Bruce R. Gordon

Geographic variation in allergic fungal rhinosinusitis

Allergic fungal rhinosinusitis (AFRS) has a worldwide distribution. This survey of 20 otolaryngologic practices throughout the United States confirmed a variation in the frequency of AFRS relative to endoscopic sinus procedures performed for all other diagnoses. The highest incidence occurred in Memphis, Tennessee at 23%, with three other southern practices reporting a frequency of at least 10%. In the northern locations the frequency ranged from 0 to 4%. No correlation with mould counts was demonstrated, possibly because of incomplete mould data relative to most of the surgical locations.

ALLERGY SKIN TESTS FOR INHALANTS AND FOODS: Comparison of Methods in Common Use

Many types of skin tests have evolved from Blackleys early scratch tests. This review highlights both the similarities between current skin tests and their differences. All current skin tests are capable of detecting allergic hypersensitivity, but the tests differ in their sensitivity, specificity, safety, reproducibility, and applications. Common factors in initial and final test doses, and in test dose increments, are identified. Test methods that quantitatively measure a range of allergen concentrations have diagnostic advantages in terms of safely detecting a wide range of allergic sensitivities. Failure to detect the full spectrum of allergic disease can lead to treatment failure; therefore, complete skin testing is desirable. This is especially important when dealing with exquisitely sensitive patients, such as many grass or ragweed sensitized patients, but is equally vital when evaluating low sensitivity patients, including many who are mold or food sensitive. Quantitation also improves test reproducibility, which is why it is used for antigen standardization. Finally, quantitation has advantages when used to initiate and escalate allergen immunotherapy. In vivo testing continues to evolve. New types of prick testing devices, and refinements of intradermal and patch test methods, continue to be reported. All allergists need to stay current with developments in vivo testing, so that they can offer their patients diagnosis that is appropriate to each individual situation.

Asthma History and Presentation

Asthma is suspected from a history of key symptoms, including cough, wheezing, dyspnea, chest tightness, and increased mucus production. A positive family or personal history of atopic diseases and diseases that are comorbid with asthma, such as allergic rhinitis and rhinosinusitis, is also important. The differential diagnosis of asthma is broad and includes potentially life-threatening diseases. Pediatric asthma and psychiatric mimics require special attention to prevent misdiagnosis. Differentiating asthma from these other disease states by history alone is not always possible. Because accurate diagnosis is critical to successful treatment, objective testing by spirometry and methacholine challenge should be employed.

Future immunotherapy: What lies ahead?☆☆☆★

There is currently great interest in developing improved methods of immunotherapy and new techniques of immune system manipulation to ameliorate allergic diseases. This article reviews current research trends in the immunologic treatment of allergy, including the use of chemically modified allergens, nonparenteral allergen exposure, sustained-release allergen delivery, anti-immunoglobulin E antibodies, γ-globulin, immune complexes, cytokines, and T-cell-tolerogenic peptides.

Miniseminar: Rhinitis: From Science to Practice

Abstract Chronic rhinitis is among the most common medical disorders in both the Western world, and is increasing in prevalence in developing nations. Otolaryngologists in practice encounter patients with rhinitis on a daily basis, and its diagnosis and management involves a major portion of their professional time. The current seminar will investigate both allergic and nonallergic rhinitis and will develop a science-based approach to the evaluation and treatment of this common problem. Using a variety of teaching modalities, including lectures, slide presentations, and interactive discussions, this seminar will provide the attendee with a thorough review of the current strategies involved in the diagnosis and treatment of rhinitis, as well as a view of future potential management methods. The seminar will focus on a discussion of the pathophysiology of rhinitis, examining both allergic and nonallergic mechanisms. Once this background is established, it will examine various methods involved in diagnosing and classifying rhinitis, including elements of the history and physical, laboratory examinations, imaging, endoscopic evaluations, and allergy testing. The program will then focus on current strategies in the management of the patient with rhinitis, including avoidance techniques, pharmacotherapy, immunotherapy, and surgical management. Finally, the seminar will examine possible future approaches in the diagnosis and treatment of rhinitis, including such areas as anti-IgE and other monoclonal antibody therapies, histamine-3 receptor blockade, and sublingual immunotherapy. With recent scientific advances and pharmacotherapeutic developments, the near-term future of rhinitis management might be somewhat different from current practice. At the conclusion of the program, the attendee will have a thorough exposure to the current state of knowledge in the pathophysiology of rhinitis, its evaluation, and its management.