Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology
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Ann. Allergy Asthma Immunol. · Feb 2003
Review Comparative StudyPharmacotherapy for allergic rhinitis: a critical review of leukotriene receptor antagonists compared with other treatments.
To review the mechanisms and clinical efficacy of leukotriene receptor antagonists, which are investigational therapies for allergic rhinitis, compared with intranasal corticosteroids and nonsedating antihistamines, which are the most commonly prescribed pharmacotherapies for allergic rhinitis. ⋯ The studies published to date demonstrate that leukotriene receptor antagonists are sometimes more effective than placebo, are no more effective than nonsedating antihistamines, and are less effective than intranasal corticosteroids in the treatment of allergic rhinitis. The combination of a leukotriene receptor antagonist and an antihistamine has not been proven to be more effective than either agent alone. This review reveals several inconsistencies that require resolution. First, whereas leukotriene receptor antagonists are predicted on the basis of their mechanism of action to improve nasal congestion significantly, clinical studies reveal leukotriene receptor antagonists to be no better than antihistamines at improving congestion. Second, leukotriene receptor antagonists would not be expected on the basis of their putative mechanism of action or nasal challenge data to improve significantly sneezing, nasal itching, or drainage. However, some studies show improvement in these symptoms during treatment with leukotriene receptor antagonists. Considered in aggregate, the data available to date do not clearly support a unique role of leukotriene receptor antagonists in the treatment of allergic rhinitis whether or not it is accompanied by asthma.
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Ann. Allergy Asthma Immunol. · Feb 2003
Case ReportsFood allergy masquerading as foreign body obstruction.
Allergic reactions to peanut and tree nuts can present as upper airway obstruction. ⋯ As peanuts and tree nuts are common causes of both food allergy and foreign body aspiration in children, both of these diagnoses should be considered in the differential diagnosis of airway obstruction.
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Ann. Allergy Asthma Immunol. · Jan 2003
Comparative StudyRelationship of house-dust mite allergen exposure in children's bedrooms in infancy to bronchial hyperresponsiveness and asthma diagnosis by age 6 to 7.
Several studies have suggested that exposure to house-dust mite (HDM) allergen in infancy increases the risk of developing asthma. ⋯ When compared with other studies, we were able to more accurately estimate the level of dust mite allergen exposure through repeated sampling over a relatively long period, incorporating seasonal variations. Although HDM sensitization and asthma were concurrently related, we were unable to find any relationship between level of HDM allergen exposure in children's bedrooms in early childhood and development of BHR or physician-diagnosed asthma by age 6 to 7 years.
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Ann. Allergy Asthma Immunol. · Jan 2003
Comparative StudyIncreased matrix metalloproteinase-9 with elastolysis in nocturnal asthma.
Matrix metalloproteinase-9 (MMP-9) is capable of degrading elastin, whereas tissue inhibitor of metalloproteinase-1 (TIMP-1) can inhibit MMP-9 activity. We observed reduced airway tissue elastin volume density in six subjects with nocturnal asthma (NA) as compared with seven subjects with nonnocturnal asthma (NNA) and seven normal controls (NL) when endobronchial biopsies were evaluated morphometrically at 4:00 PM and 4:00 AM. ⋯ Our results from these two pilot studies suggest that increased MMP-9 and decreased TIMP-1 at night in NA may lead to reduced elastin density.
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Aspirin can provoke reactions ranging from respiratory to cutaneous in susceptible individuals. There has been particular attention looking at the role of cyclo-oxygenase enzymes 1 and 2 and their role in aspirin-exacerbated respiratory disease. ⋯ This review discusses the challenges in classification, diagnosis, and treatment of those patients with a sensitivity to aspirin. Special attention is made to the possible mechanisms mediating disease progression and how specific therapies, such as leukotriene modifiers, may be helpful.