John P. Dice

Plasma Resistin Levels in Asthmatics as a Marker of Disease State

Background. Resistin is a protein produced by adipoctyes and circulating macrophages that has been found to be associated with inflammatory states. Objective. To determine the levels of resistin in relation to asthma disease state and severity, we investigated a cohort of adult patients with asthma. Methods. A cohort of moderate to severe persistent asthma patients and control patients were recruited and underwent fasting labs to evaluate levels of serum glucose, C-reactive protein (CRP), and resistin. Results. No significant differences were found between the control and asthma group with respect to serum CRP at 0.78 ± 0.60 mg/dL and 0.48 ± 0.60 mg/dL, (p < 0.36) or glucose at 92.2 ± 11.9 mg/dL and 89.5 ± 7.2 mg/dL, (p < 0.084), respectively (mean ± SD). However, plasma resistin levels were found to be significantly elevated in asthma patients, 186 ng/mL (95%CI 169-202) compared with control patients 121 ng/mL (95%CI 90.4-151), (p < 0.005). Conclusions. Patients with asthma were found to have higher levels of resistin, and resistin levels were increased with disease severity in the asthma cohort.

Aeroallergen sensitization rates in military children with rhinitis symptoms

BACKGROUND Childhood sensitization rates for many aeroallergens are underreported. OBJECTIVES To examine aeroallergen sensitization rates in military children undergoing skin testing for rhinitis and investigate the timing of atopic development for perennial and seasonal allergens. METHODS A skin testing database was retrospectively analyzed. Children 18 years and younger referred for rhinitis underwent skin prick testing to either a screening panel of 8 tests or a standard panel of 51 allergens. RESULTS A total of 209 patients underwent skin testing to the 8-test panel. Of these patients, 35.4% had at least 1 positive result. Atopy increased with age, from 6.3% in those younger than 1 year to 58.8% in those 5 years old. The most common allergens were mold mix (16.3%), cat (13.2%), dust mite mix (11.4%), tree mix (9.4%), and grass mix (9.4%). Only 4.0% were sensitized to seasonal aeroallergens before the age of 3 years. A total of 345 children underwent testing to a 51-allergen panel. A total of 80.3% had at least 1 positive test result, and the average number of positive test results was 11.4. Both the percentage of atopy and the average number of positive skin test results increased with age. The most common allergens were grasses, Alternaria, and cottonwood. Thirty-two of 51 allergens were positive in 20% or more children. Rates for many underreported allergens are presented. CONCLUSIONS In children, aeroallergen sensitization rates are high and increase with age. Perennial allergens predominate up to the age of 3 years. Rates for many underreported allergens are presented. Although performed in a military population, these results should be applicable to many practices.

Exhaled breath condensate pH in the evaluation of asthma

As a marker of inflammation, exhaled breath condensate (EBC) pH may be a useful screening tool in the evaluation of asthma, especially in a military recruit population. To evaluate the utility of EBC pH in the diagnosis of asthma, EBC pH levels were determined in basic military trainees prior to an evaluation for asthma that included a history, physical exam, baseline spirometry, and a methacholine or exercise challenge. Of 86 basic trainees who had symptoms suggestive of asthma and underwent methacholine or exercise challenges, 51 (59.3%) had a positive methacholine or exercise challenge and were diagnosed with asthma. The mean EBC pH of the trainees who were diagnosed with asthma (6.39, range 5.91-6.82), was significantly (p < 0.001) lower than those trainees without asthma (6.64, range 6.34-7.18). There was, however, some overlap of the EBC pH values between the two groups. The measurement of EBC pH did show a significant mean difference between asthmatic and nonasthmatic patients in a military recruit population.

Use of immunotherapy in the management of presumed anaphylaxis to the deer fly.

BACKGROUND Anaphylactic reactions to biting insects are generally thought to be rare events. Diagnostic and therapeutic standards for these events are not well documented in the literature. OBJECTIVE We describe a case report of a patient with multiple suspected immunoglobulin (Ig)E-mediated anaphylactic reactions to biting insects, specifically deer flies (Chrysops sp.), as well as a successful response to immunotherapy. METHODS Prick and intradermal testing with deer fly whole-body extract and measurement of specific IgE were performed to help determine the extent of the patients hypersensitivity. Immunotherapy was subsequently administered with whole-body deer fly extract. RESULTS Skin testing was unable to differentiate between the patient and normal controls. In vitro testing was positive in the study patient but only at a low level. After initiating immunotherapy, the patient had repeated exposures to deer fly bites but failed to develop symptoms consistent with his previous anaphylactic episodes. Followup testing on the patient revealed no significant change in the level of skin reactivity or specific IgE. CONCLUSIONS Anaphylaxis consistent with an IgE-mediated mechanism to Chrysops sp. is a real phenomenon and is amenable to immunotherapy for the prevention of life-threatening sequela after exposure. Skin testing using whole-body extract appears to be unreliable. In vitro testing was better able to discern a true sensitivity, although the difference between patient and controls was small.

Delay of Chemotherapy to Prevent Progressive Vaccinia

OBJECTIVE The goal was to discuss the potential risk of progressive vaccinia in the setting of smallpox vaccination with immunosuppression and to present strategies to avoid progressive vaccinia. METHODS A case report and literature review are presented. RESULTS A 21-year-old, male, military member received smallpox vaccination and was coincidentally diagnosed as having osteosarcoma approximately 2 weeks later. His recent vaccination was recognized, and chemotherapy was subsequently delayed until separation of the scab at the vaccination site. The patient received neoadjuvant chemotherapy and fared well, without any evidence of progressive vaccinia or other smallpox vaccine complications. CONCLUSIONS Smallpox vaccine should be withheld from immunocompromised patients because of the risk of progressive vaccinia. Conversely, immunosuppressive therapies should be delayed for recently vaccinated patients. There are no controlled trials in this area, but withholding immunosuppressive therapy until separation of the scab is a rational approach. This patient was exposed to chemotherapy after scab separation and did not develop progressive vaccinia.