Diane C. Napoli

Natural history of large local and generalized cutaneous reactions to imported fire ant stings in children

BACKGROUND There are no published data on the natural history of large local and generalized cutaneous reactions to imported fire ant (IFA) stings in children. OBJECTIVE To determine the natural history of large local and generalized cutaneous reactions to IFA stings in children not treated with immunotherapy by reviewing medical records from a venom clinic during the past 20 years. METHODS Patients were selected for the study if they were 16 years or younger at the time of the reaction, had only cutaneous symptoms (generalized cutaneous or large local), and did not initiate immunotherapy. Each patients parents were asked to recall whether the patient had experienced any further stings since the last evaluation at the venom clinic. RESULTS We contacted 31 of 57 patients evaluated between July 10, 1984, and February 5, 2004. Twenty patients (65%) reported that they had not developed more severe reactions with subsequent stings. Reactions remained cutaneous only. Eleven patients (35%) had not been stung again since the original evaluation. Five of these patients had moved out of the IFA-endemic region. None of the previously evaluated patients reported subsequent life-threatening anaphylaxis from IFA stings. CONCLUSIONS These limited data on IFA stings suggest a benign outcome in children 16 years and younger with large local or generalized cutaneous reactions. Larger and more extensive studies need to be conducted to further define the natural history of cutaneous reactions to IFA stings in children.

Inpatient consultation of allergy/immunology in a tertiary care setting

BACKGROUND Few studies examine the referral patterns for allergy/immunology (A/I) inpatient consultation. OBJECTIVE The purpose of this study was to examine the primary reason and trends for A/I inpatient consultation to improve fellowship training. METHODS We performed a retrospective chart review of all inpatient A/I consults from July 1, 1987 to June 30, 2001 to determine the primary reason for consultation. We also reviewed trends in the total admissions and the average daily patient load compared with A/I consultation. RESULTS A total of 1,284 A/I inpatient consults were reviewed. Thirty-six percent (460 of 1,284) of inpatient consults were for evaluation of adverse drug reactions, 21% (270 of 1,284) asthma, 21% (272 of 1,284) miscellaneous reasons, 8% (109 of 1,284) possible immunodeficiency, 7% (93 of 1,284) angioedema/urticaria, and 6% (80 of 1,284) anaphylaxis. Our results demonstrated a fall in inpatient consults that correlated with a similar fall in total hospital admissions. The ratio of A/I inpatient consults to total admissions remained constant. Additionally, the ratio of A/I consults to average daily patient load increased over the study period. There was a decrease in asthma and adverse drug reaction consults, whereas immunodeficiency and anaphylaxis referrals remained stable. CONCLUSIONS Identifying the most common reasons for inpatient consultation provides a guide for the education of A/I fellows and primary care residents. Inpatient consultation continues to play a crucial role in A/I training as it provides unique opportunities to evaluate serious life threatening diseases. An unchanged trend of consultation for immunodeficiency and anaphylaxis reaffirms the importance of the allergist/immunologist as a valuable resource for inpatient consultation.

Allergic rhinitis and asthma in a patient with unilateral pulmonary agenesis

History of Present Illness A 23-year-old woman presented to the allergy/immunology clinic with a previous diagnosis of allergic rhinitis and asthma. The patient reported that she had started immunotherapy (IT) 34 weeks ago, prescribed by her prior allergist, and had been receiving IT at her college health clinic. Following graduation 2 months earlier, she had been giving herself IT injections at home. She denied any reactions and had injectable epinephrine available at home. She was new to our area and was interested in restarting her IT. Her nasal symptoms included congestion, rhinorrhea, sneezing, itching, and postnasal drip. She also complained of ocular watering, itching, injection, and discharge when around cats or dogs. Chest symptoms included a daily cough and occasional wheezing that she did not notice but others had pointed out to her. She denied any nocturnal symptoms. She had an albuterol metered-dose inhaler available but had not used it in the previous 3 months.

Patient knowledge of immunotherapy before and after an educational intervention: a comparison of 2 methods

BACKGROUND Immunotherapy is an invaluable therapy for allergic asthma, allergic rhinitis, and hymenoptera hypersensitivity. It is, however, not without risks. OBJECTIVES To examine patient knowledge regarding immunotherapy and to determine the most effective educational method to improve their knowledge by answering the following questions: Before educational intervention, what is the current knowledge level regarding allergy vaccinations of patients receiving immunotherapy? What effect does an educational encounter have on that level of knowledge? Which educational intervention--a one-on-one session vs a handout--if either, increases patient knowledge more? METHODS An original, self-administered patient questionnaire was distributed to all patients receiving immunotherapy. Patients were randomly assigned to a control group, an intervention group that received an educational handout monthly for 2 months, or an intervention group that had a one-on-one educational session with a physician or nurse practitioner. After 3 months, all patients completed an identical follow-up questionnaire. Pretest and posttest scores were compared for each group and among the different groups to determine which method was more effective. Repeated-measures analysis of variance was used to determine the effect of instruction type on differences in pretest and posttest scores. RESULTS All 3 groups significantly improved their mean overall questionnaire scores (P < .001). The amount of change was greater in the intervention groups than in the control group, but it did not reach statistical significance (P = .59). CONCLUSIONS Baseline immunotherapy knowledge of allergy vaccination patients was better than expected, and further educational interventions did not significantly improve this knowledge.