Current allergy and asthma reports
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Curr Allergy Asthma Rep · Jan 2004
Review Comparative StudyAdverse respiratory reactions to aspirin and nonsteroidal anti-inflammatory drugs.
Aspirin-exacerbated respiratory disease (AERD) is an adult-onset condition that manifests as asthma, rhinosinusitis/nasal polyps, and sensitivity to aspirin and other cyclooxygenase-1 (COX-1)-inhibitor nonsteroidal anti-inflammatory drugs (NSAIDs). There is no cross-sensitivity to highly selective COX-2 inhibitors. AERD is chronic and does not improve with avoidance of COX-1 inhibitors. ⋯ Treatment of AERD patients with antileukotriene medications has been helpful but not preferential when compared with non-AERD patients. An alternative treatment for many AERD patients is aspirin desensitization. This is particularly effective in reducing upper-airway mucosal congestion, nasal polyp formation, and systemic steroids.
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Whether we are hiking in the back country or playing in our backyard, we run the risk of exposure to offending arthropods. Papular urticaria is a very common hypersensitivity reaction to the bites, stings, and contact with critters such as mites, ticks, spiders, fleas, mosquitoes, midges, flies, and even caterpillars. Children seem to be at greatest risk, although adults are also vulnerable. ⋯ Severity is often related to the host response to the salivary or contactant proteins. Our understanding of the immune mechanism continues to improve; however, our approach to therapy has remained essentially unchanged. Although this review admittedly reaches beyond papular urticaria, it is with the intention of improving the reader's recognition of the offending arthropods, the characteristics of reactions, and the current therapeutic approaches.
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Epinephrine is the cornerstone of anaphylaxis management. Its administration should be immediate upon evidence of the occurrence of anaphylaxis. ⋯ Patients with known anaphylactic reactivity should be prescribed an epinephrine auto-injector to be carried at all times for treatment of potential recurrences. Education of the patient or parent regarding the proper use of this tool is paramount.
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Fungal rhinosinusitis presents in five clinicopathologic forms, each with distinct diagnostic criteria, treatment, and prognosis. The invasive forms are acute fulminant, chronic, and granulomatous ("indolent") invasive fungal sinusitis. The noninvasive forms are fungal ball ("sinus mycetoma") and allergic fungal sinusitis (AFS). ⋯ Treatment requires surgery and aggressive postoperative medical management with close follow-up. Medical treatment includes allergy medications, allergen immunotherapy, and in many cases the addition of oral corticosteroids. Although medical management clearly improves patient outcomes, more studies are needed because AFS recurrence rates remain high.