The Journal of allergy and clinical immunology
-
J. Allergy Clin. Immunol. · Oct 1988
Minimal complications in a surgical population with severe asthma receiving prophylactic corticosteroids.
Sixty-eight patients with asthma followed by the Northwestern Allergy Service underwent a total of 92 surgical procedures from July 1973 to December 1986. In 41 of 92 procedures outpatient prednisone was administered, and in 92 procedures a pretreatment regimen of 100 mg hydrocortisone parenterally every 8 hours beginning the night before surgery was administered. Postoperatively, the overall incidence of pulmonary complications (either pulmonary infection or asthma) was 9.7%. ⋯ Statistical analyses to compare the overall infection rate in this asthmatic population with that in two other surgical populations showed no statistical differences. There were no deaths and no patient developed any wound complication or adrenocortical insufficiency. These results indicate that patients with asthma in optimal respiratory condition who have received preoperative clinical evaluation and a hydrocortisone pretreatment regimen can undergo surgery with minimal complications.
-
J. Allergy Clin. Immunol. · Aug 1988
Comparative StudyDiscrepancies between the skin test and IgE antibody assays: study of histamine release, complement activation in vitro, and occurrence of allergen-specific IgG.
Intracutaneous skin tests (STs) and RAST with the common allergens, grass pollen, house dust mite, and cat dander, were performed on 660 adult patients. In 117 patients (18%), we found 140 discordances (7%) in a total number of 1980 ST and RAST combinations. In agreement with studies in the literature, greater than 80% of the discordances consisted of positive skin reactions without detectable allergen-specific IgE antibodies in serum. ⋯ Low total IgG responses precluded false negative RAST results caused by competition of IgG antibodies with IgE antibodies. There were no significant differences in the degree of complement activation in vitro by house-dust extracts between healthy control subjects, nonallergic patients, and patients with unexplained skin reactivity. It is concluded that a high proportion of the positive skin reactions with common inhalant allergens, which are not accompanied by a positive RAST, are probably caused by IgE antibodies that are not detectable in serum with any of the RAST procedures.(ABSTRACT TRUNCATED AT 400 WORDS)
-
J. Allergy Clin. Immunol. · Jun 1988
Case ReportsBilateral abductor paresis masquerading as asthma.
Rare upper airway lesions may be mistaken for asthma. A 16-year-old Hispanic male athlete presented to our allergy clinic with a 4-month history of wheezing and snoring with hoarseness and progressive fatigue on exertion or during sleep. His mother taped periods of harsh stridor and sleep apnea. ⋯ His pulmonary function tests were significant for peak flow depressed out of proportion to FEV1 with reduced FVC, no response to bronchodilator, and flattened inspiratory loop unresponsive to cough or panting. Fluoroscopy and endoscopy of the upper airway was consistent with "marked bilateral limitation of vocal cord abduction." Sleep study demonstrated desaturation with CO2s in the 60s during sleep. He was started on continuous positive airway pressure, 10 cm at night, with no desaturation or sleep disturbance on follow-up.
-
J. Allergy Clin. Immunol. · Jul 1986
Comparative StudyCorrelation between A-mode ultrasound and radiography in the diagnosis of maxillary sinusitis.
A-mode ultrasound examination of the maxillary sinuses with the Echosine and Sinusvu 2500 units was compared with roentgenographic examination in the diagnosis of maxillary and frontal sinusitis. A-mode ultrasound was primarily useful in the detection of secretions within the sinus and not mucosal thickening. Both ultrasound devices had high specificities (92% for Echosine and 94% for Sinusvu 2500) in the diagnosis of maxillary sinusitis, but the Echosine had a greater overall sensitivity (61%) than the Sinusvu 2500 (29%). ⋯ Ultrasound appeared to be less helpful in diagnosing frontal sinusitis, but there were too few cases of frontal sinusitis for statistical analysis. The Echosine is a useful screening device because of the high specificity of a positive result. Although A-mode ultrasound provides limited value in diagnosing mucosal thickening, it is particularly useful in following the course of therapy once a positive diagnosis of sinusitis has been established without subjecting the patient to additional x-ray exposure.
-
J. Allergy Clin. Immunol. · Apr 1986
Emergency administration of radiocontrast media in high-risk patients.
Patients with previous anaphylactoid reactions to radiographic contrast media (RCM) are at increased risk for subsequent reactions on repeat exposure. The most efficacious pretreatment regimens require administration of medications up to 13 hours before the anticipated procedure. Emergency administration of RCM in patients requiring essential procedures precludes prolonged pretreatment. ⋯ We recommend hydrocortisone, 200 mg intravenously, immediately, and every 4 hours until the procedure is completed, and diphenhydramine, 50 mg intravenously, 1 hour before the procedure. No reactions occurred in these patients, suggesting that this pretreatment regimen may be valuable in prophylaxis for patients requiring emergency administration of RCM who have experienced previous anaphylactoid reactions. Although used in only one additional patient, ephedrine, 25 mg orally, 1 hour before the procedure may also be valuable.