Richard A. Nicklas

Diagnosis and Management of Rhinitis: Complete Guidelines of the Joint Task Force on Practice Parameters in Allergy, Asthma and Immunology

This document contains complete guidelines for diagnosis and management of rhinitis developed by the Joint Task Force on Practice Parameters in Allergy, Asthma and Immunology, representing the American Academy of Allergy, Asthma and Immunology, the American College of Allergy, Asthma and Immunology and the Joint Council on Allergy, Asthma and Immunology. The guidelines are comprehensive and begin with statements on clinical characteristics and diagnosis of different forms of rhinitis (allergic, non-allergic, occupational rhinitis, hormonal rhinitis [pregnancy and hypothyroidism], drug-induced rhinitis, rhinitis from food ingestion), and other conditions that may be confused with rhinitis. Recommendations on patient evaluation discuss appropriate use of history, physical examination, and diagnostic testing, as well as unproven or inappropriate techniques that should not be used. Parameters on management include use of environmental control measures, pharmacologic therapy including recently introduced therapies and allergen immunotherapy. Because of the risks to patients and society from sedation and performance impairment caused by first generation antihistamines, second generation antihistamines that reduce or eliminate these side effects should usually be considered before first generation antihistamines for the treatment of allergic rhinitis. The document emphasizes the importance of rhinitis management for comorbid conditions (asthma, sinusitis, otitis media). Guidelines are also presented on special considerations in patients subsets (children, the elderly, pregnancy, athletes and patients with rhinitis medicamentosa); and when consultation with an allergist-immunologist should be considered.

Pathogenesis, prevalence, diagnosis, and management of exercise-induced bronchoconstriction: a practice parameter

Chief Editors: John M. Weiler, MD, MBA, President, CompleWare Corporation, Professor Emeritus, University of Iowa, Iowa City, Iowa; Sandra D. Anderson, PhD, DSc, Clinical Professor, Sydney Medical School, Royal Prince Alfred Hospital, Department of Respiratory and Sleep Medicine, Camperdown NSW 2050, Australia; Christopher Randolph, MD, Clinical Professor of Pediatrics, Yale Affiliated Programs, Waterbury Hospital, Center for Allergy, Asthma and Immunology, Waterbury, Connecticut

Disease management of atopic dermatitis: an updated practice parameter

ratory disease but often is the first manifestation of allergic disease. Most patients with atopic dermatitis will develop allergic rhinitis or asthma. The evaluation and management of atopic dermatitis are, therefore, an integral part of an allergist/immunologist’s training and practice. It is also important for the primary care physician to understand the basis for effective evaluation and management of patients with this condition, since atopic dermatitis affects more than 10% of children and can have a significant impact on the patient’s quality of life. As discussed in this document, it is also important for the primary care physician to know when to appropriately consult a specialist in atopic dermatitis.

Symptom severity assessment of allergic rhinitis: part 1

Sheldon L. Spector, MD; Richard A. Nicklas, MD; Jean A. Chapman, MD; I. Leonard Bernstein, MD;William E. Berger, MD; Joann Blessing-Moore, MD; Mark S. Dykewicz, MD;Stanley M. Fineman, MD; Rufus E. Lee, MD; James T. Li, MD, PhD; Jay M. Portnoy, MD;Diane E. Schuller, MD; David Lang, MD; and Stephen A. Tilles, MD

Rhinosinusitis: Developing guidance for clinical trials

The Rhinosinusitis Initiative was developed by 5 national societies. The current guidance document is an expansion of the 2004 publication, “Rhinosinusitis: Establishing definitions for clinical research and patient care” and provides templates for clinical trials in antimicrobial, anti-inflammatory, and symptom-relieving therapies for the following: (1) acute presumed bacterial rhinosinusitis, (2) chronic rhinosinusitis (CRS) without nasal polyps, (3) CRS with nasal polyps, and (4) classic allergic fungal rhinosinusitis. In addition to the templates for clinical trials and proposed study designs, the Rhinosinusitis Initiative has developed 6 appendices, which address (1) health outcomes, (2) nasal endoscopy and staging of CRS, (3) radiologic imaging, (4) microbiology, (5) laboratory measures, and (6) biostatistical methods.

Paradoxical bronchospasm associated with the use of inhaled beta agonists.

Abstract Adverse reaction reports for inhaled relatively β 2 -rselective, adrenergic-agonist bronchodilators submitted to the Center for Drug Evaluation and Research of the Food and Drug Administration between 1974 and 1988 were reviewed. There were 126 reports associated with the use of these drugs by metered-dose inhaler, which were consistent with a diagnosis of paradoxical bronchospasm. In addition, 58 such reports were received for these drugs delivered as a solution for nebulization between 1983 and 1988. Increased reporting of reactions consistent with paradoxical bronchospasm generally correlated with increased availability of these products during the same time period, although there has not been a steady upward trend in such reports for metered-dose inhalers during the past 3 years, despite increasing distribution figures. Despite the apparent infrequency of inhaler-induced paradoxical bronchospasm, the potentially life-threatening nature of such reactions makes awareness of this possibility essential. Patients who report that an inhaled β-adrenergic agonist makes their asthma worse, as well as the patients who fail to demonstrate expected improvement with this form of therapy, should be suspected of having developed paradoxical bronchospasm.

Joint Task Force Algorithm and Annotations for Diagnosis and Management of Rhinitis

The algorithm and text annotations in this document are intended to assist clinical decision making about patients who present with symptoms of rhinitis. This document complements the Executive Summary of Joint Task Force Practice Parameters for Diagnosis and Management of Rhinitis (Ann Allergy, Asthma, Immunol 1998; 81:463-468) and Diagnosis and Management of Rhinitis: Complete Guidelines of the Joint Task Force on Practice Parameters in Allergy, Asthma and Immunology (Ann Allergy, Asthma, Immunol 1998;81:478-578). The Joint Task Force on Practice Parameters in Allergy, Asthma and Immunology is co-sponsored by the American Academy of Allergy, Asthma and Immunology, the American College of Allergy, Asthma and Immunology and the Joint Council of Allergy, Asthma and Immunology.

AAAAI/ACAAI Joint Venom Extract Shortage Task Force Report

PREFACE This report has been developed to provide guidance for clinicians who provide venom immunotherapy services to affected patients. The intent is to provide clinicians information about the developing shortage of Hymenoptera venoms to assist them in making decisions about the appropriate care for their patients. The recommendations made by this task force are voluntary and are intended to be strictly temporary in response to an unexpected shortage of Hymenoptera venom extracts. The recommendations will no longer be relevant when the venom supply returns to normal. The recommendations are based on objective clinical and scientific evidence where available, and on clinical experience and expertise where necessary (as identified in the text). We have extensively examined the available evidence related to these issues in the hope of finding solutions. We have made these recommendations with the understanding that some measures are needed to mitigate the venom shortage that likely will exist for some period of time. For situations in which we have a low level of confidence in making recommendations, we have refrained from doing so. Our recommendations are being

Lack of allergenic soy in intralipid for total parenteral nutrition

biological monitoring of exposure to metals. J Anal At Spectrom. 1990;5: 301e306. [6] Tanner S, Baranov VI, Vollkopf U. A dynamic reaction cell for inductively coupled plasma mass spectroscopy (ICP-DRC-MS), part III: optimization and analytical performance. J Anal At Spectrom. 2000;15:1261e1269. [7] Crinnion WJ. Toxic effects of the easily avoidable phthalates and parabens. Altern Med Rev. 2010;15:190e196. [8] Liu AH, Jaramillo R, Sicherer SH, et al. National prevalence and risk factors for food allergy and relationship to asthma: results from the National Health and

Guidelines for Asthma

SummaryInternational guidelines for the management of asthma are now available. These include the US National Heart, Lung, and Blood Institute (NHLBI) International Consensus for the Diagnosis and Treatment of Asthma and the NHLBI/World Health Organization Global Initiative for Asthma (GINA).The main purpose of such guidelines is to improve the quality of care for patients with asthma. This can only be accomplished, however, if these documents are effectively utilised. Effective utilisation will require the preparation of guidelines that can be readily adapted to requirements of local healthcare providers. To do this, consideration must be given to socioeconomic and practice differences within and between countries.