John A. Fornadley

Safety of home-based and office allergy immunotherapy: A multicenter prospective study ☆ ☆☆ ★

During a 1-year period, 27 otolaryngic allergy practices recorded all systemic reactions to immunotherapy resulting from 635,600 patient visits and 1,144,000 injections. Sixty percent of injections were given at home. Major systemic reactions were observed after 0.005% of injections. There were no hospitalizations or deaths. Eighty-seven percent of major reactions began within 20 minutes of injection. Frequently observed risk factors for major reactions were buildup phase of immunotherapy, active asthma, and first injection from a treatment vial. Home and office injections had similar rates of total systemic reactions, but home-based immunotherapy had far fewer major reactions. Home-based immunotherapy was found to be safe. The methods and precautions used to treat patients with this degree of safety are specified and discussed.

Allergic Rhinitis: Clinical Practice Guideline

This guideline was compiled by members of a standing committee of the American Academy of Otolaryngic Allergy. The intent of this guideline is to provide practitioners, referring physicians, patients, third-party payers, and cognizant government authorities with the fundamental principles involved in the diagnosis and treatment of the patient with allergic rhinitis. Although developed solely through the American Academy of Otolaryngic Allergy, the statements and recommendations are drawn from the entire spectrum of English-speaking literature from the United States and Europe. Articles were independently reviewed by members of the Committee, many of whom sit on editorial review boards for major professional publications. A grading system was used to categorize individual articles to demonstrate the format used to arrive at conclusions. The grade is recorded at the end of each article reference. The grading scale follows: Grade A: A study involving prospective or well-selected retrospective patient populations. The conclusions drawn are well supported by the scientific work. Little controversy relating to these conclusions would be expected. Grade B: A scientific study executed without major flaws. Limitations may exist such that the conclusions drawn remain subject to controversy. Grade C: An anecdotal or case report study.

The Effect of Surfactant on Eustachian Tube Function in a Gerbil Model of Otitis Media with Effusion

The relationship of eustachian tube surfactant and otitis media with effusion on eustachian tube opening pressure was studied in a gerbil model. Injection of killed Streptococcus pneumoniae bacteria created a serous effusion that increased eustachian tube opening pressure. The introduction of exogenous surfactant to this system resulted in a dramatic decrease in eustachian tube opening pressure in both normal ears and those with effusion. Identifying means to increase surfactant in the eustachian tube could be beneficial in reducing persistent otitis media with effusion.

The role of MRI when relapsing polychondritis is suspected but not proven

Relapsing polychondritis (RP), while relatively rare, presents a characteristic clinical picture. Based upon a symptom complex of auricular, nasal, and respiratory chondritis associated with ocular and otic complaints, diagnosis can frequently be made with confidence in the absence of histologic confirmation. We present a case where a therapeutic intervention was required without sufficient criteria for diagnosis. Magnetic resonance imaging (MRI) proved useful in initial evaluation and allowed follow-up imaging demonstrating a gratifying response to steroid treatment. We believe that MRI has an important role in the diagnosis and subsequent evaluation of patients with proven or suspected RP, particularly those with tracheal involvement.

Current practice trends in allergy

Clinical practices for the diagnosis and treatment of allergic disease evolve over time in response to a variety of forces. The techniques used by various physician specialties are not clearly defined and may vary from published descriptions or recommendations in the literature.

Current practice trends in allergy: results of a united states survey of otolaryngologists, allergist-immunologists, and primary care physicians

Clinical practices for the diagnosis and treatment of allergic disease evolve over time in response to a variety of forces. The techniques used by various physician specialties are not clearly defined and may vary from published descriptions or recommendations in the literature.

Skin testing for inhalant allergy

Allergy is diagnosed by a combination of history, physical examination, and confirmatory testing. Modalities for testing include skin testing, in vitro assessment, and challenge testing of the conjunctiva or nasal mucosa. Challenge testing is primarily reserved for research.

Safety of intradermal skin tests for inhalants and foods: a prospective study

Intradermal skin testing is a useful allergy diagnostic tool. Although considered safe when properly performed, systemic reactions have been reported. This is the first large, prospective study to record and evaluate all systemic reactions from intradermal skin testing (IDT) to inhalant or food antigens.

Stepwise Treatment of Asthma

Therapy for asthma has undergone substantial changes in the past three decades, prompted by a better understanding of the role of inflammation in reversible airway disease. Improved therapies and a workable algorithm of therapy guidelines have provided an improved quality of life for the patient with asthma. This article outlines the most recent revisions of the stepwise guidelines provided by the National Heart, Lung, and Blood Institute.

Clinical practice guidelines and specific antigen immunotherapy

Allergy immunotherapy is a safe, effective treatment modality in selected patients. The length of therapy and the wide variety of patient sensitivities make it difficult to develop and test evidence-based guidelines in all areas of immunotherapy. A review of techniques and the evidence supporting them is provided in this article.