Current opinion in otolaryngology & head and neck surgery
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Sublingual immunotherapy is an established treatment option for allergic rhinitis in many European countries, but it is not approved in the United States and is considered investigational. Sublingual immunotherapy has received increasing attention in the United States as an alternative to subcutaneous immunotherapy for the treatment of allergic rhinitis and possibly asthma. ⋯ Increasing data support the safety and efficacy of sublingual immunotherapy and its validity as a first-line treatment option for allergic rhinitis; however, acceptance in the United States is hindered by the lack of confirmatory evidence with United States-licensed products and the reluctance of allergists to accept evidence based on European studies and products. The future of sublingual immunotherapy in the United States will require addressing regulatory, economic and medical criteria.
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Curr Opin Otolaryngol Head Neck Surg · Jun 2008
ReviewThe impact of extra-esophageal reflux upon diseases of the upper respiratory tract.
The present paper examines the recent literature on extra-esophageal reflux and discusses how it affects patient testing and treatment of upper respiratory track inflammatory disease. ⋯ Symptoms caused by reflux may reflect underlying weaknesses in mucosal resilience to acid and pepsin in addition to the variations in exposure to gastric contents. In some patients mildly acidic or alkaline reflux may be important and gastric contents may reach the nasopharynx or middle ear. Carefully designed placebo-controlled trials are needed.
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The present article reviews the literature on anaphylactic reactions occurring in the operating room setting. The causes of anaphylaxis are discussed along with the clinical features, treatment and appropriate follow-up for patients who experience this reaction. ⋯ The management of anaphylaxis in the operating room requires a collaborative effort between anesthesiologists, surgeons and allergists. Protocols for the management of suspected anaphylactic events and subsequent testing should be in place. To prevent future events, patients must receive adequate follow-up and high-risk patients should be identified before they enter the operating room.
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Curr Opin Otolaryngol Head Neck Surg · Apr 2008
ReviewTumour boards/multidisciplinary head and neck cancer meetings: are they of value to patients, treating staff or a political additional drain on healthcare resources?
This article reviews the literature on the management of head and neck cancer using multidisciplinary team meetings as well as addressing the question of whether or not this organization is of benefit to the patients and treating staff and if it is cost efficient. ⋯ The multidisciplinary team has become more and more an integral part of the clinical pathway for a patient with head and neck cancer in many European countries. This is cost effective and benefits patient outcomes.