John C. Selner

Cetirizine in patients with seasonal rhinitis and concomitant asthma: prospective, randomized, placebo-controlled trial☆☆☆★★★

OBJECTIVE This study explored the safety and efficacy of cetirizine for treatment of allergic rhinitis and asthma. METHODS Daily treatment for 6 weeks with cetirizine 10 mg (93 patients) was compared with placebo treatment (93 patients) in a randomized, double-blind parallel study of patients with allergic rhinitis and asthma. This multicenter study was started just before onset of the fall pollen season. Rhinitis and asthma symptoms were assessed twice daily; spirometry was performed weekly. RESULTS Placebo-treated patients experienced a worsening of rhinitis symptoms from baseline throughout the study, whereas cetirizine-treated patients had a significant improvement in rhinitis symptoms at week 1, which was maintained after onset of the pollen season. Asthma symptoms in the cetirizine group improved from baseline at week 1; symptoms were significantly better than in the placebo group for 5 of 6 weeks of the study. Pulmonary function did not worsen in patients taking cetirizine or placebo; there were no differences between treatments as determined by spirometry. Albuterol use was less frequent in the cetirizine-treated patients for every week of the study, but differences did not reach significance. Pseudoephedrine use was similar in both groups. More cetirizine-treated patients (90%) completed the trial than did placebo-treated patients (74%). Both treatments were well tolerated. CONCLUSION Cetirizine 10 mg daily is safe and effective in relieving both upper and lower respiratory tract symptoms in patients with seasonal allergic rhinitis and concomitant asthma.

The economic impact of allergic rhinitis

Allergic rhinitis is the most common chronic allergic disease. Symptoms include continuous or periodic nasal congestion, rhinorrhea, sneezing, itching of the nose and eyes, generalized malaise, irritability, and fatigue. We conducted an evaluation of the costs related to management of allergic rhinitis in a U.S. population. Data are based on self-reported trends in medication and health care services usage from a nationwide population sample selected from a base of 15,000 households. The average per-patient expenditure for prescription medications was

Vocal cord dysfunction: The importance of psychologic factors and provocation challenge testing

56 yearly. The mean per-patient expenditure for nonprescription medications was

Latex allergen in respirable particulate air pollution

56 yearly. Based on the findings of this study, the estimated total annual medication cost associated with allergic rhinitis in the United States is

Effectiveness of Fluticasone Propionate in Patients- with Moderate Asthma: A Dose-Ranging Study

2.4 billion. Because 63% of our study population had consulted a physician within the last 12 months, we estimate that a further

Sensitivity to sulfited foods among sulfite-sensitive subjects with asthma

1.1 billion is associated with physician billing. The cost of the comorbid conditions of asthma and sinusitis originating from or exacerbated by allergic rhinitis could significantly alter these figures. If management of these conditions were allowed to contribute, even in part, to the indirect cost, the financial impact of this disease would be more properly appreciated.

Presence of sulfur dioxide in commonly used bronchodilator solutions

We present three case reports involving patients with vocal cord dysfunction. The onset of symptoms in one case was coincident with a generalized cutaneous reaction to penicillin with laryngeal involvement. The other cases had been misdiagnosed as food allergy and chemical sensitivity. We describe the psychologic factors in these cases in terms of the primary and secondary gain operative in the somatoform disorder of conversion reaction and emphasize the importance of belief and learned sensitivity in the induction of symptoms. The necessity of considering psychologic factors and the use of blinded, controlled, provocation challenges to evaluate subjective symptomatology is underscored. This study emphasizes the heterogenicity of clinical presentations involving vocal cord dysfunction and illustrates the value of fiberoptic-assisted examination of laryngeal function in conjunction with provocation challenge testing in establishing causal relationships for specific clinical symptoms.

Onset of action of aqueous beclomethasone dipropionate nasal spray in seasonal allergic rhinitis

OBJECTIVE Urban air samples contain numerous irregular respirable black particles, which may be airborne tire fragments. A major component of tires is natural latex. Proteins of natural latex can act as adjuvants and as antigens capable of eliciting immediate hypersensitivity, making their presence in particulate air pollution an important clinical issue. METHODS Particulate air pollutants were collected by volumetric sampling devices and characterized by optical microscopy, chemical solubility tests, and mass spectrometry. Extracts of rubber tire fragments were tested for elutable latex antigens by antibody inhibition assays. RESULTS Identification of latex in air samples and milled material from automobile tires was supported by mass spectrometry results and was further confirmed by physical appearance and chemical solubility studies. Competitive immunoassay confirmed the presence of extractable latex antigens from rubber tire fragments. CONCLUSIONS Latex antigens are extractable from rubber tire fragments, which are abundant in urban air samples. Given the adjuvant and sensitizing effects of latex, these airborne particles could contribute, through direct and indirect mechanisms, to the increase in both latex sensitization and asthma. The impact of these particles should be considered in the issue of morbidity and mortality rates associated with respiratory diseases and air pollution.

Cromolyn sodium in seasonal allergic conjunctivitis

This study was undertaken to evaluate the efficacy and safety of fluticasone propionate, an inhaled corticosteroid, in adolescents and adults with moderate asthma who were previously taking inhaled corticosteroids. After a 2-week, open-label screening period, a double-masked, randomized, parallel-group, dose-ranging study was conducted over 12 weeks in 21 outpatient centers throughout the United States. Patients (N = 304) > or = 12 years of age with moderate asthma previously treated with inhaled corticosteroids and beta-sympathomimetic bronchodilators were enrolled. Patients were assigned to receive placebo or fluticasone propionate 100, 250, or 500 micrograms twice daily via a metered-dose inhaler without a spacer device. These doses refer to the amount of fluticasone propionate released from the valve of the metered-dose inhaler; the corresponding doses released from the activator of the metered-dose inhaler are 88 micrograms, 220 micrograms, and 440 micrograms, respectively. Between baseline and end point, mean values of forced expiratory volume in 1 second decreased 0.31 L in the placebo group and improved 0.39 L, 0.30 L, and 0.43 L in patients receiving 100-micrograms, 250-micrograms, and 500-micrograms fluticasone propionate, respectively. The differences between placebo and all treatment groups were statistically significant. More patients were withdrawn from placebo (72%) than from fluticasone propionate (13% to 16%) because of failure to meet predetermined asthma stability criteria. Differences in baseline-to-end point changes in morning peak expiratory flow rate, physician overall assessments and patient-rated assessment of symptoms, and albuterol use for symptom control also significantly favored each fluticasone propionate group over placebo. There were essentially no differences in efficacy among the three fluticasone propionate groups. Treatment-related adverse events occurred in 8% of placebo-treated patients and 13% to 15% of fluticasone propionate-treated patients; these events were mainly localized to the oropharynx/ larynx. A 12-week course of fluticasone propionate (100, 250, and 500 micrograms twice daily) was well tolerated and more effective than placebo based on maintenance of asthma stability, pulmonary function tests, physician and patient assessments, and rescue bronchodilator use. No dose-related effects were observed with the dosages of fluticasone propionate used in this study.

Neuropsychophysiologic Observations in Patients Presenting with Environmental Illness

Eight individuals with asthma who had been diagnosed as sulfite sensitive on the basis of double-blind capsule-beverage challenges were subjected to challenges with various sulfited foods, including lettuce, shrimp, dried apricots, white grape juice, dehydrated potatoes (as mashed potatoes), and mushrooms. Four of these patients failed to respond to challenges with any of the sulfited foods. The other four patients experienced a decrease in pulmonary function on double-blind challenges with sulfited lettuce. Two of three of these patients reacted to challenges with dried apricots and white grape juice; the fourth patient has not yet been challenged with these products. Only one of these four patients reacted to challenges with dehydrated potatoes and mushrooms, and, in this case, the response to double-blind challenges with dehydrated potatoes was not consistent. None of the sulfite-sensitive subjects with asthma responded to challenges with sulfited shrimp. It is concluded that sulfite-sensitive subjects with asthma will not necessarily react after ingestion of sulfited foods. The likelihood of a reaction is dependent on the nature of the food, the level of residual sulfite, the sensitivity of the patient, and perhaps on the form of residual sulfite and the mechanism of the sulfite-induced reaction.