Paul Steinberg

Effects of seasonal allergic rhinitis on selected cognitive abilities

BACKGROUND Many allergy patients complain of slowed thinking, memory problems, and difficulty sustaining attention during their allergy seasons. OBJECTIVE This study evaluated the effect of symptomatic allergic rhinitis on speed of cognitive processing, ability to divide and sustain attention, working memory, and recent verbal memory. METHODS Symptomatic ragweed-allergic rhinitis patients and nonatopic control subjects did cognitive testing in, out of, and in ragweed seasons. RESULTS Test results indicate that, during ragweed seasons, allergic patients experience subtle slowed speed of cognitive processing but not deficits in attention and recent memory. Some patients also have difficulties in working memory. CONCLUSIONS These findings suggest that having allergic reactions to ragweed pollen causes significant cognitive difficulties in a subgroup of patients.

Double-blind placebo-controlled study of the efficacy of oral terfenadine in the treatment of chronic fatigue syndrome

BACKGROUND There is no established treatment for chronic fatigue syndrome (CFS), an illness characterized by disabling fatigue exacerbated by physical activity. A variety of immunologic abnormalities have been reported, including a high incidence of atopy and hypoergy or anergy. OBJECTIVE Because of anecdotal reports and uncontrolled trials showing antihistamine efficacy in CFS, we evaluated the clinical efficacy of the antihistamine terfenadine (60 mg twice daily) in a placebo-controlled study. METHODS Thirty patients with CFS were enrolled in a 2-month, double-blind, placebo-controlled trial of terfenadine. Participants underwent a battery of both immediate- and delayed-type hypersensitivity skin tests and completed a self-assessment questionnaire used to measure severity of symptoms, physical and social functioning, health perceptions, and mental health before each of six biweekly visits. RESULTS Twenty-eight patients completed the trial. History of atopy and positive immediate skin test results were prevalent, 73% and 53%, respectively. No evidence for hypoergy or anergy after delayed-type hypersensitivity skin testing was found. No therapeutic benefit from terfenadine could be detected in terms of symptom amelioration, improved physical or social functioning, health perceptions, or mental health. A high incidence of atopy in patients with CFS was confirmed. CONCLUSION Although this trial involved a small number of patients, the results suggest that terfenadine is unlikely to be of clinical benefit in treating CFS symptoms.

Asthma symptoms and airway hyperresponsiveness are lower during treatment with nedocromil sodium than during treatment with regular inhaled albuterol

In a double-blind, double-dummy, multicenter study, 212 patients with asthma whose symptoms were not controlled by as-needed use of inhaled bronchodilators were randomized to receive either 4 mg of nedocromil sodium or 180 micrograms of albuterol four times daily for 12 weeks. Asthma symptom scores (daytime asthma, nighttime asthma, morning chest tightness, and cough) and peak expiratory flow rate were recorded daily on diary cards. Bronchial hyperresponsiveness was assessed by changes in diurnal variation in peak expiratory flow rate and by methacholine inhalation challenge. Statistically significant differences were found between groups favoring nedocromil sodium for relief of day and nighttime asthma and morning chest tightness. Patients treated with nedocromil sodium also had significantly lower diurnal variation in peak expiratory flow rate compared with patients treated with albuterol. Compared with patients treated with albuterol, patients treated with nedocromil sodium showed a greater improvement in cough and a decreased sensitivity to methacholine challenge. Patients in both groups reduced their as-needed albuterol use. Regular treatment with nedocromil sodium therefore led to greater asthma symptom control and reduced bronchial responsiveness compared with regular treatment with albuterol. The study also showed that more frequent use of a beta 2-agonist (for symptom relief or not) did not improve asthma control. Both drugs were well tolerated.

Noncardiogenic pulmonary edema induced by nonionic low-osmolality radiographic contrast media

Although adverse reactions to radiographic contrast media have occurred in 1% to 4.7% of procedures, there are just seven reports of noncardiogenic pulmonary edema, six with use of high-osmolality radiographic contrast media 1-6 and one with use of the ionic low-osmolality dimer, ioxaglate meglumine. 7 Noncardiogenic pulmonary edema with use of nonionic low-osmolality radiographic contrast media has not been reported.