Theodore H. Sher

Allergic Aspergillus sinusitis with concurrent allergic bronchopulmonary Aspergillus: Report of a case

A 42-year-old female patient with previously diagnosed seasonal allergic rhinitis, anaphylactic food sensitivity, and exertional asthma is described who developed concomitant allergic bronchopulmonary aspergillosis and allergic aspergillus sinusitis. We believe that the present article is the first fully documented case in which these two syndromes coexist in the same patient.

Bisulfite sensitivity manifesting as allergy to local dental anesthesia

A case of sulfite sensitivity first manifested as possible allergy to local anesthetics is described. Implications for the broad problem of local anesthetic reactivity are discussed and a possible approach by sulfite challenge of suspect patients is outlined.

The rate of epinephrine administration associated with allergy skin testing in a suburban allergy practice from 1997 to 2010.

Allergy skin testing is considered a safe method for testing for IgE-mediated allergic responses although anaphylactic events can occur. Reported rates of anaphylaxis per patient are not consistent and range from 0.008 to 4%. The aim of this study was to determine the rate of epinephrine use associated with allergy skin-prick testing (SPT) and intradermal testing (IDT) in a suburban practice over 13 years. This retrospective chart review used billing and procedure coding records during the time period from January 1997 to June 2010 to identify encounters where epinephrine was administered after SPT or IDT. Patient encounters with procedure codes for skin testing plus either parenteral epinephrine, corticosteroid, antihistamine, or i.v. fluid administration were identified. These patient charts were reviewed to determine if epinephrine was administered, whether systemic reactions developed, and rates of epinephrine administration were calculated. There were 28,907 patient encounters for SPT and 18,212 for IDT. Epinephrine was administered in six patient encounters (0.02%) where SPT was performed; no IDT encounters led to epinephrine administration. There were no fatalities. Allergy skin testing to a variety of allergens, when administered by well-trained personnel, is a safe procedure. This study, involving the largest population to date, showed a rate of systemic reactions requiring epinephrine of 20 per 100,000 SPT visits. No epinephrine was given after IDT.

The Efficacy and Safety of Nedocromil Sodium 1% Nasal Solution in the Treatment of Ragweed Seasonal Allergic Rhinitis

The safety and efficacy of nedocromil sodium 1% nasal solution in the treatment of patients with ragweed seasonal allergic rhinitis was assessed in a double-blind group-comparative study. After a 1-week baseline period that coincided with the start of the ragweed season, patients were randomized to receive either nedocromil sodium 1% nasal solution or matched placebo (1 spray per nostril q.i.d.) for 8 weeks. The primary efficacy variable was the mean daily diary card symptom score for the 3-week peak pollen period. During this time, patients treated with nedocromil sodium showed a significant decrease in sneezing, runny nose symptoms, and sleep disturbances compared with the placebo group. Furthermore, the patients and physicians assessments of the drug efficacy showed significant differences favoring the nedocromil sodium treatment. No serious adverse experiences were reported during the study. Both groups reported transient minor adverse experiences including sneezing and nasal irritation. Nedocromil sodium was effective in relieving symptoms associated with seasonal allergic rhinitis during peak ragweed seasonal challenge without significant adverse effects.

Fenoterol dose-response study in children with asthma

We have studied the effect of fenoterol, a selective beta-2 adrenergic agent, on airway obstruction in children with asthma. The drug was administered orally in single doses of 2.5, 5, and 7.5 mg to 20 children with chronic stable asthma of moderate severity. The mean age of the children was 11.6 yr. Pulmonary function tests were performed as baseline at zero time and at intervals over a 6-hour period after drug administration. Onset of action for all doses was within 1 hr with a peak effect noted at 1.5 to 3 hr, and sustained improvement was observed over the entire 6 hr. The doses of 5 mg and 7.5 mg were equally effective in producing significant improvement of pulmonary function compared to 2.5 mg (p less than 0.05). Side effects remained acceptable for all patients. The 5 and 7.5 mg doses produced significant adverse effects that involved the central nervous and musculoskeletal systems, whereas the 7.5 mg dose caused a significant incidence of tachycardia. Our findings indicate: (1) fenoterol is a potent oral bronchodilator for large and small airways in children, (2) the 7.5 mg dose does not achieve any additive effect over a 5 mg dose; and (3) 5 mg is the optimal oral dose of fenoterol for children from age 8 to 12 yr.