneumococcal vaccine, and in ten control children, including one child with a well-tolerated vaccination, and nine non-vaccinated children. Skin tests and RAST with the vaccine were positive in the child reporting anaphylaxis, and negative in nine of the control children. Intradermal test with the vaccine was slightly positive in a non-vaccinated child with negative RAST. Skin tests and RAST with phenol were negative in all the children. These results suggest that immediate responses in skin tests and specific IgE determination have a good diagnostic value in children reporting severe reactions suggestive of IgE-dependent hypersensitivity to pneumococcal vaccine.

Grass pollen hyposensitization versus placebo therapy. I. Clinical effectiveness and methodological aspects of a pre-seasonal course of desensitization with a four-grass pollen extract.

The present work reports the results of a double-blind clinical trial, comparing the effects of hyposensitization treatment versus placebo in 33 patients with allergic rhinitis, sensitive to a crude extract of the pollen of four different grasses (Dactylis glomerata, Lolium perenne, Secale cereale, and Phleum pratense). The distribution of these patients in the two groups was done randomly and gave two comparable groups, as far as clinical and biological features are concerned. The treatment course included five low doses of the aqueous extract followed by 12 injections of Al(OH)3-adsorbed aliquots of the same extract. Evaluation of the clinical scores was based on diary cards on which symptoms and medications were recorded. A reevaluation of the significance of the symptom and medication scores is presented and the link between both scores is studied. Particular attention is given to the methodological and statistical problems raised during this study. The non-parametric tests reveal a significant difference (P less or equal to than 0.03) in the total clinical score between the treated and the placebo groups for the second half of the observation period, when the pathology was most intense.